Immediate Echolalia and the Interactive Behaviour of Autistic Children Ingrid van Zyl B.(Log) (Pret) Erna Alant D.Phil (Pret) Isabel C. Uys D.Phil (Pret) Department Speech Pathology and Audiology, University of Pretoria This research examined whether echolalia and interactive behaviour in autistic children could function within a communicative system. Four autistic children were videotaped individually in interaction with a familiar adult. A categorical system was designed whereby the children s interactive behaviour could be rated. It was found that the immediate echolalia is far more than a meaningless repetition of words The utterances are relevant, displaying the conveyance of meaningful information and the maintenance of social interaction. Con- clusions were drawn on the facilitation of communication through modification and expansion of immediate echolalia. OPSOMMING , , ., . . , , , . Die doel van hierdie ondersoek is om vas te stel ofeggolalie en interaksiegedrag in outistiese kinders binne η neer Individuele video-opnames van die interaksie van vier outistiese kinders met 'n bekende volwassene is gemaak. η Kategoriese sisteem is ontwerp vir die beoordeling van die kinders se interaksiegedrag. Bevindings dui daarop dat onmiddellikeeggolalie meer is as slegs die VteLslose herhaling van woorde. Die uitinge is meestal relevant en dui op die oordrag van betekenisvolle informasie en die behoud van sotiale interaksie. Gevolgtrekkings word gemaak oor die fasilitasie van kommunikasie deur die modifikasie en uitbreiding van onmid- dellike eggolalie. Of the language abnormalities which are quoted as primary criter- ia in the diagnosis of autism, immediate echolalia is the most fre- quently cited characteristic of autistic children who have some verbal expressive ability (Prizant & Duchan, 1982). Echolalia is general- ly defined, by many authors (Fay, 1980; Hurtig et al., 1982; Wing, 1976) as the meaningless and automatic production of words, without understanding, that are an exact or partial copy of those originally spoken by another person. I There is a certain controversy surrounding the significance of im- mediate echolalia for the autistic child. Behaviourally orientated researches consider echolalia as an undesirable symptom of the lang- uage behaviour of autistic children (Koegal et al., 1974). They con- sider echolalia as a communication disorder in itself and therefore advocate its extinction or replacement through the use of behaviour modification procedures (Lovaas, 1977). i A recent trend in research has been to consider immediate echola- lia in terms of how it may function for autistic children (Prizant & Duchan, 1982). Fay (1973), suggests that immediate echolalia enables the autistic child to maintain social interaction in the face of a severe comprehension problem. Philips & Dyer (1977), hypothesize that immediate echolalia is a late onset form of nor- mal imitative functioning in young children and that with the ap- propriate intervention programme, the echolalia becomes useful to the child and gives him access to an experience with the complexi- ties of grammar. Considering the diversity of views held in relation to immediate echolalia and how it may function for autistic children, it is of con- tention that these children, who have a severe language problem are attempting to communicate and interact socially with other peo- ple to the best of their limited capabilities. During the past few years (Schuler, 1980) much work has been carried out on the pragmatic Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 32, 1985 aspects of language. Emphasis has shifted away from a purely struc- tural view toward a more functional approach. Prizant & Duchan (1982) analyzed immediate echoic utterances ac- cording to gaze behaviour and other non-verbal components such as general body orientation and manipulation of objects. Seven dis- tinct categories of echolalia were derived and a function was at- tributed to each structural category, namely: non-focussed; turn-taking; declarative; rehearsal; self-regulatory; yes-answer; and request function. However, a functional approach does have certain limitations in that it requires an interpretation of the autistic child's communica- tion intent in a particular situation. Contextual cues (e.g. the reac- tion of the listener) are frequently used as indicators of the function of a particular verbalization (Dore, 1978). One is often inclined to interpret verbalizations according to one's own perspective. Schuler (1980) emphasizes, that in judging the relevance of ver- balizations one should