Wednesday, October 15, 2008

It Bears Repeating

(Originally posted on the New York Times Lesson Plans blog.)

Two of my preschool students with autism are currently going through stages of repeating their favorite words and phrases over and over again. Both students repeat lines from their favorite children’s videos and books — stories and episodes of “Dora the Explorer,” “Blue’s Clues,” and “Max and Ruby.”

Amanda repeatedly says, “Benny the Bull,” who, as I was slow to realize after hearing his name dozens of times one day, is her favorite “Dora” character. She has also memorized many of Benny the Bull’s lines from the show, and she repeats them at seemingly random moments. David repeats the word “notebook.” At first, I thought he just really liked the word, or that he was proud of himself for learning it. Then, after he began repeating lines from “Blue’s Clues,” I realized “notebook,” came from Joe’s “handy dandy notebook” in the show. And lest this excessive repetition be blamed solely on TV and DVD’s, one of my former students, who rarely watched TV, repeated her favorite scene from the book “Harold and the Purple Crayon” — “moose and porcupine eating pies!”

While the ability to remember and repeat words is an important step in every child’s language development, many children with autism tend to repeat words excessively and in socially inappropriate contexts. A child with autism may repeat the same word or phrase hundreds of times a day (which can drive their parents and teachers a little batty). In the autism education field, repeating lines from movies, TV shows and books is known as scripting, or echolalia. (Some people use the terms scripting and echolalia interchangeably, while others distinguish echolalia as repeating words spoken by live people, not in shows.)

Scripting was famously portrayed in the film “Rain Man,” when Raymond Babbitt, the autistic character played by Dustin Hoffman, memorized and repeated Abbot and Costello’s comedic skit, “Who’s on First.” In the film, Raymond seemed to use scripting to calm himself in stressful social situations. At times, my students appear to script for a similar calming effect; at others, it seems to be meaningless, out-of-control repetition. Despite the many challenges this behavior presents, it is possible for young students with autism to use it in socially appropriate contexts. Encouraging them to do so is one of my goals as a special education teacher.

Many of my students have proven themselves capable of memorizing a word or phrase, associating it with a particular emotion or social situation, and then attempting to use the phrase when they encounter a similar emotional or social situation. One of my favorite examples of this is described in Paula Kluth’s book, “You’re Going to Love This Kid.” Kluth tells the story of a boy who said, “Go to hell, lieutenant,” when he was upset. The boy was scripting from the film “A Few Good Men” and he correctly associated the phrase with anger. In another case, one of my students memorized the phrase, “Hello, everyone. How are you today?” — one of his teachers often said this when she entered the classroom.

One day, when I brought the boy home, he walked into his family’s apartment and said, “Hello, everyone. How are you today?” His parents and I were floored. At the time, this was by far the most socially meaningful language the boy had ever used. While he had learned the phrase through rote memory, he showed progress in social communication — a skill that children with autism often lack — by correctly associating the phrase with entering a room and greeting people.

One thing I cannot do as a teacher is miraculously change the way my students’ brains develop or the way they process language. There is clearly something in the brain development and language processing of children with autism that differs from their typically developing peers. Genetic researchers, such as the scientists with the Autism Genome Project, are currently trying to pinpoint the root causes of the disorder.

We don’t yet have all the scientific answers to what causes autism, and it remains to be seen whether a cure will be developed, or whether a “cure” is something that would be welcomed by those affected by autism. Many parents have told me they would welcome a cure, while many higher-functioning autistic adults are offended by the notion of needing to be cured. In the meantime, there are language development techniques that teachers and parents can use to help children with autism begin to socially connect with their peers and families.

One of the programs I learned while training and working with the Center for Autism and Related Disorders is a social questions activity. Using the basic principles of Applied Behavior Analysis (ABA), I am able to teach my students to answer questions ranging in difficulty from, “How old are you?” to “What was your favorite part of the book?” While my students typically learn to answer these questions in a rote manner by memorizing the questions and answers, the next step is to take what they have learned through memorization and use it in socially meaningful situations at school.

David, the boy who repeats lines from “Blue’s Clues,” was able to quickly learn the answers to many socially relevant questions. During snack time at preschool last week, I asked him, “What’s your mommy’s name?” We had worked on this question, so he quickly answered correctly. Then I asked one of his classmates at the snack table what her mommy’s name was, and soon all of the children at the table were telling their friends their mommy’s names. We then did the same activity with daddy’s names and favorite foods. (Of course, teachers should be sensitive to kids who may not have both parents.)

These are the kinds of basic, pre-school level conversations that come naturally to most kids. But David needs to be taught to participate in such conversations in a step-by-step manner. That’s where breaking things down through ABA becomes helpful. While I am not a strict ABA practitioner in the classroom, I do find it helpful to use the basic principles of breaking larger tasks into smaller steps and quickly reinforcing my students for achieving each step. Within ABA, there is a more recently developed model that I use called the Verbal Behavior Approach. This model is especially useful for language development activities.

