MAMI

1
MAMI

• BERNARDUS LARRYANT
• SONJA RONDESTVEDT
• VALERIE S. VARASTEH

2
OUTLINE

• MAMI FAMILY
• BACKGROUND INFORMATION
• ASSESSMENT
• INTERVENTION
• CONCLUSION

3
MAMI FAMILY
4
MAMI

• Mami Yamamoto
• 6 years old
• Kindergarten
• Enjoys playing with light toys, soft music, and
  visual movements
• Does not enjoy loud noises
• Limited play skills
• Repeating both English Japanese phrases

Image taken from http//silveroses69.blogspot.com/
2007_05_01_archive.html
5
FAMILY

• Lives with Mother (Reiko) and Grandmother (Akari)

Image taken from http//english.kimono-sakaeya.com
/?eid1440311
Image taken from http//flickrhivemind.net/Tags/ob
asan/Interesting
6
GOALS

• The family wants Mami to
• Increase functional use of speech and other
  English language skills
• Decrease her echolalia

7
BACKGROUND INFORMATION
8
DEFINITION

• Echolalia is the repetition or echoing of verbal
  utterances made by another person.
• Rydell Prizant (1995) stated echolalia refers
  to a general class of speech repetition with few
  distinctions made regarding the degree of
  repetition or comprehension and intentionality
  underlying the production of echolalic utterance
  (p. 106).
• 85 of verbal children with autism produce
  echolalic language (Rydell Prizant, 1995).

9
ECHOLALIA IN CHILDREN WITH AUTISM

• There is a need to consider the acceptance of
  echoic behaviour. That is, how comprehensive is
  the child with autisms utterance to the
  communicative partner? Rydell Prizant (1995)
  suggest observing the following points
• Do the words used in the echoic utterance have an
  equivalent meaning to others?
• Does it relates to the context in which it
  occurs?
• Is intention created in the utterance?
• Does the utterance assist in maintaining a social
  interaction by providing novel or needed
  information?
• Does the echoic utterance can evoke a response
  from another person?
• Does the echolalia disrupt the childs ability to
  partake appropriately in a social interaction
  and/or an educational task?
• Does the echolalic behaviour isolate the child
  with autism?

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ECHOLALIA IN CHILDREN WITH AUTISM

• Echoic behaviour is displayed in interactive and
  non-interactive forms (Prizant Duchan, 1981)
• Interactive degree of comprehension of the model
  utterance by showing appropriate gaze task
  attempt, and the use indicating behaviours
  (point, gesture, show, etc.).
• Non-interactive little comprehension of model
  utterance and lack the proper gaze, low in
  volume, and there is no observable change in
  behaviour.

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AUTISM AND BILINGUALISM

• Bilingualism is not a hindrance for children with
  developmental disabilities.
• Children who are growing up in a bilingual home
  need to learn the spoken languages in order to
  partake wholly within the family system. It is
  important for their life context and for the
  children with autism to communicate with those
  who are important to them and play a large role
  in their life (Kay-Raining Bird, Lamond, and
  Holden, 2012).

12
AUTISM AND BILINGUALISM

• Kay-Raining Bird, Lamond, and Holden (2012) did a
  survey to investigate a range of questions around
  autism and bilingualism.
• Mode of Communication
• Language Exposure
• Professional Advice
• Family ratings display that bilingualism was of
  importance and a majority felt they were
  successful in raising their child in a bilingual
  home.

13
ECHOLALIA AND BILINGUALISM

• Echolalia has also been used to teach receptive
  naming of Chinese characters (Leung Wu, 1997)
• When children with autism echo the response
  before the matching task, the children display
  improved receptive language skills. In addition,
  the difficulty of the task affected the speed of
  acquisition.
• Echoic prompt may assist in reading the name of
  the character and guided attention to the
  matching symbol

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ECHOLALIA IN LANGUAGE DEVELOPMENT

• Two viewpoints in echolalia had been developed
  around language acquisition
• Echolalia is a pathological behaviour that needs
  to be extinguished due to interference with the
  development of appropriate language skills no
  functionality is observed in the echoic
  utterances
• Echolalia is used with a functional purpose
  furthermore, echolalia can be a tool to develop
  a more conventional application of the child with
  autisms language repertoire.
• Language development in children with autism is
  linked to the Gestalt and Interactionist
  approaches.

15
GESTALT APPROACH

• Gestalt processor develops language by using
  memory and repeating multi-word utterances in
  chunks. The process aids in the comprehension of
  linguistic structures (albeit, in small amounts)
  (Bebko, 1990 Rydell Prizant, 1995 Prizant
  Rydell, 1993).
• Memorization and chunking of the conventional
  linguistic structures also supports
  generalization and applyinh the chunks in other
  proper and appropriate ways (Prizant, 1983
  Prizant Rydell, 1993).

