What is Echolalia?
The term ‘echolalia’ comes from Greek origins, with “echo” meaning “to repeat” and “lalia” implying “speech.” This term is also known as ‘echophrasia.’ Echolalia refers to the automatic and uncontrollable feature of repeating what others say without any prompting. This behavior happens effortlessly and is quite widespread. However, it’s a normal aspect of language development in young children, known as toddlers.
What Causes Echolalia?
Echolalia is a term often used to describe a speech behavior frequently found in children who have Autism Spectrum Disorder (ASD), which makes someone automatically repeat what they hear. It was first observed and documented in 1943 by a researcher named Kanner, who noticed this trait in eleven children with autism.
However, echolalia is not only found in children with autism. It has been noted in several other health conditions too. These include:
– Aphasia: A condition that affects a person’s ability to communicate.
– Autoimmune disorders: Illnesses that happen when the body’s immune system attacks healthy cells.
– Closed head injury: A type of head injury that doesn’t break the skull.
– Congenital blindness: Being born without sight.
– Cortico-basal degeneration: A progressive neurological disorder.
– Delirium: An abrupt change in the brain that causes mental confusion and emotional disruption.
– Dementia: A general term for loss of memory, language, problem-solving, and other thinking abilities.
– Encephalitis: Inflammation of the brain, often caused by a viral infection.
– Primary familial brain calcification: A disorder characterized by abnormal deposits of calcium in the brain.
– Gilles de la Tourette syndrome: A disorder that involves repetitive movements or unwanted sounds.
– Intellectual disability: Difficulty with intellectual functioning and everyday skills.
– Language delay: A delay in the acquisition of language.
– Latah reaction/phenomenon: A condition characterized by various abnormal behaviors.
– Pick disease and Frontotemporal dementia: Types of dementia that cause cell damage and brain tissue shrinkage.
– Progressive supranuclear palsy: A disease that affects movement, balance, speech, thinking, behavior, and vision.
– Schizophrenia: A mental disorder characterized by hallucinations, delusions, and cognitive difficulties.
– Stroke: A sudden interruption in the blood supply of the brain.
– Confusional states: Mental states where a person has trouble paying attention, remembering, and making decisions.
– Postepileptic status: A state of ongoing seizure activity.
Risk Factors and Frequency for Echolalia
The number of people who experience echolalia is hard to determine because it appears in many different health conditions. Importantly, echolalia can also be a normal part of language development in toddlers. Among children with Autism Spectrum Disorder (ASD), about 75% show signs of echolalia.
Signs and Symptoms of Echolalia
Echolalia is a condition where patients repeat speech immediately or sometime after it has been spoken. Though it was previously thought to be a meaningless speech disorder, modern research suggests that echolalia can actually serve a communication function. Echolalia can be classified in several ways. It is important to note that as the language and comprehension skills of a child with autism improve, the child may start to change the speech or intonation instead of just repeating it, which is known as mitigated echolalia.
- Immediate echolalia: This refers to the repetition of speech immediately after it has been uttered.
- Delayed echolalia: This refers to the repetition of speech sometime after it has been uttered.
- Unmitigated echolalia: This refers to exact repetition of speech.
- Mitigated echolalia: This refers to repeating speech but in an altered form.
- Ambient echolalia: This is when patients repeat words or sentences from their surroundings, like from the TV, or repeating names of objects like “bike”, “car”, or “fan”.
- Echoing approval: This happens when patients repeat speech in positive or negative tones, often responding to questions instead of just repeating sentences. Sometimes, they may even respond to questions that weren’t directed at them.
Testing for Echolalia
Echolalia is a term that describes the process of repeating or copying words and sounds – a fundamental way kids learn to talk. This mimicking behavior is most common in toddlers and generally fades as their language abilities grow. However, if this repetition continues or reappears after the age of three, it could indicate a speech disorder.
Marge Blanc, a practiced speech-language therapist, introduced six steps for tracking language development in children with autism.
1. Stage 1: Unchanged echolalia – Kids copy full sentences or phrases. For instance, they might repeat phrases like “Let’s get out of here,” “Want some more?”, “Are you okay?”
2. Stage 2: Adjusted Echolalia – Children start to break down sentences into smaller parts and rearrange them. For example, “Want out of here.”
3. Stage 3: They begin to isolate single words and mix and match these to make two-word phrases like, “Get more,” or “Want out.”
4. Stage 4: The child creates their first simple sentence, like “I get out.”
5. Stage 5: The child starts crafting more complex sentences using grammar rules. For instance, they might say, “I want to get out.”
