Echopraxia: Characteristics, Symptoms, Causes, Diagnosis and Treatment

It refers to the involuntary repetition of the movements of another person.

You may have heard of echolalia , the tic that many people with autism have that involves repeating words and strings of words borrowed from sources like TV shows and other people and used out of context.

Ecoppraxia (also known as acoquinéis ) is the involuntary repetition or imitation of the actions of another person. Similar to echolalia, the involuntary repetition of sounds and language is one of the ecophenomena (automatic imitation actions without explicit awareness).

It often appears in conjunction with Echolalia, but can appear on its own. The concept of echopraxia can also be confusing, because neurotypical children also mimic the actions of others, as part of natural socialization.

Echopraxia is generally not diagnosed before age three because of the difficulty of distinguishing between echopraxia and behavior that is part of socialization.

The difference, however, is that echopraxia is involuntary and repetitive, often interfering with social function and causing difficulties in relationship building.

It has long been recognized as a central feature of Tourette syndrome , and is considered a complex tic, but it also occurs in autism spectrum disorders, schizophrenia and catatonia, aphasia, and disorders involving the startle reflex, such as Latah.

Ecopraxia has also been observed in individuals with frontal lobe damage, epilepsy, dementia, and autoimmune disorders; the causes and the link between echopraxia and these disorders is undetermined.

The etymology of the term is from the classical Greek: «ἠχώ (ēkhō) of ἠχή (ēkhē» sound) and »πρᾶξις (praksis, action, activity, practice).

Characteristics and symptoms of echopraxia

Echopraxia is the involuntary reflex of an observed action. Imitated actions can range from simple motor tasks like picking up a phone to violent actions like hitting another person.

Imitative learning and the emulation of physical and verbal actions are essential for early development (up to the age of two or three), but when these behaviors become reactions rather than a means of learning, they are considered ecophenomena (behaviors copy).

Ecoppraxia often appears in people with autism, schizophrenia, Tourette syndrome, and other mental disorders. It can also occur due to brain disease or brain injury, particularly in the frontal lobes.

Some researchers theorize that abnormalities or damage to mirror neurons in that area of ​​the brain causes echopraxia.

A person with echopraxia may imitate the face made by a friend or family member, try to walk like their favorite TV character, or do the same hand and arm gestures as their teachers.

Often individuals will take part in these actions in contexts that do not seem to make any sense.

Ecoppraxia can be puzzling to those who see it and don’t know what it is, as repeated actions are often taken from a completely different context and used in a way that doesn’t make sense to most neurotypical people.

Echopraxia and tics

Like other tics, echopraxia is a repetitive movement that involves separate groups of muscles. It differs from a twitch, which involves the same muscle or muscle group.

People often unconsciously mirror the body language and movement of others. Consequently, echopraxia may be less noticeable than some other tics.

However, tic can cause great distress to the person experiencing it and, depending on the severity of the echopraxia, it can interfere with social relationships and normal functioning.

Echopraxia may seem deliberate, because tic is highly complex and generally requires mimicking several types of behavior at the same time. However, people who experience this condition have no control over the tic.

Echopraxia and Tourette syndrome

The condition of echopraxia is one of the common motor tics experienced by people with Tourette and Latah syndrome, a condition similar to Tourette syndrome that occurs in people living in Southeast Asia.

The main characteristic behavior of Latah is exaggerated startle, but people with Latah also experience other behaviors, including tics such as echopraxia.

Causes and pathophysiology of echopraxia

Echopraxia is a typical symptom of Tourette syndrome, but the causes are not well understood. Both echopraxia and echolalia are caused by brain injury, brain disease, and / or brain dysfunction.

A theoretical cause subject to ongoing debate surrounds the role of the mirror neuron system (MNS), a group of neurons in the lower frontal gyrus (F5 region) of the brain that can influence imitative behaviors.

For example, echopraxia is known to occur after damage to the frontal lobes of the brain. “Where medical information is easy to understand.” The frontal lobe is an area of ​​brain tissue located in the front of the brain on both sides.

This part of the brain contains areas with mirror neurons, which are nerve cells that fire when we perform an action and when we witness another person perform the same action.

It has been theorized that abnormalities with the reflected nervous system can lead to echopraxia, but this has not been proven.

Ecoppraxia is common in Tourette syndrome, which is an inherited disorder that begins in childhood and consists of multiple motor tics and at least one vocal tic. A tic is a sudden, repetitive, and non-rhythmic movement or sound.

Ecoppraxia is also present in various autoimmune disorders. An autoimmune disorder is one in which a person’s organs or tissues are mistakenly attacked by their immune system (defense system).

Echopraxia is known to occur in some cases of epilepsy (recurrent episodes of seizures).

A seizure is an over-excited state of nerve cells in the brain, sometimes causing sudden, violent and involuntary contractions of a group of muscles and / or manifestations of decreased awareness of the environmental environment.

Ecopraxia is known to occur in cases of dementia.

Dementia is a progressive loss of cognitive and intellectual functioning without loss of consciousness. Ecoppraxia can also occur in patients who have brain tumors. Tumors are abnormal masses of tissue that form when cells in a certain area of ​​the body reproduce at a higher rate.

Ecoppraxia is known to occur in mood disorders, such as major depressive disorder. It is also known to occur in Ganser syndrome.

Ganser syndrome is a psychological problem in which a person provides non-sensitive or incorrect answers but often close to the correct answer.