guard against over-interpretation. These over- interpretations become even more tempting when observed speech behaviours resemble our own speech. Consideration of the conflicting views of researchers in relation to the function of immediate echolalia for the autistic child and the limitations of a functional approach has led to this research. The main focus of this study is to determine whether immediate echolalia can function within a communication system. Echoic and non-echoic utterances are viewed within a framework where the initiation of utterances, turn-taking, and the segmental features of the utterances are considered to determine the relevance of the autistic child's ut- terances; analyzing the echoic and non-echoic behaviour in natural communicative interactions considering situational factors and non- verbal behaviours co-occurring with the production of echoic ut- terances. © SASHA 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 26 Ingrid van Zyl, Ema Alant and Isabel Uys METHOD AIMS To determine whether the verba, utterances, in particular the im- mediate echoic responses of autistic children have communicative relevance as described by Prizant and Duchan (1982). To construct a categorical system whereby interactive behaviour and immediate echolalic responses of autistic children can be ana- lyzed as relevant or irrelevant in communication. SUBJECTS A preliminary study was carried out by the examiner to select suita- ble subjects and to clarify the procedural aspects of the experiment. The 4 subjects who participated in the experiment were selected from the Unica School for Autistic Children in Pretoria. Each sub- ject had to be diagnosed as autistic by a professional evaluation team comprising two psychiatrists; a clinical psychologist; a speech cli- nician; the principal of the Unica School and one teacher. The Department of National Education (1971) requires that each child admitted to the Unica School must fulfil the four essential criteria of the autistic syndrome (Rutter, 1974): — onset of the disorder prior to thirty months of age; — disturbances of language and communication; — persistent, ritualistic and compulsive behaviour; — disturbed social relationship Each child must also display a minimum of seven of the 14 core symptoms noted by Clancy et al. (1964) which are most persis- tently present in the syndrome of infantile autism and are regarded as the major manifestations of the disease. To qualify for partici- pation in the experiment, each child had to demonstrate that at least 25 % of all verbal productions were echoic responses (Prizant and Duchan, 1982). study was on functional communication rather than the relation- ship between this and cognition. PROCEDURE During interaction with the children it was noted that they did not make contact with the examiner. Therefore the resident speech cli- nician participated as the interlocutor in the experiment. The struc- tured activities designed to elicit verbal responses from the children during the interaction with the interlocutor, were selected accord- ing to a preliminary study. The same activities were used for all four subjects. Although this may seem inappropriate due to the wide age and mental status range, these activities were recommended by the resident speech clinician and the children's teachers, since eating and drinking activities are enjoyed by children of all ages. Data collection was extended over a three day period for each child with a one day interval. Each child was videotaped in interaction with the interlocutor on two occasions, each 30 minutes in length, to ensure that a reliable sample of the child's communicative abili- ties was obtained. The situation involved direct interaction between the interlocutor and the child. During the interaction the interlocutor was directed to interact/communicate with each child as naturally as possible and to indirectly encourage the child to communicate by eliciting the child's interest in the activities provided. ANALYSIS: CATEGORICAL SYSTEM A preliminary study indicated that the categorical system described by Prizant & Duchan (1982) was highly complex and subjective in the interpretation of the function of immediate echolalia. There- fore the examiner constructed a categorical system for the purpose of analyzing the relevance and irrelevance of the children's utter- ances, including their echolalic responses based on interpretation Table 1 Criteria for subject selection CRITERION SUBJECT 1 SUBJECT 2 SUBJECT 3 SUBJECT 4 Mental Status Griffiths Mental Development Scales 24 months non-testable 29 months 