Can we talk about echolalia? And other concerns... — The Bump
Special Needs

Can we talk about echolalia? And other concerns...

This might be a little scattered because my 1.5 year old is about to wake up :)

My DD is four years old, and I still see a significant amount of what I think would be considered "functional delayed echolalia."  I know that echolalia is a normal part of language development and that it peaks around age 30 months, but at what age should you stop seeing it?  I've been trying to learn more about it.

My DD was diagnosed with SPD, but I'm concerned that there's more going on.  She's always been very verbal, and she is capable of spontaneous conversation, but I feel like I hear more echolalic speech from her than from other kids her age.  Sometimes it's incorporated into imaginative play, but not always.  She also has an amazing rote memory.

The main red flags that I'm seeing are the echolalia, outbursts that seem to be a result of her SPD and some inflexibility around disrupting routines.  When she was younger she engaged in some repetitive behaviors like lining up toys, but she doesn't really do that any more.  She's also always required less sleep than other kids her age.

I've thought about the possibility of Asperger's or high-functioning autism, but the areas that throw me off are imaginative play (she engages very well) and social skills. She is very social and actively seeks out other kids to play with, but sometimes she seems quirkier than her peers.

I'm going to talk to her pedi about my concerns (again).  I've also spoken with her preschool teacher who says that DD is very smart and gets along well with the other kids but the struggles with her sensory issues are very obvious. We're starting OT this week, and I'm really happy about that. 

If your child was meeting milestones but you still felt like something was off, what made you push for more evaluations? 

Thanks in advance for your thoughts!

Re: Can we talk about echolalia? And other concerns...

  • For us, the echolalia was a big part of what made me push for an eval. DD1 (ASD) was around 2.5 and a huge percentage of her speech was repetitive -- either immediate or delayed. I remember one day when we went 'round and 'round with me asking if she "was done on the potty, yes or no" and all I got was "yes or no, yes or no." We did that dozens of times with me trying to get an actual answer; at that point I knew something was off. 

    We still get a good deal of functional echolalia -- sometimes she's so good at it that even I don't catch on until she's said a new phrase a few times. Her vocal inflection is so much more animated that it's no longer glaringly obvious when she's imitating. She's made a ton of progress on that, but her pragmatic speech is often still stilted and quirky. 

    My DD tries to engage as well. She's not a loner, she just misses/doesn't process so many communication cues that it's hard for her to be successful. She tries to play with other kids, but doesn't "get" so much that it often just devolves if it's anything more complicated than taking turns chasing each other. She greets random strangers, and she likes introductions because it's such a predictable back-and-forth interaction with familiar language. I often have strangers tell me, "She's so friendly!" 

    I don't know if that helps. As far as pushing for more evals when you already have a dx, we got autism the first time around and haven't gone farther because it seems to be accurate. We have had one child psych tell us she thinks it is more of a non-verbal learning disability than autism. It's nice to hear, but having a different dx wouldn't change what we're doing in terms of service. And TBH, we have to pay OOP for private evals and probably will not do another until DD1 is around six.  

    image

    DD1, 1/5/2008 ~~~ DD2, 3/17/2010
  • image lite-bright:

    For us, the echolalia was a big part of what made me push for an eval. DD1 (ASD) was around 2.5 and a huge percentage of her speech was repetitive -- either immediate or delayed. I remember one day when we went 'round and 'round with me asking if she "was done on the potty, yes or no" and all I got was "yes or no, yes or no." We did that dozens of times with me trying to get an actual answer; at that point I knew something was off. 

    We still get a good deal of functional echolalia -- sometimes she's so good at it that even I don't catch on until she's said a new phrase a few times. Her vocal inflection is so much more animated that it's no longer glaringly obvious when she's imitating. She's made a ton of progress on that, but her pragmatic speech is often still stilted and quirky. 

    My DD tries to engage as well. She's not a loner, she just misses/doesn't process so many communication cues that it's hard for her to be successful. She tries to play with other kids, but doesn't "get" so much that it often just devolves if it's anything more complicated than taking turns chasing each other. She greets random strangers, and she likes introductions because it's such a predictable back-and-forth interaction with familiar language. I often have strangers tell me, "She's so friendly!" 

