Advice re child who repeats phrases/noises.

[Froglet]

I'm not sure whether this is the right place to post this but I'm going to ask anyway. I have a very lovely, sweet, warm little boy who has lots of speech/language issues (he had no speech at all a year ago). One of the things he does is become 'fixated' on a phrase or sound and will repeat it over and over and over. Sometimes the phrases are a repetition of something he would say normally e.g. "I want to go to the toilet." other times a bit random - a recent one was "Thank you very much today". The noises are just noises 'aaah', 'mmm' etc.

 

He won't be ignored - just gets louder and more persistent and continues even after having got my attention.

I'm just wondering if anyone has any strategies they've used for managing this kind of behaviour? I just listened to a recording I made of one of these incidences and although I was quite proud of how calm I remained (I know I was on the point of tears by the end of that morning) I also felt like none of the approaches I tried had any impact.

[Guest]

How very wearing for you.

It sounds as though he's playing with his new toy - his voice - so I wonder about giving him opportunities to record his speech? Perhaps one of those 'easi-speak' microphones, or just the plastic tube phones that let children hear what they are saying?

This really is just a stab in the dark, but didn't want to 'read and run', I'm sure other people will have more informed suggestions.

[Jo43]

Another idea maybe to ignore his noises and try to have interesting conversations with other children nearby in the hope that he might want to add something to your conversation. If he does stop you could say something positive back about what he said and that you noticed that he was doing really good talking.

So you are ignoring the unwanted behaviour and praising him when he is talking properly.

[eyfs1966]

How about a visual stop signal? Is this child receiving SALT input?

[finleysmaid]

echolalia is really common in children of this age with sal difficulties does he do it indoors and out? I would choose not to ignore it but to respond to it perhaps recast and remodel if this doesn't work recast and remodel with additional information ...see if he can add the extra word so " is bus!" becomes yes it's a bus....it's a green bus (adding concepts)

You may need to try a few strategies so see how it goes but if a child is trying to communicate and is having issues i would try to respond...after all that's want you want them to do!

[Froglet]

Thanks for the feedback. He is having lots of SLT input - one came to see him yesterday. We had a very useful conversation but I forgot to ask if she had any suggestions for this. There are ASD concerns from both home and the speech therapists he has seen. In fact the one who saw him yesterday suggested that I didn't need to work specifically on his language (beyond clear modelling/rephrasing of structure etc) but that I should use strategies to work with him that I might use with a child with ASD.

[Upsy Daisy]

There is a theory that echolalia can be a strategy for managing anxiety. If a child is finding the world a rather chaotic place and is craving predictability (common in children with ASD), they take comfort in making their own repetitive sounds because it is something they can both predict and control.

I don't think this necessarily applies to all children who use echolalia but it might be worth looking at whether there is a level of anxiety that you could reduce and seeing if the echolalia diminishes.

[Froglet]

There is a theory that echolalia can be a strategy for managing anxiety. If a child is finding the world a rather chaotic place and is craving predictability (common in children with ASD), they take comfort in making their own repetitive sounds because it is something they can both predict and control.

 

I don't think this necessarily applies to all children who use echolalia but it might be worth looking at whether there is a level of anxiety that you could reduce and seeing if the echolalia diminishes.

 

 

 

 

That's a good thought. He doesn't appear to be overtly anxious but I have been trying to ponder the times when he does this and what might be triggering it. He does it most during quiet carpet time. He seems to enjoy any laughter which comes from the other children. He seems to do it to gain my attention but not necessarily realise when he has got it - or count my response as an adequate one (i.e. if I haven't agreed to whatever he's asked he'll keep asking!). I have thought that he could well be bored (although I hate to say it!) during those sessions although they are short he's very much a flitter and doesn't settle to anything for very long at all at the moment. So, I thought I'd try perhaps giving him a 'fiddly thing' of some kind - any ideas for good ones (he tends to put everything in his mouth)! I've also been trying using a sandtimer to give him a sort of visual cue about when it would be ok to speak again - limited success as he tended to keep saying "when the timer's finished I can..." whatever it was he wanted to do.