36 months Age 5:8 8:3 8:5 11:1 Previous therapy None * — auditory perception receptive and expressive language stimulation * — auditory perception receptive and expressive language expansion None Language Afrikaans Afrikaans Afrikaans Afrikaans * During speech therapy echoic utterances were accepted but not encouraged by the speech clinician. .Table 1 presents a number of the criteria used during subject selec- tion. The age of the subjects was not deemed a significant factor since the study was focussed on the relevance of the interactive be- haviour and particularly, immediate echolalia, and not on the per- formance of a specific age group. Although reference is made to the mental status of each subject, this too was not considered a significant factor. The focus of the of behavioural aspects co-occurring with the children's utterances (see Table 2). X Due to the complex nature of the categorization procedures, data analysis was restricted to 20 utterances in each interaction. The first 20 utterances of each interlocutor — child interaction were select- ed since the children displayed excellent co-operation and atten- tion at the beginning of each interaction. The South African Journal of Communication Disorders, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) immediate Echolalia and the Interactive Behaviour of Autistic Children Table 2 Categorical system for analyzing the relevance of utterances 27 1 Initiation:A spontaneous, original utterance created by the child and not an echoic response. 2. Delayed Echolalia: A repetition of stored utterances which the child has heard some time before, in a new and usual- ly inappropriate context (Fay, 1980). 3. Turn-taking: Smooth interchanges between the child and the interlocutor (Prutting, 1982); Each utterance in this category is also coded according to whether the turn was:- - Verbal: Indicating that the utterance is not accompanied by any non-verbal behaviour. - Verbal and non-verbal: Indicating that the child's verbal response is accompanied by one or more of the follow- ing non-verbal behaviours: — eye contact with the interlocutor — gaze behaviour at the object, — head movements, — smiling, and — deliberate gestural actions; 4. Relevance: The child's utterance is either designated as a self-directed or as an other-directed response; - Self-directed: A self-directed utterance is used by the child to monitor his action, or to focus control on his ac- tions or used for planning what he will do next (Tough, 1977). - Other-directed: An other-directed utterance is directed at the interlocutor by the child for demonstrating the ac- tions he requests, instructing, forward planning, and anticipating collaborative action (Tough, 1977). The relevance of the utterance is coded by a positive or a negative rating. A positive rating indicates that the child's utterance displays communicative intent. Indicators of Communicative Intent: - any of the following behaviour associated with the verbal response: - Eye contact with the interlocutor. According to Argyle (1973), eyes provide crucial information about where the per- son is looking, and the area around the eyes is extremely expressive. One looks to obtain information and to send sig- nals; this is all concerned with the flow of information needed to perform the social skills of interacting. - Appropriate gaze behaviour at the object. Direction of gaze shows the direction of that person's attention (Argyle, 1973). - Deliberate and voluntary actions. Hand movements especially, play a role in social interaction. Their principle func- tion is as illustrators accompanying speech, and augmenting it when verbal skills are inadequate (Argyle, 1973). - The echoic response is functionally relevant to the task, or to the child's self-directed utterance, or to the interlocu- tor's utterance indicating communicative intent. A negative rating indicates that the child's response is irrelevant and a purely meaningless repetition; devoid of any indi- cation of communicative intent. 5. Linguistic Segmental Features: The utterance is rated according to whether the child changes or exactly repeats the linguistic segmental features of the model utterance. „ • ' - Changed: The child uses some of the interlocutor's words or either adds, deletes, or substitutes elements and is therefore not an exact repetition of the model utterance (Prizant and Duchan, 1982). - Same: The child gives an exact, complete or partial repetition of the interlocutor's model utterance. 