    I don't know if that helps. As far as pushing for more evals when you already have a dx, we got autism the first time around and haven't gone farther because it seems to be accurate. We have had one child psych tell us she thinks it is more of a non-verbal learning disability than autism. It's nice to hear, but having a different dx wouldn't change what we're doing in terms of service. And TBH, we have to pay OOP for private evals and probably will not do another until DD1 is around six.  

    That's incredibly helpful--thank you!  I'm currently trying to get her evaluated through the school system, and I'm going to talk to the pedi about seeing a developmental pediatrician.  I just want to make sure I can articulate my concerns in a way that will be taken seriously.

  • image -auntie-:
    image mrszee2b:

    This might be a little scattered because my 1.5 year old is about to wake up :)

    My DD is four years old, and I still see a significant amount of what I think would be considered "functional delayed echolalia."  I know that echolalia is a normal part of language development and that it peaks around age 30 months, but at what age should you stop seeing it?  I've been trying to learn more about it.

    I'm not sure what the usual age for echolalia to fade is. My son has Aspergers. His speech was impressive as a young kid. He spoke unusually early and unusually clearly which isn't the greatest thing when you're talking about a kid with a faulty filter in place.

    I was reading the board FAQs and your description of your DS really resonated with me.  My DD didn't talk as early as your DS, but she had dozens of words by 12 months and at 14 months I remember sitting at breakfast with her and H, and she said, "I see a doggy" perfectly clearly. People have always commented on her pronunciation.

    My DD was diagnosed with SPD, but I'm concerned that there's more going on.  She's always been very verbal, and she is capable of spontaneous conversation, but I feel like I hear more echolalic speech from her than from other kids her age.  Sometimes it's incorporated into imaginative play, but not always.  She also has an amazing rote memory.

    This would be my son as well. He was fully capable of spontaneous speech and did plenty of it. Yes!  She talks all the time!! I guess I never thought much of the echolalia before because when a kid that young is talking all the time it seems to make sense that they would have to borrow from other sources.  She also has a knack for repeating phrases in the absolute perfect context, so that makes it seem cute and precocious.  Much of his echolalia around age four was either in the form of scripted play (more about that later) or was in an attempt to be funny. One of DS's more quirky Asperger superpowers is the ability to impersonate people, so this played into being "funny". He used to impersonate teachers from time to time and does an impersonation of his long-time psychologist that spot on. He can also imitate the sounds of certain trains which is just weird.

    He also have a remarkable rote memory, though the older and less atypical he's gotten his range of factoids has gotten more circumscribed. He used to memorize things like license plate numbers. Not an especially useful skill. In first grade I once asked him if he missed having free play as he did in kindie. He looked at me like I was an idiot and said he could have free play in his head anytime he wanted. He told me that his brain was like a 24 screen theater where he could replay any movie, TV show or experience he'd ever had.


    The main red flags that I'm seeing are the echolalia, outbursts that seem to be a result of her SPD and some inflexibility around disrupting routines.  When she was younger she engaged in some repetitive behaviors like lining up toys, but she doesn't really do that any more.  She's also always required less sleep than other kids her age.

    The new DSM criteria are going to roll SPD into autism for those people who have both. Stand alone SPD will still be a dx but, in theory, SPD will be subsumed by ASD going forward.  The SPD was diagnosed by an OT.  The evaluation was prompted by a sudden worsening of her sensory issues triggered by anxiety caused by us moving.  By the time we had the evaluation her sensory issues were back to "normal."

    The inflexibility is a huge red flag. Kids on spectrum get stuck. They might assume or want something to play out as they expected and lose their shitte when it turns out to be different. DH tends to be the recipient of the shitte-losing more often than I am because she's with me more and is used to the way I do things. Even if different is just as good or better. And most kids on spectrum do require less sleep than same aged peers. DS is a good sleeper now, but never took two naps as a LO.

    I've thought about the possibility of Asperger's or high-functioning autism, but the areas that throw me off are imaginative play (she engages very well) and social skills. She is very social and actively seeks out other kids to play with, but sometimes she seems quirkier than her peers.

