The ECHO Program
Whom the ECHO Program Serves
How to Initiate the ECHO Program
Setup for Face-to-Face and Virtual Online Sessions
Connections Between Social Anxiety and Communication
The ARC Model - Generalizing Skills
Documentation and Progress
Module 1. Vocal Control: Gaining Control of Your Voice for Speech Initiation
Background Introduction and Theoretical Framework
Proposed Hierarchy for Face-to-Face and Online Sessions: How to Begin
Process of Vocal Control
Activity Game 1: Sound Off
Activity Game 2: Pitch Pipe
Activity Game 3: Ramp it Up!
Activity Game 4: Vocal Marathon
Activity Game 5: Tag Along Words
Activity Game 6: What’s Up?
Activity Game 7: Let’s Face It
Module 2. Building Social Pragmatic Communication for Children and Teens Who Experience Anxiety in Speaking Situations
Background Introduction and Theoretical Framework
Overarching Goals for Module 2
Activity Game 1: Word Think -The First Word That Comes to Mind
Activity Game 2: Pinpoint - Words to Sentences
Activity Game 3: Actors’ Corner - Interactive Scripts
Activity Game 4: Barriers - Following Directions
Activity Game 5: Question Match - Answering Questions
Activity Game 6: More Information Please - Changing Questions
Activity Game 7: See-Saw - Keep the Conversation Going
Activity Game 8: Road Runner - Stay on Topic Track
Activity Game 9: Conversation Wheelhouse
Activity Game 10: Conversational Role-Plays: Pragmatic Language
Activity Game 11: Chat Spin - Informal Conversations
Module 2: Outreach Activities
Appendix 2–A. Suggestions for Facilitating Activities for Children and Teen with Selective Mutism
Appendix 2–B. Suggestions for Facilitating Activities for Children and Teen who Stutter
Module 3. Role-Play Simulations for Conversation
Using the SMQ as a Guide for Activity Selection and Tracking Progress
In Preparation for the Role-Play
Role-Play / Activity
Scenario 1: Talking to General Peers at School
Scenario 2: Talking to Selected Peers at School
Scenario 3: Being Asked a Question by the Teacher
Scenario 4: Asking the Teacher a Question
Scenario 5: Speaking to Teachers or Staff at School
Scenario 6: Speaking in Groups or in Front of the Class
Scenario 7: Talking to Family Members at Home When Others are Present
Scenario 8: Talking to Family Members While in Unfamiliar Places
Scenario 9. Talking to Family Members Who Don’t Live With Me (e.g., grandparent, cousin)
Scenario 10: Talking on the Phone to Parents and/or Siblings
Scenario 11: Speaking with Familiar Family Friends
Scenario 12: Speaking to at Least One Babysitter or Caregiver (not family member)
Scenario 13: Speaking with Other Kids Who I Don’t Know
Scenario 14: Speaking with Family Friends Whom I Do Not Know
Scenario 15: Speaking with my Doctor or Dentist
Scenario 16: Speaking to Store Clerks or Waiters
Scenario 17: Talking When in Clubs, Teams, or Organized Activities Outside of School Photo Cards
Appendix A. DSM-5 Diagnostic Criteria for Selective Mutism, Childhood-Onset Fluency Disorder (Stuttering), and Social (Pragmatic) Communication Disorder
Appendix B. The ECHO Checklist
Appendix C. ECHO Program — Information About Me
Appendix D. Social Communication Skills — The Pragmatics Checklist
Appendix E. EXPRESS Selective Mutism (SM) Communication Questionnaire
ECHO: A Vocal Language Program for Easing Anxiety in Conversation is for clinicians supporting individuals who may experience social anxiety related to speaking in specific situations, or with certain individuals. Anxiety has a negative impact on working memory, which can make it difficult for individuals to communicate with ease. With reduced experiences talking to a variety of people in various situations, speaking often becomes more challenging.
