Echolalia in schizophrenia

Echolalia - StatPearls - NCBI Bookshelf

Continuing Education Activity

Echolalia is a meaningless repetition of words or phrases heard by someone. This activity reviews echolalia and highlights different conditions that may be associated with it.

Objectives:

Describe the signs and symptoms of echolalia.
Describe treatment considerations for patients with echolalia.
Describe the associated conditions with echolalia.

Access free multiple choice questions on this topic.

Introduction

The word echolalia is derived from the Greek roots “echo” and “lalia,” where “echo” means "to repeat," and “lalia” means "speech." It is also termed echophrasia. Echolalia is the unsolicited repetition of utterances made by others. It is one of the most common echo phenomena and is a non-voluntary, automatic, and effortless pervasive behavior. Echolalia is a normal finding during language development in toddlers. [1]

Etiology

Echolalia is a salient speech disturbance characteristically described in children with autism spectrum disorder (ASD).[1] It was first described in 1943 by Kanner in eleven children with autism.[2][3][4] Apart from autism, echolalia has also been described in several other disorders.[5][6][7][8][9][10][11][12][13][14]

Aphasia
Autoimmune disorders
Closed head injury
Congenital blindness
Cortico-basal degeneration
Delirium
Dementia
Encephalitis
Primary familial brain calcification
Gilles de la Tourette syndrome
Intellectual disability
Language delay
Latah reaction/phenomenon
Pick disease
Frontotemporal dementia
Progressive supranuclear palsy
Schizophrenia
Stroke
Confusional states
Postepileptic status

Epidemiology

The prevalence of echolalia is unclear as it is a heterogeneous symptom seen in various pathological states. As mentioned above, echolalia can be a normal part of language development in toddlers. Approximately 75% of children with ASD exhibit echolalia.[15]

Pathophysiology

The exact etiopathogenesis of echolalia is not entirely understood. Speech imitation and repetition is a part of normal language development in toddlers. Echophenomena improves over the first two years of life. Self-regulation in speech and language develops around the age of 3 years.[16]

Pathological echolalia persists beyond the age of 3 years. Some researchers have postulated a “broken mirror neuron system” and “wealth of stimulus” hypothesis to explain the imitative language behaviors seen in ASD.[17] Dopaminergic dysregulation has also been hypothesized as a neurobiological mechanism leading to echo phenomena. Echolalia is possibly related to dysfunction of the frontal lobe. Echolalia has been reported in lesions of the left medial frontal lobe and supplemental motor areas.[18][19]

History and Physical

Patients should undergo a detailed history and evaluation. Echolalia has several subtypes. There are two major types of echolalia:[20][21]

Immediate echolalia: This refers to the repetition of speech immediately after the utterance.
Delayed echolalia: This refers to the repetition of speech sometime after the utterance.

Historically, echolalia was described as a meaningless speech disorder. However, recent literature suggests echolalia may have a communicative function. Both immediate and delayed echolalia can be communicative (repetition with an apparent meaningful or communicative purpose) or semi-communicative (repetition with no clear communicative purpose).

Echolalia can also be classified based on the features of speech repetition.[1]

Unmitigated echolalia refers to verbatim or exact repetition of speech.
Mitigated echolalia refers to the repetition of speech in altered form.

As the language and comprehension improve in children with autism, more mitigated echolalia may be observed. The child learns to make a change in the speech or intonation instead of repeating verbatim. Mitigated echolalia may have a higher functional category.

Echolalia can also be classified based on the nature of the stimulus. The speech repetition can be person-directed or non-person directed.

Ambient echolalia refers to the repetition of words or sentences from the environment (e.g., television, bike, car, fan).[11]
Echoing approval refers to the situations where patients echo, in positive or negative intonations, replying to questions instead of repeating the whole or part of sentences. Sometimes they may respond to questions that were not addressed to them.[22]

Evaluation

Echolalia, a form of imitation, is a useful component of language acquisition. Echolalia is common in toddlers as they learn to speak. Echolalia becomes less and less prominent as language skills develop. A disorder may be suspected if automatic speech imitation persists or reemerges after the age of three.

Marge Blanc, a clinical speech-language pathologist, proposed the six stages of natural language development for childhood autism.[16]

Stage 1: Unmitigated echolalia or the use of whole language gestalts. For example, “Let’s get out of here,” “Want some more?”, “Are you okay?”
Stage 2: Mitigated echolalia or altering the gestalts into syntactic units and recombining the units. For example, “Want out of here.”
Stage 3: Isolation of single words, mix, and match of single words, generating two-word phrases. For example, “Get more,” “Want out.”
Stage 4: Generation of a first simple sentence. For example, “I get out.”
Stage 5: Generation of complex sentences with grammar. For example, “I want to get out.”
Stage 6: Generation of more complex sentences with advanced grammar. For example, “How long do you want to play outside?”

