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Is Echolalia always an indicator of autism or aspergers? Is there an age limit where it should be gone by?

(43 Posts)
MrsMushroom Thu 17-Jan-13 21:37:25

My close friend's DS is almost three and he's exhibited echolalia both immediate and delayed (mostly delayed now) since he first began to speak at two.

She's begun asking me now and then if I think he's ok but when she asks she does it in a way where I get the feeling she wants me to reassure her things are ok...she says "Do you think that's ok?" and sort of nods encouragingly so I have said yes...it's ok....is that wrong?

He's now a month off three and all his language is parts of cartoons and fave television shows and ads. He does also use phrases which he's heard from friends and family...so during a day out he heard the phrase "Come on Sarah!" and now, my friend says whenever she tells him they are going to visit Sarah he will say "Come on Sarah"

He doesn't respond at all to his new siblings (not unusual I don't think) except to get very upset and have a meltdown when they cry. He has to leave the room immediately one begins crying.

So basically I am wondering if the speech pattern is something some kids go through....and then grow out of or is it a real sign of something amiss by the time the child is three? I am very aware that she's stressed and when she asked me this, I said that I thought it was a normal part of speech development which I have heard to be a fact. She's just had a baby...I didn't feel like I should say anything to worry her and as I mentioned above, she seemed to be willing me to say it was fine.

Her DS likes playing with my DC....to the extent of jumping on the trampoline with them and he laughs as he does this....the game is always the same though and my DC fall down and he laughs and then he waits for them to do it again.

He has excellent fine motor skills on an iphone as well as counting, colours, recognising numbers and animals etc....he can match pairs and play quite complex games on the phone.

He doesn't line things up but neither does he point or clap....he sometimes lies on the floor and looks at his fave thomas books by lying his head on one side and looking sideways at them.

If it IS something she needs to see about, can you advise me...if she asks me again, should I say yes and ignore the vibes she's giving me to reassure her?

firawla Thu 17-Jan-13 21:55:19

tbh he is nearly 3, the sooner she does think about getting him seen the better cos it can take time for the whole process. does he speak other than the echolalia, because if all or majority of his speech is echolalia then it could be a cause for concern. i think you can say yes get him seen, in a reassuring way - and sometimes it feels more reassuring to have someone say that actually yes, i understand why you would be concerned about that and give them support while they go through the process off assessments etc, rather than saying "no no, all sounds fine" but in the back of their mind they really know that it isnt?

MrsMushroom Thu 17-Jan-13 22:02:02

He does speak in other ways but it is very rare...if I give him and my DC something to eat, they'll talk about it....(my DC) and he will relate to that...announcng "cheese!" or whatever as they eat it. So he does recognise things but it's not often.

Mainly he's always muttering phrases and things he's got from TV...often in a low voice so you'd not necassarily know.

I feel like she asked me...and I let her down...but she's JUST had twins and was already tired and stressed.

firawla Thu 17-Jan-13 22:08:38

Oh god.. poor woman yes she must have a lot on her plate with twins!!
still, if she brings it up again I would be honest with her that there could be some concerns. it seems like your being kind not to say anything but the kindest thing is to help her to help her ds getting the support he needs. Deep down she must know there is some concern or she wouldnt be asking?

MrsMushroom Thu 17-Jan-13 22:10:23

I will try to say it in a way as not to cause too much worry then. I could just say "I don't know...maybe you could ask the health visitor?" as she'll be having visits from them won't she....at least that wont need a special trip to the drs.

PoshCat Thu 17-Jan-13 22:21:12

I don't know either. My DD (4) has severe speech delay/disorder. There is a lot of repeating of words and phrases but she has always responded with appropriate words, "yes, no, more, please, thank you" but she still has over traits to suggest a possible ASD diagnosis. Her speech therapist seems to strongly suspect this.

PoshCat Thu 17-Jan-13 22:23:01

Meant "other" not "over" traits.

MrsMushroom Thu 17-Jan-13 22:25:08

Posh, my friends DS doesn't ever respond if you ask him if he wants anything....he doesn't say hi but looks happy to see you...he doesn't say more or please or anything indicating his needs or desires.

The more I write, the guiltier I feel for not saying yes...get an opinion from a professional. I just couldn't say it.

