Echolalia is a form of language repetition seen in autistic children and children who are blind, where they repeat words and phrases they hear. It is characterized by difficulties with language comprehension, pronoun confusion, questioning intonation, and inability to use speech functionally. Therapeutic work focuses on developing play skills, communication functions like requesting and commenting, and cognitive and social skills, through the use of visual schedules, cause-and-effect toys, and structured peer interaction. Specific techniques include modeling short phrases matched to the child's experience, using names instead of pronouns, and practicing skills repetitively to build comprehension.

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Elizabeth Ives Field, CCC-SLP
Autism Spectrum Consultant
250 Main St #405
Hudson, MA, 01749
207-852-1835
betseyfield@gmail.com
Autism, Blindness and Echolalic “Scripting”
Echolalia is a fascinating, challenging and sometimes frustrating language disorder
that often accompanies autism spectrum disorders and is frequently referred to as
“scripting”. It also occurs among blind children. In my experience, this has been
especially true of visually impaired children with Septo-optic Dysplasia, Retinopathy of
Prematurity, Optic Nerve Hypoplasia, Anophthalmia, and Leber’s Congenital Amaurosis.
Echolalia involves language that is heavily based on immediate or delayed repetition
of phrases and sentences other people have just said or have said in previous similar
situations. Characteristics include difficulty with language comprehension, confusion of
pronouns, overuse of a questioning intonation and very compromised ability to use
speech to meet functional and conversational needs.
It typically goes with excellent auditory memory, limited and repetitive play skills,
and impaired social interaction. Behavioral challenges often include automatic and
extreme resistance to changes, transitions and new experiences, as well as perseverative
self-stimulating actions, poor safety awareness, and atypical eating and sleeping patterns.
To varying degrees, some children progress through echolalia with minimal help,
others do so only with lots of intervention and some remain echolalic for life. Even after
more conventional language develops or is taught, many post-echolalic children and
adults may depend heavily on memory, associative patterns, and literal interpretation of
language. They typically decode written language much better than they comprehend it,
sometimes start reading as preschoolers, and have very poor social skills and limited
common sense.
The therapeutic process, as I see it, involves working on functional expressive
communication, cognitive development, language comprehension, play skills and social
interaction. Where to start depends on the child’s present level but it is important not to
assume that strong memory and reading (decoding) skills are indicative of the child’s
functional cognitive and language development.
Initially, it may be necessary to establish joint attention and shared activities if the
child is unable to sit and cooperate with play or instruction. Visual schedules, three

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dimensional tasks that can be done with physical assistance and primary reinforcers can
be very helpful at these early stages.
To enhance cognitive and social development, teach the use of cause and effect toys,
then problem solving toys like puzzles and shape sorters, and then address more creative
and imaginative play. Progress through one-to-one play with an adult, independent play,
parallel play with peers, and adult-supported structured play with peers to independent
peer interaction.
Early educational skills such as color, shape, number and letter recognition may be
much easier to teach and are often learned spontaneously, but also provide a good context
for communication development. For example, many children will practice requesting by
saying “I want A” and so on, to get each letter of an alphabet puzzle. Echoic blind
children tend to learn the Braille code readily.
While working on play skills and cooperation with structured instruction, focus early
language goals on the communicative functions of requesting, directing, commenting,
choice making, protesting, greeting, and answering. Articulation, vocabulary, grammar
and basic sentence structure usually progress nicely at the same time although there will
surely be significant pronoun errors, especially reversal of “you” and “I/me” and
probably confusion between “he” and “she”. Prepositions of location, like “under” and
“between”, which express unstable relationships between objects, are also often difficult
for these children.
Some of the suggestions I give most frequently to teams working with echoic
children are:
Don’t ask so many questions, especially if the child doesn’t answer questions yet; the
child who echoes will soon sound like everything he says is a question.
Model language that will still be true and appropriate if echoed. “Time for the
bathroom” works if she spontaneously says it to you but “Do you need to use the
bathroom?” is confusing if the child later echoes it as a request.
If saying “Bye Eric” gets no response or causes him to repeat “Bye Eric” to you, say
“Eric!” and when he looks up, then say “Bye!” and he will probably say “Bye” back to
you. Often you will also get good eye contact. Avoid an extra adult coaching him to “Say
‘Bye’ to...” as this very quickly creates prompt dependency.
Model one to three word phrases at first, even if the child is echoing full sentences,
and match them to what the child is experiencing. She needs the simplicity to connect the
meaning with the words even though her memory allows her to repeat longer sentences.

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Use names instead of pronouns for a while to minimize the “I-you” confusion.
Expect comprehension difficulties even if he can follow some directions. Children
who understand language well do not echo, although young children typically do imitate
key words a lot as they are learning to talk.
Don’t be afraid to model and practice the same things a lot. The more difficult skills
may take a lot of repetition and children with autism prefer predictability to novelty.
But watch out for associative patterns. If he says “Tie shoe” and you respond “Okay”
a few times, he may start saying “Tie shoe okay”. You may need to vary your response or
just tie the shoe and say nothing to avoid confusing him.
Some things get better without direct instruction. If articulation is poor it often
improves greatly as more conventional language is acquired and the child understands
what she is saying.
Delayed echoing of books and movie scripts also decreases as more conventional
language develops, or it can be addressed more directly later with an incentive plan.
If you are interested in more information on echolalia, please feel free to contact me
at betseyfield@gmail.com