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GESTALT APPROACH

• Children with autism take on a gestalt form of
  language development. Most children with typical
  development develop language through an
  analytical process.
• Analytic processors - develop language skills
  with acknowledgement of the basic structures in
  language. The meaning behind words and phrases
  are develops through linguistic stages toward
  more complex utterances (Prizant Rydell, 1993).

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GESTALT APPROACH

• Children with autism are considered to develop
  language through an extreme form of gestalt
  processing and can be correlated to
  characteristics linked to autism such as the
  degree of rigidity seen in individuals with
  autism, coping with unpredictability, lack
  flexibility, difficulty with producing generative
  and flexible language, and comprehending
  social-system rules (Prizant, 1983 Prizant
  Rydell, 1993).

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INTERACTIONIST APPROACH

• Examines the relationship among the fundamental
  variables in the social-communicative interaction
  and the influence of these variables on an
  individuals communicative performance (Prizant
  and Rydell, 1993, p.275).
• Prizant and Rydell (1993) suggest two factors
  are related to the interactionist approach
• 1. Cognitive, social, socio-emotional, linguistic
  strength or weaknesses of the child may affect
  the nature of the interaction.
• 2. The partners interactive style may influence
  the response.

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COGNITIVE AND SOCIAL FACTORS INFLUENCING
ECHOLALIA

• Task Demand/ Unfamiliar Environment
• Echolalia may occur more frequently when the
  child is in a challenging social scenario, and/or
  demanding and novel setting (Prizant Rydell,
  1993).
• Comprehension
• Echolalia is employed when there is difficulty in
  comprehension during verbal interaction with a
  communicative partner (Bebko, 1990 Prizant
  Rydell, 1993 Rydell Prizant, 1995).
• Information-processing view echolalia arises
  when the adult uses abstract language and it does
  not match the semantics that were previously used
  during the childs turn in the conversation
  (Prizant, 1983 Prizant, Rydell, 1993 Rydell
  Prizant, 1995 Schuler, 1979).

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COGNITIVE AND SOCIAL FACTORS INFLUENCING
ECHOLALIA

• Transitions (Prizant, 1983 Prizant Rydell,
  1993 Schuler, 1979)
• Children with autism display an increase use of
  echolalia and agitation due to confusion from a
  change in the usual routine. In addition, fatigue
  and distraction linked to transitions also led to
  higher incidences of echolalia.
• Adult influences (Rydell Mirenda, 1994 Prizant
  Rydell, 1993)
• The style of communication affects the level of
  echolalia produced in children with autism. The
  directive style increases echolalia while the
  facilitative style consists of natural
  turn-taking.

21
COGNITIVE AND SOCIAL FACTORS INFLUENCING
ECHOLALIA

• Adult influences (Rydell Mirenda, 1994 Prizant
  Rydell, 1993)
• An association between the communicative style
  and linguistic constraint.
• High constraint utterance when the child is
  required to respond to the adults utterance in a
  similar form of style in communication which has
  specific syntactic-semantic structure or
  content (Rydell Mirenda, 1994, p.720).
• Low utterance constraint not required to meet
  the adult directive control, more natural
  conversational comments.

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IMMEDIATE ECHOLALIA

• Is an utterance that is emitted immediately
  following the original utterance, or a brief time
  following the utterance from the communication
  partner (usually within two comments) (Prizant
  Duchan, 1981 Prizant and Rydell, 1993 Rydell
  Prizant, 1995)
• Retrieval of information from short term memory
  (Prizant, 1983).
• The researchers determined that immediate
  echolalia often was used with clear evidence of
  purposeful communication (Prizant, 1983 Prizant
  Duchan, 1981).

23
IMMEDIATE ECHOLALIA

• Immediate echolalia may support the development
  of more elaborate language skills and the
  frequency of echolalia depends on the level of
  language development (McEvoy et al., 1988).
• Children with autism who display intermediate
  level of language acquisition will emit more
  echolalic utterances since it serves as a
  function to communicate with others and a way to
  continue acquisition (McEvoy et al., 1988).

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DELAYED ECHOLALIA

• Delayed echolalia refers to utterances that are
  repeated later on in time (Prizant Rydell,
  1984).
• Usually echoic utterances are derived from TV
  commercials, movies, and repetition of parental
  reprimands.
• Involves retrieval of information from the long
  term memory storage (Prizant, 1983).
• It is easier for those familiar with the child
  with autism to decipher the meaning behind the
  delayed echolalia and how it may relate to the
  context in which it occurs (Prizant Rydell,
  1984).

