The Cues-Pause-Point Method for Overcoming Echolalia (based on McMorrow & Foxx, 1986)

The Cues-Pause-Point Method for Overcoming Echolalia                   (based on McMorrow & Foxx, 1986)

1. Select 10 questions from each of three content areas: a. Identification - (e.g., "What is your name? Where do you live?); b. Interaction - (e.g., "How are you? What kind of music do you like?"); c. Factual - (e.g., "What state do you live in? What baseball team plays in Atlanta?"). Make sure these are questions that may be commonly asked but you are sure the person does not know the answer to. You should have 30 questions.

2. Baseline. Ask each of the questions, record the answers, and score the person's answers using the following categories: echolalia(when one or more of the words in the question were repeated even if other verbalizations follow); incorrect (when the response contains an irrelevant word even if the correct response was also given); or correct (when the answer is appropriate to the question or matches the trained response).

3. Training - Step 1: Teach the person to verbally label word cards or picture cards that will be used to prompt the correct answer to the questions. For example, for the question "What is your name?", prepare a card with the written name of the person. For the question "What baseball team plays in Atlanta?", prepare a card with the word "Braves" written on it or a picture of the "Braves" logo. Accomplish the training by showing the card, asking the person "What does this say?" while pointing or tapping the card, prompting a response, providing verbal feedback (either "yes!" or "try again"), saying the correct word if the person does not say it and prompting the person to repeat it, and giving verbal praise and a reinforcer (e.g., sip of soda, piece of candy, etc.) for each correct response. Continue training each set of 10 cards until the person correctly identifies each card or picture when the trainer simply points to them, for three consecutive trials.

4. Training - Step 2: Make sure you are in a quiet place with no distractions. Sit across the table from the person. Have the ten cards that correspond to the ten questions that you will ask (placed in the order you will ask the questions) on the table in front of you. Hold up your right index finger at eye level midway between you and the person to indicate that you want silence (this is the "pause" prompt). Say, "I am going to ask you some questions and I want you to answer them as best you can." If the person says anything or tries to talk during the instructions, while the question is asked, or for one second following the question, say, "Shh!" and hold your finger out more prominently. Ask the first question and move your right index finger from the "pause" prompt position to point to the correct response card (which will be the answer to the question asked) so that your finger touches it about two seconds after asking the question. If the person does not immediately say the correct word, prompt by pointing or saying, "What does this say?", as necessary. Cover the card with your right hand while acknowledging the person's correct response with a smile or head nod. Raise your left index finger to eye level (the "pause" prompt position), ask the same question again, and move the left index finger to point to the back of the right hand (still covering the card). Prompt the correct answer as before even though the card will remain covered. Reinforce each correct answer with verbal praise and a reinforcer (e.g., sip of soda, piece of candy, etc.). Continue in this manner so that each of the ten questions in this content area are asked and at later sessions cover the ten questions from each of the other two content areas. Continue training on the 30 questions until the person is correctly answering each question with only the point prompt for three consecutive training sessions.

5. Training - Step 3: Using no cards or prompts, ask each of the 10 questions in three different training sessions. Use the "pause" prompt while the question is being asked and then move your hand back to the table and wait for the person's response. Provide feedback and reinforcement as above.

6. Training - Step 4: Fade the feedback and reinforcements by reducing the number of words you use to praise the person and rewarding every other correct response. Eventually eliminate all feedback and reinforcements. Once the person is answering your questions in a consistently correct and normal manner, have other persons ask the same questions in random order to assure that the person has generalized his learning.

7. Maintenance: Observe the person's response to asking other questions (not trained) and use the "pause" prompt if needed. Ignore echoed responses, prompt the correct answer, and have him try again. McMorrow & Foxx (1986) found that echolalic responses were dramatically reduced after their training program was used. Ideally, the person has been taught that "I don't know" is an acceptable response and a wrong response will get more results than an echoed response.