Index
It is defined as the unsolicited repetition of vocalizations made by another person (by the same person it is called palilalia).
The word “echolalia” is derived from the Greek ἠχώ, which means “echo” or “repeat,” and λαλιά (laliá), which means “speak” (of onomatopoeic origin, from the verb λαλέω (laléo), which means “to speak”).
In its deep form, it is automatic and effortless. It is one of the ecofenomena closely related to echopraxia, the mechanical repetition of movements made by another person.
Both are “subsets of imitative behavior” by which sounds or actions are imitated “without explicit knowledge.” Echolalia can be an immediate reaction to a stimulus, or it can be delayed.
Echolalia describes the precise repetition or echo of words and sounds. Echolalia can be a symptom of several disorders, including aphasia, dementia, traumatic brain injury, and schizophrenia, but it is most often associated with autism.
Echolalia is a unique way of speaking, and if your child is autistic, it may be one of the first ways your child uses speech to communicate.
So while it can be described as a symptom of autism, it can also be an excellent place for a parent or speech and language therapist to start working with your child.
On the other hand, in some cases, Echolalia doesn’t have any communicative meaning; it can simply be a self-calming tool that your child is using in the same way that you can use hand flapping or rocking.
Signs and symptoms
Echolalia can be categorized as immediate (occurring immediately after the stimulus) versus delayed (sometime after the appearance of a push).
Immediate Echolalia results from the rapid recall of information from short-term memory and “superficial linguistic processing.” A typical pediatric presentation of immediate Echolalia might be the following:
A child is asked, “Do you want dinner?” the child repeats, “Do you want dinner?” followed by a pause and then an answer, “Yes. What’s for dinner? “
In delayed Echolalia, the patient repeats multiple words, phrases, or sentences after a delay that can be hours to years later. Immediate Echolalia may indicate a developmental disorder, but this is not necessarily the case.
Echolalia can sometimes be observed when an individual echoes a statement to indicate that they are contemplating an answer and have fully heard the original word.
The researchers looked at the daily repetitions of a six-year-old autistic to examine the differences between the triggers for delayed versus immediate Echolalia.
Researchers further distinguish immediate echoes by the sequential context they occur: after corrections, after directives, or in indiscernible sequential positions.
Delayed echoes are distinguished by their properties: autoechoes, other, and impersonal echoes.
The results showed that almost all the immediate echoes produced by the six-year-old were found in sequential contexts, while the delayed echoes also occurred at the base of the property.
Although Echolalia can be a handicap, symptoms can involve many underlying meanings and behaviors between and within subjects.
Mitigated Echolalia refers to a repetition in which the original stimulus is somewhat disturbed. Environmental Echolalia refers to the replay (which typically occurs in individuals with dementia) of environmental triggers such as a television program that runs on seconds flat.
Examples of mitigated Echolalia are pronoun changes or syntax corrections. The first can be seen in the example of asking the patient, “Where is he going?” And with the patient responding, “Where am I going?”
The latter would be seen in the clinician asking, “Where am I going?” And the patient repeated, “Where am I going?” In mitigated Echolalia, some language processing is occurring. Mitigated Echolalia can be seen in dyspraxia and aphasia of speech.
A Japanese case report describes a 20-year-old college student who was admitted to the hospital complaining of headaches and meningitis; however, they also showed signs of environmental Echolalia.
The researchers stated that the young patient’s repetition was approximately the same as his average speech rate. The patient did not simply repeat the words he had heard.
The patient reported that his environmental Echolalia appeared random, but it seemed when he was distracted. She was also aware of her Echolalia but said she couldn’t stop the reps.
Immediate and delayed Echolalia
Sometimes Echolalia is an immediate echo. For example, Mom says, “Johnny, do you want a drink?” and Johnny responds, “Do you want a drink.”
In this case, it is possible that Johnny is adequately answering the mother’s question and might very well want a drink. But instead of using a novel phrase like “yes please” or “I would like the lemonade,” you echo their precise language.
