What is Echolalia?: Its Purpose and What It Means

 

Echolalia is a natural part of language acquisition. “It’s a beautiful day!” said the mother, to which the child echoed “It’s a beautiful day!” Have you ever wondered why this happens? What is it? Are there different types? If it’s a natural part of language acquisition why is it always related to Autism? Does it happen in other disorders? In this article, you will find everything you need to know about echolalia, types, purposes, what happens in the brain and much more. 

Echolalia

Echolalia

What is Echolalia?

The word echolalia comes from the Greek word “echo” meaning echo and “lalia” meaning speech. This refers to the unsolicited repeating of the same words or phrases that someone else has said. It’s automatic and effortless almost a type of imitation similar to what parrots do.  It is part of normal language development but like all child development stages, it has a beginning and an end.  Children who are learning to speak use this type of mimic to communicate. They use it because they haven’t yet obtained or developed all the vowel and/or consonants needed to pronounce an entire word. Mimicking these sounds can help them experiment and develop language. For example, if you ask a one-year-old child “Do you want a cookie?” he might repeat “cookie” or “ooki”. He doesn’t say yes yet, however, he is communicating he indeed does want the cookie by echoing the answer. As they advance in age, so does their language and vocabulary, therefore, the use of echoing or repeating declines.

See more about the Piaget Theory on childhood development

Echolalia is a normal part of development around 1-2 years old because that’s when children are learning to communicate. Around 2 years old, children will start using more complex ways of communicating and they might only use echoing when complex questions are asked, however, they shouldn’t only be using imitated speech to talk anymore. They should be using their own remarks and expressions to communicate. By the age of 3, echolalia should be minimal to nonexistent. Children at this stage are capable of expressing their own thoughts through simple sentences in order to communicate with the world around them.

If a child doesn’t move pass the echolalia stage, it might be a delay in language skills, therefore the child relies mainly on echolalia to communicate. If this is the case, the child needs to be evaluated by a speech therapist in order to pinpoint the cause and treat the language delay.

Language delays, particularly echolalia, can be associated with different disorders, including autism, Tourette’s, dementia, etc. which we will mention later in this article.

Types of Echolalia

  • Immediate echolalia: This refers to repeating the words someone has just said; it can be a word, a phrase or an entire sentence. For example, asking a child “Are you hungry” the child might answer “hungry” however it might not be possible to tell if he is really hungry or not. The same happens, for example, when you ask “Do you want ice-cream or cake?” the child might answer “cake” but will be very disappointed when he receives it if he didn’t want it. Immediate echolalia can lead to frustration and meltdowns because the child is unable to communicate his needs and desires.
  • Delayed echolalia: This is repeating sentences, words or phrases after a certain time has passed, that range from hours to years laters. The most common are usually from TV shows, video games, books or movies. This type is difficult to recognize since it happens sometime after, and the listener might have forgotten or not have been there when the original word or sentence was uttered. Unless the echolalic speaker’s syntax, vocabulary, and message is different the listener may not even notice the delayed echolalia.

These types of echolalia can have symptoms such as:

  • Mitigated echolalia: Is the repetition when the original stimulus is somewhat altered. For example, pronoun changes in the repetition, “What are you eating?” and the person responds “What am I eating?”.
  • Ambient Echolalia: refers to repetition of random environmental stimuli and not speech. This is most common in people with dementia and aphasias.
Purpose of echolalia

Purpose of echolalia

Purpose of Echolalia

All forms of communication have a purpose this is divided into two forms:

Interactive echolalia: refers to imitating the structure of the interaction, even if the words are wrong. So when children are learning to communicate they repeat what the adult is saying to mimic taking turns as if in a normal conversation. This way the child learns to practice taking turns in a conversation. This type of purpose is used to buy time or assist with speech processing. For example, repeated unexpected questions when you are thinking of an answer. “Do you want some cake?” and echoing “Do I want some cake?, yes please.” The tone in the second question has a clear query intonation and allows for the listener to understand the person is questioning themselves.  

Non-interactive echolalia: this refers to repeating sentences and words as self-regulation, self-direction, stimming or rehearsal. Let’s review the different types:

  • Self-regulation/Self-direction: repeating a word or a phrase to remember task. For example, your partner asks if you can go to the supermarket to “buy tomatoes, kale and cucumber” and on your way you repeat “tomatoes, kale and cucumber” as a way of remembering everything. Self-regulation is when an acute stress situation is happening and someone says “it’s okay”, we tend to repeat it in order to calm down and keep it together.
  • Stimming: This refers to repeating what someone has said in a fun, witty way in order to remember it. Stretching the words or transforming them into songs in order to retain the information is a way of unfocused echolalia.
  • Rehearsal: This refers to social scripts that we hear from other people. For example, asking someone what would they say in a given situation and later memorizing their words and using them.

Echolalia and the brain

Nonfunctional or non interactive echolalia seems work similar to imitation therefore scientists think it’s related to our mirror neurons. However, research shows that more serious echolalia is the result of damage to the left hemisphere frontal lobe. Even though there are many brain parts involved some cases specifically have appeared with injuries on the left medial frontal lobe and supplemental motor areas. In aphasia, it is related to surrounding anterior and posterior association cortices suffering from infarction or degeneration.

