Monday, December 08, 2008

Say what I said

When we went in for Scooter’s evaluation a couple months ago, I tried to describe what I saw as two “verbal tics.”

One is sort of a stutter, but not really. Instead of getting stuck on the beginning of a word, he will repeat the end of a word, e.g. “And then-en-en-en.” It’s not caused by, nor does it cause, stress or anxiety; rather, it’s something of a placeholder as he gathers his thoughts and translates them into words. Our inclination has been to ignore it and give him the time he needs to speak. It hasn’t improved the issue, but it keeps him from getting frustrated with us trying to complete his sentences or ask leading questions.

The other verbal behavior is the one that stands out more. Frequently after an utterance, Scooter will repeat it to himself at a whisper. We’ve suspected that he is usually playing what he said back, checking that it makes sense or simply enjoying the feel of the words. We haven’t employed any intervention on this, not entirely sure what might help—although we feel confident that drawing his attention to the behavior and suggesting he not do it would be the best way to cause him great distress.

At the time of his evaluation, our interviewer marked all this down, but did not offer any analysis or suggestions. The speech-language pathologist assured us that this was neither a stutter nor echolalia, both of which we knew, but gave no more information than that. But now we have a word for the behaviors, thanks to the final report: palilalia.

Turns out that both verbal tics are part of one behavior, and Trillian and I have received a vocabulary lesson. Just as echolalia is the repetition of another’s utterances, palilalia (from the Greek palin = again and lalia = babbling) is the repetition of one’s own speech and manifests as repeating the last part of individual words or entire phrases.

There’s not a large range of information on palilalia available online, though Trillian and I did immediately key in on the fact that it is generally associated with Tourette’s, autism, or Asperger’s. (Also some accounts of people exhibiting this behavior after accidents and illnesses.) One major piece of information missing, both from the report and online, is how to deal with it. The implication from the report, the best place for us to start, is that we should begin by working on some of the speech pieces, specifically his expressive fluency and pragmatics, and that the palilalia might resolve itself as a result of general communicative improvement.

Luckily the report has served as an impetus for Scooter’s educational team at school to work on fine-tuning his IEP. As usual, there are a number of requirements we must meet before moving ahead, but we have started the process and should be able to get things started soon. In our most recent meeting, we agreed to a re-evaluation with the same speech-language pathologist as last year. The coordinator at our school (also an SLP) noted that it may be difficult for Scooter to qualify since the state requires students to demonstrate need for support in two areas before it can be provided in the school, but that pragmatics, the second area where they expect he’d qualify, is a problematic area for accurate testing. By using the same SLP, however, she can select the tests that she thinks will best reflect his particular issues—and she’s already looking through the tests available to them to pick the best tools. If he still doesn’t qualify now, they will keep him on a “monitor” list, which will allow us to have him evaluated periodically. And you can bet we’ll be taking their referrals to a private SLP in Capital City.

The funny thing about reading up on palilalia has been a recognition of this behavior in myself. It is greatly muted, as I have learned to fill the space when I am thinking of words for translating my ideas by circumlocutions or by picking words that are close enough. I do sometimes repeat myself, but in a way that escapes most people’s notice. When responding with just a word or two, I tend to repeat them: “Good, good.” Sometimes I vary the inflection or it sounds emphatic, but I’m very aware that it’s a compulsion, not at all the way I would respond in writing or when I have a chance to think through what I will say first.

So I figure that Scooter will get this straightened out someday too and that whatever remains for him may diminish to a harmless quirk. Plus, we have another fancy, Greek-derived word to throw around.

1 comment:

Aliki2006 said...

I hadn't heard of this other side of echolalia either...

L. often repeats the beginnings of whole sentences over and over again but this is because he often speaks in scripted responses, particularly if he's trying to tell you about something detailed and interesting. So he'll start a sentence three or four times until it comes out just right, or until he's remember exactly how it's scripted (from a book, etc.).