Echolalia (also known as echologia or echophrasia) is the automatic repetition of vocalizations made by another person (by the same person is called palilalia). It is one of the echophenomena, closely related to echopraxia, the automatic repetition of movements made by another person; both are "subsets of imitative behavior" whereby sounds or actions are imitated "without explicit awareness". Echolalia may be an immediate reaction to a stimulus or may be delayed.
The word "echolalia" is derived from the Greek ἠχώ, meaning "echo" or "to repeat", and λαλιά (laliá) meaning "speech" or "talk" (of onomatopoeic origin, from the verb λαλέω (laléo), meaning "to talk").
Echolalia is one of the most salient aspects of communication disorders in autism, but is neither unique to, nor synonymous with the syndrome. Echophenomena (particularly echolalia and echopraxia) were defining characteristics in the early descriptions of Tourette syndrome (TS). Echolalia also occurs in aphasia, schizophrenia, dementia, catatonia, epilepsy, after cerebral infarction (stroke), closed head injury, in blind children, children with language impairments, as well as certain developing neurotypical children.
In Transcortical sensory aphasia, echolalia is common, with the patient incorporating another person's words or sentences into his or her own response. While these patients lack language comprehension, they are still able to read.
Imitation and learning
Imitation is a useful, normal and necessary component of social learning: imitative learning occurs when the "observer acquires new behaviors through imitation" and mimicry or automatic imitation occurs when a "reenacted behavior is based on previously acquired motor (or vocal) patterns". Ganos et al (2012) define echolalia as an "automatic imitative action without explicit awareness". It is not possible to distinguish imitative learning that occurs as part of normal development from automatic imitation or echolalia until about the age of three, when some ability for self-regulation is developed. A disorder may be suspected if automatic imitation persists beyond the age of three.
Echolalia can be categorized as immediate (occurring immediately after the stimulus) vs. delayed (some time after the occurrence of a stimulus). A typical pediatric presentation of echolalia might be as follows: a child is asked "Do you want dinner?"; the child echoes back "Do you want dinner?", followed by a pause, and then a response, "Yes. What's for dinner?" Researchers observed the daily repetitions of an autistic six-year-old in order to examine the differences between triggers for delayed versus immediate echolalia. Researchers further distinguished immediate echos by the sequential context in which they occur: after corrections, after directives, or in indiscernible sequential positions. Delayed echos are distinguished on the basis of ownership: self-echos, other-echos, and impersonal echos. The results showed that nearly all immediate echos produced by the six-year-old were found in sequential contexts, while the delayed echos also occurred in the basis of ownership.
Although echolalia can be an impairment, the symptoms can involve a large selection of underlying meanings and behaviors across and within subjects. Mitigated echolalia refers to a repetition in which the original stimulus is somewhat altered, and ambient echolalia refers to the repetition (typically occurring in individuals with dementia) of environmental stimuli such as a television program running in the background. A Japanese case report describes a 20- year old college student who was admitted to the hospital complaining for headaches and meningitis; however, he also exhibited signs of ambient echolalia. The researchers stated that the young patient's repetition was occurring at approximately the same tempo as his normal speech rate. The patient did not simply repeat words he had heard one after another. The patient reported that his ambient echolalia appeared to be random but appeared when he was distracted. He was also aware of his echolalia, but said he is unable to stop the repetitions.
In the past, echolalia was regarded as negative, non-functional behavior. However, researchers such as Barry Prizant and colleagues have emphasized the communicative function of echolalia. Among the communicative functions noted are turntaking, requesting, self-regulation and rehearsal to aid comprehension. Echolalia can be categorized as communicative (within context and with "apparent communicative purpose") vs. semicommunicative (an "unclear communicative meaning").
The use of echolalia in task response to facilitate generalization is an area that holds much promise. Research in this area is certainly needed. A series of task experiments performed on autistic children were performed by Marjorie H. Charlop. The results suggest that perhaps in certain tasks (i.e., receptive labeling), echolalia should not be eliminated, but taken advantage of as it may facilitate acquisition and generalization for autistic children.
In Tourette syndrome
Echolalia and echopraxia are distinguishing tics of Tourette syndrome (TS); the echolalic repetitions of individuals with TS are mainly echoes from within their own "tic repertoire". Evidence points to a healthy mirror neuron system (MNS) but "inadequate imitation-control mechanism, which make them vulnerable to interferences".
Studies in the 1980s showed that there may be communicative intent with delayed echolalia, "depending on the context in which it occurs"; this research on autistic children "raised questions related to behavior modification programs that defended the revocation or replacement of immediate echolalia".
Immediate echolalia results from quick recall of information from the short-term memory and "superficial linguistic processing". In delayed echolalia, a phrase is repeated after a delay, such as an autistic person who repeats TV commercials, favorite movie scripts, or parental reprimands. This delay in speech can be attributed to a deeper level of linguistic processing, including the processing of verbal and contextual information. During delayed echolalia, information is retrieved from the long-term memory as opposed to the short-term.
Uta Frith, Prizant and others have interpreted echolalia as evidence of "gestalt" processing in autistic children, including in the acquisition of language. However, a 1990 study on the acquisition of grammar by Tager-Flusberg and Calkins found that echolalia did not facilitate grammatical development in autistic children.
- Ganos C, Ogrzal T, Schnitzler A, Münchau A (September 2012). "The pathophysiology of echopraxia/echolalia: relevance to Gilles de la Tourette syndrome". Mov. Disord. 27 (10): 1222–9. doi:10.1002/mds.25103. PMID 22807284.
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- Liddell HG, Scott R. "λαλιά". A Greek - English Lexicon, on Perseus. Tufts University. Retrieved October 6, 2013.
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A type of fluent aphasia similar to Wernicke's with the exception of a strong ability to repeat words and phrases. The person may repeat questions rather than answer them ("echolalia").
- Bashe, P. R. The OASIS Guide to Asperger Syndrome; Advice, Support, Insight, and Inspiration. Crown Publishers, 2001, p. 22.
- Sterponi, Laura; Jennifer Shankey (March 2, 2014). "Rethinking echolalia: repetition as interactional resource in the communication of a child with autism" (PDF). Journal of Child Language 41 (2): 275–304. doi:10.1017/s0305000912000682. Retrieved 2 May 2014.
- Suzuki, Tadashi; Shouichi Itoh; Noritoshi Arai; Masako Kouno; Makoto Noguchi; Masami Takatsu; Katsuhiko Takeda (August 1, 2012). "Ambiant echolalia in a patient with germinoma around the bilateral ventriculus lateralis: A case report". Neurocase (Psychology Press) 18 (4): 330–335. doi:10.1080/13554794.2011.608364. PMID 22117108.
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- Rydell PD, Mirenda P (December 1994). "Effects of high and low constraint utterances on the production of immediate and delayed echolalia in young children with autism". J Autism Dev Disord 24 (6): 719–35. doi:10.1007/bf02172282. PMID 7844096.
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