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MITIGATED ECHOLALIA

• Mitigated echolalia- when the child changes a
  word, phrase, intonation, or feature of the
  utterance that is repeated (Bebko, 1990).
• Mitigation is used in both types of echolalia.
• Rydell and Mirenda (1994) suggest mitigated
  echolalia is not derived from rote repetition.
• Mitigation demonstrates a control over the
  echolalic utterances and utilization of
  rule-governed grammatical competence (Bebko,
  1990 Prizant Rydell, 1993 Roberts, 1989).
• Bebko (1990) describes two basic capabilities of
  language are intact for children with autism who
  use mitigated echolalia labeling and symbolic
  function. A third component in language that is
  seen with mitigated echolalia shows inference to
  ones self (Bebko, 1990).

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ASSESSMENT
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Data Collection

• Language Samples Ecological Assessments
• Preferably videotaped samples in multiple
  environments.
• If videotaping is not an option, audio taping or
  written observations from an observer is advised.
• In Chapter 5 of Teaching Children with Autism
  Strategies to Enhance Communication and
  Socialization, Rydell and Prizant offer 18
  different suggested activities for collecting
  language samples in different environments.

28
Some Suggested Activities for Language Sample

• Eat a desired food item in front of the child
  without offering any to him or her.
• Activate a wind-up toy, let it deactivate, and
  hand it to the child.
• Give the child four blocks to drop in a box, one
  at a time, then immediately give the child a
  small animal figure to drop in the box.
• Look through a few books or magazines with the
  child.
• Open a jar of bubbles, blow bubbles, and then
  close the jar tightly and give the closed jar to
  the child.

29
Suggested Activities for Language Sample

• Initiate a familiar social game with the child
  until the child expresses pleasure, then stop the
  game and wait.
• Blow up a balloon and slowly deflate it then
  hand the deflated balloon to the child or hold
  the deflated balloon up to your mouth and wait.
• Offer the child a food item or toy that he or she
  dislikes.
• Place the childs hands in a cold, wet, or sticky
  substance, such as Jell-O, pudding, or goo.

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Step 1

• After you have the language sample, you can now
  categorize the unconventional verbal behaviour.
• Immediate echolalia
• -immediate repetition of words or phrases
• Delayed echolalia
• -significantly delayed repetition of words or
  phrases (hours, days, or weeks later)

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Step 2Determine the function of the echolalia

• From Prizant and Rydell (1984)
• If its immediate echolalia there are two
  categories
• 1.Interactive functions
• Turn-taking
• Declarative
• Request
• 2. Noninteractive functions
• Nonfocused
• Rehearsal
• Self-regulatory

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Step 2Determine the function of the echolalia

• If its delayed echolalia there are also two
  categories
• 1. Interactive functions
• Turn-taking
• Verbal completion
• Providing Information
• Labeling (interactive)
• Request
• Calling
• Affirmation
• Directive

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Step 2Determine the function of the echolalia

• 2. Noninteractive function
• Nonfocused
• Situation association
• Self-directive
• Rehearsal
• Labeling (noninteractive)

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Step 3When does it occur?

• Possible Antecedents
• Echolalia is more likely to occur in these
  conditions
• Specific situations
• Specific interactions
• Person-specific situations

35
Step 4Communicative Intent

• What is the communicative intent?
• From Wetherby and Prizant (1989)
• Is there no awareness of the goal?
• Is there awareness of the goal?
• Is there a plan to achieve the goal?
• Is there a coordinated plan to achieve the goal?
• Is there an alternative plan to achieve the goal?
• Is there metapragmatic awareness to achieve the
  goal?

36
Step 4.5 Communicative Function

• Determining the communicative function of the
  echoic utterances are done by examining the
  communication partners interpretation of and
  reaction to the behavioural act.
• Interviewing the home and school team members
  to gain greater information about their
  interpretation of and reaction to the
  unconventional verbal behaviour is suggested. A
  functional assessment interview could be used to
  gather this information.

37
Step 5Challenging behaviours

• Another factor to consider for echolalia is the
  whether the unconventional verbal behaviour is
  challenging and who is it challenging for.
• Does it add new or relevant information?
• Does it interfere with the persons ability to
  have conversations or be apart of conversations?
• Does it have stigmatizing effects on the person
  in certain contexts?
• A functional behaviour assessment could be done
  to assist with determining those factors.

38
Step 6Intervention?

• The last stage of assessment is looking at
  whether direct intervention is needed and/or
  wanted.
• Once the language samples have been analyzed and
  coded, suggestions for either direct or indirect
  intervention can be made if the family or school
  feel it is beneficial.