    DS is quite social. In fact, it was his class clown behavior that drew us to getting a dx. Imaginary play can be learned; DS's play around toy trains looked utterly normal to the casual observer, but it was way more scripted than I thought at first. It tended to look different because he had a big library of stored scripts. Most kids with AS have a strong special interest by age 4.  This is another one that throws me.  I don't think I could identify a strong special interest at this point.  She tends to be obsessed with something for a week or two and then she moves onto something else.  She does love to draw and probably spends at least 2 hours/day drawing pictures or making playdoh creations.  She draws or sculpts her interest of the week.  Much of DS's play was related to his love of trains. He played with trains, he drew trains, he read about trains. LOL, I brought sidewalk chalk to school to help him engage kids in kindie around something other than trains. He drew tracks, assigned the kids a kind of train car, hooked them up and had them follow him around the track. It looked "imaginative" but probably wasn't.


    I'm going to talk to her pedi about my concerns (again).  I've also spoken with her preschool teacher who says that DD is very smart and gets along well with the other kids but the struggles with her sensory issues are very obvious. We're starting OT this week, and I'm really happy about that. It's great that she's bright and hitting her marks. Mine, too. If your child was meeting milestones but you still felt like something was off, what made you push for more evaluations? 

    I followed my gut. It was a different time and I got blown off a lot because my DS doesn't have the meltdown piece. My pedi didn't catch it. nor did his preschool teachers because he was so oddly mellow. He just seemed smart.

    If you really think something is off, you could ask your school district for a multifactored eval in all areas of suspected disability.

    Oh, and on the NVLD. It is considered a learning profile rather than a disability- hence it doesn't require special education support or services. It's a way schools flatter parents out of services. Be careful there.

    Thanks for the advice :)  I think if DD2 had been my first child some of DD1's quirks would have concerned me sooner.  Ah well, hindsight...

    VA has a separate evaluation process for kids age 3-5, and I'm pursuing that.  Right now the pedi thinks she'll outgrow the sensory stuff, and the preschool teacher says she's on track, and we just need to get the sensory stuff under control.  It helps to hear that other people had similar experiences--makes me feel a little less crazy.

  • Auntie, I went back and re-read my responses to you--I hope they didn't sound defensive.  I'm making a list of the red flags that I'm seeing, so I can talk to the OT and the pedi about them.  I really like my pedi, but I feel like she almost always sees DD in an environment that brings out her best qualities--she comes off as more typical than she really is.

    Thanks so much to both of you for your responses!


  • image -auntie-:

    You didn't come off at all defensive. More as if you were offering clarification. I get that. My read-between-the-lines is that your DD is a bright kid who seesm pretty typical, maybe even better than typical, much of the time. Mine was intense but rewarding at that age.

    Exactly!  Much of the time, but not all of the time.  It's hard to know if some of her odd behaviors are due to her sensory issues or some other underlying disorder.  When she's well-rested and comfortable she is delightful.

    That's funny. I remember DS's first sentense vividly. I had just gotten him out of the tub and dried off. I was looking for a diaper and realized I was out and needed to get a fresh bag from the closet. I set him on the floor, still naked. He followed me to the closet and peed on the carpet. I scowled at him and she smiled and said. "My penis is funny." Of course his first real sentene would be about so important a subject.

    That is hilarious!

    Here, too. I remember once walking down the main street in our little Mayberryesque town and DS pointing to a older lady dressed like she was 21 and headed to some club. DS looked at her and said something along the lines of her looking "so sassy". It cracked me up, but DS psych was able to pin it down to a recent Johnny Bravo cartoon. He had a much better ear for picking up echolalia than I do. DS had a classmate once who would recite entire episodes of SpongeBob. It was impressive yet annoying at the same time.

    DD likes to compliment people because she gets a positive reaction from them--things like "Your dress is so beautiful" or "Aunt Emily, how lovely to see you!"  Most of the time these are phrases she heard somewhere else.  She can definitely recite entire books and significant portions of shows that she watches.  Everyone in my family has an excellent memory, though.  My brother's is almost photographic. 

    I'm sure the SPD is real. But IME, the sensory piece as an explanation is way oversold. It seems like moving is more of a transition situation than a sensory one. Unless you moved to a house next to a fire station (or firing range as I do) or the new house was lit by bad florescents that flicker and hum. It's great, though, that she was able to get her behavior back in check more or less on her own- to self regulate. My DS never got an SPD dx, though clearly he had boatloads of sensory issues. He never got OT around sensory stuff, we took a behavioral approach to the stuff he didn't outgrow. Other than clattery restaurants and bad odors, he's been fine for years. Be hopeful.

