The Function of Echolalia

Echolalia is the repetition or “echoing” of sounds, spoken words, phrases, or sentences. Echolalia is a typical function of early language development seen in young children as they begin to learn spoken language. Echolalia can also be a symptom of various disorders including aphasia, dementia, traumatic brain injury, schizophrenia, or Tourette’s Syndrome; however, it is most often associated with autism spectrum disorder (ASD). It may be difficult to discern typical versus atypical echolalia and whether or not it is a functional part of your child’s language skills, but there are specific qualities to look out for in order to differentiate the underlying causes.

Types of echolalia:

There are two types of echolalia: immediate and delayed. Immediate echolalia is when a child repeats what they just heard. For example, if a parent asks a question, “Do you want a cookie?” and the child responds with, “You want a cookie?” rather than responding to the question. Delayed echolalia is when a child repeats something they heard hours, days, months, or even years prior. For example, the child may repeat a line from a video they saw earlier that day or a phrase heard at the park the week before.

Functional versus non-functional echolalia:

For some children, echolalia is just a meaningless imitation of sounds or words strung together. These children may imitate things they’ve heard recently or in the past with no communicative intent. For other children, echolalia serves a purpose to express wants and needs when they are unable to produce novel statements of their own.  When a child “scripts” (i.e. recites exact lines) from shows or movies, it may appear that they are producing long, meaningful utterances, when in fact they have no comprehension of what they are actually saying. In these instances, they may be using the familiar and memorized words and cadence as a calming strategy, but not to convey a specific message. Functional echolalia, however, is the use of learned words or phrases to make requests and otherwise express wants and needs. Some children will use exact words and intonation in order to get their needs met in a functional way even though they may not yet be able to produce their own novel word combinations. For example, they may say “Are you hungry?” to request food, as opposed to simply stating they are hungry or requesting specific food items. It is significant to note, the child who is “scripting” lines from a movie, may also be using those words as a way to request that movie at that time.

When is echolalia considered typical?

Echolalia is seen in typically developing children during early language development between one and two years of age. While we will continue to see some repetition of overheard language between two and three years of age, we also expect to see a consistent increase in novel words and phrases as well. By three years of age, echolalia should be observed minimally in a child’s spontaneous language, and by four and five, a child is expected to engage in conversations using completely novel language. Children with a language delay or autism spectrum disorder may demonstrate these echolalic characteristics beyond three years of age depending on the severity of the delay or disorder.

While first instinct may be to try to stop the echolalia altogether, it is important to recognize it as either a functional communication tool your child has developed, or as a stepping stone into functional expressive communication skills that can be further developed with the help of a speech therapist. If your child’s echolalia has continued past an age considered part of typical language development or appears “non-functional,” it may be helpful to consult a speech and language pathologist. They can help identify the underlying causes and use these emerging verbal skills to target and build functional communication.

Questions or concerns?

If you have questions or concerns about your child’s echolalic language, please contact us at info@playworkschicago.com or 773-332-9439.

Therese Brown, MS, CCC-SLP
Speech-Language Pathologist
Photo Credit: Echolalia Autism (repetitive speech)-Causes, Symptoms, and Treatment via hearingsol.com

Speech Therapy: Debunked

Most people have had some exposure or connection to speech and language therapy, whether it was for themselves, a friend, or a family member. It could be that your child has recently been recommended speech therapy and you are not sure what this will entail. In this blog, I hope to debunk a few common misconceptions regarding speech and language therapy, as well as provide a brief overview of the field of pediatric speech-language pathology.

Common Myths and Misconceptions: Debunked
While it may look to the outside world that we are simply playing with toys and games, there is a method to this play-based madness. Our job is to find out what motivates your child and use it to target their therapy goals. When your child is a toddler, this might mean making a cow jump over a barn. While that isfun, your speech therapist may be working on improving your child’s engagement and ability to imitate play-actions, which will hopefully lead them to imitating sounds and words. A population that is often thought of when discussing speech therapy are those with disfluencies, or those who stutter. This is true but is a small percentage of children worked with for a general speech therapist. Articulation therapy is another familiar area, as many of my friends remember being pulled-out of class to play Candyland and work on speech sounds as a child.  Although I do own Candyland and use it semi-regularly, there is so much more we, as speech-language pathologists, do to help improve your child’s communication skills.

