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Friday 31 Oct 2014

Scripting – A Parent Seeking Help

My 5 1/2 year old son was diagnosed with Autism about 2 years ago. In some ways he is doing great — sight reading, compliance, GI function, computer skills, much improved physical ability. This and other skills have been helped by therapy, ABA and diet/vitamins.

My problem is that he spends nearly every second of the day (while not in ABA or therapy) scripting from books/movies. He only takes a break to have his needs met (ex: I’m hungry or I want to go swimming). He even scripts while riding his bike. Sometimes he appears so into his script while on his bike that it looks like he will crash (hasn’t yet). I have tried to join in his scripts, but he doesn’t like it one bit. He will physically find any way he can to distance himself from me. I’ve tried to interrupt his scripts too and force him to answer questions, but he gets so mad at me. This behavior goes hand in hand with his lining up. It’s a need to escape reality. He shows us (when he is with us) that he is quite bright when it comes to concrete concepts (letters, numbers, colors, reading, computer), but the social stuff is just not there. The only REAL typical age appropriate social interaction we get is when we rough house with him or have a pillow fight. He loves it and his eyes light up and he requests more and tries to get us with the pillows too. It takes SO much energy all day to get even a little bit of true engagement. HELP! The scripting is driving us crazy. Question Submitted by Christine

One of the three core characteristics of Autism is restrictive/repetitive behavior. One of the restrictive/repetitive behaviors some people with Autism engage in is echolalia. Echolalia is the repetition of words or phrases with no meaning or function attached to them. Echolalia comes in two varieties: immediate and delayed.

Immediate echolalia is the repetition of words or phrases immediately after someone has spoken. For example, I asked a child with Autism this question the other day: “What is your name?”. He promptly responded by saying “What is your name?”. Rather than answering the question, he responded by repeating what I had just said. Immediate echolalia can be an indicator of not understanding how to respond to comments and questions from others.

Delayed echolalia is the repetition of words or phrase minutes, days, weeks or months after hearing them. Many times these repetitions will carry the same tone and intonation as the original. Sometimes this behavior is termed “scripting” because the words and phrases the person is repeating comes from tv or movie scripts. The majority of the time scripting is not directed towards a person, rather people will engage in scripting as a self-stimulatory behavior.

Echolalia in either form is not necessarily a bad trait. The positive thing about echolalia is the speech production pathway in the brain is in tact. This is promising because if a person can speak, even if they’re not currently using speech in a functional way, they already have the building blocks for functional communication. In terms of intervention for echolalia, depending on the type of echolalia and the function it serves they way it is addressed will be different.

If a person is engaging in immediate echolalia, this may be due to lack of skill or understanding how to respond to comments or questions from others. We can use the principles of ABA to teach the person how to respond to questions and comments in a more appropriate way. For example, to respond to the question “What is your name?” we would teach the person to respond by saying “My name is John” instead of repeating the question. For the child who answers the question “Do you want a cookie?” by repeating the question (or the last word), we would use our effective teaching strategies to teach them to say “Yes” or “No” in response.

When a person engages in delayed echolalia which serves a self-stimulatory function, it is many times more difficult to decrease this behavior because it is automatically reinforcing (the act of scripting itself is reinforcing, there is no other maintaining consequence). Instead of intervening specifically on the echolalia or scripting, what we typically find is that as we teach communication and social skills to the person the echolalia decreases.


So now to Christine’s question about her son and his scripting behavior which is interfering with his ability to participate in social interactions (and is “driving [the family] crazy”). The first suggestion I have is to work with a behavior analyst to identify the true function of the behavior. For some people scripting can be self-stimulatory (automatically reinforcing) but it can also serve an attention-seeking or demand-escape function. It is important to understand the function of the behavior before defining a behavior intervention plan because the plan has a higher likelihood to be effective.

The second suggestion I have is to focus on teaching independent play/leisure skills. Many times people engage in scripting when they are not engaged in something else, therefore it makes sense that by teaching them to engage in more independent activities the less likely they are to engage in scripting. Examples of some independent activities you could teach are: listening to music, drawing, playing a musical instrument, video games, reading, or scrapbooking. From Christine’s description, it sounds like this may be the area in which her son needs the most support.

The third suggestion is to teach him when and where it is okay to script. For many people with autism, scripting and other self-stimulatory behaviors are calming. I’m not a proponent of stopping people with autism from engaging in self-stimulatory behaviors (we all do it, by the way) including scripting. I am, however, a proponent of teaching people when, where and how much is acceptable. While I realize some people may not agree with this, there are two reasons why I believe this: (1) it is not acceptable to me to attempt to exert control upon one’s thoughts or actions especially ones they find calming and help them self-regulate, and (2) I believe that teaching people when, where and how much scripting is appropriate is vital to their ability to participate to the maximum extent possible in the community.

While I’ve made a few suggestions which may help to decrease scripting behavior, it is vital to collaborate with the other members of the team (i.e. parents, behavior analyst, teachers, SLP, OT, home interventionists) to determine the best course of action. The only way to have the best chance at success is to have a well-defined plan of action and for everybody involved to implement the plan reliably and consistently. Without a clear plan, and consistency across people and environments, the likelihood of any intervention being effective is low.