PoshCat Thu 17-Jan-13 22:29:50

But her paed has ruled it out.

Sorry. Not a lot of help overall. [Embarrassed]

Ineedmorepatience Thu 17-Jan-13 22:29:50

You sound like a good friend mrs, maybe you could say that you had been thinking about how her ds speaks and you think she should get it checked just in case. I am sure she would appreciate the fact that you have been thinking about it.

Good lucksmile

PoshCat Thu 17-Jan-13 22:31:51

I agree with Ineedmorepatience

zumbaleena Thu 17-Jan-13 23:14:41

Hi there. This is exactly what my dd went thru. She was ditto like the three yr old you have described here and I just kept thinking is she delayed or what. I would ask my friend as well and she kept saying everything is fine. Probably cos your df has had twins, she cannot see it but the first thing she will need to do is turn off the tv. It took full 3 months for my dd to stop the scripting. She needs to forget the hv or GP and ask straight for a speech assessment. She needs to ask straight for a community ped as well to see her kid. He is already 3 and she should move hard and fast

MrsMushroom Fri 18-Jan-13 07:33:14

Zumbaleena thanks Is your DD ok with speech now?

MummytoMog Fri 18-Jan-13 11:28:04

Turning off the TV can be a bit tricky if you've JUST had twins, although I agree that it makes a big difference with the scripting.

My DD has always done this, has a severe speech delay and also ignored her new sibling. SALT and the EP think she may be somewhere on the spectrum. I am less convinced, and it's a moot point at the moment anyway as we've refused further assessment to give me time to calm down and not do bad things to the EP when he calls my daughter abnormal. DD also has a hearing loss. It's easier for her to pick up phrases that she hears repeated over and over and over, or on a day when she has good hearing, than it is for her to pick up the sometimes indistinct speech of adults and then translate that into the rules of language. DD does use appropriate language in the right context, but this is quite a new thing for her.

We had Speech Therapy from just before DD was three. Useful in teaching us how to interact with her in a way that helped her communicate, the PECS was good for giving her ways to communicate her needs with us (although she's gone right off it now), and DD's nursery have also done sterling work with her.

I would suggest your friend asks for a referral to SALT, but I would also suggest that she looks at some of the learning language DVDs so that if she pops the TV on while dealing with her twins, she doesn't need to feel guilty that he is scripting, and it might well help him pick up words and phrases. For what it's worth, my DD moved on from ignoring her brother, to disliking him, to actively adoring him now. New siblings are a big change for a toddler, and ignoring is a far better reaction than pinching or slapping.

paranoid2 Fri 18-Jan-13 11:39:53

I would say something along the lines of " I have been thinking about your question regarding your DS’s echolalia and my response. I’ve been worried that I may have influenced you to not get him referred. You are his Mum and if you have a gut feeling that something is not quite right, then I think you need to act on that , as you are with him all the time and others may not see the same thing as you. You have nothing to lose in getting him referred and if all is ok by the time the referral comes through then there is nothing lost.”

My DS had echolalia at that age. He also had functional appropriate speech but there was something a little odd about the echolalia and I remember asking MN about it. He also had some sensory issues . When he was about 3 it was just repeating some scripts from TV and sometimes acting them out as well as copying some phrases that others would say. Then it continued a bit and when he was about 4 to 6 I noticed that he used it a bit to communicate if he was unsure of what to say in a social setting. He would say “hear this” and recite a script. Throughout all this though he also had good age appropriate speech also.
He was diagnosed with Aspergers last year (he is now 11) and his main difficulty is his processing . I believe his echolalia was related to this but of course its possible to have processing difficulties without having aspergers . It could also just be normal toddler behaviour but for me the lack of response when spoken to , no clapping and pointing would be as much cause for concern regarding ASD as the echolalia and worth looking into asap.
My Ds is a twin and his twin looked at TV for the same length of time as DS and there was a bit of scripting with DT1 at aged 3 but I had no concerns as everything else was fine and I would say it was at a normal level for a child of that age

MrsMushroom Fri 18-Jan-13 12:20:55

paranoid what you say about your DS having good age appropriate speech through all his echolalia rings a bit of an alarm bell for me because Dfs Ds does not.

I'm not an expert of course but at nearly three, I can guess he should be able to have a small conversation? Perhaps instigate a game or ask for something...but he doesn't.