6 Non-segmental Features: The non-segmental features of "the child's echoic response are rated according to the similarity in intonatioh, stress, speaking rate, duration, and voice to the model utterance. Linguists recognize that tim- ing, pitch and stress and other non-segmentals are integral to the meaning of utterances. - Changed: The child varies one or more of the non-segmental features of the model utterance. - Same: The child produces an exact repetition of the non-segmental features of the model utterance. In each subcategory, changed or the same, the echoic response is coded as being either a complete or an incom- plete repetition:- - a complete repetition indicates that the child repeats the entire model utterance, - an incomplete repetition indicates that the child echoes only a part of the model utterance. RATERS USED TO CONTROL OBSERVATION The utterances were analyzed independently by the examiner and the resident speech clinician to objectify observations. After being trained on the significant features of the categorical system, the resi- dent speech clinician viewed the first video-recording of interac- tion with each child. The interjudge reliability was measured by comparison of the results obtained by the examiner and the resi- dent speech clinician. Non-parametric statistical procedures were used due to the small number of subjects used in the experiment. RESULTS INTERJUDGE RELIABILITY Non-parametric statistical procedures determined that a high agree- ment (97,34%) existed between the paired judgements of the ex- aminer and the second judge, indicating that the categorical system designed by the examiner was a practical and easy to use scale. The reliability of this analysis procedure therefore seems to be high. Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 28 Ingrid van Zyl, Erna Alant and Isabel y s CATEGORIZATION OF THE UTTERANCES Figure 1 represents a summary of the data obtained from the categorization of the autistic children's echoic and non-echoic ut- terances. It demonstrates a tendency for a greater occurrence of immediate echolalia (61,2%), followed by initiation (36,9%) and only a token usage of delayed echolalia (1,9%). There is a marked difference between verbal versus verbal and non-verbal turn-taking; verbal and non-verbal turns being the most prevalent (81,9%). It can be seen that other-directed utterances had a higher rate of oc- currence (85%) than self-directed utterances (15%), but for both these categories most utterances were rated as relevant. It is in- teresting to note that 87,5% of the other-directed utterances were rated as relevant whereas only 66,7% of the self-directed utterances were relevant; suggesting (tentatively) that other-directed utterances are more likely to be rated as relevant than are self-directed ut- terances. e s 1 Ζ 100 90 80 70 60 50 40 30 20 10 UTTERANCES TURN-TAKING RE1.EVANCE J M 1 Immediate Initiation Delayed Verbal Verbal & Echolalia Echolalia non-vertial 100 g 90 υ 8 80 2 ε £ 8 70 3 u 60 OC Ο 60 8 1 50 η 2 Ε η • β 40 •g υ Ε £ ε 30 DO 2 υ ο 20 i 3 10 £ LINGUISTIC SEGMENTAL FEATURES NON-SEGMENTAL FEATURES Changed Same changed incomplete complete incomplete complete Figure 1 Categorization in percentages of the autistic subjects' echoic and non-echoic utterances. The data shows that the linguistic segmental features of the immediate echolalic utterances were mostly rated as the same (83,8%), rather than as changed (16,2%). The non-segmental features of the immedi- ate echolalia were more often rated as changed with only an incom- plete repetition of the model utterance (75%). The incidence of the use of the same non-segmental features with a complete repetition of the model utterance was minimal (3,5%). The data presented in Figure 1 initiated the calculation of the infor- 'mation in Figure 2. The relevance of the children's utterances is reviewed including a more specific analysis of the relevance of the immediate echolalia. Echoic and non-echoic utterances viewed together had a higher in- cidence of being rated as relevant (84,4%) in comparison to only 15,6% of these utterances being rated as irrelevant. A more specific analysis of the immediate echolalia showed a large difference be- Relevanee of the Utterances % Relative to the total no of utterances Relevance of the Immediate Echolalia % Relative to total no of Immediate echoic utterances Subject 1 \Z/A Relevant I | Irrelevant Subject 2 Subject 3 Subject 4 Figure 2 Analysis of the relevance of the utterances tween the ratings of relevance and of irrelevance. Of the immediate echolalia, 82,6% was relevant whereas only 17,5% was rated as ir- relevant. Specific analysis of each individual subject's