Just as often, Echolalia is delayed. A child watches an episode of Sesame Street and, later that day is heard reciting interactions between Bert and Ernie or singing a fragment of the theme song.
Children with autism can have extraordinary aural memories, and in some cases, they can recite large portions of favorite movies with intonation and accents.
Sometimes an autistic child may use Ernie’s words for a valuable purpose of his own; sometimes, words are just repeated sounds.
Functional and non-functional echolalia
For some autistic children, Echolalia is simply the repetition of meaningless sounds. This nonfunctional echo of the actual words in a logical order can be misleading to parents, as it appears their child is using expressive language when that is not the case.
A child can recite the entire script for an episode of SpongeBob SquarePants but does not understand who the characters are, what they say, or what the story means. It may be that the repetition of memorized sounds has a calming effect on some children on the spectrum.
Functional Echolalia, however, is the proper use of memorized phrases for a real purpose. For example, a child hears a television line, such as “Do you have milk?” and then when she’s thirsty, she can say, “did you get milk?” precisely in the same tone and accent as the TV ad.
Again, in this case, the child is using the memorized or repeated phrase, but he is using it practically this time. He orders a drink, and his order is understood, but he does not think of his phraseology.
Difference between persistent speech and Echolalia
Echolalia is a condition characterized by the repetition of noises and phrases that are heard.
This can result in an inability to communicate appropriately because individuals struggle to express their thoughts. An example would be that a person with Echolalia can only repeat a question and not be able to answer it.
Echolalia can be an attempt to communicate by the affected person or an attempt to learn or practice the language. Echolalia is not a motor tic or verbal tic and is very different from Tourette syndrome, which can include uncontrollable vocal tics as a symptom.
Repetitive speech is a ubiquitous and natural part of language development. Young children who are learning to speak often demonstrate repetitive speech.
By the time the child reaches the age of two, they will begin to change it and add their own words and the repetitions of what they have heard.
It is common for children with autism or developmental delay to have Echolalia that persists into later childhood, significantly if speech development is delayed.
Echolalia also occurs in aphasia, schizophrenia, dementia, catatonia, and epilepsy after cerebral infarction (cerebrovascular accident) and a closed head injury; in blind children, children with language impairments, and confident developing neurotypical children.
Echolalia can also be associated with forms of dementia (Pick’s disease and frontotemporal dementia), progressive supranuclear palsy, corticobasal degeneration, and a pervasive developmental disorder.
Instead, persistent speech is the constant repetition of speech or questions that can be used in communicative and non-communicative ways.
According to psychology, psychiatry, and speech-language pathology, persistent speech is the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus.
Symptoms include an inability to transition or change ideas appropriately with the social context, as evidenced by the repetition of words or gestures after they have ceased to be socially relevant or appropriate, and are most often caused by traumatic brain injury.
Persistent speech can also refer to the obsessive and highly selective interests of people with autism spectrum disorders. This term is most often associated with Asperger’s syndrome.
Furthermore, in attention deficit hyperactivity disorder (ADHD), persistent speech or “hyper center” commonly occurs as a disturbance of group switching and task switching.
Resistance to transition can be a defense mechanism or the brain’s method of compensating for the lack of ability to regulate the application of attention.
In addition to its direct symptoms, people with obsessive-compulsive disorder may have specific problems with group switching and inhibiting overbearing responses.
In those who have had a traumatic brain injury, persistent speech can feature frontal lobe injuries and other conditions that involve dysfunction or dysregulation within the frontal lobe.
This is especially true when damage to the lateral orbitofrontal cortex or inferior prefrontal convexity (Brodmann areas 47/12). In individuals with aphasia, persistent speech is also seen as a symptom.
Although persistent speech may be symptomatic of neurological disorders or structural damage, it is not the result of delayed speech development or deficits in language development that can occur as we move into childhood and learn to speak through repeating sounds and words we hear, as in Echolalia.
Causes of Echolalia
Echolalia occurs at the stage of speech development when the child begins to get acquainted with the surrounding world and actively pronounces himself. There are two stages of this type that last between 6 months and one year and between 3 and 4 years.