One thing that came out of the conversation with SLT was that he seems to like holding my hand (I love it when talking to someone else can help you to make connections) so today I tried making a physical contact when talking to him or giving instructions which did seem to help him focus a little. When he was starting to repeat this afternoon I took his hand as I was asking him to stop but then kept holding it. The repetition didn't stop but it did slow a little and didn't get as loud or disruptive so I'm wondering if the contact helped him feel that he still had my attention.

I did have to smile this afternoon though as today's repeated phrase was my name as anyone might say if they wanted my attention. We'd had lots of repeats of "Miss D, Miss D, Miss D" when I asked him to stop he said something I couldn't make out. I was trying to work what he'd said (although usually understandable lots of his sounds aren't clearly articulated) when the other children started to giggle and then one of them englightened me - he was saying "But I want to say more Miss D's!"

[Upsy Daisy]

You sound lovely and just what he needs in terms of a practitioner who is seeing this behaviour as communication, not something to be squashed.

I think he communicated something really important to you in the conversation in your last paragraph. Could you find some times when you can support his need to use echolalia and see it as a useful process that fulfils a need of his? That may make it easier for him to limit it at the times you would like him to do that. You could perhaps acknowledge his need to say whatever the day's phrase is then suggest a time coming up when he can say it as much as he like, e.g. I can tell that you're enjoying saying my name to day. You need to stop saying it while we're sharing this story but, after the story, you can play with the sand and say it as much as you like.

[Beau]

My grandson is 2 and is almost undoubtedly asd. He displays the same sort of behaviour. Usually repeating back what he is saying word for word is enough to make him stop. He seems to need the acknowledgement that you've heard and understood what he is trying to communicate.

[Froglet]

You sound lovely and just what he needs in terms of a practitioner who is seeing this behaviour as communication, not something to be squashed.

.

Upsy Daisy - what a lovely thing to say! I needed that; I have a challenging class this year and I am just exhausted - feels a bit like nothing is working a lot of the time at the moment so it was lovely to read that someone thinks it was! Thank you.

 

Beau - I'll try that, thank you for the suggestion.

[Froglet]

I promise I'm not revisiting every post I've ever made tonight but I've been thinking a lot about this boy recently in view of the progress he's made this year and he's a different child. Still lots of challenging behaviour but the noises have pretty much disappeared. The repetition can still be there and he clearly has lots of learning/development concerns. I wanted to share a conversation I had today where it was so obvious that he was thinking for himself (and others) and structuring his own sentence rather than just saying something which was appropriate but just a learned phrase.

 

I wore a skirt to school today for what was probably the first time since September - I tend to default to black trousers which can cope with glue, snot, glitter and mud! Of course, it caused much stir from the children and while I was doing the register one little boy put his hand up and said "You look beautiful today Miss D!" (How to win a girl's heart!) so I replied with "That's a lovely thing to say, thank you!". The others all wanted to get in on the act and I had a series of "Your necklace/shoes/skirt/hair/top" are pretty/nice/beautiful with everyone trying to think of something different to compliment me on. The little boy I mentioned in my first post had his hand up waiting patiently (would never have happened 6 months ago!) and he said "Miss D, your register is beautiful!" Met with lots of giggles but I thanked him and said it was kind of him to notice. It was just SO lovely to hear a full sentence, clearly articulated and one where he'd tried to think of something different - I had been complimented on my entire wardrobe by that point!

[LKeyteach]

Froglet

I love post like this. You are so clearly the right practitioner for this little boy. You are so right to feel pride in his achievements.

[Froglet]

Froglet

I love post like this. You are so clearly the right practitioner for this little boy. You are so right to feel pride in his achievements.

 

Ah, thank you! Today he has been really tired and consequently been an absolute pain in the neck this afternoon!! SLT were in to see him today too and she said exactly the same - he just didn't want to play, words largely unintelligible and in completely the wrong order when they were! Ah well, proves the benefit of a good night's sleep!

