Following up on the rebroadcast of Dr. Mark Sundberg’s episode last week, I am joined by Dr. Barbara Esch creator of the EESA assessment, The Early Echoic Skills Assessment which is part of the VB-MAPP. Dr. Esch is an SLP, BCBA-D who pulls knowledge from both professions to work with individuals with autism learning to speak.
Articulation and Speech Therapy
Too often parents and some providers are tempted to perfect articulation too early. Dr. Esch compares first words to first steps, you wouldn’t ask or expect a newly walking baby to run. This is the same for beginning babbling, sounds, and words. Word approximations are okay, especially for young or new speakers. I categorize these as Number 1 words and Number 2 words, 1 being perfected clear words and 2 being approximations to practice. There are a variety of setbacks and complications of natural development that can come from too much focus on articulation, such as a repeated Schwa ending.
Speech Therapy for Nonverbal Autism
It is often very unlikely that an individual is 100% mute. When beginning to work with a nonverbal learner, consider: Do they have any babbles? Sounds? Noises that signal communication or attention? ANYTHING is better than nothing and is a good place to start. Dr. Esch and I also agree not to rush into AAC before trying vocal speech. She refers to vocal speech as having the big 5 “fast, easy, cheap, always with you, and people can respond to it”, this is the gold standard when it comes to working on language, even with those considered to be nonverbal; it’s never too late.
Teaching Carrier Phrases
I am not an advocate for teaching carrier phrases, especially when it’s only to increase word utterances. I’ve discussed this in blogs and shows in the past. Dr. Esch is an advocate for focusing on syllables versus word utterances. Carrier phrases can set back natural development in mands and tacts. You can use strategies from my early learner activities like the shoebox which has multiple controls when a student gets a word that is part mand, part tact, and part echoic.
Dr. Barbara Esch’s new Early Echoic Skills Assessment manual will be available in May and can really help anyone who is helping teach speech whether that’s a parent, teacher, caregiver, SLP, or BCB
Dr. Barbara Esch on the Turn Autism Around Podcast
Dr. Barbara Esch is a behavior analyst and speech pathologist with over 30 years of experience in behavioral interventions for individuals with developmental disabilities. She has worked in school, home, clinic, and hospital settings. Her workshops, training symposia, and research have been presented in the US, Canada, Europe, and Australia and focus on the use of behavioral procedures to improve speech, language, and feeding skills for individuals of all ages with a wide range of medical and educational diagnoses. Dr. Esch received a Ph.D. in Applied Behavior Analysis from Western Michigan University and a Master’s degree in Speech Pathology from Michigan State University.
She is the author of the Early Echoic Skills Assessment, part of the Verbal Behavior Milestones Assessment and Placement Program: VB-MAPP (Sundberg, 2008/2014) and the upcoming Early Echoic Skills Assessment and Manual for Speech Acquisition, an expanded version of the original EESA, including a program planning guide. She is the founder and past chairperson of the Speech Pathology Special Interest Group of the Association for Behavior Analysis International. Her research on behavioral treatments for early speech acquisition appears in The Analysis of Verbal Behavior and the Journal of Applied Behavior Analysis.
- The benefit of working with an SLP-BCBA trained provider.
- What is the EESA Assessment?
- Who can use the EESA Assessment and Manual?
- Should you focus on articulation when teaching first words?
- How can carrier phrases inhibit natural progression?
- The difference in focusing on syllables versus word utterances.
- Is AAC always the answer for “non-verbal” learners?
- Assessment App
- Mary Barbera – Turn Autism Around – YouTube
- Mary Barbera
- Mary Barbera on TikTok
- Mary Barbera on Instagram
- National Autism Conference – Session 7- Dr. Barb Esch
- Teaching Autoclitics and Manding for Information with Dr. Sarah Lechago
- Gestalt Language Processing: What Is It and How Does It Relate to Scripting and Echolalia in Autism
- Speech Development | Interview with Rosemarie Griffin, SLP & BCBA – Dr. Mary Barbera
- Apraxia and Autism: What is Apraxia with Tamara Kasper – Dr. Mary Barbera
- Why Teaching Carrier Phrases is a Bad Idea – Dr. Mary Barbera
- Expanding Expressive Language: What’s Wrong with the Goal for Timmy to Talk In 4-Word Utterances? – Dr. Mary Barbera
- Mistakes to Avoid when Increasing Language Skills in Children with Autism – Dr. Mary Barbera
- Interprofessional Collaboration Between SLPs and BCBAs: Interview with Dr. Joanne Gerenser
- SPABA SIG
- Dr. Barbara Esch – LinkedIn
Dr. Barbara Esch – Turn Autism Around Podcast Transcript
Transcript for Podcast Episode: 220
EESA Assessment: Dr. Barbara Esch on Building Vocal Language and Avoiding Carrier Phrases
Hosted by: Dr. Mary Barbera
Guest: Dr. Babera Esch
Mary: You're listening to the Turn Autism Around Podcast Episode number 220. Today we have a very special guest, Dr. Barbara Esch, who is both a speech pathologist and a board certified behavior analyst at the doctor level. Barb is the author of the EESA, which is the echoic assessment, which is part of the VB-Mapp assessment. We heard from Dr. Mark Sundberg in last week's episode. And so Dr. Esch has worked with Mark Sundberg and others in the verbal behavior field. She's been in the field for over 30 years, and her new book, her new manual, is the early echoing skills assessment and manual for speech acquisition that's going to be coming out soon. Today's episode, we focus on things I learned from Dr. Barbara Esch over the years, and we talk about echoics. We talk about how language develops, how it's never too late, and we give some examples with older kids how we can get just language progressing as naturally as possible, and then we can get better language over time. It's a great episode. Hope you love it as much as I do. Let's get to this episode with Dr. Barb Esch.