Several tools have been studied for quantifying the repeats in children with echolalia. [15][23]

Treatment / Management

Treatment of echolalia depends on the etiology. The management of echolalia related to autism requires a multidisciplinary team, including parents, neurodevelopmental specialists, therapists, psychologists, and special educators. The key to managing echolalia in children is to know the reason for speech repetition, the meaning behind the repetition, and responding in a manner to help the child learn to communicate. Observing, listening, and waiting during the child’s interaction and talking helps gather messages behind the echolalic speech. While interpreting the child’s echolalia, the ideal response is to “say it exactly how the child would if he or she could.”

A speech-language pathologist plays a pivotal role in treating echolalia in childhood autism. Applied behavior analytic interventions for echolalia in ASD include cues-pause-point training, script training, visual cues, gestalt learning, verbal modeling, self-monitoring training, differential reinforcement of lower rates of behavior, and positive reinforcement for appropriate responses. [16][24][25] Similarly, echolalia related to aphasia include interventions like constraint-induced aphasia therapy. Music therapy has also been incorporated into the assessment and treatment of echolalia.

Pharmacotherapy may be indicated in older children, where the echolalia is triggered by stress and anxiety. Selective-serotonin reuptake inhibitors have been used in echolalia secondary to stroke.[26]

Differential Diagnosis

Echolalia is one of the most common echo phenomena and is a non-voluntary, automatic, and effortless pervasive behavior. Other examples of echo phenomena include echopraxia (the involuntary repetition of movements), echolalioplasia (repetitive sign language), echomimia (imitative facial actions), echographia (written repetition of speech), coprolalia (automatic repetition of obscene and socially inappropriate words), klazomania (compulsive shouting), and palilia (repetition of one’s own words).[27] Echolalia is a heterogeneous symptom seen in various pathological states which must be differentiated.

Autism spectrum disorder: Recent studies have shown that echolalia is a coping mechanism for children with autism to communicate when they cannot produce spontaneous speech. Prizant et al. have reported echolalia as evidence of "gestalt" processing in children with ASD to acquire language.[18][21] Autism spectrum disorders are a group of pervasive neurodevelopmental disorders characterized by impaired social functioning, communication, and restricted, repetitive behaviors. It usually manifests before three years of age, and there is a wide variation in severity of clinical presentation.
Gilles de la Tourette syndrome: Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by vocal and motor tics. Echolalia, coprolalia, and echopraxia are some features of TS. Motor tics present in TS include jerks, twitches, and tics. The disorder has a wide range of severity and is associated with other behavioral and psychiatric disorders. TS is often associated with attention deficit hyperactivity disorder and obsessive-compulsive disorder. Tourette syndrome has a waxing and waning course. Cognitive-behavioral therapy is the first-line treatment for TS. Pharmacotherapy is used if behavioral therapy alone does not work. Medications like clonidine, risperidone, fluoxetine have been used.[28]
Stroke: In adult patients, echolalia after stroke is seen in transcortical motor aphasia. Positron emission tomography scans can show increased uptake in frontal, temporal, and parietal lobes.

Prognosis

Many years ago, echolalia was regarded as negative, meaningless, stereotypic behavior. However, several researchers have recently studied the communicative function of echolalia. Echolalia is an adaptive response of patients to their language learning difficulties. It is considered a positive prognostic sign for potential future language growth. Some of the functional categories of echolalia include turn-taking, declarative, requesting, self-regulation, rehearsal, situation association, calling, affirmation, requesting, verbal completion, interactive labeling, and directives. Echolalia should be taken advantage of to facilitate language acquisition and generalization.[29]

Complications

Echolalia can impair social interactions and learning. It can be a barrier to forming and maintaining social relationships.

Echolalia can lead to multiple complications in children with ASD.[30]

Aggression, anxiety, and depression
Caregiver stress and family conflict

Learning difficulty and poor school performance
Peer victimization
School absenteeism
Social isolation because of bullying and non-acceptance

Consultations

The following consultations are required:

Speech-language pathologist
Neurodevelopmental specialists
Therapists
Psychologists
Special educators

Deterrence and Patient Education

Parents’ participation plays a pivotal role in managing echolalia and speech disorders associated with autism and other neuropsychiatric disorders. Individualized education programs help educate patients/parents about echolalia, comorbid conditions, and prognosis. Management strategies and interventions are recommended. The pediatrician/provider should also share informative websites with the child’s parents for more information and to connect with support groups.[31]

