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Echolalia and Emma

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Some time ago, I worked freelance as a Community Artist. This involved me visiting private homes, public spaces and institutions. I painted murals that ranged from 6 feet square to 6 by 25 feet. The largest one was a hospital corridor in the Oncology department.

One job I did was to create a temporary mural in a centre for young people and adults with Autism – many with severe forms of Autism. The centre referred to the users as client-students. I went daily for over a month to work with the client-students on planning and then after draughting out the design was assisted by a few of the more able ones.

It was here I met Emma*. Emma was in a wheelchair; though she did not have any physical disability which was obvious. Emma’s use of the wheelchair was purely because often she would choose not to walk; for whatever reason, and she occasionally fell over.

This was also my first encounter with a condition known as Echolalia.

Echolalia is, commonly, the repetition of phrases, words or parts of words. It is not always easy to diagnose the underlying cause, Echolalia without Autism may be part of another neurological condition or a developmental disability.

Parents may be aware of their toddler going through a stage in which they “parrot” words and phrases that they overhear. This is usual behaviour and the child generally moves on with their language acquisition. However, in the case of the Echolalia toddler with Autism, this stage might not pass so quickly – especially without intervention. Emma had become ‘stuck’ at that stage. When I first was introduced to her she repeated the last word that her support worker used – “Emma has come to say hello”. Emma said “Hello”. I said hello back and asked, “How are you?”. Emma said “You”. And quickly I realised that I was not having a two way conversation.

When Emma spoke, it was only to repeat the last word of a sentence directed at her; or someone nearby. If that was a long word, she would only repeat the last syllable. Emma never initiated a conversation, she never joined in conversations, she never asked questions – nothing, the only words she ever said were the repetition of someone else’s final word. The other thing Emma did as part of her Echolalia was to make sudden sounds; almost like a Tourette’s sufferer.

I found it incredibly difficult to know if Emma understood what I was saying. I never knew if she was happy or unhappy to be painting alongside me – for Emma could never object to where her wheelchair was manoeuvred to, or what activity was selected for her. At the time I made the, possibly false, assumption that because Emma had Autism and could not/would not speak, that her levels of comprehension were low. In the UK 30 years ago, our understanding of Autism and Asperger Syndrome was still in it’s infancy, assumptions were made about people on the Autistic Spectrum which today have proved incorrect. So as a none specialist, I had no clue what was going on in Emma’s mind; nor how to deal with it.

Each day I would turn up with my kit of brushes and a small number of client-students would join me. Each would have to be given very specific instructions; Use this brush to paint the grass green, like this. Work here and paint the sky pale blue, like this. Sometimes I was able to ask what they would like to do that day and he or she might be able to tell me. Emma did not visit the centre everyday, but when she came to the room where we were making the mural, I still asked her what she wanted to do, Emma replied “Do”. Then I would have to put the paintbrush into her hand; Emma would not pick anything up herself. Then holding her hand, together we would begin to paint an area. After a few moments, I could let her continue alone; but I had to keep loading her brush with paint.

Astonishingly, one of the things that happened when I was a Community Artist, was that I would be left alone to get on with the job, regardless of whom I was working with. (This would never be allowed to happen today). And this place was no different. Once the clients were in the room with me, the staff would go off and do other tasks. I had no idea how to communicate with 5 to 8 people with varying degrees of Autism. One or two would chatter constantly. One would stand and rock for long periods at a time, and Emma would repeat the last words of what I and some of the others were saying.

Emma was about 18 years old and I have no idea if there was any verbal developmental support in place for her. Echolalia for the person with autism can be a useful tool for learning new words as a small child, however, in an adolescent or adult  the habit can interfere with social interaction and learning. Today, Echolalia treatment involves most researchers focusing on helping the person move to a more creative form of language. Initial diagnosis should take place with a doctor, who will then refer you and your child to a speech therapist. The speech therapist will know which treatment or intervention best suits. I imagine that had staff and parents had the knowledge we have today regarding Autism, that Emma could have been trained to respond in different ways. With greater understanding of the variety of conditions that Autistic persons have, the better we as family, friends, support workers and so forth, are able to assist with communication.

Echolalia in adults does exist, and may be due to a variety of underlying symptoms; occasionally it is a habit formed from anxiety in social situations. Echolalia Autism is treatable today, it was not 30 years ago.

I sometimes wonder about Emma to this day. If no-one ever intervened, is she now a 45 year old woman who still has no method of communicating her thoughts and feelings?

*Name changed for privacy reasons.

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About the author:

Alexandra Peel is a contributing writer for The School of Autism blog. She is the author of Sticks & Stones and writes the blog, Flailing Through Life. She is also a Learning Support Practitioner at an F.E/H.E College, England.

Visit Ms. Alexandra Peel’s blog.

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