Im going to broach it next week. Bit nervous but if she's asking me, as someone else said it means she's got doubts and wants confirmation.

zumbaleena Fri 18-Jan-13 12:41:23

Yes dd is not scripting like crazy anymore. She is at phrase level functional language

EllenJaneisstillnotmyname Fri 18-Jan-13 12:42:43

When I was in denial about my DS2, who has ASD, I would always be seeking reassurance/confirmation from friends. Most would try to reassure, thinking they were being kind, saying things like, 'lots of DC do that.' What I really needed to hear was someone gently confirming my worries and persuading me to seek help, via the HV or GP. My SALT persuaded me to get my HV to assess my DS age 3, who then immediately referred me to a Paed. I spent about 12 months in denial, 12 months wasted IMO.

I would say there are a number of red flags from your description, the echolalia, the lack of interaction with peers apart from rough and tumble play, the fact that the 'game' has to be the same each time. Looking at his toys from odd angles. Not asking to have his needs met. Sensitivity to the sound of his siblings crying.

Any one of them could be present in a NTly (Neurotypically) developing child, but the fact that there are quite a few would concern me quite a lot, I'm afraid. You don't need to go in all guns blazing, of course, but a gentle suggestion that she may be right to be concerned and an assessment from her HV may reassure her? Nothing to lose, etc.

I would guess that she's going to spot that things aren't quite as they should be herself once she has got over the twins early days, and once her DS attends a preschool, hopefully staff there 'may' pick up on things, but the earlier she can kick off getting some assessment in place the better for her DS, early intervention can be so useful.

paranoid2 Fri 18-Jan-13 12:58:45

yes I would think a small conversation would be expected although if a child has a S&L delay this may not be attainable. However as I said earlier I think there are other issues that would give cause for concern.

Although DS did have good appropriate speech at that age, I suppose it was around that age or maybe a bit later that i started to notice how he lacked the intuitive, non taught ability to interact with his peers. He still lacks the banter type conversations that 11 year olds engage in and looking back I suppose his conversations even at aged 3 were a bit onesided and a bit factual. However I was a bit in denial I suppose and always looking for evidence that there was nothing wrong. So I would see his great vocabulary and how every report would arrive with "DS is a very sociable and popular Boy" and I would convince myself that all was Ok. On the surface he was and is but mainly on his terms and mostly with adults. After DS' diagnosis last year I vowed never to ignore my gut instincts again as I suspected from a very young age that DS was ASD and no prof ever mentioned it until he was 10. i dont think it was any ones fault as his traits are pretty subtle and masked by many non asd traits and he had been having ASD type therapy such as OT and help at school . Sorry for too much info but all I'm saying is that often if a mother thinks there is something not quite right , she is correct.

TheLightPassenger Fri 18-Jan-13 15:54:58

agree with the others, by 3 you would not expect this sort of echolalia, and it's particularly concerning since his general language/understanding seem behind for his age. I think it's worth you suggesting that your friend looks for a hearing test and speech therapy assessment, she may be able to refer directly for speech therapy rather than needing HV or GP to "permit" that.

Btw my DS was v similar to how you describe your friend's child at 3, his language and understanding of language were delayed, he didnt quite have all the traits for an autism diagnosis, just traits. Over the years, his language is now pretty much age appropriate, his social skills not quite there yet, I would not be surprised if he ends up with some sort of Autism diagnosis before adulthood. If I hadn't gone for NHS and private speech therapy for him, he probably would have not made as much progress (also v good infant school).

BackforGood Fri 18-Jan-13 16:21:19

I agree with others. There definitely sounds like there are enough concerns there to seek further advice. I also think the fact she is asking you (and others?) shows that the Mum is already concerned, and I think that telling her you wouldn't be isn't what she needs now. By supporting her to ask for a Paediatric Assessment - or at least a Sp&Lang Assessment, you are not diagnosing anything yourself, you are just saying "Yes, I see what you are a bit worried about, I think if it were me Id like to be reassured everything is OK, or, if it isn't, to know that he's started in the system, so the right professionals can give us some support."

mariammama Fri 18-Jan-13 17:59:23

She can phone and discuss with a speech therapist or a if that's too scary, a trained parent volunteer.

