PERSEVERATION IN PWS

There is at present a debate whether the phenomenon of perseveration is a behavioural problem or a linguistic one. Has the child just not understood the answer, not listened, or is s/he "stuck" on that particular utterance? Is the child seeking reassurance, or is it that s/he cannot move on to the next step in the conversation?

Some parents and teachers feel that it is almost a personal attack when they have answered the same question six, or even sixteen, times already, and the child repeats it again. Whatever the cause, there are some strategies that are worth trying to see if if your child will respond to some, all, or a combination of them.

Some Practical Suggestions

1. Diversion. Can you change the subject for him/her? - e.g. "We've talked about that, let's talk about this now." If the problem the child is experiencing is "topic shifting", this should help.

2. Reassurance. It may be that s/he needs the answer confirmed, or to hear an answer more than once before s/he can process it and compare it to the original question. When you have answered again, try confirming that s/he has the answer right by asking, "You know that. I told you. You tell me." In this way s/he can confirm that the answer is what s/he thought and also you are indicating that further repetition is not necessary.

3. "I don't know" can be an answer too, but some children may have to be taught this concept. They may think that you are just not bothering, or that if they ask again you will know next time.

4. Wait. If you cannot answer for some reason, but could find out, put a time limit on. Say, "I'll tell you in 10 minutes", or if s/he can't tell the time, "I'll tell you when the hands on the clock get to ...." and point to the clock, but do make sure you answer then, or this will not work again.

5. Demonstrating knowledge. Sometimes the repetition is just to let you know, or to get you to confirm, something s/he is not sure of, e.g. "It's sewing today", "Is it sewing today?", "It' s sewing because it' s Thursday". All it should take to solve this one is to say that "Yes it is Thursday and that means sewing today." although, as above, this might take more than one exchange.

If this problem is regarded as a linguistic, higher language difficulty, although diversion and behavioural management may well help to control it, ultimately the only way to bring about any lasting change in the way the person operates in conversation is to teach the correct, acceptable social exchange patterns, so that a reference is available the next time their linguistic "set" lets them down. It is not enough to explain that it is upsetting to have the same question repeated; if they are stuck on an idea there is no way they can go on to another subject without our help.

There are other techniques for teaching social and conversational skills that could be helpful, but these would have to be specific to the individual' s presentation, and therefore I cannot detail them here.

If none of the above ideas help, or if you require more specific advice, please contact the speech and language therapy service for your school or area. There is no need to go through your GP, as speech therapists operate an open referral system. If your speech and language therapist requires more advice on specific aspects of communication difficulties of children with PWS, I can be contacted through Jackie Waters.

Fiona Whyte Hon. Speech and Language Advisor to the PWSA (UK)

The Prader-Willi Syndrome Association (UK) - Web page last updated 25th April 2001
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