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. Echolalia definition
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 echopraxia, in which actions or gestures of others are repeated, and ecomania, 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 echolalia 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 . Echolalia definition
The echolalia’s 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, echolalia can be an exact repetition of a phrase or text, with a perfect imitation of intonation, and even gestures (ecopraxia), observed by the patient.
The main symptom of echolalia is the repetition of phrases and noises that have been heard. It can be immediate, with the speaker repeating something right away after hearing it. It can also be delayed, with the speaker repeating something hours or days after hearing it.
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. Echolalia definition
From 3 years of age, echolalia 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 echolalia 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.
Types of echolalia
There are two main categories of echolalia: functional (or interactive) echolalia, and non-interactive echolalia, where the sounds or semantic unit of a text. In other words may only be for personal use instead of communication.
Functional echolalia is attempted communication intended to be interactional, acting as communication with another person. Examples include:
Turn taking: The person with echolalia uses phrases to fill an alternating verbal exchange.
Verbal completion: Speech is used to complete familiar verbal routines that are initiated by others. For example, if people with echolalia are asked to complete a task, they might say “good job!” while completing it, echoing what they’re used to hearing. Echolalia definition
Providing information: Speech may be used to offer new information, but it may be hard to connect the dots. A mother might ask her child what he wants for lunch, for example, and he’ll sing the song from a lunch meat commercial to say he wants a sandwich.
Requests: The person with echolalia may say “Do you want lunch?” to ask for their own lunch.
Non-interactive echolalia is typically not intended as communication and is meant for personal use, like personal labeling or self-stimulation. Examples include:
Non-focused speech: The person with echolalia says something that has no relevance to the situational context, like reciting portions of a TV show while walking around a classroom. This behavior may be self-stimulatory.
Situation association: Speech is triggered by a situation, visual, person, or activity, and doesn’t seem to be an attempt at communication. If someone sees a brand-name product in the store, for example, they might sing the song from the commercials.
Rehearsal: The speaker may utter the same phrase softly to themselves a few times before responding in a normal voice. This may be practice for the coming interaction.
Self-direction: People might use these utterances to walk themselves through a process. If they’re making a sandwich, for example, they might tell themselves to “Turn on water. Use soap. Rinse hands. Turn off water. Dry hands. Get bread. Put bread on plate. Get lunch meat,” and so on until the process is completed.
Interactive vs. non-interactive echolalia
Echolalia is reflective of how the speaker processes information. Sometimes, recognizing the difference between interactive and non-interactive echolalia is difficult until you get to the know the speaker and how they communicate. In some cases, echolalia seems completely out of context. Echolalia definition
Consider this great example from Susan Stokes. If a child with echolalia gets angry at his teacher when recess is over, he might suddenly say “Go to hell, Lieutenant!” The teacher might later discover that the child had been watching “A Few Good Men” and had used a phrase he knew was tied to anger to convey his feelings in that moment. While his response seemed out of context, he had a reason to use that phrase to communicate.
A professional can diagnose echolalia by having a conversation with the person with echolalia. If they struggle to do anything other than repeat what has been said, they may have echolalia. Some autistic children are regularly tested for this during their speech lessons.
Echolalia ranges from minor to severe. A doctor can identify the stage of echolalia and prescribe the appropriate treatment.
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. Echolalia definition
It is from the age of three when echolalia 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
Echolalia 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 echolalia 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, echolalia 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 echolalia occurs. If it occurs every day, naturally when listening to the adult, when watching cartoons, etc. Echolalia definition
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 echolalia 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 Echolalia definition
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 echolalia and echopraxia also occur in the context of this disorder. Palilalia is another possible symptom of Tourette’s syndrome.
Injuries due to strokes or head injuries often cause aphasia , a set of language disorders associated with brain damage. In these cases, echolalia 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 echolalia, other characteristics of this type of aphasia are the presence of paraphasia (replacing words with incorrect ones) and maintaining verbal comprehension.
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. Echolalia definition
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.