6. Stage 6: The child generates even more complex sentences with advanced grammar such as, “How long do you want to play outside?”
There exist several tools to help assess the level of repetition in children with echolalia.
Treatment Options for Echolalia
Echolalia is a condition where an individual repeats what they have heard. The treatment for echolalia depends on its cause. When it’s associated with autism, a team approach is required. Parents, specialists in brain development, therapists, psychologists, and special educators work together to help the child. Key to managing echolalia in children is understanding why they’re repeating sentences or phrases, what they mean by it, and responding in a way that will help them communicate better. It’s important for caregivers to observe, listen, and wait during the child’s interaction, as this can provide clues to understand the echolalic speech. Ideally, responses to the child should be expressed in a way that the child would use if they could.
A speech-language pathologist, a specialist who assesses, diagnoses, and treats disorders involving speech, language, and swallowing, plays a major role in treating echolalia in children with autism. Several techniques may be used to manage echolalia in these children, such as cues-pause-point training, script training, visual cues, verbal modeling, self-monitoring training, and rewarding appropriate responses.
Similar to autism, echolalia can be also be a symptom of aphasia, a language disorder that affects a person’s ability to communicate. In this case, interventions like constraint-induced aphasia therapy might be used. Music therapy has also been shown to be beneficial in treating echolalia.
Older children, whose echolalia may be triggered by stress and anxiety, could be given medications. Medications such as selective-serotonin reuptake inhibitors, which are commonly used in treating depression and anxiety, have been used in treating echolalia that appears after stroke.
What else can Echolalia be?
Echolalia is a behavior where a person repeats what they hear. It’s not voluntary, it just happens automatically and effortlessly. Alongside echolalia, there are several other reflex behavior in the same category, these can be actions that stem from watching other people’s behavior, or repeating your own actions or words. Examples include:
- Echopraxia (involuntary repetition of others’ movements)
- Echolalioplasia (repeating sign language)
- Echomimia (copying facial expressions)
- Echographia (writing down what someone has said)
- Coprolalia (repeating obscene or inappropriate words)
- Klazomania (compulsive shouting)
- Palilia (repeating one’s own words)
Echolalia can be a symptom of various conditions, so careful examination is needed to identify the specific cause.
- Autism Spectrum Disorder: Certain studies have found out that children with autism may use echolalia as a way to communicate when they can’t generate their own speech. Autism Spectrum Disorder includes a range of conditions that are typically characterized by problems with social interaction and communication, and by limited and repetitive patterns of behavior.
- Gilles de la Tourette Syndrome: This is a neurological disorder often identified by multiple involuntary movements and vocal sounds, called tics. Echolalia, coprolalia, and echopraxia are some particular symptoms of this disorder, which can vary greatly in severity and can also be associated with other behavioral and mental disorders. Cognitive-behavioral therapy is usually the first step in treatment, but medication may be required if it is not effective.
- Stroke: Echolalia may be observed in adult patients after a stroke. In these conditions, known as transcortical motor aphasia, advanced imaging techniques can show increased activity in certain areas of the brain.
What to expect with Echolalia
In the past, echolalia – the unconscious repetition of words or phrases spoken by another person – was thought to be meaningless and stereotypical behavior. However, recent research suggests that it can actually be a way for people to cope with difficulties they are having in learning language. It is now seen as a positive sign that could indicate potential improvements in future language development.
Echolalia can serve a variety of functions. These include taking turns in a conversation, making statements, asking for something, managing oneself, practicing speech, associating with a situation, drawing attention, confirming something, completing a sentence, labeling in an interactive manner, and giving directions. As such, echolalia can be helpful in furthering language acquisition and generalization.
Possible Complications When Diagnosed with Echolalia
Echolalia, a symptom often seen in people with Autism Spectrum Disorder (ASD), can make social interactions and learning challenging. It can also make forming and maintaining relationships difficult.
For children with ASD specifically, echolalia can lead to a range of problems, including:
- Aggression, anxiety, and depression
- Increased stress for caregivers and potential family conflict
- Difficulty learning and decreased performance in school
- Victimization by peers
- School absenteeism
- Social isolation due to bullying and non-acceptance by peers
Preventing Echolalia
The involvement of parents is very important in dealing with echolalia (uncontrolled repetition of spoken words) and speech disorders often seen in autism and other brain-related disorders. Individualized education programs are useful tools to help patients and parents understand more about echolalia, related conditions, and what to expect in terms of outcomes. Doctors generally suggest the specific methods and treatments to use.
It’s also helpful for your child’s doctor to provide resources such as informative websites. This not only offers more information but also connects parents to support groups where they can interact with others facing similar challenges.