performance was car- ried out and summarized into a single table (Table 3) indicating Jeach subject's performance as a percentage relative to the total number of utterances. A brief comparison of the subjects' performances according to the data in Table 3 indicates that Subject 4 has the highest initiation of original utterances (55%), followed by 40% immediate echola- lia and only 5% delayed echolalia. Of these utterances, 95% were rated as relevant and 100% of the immediate echolalia was rated as relevant. It is interesting to note that Subject 4 had the highest mental status for all four subjects (36 months) and was the oldest subject. Subject 2's performance shows very little initiation (17,5%), no delayed echolalia and a high incidence of immediate echolalia. Subject 2 was, at the time of the study non-testable and mental sta- tus could not be determined. Subject 1 and 3 display the same general tendencies of more initiation than delayed echolalia and the majority of utterances being immediate echolalia (55% and 67,5% respec- tively). They also show a high rate of relevant utterances and rele- vant immediate echolalia. The South African Journal of Communication Disorders, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) Immediate Echolalia and the Interactive Behaviour of Autistic Children T&ble 3 Performance of subjects on each category 29 4. Initiation Delayed Echolalia Turn-taking 3.1 Verbal 3.2 Verbal and non-verbal Relevance 4.1 Self-directed 4.2 Other-directed + + Linguistic Segmental Features 5.1 Changed 5.2 Same Non-Segmental Features 6.1 Changed — complete — incomplete 6.2 Same — complete — incomplete Immediate echolalia RATING - % RELATIVE TO THE TOTAL NUMBER OF UTTERANCES Subject 1 The range of the four subjects' performances indicates interesting tendencies as well as variance among their performances. In the category of initiation, Subject 2 scored 17,5% whereas Subject 4 scored 55%, pointing out that a large variance exists in the inter- subject performance. This could1 possibly be related to the variance between these subjects' mental ages. The average of the 4 subjects' performances in initiation (36,9%) is therefore not indicative of the individual scores. A broader inspection of Subject 2's and Subject 4's overall performance shows that Subject 2 has 82,5% immediate echolalia compared to Subject 4's:40% rating; a difference of 42,5%. However, in the case of relevance both these subjects (2 and 4) have the highest percentage of utterances rated as relevant, that is 90% and 95% respectively. Therefore the apparent difference in perfor- mance in production of the type of utterance does not necessarily affect the rating of relevance of the subjects' utterances. A relatively small range of performance exists between the four sub- jects' production of delayed echolalia, the highest score being 5% (Subject 4) and the lowest rating 0% (Subjects 2 and 3). The category of turn-taking indicates a wider range of performance among the subjects. Subject 1 has 42,5% verbal turns compared to 57,5% verbal and non-verbal turns. The remaining subjects show a much greater difference between these two sub-categories with a higher incidence of verbal and non-verbal turns. For example, Subject 2 has 2,5% verbal turns compared to 97,5% verbal and non-verbal turns. The data supports a general tendency of a greater percentage occurrence of verbal and non-verbal turns. In the category of relevance there is a small range between the sub- jects' performances indicating a general tendency for a greater preva- Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 32, 1985 42,5 2,5 42,5 57,5 7,5 2,5 70,0 20,0 Subject 2 17,5 0 2,5 97,5 5,0 5,0 85,0 5,0 Subject 3 32,5 0 7,5 92,5 20,0 10,0 55,0 15,0 Subject 4 55,0 5,0 20,0 80,0 7,5 2,5 87,5 2,5 % RELATIVE TO THE INDIVIDUAL TOTAL NO OF IMMEDIATE ECHOIC UTTERANCES 22,7 77,3 13,5 77,3 4,6 4,6 55,0 0 100,0 15.2 48,4 6,1 30.3 82,5 29,6 70,4 7,4 74,1 3,7 14,8 67,5 12,5 87,5 0 100,0 0 0 40,0 lence of other-directed utterances (85%) and the large majority of both self-directed and other-directed utterances being rated as rele- vant (84,4%). There is a degree of variance between the subjects' performances in the category of linguistic segmental features. Subject 2 produced all his immediate echolalia with the same linguistic segmental fea- tures of the model utterances. Subject 3 produced the greatest change in the linguistic segmental features (29,6%) of the model utterances. There is however a general tendency for the four subjects to display the same linguistic segmental features of the model