What is speech and language therapy?

Variety is the spice of life, and as speech therapists, we get a good taste of this! Speech therapists have a broad scope of practice when it comes to the pediatric population. Below are a few of the most common areas a speech therapist might help your child with.

  • Articulation/Phonology:The actual sounds your child makes to create words.
  • Motor planning:Your child’s ability to plan and execute the fine motor movements required to speak in words, phrases and conversation.
  • Language:The words and phrases your child both usesand understands.
  • Feeding:This involves oral-motors skills like sucking, chewing and swallowing. Also, the sensory processing of different textures, tastes and consistencies.
  • Voice:Your child’s vocal quality. Is it appropriate for a child their age and size or is it breathy or hoarse?
  • Fluency:The way your child’s speech flows.
  • Pragmatics:Your child’s social communication skills, such as making eye-contact, initiating communication with peers, and taking conversational turns.
  • Advocacy: Your child could benefit from additional therapies that you may not be aware of. Your speech therapist can help advocate for your child to ensure they get the best possible care from a qualified team of providers, if necessary.

If your child is demonstrating difficulty in one or many of the areas above, consider contacting one of our speech-language therapists.

Questions or concerns?

If you have questions or concerns about your child’s communication or feeding skills, please contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall Burgoon, M.S., CCC – SLP 
Speech-Language Pathologist

Photo Credit: Photo by Leo Rivas on Unsplash

Early Intervention Initial Evaluation: What to Expect

Making the call to Early Intervention (EI) can be the daunting first step in addressing developmental concerns for your child. What comes next? PlayWorks Therapy’s Director of Developmental Therapy, Kim Shlaes, explains what to expect during an Illinois Early Intervention initial evaluation.

Service Coordinator
After a referral is made for your child, a service coordinator is assigned to your case. The service coordinator:

  • Is the point of contact for you and your family to help guide you through the EI process.
  • Is responsible for conducting an intake meeting to collect all the needed information and paperwork to set up an initial evaluation.
  • Coordinates the evaluation and ongoing services, should your child qualify.
  • Is responsible for writing and updating the Individualized Family Service Plan (IFSP) based on recommendations made by providers during their initial evaluation, goals you and your family have for your child, and assessments while in EI.
  • Is responsible for informing a family of their rights while in EI.
  • Helps facilitate the transition from EI as the child ages out of the program at three years old.

Initial Evaluation
Next, your service coordinator organizes a team of at least two credentialed evaluators. The evaluation team is selected based on developmental concerns you have for your child. An evaluation team typically has a combination of the following: developmental therapist, occupational therapist, physical therapist, and/or speech and language pathologist. Other providers, such as social workers, nutritionists, interpreters, and others are added to an evaluation team as needed.

The initial evaluation typically takes about one hour to complete. A parent/guardian is required to attend the evaluation. A typical evaluation follows the following routine:

  • Review reasons for the referral to EI, including parental and pediatrician concerns.
  • Review the child’s birth and medical history. The evaluators will also ask questions about your child’s milestones, their social history (including who your child lives with, who cares for your child during the day, any languages your child is exposed to), and your child’s opportunities to socialize with other children.
  • The evaluators take turns playing with your child.
  • The evaluators ask you several questions about your child’s development (i.e. how your child completes “self-help” skills such as eating and dressing, how they socialize with other children, how they communicate with you, how they process sensory information, etc.).
  • Evaluators then score their assessments and make recommendations for ongoing therapy or additional evaluations. If your child qualifies for services, you and the evaluators write discipline specific goals for your child, based on what your family wants to target while in EI. This part of the evaluation is the “IFSP meeting”.