Pearls and Other Issues

Echolalia is the most common of the echo phenomena.
Echolalia is a normal part of speech and language development. It improves over the first two years of life. Pathological echolalia persists beyond the age of 3 years.
Echolalia is a salient speech disturbance characteristically described in children with autism.
Apart from autism, echolalia has also been described in aphasia, autoimmune disorders, closed head injury, congenital blindness, cortico-basal degeneration, delirium, dementia, encephalitis, postepileptic status, Gilles de la Tourette syndrome, intellectual disability, language delay, latah reaction/phenomenon, Pick’s disease, progressive supranuclear palsy, schizophrenia, and stroke.
Echolalia can be immediate or delayed, communicative or semi-communicative, mitigated or non-mitigated, person-directed or non-person directed.
Applied behavior analytic interventions and speech therapy are primarily used for the management of echolalia related to ASD.
More studies are needed to enhance the management of echolalia and improve functional communication.

Enhancing Healthcare Team Outcomes

Echolalia is one of the most common echo phenomena. It is seen in several neuropsychiatric illnesses, including ASD. Echolalia should be viewed as a positive sign for language development in children with ASD.[32] Early comprehensive multidisciplinary assessment and evidence-based intervention strategies are necessary to enhance outcomes. An interdisciplinary team, including parents, neurodevelopmental specialists, therapists, psychologists, and special educators, are recommended to improve outcomes.