[Froglet]

Just wanted to add another update on this little boy. About a month ago he did finally get a diagnosis of autism. A relief to his parents I think as he was finally not just 'the naughty boy'. Yesterday a speech therapist who hasn't seen him for a year (he has various different ones) came in and was stunned by the progress his has made - she spent an hour saying "I can't believe it!". He talks in sentences, asks questions (spontaneous ones) of me and the other children. His need for physical contact has become clearer over time and now if he is anxious/tired/stressed at all he will want to hold hands at the very least. This afternoon (last day of term) he spent half an hour with his head on my leg and arms wrapped round me - he got upset by our visual timetable! It has been reinstated for his benefit as a Y1 as there is so much more going on in the day in terms of defined times and usually he loves it. However today - he was upset by the hometime picture and I eventually worked out that he didn't like it because it wasn't right - he is going on holiday straight after school and not going home so it wasn't hometime!

 

Also, yesterday the TA in with me had discovered it was my birthday next week and she got all the children to sign a birthday card for me. He was much taken with this plan and when his parents came back later they brought with them a card he'd made which says 'Happy birthday Miss D love from ...' and what's more he'd even sent me one of his pokemon cards as a present! I nearly cried.

 

I am leaving at Christmas to go to a new school and even though I know things are in place to support him I will miss him so much!

[Panders]

Oh Froglet - If only we could take all those adorable darlings with us!! Are you planning quite an involved transition for him?

[Froglet]

To be honest Panders I haven't thought through transition in detail. Now I know who will be replacing me I can make a start on that in a more concrete way. His MEP is nearly finished, our brilliant SENDCo is fully involved, head is aware etc. We also recently appointed a TA to replace one who'd left from KS2. However, we have based the new one in my class so that come January there will be a familiar face and he is already beginning to bond with her - gave her a hug earlier this week!

[Froglet]

It was my last night yesterday - as you might imagine an emotional one generally - 9 and a bit years in a school is a long time! There were lots of special moments but I wanted to share this with you.

 

Part way the morning one of my Y1 girls came to get me - she had drawn a rainbow on our outside chalkboard, written 'just for you' and 'I love you'. This little boy was listening - he has been hovering very near me all day but then he disappeared for a little while. He came back saying "Come and see, I have a present for you; it has two kisses!" He took me outside to see where he'd written my name on the chalkboard (independently and it's not a 'phonically regular' one!) and put two kisses on for me. I had to give him a hug. We sent him home early - he'd had a bit of a temperature the night before and was just exhausted but had insisted on coming in as it was my last day. As we said goodbye I just sobbed and so did his mum. I know he will be ok and everyone will look after him for me but it was so hard to say it! Am crying again now, just thinking about it!

[sunnyday]

Oh how incredibly special.....

[Upsy Daisy]

Oh Froglet, what a wonderful update!

I had missed your update about the Autism diagnosis so it's nice to read that things are going well for him.

You've clearly set him up to succeed in school. I hope things remain as positive for him as he gets older.

I wish all teachers were as reflective and caring as you. My own children would have been far better off now, had that been the case.

[Cait]

I've tagged this request for input onto this old thread, as there are a few similarities.

 

Preschool have a lttle 2 year old girl whose only speech seems to be swearing and then saying 'don't swear'. She has echolalia, and everything, but everything goes into her mouth. Playdough, PVA glue, paintbrushes, (she will scoop paint into her hand and put it in her mouth) gloop - whatever is around, but mainly wet things, not bricks or buttons etc. I've had a child who ate playdough before, but not a paintbrush sucker. Any ideas on how we can stop this behaviour? Advice or anything?

[Upsy Daisy]

Oh Cait! That made me gag!

 

Could you ask the parents to get the GP to refer her for an OT assessment? Maybe they could suggest ways in which you could replace the sensory experience she is craving that is leading her to put those things in her mouth.

You could also look into giving her a chewy gem necklace that staff could redirect her to, although I'm not sure how successful this would be give that it will be a very different texture.

I can't think of a safe substitute for a paintbrush to suck. Even this silicone pastry brushes might be easily bitten off.

You could look at her overall sensory/social/routine experience as I know that those being difficult can make sensory issues worse so making them easier may reduce her need to put these things in her mouth.

Do you have a strategy to deal with the echolalia? Maybe you and the parents could come up with one or two other phrases you could use lots around her which, if she hears them enough, might replace the swearing sentences?