Inro: Welcome to the Turn Autism Around podcast. For both parents and professionals in the autism world who want to turn things around, be less stressed and lead happier lives. And now your host, Autism mom behavior analyst and bestselling author, Dr. Mary Barbera.
Mary: Okay, I have Barb Esch here who is just one of my heroes, one of the real proponents in the field. So thank you for joining us today, Bar.
Dr. Esch: Yeah, it's great to be here.
Mary: Yeah, we haven't gotten together in person for a very long time, so we're going to have to figure that out soon. But let's just jump right in. If you've listened to my podcast, you'll know that I start out with the same question. Describe your fall into the autism world.
Dr. Barbara Esch on The Turn Autism Around Podcast
Dr. Esch: Oh, my fall. Oh, what an opportunity. Yeah. At the time that I was acquiring my skills and my education and behavior analysis, which came after I was already working as a speech pathologist. I think the whole autism world sort of began exploding. You know, I think that there was funding for it. There was attention to it in the public schools. Parents were interested in in-home programing and so on. And so there was kind of this matchup that happened in time that was sort of serendipitous. And it just worked out that there was this wonderful population of people that wanted to work with me and that I could work with to begin to see how we could apply the principles of behavior analysis and the techniques and so on to jump start speech and strengthen language. So I don't know if that exactly answers the question, but I think this was kind of happening in my life back in the eighties.
Mary: And now you are already a speech pathologist.
Dr. Esch: In the eighties and nineties.
Mary: And then you became a BCBA and then a BCBA-D pretty early on, as soon as it was a credential.
Dr. Esch: Yes, Yes. I worked as a speech pathologist in public schools and in hospitals, rehab centers, nursing homes. I worked with some geriatric folks as well, but primarily in preschool and elementary. I did a lot of work with head injured people and people with acquired brain injury and part of the population that I was working with, in addition to deaf hearing impaired and physically impaired, was this population of children that were diagnosed with autism. And so at that point, I decided to start taking classes toward a BCBA. And then after a while, I decided, you know, I really need to just take a leave from my jobs and I need to go back to school. So I did. I moved to Kalamazoo, Michigan, and my husband was a behavior analyst. He stayed in Florida and we kind of traveled back and forth, you know, visiting each other. But I was in grad school at Western Michigan University with the likes of Kyle Miguel and Anna Petursdottir, and Sarah Lechago. And some of those folks studying with Jack Michael and Jim Carr. So it was a wonderful, wonderful education. And it really was kind of like drinking the Kool-Aid.
Mary: Yeah, I think you were one of the last or the last Ph.D. students of Dr. Jack Michael. Sarah Lechago, we did a podcast interview with her. We can link that in your show notes. So you do have a very unique combination. You're an SLP, BCBA-D.The D on the end means doctorate. So with that combination and with all your research and being really in the thick of, you know, at Western Michigan, where much of the research is done and just over the years as being the combination of both. We've had many SLP BCBAs on the show recently. We had Sarah Risen and we can link her in the show notes, but she told me there were under 500. Still, the combination of SLP, BCBAs. We will also have Rose Griffin from ABA speech and Tammy Casper, who I know is a good friend of yours. She's an SLP BCBA. Her episode was all about apraxia and autism, so we can link those in the show notes. There's others that have been on too, but tell me about that combination of SLP, BCBA and like what you see in terms of SLPs in general, like their education about autism and about ABA, and same with BCBAs, their education, about speech and things like that.
SLP - BCBAs
Dr. Esch: Yeah, well there's opportunities on both sides. Certainly speech pathologists have lots and lots of background information in listening to what comes out of your mouth and what that sounds like and how to analyze it and so on. A lot of information about physiological processes that are going on in the mouth and the throat and all of the mechanisms for voicing and vocalizing. But I think. Where it becomes really sort of the gold standard is when you add in knowledge of how people learn things. What happens when children start to speak? Look at the millions and millions of typical developments where we all learn to talk. Most of us with no formal education at all, we're already talking up a storm by the time we're three or four, and certainly we haven't been to school yet. So blending the expertise that speech pathologists bring with the expertise of behavior analysis, how people learn is, I think, a perfect combination for addressing the needs of children with a diagnosis of autism. I think, you know, if there was one sort of statement I could make to parents and teachers and of folks that have children under their care with a diagnosis of autism, it's to relax with this as much as you possibly can. There are people that can help. And it's, I don't think, ever too late to get started. I'm trying to get vocalizing from someone that hasn't been vocalizing, but you have to do it in a really smart way with good teaching techniques so that you can strengthen what's coming out and so that you don't ask the learner to do things that are sort of out of sequence taking steps before they can crawl, for example. So I enjoy having those two hats. One of the things that I did in 2005 was I was still in grad school and I remember asking Dr. Jim Carr, my advisor at the time, How is it that you can start a new SIG at a new special interest group for ABAI, Behavior Analysis International. And he said, Well, I think you just can apply for it. So I did. And it was a very simple process. And that SIG is called SPABA, the S-P-A-B-A. And there is a website, I think it's still behavioral speech dot com. And Nikia Dower is the chairperson of the SIG now. But that's a great resource also to possibly link.