In these age ranges, children actively repeat the words of others, study the basics of speech, and try to enter into a dialogue. Causes of Echolalia:
- Disorders of the psyche.
- Various neurological pathologies.
- The defeat of the frontal lobes of the brain.
- Mental retardation.
- An autistic disorder.
- Turret syndrome.
- Imbecility.
- Schizophrenia.
- Rett syndrome.
- Brain cancer
- Dyslexia .
- Dysphasia.
Any of the above disorders can be diagnosed in children, so they involve unidentified violations in childhood when it comes to Echolalia in adults. In addition to the main reasons, the disease can be aggravated or caused by certain factors that provoke:
Self-deception in the communication process: by repeating what has been heard, the child has a specific range of emotions and associations. If such images appear too often and are wrong, this becomes a communication problem.
Emotions in the communication process: Echolalia acts as an indicator of the patient’s mood since repeated phrases have moving images.
Information processing and ordering: repeating what has been heard, the patient classifies the events and shares this information and emotions with others.
Regardless of the patient’s age, the disease is always accompanied by mental and neurological pathologies. With the diagnosis of autism, Echolalia acts as a peculiar form of communication.
This is an attempt to carry on a conversation or enter a dialogue before realizing what has been said.
Until four years of age, automatic repetition of words for others is every day. But in the elderly, this symptom requires medical attention, as it indicates a severe pathology.
In medical practice, there are often cases when the disease becomes a provocateur of hysterical seizures due to the resulting misunderstanding.
Treatment
Treatment for Echolalia is not as easy as it sounds. That’s because Echolalia can serve many different purposes. To treat Echolalia correctly, you need to know why the child is repeating or echoing.
If he does not know the correct language to use, he will treat you differently than if it is because he finds it relaxing to repeat the familiar movie lines.
For that reason, it is highly recommended that Echolalia be treated by a licensed speech-language pathologist who can find out exactly why Echolalia is used.
A combination can treat Echolalia with the following methods:
Speech therapies
Some people with Echolalia go to regular speech therapy sessions to learn how to say what they are thinking.
A behavioral intervention called a “tile-pause-dot” is often used for intermediate Echolalia. In this treatment, the speech therapist asks the person with Echolalia to answer a question correctly and tells him that he will point it out when it is time to respond.
Then the therapist asks you a question, such as “What is your name?” After a short pause, they ask the speaker to respond. They also hold a cue card with the correct answer.
Medication
A doctor may prescribe antidepressants or anti-anxiety medications to combat the side effects of Echolalia. This does not treat the condition itself, but it helps to keep the person with echolalia calm.
Because echolalia symptoms can increase when a person is stressed or anxious, the calming effect can help lessen the severity of the condition.
Home care
People with Echolalia can work with other people in the home to develop their communication skills. Online and text-based training programs help parents get positive responses from their children.
Encouraging a child to use a limited vocabulary can make it easier to learn to communicate more effectively.
Echolalia is a natural part of language development. It is not always a good idea to prevent it altogether. To avoid permanent Echolalia in children, parents should encourage other forms of communication.
Expose a child to a wide variety of words and phrases. Over time, most children can overcome their Echolalia naturally.
Here are some strategies that will help you reduce a child’s use of Echolalia, either in therapy or in conjunction with treatment.
When Echolalia is a result of poor language skills
We see children using Echolalia because they don’t have strong enough language skills to know what to say instead. This is the same reason your 1-year-old uses Echolalia.
He doesn’t know what he should say, so he repeats me. This is not a problem for a 1-year-old because it is still appropriate for him to be at that stage of development.
But if you have an older child using Echolalia, he may need a little therapy to increase his other language skills, making him less dependent on Echolalia.
Echolalia is generally not “treated” specifically if this is the case. Instead, language delays are addressed. You see what language skills the child is lacking and are taught correctly.
For example, if the child does not know enough words to be able to use them spontaneously to request, respond, etc., work will be done to develop that child’s vocabulary skills.
