What to Know About Echolalia and Children With ADHD

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that starts in childhood and usually continues into adolescence. People with ADHD show symptoms of hyperactivity and impulsivity, inattention, or a combination of both.

Echolalia is when a person repeats what another person has said, either immediately after or later on. Echolalia is a normal part of language development but usually stops by about age 3 when children have acquired more developed language skills. If a person over age 3 is still regularly engaging in echolalia, it's possible something else is at play.

Echolalia is usually associated with autism spectrum disorder (ASD), but some people with ADHD also engage in echolalia. This article will explore the types of echolalia, why it occurs in children with ADHD, and treatment options.

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What Is Echolalia?

Echolalia describes the repetition of what another person says. It isn't a one-off episode, or the occasionally repeating or quoting someone to make a point, for clarification, or some other reason, but rather a repeated behavior that often seems meaningless, but is believed to have several purposes.

Echolalia is most associated with ASD, but it isn't limited to it.

Types of Echolalia

Echolalia is categorized in multiple ways.

It is characterized by time frame, such as:

  • Immediate echolalia: Phrases or words repeated immediately or after a brief delay
  • Delayed echolalia: Phrases or words repeated after a significant period of time

It is characterized by purpose, such as:

  • Functional/interactive echolalia: Used as a way to communicate with others
  • Noninteractive echolalia: For personal use or benefit, not generally as a means to communicate with others

Echolalia can also be mitigated, meaning the person changes the wording to some extent when repeating it.

"You" and "I"

It's common for people who use echolalia to mislabel pronouns. For example, they may say, "You want to watch cartoons?" as a way to indicate they would like to watch cartoons.

Causes and Symptoms

Echolalia usually develops when a person doesn't have or doesn't use the typical language for communication. This can be from a language delay, or from a condition such as ASD.

The symptoms of echolalia, or more accurately how echolalia manifests and is expressed, largely depends on the purpose behind it.

Examples include:

  • When asked, "What did you have for dinner?," the person may repeat the question and then wait for another to be asked that is more specific. Or the person may say, "Don't slurp your spaghetti," repeating something what was said to them during the meal.
  • The person may sing the jingle of a product to indicate that's what they would like for lunch, or ask, "Do you want juice?," to indicate that they would like juice or are thirsty.
  • A child may say to another child, "We don't take our friend's toys," when another child is doing something they don't like, even if it doesn't match the action. They are repeating a phrase they have heard that indicates an admonishment of a behavior. They may also repeat it to themselves to self-direct their own behavior.
  • A person may rehearse what they are going to say by repeating the sentence quietly to themselves before addressing another person.

Echolalia can also be a way to self-stimulate (called stimming) or self-soothe. For example, the person may repeat phrases they have heard in a movie or a TV show to themselves.

Echolalia can manifest in a myriad of ways beyond these examples but is usually done as a way to communicate with others, to note/reinforce information to themselves, or to self-regulate.

Echolalia and Decision-Making

When asked a question that contains two choices, a person who is using echolalia will usually repeat the second option.

If asked, "Would you like your red jacket or blue?," they would be likely to answer blue.

If asked immediately afterward, "Would you like your blue jacket or red?," they would likely say red.

An example of this can be seen in this video.

This doesn't mean people who use echolalia can't indicate their preferences, but it is something to consider when asking between choices.

Echolalia in Children

Echolalia is developmentally appropriate in very young children. Toddlers use echolalia as they are learning how language works, and to practice communicating with others.

By about age 3 years, most children no longer use echolalia regularly. They have usually acquired sophisticated enough language to communicate without it.

If your child is still using echolalia after age 3, it's worth bringing it up with their healthcare provider.

Echolalia in Adults

Echolalia is uncommon in adults. Autistic adults may use echolalia just as children with autism do.

Echolalia may develop in adulthood in people with certain psychiatric conditions such as catatonia (a psychomotor disturbance in behavior or movement that often appears as unresponsiveness), or if head trauma, serious amnesia, or anything else that necessitates relearning language occurs.

Echolalia and ADHD

Children with ADHD can experience language delays. While this may not result in echolalia, language delays are one cause of echolalia.

Echolalia is not common in children with ADHD, but it can occur. One way it presents in people with ADHD is as a stim (self-stimulation behavior).

Stimming is common in both ASD and ADHD, though it isn't expressed in the same way in both conditions. For people with ADHD, stimming is typically used for a short period of time (generally under an hour) and usually while trying to concentrate. An autistic person may stim for several hours at a time.

As evidenced by the recent fidget spinner craze, stims associated with ADHD tend to be physical, such as hand/pencil tapping, or hair twisting—but stims come in a variety of behaviors and include all of the senses.