Mary: Yeah we can definitely link that in the show notes and they also have the speech pathology and ABA is a very active Facebook group. Nikia Dower describes these SLP BCBAs as unicorns or somebody in that group because you know, that seems to be the term. But yeah, when I need guests for the podcast or a specific speech related topic, I always like to go first in there and see if I can find an SLP BCBA who has experience with that topic because I think I said this last time I interviewed an SLP, BCBAs. I don't think I've met one that I don't like and we tend to have very similar philosophies and very similar ways of trying to help kids, whether they're our own children or whether they're our clients. So way back I think it was 2015 because I think I had started my online course and we're just coming up to the eight year anniversary of my very first online course. It was initially titled Autism ABA Help Online Training for Professionals and Gung Ho Parents. And since then I've also added the intermediate course, changed those two courses to a verbal behavior bundle and added my toddler course. But I already worked for the Verbal Behavior project. I wrote my first book, The Verbal Behavior Approach, like I was in it, you know, and I had started an online course and then I signed up to come to your ABAI workshop, which was a three hour workshop. You actually repeated something very similar at Penn State at the National Autism Conference, in which we can actually link my show notes because I have linked it for my online members. It's a very excellent, three hour talk. And like I said, I felt like, you know, writing the verbal behavior approach, but not now that I had it all figured out. But I learned so much in that three hour workshop that you gave Barb, that I. You want to kind of point out some of the things I learned that some of my listeners may not know. And it was the thing that caused me to create some blogs, create some processes within my courses, because I think a lot of people, a lot of us get it wrong when it comes to getting speech, when a child has none or has very little. So some of the things was that if a child, no matter what their chronological age is, if they just started talking, just started saying word approximations. You can't expect great articulation or great, you know, clarity right away. I mean, some kids do start talking and they're pretty clear. But, you know, if a child is six and their articulation is bad for a pretzel, you know, if they just started talking. That's okay. We're not, we shouldn't dive in too quickly to articulation. We have to consider the age of babbling word approximations and your first words. Do you have anything to say about that point?
Babbling Word Approximations VS. Articulation
Dr. Esch: Yeah, I sure do. And I'm so glad that you brought that up. I think about it kind of as an analogy to learning to walk. None of us would even consider taking on a person that was just learning to walk and pushing them to run if they were still kind of crawling, barely able to stand up. We just wouldn't do it. We recognize that things happen in a sequence. And speaking is a mechanical skill. It becomes a much more sophisticated automatic skill of moving all of your articulators, your tongue, your vocal cords, your lips, your jaw. All of that has to move in concert along with breathing and all of that sort of thing. But it happens in particular sequences. So if you look at a newborn infant up to about the age of, let's say, 3 to 5 months, most of what comes out of their mouths are vowel sounds, and they're still learning to move their tongue in various positions. They're learning to breathe and vocalize on escalated air, not inhalation air, because infants do phonate or vocalize inhalation. So that has to all kind of get in place and then they begin to make some consonant sounds sort of randomly. And at that same time, parents and other caregivers are reinforcing the ones of those sounds that occur in whatever the language is of that family, that caregiving unit. And so those sounds, those syllables get selected, and so they're sort of automatically reinforcing. And those are the building blocks. So, for example. Sometimes I've heard people say or ask, well, if they can say Mama. Isn't it the same difficulty to say Mommy? And it isn't. And the reason it isn't. Even though you have the same consonant in both of those that m consonant, you have two syllables in both of those. Mama and Mommy, you don't have the same vowels in the first one, Mama. You have the same vowel repeated twice. It's repeated. It's called re-duplication. And that's what babies do. Bah bah bah bah bah bah bah. Mama, mama. We hear that all the time. And then they begin to sort of expand and vary some of those other vowels and consonant sounds. So when we code and this is what speech pathologists know how to do, we code what children say or what learners say, we can assign a code. How many different consonants were in that? How many different vowels were in that? And that's what we call syllable complexity. And in my new manual that's coming out, I think we'll talk about that in a bit. There's a whole chapter on syllable complexity. So that's what you learned at that workshop was kind of my attempt to have people be comfortable with mis-articulated fledgling syllable strings that beginning learners are coming out with. And it doesn't matter whether they're two or 12 or 22. It's important to think about kind of to do a baseline of what are the skills that they have right now. How complex are the syllables that they can say and what's the next higher complexity level? Let's take them to that next higher level. And if you approach it like that, if you approach speech training like that, it will never be easy, but it's much less difficult because you actually can kind of take it step by step and you can go from, for example, tata to taca to taco and now you've got a useable word, but you couldn't get there in a leap. You have to kind of go in steps.