utterance. Characteristic for all the subjects is the general tendency for non- segmental features of the immediate echoic utterances to be more often changed and incomplete repetitions of the model utterance. The percentage production of immediate echolalia differs among the subjects. Subject 2 produced the most immediate echolalia (82,5%) whereas Subject 4 produced the least immediate echolalia (40%), but both subjects have the highest ratings of relevance, that is 84,9% and 100% of their immediate echolalia was rated relevant respectively. Subject 1 who produced the most verbal (only) turns (42,5%) produced the least relevant immediate echolalia (68,2%). However comparison of the individual subject's relevant and irrele- vant immediate echolalia indicates a general tendency of a greater percentage occurrence of relevant immediate echolalia. DISCUSSION The general attitude toward autistic immediate echolalia is to view it as an automatic and meaningless repetition of words, and not as R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) 30 Ingrid van Zyl, Erna Alant and Isabel LJys the child's attempt to initiate and sustain social contact (Fay, 1980) or to communicate his intentions. The high occurrence of immedi- ate echolalia is coupled with the finding that 85% of these echoic responses were rated as relevant, meaningful and an attempt at com- munication within their limited capabilities. In response to, "Gaan jy nou saamwerk?" Subject 4 replied "Saamwerk", while smiling and making rare eye contact with the interlocutor. Subject 4 changed the non-segmental features of the model utterance and made a state- ment of the word he echoed and did not copy the questioning tones of the model utterance. He clearly displayed his intention to the in- terlocutor through the manipulation of an immediate echoic response accompanied by non-verbal cues of eye-contact and smiling. In the interaction analyzed by the examiner, the children always responded to a question or a statement directed at them by the in- terlocutor. Acceptance and expansion of echoic behaviour appeared to reinforce the autistic child's turn-taking echoes and utterances. Important non-verbal communication co-occurred with the other- directed utterances providing indicators of intent whereby the ut- terances could be rated. These responses can be interpreted in terms of attention, need for interpersonal feedback and an attempt at sus- taining the flow of interaction (Argyle, 1973). A comparison of the individual subjects' performance shows some interesting differences. A brief comparison shows Subject 4, the ol- dest subject producing the most initiation, less immediate echola- lia and no delayed echolalia; whereas Subject 2 displayed the least initiation, no delayed echolalia and the most immediate echolalia. This suggests that Subject 4 has more advanced language skills as shown by his ability to produce more initiated utterances and fewer echoic responses supporting the view of Carr, Schreibman and Lovaas (1975) that immediate echolalia may be an early stage in the development of normal language functioning. Of great importance is the fact that a very small difference existed between these two subjects in relation to the relevance of their echoic and non-echoic utterances; Subject 2 displayed 90,0% relevance and Subject 4, 95,0% relevance. This suggests that the relevance of the autistic child's echoic and non-echoic utterances is not necessarily dependent on the child's level of speech and language development. Subject 3 produced the greatest change in the linguistic segmental features of the model utterance, using some of the interlocutor's words and adding elements to indicate his own meaning. Prizant and Duchan (1982) view this type of immediate echolalia as proba- bly the most intentional and least automatic response and an exam- ple of intentional mitigation. Subject 3's performance may be influenced by the fact that he received speech therapy to expand receptive and expressive language and had a mental status of 29 months. The examiner recognizes that analysis of the child's utterances alone is a limitation of the study. Analysis of the interlocutor's utterances would provide interesting and relevant information related to the type of response made by the child. However, a brief survey of the inter- locutor's utterances shows that when the interlocutor repeated a child's relevant immediate echoic response and the child echoed the interlocutor, the child's second echo was more likely to be rated "as irrelevant. This suggests that the speech clinician should take care not to