Associated disorders
Echolalia can indicate communication disorders in autism, but it is not exclusive to syndromes. Echophenomena (particularly Echolalia and echopraxia) were defining features in the first descriptions of Tourette syndrome (TS).
Echolalia also occurs in aphasia, schizophrenia, dementia, catatonia, epilepsy, after cerebral infarction (cerebrovascular accident), closed head injury, in blind children, children with language disorders, and certain neurotypical developing children.
Other disorders associated with Echolalia are Pick’s disease, frontotemporal dementia, corticobasal degeneration, progressive supranuclear palsy, as well as a pervasive developmental disorder.
In transcortical sensory aphasia, Echolalia is expected, with the patient incorporating someone else’s words or sentences into their response. Although these patients lack an understanding of language, they can still read.
Why are people with autism often ecologists?
Many children with autism use words (sometimes very complex and adult words), but their words are said in the same order and usually in the same tone as those they heard on a TV show, in a book, from their teacher, or some other source.
Echolalia in autism can have several purposes, or its meaning can change over time. It is also possible for a person to use Echolalia for multiple purposes simultaneously.
Some children (and adults, too) imitate the sounds of human speech without grasping the meaning behind those sounds. They can use Echolalia as a sensory outlet:
A way to calm down when anxious or to face overwhelming sensory challenges. When this is the case, Echolalia can be considered a form of self-stimulation or “acclimatization.”
Other people on the spectrum use “ready-made” phrases and scripts to communicate ideas when it is too difficult to formulate their novel speech patterns.
For many children with autism, Echolalia is an essential first step toward more typical forms of oral communication.
For example, a child with autism may repeat a teacher’s phrase (“say thank you,” for example) in precisely the same way that the teacher says, instead of saying “thank you.”
The memorized phrases can also be a tool to “speak for yourself.” For example, a child may talk through a complex process using words he has heard from parents, teachers, or on television.
Anatomical correlations
Echolalia can be the result of damage to the left hemisphere. In specific damage to the frontal lobe of the left hemisphere, it has been associated with strained Echolalia. Cases of Echolalia have appeared after lesions of the left medial frontal lobe and supplementary motor areas.
Unintentional or nonfunctional Echolalia shows similarities to the copycat behavior seen after frontal network disinhibition and is most likely related to mirror neurons.
In cases where Echolalia is a part of mixed transient aphasia, the Perisylvian language area remains intact, but the surrounding anterior and posterior association cortices undergo infarction or degeneration.
Imitation and learning
Echolalia is common in young children learning to speak for the first time. Echolalia is a form of imitation. Imitation is a practical, standard, and necessary component of social learning:
Imitative learning occurs when the “observer acquires new behaviors through imitation,” and mimicry or automatic imitation occurs when a “re-created behavior is based on previously acquired motor (or vocal) patterns.”
Ganos et al. (2012) define Echolalia as an “automatic imitation action without explicit awareness.” Children often stammer out the syllables first and finally the words they hear. For example, a baby can often hear the word “bottle” in multiple sentences.
The baby first repeats with only syllables, such as “baba,” but as his language skills progress, the child will eventually be able to say the word “bottle.” Echolalia becomes less and less common as a child’s language skills develop.
Function
In the past, Echolalia was considered a negative and nonfunctional behavior. However, researchers such as Barry Prizant and his colleagues have emphasized the communicative function of Echolalia.
Communication functions include turn, request, self-regulation, and rehearsal to aid understanding. Echolalia can be categorized as communicative (within the context and with “apparent communicative purpose”) vs. semi-functional (a “confused communicative meaning”).
The use of Echolalia in task response to facilitate generalization is an area of great promise. Research in this area is undoubtedly necessary. Marjorie H. Charlop conducted a series of homework experiments with autistic children.
The results suggest that in specific tasks (i.e., receptive labeling), Echolalia should not be eliminated but should be taken advantage of as it can facilitate acquisition and generalization for autistic children.
Tourette syndrome
Echolalia and echopraxia are hallmarks of Tourette syndrome (TS); echolalia repetitions of individuals with Tourette syndrome are mainly echoes within their own “tic repertoire.”