Mary: Yeah. So this coding that you do that you're talking about, I kind of think of it as a little shorthand. And I was always impressed by speech pathologists who would be in the room with me and they'd be scripting out like I couldn't even hear it because I'm not trained in that. But I remember a couple other things from the three hour workshop. Again, we're going to be able to link that in the show notes. That's going to be MaryBarbera.com/220. That's going to be Barb's episode. But you did mention it. But vowels are the first babbles usually so ahhh or abahhh and the B or the M, they'll usually come a little bit later. But you also talked in that workshop about vowel neighbors, I think you called it, and that and versus a versus and there's like five different A's or whatever. Like there were just so many. Is it A like Apple? Is it ahhh like a dentist going ahhh. Is it, you know, just so complex? So if you have a nonverbal child or or clients, it really is important that you have a speech pathologist on the team as they're becoming, you know, vocal. So to help you figure out what is the baseline, if that's possible. But sometimes speech pathologists who aren't familiar with ABA can focus on the wrong things, not because they don't know how to code. Or maybe they don't, maybe they know about, you know, talkers and vowel neighbors and stuff, but then they tend to want to jump to carrier phrases which can increase the syllable length. And one of the big takeaways, like literally, I came home from that three hour workshop, which was before ABAI and I changed a lot for my independent clients for my course, you know, because one of the big things you said, which is a huge takeaway for me is, you know, the syllable lengths so you have refrigerator, which is one word, five syllables. And the cat drank the milk with five words, one syllable, aged four. So five syllables. And when you add I want or please and thank you, at the end of things, you automatically raise those syllable length. So even if you have decent articulation or not good articulation, you're just going to. You know, mess things up. So I give the example of a child saying prettle, but you know, and it's two syllables and now you add, I want in front of it. Oh my God. And then you say, Well, we have to go to an AAC, because these are not understandable. Do you have anything to say about that?
Using AAC with Non-Verbal Learners
Dr. Esch: Yes, I do. Yeah. I've worked with a lot of AACs, and I know that there are a lot of speech pathologists that support that. And I think that, you know, there is a place for that and a time for that. I tend to not worry about that so much. And I've been very lucky in my professional career to be able to focus on something else which is getting vocalizing jump started. And for exactly the reason that you say I would want to rule out every possible approach that we can be tried to to get speech in place before I want to consider not using speech. And, you know, there are reasons for that. You know, speech has what I call a section in chapter one of my new EESA manual. The big five speech is fast, easy, cheap, it's always with you, and people can respond to it. And so you want to get as many of those five as you possibly can. I think that by counting syllables instead of words, it frees people of that confusion or that awful feeling that, gosh, I've been trying so hard and my learner is just not progressing. I would want to sort of step back and say, well, what did that progression look like? Was it sequential? Were you counting syllables instead of words in? It's kind of the advantage of also phonetic transcription instead of alphabet letters that you want to know, how many syllables can this person handle? How many different consonants, but how many different consonants now? How many vowels, but how many different vowels within any kind of a syllable string, whether it's two or three or four or more syllables. What children do automatically, typically developing children or any other person that's learning to talk is when the load becomes too weighty, too much, they'll drop something out and think about, for example, say, a tongue twister. What do we do to get it right? We slow down and if we don't slow down, we drop out syllables. So it's not unusual. For example, for a small child that's learning to talk, to, say, puter instead of computer or bufii, it's for a butterfly and the child's verbal community or caregiving community. Also, I guess you could call them the language teaching community. We accept that. We accept it for years. We accept articulation errors. Many, many children go to kindergarten not being able to say all of their sounds correctly. And that's not a concern generally. And the reason for not being able to do that is practice time. We need more. That learner needs more practice time with changing from whatever number of syllables they say to the next higher number, whatever number of different consonants, if they can handle saying two syllables with two different consonants. Now we need to put a third consonant in those two syllables or a second vowel in there, so that we need to very carefully change that difficulty level, just like we would graduate steps we wouldn't expect. The young person has learned to want to step up really high if the step is too great, we just wouldn't expect that. And yet when it comes to language, I think lots of times. People don't think about it as a mechanical skill as well as a behavioral skill. They just think about it as a behavioral skill. So I would encourage parents and teachers and anybody that's trying to teach somebody how to speak, to think about what are the mechanics involved in what I'm asking them to say. From cookie to want cookie to I want cookie, please. That's a huge, huge step of many more syllables, many more different consonants, many more different vowels. And the reason it's difficult is for the reason that you brought up the vowel neighborhoods. The neighborhoods are just a chart that I wrote, Drew. And what it shows really is the position in the mouth that the tongue has to be for all these different vowels. So, for example, to say E, the tongue has to be really high in the front and to say, Ooh, it has to be really low and in the back and kind of bunched up in the back. Well if you throw in a consonant like T for example, and you, and you want the child to say toe or to the tongue has to move in a very different way, then if you want them to say T. And so that knowledge, I think, is what speech pathologist can bring to the picture. And then with a background in behavior analysis or working with a behavior analytic consultant, you can avoid sort of another trap then. I don't know if you were going to ask about this, but that is to put the word or the utterance in some kind of context that matters to the child. So we all spend time with children saying, say Mama, say daddy, say this or say that. And the reason we do that is not because we just want them to repeat us, but because we want them to learn to say those same things in other contexts, like when they want something or when they see something. And so there are a lot of natural environment kinds of training contexts where we can use the echoic as a prompt to strengthen, asking for things or naming things or commenting on things and so on.