While I can’t get inside David’s brain to know for sure what he’s thinking, something does seem to click for him when he participates in these kinds of peer conversations at school, and he seems to enjoy them. Being able to use his memorized language with his peers, and hearing that they have different answers to the same questions, does appear to be helping him connect with them socially. Throughout the pre-school year, our social question activities will become more complex and, step-by-step, we will build up to asking questions and initiating peer conversations. The ultimate goal is for David to begin talking with his peers more spontaneously. Spontaneity in language is difficult to teach, but I aim to give David more opportunities to reach this stage by pushing him beyond his scripted comfort zone.

Language issues like this, which can be so exasperating for parents and teachers, do not disappear overnight, but I find it helpful as a teacher to keep in mind that the same strong memorization skills my students use while scripting can be shaped into socially meaningful language.


Anonymous Dave Spicer said...

Thanks for writing this! :-) My son and I are both autistic, and in his childhood we often found ourselves conversing in sound bites. We each sound "more typical" these days, but sometimes I wish I didn't - here's why:

During those times when words fail me, I would be happy to be able to use even off-the-wall references to try to communicate what was going on inside. But I've managed to value articulateness so much that I shut down instead. I'm not sure that represents useful progress.

6:36 AM  
Blogger Lori said...

I am a speech-language pathologist who also works intinerantly and with preschoolers (some of whom have autism) in NYC and just read this piece in the NY Times. Absolutely - you can shape the rote speech into more meaningful speech - that's what we speechies do. You can also shape language use into spontaneous speech by taking into account what the child is expressing and building on that (e.g. "Benny the bull" can be expanded to talk about the show, characters on the show bulls, cows, farms, etc.) Some more ideas on this theme can be found in the work or Stanley Greenspan and by consulting your friendly neighborhood speech-language pathologist! Keep up the good work with all your kids!

6:51 AM  
Blogger Cock It And Pull it said...

I love your writing and admire your work. I have a suggestion. There is so much written about autism these days and something in this universe commonly gets left out.

The aide.

Having been there many, many times; having changed lots of diapers and having designed toilet-training programs, I am constantly surprised that the role of the aide is often simply shoved to the side. These are usually lowly-paid, stressful, demanding jobs. These are VIPs in the system and what they do and how they do it merits focus attention.

7:47 AM  
Blogger loonyhiker said...

I love when things come together! I had my students and their parents over my house for lunch one spring and we were all floored when my husband put his hand out to shake my autistic student's hand and the student shook it and said, "Hello." Parents and I were floored. My husband didn't know why we were amazed because he didn't know the student was autistic and didn't treat him any different than anyone else. This was an "aha" moment for me that maybe I treat my students with kid gloves way too much.

8:22 AM  
Anonymous Anonymous said...

Your approach worked well for my son who has Aspergers and is presently a freshman at Columbia. I don't think that my son intuits socially appropriate speech, but he has learned it in the same way he learned Chemistry. In fact, because he has learned social interaction, his skills are rather superior--he works the cell phone setting up social events, following up, etc, in a way that most 18-year-olds can't. My son sees his autism as a competitive advantage, not a disability and his mastery of socially meaningful language has enabled him to make friends quickly and easily. I hope that other teachers and parents understand that social skills practice can and does yield great results.

P.S. My son memorized the entire Beatrix Potter oevre and the more obscure the language, the more he enjoyed saying it, ie "she ironed it and goffered it and shook out the frills." That love of language has persisted in more manageable forms.

8:57 AM  
Anonymous Anonymous said...

I am a high-functioning Autistic (Aspergers), and I feel compelled to share with you my favourite two points.

First "many higher-functioning autistic adults are offended by the notion of needing to be cured." I couldn't agree with this more. I am who I am with Aspergers. Given the degree with which high-functioning autitic people are affected, the 'benefits' or, medically, symptoms of the condition are things I like or can be viewed as a benefit. Such as intense focus on a subject.

Which segues nicely into the second favourite point. I currently have an intense focus in the 2008 US Election. I enjoy debating it, but whilst doing so I end up scripting my points. Whatever issue I raise, I simply go through my memorised bullet points in my head.

I share my tiny contribution since I felt, for a moment, that, in a way, it was me being written about. A thing I find odd about this diagnosis. When it's described, you feel like someone knows you and your personality to an extent without having met.

9:31 AM  
Blogger Helen said...

Thanks for the wonderful article. Among my son's stock phrases to convey emotions have been:

"I'm sixteen years old; I'm not a child" (Ariel, The Little Mermaid) -- intense emotion (not just exasperation) [although he's now 15, he mostly said this when he was between the ages of 5 and 8)

"It's o.k., Mother; we were just having fun" (Henry Fussy, Charlotte's Web [Warner Bros. animation] -- protest or objection

11:13 AM  
Blogger Mom to JBG said...

I enjoyed this article. I'm a mom of twins with autism, and I taught special ed. before having kids. Back in the early, silent days of my boys' toddlerhoods, I often thought to myself, "Bring on the echolalia!"

Now, at 3, my boys tend to have musical echolalia...they still don't use much language functionally, but both can sing long stretches of favorite songs. I take this as an encouraging sign that someday they'll do more talking.
Keep up the good work!

12:17 PM  
Anonymous Anonymous said...

Thank you for your blog. It was pointed out to me by a colleague--we are not in the field of special education--and I have learned so much from reading this post!

3:03 PM  

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