Or you can ring the local speech therapy department and find out when they're next running a drop-in triage/advice session in the local children's centre (not every area has this, but lots do).

The TAMBA boards usually are a great source of advice, as lots of twins have additional needs.

mariammama Fri 18-Jan-13 18:02:03

I wouldn't waste her time with a random HV or GP till she knows what to ask them for, and how to insist if they try to reassure her too quickly. Most health professionals will realise this is a red flag, but not all... and unlike you, they probably don't have access to mumsnet for second opinions grin

HecateWhoopass Fri 18-Jan-13 18:14:23

She needs to get him seen.

If there's no issue, then having him assessed won't hurt.
If there is somethjng then I promise you that the earlier its picked up on, the better.
Cases like this, the wait and see approach is the very worst thing someone can have

zzzzz Fri 18-Jan-13 18:23:40

hecate what intervention do you think might be needed/offered?

HecateWhoopass Fri 18-Jan-13 18:56:04

First of all, an assessment.

Then everything would depend on what the outcome of the assessment was.

TheLightPassenger Fri 18-Jan-13 19:13:33

zzzz- at this stage with my DS, the massively important thing to emerge from SALT assessment was being told that my DS's receptive language was 12-18 months delayed at 3, and he was at one word level. This meant that I knew I had to dramatically change how I communicated with him. I was in massive denial about how little he understood.

zzzzz Fri 18-Jan-13 20:30:11

I personally don't see assessment as a therapy/intervention, though I take lights point that if you have misjudged the level of language, clarity as to where your child is could be helpful.

I'm genuinely interested in what therapy is available for a 2 year old with these kind of issues. In my area there simpley isn't any, so I guess for my ds we effectively did "wait and see" ie the worst approach.

I've had 3 small children under 3, in fact I had 5 children under 7 including twins, I think it is important to understand what you will get out of assessment and picking your moment carefully.

HecateWhoopass Fri 18-Jan-13 20:46:41

I didn't say the assessment WAS the intervention. I said you need the assessment in order to determine what is needed.

I can't possibly say what if anything the child in question needs. An assessment would do that.

My children were diagnosed with autism at 2.5 and at 3. My youngest was exclusively echolalic for years. My eldest didn't talk in any form for years. Just squeals and grunts and things. They didn't come out of nappies until they were 5 and 6.

They had a home visiting teacher from the early years team 3 times a week from diagnosis until they started school. We worked on getting statements right away so they had 1:1 in place for when they started school (they got funding for 1:1 in nursery too). At 12 and 13 they both still have full time 1:1 (youngest 2:1 offsite). They had SALT (don't get me started on how useless THAT has been!) sssen. Autism advisory service. specialist paed. child development centre. my eldest recently had some camhs sessions. ed psyc-not seen one of those for years, mind. 'Opportunity class' - which we withdrew them from because we didn't like it.

That sort of thing.

But that is my kids, based on their diagnosis and their needs. Some or all of that may not be appropriate for this child.

That's why I advised that she just at this stage, request assessment. That will let everyone know what if anything they are dealing with. Then they can look at what the options are.

zzzzz Fri 18-Jan-13 21:24:20

hecate I'm looking for understanding/information not to upset/disagree. I too have two children with sn, and I'm interested in your experience of early intervention. Of course you can't diagnose and recommend a treatment plan for this child shock, but you did say "cases like these, the wait and see approach is the very worst thing someone could have". Thinking about my own experience, I'd like to understand why you feel that.

In my area SALT is not offered to children with ASD. In fact after dx, many are discharged. But even for those tha aren't and have multi agency input, what is that input? I guess what I'm asking is for you to look back at your experience and say what was helpful and what wasn't. Also what with years more experience of language disordered children you would put in place?

My ds1 was Echolalic but his only words were numbers/colours a 2. He first said dada at 3.5 and mama took another year. NHS salt was unhelpful, but private SALT was the best mone I have ever spent. Assessment was gruelling and inconclusive, parts of it were very helpful, parts infuriating.

HecateWhoopass Fri 18-Jan-13 21:58:49

Oh. I didn't understand that. I'm not arguing with you at all, honestly. I was just explaining why I limited my reply to her to advice to get an assessment and take it from there, and then gave some background on my own situation, to demonstrate where I'm coming from.

