Saturday, September 11, 2010

Echolalia...lalia

For those of you who haven't spent a day with Evan (OK you'd hear it if you spent 5 minutes with him), Echolalia (or scripting) is the repetition of speech which is often involuntary and compulsive. It's fairly common in children with Autism and Asperger's Syndrome and it runs rampant in our house.

After Evan's first birthday, he started speaking a few words like other toddlers his age. By 15 months he spoke about 60 words and we stopped counting. He was obsessed with naming the pictures in his Roger Priddy books and endless collection of flashcards. If somebody saw how we spent time in the playroom day after day they would think we were prepping him for his first standardized test. Although, I was daydreaming of Evan taking the SATs and doubling my pathetic score (yeah, it was that bad).

Shortly after Evan turned two years old he replaced the flashcards with a love of maps. He memorized all the states and had over 70 countries down (again trumping my geography skills). One day my pride started to turn to puzzlement. I think my first thought was "OK this can't be normal." I might have even tilted my head to the side and looked at Evan with an expression of bewilderment. We started to pay more attention to his speech. He sure did like to repeat dialogue from his favorite shows. He didn't seem to make observations or convey his feelings like other kids his age. No other two year old we knew thought it was fun to repeat a long list of classical musical composers. It didn't take long for us to realize his speech was memorized -- all of it.

After putting all the pieces together and getting him diagnosed, he started receiving speech therapy. And boy did he need it. We were so impressed and bemused by all the things he did say, we didn't realize all the things he didn't. He didn't express his feelings, ask for help, make observations, have conversations, or answer questions.

Eventually the speech therapy started paying off. He was progressing with his original speech and his scripting was not decreasing, but evolving. He still did plenty of "show talk" (as we call it). But instead of talking to himself, he started to direct the scripting at us and become more engaged.

He also began to alter the script to make it more appropriate to real life. This change meant that he got very good at fooling people. We had just returned home after a trip to Florida to visit Grandma and Evan came out of his occupational therapy (OT) session with his therapist. She said, "You won't believe it. Evan told me all about going to the lighthouse and watching the waves in the ocean with Grandma." I had to break the news that she was duped. It might have happened on the Disney channel, but not on our vacation.

One trick to determining what is real and what is scripting is the inflection of Evan's voice. His memorization is so precise that the scripted speech sounds exactly like it is spoken on television. This means that most of the day it feels like we are living with a very enthusiastic cartoon character. Although not many people can tell the difference. During one recent playdate Evan asked for a blueberry muffin. His friend Ava quickly chimed in, "No, no, that's show talk. That's from the show Strawberry Shortcake. There's a guy named Blueberry Muffin." I told Ava, "Good thinking, but considering Evan is currently trying to break into the pantry, I think he actually wants a blueberry muffin."

Sometimes Evan's excessive scripting can put him in a precarious position. Just yesterday I was upstairs tackling the laundry while Grandma kept an eye on Evan. He was watching a show from a headstand position on the couch (if I knew why I would tell you). My mom said she heard him saying "Help me, I'm stuck." over and over. She assumed he was doing 'show talk.' Evan finally said, "Grandma, don't just sit there! Come and help me!" Too much scripting and he became the boy who cried wolf.

Occasionally, the scripting can be pretty darn cute (well, until the 14th time in an hour). But one little sentence of original speech recently had the whole family in stitches, unfortunately at someone's expense. We had a bunch of relatives over for dinner when one family member stood up and walked in front of Evan. Let's just say this person has a larger-than-average behind. With wide eyes Evan exclaimed, "Wow, that's a big giant tushie!!!" I am sure this person/Evan's victim is going to read this. I want to say thank you for allowing me to relay this story for the greater good of Asperger's awareness. The comment was extremely rude and I am definitely not reliving the moment and laughing right now. Really I'm not...OK just a little.

His scripting can also really come in handy. It has helped Evan memorize social stories, which teach him steps to follow for specific tasks, and thus become more independent. It also has assisted Evan in remembering ways to initiate conversations. Leaving OT one day, Evan saw another boy around his age. Evan went up to him and the conversation went something like this:

Evan: What's your name?
Boy: Jack.
Evan: Hi Jack. I'm Evan and this is my Mommy and Ms. Tiffany.
Jack: How old are you?
Evan: I'm 4.
Jack: I'm 6.
Evan: You said it brother!

Yes, I could tell it was directly from a script and the last line was straight out of Team Umizoomi (complete with sweeping hand gesture). But he was having a conversation and Jack actually thought Evan was pretty funny.

Sometimes he can take his scripting to a whole other level. There are costumes, accessories and a mirror to watch the whole scene play out. He also has a very willing accomplice in his little sister. Lia copies everything her brother does, including scripting. Sometimes we say we have a second Aspie by affiliation. They can reenact scenes from Max and Ruby and keep each other entertained for hours. OK maybe 45 minutes, but that's enough time for me to prepare dinner, so it works for me!

Unfortunately, there are times where Evan's scripting greatly increases. When he is stressed or overwhelmed, he becomes more detached and delves deeper into his world of scripts. Recently, my closest friends from high school came to visit. The first few days we had an extra 7 people in our house. Evan barely engaged with anyone and amped up his scripting. I tried to explain to my friends it wasn't usually like this. As my friends returned home and our number of house guests tapered, Evan returned to normal. Well, our definition of "normal."

These days Evan is getting so much better at recalling information and answering questions. A few weeks ago I was cleaning up downstairs while Steve was giving the kids a bath. I went to the counter to put away my jewelry when I realized my engagement ring was missing. I ran upstairs to the bathroom and asked Lia (Evan's two year old sister who takes out her hair clip 18 times a day, but always tells me where it is when I ask), "where is Mommy's ring?" "I don't know," she answered. Damn, no luck. I turned to Evan, "where is Mommy's ring?" He paused and I prayed whatever he said next was not from the last episode of the Backyardigans. "In the playroom, behind Mack." I rushed downstairs and there, behind Mack the truck, was my engagement ring. OK, it was wet from apparently being in Evan's mouth, but I found it. And I found it because my son told me where to look.

As his speech therapy continues, he will work on pragmatics and be able to use more original speech. He's expressing himself better and progressing everyday. We still cherish every time Evan says something completely authentic. It becomes a little gem we hold on to until the next one comes along.