Echolalia In The Classroom


I remember visiting a nursing home, a few years ago, where I came across a patient with echolalia. I have memorized the striking image of her, which I play inside my mind from time to time; her long grey hair, a white flannel nightgown, sitting in the wheelchair with her back toward me. Echolalia, as described by Prizant is typical of autism, but there remains a mystery about echolalia as well as autism, its varying degrees and the "causes" for both.

The nameless woman, I encountered, made me curious and continued to "haunt" me for several years. Evidently, her hearing was exceptional as she repeated the words of people in the corridors and several rooms away from her's. The keenness of her auditory skills, somewhat amazed me and I was sincerely struck by her image. Each time she repeated phrases her right arm was raised and her index finger would be pointing skyward - as if answering a question in a classroom.

The image continued to intrigue me until I came across the work of Oliver Sachs, whose work is impressive and enlightening. Oliver Sachs is the neurologist who was played by the actor, Robin Williams, in the film version of Sach's book, "Awakenings".

Once I had read a few books by Sachs, the image of this woman became less surreal and I found myself painting her in my mind, not as a curiosity - but more as a heroine of sorts. Her posture, for instance, appeared to indicate a traumatic educational experience though she did not seem to display a desire or need to communicate.

Although her posture exhibited the behavior of a school girl, there remained a question in my mind. Was her apparent reversal to a child-like state due to an overwhelming, traumatic experience or was it, instead, the result of a childhood disease? As I became more involved in reading Oliver Sach's work, I came to an understanding (I believe) that this woman may have suffered from Encephalitis.

The reason for my conclusion was based on the fact, her echolalia did not indicate any attempt toward communication and appeared  to be a non-sensical reaction to any auditory expression.  I noted, week after week, the woman's position or posture remained the same. Always, her right arm would be raised and her index finger, pointed skyward. I found this very curious and began to wonder if her position/posture was the same week after week, was this a physical form of echolalia?

Several years later, I had a wonderful opportunity to work with a young, female student, named Erika. Erika was determined or diagnosed as severely autistic and she displayed the constant and classic symptoms of echolalia, except that Erika was capable of communication on several degrees.

Working with Erika, was a rewarding, unique experience, and her behavior was strongly different from the previous encounter with the woman in the nursing home. Erika fluxed from one personality to another and quite often, was disoriented. Because Erika displayed some ability to react to positive feedback, this became the most vital and  reasonable tool for establishing and maintaining 
communication.

Of course, the details of Erika's diagnosis were never completely revealed and in order to work with her, my only resource was to pay attention and keep note of everything that indicated her particular needs; her preferences and dislikes and to maintain an inventory of mental notes of various situations which might over-stimulate and/or cause her stress.

She was highly sensitive to any negative stimulation and it was my job (as substitute teacher) to pay attention to remote indicators which could cause immediate rebuttal, resulting in emotional, physical and verbal attacks or, in the worse case, a seemingly random act of violence against herself, me or her fellow students.

The main problem with physical echolalia is; children with symptoms similar to Erika, are most likely to repeat the same physical violence toward the same child/teacher/parent, etc. Although the first attack is actually random in most cases and not relative to the person being attacked, it is obvious the repetition of the incidents are just that, the person is using the same physical force toward the same "victim" over and over again.

The reason I say victim, in quotes, is because Erika was reacting and acting-out with a natural impulse, using the behavior patterns such as someone diagnosed with echolalia. The person being attacked is not chosen or selected and rather, or more likely, is the first person the patient encounters while in a state of disorientation.

The patient is behaving according to the specifics of echolalia, which can be both, auditory and physical repetition. The question is, are children with differring levels of echolalia doomed to a lifetime of repetition or will our society continue to investigate and implement cognitive, haptic and developmental approaches to empower these children with communication skills that enable them to grow socially and physically aware?  

Deborah Russell, © 2005