Yes, when there is a child who is displaying possible speech/language problems, or signs of asd, or anything like that, it is really the best thing to get the ball rolling as soon as possible. This is because it is very well documented that the earlier the intervention - the more positive the outcome. Generally. (I hate to say 'positive outcome' but I can't think of a better way to phrase it. But I am aware it's not quite what I want to say, because I don't mean that not being able to do that is a negative outcome!)

Of course, if you can't get the assessment/support then there's nothing to be done but fight! If the diagnosis is given and then the support is withheld from the child, then it's a long battle and sometimes a legal one. This whole thing all takes time. But my point to her was that it's best to do your (general your not specific your) part as early as possible. If a parent thinks there may be something, then they shouldn't wait and see if the child catches up. They should go and ask for a professional opinion.

Then begins the battle, in many cases.

But the longer they leave it to begin the battle, the worse it may be.

SALT is, I think, a problem nationwide. In my area they try to tell you there IS no provision after primary school hmm of course with that, as will all things, I ignored them. grin and my son (younger) has not been discharged because I refused to allow them to. But really, it just consists of a few sessions and telling me stuff I already know and advising me to do stuff I'm already doing. Getting an autism specialist is hard.

I found the home visiting teacher amazing. 3 sessions a week each, doing basic skills training. eg turn taking. she had a pig that you put coins into and every so often it would oink. grin she used this to develop turn taking. there was play with little animals. bubble blowing to get eye contact - she wouldn't blow the bubbles until they looked at her. Lots of things that I watched carefully and did on daily basis with them too, to aid their development.

PECS (the picture exchange). That was good. give me the picture of the drink and you can have the drink. I will also say the word drink. Taught them that some communication and interaction is needed to get what they want grin

did not find makaton helpful. Couldn't get on with it.

Didn't like opportunity class - it felt like they just gathered up all children of any age who happened to have any form of disability whatsover and shoved them in a room. hmm

I did quite a bit of the dreaded sonrise as well! grin - people on here prefer aba, I think, but I found sonrise really good. I don't agree with their opinion of what autism is and it's not all I did with them, but I liked a lot of it.

I find those things that teach basic skills to be most helpful. These days, I'm working on my eldest going into a shop and buying something. And working on my youngest to not ignore people when they talk to him!

I just think that lots and lots and lots of work with them is the key. The hours you spend on the floor with them, actively teaching them the stuff that NT children just seem to pick up without trying.

I remember when I was first teaching them about feelings. I did happy face sad face happy face until my face was about to fall off grin

HecateWhoopass Fri 18-Jan-13 21:59:04

Holy CRAP that's long.

zzzzz Fri 18-Jan-13 23:11:57

Long and interesting.

Laughing at happy and sad face fatigue.....ds1 has always been good at emotions but when he was three I felt moved to teach them to him formally hmm..... What a mistake!

He demanded "surprise" endlessly, it was his greatest pleasure confused.

It had some benefits.

Let's face it pulling a surprise face is a pretty easy reward to have up your sleeve. grin

BackforGood Fri 18-Jan-13 23:27:41

zzzzz I don't know if it's the same across the country, but in my LA, waiting lists are shorter pre-school, and the whole approach to assessment is just FAR better.
If , and I emphasise I'm not passing judgement on the original child in this thread, but if the child is going to need support in school, then the earlier to can get the referral to the EP, the better. If you can get a Statement in place before school applications, it gives you a wider choice of schools, and it gives you a promise of support once you reach school. Also extra help with transition, if that's needed. Generally, if a child starts school without things already in place, then first they are given time to settle, then they join the end of a queue of children who have been waiting for assessments for longer than they have. Just some of the reasons I agree with Hec saying getting assessment early has got to be a good thing.

zzzzz Sat 19-Jan-13 00:02:31

Once you are school age does assessment have to go through school then?

Can you not just get referred to developmental pead via your GP?

I do believe that my ds's language disorder is developmental. I think I can minimise the damage done by his condition, but that ultimately much of the development does take time and can't really be pushed in any significant way.

MummytoMog Sat 19-Jan-13 00:05:24

Re assessment - this has been the most stressful year of my life. Full stop. And a giant part of that has been the 'helpful' people who keep telling me my daughter is autistic, when not a single one of them is qualified to make that diagnosis. I can't see any value for her right this second in having an official diagnosis, and the process of assessment makes me want to pull my face off.