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

References

1.: Schuler AL. Echolalia: issues and clinical applications. J Speech Hear Disord. 1979 Nov;44(4):411-34. [PubMed: 390245]
2.: Kanner L. [Follow-up study of eleven autistic children originally reported in 1943. 1971]. Psychiatr Enfant. 1995;38(2):421-61. [PubMed: 8657796]
3.: Kanner L. Autistic disturbances of affective contact. Acta Paedopsychiatr. 1968;35(4):100-36. [PubMed: 4880460]
4.: KANNER L. Irrelevant and metaphorical language in early infantile autism. Am J Psychiatry. 1946 Sep;103(2):242-6. [PubMed: 21001998]
5.: Sharawat IK, Panda PK. Echolalia: Presentation of Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis. Indian J Pediatr. 2021 Feb;88(2):186-187. [PubMed: 32607670]
6.: Suzuki T, Itoh S, Arai N, Kouno M, Noguchi M, Takatsu M, Takeda K. Ambient echolalia in a patient with germinoma around the bilateral ventriculus lateralis: a case report. Neurocase. 2012;18(4):330-5. [PubMed: 22117108]
7.: Linetsky E, Planer D, Ben-Hur T. Echolalia-palilalia as the sole manifestation of nonconvulsive status epilepticus. Neurology. 2000 Sep 12;55(5):733-4. [PubMed: 10980752]
8.: Chung BI. Brief report: treatment of echolalia in a girl with Rubinstein-Taybi syndrome: functional assessment of minimizing chances to provoke echolalia. J Autism Dev Disord. 1998 Dec;28(6):573-8. [PubMed: 9932244]
9.: Saldert C, Hartelius L. Echolalia or functional repetition in conversation--a case study of an individual with Huntington's disease. Disabil Rehabil. 2011;33(3):253-60. [PubMed: 20831380]
10.: Zapor M, Murphy FT, Enzenauer R. Echolalia as a novel manifestation of neuropsychiatric systemic lupus erythematosus. South Med J. 2001 Jan;94(1):70-2. [PubMed: 11213948]
11.: Suzuki T, Itoh S, Hayashi M, Kouno M, Takeda K. Hyperlexia and ambient echolalia in a case of cerebral infarction of the left anterior cingulate cortex and corpus callosum. Neurocase. 2009 Oct;15(5):384-9. [PubMed: 19585352]
12.: SIMONYI G. [Echolalia simultaneous with aphasia in Pick's atrophy]. Monatsschr Psychiatr Neurol. 1951 Jul;122(1-2):100-20. [PubMed: 14863316]
13.: Fernández-Pajarín G, Sesar Á, Ares-Pensado B, Jiménez-Martín I, Castro A. [Echolalia and progressive supranuclear palsy, an unexpected association]. Rev Neurol. 2015 Aug 01;61(3):143-4. [PubMed: 26178519]
14.: Bakker MJ, van Dijk JG, Pramono A, Sutarni S, Tijssen MA. Latah: an Indonesian startle syndrome. Mov Disord. 2013 Mar;28(3):370-9. [PubMed: 23283702]
15.: van Santen JP, Sproat RW, Hill AP. Quantifying repetitive speech in autism spectrum disorders and language impairment. Autism Res. 2013 Oct;6(5):372-83. [PMC free article: PMC3808497] [PubMed: 23661504]
16.: Stiegler LN. Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand? Am J Speech Lang Pathol. 2015 Nov;24(4):750-62. [PubMed: 26161804]
17.: Perkins T, Stokes M, McGillivray J, Bittar R. Mirror neuron dysfunction in autism spectrum disorders. J Clin Neurosci. 2010 Oct;17(10):1239-43. [PubMed: 20598548]
18.: Prizant BM. Language acquisition and communicative behavior in autism: toward an understanding of the "whole" of it. J Speech Hear Disord. 1983 Aug;48(3):296-307. [PubMed: 6621020]
19.: Margari L, De Giacomo A, Craig F, Palumbi R, Peschechera A, Margari M, Picardi F, Caldarola M, Maghenzani MA, Dicuonzo F. Frontal lobe metabolic alterations in autism spectrum disorder: a ¹H-magnetic resonance spectroscopy study. Neuropsychiatr Dis Treat. 2018;14:1871-1876. [PMC free article: PMC6055909] [PubMed: 30050301]
20.: Prizant BM, Duchan JF. The functions of immediate echolalia in autistic children. J Speech Hear Disord. 1981 Aug;46(3):241-9. [PubMed: 7278167]
21.: Prizant BM, Rydell PJ. Analysis of functions of delayed echolalia in autistic children. J Speech Hear Res. 1984 Jun;27(2):183-92. [PubMed: 6738028]
22.: Ghika J, Bogousslavsky J, Ghika-Schmid F, Regli F. "Echoing approval": a new speech disorder. J Neurol. 1996 Sep;243(9):633-7. [PubMed: 8892063]
23.: Grossi D, Marcone R, Cinquegrana T, Gallucci M. On the differential nature of induced and incidental echolalia in autism. J Intellect Disabil Res. 2013 Oct;57(10):903-12. [PubMed: 22676294]
24.: Freeman BJ, Ritvo E, Miller R. An operant procedure to teach an echolalic, autistic child to answer questions appropriately. J Autism Child Schizophr. 1975 Jun;5(2):169-76. [PubMed: 1174119]
25.: Lim HA, Draper E. The effects of music therapy incorporated with applied behavior analysis verbal behavior approach for children with autism spectrum disorders. J Music Ther. 2011 Winter;48(4):532-50. [PubMed: 22506303]
26.: Bae H, Park J, Yang Y. Improvement of Post Stroke Echolalia after Using Selective Serotonin Reuptake Inhibitors. Dement Neurocogn Disord. 2019 Mar;18(1):30-32. [PMC free article: PMC6494782] [PubMed: 31097970]
27.: Magnin E, de Bustos EM, Moulin T. Pali and Echo Phenomena: Symptoms of Persistence and Perseveration. Front Neurol Neurosci. 2018;41:28-39. [PubMed: 29145181]
28.: Ganos C, Ogrzal T, Schnitzler A, Münchau A. The pathophysiology of echopraxia/echolalia: relevance to Gilles de la Tourette syndrome. Mov Disord. 2012 Sep 01;27(10):1222-9. [PubMed: 22807284]
29.: Sterponi L, de Kirby K, Shankey J. Rethinking language in autism. Autism. 2015 Jul;19(5):517-26. [PubMed: 24916453]
30.: Ip A, Zwaigenbaum L, Brian JA. Post-diagnostic management and follow-up care for autism spectrum disorder. Paediatr Child Health. 2019 Nov;24(7):461-477. [PMC free article: PMC6812300] [PubMed: 31660043]
31.: Hetzroni OE, Tannous J. Effects of a computer-based intervention program on the communicative functions of children with autism. J Autism Dev Disord. 2004 Apr;34(2):95-113. [PubMed: 15162930]
32.: Leung JP, Wu KI. Teaching receptive naming of Chinese characters to children with autism by incorporating echolalia. J Appl Behav Anal. 1997 Spring;30(1):59-68. [PMC free article: PMC1284038] [PubMed: 9157099]

Echolalia - StatPearls - NCBI Bookshelf

Continuing Education Activity

Echolalia is a meaningless repetition of words or phrases heard by someone. This activity reviews echolalia and highlights different conditions that may be associated with it.

Objectives:

Describe the signs and symptoms of echolalia.
Describe treatment considerations for patients with echolalia.
Describe the associated conditions with echolalia.

Access free multiple choice questions on this topic.