Mary: Yeah, we definitely are going to move into the Echoics in a minute. But before we do that, I just want to mention a couple of things. As you were talking, I was like, Yes, totally. Things I learned at that workshop and I mean over the years too. One of the things I came back and I, I assessed all my clients in terms of Syllable length and the one little boy was at to two syllable length in general, so he could say circle and he could also say, you know, one word like no's and, and those sorts of things. So one of the interventions was when we were within Mandy, when we were, you know, on the Magna Doodle, making a circle, instead of just saying circle like we had been doing, we would say, draw a circle. And so just to get them up to the next level, I did a video blog on what's wrong with the goal of Timmy to speak in four word utterances. We can link in the show notes as well as a carrier phrase blog. Why I don't use carrier phrases is because it not only can crash, articulation is a huge jump up from two syllables to four syllables. Those words don't tend to really matter to the child, and they can also affect spontaneous manding. If every time the child spontaneously mands for one or two syllables and then you, even if they can clearly say, say it in a big voice like a big boy, say it in a sentence and it tends to really mess up language. And finally, before we move on to Echoics and your new book and your EESA, I also heard a lecture also at the National Autism Conference with Dr. Vincent Carbone speaking. And he was talking all about how we should let language progress to two word utterances before we mess with it too much, because it can really, you know, adding carrier phrases or adding things that are teaching colors, for instance, and making them say, yellow chair or whatever. Or you can mess with just the natural language that's going to develop if we rush it. And I tried to get him on the show but couldn't. So I ended up doing a solo show at his lecture. And that's a really good one that we don't talk about much. But I think the listener is listening to you talk. Barb, And you would be interested. That's episode number 94, and we can link that in the show notes. Oh, and one more thing. I have another podcast with Joanne Gerenser, and I'm sure you're familiar with her and her work, and she was doing a lecture in my county early, early on, like Lucas was like four years old and I was having problems because his articulation, like instead of saying water, he'd say, Why you're So we started emphasizing like water, and he could say it water. And then we started also emphasizing everything like cups and cats. And what he did was he added, which I didn't know what it was. That's why I asked Joanne Gerenser over email, but he added a schwa ending when you're over emphasizing like, say, cup. And then the child hears cuppa and he starts talking like a little Italian. So I have that in my first book, The Verbal Behavior Approach, How we stopped overemphasizing ending consonants to get rid of that little problem. But the other thing she said, which I don't remember you talking about in the three hour workshop, but I've done a lot more work over it and over the years is the correlation Joanne Gerenser saw when she was sore. Lucas for a few moments she said get rid of that sippy cup because he had a spill proof sippy cup with a valve. And, and we've had Melanie Potok, who is an expert SLP on, you know, oral motor feeding issues. And and I say it in chapter ten of my Turn Autism Around book is I really haven't met a child who's not speaking who doesn't also that has autism that or signs of autism that also doesn't have feeding issues like sucking and you you're talking about the tongue and the movement of the tongue. And a lot of times that I don't know which comes first, but the tongues are not moving the right way because they're still sucking on bottles, pacifiers, spill proof sippy cups so we can link that stuff in the show notes to. I don't know if you have any additional things to say before we move to echoics, you know, because this is all like trying to get babbling, trying to get word approximations and then then coming to where we want to improve clarity and improve echoics but do you have anything to add there in terms of feeding and sucking and tongue movements and talking?