Echolalia and different disorders

Autism

Echolalia is most commonly associated with autism. Autistic children tend to use immediate and delayed echolalia. Researchers believe that the immediate type is commonly used because these children still haven’t been able to develop language process of their own and cannot produce their spontaneous speech to express their thoughts and feeling, therefore they repeat what they hear. On the other hand, children with autism use the delayed type for other purposes Some of them:

  • Self-stimulation: Autistic children tend to use echolalia to entertain themselves with things they are interested in, and this also serves a purpose of keeping them from social interactions. Caretakers can use this to redirect the behaviour into a more constructive one. Examples of self-stimulatory behavior are children who repeat the favorite part of books, videos, etc.
  • Communicating the Mood: Since autistic children haven’t yet developed spontaneous language they associate language given to them at certain times with emotions and later use these sentences or words to express the emotion. For example, a mother tells his son he can’t watch his favorite show because the “TV is broken”, the child is visibly sad. Days later the mom tells the same child that “daddy is going on a work trip” and the child answers the “TV is broken”. He is communicating that he is sad that his father is going away even though he can’t say the correct words. The same happens with feelings of joy and happiness, they associate words to the feelings and later repeat the same words to express the emotion. When this happens the important thing to do is to redirect emotions, for example, “I know you are sad but daddy will be here soon.” Children under stressful situations tend to become more echolalic due to the pressure of communicating their feelings.
  • Processing Memories: this refers to using echolalia in order to process memories that come to the surface of their mind. For example, children after school might remember something their teacher said (“Billy wash your hands after finger-painting”) and might repeat it in order to organize and manage the memories.  

Autistic children also use non-interactive echolalia, particularly for self-regulation and self-direction. If an autistic child has a had time self-regulation it can lead to meltdowns, so don’t miss our article on how to calm down a child with autism.

Echolalia and other disorders

Echolalia and other disorders

Aphasia

Aphasia is related to brain damage where the person cannot understand spoken or written speech and language function deteriorate quickly. Due to these symptoms, the person tends to repeat everything he hears. In transcortical aphasias, echolalia is very common when deterioration starts happening. However, in perisylvian aphasias, echolalia tends to appear in recovery after a stroke, which may have the same function as in children learning to speak.

Dementia

Brain injury and/or brain disease can have many consequences including dementia. Dementia is a chronic disorder of the mental process including memory. They tend to have impaired reasoning. Since they have memory loss and comprehensive loss capacity they can no longer produce spontaneous speech, leading to echolalia.

Epilepsy

Epilepsy is characterized by seizures and on occasions, people with epilepsy after losing consciousness can wake up to have echolalia.

Echolalia and Schizophrenia

Schizophrenia is a chronic and severe mental disorder. Due to it’s psychotic symptoms, where reality is not differentiated from delusions or hallucinations, people might have delayed echolalia from things they hear, hours, days or even years later.

Tourette’s Syndrome

Another common syndrome with echophenomena (echolalia and echopraxia) is Tourette’s. The person involuntarily tends to repeat whatever they listen to. This can be frustrating because it’s hard for the person to control what they say and when they say it.

Quick Tips

As you can see, echolalia is more common than you think and it doesn’t only happen in autism. The important things to keep in mind is that echolalia has a purpose and many of us might use it at certain times.

  • If your child has echolalia, make sure what child developmental stage he/she might be in. If there is a delay, visit a speech therapist or a specialist that can start helping them develop their own language.
  • Each disorder mentioned above has its own characteristics so it’s important to visit a physician and/or specialist to know what treatment options are available. 

 

Hope you enjoyed this article! Feel free to leave a comment below 🙂 

References

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Carr EG, Schreibman L, Lovaas OI. Control of echolalic speech in psychotic children. J Abnorm Child Psychol. 1975;3(4):331–351.

Christman, S. S., Boutsen, F. R., and Buckingham, H. W. (2004). Perseveration and other repetitive verbal behaviors: functional dissociations. Semin. Speech Lang. 25, 295–307. doi: 10.1055/s-2004-837243

Lebrun, Y., Rubio, S., Jongen, E., and Demol, O. (1971). On echolalia, echo-answer, and contamination. Acta Neurol. Belg. 71, 301–308.

López-Barroso, D., Torres-Prioris, M. J., Roé-Vellvé, N., Thurnhofer-Hemsi, K. J., Paredes-Pacheco, J., et al. (2017). “A reappraisal of echolalia in aphasia: A case-series study with multimodal neuroimaging,” in Presented at the XXXV European Workshop of Cognitive Neuroscience. Bressanone.

Rutter M. Diagnosis and definition of childhood autism. J Autism Child Schizophr. 1978 Jun;8(2):139–161.

Vicker, B. (2009). Functional categories of immediate echolalia. Bloomington, IN: Indiana Resource Center Autism.

Vicker, B. (1999). Functional categories of delayed echolalia. The Reporter, 4(2), 7-10.

Wang, K. (2012). Friendshipcircle. http://www.friendshipcircle.org/blog/2012/04/18/what-you-need-to-know-about-echolalia/

Wikipedia, Echolalia. https://en.wikipedia.org/wiki/Echolalia

 

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.