Ecoppraxia can occur in autism and related disorders.

Autism (autistic disorder) is a type of neurodevelopmental disorder that causes deficits in social interaction, deficiencies in communication, and restricted, repetitive, and stereotyped patterns of behavior, interests, and activities.

Echopraxia can occur in schizophrenia, especially in the form that occurs with catatonia. Schizophrenia is a type of mental disorder in which one loses contact with reality.

The catatonia is a condition characterized by lack of movement, decreased responsiveness, stiff muscles and agitation.

But no widely accepted neural or computational models have been presented to describe how mirror neuron activity supports cognitive functions such as imitation.

Other causes of echopraxia

This tic can also occur with autism and catatonic schizophrenia, a type of schizophrenia characterized by extreme behaviors. It also appears in people who experience neurological conditions such as aphasia and dementia.

Those with head injuries, tumors, or epilepsy may also experience echopraxia.

Tic is known to occur during brief periods of extreme anxiety, especially in people with conditions that cause echopraxia, who may be more likely to exhibit echopraxia during periods of stress.

Diagnosis of echopraxia

Echopraxia is diagnosed by a healthcare provider through observation of behavior.

There is no formal test to diagnose echopraxia. It is easier to distinguish in people over the age of five, because younger children often imitate the actions of others.

Imitation can be divided into two types : imitative learning and automatic imitation. Imitative learning occurs when a person consciously imitates an observed action to learn the mechanism behind that action and perform it himself.

Babies begin to copy movements shortly after birth; this behavior begins to decline around the age of three.

Before that, it is not possible to diagnose echopraxia, because it is difficult to differentiate between imitative learning and automatic imitation. If the imitative behavior continues beyond infantry age, it may be considered echopraxia.

Some involuntary imitative behaviors are so widespread (eg, imitative yawning) that they are considered normal rather than labeled as echopraxia. Voluntary imitative behaviors (for example, imitating someone to annoy the person) are not echopraxia.

Ecoppraxia can be more easily distinguished in older individuals, because their behaviors relative to previous behaviors can be differentiated. They report feeling an uncontrollable urge to take an action after seeing it done.

Automatic behavior is occasionally present in healthy adults (for example, when a person observes someone yawning, they can do the same); these behaviors are not considered echopraxia.

Treatment for echopraxia

There are no formal tests for echopraxia, and there are several possible causes, so most doctors will observe the patient’s behavior and try to determine the cause before deciding on a treatment.

Behavior modification, medication, and psychotherapy are used in some cases to treat echopraxia.

However, when this behavior is not physically harmful and does not cause a disruption in the person’s education or other important aspects of his or her life, it can be left untreated.

Doctors generally try to understand the underlying cause of echopraxia before starting treatment. The condition is identified by observing the behavior of the person in question, rather than by formal testing.

Because intentional imitated behavior in children can be difficult to distinguish from the involuntary behavior that characterizes tic, the condition is not diagnosed in children younger than 3 years old.

Treatment is directed at the condition causing the echopraxia and may include behavior modification, medications, and psychotherapy.

Ways to Help Your Child Cope with a Language Disorder

Many people with echopraxia have a fantastic understanding of language in terms of grammar, spelling, and syntax, but have difficulty using language in particular settings.

Language impairment can present itself in different ways in people with echopraxia, including the ways they use language and the way they understand other people’s language.

It is common for parents and guardians to feel helpless when it comes to a language disorder and constantly worry about how others will perceive and treat their children because of their behavior.

But it is important for you to know that there are some steps you can take to help your child use language more appropriately and fit in better. Here are just a few tips you can use to get started:

Discuss the appropriate language for different situations

Some people with echopraxia who struggle with language impairment compensate by being very capable of memorizing the rules. You can make use of this skill by being more explicit in your teaching methods.

Your child may not be able to learn language skills simply by watching and listening to other people, but you can teach your child about language through more structured conversations.

Talk with your child about a wide variety of made-up and real-life situations and what is okay or wrong to say in those situations. Be specific:

  • Who is it okay to say these things to?
  • When is it okay to discuss these topics?

Set rules along the way that your child can understand and apply to real life (you can write them down to help him follow them). These rules can be adjusted and added over time as you and your child learn.

Role-playing games to practice

Practice makes perfect! Once your child has a few ground rules under his belt, you can start by practicing creating mock dialogues or role plays and asking your child to respond appropriately to what you have said.

If you’re not the creative type who can come up with scenarios on your own, keep an eye out for real-life situations (good or bad) that you can recreate with your child later and practice appropriate conversations.

Once you start to see a significant improvement in your child’s ability to respond appropriately to what someone tells you, try asking your child to come up with more than one possible response appropriate to each situation.

This will help develop an understanding that there is always more than one acceptable way for a conversation, as long as it stays within the confines of social norms.

Encourage Your Child to Suppress What He Said

You can also provide an appropriate language model in your own speech when responding to a child.

If your child says the wrong word or uses the wrong grammar, you can respond and rephrase the desired message instead of making them feel like you’ve failed by focusing on the errors in the message.

So instead of responding with “No, that’s not what you mean,” you can try “Did you mean _____?”

Or try an even more positive approach. If your child says, “I went to the park with Dad,” you can say, “Yes, you went to the park with Dad.” You had fun? “This will allow your child to feel like they are being heard and to learn language without feeling punished for saying the wrong thing.