Dr. Esch: Well, I won't get into that too much, although I've done some swallowing work and some of that. There is divided opinion about whether or not oral motor work will improve speech or whether it will just improve oral motor movement and swallowing and chewing and things like that. So, you know, it would be if those were the concerns that you'd want to speak with someone specifically about your particular learner or your child. But, you know, in a more general statement, I could say that because speech is a mechanical skill, it requires a lot of practice. And if you have a plug that's sort of in your mouth, a plug of any kind of finger, a thumb, a pacifier, rag, you know, I've seen them all. Shirt? then those parts of your body don't have the same opportunity for the same amount of practice. And I will say this about practice. It's unfortunately often the case that in school programs, children receive like a 15 or 30 minute intensive speech therapy session, and they might do that if they're lucky, every day or three times a week or whatever. But if you think about how often your average speaker that's three years old or five years old or eight years old, vocalizes and says something, it's not a big intensive time from 8:00 to 830 in the morning and again from 2 to 230 in the afternoon. It's all day long. It's sprinkled in kind of like salt and pepper on mashed potatoes. You know, it's just always there and. So that's something that I think, you know, parents often said, well, what can we do? You don't have to be an expert, but you can make sure that this mechanism, these muscles are beginning to get enough practice to move in concert. So any kind of activity that gets vocalizing happening with tongue movement, lip movement, jaw movement, I think is all to the good because that's the one piece I think when people think about a child learning to talk, they might sort of focus on the behavioral aspects, the learning aspects, like they're learning to do this or that, but which is true, They're learning to say particular things. But some of that learning is mechanical, just like typing or walking or doing anything to a level of expertise and automaticity. So you and I, as we're speaking right now, probably neither one of us is paying a whole lot of attention to what our jaw is doing or our tongue movement or whatever. I am a little bit because I had to have speech therapy for a lisp when I was younger, when I was actually in college as an undergrad. So I kind of monitor that so it doesn't pop out too much. But in general, I would encourage people to do what they can to provide a lot of just sound making practice to help that mechanical system become more sophisticated.
Mary: Yeah, and if a child does have some clear words, I actually created this procedure somewhere along the way. But I would say the number one words is words that anybody would say, yeah, that is cup, that is cat, that is pizza. To record those words as number one words, clearly articulated words. And then a list of number two words might be baba for bottle or kind of deleting the end and or it's kind of like a non speech therapy way of figuring things out. And then the number two word lists also get you know, put on. But we need to teach parents through my online courses to really focus on practicing, especially those number one words a lot keeping them strong and then working on the number two words maybe with a speech pathologist to go like, you know, he really likes Taco. We had this little boy and I had permission to share his name and everything. His name his nickname was Chino. And he couldn't say Chino, but he could say no and he could say Cheeto. So there it doesn't take a speech pathologist to go like, Oh, well, he can say this and he can say this. And part of the thing was say chee, you know, say no, say chee say Chino. Say Chino. And we got him. We got it moved from number two to number one. So just to kind of go along, what you're saying is parents really do have a lot of power to work on words and try to get words clearer.
Dr. Esch: Yeah. Yeah. And in the new EESA manual, there is a form called a syllable tracker, and it's a tracking device that would do exactly what you just said. You know, you can fill in the little boxes with the consonants and the vowels and kind of find where do they come together to determine, just to kind of track what can my child say, what can my learners say, and how can I put some of these together to make actual meaningful utterances for them? What can we do for this?
The Early Echoic Skills Assessment
Mary: Let's talk about your new manual now. Many of at least the speech pathologist BCBAs is that use the VB-Mapp assessment by Dr. Mark Sundberg. And last week we replayed Dr. Mark Sundberg's interview. Next week we're going to be talking to Liz and Steve Mahr about the VB-Mapp. But a lot of people, a lot of the professionals listening may know you from your work with the EESA the echoic assessment, which is part of the VB-Mapp, and that was originally published in 2008 and redone in 2014. And so it's EESA,a separate echoic assessment. And can you tell us? I mean, I described it a little bit, but why now? Do you have a new book coming out this spring? Well, you can give the title and stuff, but like, how is that different from the EESA or is it the same?
Dr. Esch: Well, the name is the same in early echoic skills assessment, but the new one is expanded and into more of a manual form which has the test in it. And then it has some instructional chapters to talk about syllable complexity or speech as a mechanical process and some of those sorts of things. But the impetus for improving it and just sort of providing there is a work packet as part of the manual to do program planning. The impetus for that came about from a lot of feedback that I got in questions over the years. And then Nikia Dower, who is the chair of Speech Pathology, a behavior analysis, SID and ABAI did a SurveyMonkey for me a couple of years ago now, and we got a lot of feedback. For example, well, now that I've given this test, what do I do with the results? How? How do I? And most of those questions were from behavior analysts, because they were looking at it as a new quick assessment, thinking that, well, I guess I'm supposed to just teach echoics to this child that I'm trying to teach to speak. So I realized that there was a real need to kind of put that in perspective that, yeah, the echoing skill really for a young learner is a sort of a crutch or a support system for learning mands and tacts and intraverbals and other language skills. So, for example, if you want to strengthen asking for something, you can say, say cookie and and if you are working on it, coping skills, that will then strengthen it in a manned context. So it has to stay. That's the way language is learned. So we don't want people just practicing echoics like in drill format. There may be a place for that with older learners, like when I was in speech therapy or anything in that list. I was 18 years old and I did a lot of drill and that was fine. But I had already acquired very strong language skills. So. But new learners need not to drill for drills sake on and say to say this, say this, say this as an echoic skill that doesn't have any connection to anything. So the information about, well, what do you do with this echoic assessment information? It became obvious that people needed a guide. They needed to know, well, how do I plan a beginning speech acquisition speech language acquisition program with this information? So there's program planning and the work packet. There are a lot of practice sheets on coding and figuring out what the sort of the profile of syllables is. How hard is it, how many different consonants, how many different vowels, how many syllables, and so on. There is also a. An appendix full of, I don't know, maybe a couple dozen forms worksheets that people can access and print those and use them for their own programs, including the syllable tracker that I mentioned.