What comes next?
Should you decide to move forward with Early Intervention services, your service coordinator organizes a team of credentialed therapists to provide service to your child. These therapists contact you directly to schedule your child’s therapy sessions, which are held in a natural environment for your child, most commonly your home or their school/daycare. Services typically begin within a few weeks of the initial evaluation.

Questions or concerns?
If you have questions or concerns about your child’s development or the Early Intervention process, please contact us at info@playworkschicago.com or 773-332-9439.

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Photo Credit: willingness.com.mt/types-of-play-therapy/

Apraxia vs. Phonological Disorder: How can I tell the difference?

“Help! My child has a lot to say, but only his father and I can understand him. What’s wrong with his speech?”

“My three-year old understands everything we say, but she rarely makes any sounds at all! What’s going on?”

Pediatric speech-language pathologists spend a lot of time working with families who have these same questions. The answer to these questions is likely that your child has a phonological disorder or a motor speech disorder. But, what’s the difference between the two? Read on.

Phonology is the sound system of a language. Oftentimes, as a kiddo’s speech is beginning to develop, they will use a series of phonological processes to simplify word production. These kiddos may consistently substitute one sound for another, they might make all the sounds in their words the same, or they might delete certain sounds and/or syllables in a word. These speech sound substitutions are tricky because they can often result in significantly decreased intelligibility. For example, a child with a phonological disorder might consistently substitute his “t” sound for a “k” sound. So, “cat” becomes “cack.”

Unlike phonological-based disorders, childhood apraxia of speech is a motor speech disorder. This means that a child is having difficulties transmitting a speech signal from their brain to their mouths. A child who is diagnosed with apraxia of speech may produce frequent vowel distortions, speech sound distortions, and inconsistent productions of the same speech sound. Speech production for these children can additionally be characterized at perseverative and effortful.

Diagnoses of either a phonological disorder or a motor speech disorder should only be made by a speech-language pathologist. If you have concerns regarding your child’s speech sound development, please contact PlayWorks Therapy, Inc. for a comprehensive speech-language evaluation.

Julie Euyoque MA CCC-SLP
Speech-Language Pathologist

Early Pronouns: When They Should Be Acquired and How to Teach Them

Your child’s pronoun usage can be very difficult to understand and even more difficult to teach! Many parents – and therapists alike–  struggle teaching this concept to their little ones. First, you need to have a basic understanding of when each pronoun should be acquired. This way, you’ll know what is appropriate to teach and what isn’t! The research varies slightly with regard to pronoun acquisition; however, all research agrees that I and it are the first to emerge, followed by you.

Approximate Age of Acquisition:

12-26 months – I, it

27-30 months – me, my, mine, you

31-34 months – your, she, he, yours, we

35-40 months – they, us, her, his, them, her

41-46 months – its, our, him, myself, yourself, ours, their, theirs

47+ months – herself, himself, itself, ourselves, yourselves, themselves

Sources: Adapted from Haas & Owens (1985); Huxley (1970); Morehead & Ingram (1973); Waterman & Schatz (1982); and Wells (1985).

Now for the tricky part – teaching pronouns! Many children with language delays, auditory processing issues and echolalia struggle with correct pronoun use. Yet, parents often don’t understand how to practice the skill at home and facilitate generalization. Pronouns by nature are ABSTRACT, and therefore, difficult to “see” or conceptualize, thus difficult to teach to children.

