Echolalia: Definition, Signs, Symptoms, Causes, Treatment and Associated Disorders

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 automatic 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 a great 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 really 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 (some time after the appearance of a stimulus).

Immediate echolalia results from 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 be indicative of 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 that they have fully heard the original statement.

The researchers looked at the daily repetitions of a six-year-old autistic in order to examine the differences between the triggers for delayed versus immediate echolalia.

Researchers further distinguish immediate echoes by the sequential context in which they occur: after corrections, after directives, or in indiscernible sequential positions.

Delayed echoes are distinguished by their property: autoechoes, other echoes, 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 a large selection of underlying meanings and behaviors between and within subjects.

Mitigated echolalia refers to a repetition in which the original stimulus is somewhat disturbed, and environmental echolalia refers to the repetition (which typically occurs in individuals with dementia) of environmental stimuli 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 repeating “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 hospital complaining of headaches and meningitis; however, it also showed signs of environmental echolalia.

The researchers stated that the young patient’s repetition was occurring at approximately the same time as his normal speech rate. The patient did not simply repeat the words he had heard one after another.

The patient reported that his environmental echolalia appeared to be random, but it appeared when he was distracted. She was also aware of her echolalia, but said she can’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 are echoing 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 useful 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 non-functional echo of the actual words in a logical order can be very misleading to parents, as it appears their child is using meaningful language when that is not really 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 line on television, such as “Do you have milk?” and then when she’s thirsty, she can say “did you get milk?” exactly the same tone and accent as the TV ad.

Again, in this case, the child is using the memorized or repeated phrase, but this time he is using it in a functional way. He is ordering a drink, and his order is understood, but he does not think of his own 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 properly because the individual is struggling to express their own thoughts. An example would be, 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 language. Echolalia is not a motor tic or verbal tic and is very different from Tourette syndrome, which can include uncontrollable verbal tics as a symptom.

Repetitive speech is a very common 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 along with 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, especially if speech development is delayed.

Echolalia also occurs in aphasia, schizophrenia, dementia, catatonia, and epilepsy; after a cerebral infarction (cerebrovascular accident) and a closed head injury; in blind children, children with language impairments, as well as in certain developing neurotypical children.

Echolalia can also be associated with forms of dementia (Pick’s disease and frontotemporal dementia), progressive supranuclear palsy, corticobasal degeneration, as well as a pervasive developmental disorder.

Rather, persistent speech is the persistent repetition of speech or questions that can be used in both 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 “hypercenter” 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 be a feature of frontal lobe injuries and other conditions that involve dysfunction or dysregulation within the frontal lobe.

This is especially true when there is 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 1 year and between 3 and 4 years.

It is in these age ranges that 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.
  • Defeat of the frontal lobes of the brain.
  • Mental retardation.
  • An autistic disorder.
  • Thurret syndrome.
  • Imbecility.
  • Schizophrenia.
  • Rett syndrome.
  • Brain cancer
  • Dyslexia .
  • Dysphasia.

Any of the above disorders can be diagnosed in children, so when it comes to echolalia in adults, they involve unidentified violations in childhood. 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 certain range of emotions and associations. If such images appear too often and are wrong, then this becomes a communication problem.

Emotions in the communication process: echolalia acts as an indicator of the patient’s mood, since repeated phrases have emotional images.

Information processing and ordering: repeating what has been heard, the patient classifies the events that happened, shares this information and emotions with others.

Regardless of the age of the patient, 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 the realization of what has been said.

Until 4 years of age, automatic repetition of words for others is normal. But in the elderly, this symptom requires medical attention, as it indicates a serious pathology.

In medical practice, very often there are 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 it is because 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.

Echolalia can be treated by a combination of 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 answer.

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 are available to help parents get positive responses from their children.

Encouraging a child to use a limited vocabulary can make it easier for them to learn to communicate more effectively.

Echolalia is a natural part of language development. It is not always a good idea to prevent it completely. 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.

With that said, here are some strategies that will help you reduce a child’s use of echolalia, either in therapy or in conjunction with therapy.

When echolalia is a result of poor language skills

The most common reason we see children using echolalia is 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 who is using echolalia, he may need a little therapy to increase his other language skills, making him less dependent on echolalia.

If this is the case, echolalia is generally not “treated” specifically. Instead, language delays are addressed. You see what language skills the child is lacking and are taught in the correct way.

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 be an indicator of 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, as well as in certain neurotypical developing children.

Other disorders associated with echolalia are Pick’s disease, frontotemporal dementia, corticobasal degeneration, progressive supranuclear palsy, as well as pervasive developmental disorder.

In transcortical sensory aphasia, echolalia is common, with the patient incorporating someone else’s words or sentences into their own response. Although these patients lack understanding of language, they are still able to 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 your teacher, or from some other source.

Echolalia in autism can have one of several purposes, or its purpose can change over time. It is also possible for a person to use echolalia for multiple purposes at the same time.

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 facing overwhelming sensory challenges. When this is the case, echolalia can be thought of as 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 for them to formulate their own novel speech patterns.

For many children with autism, echolalia is an important 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 exactly 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 himself through a difficult process using phrases he has heard from parents, teachers, or 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 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 who are learning to speak for the first time. Echolalia is a form of imitation. Imitation is a useful, normal, 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 non-functional 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 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 certainly necessary. Marjorie H. Charlop conducted a series of homework experiments with autistic children.

The results suggest that perhaps in certain 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 be considered a sign 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 to panic because echolalia seems so strange, but it’s best to realize the purposes that echolalia can serve your child and work with that.

At the most basic level, it is an attempt at communication, not a particularly clever attempt, but one that one can work with once one understands that it is not an attempt to be annoying, or that the speech takes it at face value. .

Repetition of phrases in appropriate contexts is often a way for children to engage in conversation, and 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 extremely 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 for 10,000 children from 2 to 6 years old they have symptoms of pathology.

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 mechanism of development of the speech behavior disorder can be associated with functional and organic changes in the brain.

The pathogenesis involves a series of processes that cause the appearance of echolalia symptoms. This can be caused by existing or transferred diseases, congenital pathologies.

Signs of the disease manifest during hyperarousal of neurons in the motor zone of the frontal lobe of the brain. 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 normal 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 certain areas 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 original source, or extend into long scripts of favorite TV shows and movies.

Echolalia is actually a normal part of childhood development: As young children learn to speak, they imitate the sounds they hear.

Over time, however, a typical developing child will begin to use language to communicate wants, needs, and ideas, by putting sounds and words together in novel ways.

By the time 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 own unique voices and intonation.

By the time they are four or five, they can ask and answer questions, have conversations, and otherwise use language in their own way to communicate with others.

Recording the world around them

Another often helpful 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 hear. Those repetitions can offer a pleasant record of your child’s day or an early warning of problems.

Keep in mind, however, that your child may also be repeating things heard at home in appropriate contexts at school, so if you’re going to have an angry tirade about a teacher, you might want to do it out of earshot. of his son.