inhibit the child's relevant utterances by producing meaning- less repetitions of the child's echoes. IMPLICATIONS FOR DIAGNOSIS AND TREATMENT The findings of this study should be regarded within the greater framework of diagnosis and treatment of the autistic child. As previ- ously cited, behaviourally orientated researchers (Koegal, Lovaas and Schreibman, 1974) consider echolalia a communication disorder and advocate the extinction or replacement of echolalic behaviours through the use of behaviour modification procedures (Lovaas, 1977) The findings of this study dispute a non-functional view of immediate echolalia. The consideration of immediate echolalia as having communica- tive intent must form an integral part of diagnosis and therapy. The clinician should guard against regarding a high occurrence of echoic utterances in the child as indicating less meaning than a higher oc- currence of non-echoic utterances, but should rather view echola- lia as possibly a necessary stage of language development for verbal autistic children (Philips and Dyer, 1977). According to Prizant & Duchan (1982), indiscriminate extinction of all forms of immediate echolalia is ill-advised because of the func- tions that echolalia may serve for autistic children. Individual differ- ences do exist and each child has a certain potential to learn to communicate. Different therapeutic procedures should be used to treat, for example, a child who has been predominantly echolalic for some years than those used to treat a child who displays com- prehension and communicative intent with the echoic utterances he produces. The latter child needs to accept and exploit immediate echolalia and learn to relate the repetitions to aspects of the environ- ment and communicative interactions (Prizant & Duchan, 1982). REFERENCES Argyle, M. The Psychology of Interpersonal Behaviour. Penguin Books Ltd, Harmondsworth, Great Britain, 1973. Argyle, M. Social Interaction. Tavistock Publications Ltd, London, Great Britain, 1973. Carr, E., et al. Control of Echolalic Speech in Psychotic Speech. J. Abnor. Child Psycho., 3, 331-338, 1975. Clancy, H., et al. The Diagnosis of Infantile Austism. Develop. Med. Child Neuro., 11, 432, 1969. De C. Murray, C.H., A Report of the Committee of Enquiry into the Treatment, Education and Care of Autistic Children. Depart- ment of National Education, Government Print, Pretoria, RSA, R.P. 26/72, 1971. Dore, J. Requestive, Systematic Nursery School Conversation. In: Campbell, R. and Smith, R., (Eds.), Recent Advances in the Psy- chology of Language. Plenum Press, New York, 1978. Fay, W.H. On the Echolalia of the Blind and of the Autistic Child. J. Speech Hear. Disord., 38, 478-489, 1973. I Fay, W.H. Aspects of Language. In: Fay, W.H. and Schuler, A.L., (Eds.) Emerging Language in Autistic Children. Language In- tervention Series, Vol 5, Edward Arnold Ltd, London, Great Bri- tain, 1980. Hurtig, R., Ensrud, P, and Tomelin, B. The Communicative Func- tion of Question Production in Autistic Children. J. Autism De- velop. Disord., 12, 57-69, 1982. Koegal, R., Lovaas, O.I. and Schreibman, L. A Behaviour Modifi- cation Approach to the Treatment of Autistic Children. J. Au- tism Child. Schizoprenia. 4, 111-116, 1974. Lovaas, O. The Autistic Child: Language Development Through Be- haviour Modification. Halstead Press, New York·;' 1977. Philips, G. and Dyer, C. Late Onset Echolalia in Autism and Al- lied Disorders. Br. J. Disord. Commun., 12, 47-59, 1977. Prizant, B.M. and Duchan, J.F. The functions of Immediate Echola- lia in Austistic Children. J. Speech-Hear. Disord., 47, 241-249, 1982. Prutting, C.A. Pragmatics as Social Competence. J. Speech Hear. Disord., Al, 123-134, 1982. The South African Journal of Communication Disorders, Vol. 32, 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2) Therapy Programme with Spastic Dysphonia - a Single Case Study 31 Rutter, M. The Development of Infantile Autism. J. Psychol. Med. 9, 147-163, 1974. Schuler, A.L. Aspects of Communication. In: Fay, W.H. and Schul- er, A.L., Emerging Language in Autistic Children. Language In- tervention Series, 5, Edward Arnold Ltd, London, Great Britain, 1980. Tough, J. The Development of Meaning: A Study of Children's Use of Language. George Allen and Unwin Ltd, London, Great Bri- tain, 1977. Wing, L. Early Childhood Autism: Clinical, Educational and So- cial Aspects. A Wheaten and Co., Exeter, Great Britain, 1976. A Stuttering Therapy Programme with Spastic Dysphonia - a Single Case Study Ingrid Meyers BA (Sp & Η Th) (Witwatersrand) Speech Therapy Department Baragwanath Hospital Denise