Here are a few tips and activities for targeting pronouns with your toddler at home:

  • Use GesturesAlways pair pronouns with gestures! This provides a great non-verbal cue for the child to understand who you are referring to and what each pronoun represents. Point to yourself for “I” and tap your child’s chest for “you.” When you are modeling what, you want your child to say, take his/her hand and use it to pat their own chest for “I” or “my.”
    • Raise your intonation to emphasize the pronoun as you gesture to help the child make the connection
  • Modeling – Providing frequent models is important! Often times, parents and therapists simplify language and use proper nouns instead of pronouns. For example, “Mommy is eating” or “Ms. Lisa is going bye-bye.” This strategy is great for babies who are not talking or who are just learning to talk because it improves understanding and attaches meaning to the words. However, once your child is talking, it is important for them to hear you modeling the correct pronouns! For example, “I am eating” and “I am going bye-bye.”
    • Don’t worry if you forget! Simply follow-up with an emphasized model: “Mommy is eating. I am hungry.”
  • One at a time – Focus on just one pronoun at time. This can be challenging because it is natural to want to use them together. “I have blue and you have green.” Although, it may seem helpful, it can actually be quite confusing for your little one!
    • It takes time and maybe a slow process. That is okay!
  • Prompt with how the child should say it – Rather than saying, “Do you need me to help you?” prompt your child with a model of what he/she should be saying. So, for example, you would simply model, “Help me.”
    • This can be challenging because our tendency is to prompt with phrases such as, “you say” or “tell me,” which may only lead to more confusion and repetition of the wrong pronoun!
  • Look for opportunities in everyday play and routines – pronouns are best taught during normal play and interactions. Model, gesture/point and emphasize the pronoun by raising pitch, intonation and volume. Provide lots of opportunities for repetition and practice!
    • “Mine” – If your child produces the /m/ sound, mine is a great place to start! Model the word as you hold a toy (or part of a toy). Be sure to keep it light and fun and always give the object right back! It’s important for your toddler to know that you are not there to take their toy. You are simply being playful and having fun (while teaching a pronoun).
      • Tip: Do not do this with your child’s favorite toy. They will not like you saying, “mine” and will likely become very upset. If you see that your child is getting frustrated or upset, stop working on it and try again later!
    • “Me” – Look at family pictures (printed or on your cell phone) and ask, “Whose that?” Model, “me” while pointing to a picture of yourself and tapping your own chest. Model “me” again and use hand-over-hand assistance to help your child touch his/her own chest.
      • Selfies – Children love phones and they especially love taking pictures on phones. Take a few “selfies” with your child for extra engagement, motivation and fun, then use the pictures to model me!
    • “I”
      • Choosing items – Lay a few objects out in front of the child and say, “I want banana” or “I want car” as you take the object. Exaggerate “I” as you take the item.
      • Snack time – Ask, “Who wants ____?” Help your child touch their own chest while modeling “I do! I do!”
      • Actions – Use actions to practice the pronoun “I.” Children love gross-motor and movement activities and this is the perfect opportunity! Pair “I” with simple actions (i.e. I run, I jump, I hop, I sleep, I laugh, I cry, etc.) as you act out the action. For example, “I laugh” and then crack-up laughing or “I cry” and pretend to cry. Have fun and get into it! The more you are enjoying it, the more your child will too.
    • “You”
      • Playful commands and help scenarios. Create “you do it” situations where you need to ask your child for their help.
        • Roll a toy car under the table and say, “Oh no! Oh no! You get it.”
        • Wrap a toy in Play-Doh or putty a say, “Oh no! Stuck! You do! You!”
        • Think of the key phrases, “You do,” “You go,” “You get,” “You eat,” etc.
      • My” vs. “Your”
        • Practice with clothing, body parts or food. “My pants” and “Your pants” while gesturing.

Resources: Laura Mize, Teach Me to Talk

Kelly Fridholm, M.C.D., CCC-SLP

How can I encourage my son/daughter to practice their “speech homework” outside of therapy?

