Case Study

Teaching Echoics Using Visual Cues

Portia Curriculum
Domain: Communication
Skill Category: Echoics



Establishing echoic behavior in children with autism that have limited speech can be challenging. Evidenced based prompting strategies are limited and differential reinforcement procedures alone are often not enough to evoke the correct speech sounds.

This is especially true when a learner is attempting to echo, but the approximation of the sound can not be produced reliably. Oral motor placement therapy® uses visual and tactile cues to prompt the correct lip placement for the sound and evoke the correct approximation.


The learner is the oldest of three children living at home with his mother and father. Both English and Polish are spoken at home.  The learner is currently receiving 15 hours of Comprehensive ABA per week and is a level 1 learner on the VB-MAPP. The purpose of the study is to evaluate oral motor placement therapy as a way of increasing the frequency and accuracy of vocalization of the /m/ sound.


The study was conducted using a simple AB design. The first procedure was echoic training of the /m/ sound with the adult model alone. The second procedure introduced the use of the oral motor placement tools in the form of a Bilabial Shape from Talk Tools® with the adult model and with the placement tool, followed by the placement tool being inserted into the learner’s mouth.
An example of the kit used can be found here.

Baseline Data Summary

The baseline assessment was completed over 31 days and revealed no progress based on accuracy of the sound, with an average percent correct of 4.3% and 20 days of 0% correct.

Data Collection/Measurement

The program was developed using Portia Virtual Clinic and data was collected on each trial with the  PortiaPro™ app and graphed as a percentage of successful echoics and displayed on Portia Virtual Clinic.


During the first procedure, the therapist presents the instruction ‘say mmm’. If the learner echoed the /m/ sound on the first presentation of the sound, he received an edible reinforcer and the therapist recorded ‘yes’ on the PortialPro™  app. If the learner did not echo the sound a ‘no’ was recorded on the PortiaPro™ app and no reinforcement was delivered.
During the second procedure, the therapist delivered the instruction ‘say mmm’ inserting the bilabial shape for the /m/ sound into their own mouth while presenting the model of the sound.  The therapist would then insert the learner’s own bilabial shape for the /m/ sound into the learner’s mouth.  The learner was provided with an edible reinforcer for successful production of the /m/ sound and the therapist recorded ‘yes’ on the PortiaPro™ app.  If the learner did not echo the sound a ‘no’ was recorded and no reinforcement was delivered.



Developing an echoic repertoire is an essential skill requirement for the development of verbal

communication.  The ability to imitate adult approximations accurately is a priority in most early intervention programs for individuals with autism.  When reinforcement contingencies are not enough to increase the behavior alone, additional techniques and tools must be used to teach the skill.  

Since there are limited evidenced based tools and procedures available to use as additional techniques, Bilabial shapes were developed by Renee Roy Hill as part of the Talk Tools® program.

For this case study it is hypothesized that the bilabial shape for the /m/ sound provided a tactile and visual prompt for the learner to make the correct mouth placement for the sound.  Additional research is required to establish tools for best practice going forward.


Oral Motor Placement Therapy® and Talk Tools® is a registered trademark of  Talk Tools.

Barrera, R. D., Lobato-Barrera, D., Sulzer-Azaroff, B. (1980). A simultaneous treatment comparison of three expressive language training programs with a mute autistic child. Journal of Autism and Developmental Disorders, 10 (1), 21-37.

Barberra, R. D., Sulzer-Azaroff, B. (1983). An alternating treatment comparison of oral and total communication training programs with echolalic autistic children. Journal of Applied Behavior Analysis, 16, 379-394.

Goodwyn, S. W., Acredolo, L. P., Brown, C. A. (2000). Impact of symbolic gesturing on early language development. Journal of nonverbal behavior, 20 (2), 81-102.

Esch, B. F., Carr. J. F., Michael, J. (2005). Evaluating stimulus-stimulus pairing and direct reinforcement in the establishment of an echoic repertoire of children diagnosed with autism. The Analysis of Verbal Behavior, 21, 43-58.

Hill, R., Renee. (2013). Complete Apraxia Kit.




Kim Moore, M.ADS, BCBA

Want to learn more about the Portia Curriculum?

In 30 minutes let us show you how Portia ABA Clinic Software can help you
run your ABA Clinic efficiently, effectively and ethically!
Email us at or call us 1.855.297.6431 today!
Request Demo