Decreasing Echolalia In Individuals with Autism

Background: Echolalia is a defining characteristic of autism and may interfere with the development of functional language.  Echolalia can be particularly problematic when teaching a child to answer questions.  For example, when teaching a response to “what says moo?” by providing the verbal prompt, “cow,” some may consistently echo the verbal stimulus (VS; “what says moo”) and the verbal prompt (“cow”).  Echolalia can also be problematic when teaching vocal imitation. For example, an instructor may present a task, “say oooh” and the child may, instead of imitating only the targeted sound “oooh” echo the entire phrase, “say oooh.” In 1986, McMorrow and Foxx investigated the use of a procedure they labeled “cues-pause-point” (CPP) which was successful in decreasing echolalia and increasing correct responding to questions with one adult with mental retardation.  The results were replicated with other adults with mental retardation with successful generalization to novel people, places, and stimuli.

Objectives: The first aim was to replicate findings of previous CPP literature with a child with autism, specifically to teach the child to answer questions without echoing the verbal stimulus. The second aim was to extend the CPP procedure to vocal imitation tasks in another individual with autism.

Methods: Two male children participated in the study. Ian was 9-years-old and Tim was 4-years old. For Ian, conversational language was targeted. For Tim, vocal imitation was targeted. A multiple probe across responses design was used to evaluate treatment effects for both participants.  During baseline for Ian, five trial sessions of each question were conducted.  The therapist presented the VS (e.g., “what do you sleep in”) and allowed 3 s for a response.  If Ian responded correctly, brief verbal praise was provided.  If Ian responded incorrectly or echoed the VS, the therapist moved to the next trial.  During baseline for Tim, the vocal imitation task was presented (“say cup”) and he was allowed 3 s for a response.  If Ian responded correctly, brief verbal praise was provided.  If Ian responded incorrectly or engaged in echolalia, the therapist moved to the next trial. During treatment, the cues pause point procedure consisted of two cues (a picture of the correct response, and the therapist holding her finger to her lips), a 2 s pause, and a point to a picture of the correct answer to the question. The procedure included fading of the picture for both participants so they emitted correct responding without the additional pictorial cue.

Results: The CPP procedure resulted in decreased echolalia and increased correct responding to answers to questions (Ian) and vocal imitation tasks (Tim). For Ian, training generalized to novel questions with just the application of the cue (i.e., finger gesture) and results were maintained at 8 and 12 mos follow-up. 

Conclusions: Echolalia can result in reduced language acquisition. Thus, it is necessary to validate procedures to decrease echolalia. The results of the current study provide clinicians with a procedure that may be effective when teaching functional language to individuals with autism.