Verbal Perseveration! Verbal Perseveration!

by NFXF

child-using-ipad

“You’re fired!! YOU’RE FIRED!!

I’M GONNA HIT YOU MOUSIE!!, WATCH OUT, I’M GONNA HIT YOU.

Where’s Mommy? She’s done? Mommy’s done?…(pause)…Where’s Mommy? She’s done? Mommy’s done? Where’s Mommy? She’s done? Mommy’s done? I’m gonna hit you…(pause)…She’s done? Mommy’s done? Where’s Mommy? She’s done? Mommy’s done?”

Oh my! Verbal Perseveration!

The above is NOT the typical daily event of Tracy yelling at Mouse for yet again some Three Stooges type of antics. No, the above monologue is a typical part of our day with our friend James. Tracy and I look at each other, both thinking, it must have been a rough day at school for this guy.

This Coffee Talk is dedicated to a discussion of verbal perseveration (VP), a very typical and pervasive aspect of language in Fragile X syndrome. Does VP interfere with daily living and activities? You bet your boots it can! At home, school, after school activities, transition times: VP can have an impact on them all. On the list of questions parents ask, verbal perseveration is at the top. Let’s start with some basic information.

Why do we think VP occurs? We think VP occurs for several reasons. A higher level of anxiety leading to overarousal in different situations may impact the ability to quickly and spontaneously formulate language responses or to partake in a conversation. Verbal perseveration is most likely to occur in states of hyperarousal, during which the brain is less likely to be able to be planful, activate “stop” mechanisms and very likely to produce automatic, habitual behaviors.

What you hear as perseveration is the brain being “stuck” on an oft-used sentence or idea. What you hear may be reflective of the child’s interests, or perhaps a “power phrase,” heard in an emotionally-charged context and reinforced (e.g. you’re fired)! The content of James’ example above is also an obvious window into his internal state. Thus, we think of VP as a telltale sign of reduced internal coping with overarousal.

Joshua is entering a special needs class at the local community college. When interacting with us, he appears cool as a cucumber, telling us about the school he’s going to and how he’s going to get there. Every now and then we hear him whisper to himself, “I’m doing ok. I’m alright…I’m doing ok. I’m alright… I’m doing ok. I’m alright…” Joshua’s verbal perseveration is a little different. He’s aware that he’s somewhat anxious in this situation, and he’s actually using VP to self-calm.

Anxiety for him is the tip of the overarousal iceberg. He knows that if he is anxious, he needs to try to maintain calm, or the anxiety will turn into full blown overarousal where he can no longer self-manage it.

Wally loves to come to Denver for lunch at the Italian Restaurant. This is a highlight experience for us, as we join him. Wally is happy to tell us about his job at the fast food restaurant, about shopping and doing exercise videos. After he has run through this list of daily topics that he has learned to use in conversation, he will begin to talk about his love of soap operas. Here is where we always start to hear his perseverations. He begins by saying, “I like soap operas. Did you see Days of our Lives? Oh that Marlena, she is so pretty.” However, soon after he starts down his perseverative path of negative emotionality.

Wally doesn’t perseverate so much with phrases or words, as with negative emotional tone. “Those soap operas are so sad. No one can stay married. They are so bad…It is so sad…oh, how I hate it.” Now, he is stuck in negativity land, and any conversation topic is about how hard, bad and sad things are. Wow, did I say this was a fun lunch? We need to employ some of our sage strategies to turn this around!

Ok, so perseveration happens. Sure, it presents itself in the language area, in the domain of the speech language pathologist, but the origin is seated in the domain of the occupational therapist and medication manager. VP is the prime example of why everyone needs to work together to solve the issues making life challenging for our FX kids. From our perspective, here are some of the interventions we have found useful in managing VP.

Break that Perseveration Hierarchy

  • Initially...
  • Next...
  • When all else fails...

Distract with activity change:

“Mom is working with Jennifer. Let’s go outside.”

Slow down, acknowledge verbally and stay with the child in the task:

Slow down the child and acknowledge their need to perseverate, even joining them for a couple of repetitions, all the while you are physically calming them with pressure and repetitive breath and deep touch.

Next, you will talk about and model for them what to do when anxious/upset. Move them on to calming or other activity. “You miss your mommy, you miss your mommy, I know you miss your mommy.”

After rubbing their back for a minute or so and staying with them in this “moment,” shift to say, “Now we are going to go have a snack.”

Visual Cue and verbal distraction: 

“Stop! (coupled with sign for stop or picture symbol for stop). We are done talking about (perseverative idea). We are talking about (whatever).” Couple with visual cue of topic/idea you want to focus on.

Visual Cue and big motor movement:

You can use a repetitive, simple motor task as a way to break the perseveration. For instance, they could jump up and down twenty times, run up and down the stairs, carry the laundry basket to laundry room or use the vacuum.

Ignore it, cope and go take a bath. It’s just one of those days.

Cheers, ah time to go, cheers, ah time to go, cheers, ah time to go!!! Just go already would ya?!!

Authors
Sarah “Mouse” Scharfenaker, MA, CCC-SLPSarah “Mouse” Scharfenaker, MA, CCC-SLP fondly known as “Mouse”, is vice-president, CFO and co-founder of Developmental FX. She has worked in the fields of Fragile X syndrome and neurodevelopmental disorders for more than 25 years. She received both her undergraduate and graduate degrees from the University of Montana, Missoula.
Tracy Stackhouse, MA, OTRTracy Stackhouse, MA, OTR a Colorado native, is president and co-founder of Developmental FX. She is a leading pediatric occupational therapist (OT) involved in clinical treatment, research, mentoring, and training regarding OT intervention for persons with neurodevelopmental disorders, especially Fragile X syndrome and autism.