Echolalia as Communication

There are instances that echolalia is used as a form of communication. In these situations, the individual knows that he should say something. He just doesn't know what he is supposed to say.

An example is when an individual says, "And today's specials are..." he might be trying to communicate that he is hungry. The individual with autism knows that words are appropriate, he just doesn't know which ones to choose.

Echolalia may also be used to communicate feelings. The individual with autism may not know how to express a particular emotion. For example, he may say, "Oh, no. Not again!" when he is trying to communicate that he doesn't want to complete a task.

When an individual uses echolalia in an attempt to communicate he should be recognized and rewarded. As he becomes used to using words to make request, protest, or reciprocate conversation the therapist or parents can prompt him to use the proper words.

The Son Rise Program

One program has been developed that focus on self stimulatory behaviors and motivation. The Son Rise Program was developed by parents of an autistic boy. Barry and Samahria Kaufmann developed a home-based, child-centered program that uses the child's interests as a way of connecting with others.

Rather than discouraging the child from engaging in self stimulatory behaviors, the Son Rise Program embraces them as the central part of the child's therapy. With this approach, the individual who is working with the child imitates the child's self stimulatory behaviors.

If the child shifts his weight from one foot to the other while staring at a line of blocks, the therapist does as well. The theory behind this approach is that the therapist and parents enter the child's world in an effort to pull him out.

The goal of the Son Rise Program is to encourage interaction by using the child's interests and likes. The hope of making a significant connection that facilitates communication, awareness and understanding is a big part of the program. Once the connection is made the child will reciprocate and interact better.

Behavior and the Gambler

An autistic individual's behavior can be baffling for many of us. Dealing with difficult behavior is a major concern that families and professionals have. If we consider the autistic (as well as any other) child as a gambler, we might have new insight as to why negative behaviors are repeated even when faced with unwanted consequences as well as why consistency is crucial in successful intervention.

People gamble even though they know that the odds of a payout are astronomical when playing a slot machine. Even the sliver of a chance will bring the gambler back to the behavior of pulling the lever no matter how slim the odds are. The possibility of a payout is such a motivator that the person repeats the behavior.

In the same sense, an autistic child is seeking a payout, whether it is the sensory feedback from the other person's reaction or the reward of getting what he wants. When a behavioral approach like planned ignoring is used consistency becomes extremely important. If the child consistently receives the same neutral, uneventful response he soon begins to understand that there is no payout for that behavior.

However, if he uses the behavior and receives different responses including the payoff, he will be more likely to repeat that behavior. If a gambler knows that a particular slot machine will never pay out he will not continue to play that machine.

Television Talk

Television talk, or TV talk, is a form of echolalia that involves the repetition of scripts from movies, television shows and commercials. The individual with autism memorizes entire sections of dialogue from television shows, movies, cartoons and commercials and will repeat them over and over with seemingly little purpose.

TV talk is often used as a form of self stimulation and it is sometimes used as a way to help the individual sort through certain situations. The familiar words can bring relief during times of stress.

This memorized form of speech can also be used as a form of communication in some cases. All forms of echolalia are used to communicate in some way.

History of Autism

The word "autism" first emerged in the English language around 1912 when a psychologist named Eugene Bleuler used the term to describe a population of schizophrenic patients who seemed to be detached from the rest of the world. The root of the word autism is "autos" from the meaning "self" in Greek.

The term was later used to refer to autistic individuals as we understand it today around 1943 when Leo Kanner described a group of patients that shared certain behavioral and social characters. It is interesting to note that in 1943, Dr. Hans Asperger identified autistic characteristics in another group of individuals in an entirely different research project. His descriptions related to what we know as Asperger's syndrome today.

When Bad Behavior is Good

Not all bad behavior is really bad. In fact, sometimes negative behavior is a wonderful sign that the individual is becoming aware of his surroundings. The negative behavior is also a form of communication as well.

There is a distinction that has to be made between being compliant and being complacent. Many individuals, especially ones who have spent considerable time completing discrete trial drills, merely go through the motions. They are not actively involved with their environments. They have simply been trained to make certain responses to certain cues.

When a complacent individual begins to protest and whine when given directions it indicates that he is trying to communicate. He is also developing an awareness that his behavior can have an impact on his environment.

While it isn't wise to encourage non-compliant behaviors, it is promising to see an individual in the autism spectrum move from complacent behavior to protesting. The individual may be given choices if he demonstrates that he sincerely does not want to complete a task.

Choices and Compliant Behavior

It is never a good idea to cave in when faced with a full-blown tantrum. However, parents and therapists can use choices as a kind of compromise when the child is trying to communicate that he does not want to engage in a task through more appropriate ways.