39
Other Assessments continued

• The Inventory of Potential Communicative Acts
  (IPCA) by Jeff Sigafoos et al.
• Social Networks A Communication Inventory for
  Individuals with Complex Communication Needs and
  their Communication Partners by Sarah Blackstone
  and Mary Hunt Berg, Published in 2003.

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INTERVENTION
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INDIRECT INTERVENTIONS

• Focus on modifying the environment
• Based on information gathered from Functional
  Assessment

42
SETTING EVENT INTERVENTIONS

• Lack of appropriate play skills
• Introduce different activities and toys in order
  to expand her repertoire of preferred activities
  and toys increase choices for her reinforcer
  menu

43
ANTECEDENT INTERVENTIONS

• Environment is too loud/noisy
• Gradual exposure to loud and noisy environment
• Short period of exposures (5 minutes)
• Removal upon request using AAC or speech
• Gradually increase the amount of exposure in
  small increments
• Provide safety signal for Mami to make it through
  the session
• Use a timer to provide a visual support for Mami
• Pre-correct Mami to use her AAC or speech to ask
  for break
• Remember, if you want to leave, you can ask for
  a break.

44
TEACHING INTERVENTIONS

• Echolalic speech minimal functional speech
• Teach Mami to use her AAC to request for a break
  from the loud and noisy environment
• Every request made using AAC should be followed
  by vocal approximation in order to encourage
  speech
• Echolalia replacement strategy

45
FOXX (2004)

• Response training - getting the subject to
  correctly label picture symbols that will be used
• Cue-pause-point procedure
• Deliver the instruction (CUE)
• Holding up a finger to signal silence and say
  shh or no whenever silence is desired (i.e.
  during instruction). (PAUSE)
• Move your finger so that it touch the picture
  card about 2 seconds after the instruction was
  delivered. (POINT)
• Prompt to ensure the correct labelling occurs
• Intermittently reinforce correct responding

46
FOXX (2004)

• To fade the prompts, cover the picture card with
  a folder and touch the folder during the POINT
  phase
• Eventually, fade the prompts all the way to
  simply PAUSE after delivering the instruction

47
MAMIS CASE

• Practice with Mami so she can correctly label the
  break card- I want a break
• In a loud and noisy environment
• Ask her, What do you want?
• Holding up a finger and saying shh whenever her
  echolalia starts
• Touch the break card approximately 2 seconds
  after
• If no response, prompt her to say I want a
  break
• Immediately, let Mami leave the noisy environment
  upon asking

48
MAMIS CASE

• Eventually, cover the break card with your hand
  and simply point to the hand
• Finally, simply pause 2 seconds after delivering
  the question for Mami to respond correctly
• GENERALIZATION
• The same procedure can be used in other
  situations as well, such as requesting for items,
  asking for attention, and others.

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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC)
DEVICES

• Has been shown to help children with autism make
  gains in speech production (Schlosser Wendt,
  2008 Millar, Light, Schlosser, 2006)
• Comes in a number of different modes manual
  signs, picture symbols, or voice output devices
  (Mirenda, 2003)
• Use it in the early part of Mamis intervention
  in order to give Mami an appropriate mean of
  communication
• Gradually fade it out as her functional speech
  increases

50
PROLOQUO2GO

• Augmentative and Alternative Communication
  application for iPad, iPhone/iPod Touch
• Consists of picture symbols as well as voice
  output capabilities
• Chosen because of its functionality cost
• Costs
• App 189.99
• iPad 2 419.00
• iPhone 375.00
• iPod Touch 199.00
• http//www.youtube.com/watch?vvomkNSluWW4

Total Cost 400.00 650.00
Images are taken from http//www.proloquo2go.com/A
bout/
51
CONSEQUENCE INTERVENTIONS

• Main function is ESCAPE
• Let Mami have a break when she uses her AAC to
  ask for one
• Reinforce Mami with a preferred activity or toy
  when she uses appropriate and functional speech
• Create a reinforcer menu for Mami to choose from
• Prompt Mami to use appropriate speech

52
REPLACING ECHOLALIA

• Risley and Wolf (1967) replace echolalia with
  stimulus specific responses
• Schreibman and Carr (1978) replace echolalia
  with a generalized verbal response
• Foxx (2004) replace echolalia with functional
  use of verbal labelling

53
CONCLUSION
54
CONCLUSION

• Believe that the function of her echolalia is,
  for the most part, escape
• Functional communication training
• Cue-pause-point method to teach her appropriate
  speech
• AAC to help Mami use appropriate language at the
  beginning of the intervention
• Proloquo2Go is the choice due to its
  functionality and cost

55
Questions?
Image is taken from http//therealkenjones.wordpre
ss.com/2012/02/08/capitalism-and-socialism-making-
sweet-love-for-over-200-st-valentines-days/
56
REFERENCES

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57
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61

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