I've decided to write the post I desperately wanted to read a few years ago when Bud's speech was exclusively echolalic, when I was split down the middle, half of me thrilled to hear the sound of his voice and the other half of me anxiety-ridden by the thought that I should find a way to make him stop obsessively quoting videos. I felt like I was standing at a high-stakes crossroad without a guide map, and I had the overwhelming feeling that whatever I did at that very moment would lead to a happy, rewarding life for Bud or would unleash the doomsday machine that would spell the end of life as we knew it.
It started the summer before Bud turned three, on a family trip to a Sesame Street-themed amusement park in Pennsylvania. Bud was in Early Intervention but had not yet gotten a diagnosis. We knew he had a speech delay, but beyond that we just thought he was a little quirky in a high-maintenance kind of way. In retrospect I recognize that much of the language he did have then was echolalic (singing songs word for word, falling down and saying "areyouokay?"), but I didn't really see it at the time.
The issue came into much clearer focus at the theme park, though. It was the first time I remember Bud having the "I love this, make it stop! I hate this, I want more!" reaction that I have come to know as one of the hallmarks of dysregulation for him. Bud was simultaneously enchanted and overwhelmed in an overactive, unfocused sort of way. And throughout our time at the park, our mostly nonverbal boy kept repeating the same thing over and over: "Duh-No! Ahssiswih dunna. Deedeedee! DUWAH!" I couldn't understand what he was saying, but there was something about the cadence of his speech that triggered recognition in the recesses of my mind.
On the same trip, our hotel television was one that powered on to a hotel "preview" channel with a cartoon cowboy who welcomed us and told us what to expect during our stay. Bud was fascinated with this cowboy, and after a couple of days in the hotel he started mimicking the character's speech. My immediate reaction was one of panic, and the word flashed in my brain: ECHOLALIA. I began to pay more attention to the other phrase that I kept hearing from Bud throughout the trip: "Duh-No! Ahssiswih dunna. Deedeedee! DUWAH!" and kept running it through the filters in my mind - what did it mean?
I remember the moment that I figured it out. I was strapping him into his car seat, and he was clutching several of his Sesame Street figures (one of his quirks was the tendency to carry small characters with him wherever he went.) I started saying the script along with him, paying close attention to the tone, the inflection and the emphasis he put on each syllable, and it hit me: Baby Bear, from the beloved Elmo's World video - "Behold! Artist with crayon! trill of music Drawing!"
I was fascinated and horrified.
From that point on, I began to tune in more intentionally to the cadence of the sounds he made and I came to recognize that he was repeating scripts from favorite videos frequently. As his speech grew less garbled, it became even more obvious. At first the scripts did not seem to serve a purpose beyond their play value and their self-soothing qualities. But he was talking and scripting more and more and more.
That's when I first encountered that crossroads feeling. What should I do? If I try to make him stop scripting will he just stop talking altogether? Will he feel like I'm telling him that he is not good enough? But if I just let him keep scripting will it drive him further and further into a fantasy world, and further and further away from the real one? I'm sure I must have read things. I'm sure I must have talked to people - his EI specialist, his doctor... someone! - but I have no recollection of any advice that I got about it.
I just remember thinking that the most important thing - the thing that would keep him in this world, that would make him prefer the real world to the fantasy world - was connection to other people. You can connect without language, I reasoned, but language without connection is useless. And so, the content of his speech became a secondary concern. My primary goal, instead, was to use his speech to connect with him - however and whenever I could.
So I learned the scripts, and climbed into his fantasy world with him. I tried to engage him in dual-scripting - you say one line, I'll say the other - to approximate the reciprocal flow and give-and-take of conversation. I worked with him to develop scripts of our own - private jokes that we shared with each other. And whenever I could, I looked for the moments when he was well regulated and I tossed a little chaos into the creation, hoping to provide just enough dissonance to move him forward a bit, to expand the possibilities of language, to help him consider that there could be more to talking than scripting alone.
Bud continued to script, but as time passed I noticed a clear evolution in his scripting. It became less random. He began to assess his surroundings and select the script he had that best fit the circumstance. So if he wanted to play ball, he would approach us with ball in hand and say "Quick, Dipsy. Help Laa Laa catch the ball."
After more time passed, he began to modify his scripts. The sentence structure would remain intact, but he would swap out the pertinent details, so that "Quick, Dipsy. Help Laa Laa catch the ball" would become "Quick, Daddy. Help Mama catch the ball." As his talent to modify scripts became more sophisticated, it allowed him to interact and be understood by people outside our home. His speech patterns still sounded stilted and awkward to "outsiders," but they could finally understand the basic gist of what he was trying to say - and it seemed that this new milestone became a real turning point for him.
Bud's confidence seemed bolstered by his ability to be understood, and allowed him to start taking risks with language and start putting words together on his own. Using creative, spontaneous language was much more difficult for Bud and took a great deal more time than it did for him to assess a situation, mentally thumb through hours of memorized scripts to find the most relevant script to the given situation, and modify the script by swapping out a few details. As a result his creative speech was much slower and less polished than his modified scripts. But, in time, "Quick, Daddy. Help Mama catch the ball" became "Daddy ball?". And slowly, slowly, two-word and three-word phrases became sentences, and sentences became conversations, and personal pronouns began to match, and the rules of grammar began to emerge.
It was in the midst of this transformation that I attended a workshop led by SLP Barry Prizant, and during one of the breaks I told him about Bud's increasingly complex modification of movie scripts. Dr. Prizant told me that Bud was using "mitigated echolalia," and that it was an excellent prognostic indicator for future language development.
"I'll bet you'll start seeing spontaneous language soon," he said.
"We already are, " I said.
Dr. Prizant smiled and said, "And I think you'll probably see a lot more." He pointed me in the direction of some great articles on echolalia. One of them was Finding the Words by Marge Blanc in the May-June 2005 issue of Autism/Aspergers Digest Magazine. The article talked about "gestalt language acquisition," or exhibiting delayed echolalia with whole sentences repeated verbatim. I read the article with fascination: it seemed that she was writing about Bud.
And there in the sidebar was a quick overview titled The Stages of Gestalt Language Acquisition. It could have been titled The Stages of Bud's Use of Language. It read:
Stage 1: Communicative use of language gestalts (learned and spoken in their entirety) - "Let's get out of here!", "Want some more?"
"Quick, Dipsy. Help Laa Laa catch the ball!"
Stage 2: Mitigation into chunks (a) and recombining (b) - (a) "Let's get + out of here!", "Want + some more?"; (b) "Let's get some more!", "Want out of here?"
(a) "Quick + Daddy. Help Mama + catch the ball!"
(b) "Daddy catch the ball!"
Stage 3: Isolation of single words and morphemes, and beginning generation of original two-word phrases - "Get...more!", "Want...out?"
Stage 4: Generation of more complex sentences - "I got more.", "I wanna go out?"
"I playing ball with you, Daddy!"
Bud still does a lot of scripting, especially when he's dysregulated or when he is focused on pretend play. But he also uses a lot of spontaneous language, with increasing frequency, in a greater variety of situations, and with a greater number of people. He is really beginning to understand this confusing morass we call "language."
And so the movie quotes, the sound bites, the long streams of monologue and dialogue he recites verbatim - they are no longer the enemy. I am no longer standing at a high-stakes crossroad. Bud has chosen his path and I've joined him on it. Our traveling companions may include Blue and Joe, Snook and Bob, Jack and Mary, Zack and Weezie, Zoboomafoo, the Teletubbies, and the entire cast of Sesame Street, but we travel secure in the knowledge that we are moving forward, together, toward a very promising future.