If your child receives therapy for their articulation or phonological skills (i.e. how they produce specific sounds), intervention focuses on repeated practice of the target sounds at different levels. Your therapist structures the session to be highly motivating and engaging for your child so that they are motivated to participate in the repetitive nature of the task. Additionally, your therapist most likely assigns homework to work on in between sessions to help with generalization of your child’s articulation skills—but here’s where the challenge lies! Most kiddos are reluctant to practice their ‘speech homework’ outside of therapy because it is challenging and because it is not the most exciting work. However, daily practice of articulation skills is necessary for both acquisition and maintenance of these age-appropriate articulation skills. Here are a few tips and activities to encourage your child’s home practice:

  • Choose the same time each day to practice—on the way to school, after dinner, right before bed, etc. Creating a routine makes it easier to incorporate practice into daily life.
  • Set attainable goals—45 minutes of articulation practice per day is not going to fit into your daily routine, and it doesn’t have to! 10 to 15 minutes of directed practice per day is all you need to ensure that your child does not lose the progress that he/she has made in therapy.
  • Provide the correct cues for target sounds—Your therapist will create articulation goals based on your child’s current level of functioning. Talk with your therapist to determine if your child is working on targets at the syllable/word/phrase/sentence level and support their production of target sounds at that level.
  • Make practice fun! – Articulation homework does not have to be ‘drill’ work; you can use your child’s speech targets in a variety of fun activities, such as:
    • Sound scavenger hunt
      • Cut out pictures of your child’s target sounds and hide them around the house. Go on a scavenger hunt to find the missing words!
    • I-Spy
      • Try to find objects that start with the target sound while in the car, on a walk, looking through books, etc.
    • Adapt age-appropriate crafts
      • Making a spider for Halloween? Cut out 8 target words/pictures and attach to the spider’s legs
      • Winter crafts? Make a penguin out of an old Kleenex box and ‘feed’ it your target words
      • Jewelry? Put one bead on each target word and practice the word before adding the bead to your bracelet/necklace
    • Snack time!
      • Cover target words/pictures with one piece of a favored snack (cheerios, popcorn, fruit loops, nuts, raisins, cheddar bunnies, etc.); practice each word 3 times before eating the snack
    • Do-A-Dot
      • Say target words for X-number of dots per page

 

**Remember to consult your speech-language pathologist to make sure you are providing the appropriate level of prompting for your child’s goals

Autumn Smith, MS, CCC-SLP
Assistant Director of Speech-Language Services

36-48 Month Milestones in Speech and Language Development

Is your child aging out of the Early Intervention program? Questions about what to look for next in terms of speech and language development? Our speech-language pathologist Jessie Delos Reyes provides a helpful checklist for upcoming milestones and developmental red flags:

36-48 months of age

Receptive Language (what your child understands):

  • Understands 1,200-2000+ words
  • Hears and responds when you call them from another room
  • Follows simple commands if item is out of sight
  • Follows two- and three step directions
  • Understands words for some primary colors (i.e. can point to named colors)
  • Understands some simple shapes (circle, square)
  • Understands concepts (big/small, soft/hard, rough/smooth) when contrast is presented
  • Follows simple two- and three-step directions
  • Listens and understands longer stories

Expressive Language (how your child uses language to express himself and communicate needs and wants):

  • Uses 1,000-1,600+ words
  • Speech intelligibility is 90% or greater
  • Talks about activities at school or with friends
  • Talks about daily happenings using about four sentences at a time
  • Requests permission
  • Shares and ask for turns
  • Answers simple “who?”, “what?”, and “where?” questions
  • Asks “when” and “how” questions
  • Uses pronouns: I, you, me, we, they, us, hers, his, them
  • Uses plurals
  • Uses four or more words in a sentence
  • Labels parts of an object (wheels, steering wheel)
  • Begins to express feelings (sad, happy, frustrated)

Speech and language red flags:

  • Difficulty being understood by familiar and unfamiliar listeners
  • Consistently dropping beginnings or endings of words (“ike” for “bike,” “ca” for “cat”)
  • Difficulty producing three to four word phrases
  • Difficulty following two- and three-step directions and simple sequences
  • Inconsistently answering simple WH questions (who, what, when, where)
  • Difficulty stating wants and needs
  • Difficulty playing with others or a lack of interest in other children

If you have concerns regarding your child’s speech and language development, call our office to schedule an evaluation with a speech language pathologist.