Introduction

Etiology

Aphasia
Autoimmune disorders
Closed head injury
Congenital blindness
Cortico-basal degeneration
Delirium
Dementia
Encephalitis
Primary familial brain calcification
Gilles de la Tourette syndrome
Intellectual disability
Language delay
Latah reaction/phenomenon
Pick disease
Frontotemporal dementia
Progressive supranuclear palsy
Schizophrenia
Stroke
Confusional states
Postepileptic status

Epidemiology

Pathophysiology

History and Physical

Patients should undergo a detailed history and evaluation. Echolalia has several subtypes. There are two major types of echolalia:[20][21]

Immediate echolalia: This refers to the repetition of speech immediately after the utterance.
Delayed echolalia: This refers to the repetition of speech sometime after the utterance.

Echolalia can also be classified based on the features of speech repetition.[1]

Unmitigated echolalia refers to verbatim or exact repetition of speech.
Mitigated echolalia refers to the repetition of speech in altered form.

Echolalia can also be classified based on the nature of the stimulus. The speech repetition can be person-directed or non-person directed.

Ambient echolalia refers to the repetition of words or sentences from the environment (e.g., television, bike, car, fan).[11]
Echoing approval refers to the situations where patients echo, in positive or negative intonations, replying to questions instead of repeating the whole or part of sentences. Sometimes they may respond to questions that were not addressed to them.[22]

Evaluation

Marge Blanc, a clinical speech-language pathologist, proposed the six stages of natural language development for childhood autism.[16]

Stage 1: Unmitigated echolalia or the use of whole language gestalts. For example, “Let’s get out of here,” “Want some more?”, “Are you okay?”
Stage 2: Mitigated echolalia or altering the gestalts into syntactic units and recombining the units. For example, “Want out of here.”
Stage 3: Isolation of single words, mix, and match of single words, generating two-word phrases. For example, “Get more,” “Want out.”
Stage 4: Generation of a first simple sentence. For example, “I get out.”
Stage 5: Generation of complex sentences with grammar. For example, “I want to get out.”
Stage 6: Generation of more complex sentences with advanced grammar. For example, “How long do you want to play outside?”

Several tools have been studied for quantifying the repeats in children with echolalia. [15][23]

Treatment / Management

Differential Diagnosis

Autism spectrum disorder: Recent studies have shown that echolalia is a coping mechanism for children with autism to communicate when they cannot produce spontaneous speech. Prizant et al. have reported echolalia as evidence of "gestalt" processing in children with ASD to acquire language.[18][21] Autism spectrum disorders are a group of pervasive neurodevelopmental disorders characterized by impaired social functioning, communication, and restricted, repetitive behaviors. It usually manifests before three years of age, and there is a wide variation in severity of clinical presentation.
Gilles de la Tourette syndrome: Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by vocal and motor tics. Echolalia, coprolalia, and echopraxia are some features of TS. Motor tics present in TS include jerks, twitches, and tics. The disorder has a wide range of severity and is associated with other behavioral and psychiatric disorders. TS is often associated with attention deficit hyperactivity disorder and obsessive-compulsive disorder. Tourette syndrome has a waxing and waning course. Cognitive-behavioral therapy is the first-line treatment for TS. Pharmacotherapy is used if behavioral therapy alone does not work. Medications like clonidine, risperidone, fluoxetine have been used.[28]
Stroke: In adult patients, echolalia after stroke is seen in transcortical motor aphasia. Positron emission tomography scans can show increased uptake in frontal, temporal, and parietal lobes.

Prognosis

Complications

Echolalia can impair social interactions and learning. It can be a barrier to forming and maintaining social relationships.

Echolalia can lead to multiple complications in children with ASD.[30]

Aggression, anxiety, and depression
Caregiver stress and family conflict
Learning difficulty and poor school performance
Peer victimization
School absenteeism
Social isolation because of bullying and non-acceptance

Consultations

The following consultations are required:

Speech-language pathologist
Neurodevelopmental specialists
Therapists
Psychologists
Special educators

Deterrence and Patient Education

Pearls and Other Issues

Echolalia is the most common of the echo phenomena.
Echolalia is a normal part of speech and language development. It improves over the first two years of life. Pathological echolalia persists beyond the age of 3 years.
Echolalia is a salient speech disturbance characteristically described in children with autism.
Apart from autism, echolalia has also been described in aphasia, autoimmune disorders, closed head injury, congenital blindness, cortico-basal degeneration, delirium, dementia, encephalitis, postepileptic status, Gilles de la Tourette syndrome, intellectual disability, language delay, latah reaction/phenomenon, Pick’s disease, progressive supranuclear palsy, schizophrenia, and stroke.
Echolalia can be immediate or delayed, communicative or semi-communicative, mitigated or non-mitigated, person-directed or non-person directed.
Applied behavior analytic interventions and speech therapy are primarily used for the management of echolalia related to ASD.
More studies are needed to enhance the management of echolalia and improve functional communication.

