Echolalia in Autism

Why Autistic Children Echo Words and Sounds

echolalia

Verywell / Laura Porter

Echolalia is the precise repetition (echoing out loud) of words and sounds. Echolalia can be a symptom of aphasia, dementia, traumatic brain injury, and schizophrenia, but it is most often associated with autism spectrum disorder (ASD).

Echolalia is not always a self-calming tool for autistic kids, like rocking or hand-flapping tend to be (these repetitive behaviors are called stimming). Echolalia has its own patterns—it might even be how your autistic child first uses speech to try to communicate with you.

While echolalia can be a symptom of autism, it's also a point of entry for a parent or speech-language therapist to start working with your child.

This article will go over what echolalia is and how it's related to child development and conditions like autism. You'll also learn how to help a child manage echolalia if the behavior is not helpful.

Echolalia in Child Development

Echolalia is actually a normal part of child development. As toddlers learn to speak, they imitate the sounds they hear. Over time, a typically developing child learns language and is able to use it to communicate their needs and ideas by connecting new words together.

By the time they are 3 years old, most children communicate with others by selecting words or crafting phrases using their own unique voices and intonation.

By the time they are 4 or 5, kids are able to ask and answer questions, carry on conversations, and otherwise use language in their own way to communicate with others.

Echolalia in Autism

Echolalia can also be a common feature of autism. Autistic children are not always nonverbal—many use words and may even use very complex "adult" words. With echolalia, these words are, in a sense, not their own.

A child says the words in the same order—and usually in the same tone—as they heard them on a TV show, read in a book, or overheard from a teacher or another adult in their life.

One of the difficulties in understanding echolalia in autistic children is that the repetitive echolalia speech patterns can be used for different reasons. Those purposes might change over time. It's also possible for a person to use echolalia for multiple purposes at the same time.

Reasons autistic children use echolalia in speech patterns include:

  • Self-stimulation: Often called "stimming," this use of echolalia speech patterns is meant as a calming strategy. The repetition helps an autistic child cope with overwhelming sensory challenges.
  • Prefabrication: The use of repeated phrases and scripts helps to communicate when it is too difficult or stressful for the speaker to form their own original words.
  • Self-talk: Memorized phrases may help a child talk themselves through a difficult process. They can use phrases heard from parents, teachers, or on television.

For many autistic children, echolalia is an important part of developing spoken communication.

For example, if a teacher tells an autistic child to "say thank you," the child might repeat "say thank you" back to them instead of just saying "thank you." It may not be the response the teacher was going for, but it's a step in the right direction.

Types of Echolalia

There are different kinds of echolalia. The terms can be a bit confusing because our understanding of echolalia has changed over time. What was once considered a problem to "fix" is now viewed as a possible pathway for speech development.

The different types of echolalia include:

  • Functional or interactive echolalia, which is directed toward communication with others
  • Non-interactive echolalia, which occurs for reasons other than communication
  • Mitigated echolalia, which repeats some words but with changes
  • Immediate or delayed echolalia, which describe the timing of the repetitive words

Interactive and Non-Interactive Echolalia

Children speaking in an interactive way are trying to communicate with another person and are using memorized phrases for a real purpose—the challenge is figuring out the meaning.

For example, a child may hear a line from a TV commercial such as "got milk?" Later when they are thirsty, they may say "got milk?" in exactly the same tone and accent as the ad on TV instead of directly asking for a drink.

Another example: A child might say "Back off, Lieutenant!" when angry, because they heard an angry character say that in a movie. The child has connected the words with the emotion of anger and is using the phrase to indicate that they're mad.

As the listener, it can be confusing at first. You'll need to try to understand how the child has "wired" these words to their ideas.

It's much the same way that idioms—descriptive turns of phrase— get lost between languages. No one literally means that “it’s raining cats and dogs”—but we know what is meant when it's said.

In non-interactive echolalia, the child isn't trying to speak to anyone else. They might be repeating words or phrases to themselves for their own purposes—for example, to "practice" an idea or as a calming mechanism.

The repetition could be stimming, but it may have no meaning at all. It's not always clear if the child is choosing intentional words or repeating words they don't understand.

Either way, what's important is that an autistic child is borrowing the words of others and still needs help finding their own. Tapping into these echolalia patterns may offer a window for caregivers and speech pathologists to build on a child's unique style and work toward original language use.

That's especially true of mitigated echolalia, in which the child makes small changes to the original phrasing.

For example, if you ask a child which cookie they would like for a treat, they might just echo back "cookie" at first. As they gain more language skills and understanding, they might respond in the future by using a phrase they heard on a cookie commercial—like "Oh, oh, Oreo!"—to respond in a more specific way.

In this example, they might eventually drop the "Oh, oh" and just echo the word "oreo" to make their preference known.