[Cait]

The swearing is definitely reducing, again, this is echolaic, as she is repeating the language she hears at home, just not saying it immediately, (although she might). She 'chunters' to herself if she thinks nobody is listening, and this is generally strings of profanities, spoken very quietly.

 

She will repeat the last couple of words, so we are using this to expand her vocabulary, but talking to her perhaps more than we might normally, explaining what we are doing, like a driving test! 'I'm putting this jigsaw in the box, there's a piece here and a piece there - can you get me the piece there?' "Piece there". 'Thank you, in the box' "box" 'Is that all the pieces?' "All a pieces" type of thing. It doesn't seem to stay in her head.

 

Mum took her to the health visitor for her two year assessment, and apparently the hv said she had autism, because she wouldn't make a stack of blocks. Hmmmm.

[Upsy Daisy]

Mum took her to the health visitor for her two year assessment, and apparently the hv said she had autism, because she wouldn't make a stack of blocks. Hmmmm.

 

Wouldn't it save a lot of time and money if you really could diagnose ASD that way? All those long, in depth neurodevelopmental assessments with input from all those different professionals would be unnecessary. All we would need is a bag of bricks!

 

That has made me cross.

 

Has this child been referred for a ND assessment? It sounds like she needs one.

Edited July 4, 2016 by Upsy Daisy

[finleysmaid]

we had a little chap with downs syndrome with us two years ago....he LOVED sucking paint brushes, at first (having checked it wouldn't do him any harm) we allowed him to do it as we thought it might be for attention but then we started to gently put his hand down and say Paint on paper.....No paint in mouth...paint on paper then eventually paint on paper or no painting....eventually working up to taking away the paintbrush if it went in his mouth. Seemed to work after some time. Tricky to give a substitute because they need their hands to paint.

Is there a safeguarding issue with the swearing??

commentary may work but language reduction may be more effective at this point so just repeating the same word ..so if playing with the blocks ...just saying that over and over until she's got it.

[Cait]

Thanks. Some good ideas. I've had several chats with Mum to reassure her that her child isn't exhibiting any of the triad of impairment.

 

 

It made me angry too, Upsy!

[Foreveryoung]

We had a child (asd) who would eat all the play dough and more we added various herbs etc till we hit the right ones, if I remember right think he liked most even curry powder but it was one of other ones like thyme or something he hated so we used that in the dough, paint, cornflour for a while till he trained his brain it didn't warrant eating. Was a big adventure to find the taste he didn't like but his nappies were more bearable as time went on, still used to find crayon remnants though

[finleysmaid]

Thanks. Some good ideas. I've had several chats with Mum to reassure her that her child isn't exhibiting any of the triad of impairment.

 

 

It made me angry too, Upsy!

tricky with girls though as they sometimes mask the symptoms....especially at this age. (please don't think I agree with the HV at ALL!!!)

[Upsy Daisy]

tricky with girls though as they sometimes mask the symptoms....especially at this age. (please don't think I agree with the HV at ALL!!!)

 

I couldn't agree more.

 

Neurodevelopmental assessments are in depth and carefully considered processes involving experts who are highly qualified. The NICE guidelines state gives a list of people who should be making this diagnosis together:

 

In each area a multidisciplinary group (the autism team) should be set up. The core membership should include a:

• paediatrician and/or child and adolescent psychiatrist

• speech and language therapist

• clinical and/or educational psychologist.

1.1.4The autism team should either include or have regular access to the following professionals if they are not already in the team:

• paediatrician or paediatric neurologist

• child and adolescent psychiatrist

• educational psychologist

• clinical psychologist

• occupational therapist.

 

 

 

 

It also says that

 

Include in every autism diagnostic assessment:

• detailed questions about parent's or carer's concerns and, if appropriate, the child's or young person's concerns

• details of the child's or young person's experiences of home life, education and social care

• a developmental history, focusing on developmental and behavioural features consistent with ICD-10 or DSM-IV criteria (consider using an autism-specific tool to gather this information)

• assessment (through interaction with and observation of the child or young person) of social and communication skills and behaviours, focusing on features consistent with ICD-10 or DSM-IV criteria (consider using an autism-specific tool to gather this information)

• a medical history, including prenatal, perinatal and family history, and past and current health conditions

• a physical examination

• consideration of the differential diagnosis (see recommendation 1.5.7)

• systematic assessment for conditions that may coexist with autism (see recommendation 1.5.15)

• development of a profile of the child's or young person's strengths, skills, impairments and needs that can be used to create a needs-based management plan, taking into account family and educational context.

