Thursday, May 10, 2007

Scripters Anonymous

One feature of autism that distinguishes it from a language disorder is echolalia (echoing memorized word patterns either immediately or much later). In the movie, Rainman, Raymond Babbitt rocked and repeated Abbot and Costello's "Who's on First?" skit to calm himself. Echolalia can be much more sophisticated than that. Pamela memorized whole chunks of word patterns and used them when she thought appropriate. For example, when she was five, she had memorized the mournful tone of Baloo in the Jungle Book, "Mowgli, Mowgli, come back!" and repeated it when she was sad and trying to comfort herself. This description fits what we saw:
Echolalia is reflective of how the child processes information. The child with autism processes information as a whole "chunk" without processing the individual words that comprise the utterance. In processing these unanalyzed "chunks" of verbal information, many children with autism also process part of the context in which these words were stated, including sensory and emotional details. Some common element from this original situation is then triggered in the current situation which elicits the child's echolalic utterance.
We first started addressing Pamela's language way back in 1991, when she was two years old. We could not find much information because Pamela was at the beginning of increase in the rate of autism. We had to improvise while we kept on top of emerging research and started Pamela off with sign language. When her echolalia emerged, we opted to mold it and use it, rather than discourage it. For example, Pamela picked up one phrase "It's Sunday" advertising a show aired on that day of the week. Every day, we would use that phrase "It's _______". Then, when she could do that, we would work on negation "It's not _______". After that, we twisted it to, "Yesterday was ________" and "Tomorrow's _______". We eventually transitioned to months and seasons. One little jingle afforded a great deal of mileage. This word pattern started out as a stim and, as such gave us many opportunities to practice new language.

Today, books are dedicated to teaching scripts that help autistic children learn to converse. This still would not have helped Pamela because she has a hard time memorizing scripts unless they are jazzed up for "viewers like you" (*ahem* a new scripted line). We did not figure out until recently that Pamela can memorize poetry with multi-sensory methods and have known for several years that meaningful progress in syntax comes in seven multi-sensory steps! Children who can memorize scripts can also become dependent upon the scripts and unsure of what to do with people who fail to follow the script. Thus, researchers have developed ways to fade scripts.

I am not a fan of the formal teaching of scripts, and I tend to concur with RDI's recommendation to avoid them. Anyone who has been sucked into scriptland knows that sense of helplessness as your sanity evaporates. We have tried a variety of techniques to teach flexibility: laughing at unexpected twists I made in the script, making her own twists, being silly with pauses, changes in pitch, sound effects, etc. Monkeying around with scripts taught Pamela to go with the flow and enjoy surprises.

One of Pamela's issues is that she does not always realize when she confuses people with references to her scripts. She has a couple of patient aunts who play along and that is it! Lately, I have been experimenting with ways to discourage scripting without discouraging Pamela from speaking and interacting with us.

* Ignoring It - Ignoring scripting is the least effective strategy in my experience. When I ignore Pamela, she gets annoyed and will repeat the script prompt followed by "Say it!" In this case, Pamela wagged her finger at me and badgered me. Ignoring her only intensified her nagging.

* Sad Reaction - After she started wagging her finger, I become very quiet, stuck out my poochie lip, and looked down at my feet. Pamela did something splendid. She walked up to me, studied my face, smiled, and said, "Sad." Then, she abruptly transitioned to the locked box.

* Springing off of It - Pamela started a Betty Crocker script, so I declared in off-script sentences, "We're just like Betty Crocker! You could be the Betty Crocker of gluten-free, casein-free." She clasped her hands and giggled with delight at my surprising comment.

* Adapting It - I adapt the script to her task. Pamela said, "You must be 18 or older to order." I ignored her, so she came back to it, "You must . . . I must . . ." She was stirring her batter, so I said, "stir and stir and stir." She laughed and giggled since she likes twisting scripts.

* Distracting Her - Sometimes, I can distract Pamela by gasping and turning my gaze to the next step in whatever we are doing. I have also succeeded by using declarative language to switch topics completely. In this case, I started talking about the need to stir the batter thoroughly until all the dry ingredients to become wet. Later, Pamela was stuck on her, "You must . . . " prompt. We had just added the pecans, so I asked her about her preference on how to say this nut, "Pamela, do you prefer PEE-can or pe-CAHN?" She persisted, so I added, "You must . . . eat . . . PECAAAHHNNNSSS!"

* Saying the Wrong Thing - I often say something wrong to encourage flexibility. She was stuck on the "You must" train, so I said, "Eat spinach." She prompted, "You must be" and I returned, "29!" We have been doing this for years, so she loves when I say the wrong things.

* Reacting to Her Script Twists - Sometimes, she twists her own script as a joke. This time, she said, "You must be 18 to . . ." while reaching for a utensil. She paused and glanced at me to see my reaction when she sneakily added, "die". Pamela is about the happiest person you will ever meet and not morbid about death. I think she was trying to surprise me with something entirely unexpected. I exaggerated my reaction by covering my mouth and said, "Nooooo! We don't want that to happen. You made a joke! That was a joke!" Then she confirmed it by saying, "Only to order!"


Anonymous said...

Oh, how well I can relate to Scriptland! Thanks for the reminders of how to keep our sanity.

One thing we've been doing lately is addressing the script head-on by saying, "We've already talked about that. Now let's talk about something else." Which works sometimes, but other times triggers the follow-up script line, "You mean it's a routine?" Sigh. We get sucked in when we're not looking, don't we?

Karla Akins said...

Awesome. You have such a plethora of info on your site! I love it. Thanks for visiting my blog! And yes, the sneakers do look wonderful!

For my boys it's articulation that is a problem. But if I ever have a child with echolalia, I would certainly want your site at my fingertips. There is just wonderful information there!

I would love some tips on how to re-direct my stubborn sons when they get stuck on being upset. Today we went to the forest, and one of them was very, very angry that he didn't have a bug container like some of the other kids. He would not quit saying it over and over again and began to pick at his brother and hit a tree, etc. Finally I told him if he didn't stop saying it, he was going to write it. Then he disolved into tears.

Every day is a challenge!

What would you have done? Redirecting doesn't work, btw, they are little brick walls stuck in mortar when it comes to an issue!

God Bless!

walking said...

I can use all the tips I can get! We call nagging, but identifying it as nagging does not help. She has found ways to hint at the topic, then wag her finger at me and say, "No nagging!"


One thing I would probably do is hand Pamela a piece of paper and at the top write, "Shopping List", and have her put "bug container" and anything else she can think of at the moment. I am not into instant gratification, but I might say to her, "I will help you get calm. If you calm down, I will take you shopping as soon as we are finished and we will buy the bug container."

When she is upset and when she was younger, we found sensory integration techniques to calm her (spinning her worked best). Today, she is too big for me to spin, but she regulates herself well. Now, I will ask her to breathe, and we will breathe deeply together. I am not a fan of scripts, but, in this case, I might launch one of her favorites to help teach her how to change her thoughts and cheer up. Yes, I will hazard a trip into scriptland if it means avoiding an ugly scene--a choice between the lesser of two evils, LOL! If I know we are going into a stressful situation, I might bring one of those small, squishy balls to squeeze tightly.