Mary: I do want to tell listeners that I got to preview Barb's book and it's excellent and it really does take the EESA, which is just really a very one part of the big map assessment, but not a whole lot of direction and not a whole lot of in terms of what where to take it. So I'm hoping that your new manual, which should be out by May and it will be available on Amazon and the title of it is Early Echoic Skills Assessment and Manual for Speech Acquisition. So that's awesome. So do you see parents being able to read and put this in place or do you see who's really your target market for this book?
Dr. Esch: Yeah, there is actually, I think, a sentence about who I hope will benefit from this. And it's anybody that's charged with the responsibility of trying to teach somebody to speak, and that includes certainly parents and classroom teachers and caregivers and people that don't have special training in speech pathology or in behavior analysis. I tried to be very redundant, saying things in different ways and different places, giving references that the information for this is back in chapter two or here's another link. Here's a video that you can look at to see What does it look like when I give the EESA to my child? You can watch these series of videos to see.
Mary: That part of it. That'll be great and that'll be really nice. And I know a lot of the parents and professionals in my online courses, you know, struggle with this in terms of teaching echoics. I've done echoic, how to gain echoic control or how Yeah. Because if people get stuck you know, and even just using like the early learning materials it's in my book and courses and, and I've talked about here but you know like you said don't sit knee, knee the and say say ball say you know Bubba say you know it's all your early learning materials that I do like a shoebox with a slit into it you know cup or banana or whatever and you say it up to three times and if the child says it, it's part mand because they want to take it and put it in the box. It's part tact because they can see it. It's part echo because they hear you saying it, they're following directions. They're sitting there happy, you know, And all of the materials that we use are what we call multiple for control. So it's part mand, part tact, part echoic. And that's really where I mean, you and I have been practicing this way for decades, you know, because I've had my son and and, you know, in the past, I mean, we did strict ABA, traditional style. And he was sitting knee and we were doing that kind of thing. But ever since I've been a behavior analyst, we've been really using more child friendly natural approaches to get that echoic to be better and better yeah.
Dr. Esch: And I think by that approach you avoid some of the old style ways of trying to teach children that are having a tough time learning to talk it where it becomes just a tug of war. You know, I don't want to go with you. I don't want to say what you're asking me to say because there is such a thin reinforcement schedule available to them. In other words, if they do it wrong or they don't say anything, then nothing. You know, their life doesn't improve in any way. They don't get that thing or or they don't get another push on the swing or whatever, or they see the look on your face, you know that, Oh, you didn't do it. Right. So one of the things I included in the new manual is a pretest of emergent, echoic skills. And there's also in this pretest, there is some direction to if your child is not consistently vocalizing, then go to this other. Here are some other resources. And so there's a little list of the kinds of things that you're talking about peekaboo or making. Anything where you're making fun sounds. They don't necessarily have to make sense, but they can just kind of get that foundation babbling stuff in place. It's also the case, though, that with older learners that have not yet learned to speak very well at all. And I'm not you know, my book, in my interest in my most of my work has not been with children that could already talk but just had articulation errors maybe 30 years ago, but not not any time recently. It's more of a concern to me. What if you're not really speaking at all? Now, what do I do as the teacher, the parent, whenever those folks that are older that aren't talking? You know, a lot of teachers are resistant to kind of thinking about, well, you know, having them babble nonsense kinds of things. And you don't have to do that. You can carefully arrange some things for them to say that are quasi-babbling. But the thing about babbling that's important is that it's usually very simple in terms of syllable complexity, not a whole lot of different consonants, not a whole lot of different vowels in one unit of a syllable. So those are the kinds of things to pay attention to. If you have an older child or an older learner that isn't yet talking, you don't they don't have to say goofy kind of sounding things. You can if you pay attention to, well, what do I want to teach them to say? And how complex are those syllables that I'm trying to put together for them? If you keep that simple, then you've achieved the same thing that a beginning learner is achieving at six months, nine months, 12 months old, because now you'll have the sequential steps in the right order.
Mary: Mm hmm. And I love what you said earlier. You know, it's never too late for vocalization. Like I've seen people, Anna joined our online course when her son Nick was eight years old. And he had been through ABA school since he was three. He had a doctoral level behavior analyst and speech pathologist working with. And they were really focusing a lot on a device, you know, having him use carrier phrases, having him answer, My name is Nicholas. Even though he was, she was fine with him saying, Nick, you know. So when we started to, you know, he was actually saying some things or trying to say some things like ahhhwawawa, you know, as he was as the AAC was talking. And so we, you know, had her focus on, you know, Nick versus my name is Nicholas. And didn't he start talking just with mom, working with him at home. So it's never too late. I remember, you know, a lot of parents and professionals when I've done independent evaluations, which I haven't done for years. But I remember one of my last ones, it was a 17 year old. He had been in residential placement since he was eight. And I interviewed the mom on the phone before I went in, and everybody's calling him non-verbal. And I was like, So yeah, he's nonverbal, blah, blah, blah. And I'm like, Does he say anything? Does he babble? Does he say, UH, you know, like even even saying, UH, to get your attention is better than nothing? Like, is he completely silent? And there's been I can't even think of one child that's been completely mute. And, sure enough. Oh, well, you know, he can say mama occasionally or he can say this or, you know. And then when I went in to observe for the first and only time, he was saying Beee, but he was saying B, you know, he was humming music like, look for clues. Don't just say a child's non-verbal. Like, look for clues, look for syllables, look for vowels, look for word approximations and don't give up.
