People with echolalia repeat noises and phrases that they hear. They may not be able to communicate effectively because they struggle to express their own thoughts. For example, someone with echolalia might only be able to repeat a question rather than answer it. In many cases, echolalia is an attempt to communicate, learn language, or practice language.
Echolalia is different from Tourette syndrome, where a speaker may suddenly yell or say random things as part of their tic. In this case, they speaker has no control over what they say or when they say it.
Repetitive speech is an extremely common part of language development, and is commonly seen in young toddlers who are learning to communicate. By the age of 2, most children will start mixing in their own utterances along with repetitions of what they hear. By age 3, most children’s echolalia will be minimal at most.
It’s common for children with autism or developmental delays to have echolalia further into childhood, especially if they’re experiencing delayed speech development. Identifying why and how your child is using echolalia will help you develop a treatment plan for it. Consulting a language pathologist can help.
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.
Other signs of echolalia may include frustration during conversations, depression, and muteness. A person with echolalia may be unusually irritable, especially when asked questions.
All children experience echolalia when they learn a spoken language. Most develop independent thought as they age, but some continue to repeat what they hear. Children with communication disabilities hold on to echoed expressions much longer. Children with autism are particularly susceptible to echolalia.
Some people experience this issue only when they are distressed or anxious. Others experience it all the time, which may eventually cause them to be mute because they can’t express themselves.
Adults with severe amnesia or head trauma may experience echolalia as they try to regain their speaking abilities.
There are two main categories of echolalia: functional (or interactive) echolalia, and non-interactive echolalia, where the sounds or 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.
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.
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.
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 children with autism 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.
Echolalia may be treated through a combination of the following methods:
Some people with echolalia go to regular speech therapy sessions to learn how to say what they’re thinking.
A behavioral intervention called “cues-pause-point” is often used for intermediate echolalia. In this treatment, the speech therapist asks the person with echolalia to answer a question correctly and tells them they’ll point to them when it’s time to answer. Then, the therapist asks a question, such as “What’s your name?” After a short pause, they prompt the speaker to answer. They also hold up a cue card with the correct answer.
A doctor can prescribe antidepressants or anxiety medications to combat the side effects of echolalia. This doesn’t treat the condition itself, but it helps keep the person with echolalia calm. Since echolalia symptoms may increase when a person is stressed or anxious, the calming effect can help lessen the severity of the condition.
People with echolalia may work with other people at home to develop their communication skills. There are text and online training programs available to help parents get positive responses from their children. Encouraging a child to use limited vocabulary may make it easier for them to learn to communicate more effectively.
Outlook and prevention
Echolalia is a natural part of language development. It’s not always a good idea to prevent it completely. To avoid permanent echolalia in children, parents must encourage other forms of communication. Expose a child to a wide variety of words and phrases. In time, most children can overcome their echolalia naturally.