Vocalization Disorders

Once upon a time there was a boy named Joey. (Yes, I know. Just roll with it.) Joey was born into a standard middle class home with a loving father, doting mother, and precocious older brother. But when Joey began to start talking, he began to exhibit a behavior not so standard…he would scream profanities. Joey seemed to NEED to say these cuss words over and over for himself and to others. Joey was diagnosed with Tourette’s Syndrome. By definition, TS is a disorder in which children and adults exhibit motor and sometimes vocal tics. This means a child diagnosed with TS may yell certain words and have a compulsive set of behaviors that precede or closely follow a vocalizing. For Joey, his vocal tic was screaming profanities paired with grabbing himself. As any of you can imagine, such behavior is quite alarming for parents who have never dealt with verbal impulsivity. However, for many parents of children with autism verbal impulse is seen on the daily.

Other than Tourette’s syndrome, there are a variety of other disorders that deal with vocalization. In autism, the most common ones are palilalia and scripting. First let’s go over palilalia. It is quite similar to Tourette’s in the need to fulfill the impulse to say words. While with Tourette’s Syndrome the impulse is innate and most often unwanted, palilalia is typically intentional (to a certain extent.)

Palilalia is the repetition of words or phrases that are pleasing to the person. For instance, one of my clients will watch an episode of Teenage Mutant Ninja Turtles before his session. While he’s walking to the restroom or working on some menial task I’ll hear him whisper “Donny, be careful! They’re dangerous!” My client is not just scripting. He is repeating to himself something he has experienced that he enjoyed. In essence, he is verbally daydreaming.

Scripting has a different connotation. It is more inline with verbal “stimming,” in which a person repeats a variety of sounds and words. Another type of scripting is echolalia, where the person repeats words or phrases that are said to them such as “Say ‘hi,’ Mark,” and the child will reply, “Say hi!” There are multiple theories as to why children on the spectrum script. Many leading professionals in the field believe that it is their way of acquiring language. Another theory is that the sounds of the words described are verbally and auditorally pleasing (we have officially coined auditorally as a new word…deal with it.)

Going back to Tourette’s, it seems to be functionally similar to scripting. Many times words that are scripted and words that are vocal tics tend to have hard consonants. This is why a percentage of children with Tourette’s have what is called coprolalia or foul-mouthed tics. Those hard consonants in a variety of cuss words are incredibly harsh…and fun to say. For instance, the word ‘crisp’ utilizes the whole mouth to say; it starts at the back of the throat with the “cuh” sound and ends at the lips with the “puh” sound. Beautiful, isn’t it? Another client likes to repeat the names of their therapist. One way to look at this is that their names are, as one of my coworkers put it, crispy.

Whatever the vocalizations your child has, it is important to know the cause of them. Not just for the sake of knowing, but because proper medication and therapy may aid in reducing such vocalizations. The treatments for Tourette’s and autism related stimming require different interventions. So knowing the cause of your child’s behaviors, will be an incredible help in providing your child with the appropriate therapy.

Joey’s coprolalia passed with age. It was replaced with other types of behavioral tics such as barking and clearing his throat…much more manageable than its predecessor. It was crucial for Joey not to feel guilty for his tics, for they were not under his control. Such behaviors, or compulsions will be explained in depth in the future.

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