    When we moved she was anxious and not sleeping as well and that manifested itself in being unable to walk normally while wearing shoes.  (barefoot walking was completely unaffected).  The sensation of the heel slipping on the back of her shoe made her so worried that her shoes would fall off that she developed a very strange shuffle to avoid it.  This lasted for about 3 weeks.  As her anxiety subsided, her walk went back to normal.  Whenever she is tired, hungry, or stressed, she has a harder time coping with tactile discomfort.  I agree with you, though, it seems too easy to blame it all on the sensory stuff.

    She has made a lot of progress with some of the sensory issues in the past year.  She used to almost vomit if you tried to get her to put her hands under running water.  Even watching me wash my hands would trigger her gag reflex.  We worked with her for a few months when she was potty training to get her to the point where she could wash her hands without freaking out.  Water is still a big trigger for her, but she is learning to control herself. 

    Most kids with Aspergers have a very strong attachment to their mom. Hans Asperger talked about this in his orginal papers. Often mom acts as a translator or advocate for the child in the greater world. Because you know her better than anyone else, you are likely accommodating her in ways other care givers can't or won't.

    In a bigger picture sceenario, you want her to become more resilient and able to be OK with different people and different ways of doing things. The usual strategy is deliberate sabotage. Alan Sohn's "Parenting Your Aspergers Child" talks about this strategy for getting anxious kids to be OK with things when they aren't what was expected.

    This was lesson one for me with DS. He's an only and building situations where he was challenged by changes or disruptions weren't a natural part of our lives. DH traveled a great deal then and I was organized so life went a little too smoothly. My homwork from Sohn was to run out of things, let favorite shirts stay in the laundry and just generally keep DS's life mixed up more than was comfortable. He's a really resilient kid now as a result. He's quoted on page 62 of the book, btw.

    Lucky for her, I'm not that organized ;)  She also has a fantastic little saboteur in her younger sister.  DD2 is always all up in DD1's business, and it's been so good for her.  It's also nice to see her be physically affectionate with someone besides me or DH.  She has never liked being held or hugged by anyone other than the two of us, so it's wonderful to see her spontaneously hug her little sister.

    Two other books that might settle your concerns would be Kirby/Romanowski's OASIS Guide to Aspergers Syndrome and James Coplan's Making sense of Autism Spectrum Disorders. In the latter, read about "Teddy". Much of Teddy is based on DS. Read it and see if it feels familiar.

    I will definitely read these--thanks for the suggestions!

    DS's special interest in trains is a little extreme. He's also gone through pahses where he gloms onto a subject and learns pretty much all there is to know about it ad then moves on. There are kids with PDD-Nos who ended up with that dx because they seem really Aspergery except they don't have the consuming special interest. Or maybe something hasn't caught her eye yet. I've known a few kids who have academics or music as an SI but didn't really start with it until they were school aged.

    See if you can locate the books I suggested. They might help you decide if more evals are worth it at this time or if she's just a quirky preschooler.

    My DH has an undiagnosed LD that has plagued him since second grade.  I don't want to overlook something like that in DD, you know?  I really appreciate all the info.

     

     

  • My DD1 does the compliment thing, too. She loves getting that positive communication feedback.

    Most of the time it's very appropriate, but sometimes she tries so hard it's funny. DH got her and DD2 dressed the other day while I was showering and sent them in as I got out so I could "see how pretty they are." I told DD1 that she looked very nice, and she thanked me and then said, "Mama, I like your towel!" Because that's all I was wearing, so it was the only thing for her to comment on to return the compliment!

    DH and I cracked up.  

    image

    DD1, 1/5/2008 ~~~ DD2, 3/17/2010
  • image lite-bright:

    My DD1 does the compliment thing, too. She loves getting that positive communication feedback.

    Most of the time it's very appropriate, but sometimes she tries so hard it's funny. DH got her and DD2 dressed the other day while I was showering and sent them in as I got out so I could "see how pretty they are." I told DD1 that she looked very nice, and she thanked me and then said, "Mama, I like your towel!" Because that's all I was wearing, so it was the only thing for her to comment on to return the compliment!

    DH and I cracked up.  

    Awesome!  I could definitely see my DD saying something like that, too--I think our girls would get along very well :)

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