In this article
Echolalia is the repetition of phrases and words. People with echolalia repeat what they hear, whether this is the spoken language of people around them or things they hear on the TV. They may struggle to express their own thoughts and may not be able to communicate effectively.
Someone with echolalia may only be able to repeat a question rather than answering it, for example if someone asked “do you want to go for a walk?” they may repeat “go for a walk”. Some people can experience this issue only when they are distressed or anxious, others experience it all of the time. Adults with severe amnesia or head trauma may experience echolalia as they learn how to speak again.
Repetitive speech is very common in toddlers and young children as it is a useful part of normal language development and nothing at all to be concerned about. It would only become a cause for concern if it continued past the age of three years old.
What causes echolalia?
All children experience echolalia when they learn a spoken language and most develop independent thought as they age, and echolalia will stop; however, some continue to repeat what they hear for longer or even long term depending on the severity of their echolalia and the reasons for it.
Children who have communication difficulties may continue to have echolalia for longer. It is common for children with autism to have echolalia and this may be due to them struggling to communicate effectively or develop their own language skills. Echolalia may also be observed in someone with Tourette syndrome.
Echolalia may be made much worse when someone is feeling anxious or distressed, although some people can experience it all the time in more severe cases.
Adults who have had a head trauma or who have severe amnesia may experience echolalia while they are learning how to speak and communicate again. It may also occur in some forms of dementia.
How common is echolalia?
All children who are learning and developing language will use echolalia initially as this is how they will continue to learn and eventually develop their own language. This is completely normal and nothing to worry about.
It is estimated that 75% of people on the autism spectrum have exhibited echolalia, as it is thought to be as a result of them struggling to exhibit spontaneous speech and can be used as a coping mechanism. This allows the person to participate in conversation even though they are unable to speak spontaneously themselves; they can still be involved in what is being said.
Echolalia is not usually common in children past toddler age nor is it common in adults. Adults who have received a trauma to their head may experience echolalia and this may be for a short period of time while they are learning to speak and communicate again.
What is echolalia a sign of?
Echolalia may be a sign of autism, developmental delay or speech or communication delay in children over the age of three. In some cases, it may be a sign of a head trauma or severe amnesia.
The main symptom of echolalia is engaging in repetitive speech. This does not necessarily mean saying the same word over and over. This may be repeating a question rather than providing an answer.
Types of echolalia
This is communication that is meant to be interactive with another person.
This may include:
- Turn-taking – This involves holding a conversation with someone else and taking turns in speaking.
- Providing information – Speech may be used to offer information, but it is not always easy to understand.
- Verbal completion – The speech is used to complete familiar verbal routines. They may say something while doing a task that they are used to someone else saying to them while doing that task, for example, “well done, you’re doing a great job”. They may say this to themselves while completing the task.
- Requests – The person with echolalia may ask “do you want a drink?” instead of asking for a drink for themselves.
This is not intended for communication purposes and is meant for personal use.
Examples of this include:
- Non-focussed speech – The person with echolalia may say something that has no relevance to the situation, like reciting something, and this may be used for self-stimulation purposes.
- Rehearsal – The person may say something to themselves in a quiet voice before responding in a normal voice in order to rehearse what they are going to say.
- Self-direction – The person may use this to walk themselves through a task; for example, if they are making themselves a drink they may say “get the glass from the cupboard, turn on the tap, fill the glass up with water”. This may continue until the task is complete.
There are two forms of echolalia:
This is where someone repeats something back immediately, for example they may be asked a question and they would repeat the question rather than providing an answer. This form of echolalia is thought to be a way for them to be involved in the conversation and a way of communicating that they have heard what the other person is saying.
Immediate echolalia may lead to miscommunication as they will usually echo the last thing that is said, whereas they may have wanted to provide another answer.
This is where an individual memorises a phrase. The phrase or even a paragraph may have been heard from a book or something else they have listened to and then repeated after a period of time. When a child repeats lines or phrases that seem too complex for them to understand, or is not appropriate or suited to the situation, this may indicate delayed echolalia.
Is echolalia linked to autism?
Many children with autism use echolalia. This is often because they have some difficulties in communicating with others. They may repeat the words of familiar people such as parents or carers or they may repeat sentences from their favourite TV show. Echolalia is one of the most common characteristics of communication in people with autism.