Anderson BA (Sp & Η Th) (Witwatersrand) Department of Speech Pathology and Audiology, University of the Witwatersrand, Johannesburg ABSTRACT This study was motivated by reported similarities in vocal tract dynamics in stuttering and spastic dysphonia. The effects of a stuttering therapy programme with an adult with spastic dysphonia were observed. Subjective and objective measures obtained pre- and post- therapeutically included a qualitative analysis, laryngographic tracings, and fiberoptic examinations. Results showed subtle improvements on all measures suggesting improved laryngeal behaviours. Findings are discussed in relation to therapeutic utility. OPSOMMING Die motivering vir hierdie ondersoek is gebasseer op die ooreenkomste t.o.v. die dinamiek van die vokale gang tydens hakkel en spastiese disfonie Dieuitwerkingvan 'nterapieprogram vir hakkel wat uitgevoer is op 'n pasient met spastiese disfonie, is waargeneem. Subjektiewe en objektiewe metings is voor- en na-terapeuties van laringografiese afdrukke, fiberoptiese ondersoeke en van 'n kwalitatiewe anahse ver- kry. Resultate dui op 'n subtiele verbetering op alle metings, wat verbeterde laringale werking aandui. Die bevindinge word bespreek t. o. v. kliniese bruikbaarheid. Of all the human voice disorders, the syndrome of adductor spas- tic dysphonia has remained the most mysterious, the most poorly understood, and the most resistant to effective treatment, (Boone 1972; Aronson 1980; Reich and Till 1983). Spastic dysphonia is a rare disorder and literature on the subject is limited, which has led to some confusion with regard to treatment (Wolk, 1980). Yet most authorities agree on its poor response to therapy procedures. The disorder, first described by Traube in 1871 is characterized by "a strained, creaking, choked vocal attack and a tense squeezed voice accompanied by extreme tension of the entire phonatory sys- tem." (Luchsinger and Arnold 1965). Various terms have been used to describe the disorder of spastic dysphonia. It has been referred to as 'glottal spasms', 'stammering of the vocal cords' and 'laryn- geal stuttering', and has been parallelled to the disorder of stutter- ing by McCall (1975) and Salamy and Sessions (1980). Stuttering is a more common disorder, and the age of onset and sex distribu- tion are well defined. The two disorders can, however be likened in terms of their variability, development and course, etiological controversy and history of therapeutic failure with high rates of symptom relapse (Ingham and Andrews 1973; Aronson 1980; Sala- my and Sessions 1980). Perhaps the abnormality in the physiology of the larynx for stut- tering and spastic dysphonia could be considered a major similar- ity. McCall (1975) found that similarities between spastic dysphonia and the stuttering block included muscle spasms, disturbed muscle tone and involuntary movements e.g. tremor, with normal laryn- geal structures evident on laryngologic examination. Die Suid-Afrikaanse Tydskrif vir Kommunikasieafwykings, Vol. 32, 1985 The past decade has brought about a dramatic transition in the the- oretical foundation and purpose in the treatment of stuttering. Based on the factors which induce fluency in stutterers, remediation has shifted to manipulation of phonation utilizing behaviour modifica- tion techniques as a vehicle for establishing fluency (Shames and Florance 1980). Common to all 'fluency-based' programmes are smooth initiation of phonation, decreased rate and continuous pho- nation and breath flow which facilitates co-ordination of the vocal folds concurrent with the execution of articulatory gestures (Miller 1982). Schwartz (1976) felt that it was the reduction in stress on the cords which facilitated their laxing and lengthening and ena- bled their greater bulk to vibrate. The literature on spastic dysphonia does not reflect the same ad- vances regarding treatment approaches. While some authorities have described similar techniques to those constituting 'fluency-based' programmes, no-one has as yet integrated these techniques into a unified therapy programme. In view of the limited investigations into the field of spastic dysphonia, and of the need to explore new avenues for treatment, the writers decided to investigate the effects of a fluency-based programme (developed for stutterers) by Shames and Florance (1980) on a subject with spastic dysphonia. METHOD SUBJECT The subject, S, was an English speaking adult male, aged 34 years whose profession involved much public speaking. His voice problem © SASHA 1985 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 2)