Natural Language Acquisition on the Autism Spectrum:
The Journey from Echolalia to Self-Generated Language
by Marge Blanc, M.A., CCC-SLP
A review by megan Snow, m.s., ccc-slp, November 2012
speech-language pathologist, beaverton, OR;
speech-language pathology assistant at cdc 2001-2008
From the Introduction of Natural Language Acquisition:
"Even a complete lack of speech doesn't mean a lack of language or a lack of language development." (p. vii)
"Let's put that in the book!"
This phrase was echoed weekly at our team meetings at the Communication Development Center when I was a Speech-Language Pathology Assistant early in my career. At that time, 'the book' was a sheet of butcher paper on the wall with various ideas scrolled across it. Now, to have this book in front of me with Marge's insights and clinical guidance, is unbelievable!
"It's time to reframe the misconceptions we have had about kids... who use echolalia." "... we can now see how competent our kids actually are." (p. 9)
Working with Marge over the course of 7 years, I learned to look at child development and therapy itself through the eyes of a child. Never did we speak of "low functioning," "high functioning," or "stims." We discussed voice access, timing of utterances, communicative intents, and OT/ PT recommendations. Staff meetings were 20% agenda, and 80% stimulating conversation about children's stories–their brilliant insights, achievements, and breakthroughs within families who understood their children's intentions. Children's echolalia was always a part of our thinking.
"Consider this: when any one of us uses one of these lines, it's a quote. But when these colorful expressions make up almost the entirety of a child's language, we refer to it as echolalia. It's not strange at all, just pervasive. It used to be called 'delayed echolalia,' meaning that kids echo the words not right after they hear them ('immediate echolalia'), but later, or 'delayed.' ... It's all echolalia, but it's the delayed kind we notice."(p. 4)
This book is a genuine delivery of Marge’s treatment style. Whereas third party payers are always pressing for percentages and numbers (which we also provide), Marge encourages us as professionals and parents to track the heart and the meaning of a child’s expression. Marge’s unique style of treatment gives professionals and parents the freedom to ‘be there’ with children. To truly listen. To converse in the form the child is capable of. To acknowledge echolalia as a stage of language development; one that we can shape and support like we would any other stage of language development. We learned to see the pitfalls in 'teaching' language like a skill.
“A child is often taught to produce (or choose) something like “I want chips” soon after he can produce (or choose) “chips,” without regard for the developmental appropriateness of the decision…” “In the midst of this trend, too few of us realize or remember that echolalia communicates, and even fewer of us know what to do about it.” (p. 7)
Through my clinical training with Marge, I received an education in reciprocity with children that was unparalleled. I learned to listen to the nuances, not just the literal message of a phrase. I learned to hear the message behind gestalt phrases, not dismiss them because they were from a movie. I learned to wait. Quietly–for more–until I had a sense about what I was hearing.
Sometimes that waiting took a long, long time. Giving children the time they need to complete a task—whether it be getting dressed or thinking of the right word—is an incredible gift. This gift builds competency, positive self-concept and relationship trust–themes echoed in Natural Language Acquisition on the Autism Spectrum through case studies and narrative of life “in the trenches.”
“This time, however, I began doing something more than repeat a few words here and there while frantically writing down as much as I could. This time, I took an active verbal role and began repeating back the parts of what Bevin said that seemed important. I was extremely judicious. I didn’t want to look like I was judging him or criticizing him. And, most of all, I didn’t want to interrupt him and risk stopping him if he perceived my comment as judgment. If he stopped, I would miss out on something more Bevin might want to say.” (p. 33)
Tuning into the intentionality behind echolalia takes practice, and is difficult to listen to amongst our busy lives. We hear it as merely "movie talk," and we just don't have time for it.
“The reason we don’t encourage echolalia or want it to generalize, I think is because we really don’t like it. We have real trouble recognizing that echolalia has value.” “…we worry about it—and this determines our strategies for dealing with it.” “…we try to ignore it or we actively try to make it stop.” (p. 8)
But guess what? Across time, as I implemented the principles of natural language acquisition, kids made progress–true, developmental progress. When tuned into the intent of a child’s language, the regulatory needs of the child, and the child’s life context, I provided therapy that was relevant to the child in the context of their family life. I provided therapy that could be transferred to school SLPs who did not know how to work through gestalt language processes. I provided therapy with heart.
“Being echolalic isn’t what makes our kids different; it’s being echolalic so late in their lives. Typical echolalic kids move on to the next stages by the time they’re five years old.” “By the time they start school…they might sound delayed but not deviant.” (p. 9)
I am now half way across the country from the Communication Development Center. However, in my practice I have been able to maintain the playfulness with children that Marge underscores, and the validation of intentionality that lies within this long-misunderstood process of language development.
Open your mind to the possibility that your child is communicating with you, is doing his or her best, and will be able to develop more sophisticated forms of communication with you as your child's guide. Open this book, and share it with those who support you and your child on this ride of life. Enjoy!