Providing simple choices while encouraging the individual to complete the task is a great approach to gaining complaint behavior. For example, a child may have an aversion to brushing her teeth. She has sensory issues that make the whole ordeal uncomfortable. However, this is a task that needs to be addressed.

Starting with simple choices like a selection of toothpastes and toothbrushes is a start. Also, breaking down the task into very small steps and ending the session is another way to encourage compliant behavior as well.

The parent or therapist could model brushing teeth and prompt the child to choose a toothbrush. Once the child makes the choice, she is rewarded and the process is ended.

At a later time, the toothbrush activity is introduced again and the initial step of choosing a toothbrush is followed by choosing a toothpaste. One step is added to the next progressively, all the while the child is given choices to make in order to encourage compliance.

Self Stimulatory Behavior

One of the most noticeable traits of autism is self stimulatory behaviors simply because they are so outstanding. The stereotyped, repetitive movements serve a particular purpose for the individual with autism and they are very motivating and rewarding as well.

Some adults who have autism like Stephen Shore describe self stimulatory behavior as "self regulating behavior" in an effort to communicate how reinforcing and important these repetitive movements are to the individual.

Everyone engages in self stimulatory behavior, whether it is nail-biting, eating or watching television. The intake of sensory information is part of our daily lives and individuals who are wired a little differently are challenged with a bombardment of input that is impossible to organize and manage without some form of release.

In other cases the individual is seeking out sensory input that is lacking. The stereotyped repetitive movements help to stimulate the nervous system to provide the lacking sensory input.

Common self stimulatory behaviors include hand flapping and rocking. Each behavior corresponds to a sensory system in the body that is either lacking or craving input.

Sensory Integration and Self Stimulatory Behavior

Determining which sensory integration activities should be used depends on the individual's needs. Basically, either the individual's sensory system is hypoactive or hyperactive. The hypoactive system will seek out input while the hyperactive system will seek to block input.

The necessity of replacing self stimulatory behaviors to regulate sensory input is great. Prompting the child to cease the self stims without providing another outlet will only lead to the child's finding another way of addressing this valuable need.

In some cases an autistic individual may turn the behavior inward. This can lead to self stimulatory behaviors like regurgitation and swallowing. This behavior often goes unnoticed and it not redirected and the individual gets his necessary stimulation in the process.

Sensory Integration Activities

Sensory integration activities are very valuable in that they can be used as a motivational tool. They can encourage communication and they help the individual calm and organize his behavior. Sensory integration activities can also be used to increase attention and time on task.

Choosing which activities to implement depends on the specific needs of the individual. These needs can be identified through self stimulatory behaviors that are exhibited.

Rocking is a common stereotyped repetitive movement that serves to address visual and vestibular sensory systems. This behavior can be replaced with activities like swinging on a swing or alternating sit-ups with a partner while holding hands.

Tactile sensory integration activities include tickles, materials and sensory bins. Sensory bins are containers filled with beans, pasta, smooth stones or anything that has an interesting and textures. The auditory system can be addressed as the individual moves his hands through the bin making interesting sounds.

Deep pressure is a valuable approach to dealing with common proprioceptive needs. Deep pressure involves burrowing into pillows or hugging a large stuffed animal. The individual can roll on the floor or be wrapped in a blanket. These activities are helpful in calming behavior in many cases.

Autism and the Individual

Many of the interventions in cases of autism and related pervasive developmental disorders seem to communicate a "cookie cutter" approach to treatment. However, each case is unique and interventions and rewards should be catered to the individual.

One important thing to remember is that each individual is unique. Interventions that work for one person within the autism spectrum of disorders might not work for another. Taking the individual's strengths, interests and needs into consideration will increase the probability that interventions will be successful.

The individual with autism is not the only person to consider when using interventions and various treatment approaches. The person implementing the interventions should be considered as well. An individual who is analytical in nature might fair better beginning with play therapy while a person who is focused on cause and effect might fair better by using behavioral interventions from the start.

The autism spectrum of disorders is vast and there are many different levels of abilities and needs among the autistic population. Interventions that are effective with one child might not be effective for another. What is motivating for one child may not be rewarding for another.

For example, many children within the autism spectrum of disorders crave hugs and physical contact. Others may not be able to tolerate hugs and excessive physical contact because it is overwhelming to their sensory systems. Using a big hug as a reinforcing reward would be beneficial for some while it would be distracting and uncomfortable for others.

Individuals with autism offer a wide variety of strengths and interests. Taking time to observe and consider these characters specific to the individual is crucial in determining which interventions to use.

Echolalia

Functional language serves a purpose and that purpose is communication. The basis of communication is to make the thoughts in the listener's mind match the thoughts in the speaker's mind. Echolalia serves a purpose as well. However, that purpose is not always to communicate with another individual.