The ECHO program was developed to build ease and comfort with social pragmatic communication, focusing on improving conversational skills for children from later elementary through teenage years. The program can be implemented by speech-language pathologists, psychologists, educators, and other facilitators (including parents), who support the needs of children and teens with selective mutism, stuttering, and those in need of social communication support. This unique intervention program combines methods of vocalization and verbalization to enhance conversational skills with role-play simulations for real-life application.
There are three modules in the ECHO program that build upon each other:
- Module 1 uses interactive games to focus on vocal control, helping the child or teen learn how to initiate voice, modulate intonation and volume with greater ease, and produce classes of speech sounds in words and sentences.
- Module 2 provides targeted skills for the child or teen to use language for different purposes, change language for the listeners or situation, and follow rules for conversation and storytelling; all with online interactive games to become a more spontaneous communicator.
- Module 3 builds on the previous two modules by providing conversational role-plays which simulate real-life situations in school, at home, and in social and public settings. A cognitive behavioral therapy (CBT) framework is applied to help reduce cognitive distortions.
- Three modules bridging the gap from vocalization to conversation
- The ECHO Checklist to identify communication needs
- Social Communication Skills Pragmatics Checklist
- The ARC model for understanding anxiety tolerance, rescue reduction, and communication confidence
- Thirty-five interactive games and activities with over 150 photos (online and printed) to help children and teens gain skills necessary to vocalize and engage in conversation
- A PluralPlus companion website with interactive activities for in-person and telepractice use
Cesar E. Ruiz, SLP.D, CCC-SLP, BCS-S, is a Full Professor at La Salle University in the Department of Communication Sciences and Disorders where he has taught for 18 years. Dr. Ruiz is a licensed and certified speech-language pathologist. He holds Board Certification in Swallowing and Swallowing Disorders and is a Voice Clinical Specialist. Dr. Ruiz received the Lindback Distinguished Teaching Award in 2015. He is engaged in private practice and teaches, supervises, and advises students pursuing degrees in speech-language pathology. His areas of specialization include selective mutism, dysphagia, voice disorders, and bilingualism. Dr. Ruiz co directs the CASTLE Center at La Salle University in Philadelphia. The CASTLE Center is a specialized comprehensive assessment center where children with Selective Mutism are evaluated. Dr. Ruiz has pioneered the use of vocal control to help children with Selective Mutism and has presented on the topic locally and nationally.
Evelyn R. Klein, PhD, CCC-SLP, BCS-CL, ASHA Fellow, is a Full Professor at La Salle University in the Department of Communication Sciences and Disorders where she teaches, supervises, and advises students pursuing degrees in speech-language pathology. She also co-directs the CASTLE Assessment Center at La Salle. Dr. Klein is a certified and licensedspeech-language pathologist and a licensed psychologist with postdoctoral training in clinical neuropsychology and cognitive behavioral therapy. She is a Board-Certified Specialist in Child Language and Language Disorders affiliated with ASHA. Dr. Klein received the Lindback Distinguished Teaching Award in 2011 and Faculty Distinguished Scholarship Award in 2018. She is also engaged in private practice. Her areas of specialization include selective mutism, autism spectrum disorders, fluency disorders, language disorders, and counseling. Dr. Klein is an editor and author of textbooks and treatment programs including EXPRESS (Expanding Receptive and Expressive Skills through Stories), More Than Fluency: The Social, Emotional, and Cognitive Dimensions of Stuttering, and Acquired Language Disorders: A Case-Based Approach, Third Edition (all published by Plural Publishing). She is on the Scientific Advisory Board of the Selective Mutism Association.
Louis Chesney, BSc, is a well-respected neurodiversity expert and researcher. Currently serving at Whil, a Rethink Division, Louis manages the DEI/neurodiversity program, delivering employer support to drive workplace inclusion and strengthen interpersonal skills through digital learning. Louis provides his knowledge in learning and development to industry leaders seeking to further their diversity and inclusion initiatives. He continually aims to make a positive impact on those who are underserved. As part of his efforts, he has served on the Disability:IN committees and the Selective Mutism Association board of directors.