An auditory stim that some people engage in is reciting songs, phrases, or words from TV, movies, commercials, or other places. Everyone does this from time to time, but with this form of echolalia/stim, it is done as a way to self-stimulate or self-soothe, and usually is done out of context.

ASD and ADHD

ASD and ADHD are two distinct conditions with separate criteria for diagnosis, but they show high comorbidity, meaning they often occur together.

Some children with ADHD show symptoms of ASD and vice versa, even if they don't meet the full criteria for a diagnosis of both.

Evaluation and Diagnosis

Echolalia is usually diagnosed by a healthcare provider by interacting with the child and by listening to the observations of the parent or guardian. Echolalia is a clue to look further to determine why the child is engaging in it and if there are any underlying conditions or speech delays.

Treatment

Trying to immediately extinguish echolalia is not often advised, as it serves a purpose. The people using it are doing so as a way to communicate, self-regulate, self-soothe, and other beneficial behaviors.

Treatment usually involves building communication skills that gradually replace the echolalia. The first step in the process is determining why the person uses echolalia so that you know what needs must be met and which tools to give them to do so.

Speech Therapy

Treatment for echolalia usually involves a speech therapist. A speech therapist has a variety of tools, including play therapy, at their disposal to assess language skills and promote the building of new ones.

A speech therapist can also look for and address other language difficulties that may or may not be related to echolalia.

If echolalia is comforting or purposeful to the person, a speech therapist can teach them appropriate times and ways in which to use it.

Medication

There is no medication for echolalia specifically, but it may be prescribed to address the causes for echolalia.

For example, because echolalia is sometimes used when a person feels anxious, antidepressant or antianxiety medication may be prescribed so that the person feels more relaxed and is less likely to feel the need for echolalia.

ADHD medication such as stimulants can reduce the need for stimming in a person with ADHD, including echolalia.

Improving Communication

Parents or guardians can help build communication skills by gently redirecting and correcting when echolalia occurs.

For example, if the child says, "Hold you?," you can model the correct sentence, "Will you hold me?," and have the child repeat it back to you before you pick them up. After a while of doing this, you can expand upon it. If the child indicates they want juice by saying, "Do you want juice?," try responding, "No, I don't want juice, but you do. Say 'I want juice.'"

If the echolalia such as repeating phrases from TV is happening because the child finds it comforting or stimulating, it doesn't necessarily have to be changed. If it isn't interfering with their functioning or being disruptive, it's fine for them to use this tool, just as with other stims.

If echolalia is happening in a way that is disruptive to themselves or others, try to find out what is making them feel anxious, uneasy, or bored when they do it, and work on other ways they can calm down or engage that are less disruptive.

Summary

Echolalia is the repetition of words or phrases, either immediately after the person hears it or at a later time. Echolalia is part of early language development, but usually stops by age three.

Echolalia is a common symptom of ASD, but people who are not autistic can engage in echolalia as well. Some people with ADHD use echolalia as a stimming behavior to self-stimulate or self-soothe.

Treatment for echolalia involves helping the person to expand on their language skills to communicate in more diverse and direct ways, and is typically administered by a speech therapist.

A Word From Verywell

If you notice your toddler repeating what you or others say, don't worry. This is part of typical language development.

If your child is still regularly repeating words and phrases, particularly if they are not communicating clearly in age-appropriate ways, see your healthcare provider. There are a number of reasons a child may engage in echolalia when it is not developmentally typical. Your healthcare provider can help perform an assessment and point you in the right direction for treatment, if needed.

Frequently Asked Questions

  • Does ADHD cause speech or communication issues?

    ADHD can cause speech and communication problems, particularly articulation disorders (the inability to pronounce letter sounds in an age-appropriate way).

    People with ADHD can also speak loudly and have variability in their pitch. Language delays can also happen with ADHD. These difficulties are often related to organization and distractibility challenges that come with ADHD rather than a specific speech delay.

  • Is echolalia a common symptom of ADHD?

    Echolalia as a whole is not a common symptom of ADHD, and it is not listed in the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for ADHD.

    Stimming is common in ADHD, and one way echolalia can manifest is as a stim, typically repeating phrases from TV shows or other forms of entertainment.

  • Is there a way to fix echolalia?

    Echolalia does not always need to be "fixed." It depends on the reason behind it and how it is manifesting.

    A person who uses echolalia to stim in a way that is not disruptive to them or those around them, and who otherwise communicates well, may not need any intervention.

    If echolalia is taking the place of more advanced or clear communication, speech therapy is the common approach to treatment.

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