Enhancing Healthcare Team Outcomes

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

References

1.: Schuler AL. Echolalia: issues and clinical applications. J Speech Hear Disord. 1979 Nov;44(4):411-34. [PubMed: 390245]
2.: Kanner L. [Follow-up study of eleven autistic children originally reported in 1943. 1971]. Psychiatr Enfant. 1995;38(2):421-61. [PubMed: 8657796]
3.: Kanner L. Autistic disturbances of affective contact. Acta Paedopsychiatr. 1968;35(4):100-36. [PubMed: 4880460]
4.: KANNER L. Irrelevant and metaphorical language in early infantile autism. Am J Psychiatry. 1946 Sep;103(2):242-6. [PubMed: 21001998]
5.: Sharawat IK, Panda PK. Echolalia: Presentation of Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis. Indian J Pediatr. 2021 Feb;88(2):186-187. [PubMed: 32607670]
6.: Suzuki T, Itoh S, Arai N, Kouno M, Noguchi M, Takatsu M, Takeda K. Ambient echolalia in a patient with germinoma around the bilateral ventriculus lateralis: a case report. Neurocase. 2012;18(4):330-5. [PubMed: 22117108]
7.: Linetsky E, Planer D, Ben-Hur T. Echolalia-palilalia as the sole manifestation of nonconvulsive status epilepticus. Neurology. 2000 Sep 12;55(5):733-4. [PubMed: 10980752]
8.: Chung BI. Brief report: treatment of echolalia in a girl with Rubinstein-Taybi syndrome: functional assessment of minimizing chances to provoke echolalia. J Autism Dev Disord. 1998 Dec;28(6):573-8. [PubMed: 9932244]
9.: Saldert C, Hartelius L. Echolalia or functional repetition in conversation--a case study of an individual with Huntington's disease. Disabil Rehabil. 2011;33(3):253-60. [PubMed: 20831380]
10.: Zapor M, Murphy FT, Enzenauer R. Echolalia as a novel manifestation of neuropsychiatric systemic lupus erythematosus. South Med J. 2001 Jan;94(1):70-2. [PubMed: 11213948]
11.: Suzuki T, Itoh S, Hayashi M, Kouno M, Takeda K. Hyperlexia and ambient echolalia in a case of cerebral infarction of the left anterior cingulate cortex and corpus callosum. Neurocase. 2009 Oct;15(5):384-9. [PubMed: 19585352]
12.: SIMONYI G. [Echolalia simultaneous with aphasia in Pick's atrophy]. Monatsschr Psychiatr Neurol. 1951 Jul;122(1-2):100-20. [PubMed: 14863316]
13.: Fernández-Pajarín G, Sesar Á, Ares-Pensado B, Jiménez-Martín I, Castro A. [Echolalia and progressive supranuclear palsy, an unexpected association]. Rev Neurol. 2015 Aug 01;61(3):143-4. [PubMed: 26178519]
14.: Bakker MJ, van Dijk JG, Pramono A, Sutarni S, Tijssen MA. Latah: an Indonesian startle syndrome. Mov Disord. 2013 Mar;28(3):370-9. [PubMed: 23283702]
15.: van Santen JP, Sproat RW, Hill AP. Quantifying repetitive speech in autism spectrum disorders and language impairment. Autism Res. 2013 Oct;6(5):372-83. [PMC free article: PMC3808497] [PubMed: 23661504]
16.: Stiegler LN. Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand? Am J Speech Lang Pathol. 2015 Nov;24(4):750-62. [PubMed: 26161804]
17.: Perkins T, Stokes M, McGillivray J, Bittar R. Mirror neuron dysfunction in autism spectrum disorders. J Clin Neurosci. 2010 Oct;17(10):1239-43. [PubMed: 20598548]
18.: Prizant BM. Language acquisition and communicative behavior in autism: toward an understanding of the "whole" of it. J Speech Hear Disord. 1983 Aug;48(3):296-307. [PubMed: 6621020]
19.: Margari L, De Giacomo A, Craig F, Palumbi R, Peschechera A, Margari M, Picardi F, Caldarola M, Maghenzani MA, Dicuonzo F. Frontal lobe metabolic alterations in autism spectrum disorder: a ¹H-magnetic resonance spectroscopy study. Neuropsychiatr Dis Treat. 2018;14:1871-1876. [PMC free article: PMC6055909] [PubMed: 30050301]
20.: Prizant BM, Duchan JF. The functions of immediate echolalia in autistic children. J Speech Hear Disord. 1981 Aug;46(3):241-9. [PubMed: 7278167]
21.: Prizant BM, Rydell PJ. Analysis of functions of delayed echolalia in autistic children. J Speech Hear Res. 1984 Jun;27(2):183-92. [PubMed: 6738028]
22.: Ghika J, Bogousslavsky J, Ghika-Schmid F, Regli F. "Echoing approval": a new speech disorder. J Neurol. 1996 Sep;243(9):633-7. [PubMed: 8892063]
23.: Grossi D, Marcone R, Cinquegrana T, Gallucci M. On the differential nature of induced and incidental echolalia in autism. J Intellect Disabil Res. 2013 Oct;57(10):903-12. [PubMed: 22676294]
24.: Freeman BJ, Ritvo E, Miller R. An operant procedure to teach an echolalic, autistic child to answer questions appropriately. J Autism Child Schizophr. 1975 Jun;5(2):169-76. [PubMed: 1174119]
25.: Lim HA, Draper E. The effects of music therapy incorporated with applied behavior analysis verbal behavior approach for children with autism spectrum disorders. J Music Ther. 2011 Winter;48(4):532-50. [PubMed: 22506303]
26.: Bae H, Park J, Yang Y. Improvement of Post Stroke Echolalia after Using Selective Serotonin Reuptake Inhibitors. Dement Neurocogn Disord. 2019 Mar;18(1):30-32. [PMC free article: PMC6494782] [PubMed: 31097970]
27.: Magnin E, de Bustos EM, Moulin T. Pali and Echo Phenomena: Symptoms of Persistence and Perseveration. Front Neurol Neurosci. 2018;41:28-39. [PubMed: 29145181]
28.: Ganos C, Ogrzal T, Schnitzler A, Münchau A. The pathophysiology of echopraxia/echolalia: relevance to Gilles de la Tourette syndrome. Mov Disord. 2012 Sep 01;27(10):1222-9. [PubMed: 22807284]
29.: Sterponi L, de Kirby K, Shankey J. Rethinking language in autism. Autism. 2015 Jul;19(5):517-26. [PubMed: 24916453]
30.: Ip A, Zwaigenbaum L, Brian JA. Post-diagnostic management and follow-up care for autism spectrum disorder. Paediatr Child Health. 2019 Nov;24(7):461-477. [PMC free article: PMC6812300] [PubMed: 31660043]
31.: Hetzroni OE, Tannous J. Effects of a computer-based intervention program on the communicative functions of children with autism. J Autism Dev Disord. 2004 Apr;34(2):95-113. [PubMed: 15162930]
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Echolalia - causes, diagnosis and treatment