Jessie Delos Reyes, MA, CF-SLP

Fall Family Fun!

Last fall, I brought my Goddaughter and her younger sister to an amazing apple orchard/pumpkin patch called All Seasons Orchard in Woodstock, Illinois. In addition to the apple orchard, All Seasons has a corn maze, tractor and pony rides, a petting zoo, a mini zip line, tube slides and multiple bouncy houses! It is about an hour outside of Chicago, but well worth the drive! Whether you make it out to All Seasons or find an apple orchard closer to the city, check out these awesome ways to support your child’s speech and language development on your fall outings:

Vocabulary: Label both the familiar and novel items you encounter on your outing, and talk about ways to describe the new objects (big/little, soft/hard, wet/dry, etc.). You can easily teach and reinforce animal names at the petting zoo; fruits, veggies and other food labels at the country store; parts of a tree in the apple orchard; etc. Use the object labels frequently to reinforce their meaning:

“Look! A big leaf. My leaf is red. What color is your leaf? My leaf feels crunchy.”

Following simple directions: Target two skills at once by giving your child a direction using familiar attributes, such as “Put one apple in the red basket” or “Give the little pumpkin to your brother.”

Increase expressive language: There are many fun and exciting activities at the apple orchard that will have your child communicating like you’ve never seen before! If you are working on sign language, encourage requesting ‘more’ or ‘help’ for picking more apples, going down the slide, or jumping in the bouncy house, for example. If you are working on simple one- to three-word phrases, expand on your child’s utterance by one word and encourage them to imitate your model:

Child: “More!” or “Go horsie!”

Adult model: “More slide!” or “Go on horsie!”

Basic concepts: Teach basic preschool concepts, such as colors, shapes, numbers, etc. by identifying objects throughout the orchard. A simple way to target these skills is by playing “I Spy…” Encourage your child to find what you label and help them come up with their own objects for you to find!

If you would like more information on All Seasons, you can check out their website: http://www.allseasonsorchard.com/

Happy Picking!

Autumn Smith, MS, CCC-SLP

Withholding Desired Objects to Encourage Speech: What to think about.

Q: My toddler’s speech therapist instructed me to withhold desirable objects to encourage communication. Every time I try to do this, my child has a complete meltdown. How is this supposed to help him talk?

A: Withholding preferred or highly favorable objects is a common technique used by many speech-language pathologists to encourage language expression. It is just one of the many tools in your talking “toolbox” that you can use to model appropriate requesting, either verbally or through sign language. By withholding a favorite object, you are essentially setting up an opportunity to model what you want your child to do in order to request that object (“You want ‘more.’ Tell Mama, ‘ma-ma-more’”). But here’s where it gets tricky: As soon as you prompt your child to use sign language or to imitate your verbal model, they have a meltdown, despite imitating your therapist’s prompts 30 minutes earlier with no problem.

While frustrating, your child’s behavior makes complete sense. He has been able to meet his wants and needs up until now using nonverbal communication, such as gestures (pointing, pulling on your hand, etc.) or eye contact. Now you are requiring him to do something much more difficult, and this change to his routine is stressful! But the key to success is repetition, so don’t give up! As a rule of thumb, prompt your child to imitate your model no more than three times before helping them with hand-over-hand cueing of sign language. This teaches your child that they have to use at least one form of expressive language before you are going to meet their needs. Model the sign while verbally saying the request, and then give them the object while praising them for great talking. The idea is not to make them so upset that they no longer want to communicate with you, so use your judgment to keep your child from getting to that point.

The bottom line is, every child is different and you know your individual child’s wants, needs, abilities and frustration tolerance better than anyone. So trust your instincts and pull back when you know your child is being pushed farther than his/her tolerance. With practice and patience, you will be able to use this technique to support the progress of your child’s expressive language development.

Autumn Smith, MS, CCC-SLP