Many individuals who have autism often repeat phrases and parts of scripts from movies that they have seen. The repetition is excessive and it is often used for self stimulation. Other times echolalia is used to help ease stress and perform tasks.

Echolalia can be used to help the individual organize his thoughts when entering a situation that may be confusing to him. For example, an autistic individual may say, "Everybody get in line," while approaching a check out counter in a store. The statement is used to help him navigate through the situation, not to communicate anything to another individual.

Behavioral and Analytical Approaches

Basically, we can look at an individual who works in the field of autism as behavioral or analytical. The behavioral approach is suitable for a therapist who prefers to jump right into discrete trials and Applied Behavior Analysis.

The behavioral approach is useful in setting a tone and laying down the rules. The child grasps the concrete, concise prompts and visual nature of the program. Play activities are used as rewards for desired behavior. Starting with a behavioral approach is a common practice for many interventions.

However, those who are more analytical in nature may want to use another approach. Many therapists like to observe the child and gradually work their way into his environment. RDI and Greenspan's floortime are great approaches for the therapist who wants to make a personal connection and build trust before introducing behavior-based therapies.

The approach you choose will depend on your personality and the way that you interact with children.

Sensory Systems

There are five senses. However, there are seven sensory systems in the human body. Each system is a complex interaction of perception and experience that can be dysfunctional in some cases of autism. Specific behaviors can help us identify which system is lacking or over stimulated.

The five senses are taste, touch, sight, hearing and smell. The sixth sensory system is the vestibular system and the seventh is the proprioceptive system. The vestibular system involves how our bodies process movement.

Sight is closely tied to this system. For example, hand flapping is a self stimulatory behavior that involves motion as well as sight.

The proprioceptive system involves the body's natural way of adjusting to its environment. This system involves fine motor activities like buttoning a shirt and coordinated activities like walking down steps.

Sensory integration activities are designed around the individual's self stimulatory behaviors and they are designed to replace those behaviors with ones that are socially appropriate.

DSM-IV

The DSM-IV is the 4th edition of the Diagnostic Statistical Manual of Mental Disorders. This resource defines and sets the criteria for all known mental disorders. The DSM-IV is used to help psychologists and psychiatrists diagnose autism and related pervasive developmental disorders.

The DSM-IV presents the criteria for all five pervasive developmental disorders, making clear distinctions between each. For example, Asperger's syndrome will share some of the same characteristics in the autism spectrum like self-stimulatory behaviors and difficulties with social interaction. Asperger's syndrome is unique in that many of the communication and language processing deficits are not present.

The ABC Chart

The ABC chart is a data collection sheet used to determine possible causes for a particular negative behavior. ABC stands for antecedent, behavior and consequence. The information collected can help to address certain repetitive negative behavior.

The antecedent to the behavior is what occurs right before the negative behavior. This is not necessarily the specific trigger for the incident but it can be an indicator of what is going on.

The behavior itself is recorded then the consequence for the behavior is written on the chart as well. While this seems quite straight forward it does require keen observation as well as some thought.

The events that are recorded on the ABC chart are always objective and measurable. The individual collecting data should not interpret the events or add emotionally-charged language in the chart.

For example an incorrect entry would look like:
Antecedent= child didn't want to sit
Behavior= child got mad about being told to sit
Consequence= child had a tantrum but had to sit anyway

These statements are emotionally charged and they think for the child. The ABC chart is not a summary of the observer's conclusions. It is a collection of observable behavior.

The correct approach would be:
Antecedent= Child was directed to "come sit"
Behavior = Child threw himself on the floor, kicking and screaming.
Consequence= Child was physically prompted to take his seat.

The second example presents the events in an objective, observable manner. If the behavior is repeated and the information is recorded accurately, the team can determine the cause of the negative behavior.

This is not always as simple as it seems. The child may engage in a behavior at a certain time of the day, no matter what activity he is completing. There might be a fragrance or a sound that others might not notice that is aggravating the situation as well.

The child may also engage in the behavior for the consequence. For example, the child may like the sensory feedback of the therapist saying, "nope" each time he acts out. He may feel the need to repeat the ritual of running to the corner and whining before each drill.

There are many reasons that a child will engage in a certain negative behavior. Finding the source of the problem usually takes some time.

Autsim: a Medical or Psychologial Condition?

Autism and related pervasive developmental disorders are approached as psychological condition that has a neurobiological foundation. However, some believe that autism should be approached as a medical diagnosis as well. Since the developmental disorder has is fundamentally a neurobiological condition it should be treated as such.

There are major implications to shifting the perspective from a psychological disorder to a medical condition especially when it comes to insurance coverage. Mental health insurance coverage is limited but if the companies recognize that autism is a medical condition many families will receive the support that they need in the treatment of autism.