• communication of assessment findings to the parent or carer and, if appropriate, the child or young person.

1.5.6Perform a general physical examination and look specifically for:

• skin stigmata of neurofibromatosis or tuberous sclerosis using a Wood's light

• signs of injury, for example self-harm[2] or child maltreatment[3]

• congenital anomalies and dysmorphic features including macrocephaly or microcephaly.

1.5.7Consider the following differential diagnoses for autism and whether specific assessments are needed to help interpret the autism history and observations:

• Neurodevelopmental disorders:

   

  • specific language delay or disorder

  • intellectual disability or global developmental delay

  • developmental coordination disorder (DCD).

   

• Mental and behavioural disorders:

   

  • attention deficit hyperactivity disorder (ADHD)

  • mood disorder

  • anxiety disorder

  • attachment disorders

  • oppositional defiant disorder (ODD)

  • conduct disorder

  • obsessive compulsive disorder (OCD)

  • psychosis.

   

• Conditions in which there is developmental regression:

   

  • Rett syndrome

  • epileptic encephalopathy.

   

• Other conditions:

   

  • severe hearing impairment

  • severe visual impairment

  • maltreatment

  • selective mutism.

   

1.5.8Consider which assessments are needed to construct a profile for each child or young person, for example:

• intellectual ability and learning style

• academic skills

• speech, language and communication

• fine and gross motor skills

• adaptive behaviour (including self-help skills)

• mental and emotional health (including self-esteem)

• physical health and nutrition

• sensory sensitivities

• behaviour likely to affect day-to-day functioning and social participation

• socialisation skills.

1.5.9If there are discrepancies during the autism diagnostic assessment between reported signs or symptoms and the findings of the autism observation in the clinical setting, consider:

• gathering additional information from other sources and/or

• carrying out further autism‑specific observations in different settings, such as the school, nursery, other social setting or at home.

 

 

 

and that

 

When considering the possibility of autism, be aware that:

• signs and symptoms should be seen in the context of the child's or young person's overall development

• signs and symptoms will not always have been recognised by parents, carers, children or young people themselves or by other professionals

• when older children or young people present for the first time with possible autism, signs or symptoms may have previously been masked by the child or young person's coping mechanisms and/or a supportive environment

• it is necessary to take account of cultural variation, but do not assume that language delay is accounted for because English is not the family's first language or by early hearing difficulties

• autism may be missed in children or young people with an intellectual disability

• autism may be missed in children or young people who are verbally able

• autism may be under-diagnosed in girls

• important information about early development may not be readily available for some children and young people, for example looked-after children and those in the criminal justice system

• signs and symptoms may not be accounted for by disruptive home experiences or parental or carer mental or physical illness.

 

It's an extremely complex and painstaking process and panels generally take their responsibility to consider everything carefully against the diagnostic criteria and their collective knowledge and experience very seriously. They are acutely aware that giving or denying a diagnosis can have a permanent and hugely positive or devastatingly negative impact on a child and their family.

 

If there are any concerns, the child should be referred for a neurodevelopmental assessment because early intervention can make a big difference to children's outcomes.

 

If this child were in my care, I would be encouraging the parents to ask the GP for a referral to a community paediatrician..

 

 

[Cait]

Thanks. A lot of that is familiar from my Open Uni Autism course. Good to refresh my memory though, so thank you. I have worked with several children with varying degrees of Autism and Aspergers over the years, and this child isn't exhibiting any of the classic 'flags' at all. I'm angry that this HV took it upon herself to even suggest it - unless of course, Mum has misheard her? In my experience, even professional paediatricians who deal with it day in and day out wouldn't give an instant diagnosis for a just two-year-old in any case!

 

I have already suggested that Mum speaks to her GP if she has any concerns at all.