Dr. Esch: Yeah, I completely agree. Vocal is you really want a blend of vocal, verbal and vocalizing. If you think about it as a mechanical skill, it is actually Mark Sundberg in a book that he published with Jim Partington, I think in 98, teaching language to children with.
Mary: The big book that came with the ABLES.
Dr. Esch: Their foreward was on alternative communication. And they really introduced the topic, you know, very, very well from my perspective. Why would you consider a non speech system, either sign language or an AC? Why would you do that? Well, there are times to do that. But if you have someone that's regularly vocalizing and even maybe has some echoic skills, then you want to maximize that first before you sort of let that go by the wayside. And I think it's easier for people to maximize that vocalizing and see if they can sort of parlay that into speech. Like your friend who was switching from something difficult like Nicholas to something easier like Nick. If you think about syllable complexity, that's a much easier thing to say, Nick, than to say Nicholas. And whenever you make it easier, you also increase the likelihood that there will be reinforcers available, that that will strengthen. And so it kind of snowballs into a lot of success by taking that approach, I think.
Mary: Yeah, definitely. Well, this has been super valuable. How can people I know say that in May your book will be available on Amazon. How can people get in touch with you or follow your work?
Dr. Barbara Esch on the Turn Autism Around Podcast
Dr. Esch: I'm on LinkedIn and I'm happy to have people email me if they want, so you can certainly post that. Or I could be reached through the SPABA website or their Facebook page as well. And although I'm not on Facebook, they will get those messages to me.
Mary: Okay, Well, I really appreciate your time. Let me ask you one more question before I go. Part of my podcast goals are not to just help the kids, but also help parents and professionals be less stressed and lead happier lives. So do you have any self-care tips or stress reduction techniques that you use to be less stressed?
Dr. Esch: There is something I've said to a lot of parents that seems to resonate with them, and that is to take the long view that your child is not getting any younger. Your child is going to be a grown up someday. So you have a lot of a big long timeline as a trajectory for this person to learn things. And it doesn't all have to get done by tomorrow morning and it doesn't have to be done perfectly. I think we all want to be as perfect as we can as much of the time as we can, but that's unrealistic. And so one needs to accept the fact that I'm doing the best I can with my available information and my available skills. And those will increase as I learn more and as I practice more. But in the meantime, I can take the long view that I don't have to do everything and I don't have to do it all by tomorrow morning or next week. And I think a lot of people have said to me, parents have said, you know, that feels good, just to remind myself, because it's a heavy burden and I don't have to tell you that. And to find anything that can de-stress, you think about, well, what is stress? It's a lot of expectations that we put on ourselves. And so if you can change those expectations somewhat to be more realistic, I think it's a kindness that you can do for yourself. I saw someone one time say, you know, just do this, give yourself a hug.
Mary: A hug. Yeah, that's awesome. Yeah, I know. I never really thought about stress being expectations that you had that were unrealistic or potentially unrealistic.
Dr. Esch: I mean, there are a lot of other kinds of stress for something. But when you.
Mary: Look at it though, now I would say that and yeah, I think taking a long view and and you know, this is your this is not just your child's life. It's your life, too. And so you need to, you know, have goals and do stuff other than autism. 24/7. Which tends to be hard, but thank you so much, Barb. I always enjoyed talking to you. I have learned a ton from you and I think you know your work has just been really instrumental in helping a lot of kids and their families and professionals too, and helping the field of speech pathology as well as behavior and now analysis. It's just been really, you're just a true pioneer. So thank you. For me and all my listeners out there and thanks for your time today.
Dr. Esch: Thanks for the opportunity, Mary. It's been wonderful and back at you with the books that you've written.
Mary: Thank you. Thank you. So you can get all the information about everything we talked about at MaryBarbera.com/220. I would really take a look at that three hour workshop that changed my life way back in like 2015 or 16. You will glean some stuff, I'm sure. So thanks again, Barb. Have a good one and I'll see you all next week.
Mary: If you're a parent or an autism professional and enjoy listening to this podcast, you have to come check out my online course and community where we take all of this material and we apply it. You'll learn life changing strategies to get your child or clients to reach their fullest potential. Join me for a free online workshop at MaryBarbera.com/workshop where you can learn how to avoid common mistakes. You can see videos of me working with kids with and without autism, and you can learn more about joining my online course and community at a very special discount. Once again go to MaryBarbera.com/workshop for all the details. I hope to see you there.
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