A three-and-a-half-year-old boy in my class has just recently begun to talk in sentences. His parents and I were excited until we realized that he doesn't seem to be using words to communicate. Instead, he just says them over and over again, almost in the same way be plays with toys - with great repetition, seemingly without purpose. This same child shows other repetitive behaviors, too, that shut people out. What are some possible causes, and how can we help him?

Sometimes early speech is repetitive because children are having problems with receptive language (auditory processing). They may be hearing okay but unable to make sense of the content, since it's difficult for them to understand or decode what they're hearing. Other children may actually have a problem with hearing itself. In either case, when a child with at least normal intelligence has a hard time figuring out what you're saying, even though his expressive language is emerging, the child will be inclined to listen to himself say things over and over. He may repeat a song heard on a tape, video, or TV, or just babble. But he does not absorb what you're saying or connect his thoughts to your thoughts, so there is no true conversation.

Another underlying cause of repetitive behavior is difficulty with motor planning and sequencing. The same ability that helps a child walk to the door, open it, and push it closed again enables a child to say, for example, "I want juice." Instead, he might repeat a phrase from TV having to do with juice or say, "Juice is a goose is a boose," because he can't sequence the three items - I, want, juice - together.

Then, too, a child may be repetitive because his cognitive abilities or his social and emotional skills are developing atypically, and/or there may be differences in the way his senses or his motor system is operating. There can also be underlying neurologic problems.

Working With Children

A very good way to help tease out the underlying reasons and at the same time intervene for positive change is to interact with the child in the special kind of way that we call Floortime. This method helps a child who's being repetitive and aimless in play to become purposeful and to speak meaningfully. The trick to Floortime is starting with the child's aimless behavior and then creating meaning and purpose. For instance, if the child is opening and closing the door, as a first step you might get stuck behind the door. All of a sudden, you, rather than the door, become the object of the child's focus, since he needs to push you out of the way in order to open and close the door again. If the child is repetitively pushing a train back and forth, you can have another train join his train or alight on a crossroads that blocks the path. The child is then compelled to deal with you again. You play your part of "troublemaker" with a gleam in your eye so that, very playfully, you are joining the child's world to get his engagement and his affect going.

In the next step, you get further into the action; in fact, you become part of the action. Now that you've blocked the train, you ask if your dolly can go for a ride. You can do the same thing with language even if the child is still using words somewhat randomly. He could be wheeling a car back and forth and saying random words like "out, in, out, in, out, in." Your role is to purposely take a dolly and put it in the car, then knock it out, then put it in, and so on. Now you're involved in purposeful interaction, putting the dolly in, out, in, out, in. So, step two's mission is accomplished.

In step three, you try to bring words into the play, words that emerge from the action and provoke more interaction. You talk about what you two are doing and try to create a dialogue sparked by whatever that is. For example, you get in the way of the door the child's opening and closing, and while he's protesting, you say, "Should I go away or stay? Stay or away?" The child wants you out of the doorway, but he says, "Away stay." You say, "I'll stay. Oh, you want me to go away?" Then you show him what walking away looks like, then go back and say, "You want me to go away? Or stay?" Five or six times later, he gets the idea - he wants you to go away and, ultimately, he says, "Away!" Remember, you want to draw the child from random, aimless, or repetitive dialogues and action patterns into purposeful, meaningful ones. With a repetitive child, you do these things all the time, not for two minutes as part of a little game after which he goes off into the corner to wheel his car back and forth or sing songs to himself the rest of the day.

Make Sure You Have Help

There are so many little games you might create to enable the child to use words that emerge appropriately from his play. If he is already using a lot of words in a repetitive or seemingly meaningless way, you know he can pronounce them and he can imitate. And once he can do both those things, he can learn to use them meaningfully. But some children need a lot of practice. So we adults have to see that they get it, all day long, in fun ways. You will need assistance to keep this going. If you're in a public school system, alert the proper special education colleagues to help you get an aide. You can also ask the parent to come in, train a volunteer, or utilize an extra staff person so you can keep these interactions going throughout the day.

What You Can Learn

While all this is going on, you'll gain further information about underlying causes. For example, if the child has a hard time understanding, or he understands only with a lot of effort, that suggests his receptive language (auditory processing) is challenged. However, if you notice the child can't seem to do three things in sequence, he may be having a hard time with sequencing. In still another case, if the child is struggling to copy simple shapes, this gives you a clue that he has some motor-planning problems. Or, if the child is making repetitive movements, like flapping or spinning, it's often because his motor system is immature. The key: Don't fight the behavior; help organize it and make it interactive.

Focus on Individuals

Among the most common causes of repetitive behavior is the possibility that the child is underreactive to sounds or underwhelmed by the expression of your enthusiasm. If that is the case, you have to heighten your affect, you have to energize up, talk in a very loud voice, and be very animated even to get that child to just look at you. On the other hand, some children are oversensitive to sound and shut down when it overwhelms them. These children may do better in a part of the room that is relatively quiet and when you talk in a soothing, low voice, rather than a very animated, high-pitched one.

When to Worry and What to Do

Children with any of these difficulties should at some point have a proper team evaluation by a developmental pediatrician, a pediatric neurologist, a child psychiatrist or a clinical psychologist, a speech and language specialist, an occupational or physical therapist, or all of the above to determine the underlying reasons for repetitive behavior. Often, the people who have the closest contact with the child, usually parents and educators, will have the best feel for possible underlying reasons and can provide information that can be enormously helpful. Parents or teachers may notice that the repetitive behavior has a self-soothing quality that makes up for any of the deficits I've mentioned. The goal then is enabling the child to feel soothed instead through successful interaction.

If a parent and teacher follow these suggestions and find that the child responds surprisingly quickly, as many children do, and that his behavior soon begins to be more meaningful and purposeful, the child very likely has mild processing problems in some of the areas mentioned. This child will respond very well to continuing extra practice, which is very reassuring to everyone.