Psycholinguistics & Neurolinguistics

Echolalia and its causes and related disorders

Echolalia and its types

Echolalia

The term “echolalia” is used to refer to the involuntary repetition of words spoken by other people . It is a characteristic symptom of different psychological disorders, both organic and functional, such as autism, aphasia and schizophrenia.

The repetition may consist of a single word or, conversely, very long messages; Sometimes not only words or phrases are repeated, but monologues, conversations or entire songs. When the person imitates herself instead of others we talk about palilalia.

Echolalia is a eco fenómeno , ie, an imitative behavior that occurs without conscious control. Two other very common eco-phenomena are ecopraxia, in which actions or gestures of others are repeated, and ecomimia, consisting of the imitation of facial expressions.

The origin of this speech disturbance is found in another major pathology, with echolalia being a symptom of other diseases such as  Autism Spectrum Disorders (ASD) , Tourette’s syndrome , aphasia , schizophrenia , dementia , epilepsy , a brain injury…

Human beings learn to speak by imitation repeating what we hear in our environment, but if a child from 30 months of age, on average, continues to maintain this pattern, it is necessary to consult with a language specialist such as the speech therapist , to rule out that what they are producing are ecolalias, since after three years it is considered a pathology.

Consequently, the diagnosis of ecolalia will always be associated with the diseases mentioned above and, in the absence of these, when a child over three years of age maintains this type of repetition, it can be a simple language delay .

The ecolalias are characterized not only by the imitation of words or phrases, but by the prosody (intonation and articulation) that the affected person uses while repeating them. His speech is usually monotonous, mechanical, like that of a robot, and always maintains the same rhythm and tone. From 6 or 7 years of age, ecolalia can be an exact repetition of a phrase or text, with a perfect imitation of intonation, and even gestures (ecopraxia), observed by the patient.

Types of Echolalia

The symptoms of echolalia are classified according to two criteria: the latency of the response (that is, the time it takes for the repetition to appear) and the intentionality of the behavior. Thus, we can talk about immediate or delayed echolalia and functional or non-functional ecolalia .

Immediate echolalia, as the name implies, occurs right after the person hears the vocalization. Delayed echolalia can occur at any time, sometimes there is a temporary distance of years between the original verbalization and imitation.

Following the criterion of intentionality, we divide the ecological manifestations into functional, when the person has a communicative or self-regulating intention , and not functional, if the above conditions are not met.

Causes of this phenomenon

Imitative behavior, including echolalia, is normal and adaptive in boys and girls , since they use it to acquire and internalize new behaviors. However, as the language develops and the child learns cognitive self-regulation skills, this phenomenon becomes less common.

From 3 years of age, ecolalia may be a sign that there is an underlying disorder that affects the progress of language or behavioral inhibition; in this way, it is common for ecolalia to appear in blind children , with learning difficulties or with a generalized developmental disorder.

Echolalia in adults is usually considered pathological because it tends to be a manifestation of lesions in the brain; It is particularly associated with damage to the frontal lobe of the left hemisphere caused by genetic factors, trauma, strokes or other causes.

In this sense, the supplementary motor area and the medial part of the frontal lobe seem to have special relevance. The role of the so-called “mirror neurons”, which are triggered when we imitate the behavior of others, both externally and in imagination, has also been highlighted.

How long does echolalia last?

Children who are between 1 and 2 years old should echo in their environment imitating a lot since it is the way they are learning. On the other hand, when children are over two years old, it is normal for them to start expressing their own words. You can see a two-year-old boy who continues to imitate your words but will also have a lot of his own sentences. By this I mean that after two years you should not only repeat words to communicate, but usually say “homegrown” words.

It is from the age of three when ecolalia must be quite scarce, children at this age create their own simple phrases to communicate with the world around them. It is possible that there is still a little echolalia, and it will be completely normal, but your speech should be dominated by your own thoughts

The withdrawal of echolalia

Ecolalia will gradually withdraw naturally in children. Maybe you watch how your son repeats what he hears on television and maybe he just likes it and repeats it, and nothing happens. The problem will be if the child begins to get stuck in a scene or in a sentence and repeats it over and over again, if that happens the time has come to think that perhaps the ecolalia is something else.