While echolalia is a common characteristic of language development, it becomes a sign of autism if it continues beyond the toddler years. Some children with autism have great memories which help them recite things they heard from memory; this is delayed echolalia. Delayed echolalia may be used as a way of self-stimulation or a way of communicating their needs.
Echolalia may be used by people with autism as a way to interact with people, maintain a conversation, ask for things or attract the attention of someone.
Autistic children and adults may use echolalia:
- As a sensory outlet – Speech may be imitated without really understanding the meaning. This may be used as a calming technique.
- To self-aid – The person may talk themselves through a difficult process, they may use words and phrases which are familiar to them.
- To communicate ideas – It may be used as a way to communicate ideas when it may be too difficult to form their own speech patterns.
- To communicate wants – Echolalia can be used as a way to communicate their wants.
- For building relationships – It can be used as a relationship-building tool. It may be used to create social closeness and for them to interact and engage with others.
Echolalia may be non-functional for some children with autism which means that the words and phrases are not used to mean anything. It is not intended for communication and is intended for personal use as a way of self-soothing, for example. Functional echolalia is when memorised words are phrases are used in a meaningful way and serves a purpose.
It has been noticed that there are patterns with the way echolalia progresses in children with autism. Initially, children may repeat chunks of language without actually understanding what it means.
Children may then start to modify this by adding in their own words or sentences. As children begin to understand more language they may use shorter sentences or single words to express themselves.
Gradually language may become more flexible and spontaneous. Echolalia may still be used occasionally when the child is frustrated, tired or upset. By understanding how echolalia is used to build more flexible language and understanding why children use it can help adults in understanding the child and in turn they will be better supported by the adults around them.
A helpful guide about when to suspect autism spectrum disorder in a pre-school child can be found on the National Institute for Healthcare Excellence.
Can a child outgrow echolalia?
By the age of two most children will start saying their own words along with repetitions of what they hear, and by age three most children’s echolalia will be minimal or will have stopped completely. All children experience echolalia when they learn a spoken language and most children will develop independent thoughts as they age, but some children do continue to repeat what they hear.
Some children do not move past this echolalia stage. Some children will only repeat what others have said and rarely come up with their own sentences or thoughts. This is not usually a normal part of language development and could indicate that the child is having trouble learning to use language.
When children repeat words right after they hear them it is known as immediate echolalia; when the words are repeated at a later time it is known as delayed echolalia. It is helpful to expose children to a wide variety of words and phrases and encourage different kinds of communication. In time most children will overcome echolalia naturally.
Children with communication difficulties hold on to echoed expressions much longer. Children with autism are particularly susceptible to echolalia and this may continue throughout their childhood and into adulthood.
In the past, echolalia was viewed as a negative behaviour and was thought to have no use; however, research has found that echolalia has an important function, not only for young children who are learning to speak but also, for example, for a child with autism, as it can have an important communicative function.
For further reading about child development stages you can visit our knowledge base.
How to help a child with echolalia
Echolalia can make things difficult in daily life, however, echolalia can be valuable for children with autism and speech or communication delay. Functional echolalia can mean that the child has developed a way to communicate their wants and needs.
With the support of a speech therapist, communicating in this way can be expanded and can be really helpful for the child. With non-functional echolalia, a child may repeat phrases over and over again as a way to calm their anxiety.
Speech and play therapy with a trained therapist may be a good way to help the child use their language skills more appropriately in time.
A professional can diagnose echolalia by having a conversation with the person with echolalia and by observing their language skills. A parent will be able to support with this assessment by giving information about what they have observed at home as the person who will know the child best and how they communicate usually.
Some children with autism are regularly tested for this, and echolalia ranges from minor to severe. A doctor can identify what stage the echolalia is at and recommend the appropriate treatment for that child.
Treatment options for echolalia may be:
- Medication – A doctor can prescribe medication such as antidepressants or anxiety medication to reduce the side effects of having echolalia. This will not be able to treat the condition itself but can help with the person’s mood and mental state. As echolalia can increase when a person is stressed or anxious, this can be effective in managing how severe the echolalia is by keeping the person calm.
- Speech therapies – Speech therapy sessions can help with echolalia as it can teach people to say what they are thinking and about turn-taking in conversations, for example. A helpful guide on what speech and language therapy is can be found on Kids Health.
- Home care – People with echolalia may work with other people at home to develop their communication skills. This can also support parents in their interactions with the child.
You can find some practical tips about how to support your child with echolalia at Looks Like Language.