Echolalia is a symptom of a speech disorder, manifested by uncontrolled automatic repetition of words or phrases spoken by another person. Echolalaemia is normal in the development of speech before the age of two, later they are considered as a symptom of a mental or neurological disease. Signs of echolalia: repetition of the endings of the interlocutor's phrases, delayed reproduction of his requests and questions, quoting replicas from films. Diagnosis is performed by a clinical method. Treatment is based on psychocorrection.

General characteristics

According to clinical manifestations, echolalia is of two types: immediate and delayed. In the first variant, patients unconsciously repeat words and phrases they have just heard. For example, a child, to the question: “Will you be an apple or a banana?”, answers: “Banana”, even if he wants an apple (he is unable to choose an answer). In the delayed form of the disorder, information heard some time ago is repeated. Example: Reproducing phrases from dialogue in a movie.

Echolalia within the framework of normal speech development can be observed at the age of 1-1.5 years. Gradually, the need for them disappears. Pathological echolalia is clearly manifested after 2-3 years. Children do not master independent speech, but continue to repeat phrases after others. Their entire active vocabulary may consist of sentences often repeated by their mother, replicas of cartoon characters, monologues of TV presenters.

Echolalia is the automatic but not meaningless repetition of phrases. It performs several important functions for the patient: it helps to maintain a conversation, understand the interlocutor, designate objects and phenomena. Patients with autism use automatic repetition of words as a ritual to restore emotional balance or as a tool for self-stimulation (repeating phrases causes arousal).

Causes of echolalia

Echolalia is based on the disinhibition of the imitative (imitative) reflex, which is the easiest way for children to master complex skills and speech. Imitation of an adult is manifested by an immediate echolalic reaction. If the reflex is not replaced in a timely manner by other techniques for mastering speech, then its disinhibition is present. The causes of echolalia can be divided into two large groups: physiological and pathological.