Is it normal for your child to repeat what he hears?

If your child is within the age according to the development of echolalia, then it is normal, although there may be other factors to consider. Imitating language and repeating is a very important part of language development, as children develop speech and language skills in addition to repeating words, they also focus on facial expressions. But after a certain point of development, when it should have been withdrawn, ecolalía can be considered atypical and indicate weakness in language skills. There are some factors to consider:

  • The age of the child, between 1 and 3 years children repeat what they hear.
  • The frequency of echolalia. Children even if they repeat they must say their own words, not everything is echolalia.
  • When ecolalia occurs. If it occurs every day, naturally when listening to the adult, when watching cartoons, etc.

Related disorders

There are many disorders that alter the functioning of language and behavioral inhibition and are therefore likely to cause echolalia. Below we will briefly describe the alterations that are most commonly associated with this phenomenon.

1. Autistic spectrum

The concept of “autism spectrum disorders”, which was introduced in the DSM-5, encompasses Asperger syndrome, childhood disintegrative disorder and Rett syndrome, in addition to Kanner’s own autism and other generalized developmental disorders.

This set of syndromes is probably due to dysfunctions in mirror neurons derived from genetic causes . Autism spectrum disorders affect communication, social interaction, and the breadth of the behavioral repertoire, and in many cases they involve intellectual deficits.

Within the framework of autism, the type of ecolalia may vary depending on the intensity of the alterations and the specific situation. Thus, non-functional echolalia is more likely to occur in autistics who do not understand speech, while the functional one can be used to compensate for language difficulties. In these cases immediate echolalia is common

2. Tourette syndrome

The  Tourette syndrome characterized by chronic and simultaneous presence of motor and vocal tics . One of the best known symptoms of Tourette’s syndrome is coprolalia, which consists in the impulsive emission of obscene or socially incorrect words, although it only occurs in approximately 10% of cases.

Similarly, and although they are less frequent than coprolalia, eco-phenomena such as ecolalia and echopraxia also occur in the context of this disorder. Palilalia is another possible symptom of Tourette’s syndrome.

3. Aphasia

Injuries due to strokes or head injuries often cause  aphasia , a set of language disorders associated with brain damage. In these cases, ecolalia usually has a compulsive and non-functional nature .

Echolalia is particularly common in transcortical sensory aphasia, which occurs as a result of lesions in the temporal lobe. In addition to ecolalia, other characteristics of this type of aphasia are the presence of paraphasies (replacing words with incorrect ones) and maintaining verbal comprehension.

4. Dementia

Dementias are neurodegenerative diseases that cause a progressive loss of cognitive faculties, especially memory. When the lesions affect the brain regions involved in language and self-regulation, they can cause symptoms of echolalia similar to those of aphasia.

Ecolalia is especially common in frontotemporal dementias , especially in Pick’s disease. Degenerative disorders that affect the basal ganglia, such as Parkinson’s disease, Huntington’s disease, and progressive supranuclear paralysis, also cause eco-phenomena frequently.

5. Schizophrenia

The DSM-IV defines schizophrenia as a chronic disorder characterized by the presence of hallucinations, delusions, disorganized language and / or affective flattening, among other symptoms.

One of the subtypes of schizophrenia is catatonic , which involves alterations due to excess or defect in movement. Echolalia and echopraxia are common in catatonic schizophrenia.

The importance of understanding the child with echolalia

It is important to keep in mind that the child or ecologic adult is not really understanding anything that he repeats, and does not realize that he is doing it, so we should not scold them for their behavior. These repetitions are not intended, and are not intended to disturb or interrupt, but arise spontaneously, even if they are completely out of context.

The child or adult adults processes the language in a different way, does not analyze the words individually, but analyzes the totality of the language, the set of words that he has heard, which requires a greater effort to analyze and come to understand what he has listened.

The echolalia is a disorder that has no cure , but it can work for the number of repetitions and intensity thereof is reduced as well as better communication with those affected, whether children or adults. Later we will indicate guidelines and advice on how to work to achieve it. When echolalia is a consequence of a mental pathology , medication to treat it favors repetition decreases. The duration of ecolalia depends directly on the severity of the disorder with which it is associated.

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