The best incentive the EP could offer me was that it would help people to understand her 'abnormal developmental curve' which I completely disagree with actually. Right now she has SALT and she has a lot of input from Early Years. I'm looking into various private therapists in the hope of finding someone who can encourage her speech and communication without making me want to pull their face off. She has support at nursery from a TA. I don't think she'd get anything else out of a dx and she might well lose her SALT.

The OP's friend is concerned about the echolalia - I would honestly just start there with SALT. If the other stuff is of concern, I'm quite sure they'll bring it up. They did with us.

zzzzz Sat 19-Jan-13 00:19:42

mummytomog very clear description of assessment process for me too. Twins are full on too.

If OP is still reading babysitting would be really really kind as would listening to the same anxieties again and again and again.

MrsMushroom Sat 19-Jan-13 08:30:25

Guys thank you all so much. I feel a lot of responsibility towards my friend (she's really more like a sister to me. I do babysit for her and always have done really which is another reason I've been concerned...spending whole days with her DS whilst she's at work has made things more apparent to me really.

Because she only needs childcare on odd days due to her work, I usually step in to save her money as I'm at home anyway, therefore her son has been with me where he might have been with a childminder...a professional who may have flagged things for her.

I'm the closest she's got to a female relative and the closest she's got to childcare.

Just putting it down like that helps.

MummytoMog Sat 19-Jan-13 10:24:52

I doubt a CM would have noticed anything wrong, ours didn't until we mentioned DD w having speech therapy and then they suddenly got very on board with the problem spotting hmm

Hope you find a way to help your friend OP - there's plenty of things that can be done to encourage speech and plenty of reasons for funny speech patterns and quirks that don't go hand in hand with serious impairments.

zzzzz Sat 19-Jan-13 11:28:21

The kindest thing you can do is to support your friend, however she copes with issues.

What she doesn't need is anyone telling her how to parent her child, or what action to take. Let her be the expert. Realise that whatever worry/doubt she is showing is a teeny fraction of what she is experienceing.

People often say "I can't imagine" how "worried you must have been", or how "difficult it was". Frankly, no you can't.

Love her, help her to do a good job, be her friend.

BackforGood Sat 19-Jan-13 12:10:35

zzzzz In my LA, you can still go to your GP for a referral to the Paediatrician at any age, but the CDC (Child development Centre) services are divided into U5s / Pre-School ,and school Age children, so it's not other children at your school necessarily that you would be waiting behhind, but other children across the authority. Sorry I didn't express that very clearly. smile

FreckledLeopard Tue 22-Jan-13 17:45:12

My ex-H's son is autistic. Frankly, the delay in getting a diagnosis has, IMO, caused no end of problems.

Kindest thing of course, is to support your friend. But, I would say that fobbing her off with reassurances is detrimental to her and her son (not meaning that in a nasty way).

I agree with Hecate that early intervention and some kind of plan of action is the best thing to do. I don't know if your friend is a pushy kind of person, or wealthy - it's a pretty sad state of affairs that if you're neither, your child is less likely to receive the help he or she needs and will likely fall through the gaps. But, IF there is a problem, then no-one else is going to advocate for that child, battle the obstacles and get some kind of programme (ABA or otherwise) in place. And, the earlier the intervention, the more likely it is that there could be a better outcome.

Mimishimi Thu 24-Jan-13 07:40:40

I would recommend getting him checked ASAP. Our son was diagnosed with a severe speech delay when he was 3.5 and showed the same symptoms as your friends son. Everyone said to wait because boys take longer. As he is a very friendly, sociable little boy who also learned the alphabet in a week, is good with numbers, pattern recognition etc we just waited for his speech to catch up. It never did. To this day, he is a good 18 months behind his peers and received a PDD-NOS assessment at 4.5 after being assessed for autism (which means that he's sort of on the spectrum but it isn't classic autism - the delay cannot be explained). Only after intensive speech therapy and starting school has he improved to the point where he can be understood about 75% of the time (he's now 6.5) - the rest of the time his speech is garbled and quite disordered as are his thoughts (ie he will also rave on about favourite shows/computer games etc at moments where it's not really relevant).

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