Physiological factors

At an early stage of speech development, a child can actively use imitation when communicating with an adult. The mechanism of repetition of words and phrases is gradually replaced by independent spontaneous speech, but can be extended in time or returned again as a result of a number of reasons:

Unformed speech skills. When a child does not know what to say, he simply copies the words of an adult. Speech echo-repetitions occur in children who do not have sufficient vocabulary, cannot spontaneously create phrases to answer questions.
Misunderstanding of lexico-grammatical constructions . In the development of speech, a stage is possible at which the child understands the meanings of words, but does not know how to correctly compose them into sentences. He uses repetition of questions for requests. For example, voices heard earlier; "Are you hungry?" to let your mom know you're hungry.
Experience of stress. A new environment and the need to communicate with strangers can cause a child's speech regression. In a stressful situation, echolalia returns as the easiest way to communicate.
Habit. Sometimes the child is aware that he is repeating the phrases of an adult. He does it out of habit, following a fixed pattern. The reason for this speech behavior is the lack of self-regulation skills. To get rid of the symptom, it is necessary to point out to the child that the use of echolalia is unacceptable.

Causes of pathological echolalia

In adults and children over 2 years of age, echolalic symptoms are manifested in mental and neurological diseases. Delayed echolalia is characteristic of mental disorders and is associated with a violation of the purposefulness of cognitive processes. Immediate echolalic reactions develop as a result of damage or underdevelopment of the frontal lobes of the brain responsible for controlling activity. Pathological causes are represented by the following diseases:

Autism Spectrum Disorders. Echolalia is a common symptom of speech disorders in early childhood autism. Automatic multiple repetition of sentences is used as a means of self-regulation of emotions and behavior. Also, a symptom can be observed with Asperger's syndrome.
mental retardation and mental retardation. In diseases with intellectual retardation, insufficient development of speech is noted. Echolalia allows you to compensate for the lack of vocabulary, the skill of self-constructing an utterance. With mental retardation, echolalic symptoms are often combined with echopraxia - imitation of gestures, postures, movements.
Schizophrenia. Echolalia is possible in catatonic schizophrenia. It may be of a delayed nature, not related to the current situation. There are variants with mechanical repetition without intonation, with exact repetition (“gramophone” speech), with a kind of modulation (“parrot” speech).
Organic lesions of the brain. Echolalia occurs in pathologies affecting the frontal lobes. In Pick's disease, initially there is an inaccurate repetition of speech in combination with sensory aphasia, which is replaced by true echolalic reactions. After a stroke with sensory-motor aphasia, automatic echolalia is formed with a possible reverse development. Vascular atherosclerosis may be accompanied by intermittent inaccurate echolalia.
Genetic neuropsychiatric diseases. Automatic repetitions of phrases and words are detected in the clinical picture of Rett's syndrome, grow along with stereotypical monotonous hand movements, general impoverishment of speech, and a decrease in intelligence. In patients with Tourette's syndrome, echolalic manifestations are vocal tics accompanied by multiple motor tics.

Diagnosis

Long-term preservation of vocabulary and syllabic speech imitation in childhood or the appearance of this symptom in adults requires a visit to a psychiatrist and neurologist. Echolalia is diagnosed in the course of communication with the patient, observing his speech. Usually, detecting automated repetitions of sentences and words is not difficult. To establish the nature of echolalic symptoms, a comprehensive examination is performed:

Assessment of neuropsychiatric status. Taking an anamnesis, clinical conversation, neurological examination allow doctors to assess the general condition of the patient: his ability to establish and maintain contact, navigate in space and time, and be critical of his disease. Accompanying echolalia neurological disorders, psychopathological symptoms are detected.
Logopedic testing. A speech therapist examines the speech function, determines the degree of its formation, the presence of pronunciation defects, the loss of individual links. In conclusion, he notes whether echolalia is the result of speech underdevelopment or speech decay.
Pathopsychological testing. Memory, thinking, attention and intelligence are being tested. The results indicate the presence or absence of signs of organic damage to the central nervous system, intellectual underdevelopment as the cause of echolalic manifestations.
Neuropsychological testing. Diagnosis by a neuropsychologist is aimed at analyzing higher mental functions. Testing data allow us to determine neuropsychological symptoms (various types of alalia, aphasia), to differentiate neurological diseases.

Treatment

Echolalia is eliminated with the help of psycho-corrective exercises. In parallel with them, the treatment of the underlying disease that caused the symptom is carried out. Corrective work can be carried out by a psychologist, defectologist, speech therapist. Important conditions for obtaining a positive result are the patient's ability to maintain contact, the absence of pronounced emotional and behavioral disorders, and a sufficient level of intelligence to conduct a conversation.

Visual aids, tables, audio and video materials are actively used in the classroom. At the initial stage, dialogue exercises are used, in which the patient is asked to replace the echolalic "response" with a choice of visual stimulus - pointing to a picture, an object. Gradually, the visual support is replaced by speech statements, the duration and complexity of the dialogue increases. After a dialogue speech, a monologue and communication in a group are mastered.