The evidence points to a healthy mirror neuron system (MNS) but “an inadequate mimic control mechanism, which makes them vulnerable to interference.”
Autism
It is estimated that up to 75% of people on the autism spectrum have exhibited Echolalia. A symptom of some children with autism spectrum disorder (ASD) is difficulty producing spontaneous speech.
Echolalia is most strongly associated with autism and can signify that a child has an autism spectrum disorder. However, children with other neurological, developmental, and mental health challenges may also have some degree of Echolalia.
It can be tempting to get your child to stop repeating things or panic because Echolalia seems so strange, but it’s best to realize how Echolalia can serve your child and work with that.
At the most basic level, it is an attempt at communication, not a creative effort. Still, one can work with it once one understands that it is not an attempt to be annoying or that the speaker takes it at face value.
Repetition of phrases in appropriate contexts is often a way for children to engage in conversation. It is possible to celebrate an understanding that puts those words in the right place as they work to put those messages in their own words.
Hyphens or routine repetition of phrases (as annoying as they can be) are often highly comforting for children who may find the unstructured world threatening. Use them as a sign that something is agitating your child.
And recognize that you, too, probably have some comfort activities that other people may find strange or unhealthy.
Studies have shown that, in some cases, Echolalia is used as an adaptive mechanism that allows a person with autism to contribute to a conversation when they cannot produce spontaneous speech.
Studies in the 1980s showed that there may be communicative intent with delayed Echolalia, “depending on the context in which it occurs”; this research on children with autism “raised questions related to behavior modification programs that advocated reversal or replacement of immediate echolalia.”
Uta Frith, Prizant, and others have interpreted Echolalia as evidence of Gestalt processing in children with autism, including language acquisition.
However, a 1990 study of grammar acquisition by Tager-Flusberg and Calkins found that Echolalia does not facilitate grammatical development in children with autism.
epidemiology
The incidence of neurological disorders tends to increase. The epidemiology of Echolalia points to its age appearance, so 10,000 children from 2 to 6 years old have pathology symptoms.
Such a violation in most cases is detected by early diagnosis, that is, in the early stages, which is better to correct.
Such a qualitative anomaly provokes violations in social interaction and communication.
This is due to repetitive and uncontrolled words and phrases, which makes the process of adaptation to society impossible. The disease can be accompanied by progressive mental retardation.
Pathogenesis
The development mechanism of speech behavior disorder can be associated with functional and organic changes in the brain.
Pathogenesis involves a series of processes that cause the appearance of echolalia symptoms. This can be caused by existing or transferred diseases and congenital pathologies.
Signs of the disease manifest during hyperarousal of neurons in the motor zone of the brain’s frontal lobe. This was established by transcranial magnetic stimulation.
The defect is characterized by abnormalities in the functioning of the nervous structures of the brain; complexity in the social and emotional sphere provides everyday thinking and attention.
As Echolalia can be an early symptom of autism, in some cases, there is an imbalance of inhibition and excitement, an excess of local bonds in some regions of the brain, and other pathologies.
Echolalia in normal child development
As you can guess from the echo at the beginning of the word, Echolalia involves the repetition of words or phrases. Your child can repeat something immediately after saying it, or he can store it for later use.
Delayed Echolalia can involve short phrases, often used in the appropriate context but with the exact intonation of the source, or extend into long scripts of favorite TV shows and movies.
Echolalia is a normal part of childhood development: As young children learn to speak, they imitate the sounds they hear.
Over time, however, a typically developing child will begin to use language to communicate wants, needs, and ideas, by putting sounds and words together in novel ways.
When they are three years old, most children (even if they have memorized snippets from television shows) communicate with others by selecting words or making sentences using their unique voices and intonation.
By the time they are four or five, they can ask and answer questions, have conversations, and otherwise use language to communicate with others.
Recording the world around them
Another beneficial aspect of Echolalia is that your child may repeat phrases heard at school or in other places outside the home where he doesn’t have an ear to listen to. Those repetitions can offer a pleasant record of your child’s day or an early warning of problems.