Immediate and Delayed Echolalia

Sometimes echolalia is immediate and the child is echoing the words they hear. For example, a caregiver asks the child, "Do you want a drink?" and the child responds with "You want a drink."

The inability to switch pronouns is common. The child might be responding appropriately and may actually want a drink. However, instead of using an original phrase in the flow of normal conversation (like "yes, please," or "I'd like lemonade"), the child echoes the precise language.

Echolalia can also be delayed. For example, a child watches an episode of "Sesame Street" and later that day they recite the interactions between Bert and Ernie or sing a line from the theme song.

A child may also use Ernie's words intentionally, or the words are just repeated sounds. In delayed echolalia, there's a distance between hearing and using the words.

Related Behaviors and Conditions

There are some other behaviors and conditions that are similar to echolalia that may occur in autism.

Palilalia

Palilalia is a speech disorder that's marked by the involuntary repetition of words and phrases. In that sense, it is like echolalia but there are some key differences.

One difference is that in echolalia, the repetition or echoing is focused on other people's words and is received when the child hears them.

Palilalia often involves increasingly rapid speech with the same repeated sounds.

Echolalia and palilalia are not limited to autism; in fact, palilalia tends to be seen more in Tourette's syndrome, Parkinson's disease, and seizure disorders. Palilalia can even be a side effect of some drugs.

Echopraxia

Echolalia is sometimes confused with a term that sounds similar—echopraxia.

In echopraxia, a person repeats a movement that they see another person doing. However, they are not doing it intentionally—it's more like a reflexive action that they may not even be fully conscious of.

For example, they see a person scratch their head and they automatically move to scratch their head, too.

An autistic child may have echopraxia, but it also occurs in Tourette's syndrome.

Scripting

Scripting is another tool many autistic people use. It's a little like echolalia since they are saying words or phrases that they heard somewhere.

However, scripting is generally an intentional strategy. For example, an autistic child might repeat a catchphrase from a character on a TV show when they're talking with their classmates because they are not sure what to say.

Echolalia Treatment

Much as you may wish to limit your child's echolalia, especially in public, the reality is that echolalia can serve a valuable function. It can be a very positive behavior in the right circumstances.

Even if echolalia is less functional, it's a good starting point for interventions like speech therapy. For example, a child might memorize entire segments of a favorite video and recite them repeatedly as a way to calm themselves down and reduce anxiety.

The recitation may also indicate a real fascination for aspects of the video, just as it does in neurotypical children.

Echolalia that's functional is a reason to celebrate—it means that your child has developed a tool for verbally communicating their wants and needs.

They can keep building skills with the help of a speech therapist and will benefit from having caring adults around them who are intentional about words when talking with them.

Improving Communication

While it can be difficult to effectively communicate with your child when they’re exhibiting echolalia, there are multiple exercises that speech therapists use that can be directly applied to home practice, interaction, and engagement. Some of these techniques include: 

Limiting the “WH” Questions 

You may routinely ask “who”, “what”, “when”, “where”, and “why” questions just as a matter of daily interaction with your child, and this perfectly normal. Unfortunately, however, they may not understand or internalize the nature of the question and continue to repeat it. 

Instead of asking them generic questions, such as: “What do you want for a snack?” or “How are you feeling?” give them choice-questions, such as “Do you want an orange or cheese?”

Once they are more comfortable with this exercise, you can start gradually working the “WH” questions back in.  

This will help your child to learn how to answer your questions and cut down on the potential for repetition.

Communicate Visually

When asking choice-questions, try and show them their options (clothes, food, books, etc.) so they can take visual cues and make their choice. You can also animate their choices by shaking your head “yes” or “no” so they can easily understand

Using visual aids improves vocabulary and comprehension while giving your child a clear and simple choice while building communication skills.

Follow Through Immediately on Their Answers 

Once they make their choice, complete the dialogue by accommodating their selection. This fulfilment is a language lesson in and of itself and helps them identify objects by name. Repeat the name of the object as often as possible so they can understand. 

You can also use special intonations to let them know which options are good (foods, books, toys, pets). and which are dangerous (fire, knives, needles, medications, etc.).

Conversational Modeling with Relevant Terms

You can use key terms to help your child improve their communication and understanding of certain items. Try removing the actual question from the dialogue and just focus on the key word itself.

For instance, if you want to know if your child is tired, just ask repeat the word "tired" or "sleepy" instead of asking them if "they are" tired. This will help to reduce repetition of questions while expanding vocabul

You can practice these techniques and others for about 10-15 minutes per day, or however long or frequently is recommended by your child’s speech therapist. It’s important to realize that these techniques take time and repetition. Try not to get overwhelmed or discouraged if they don’t work immediately. 

Summary

Echolalia is the repetition of words or phrases. It's a common behavior in autistic people and can have many functions. For many autistic children, the different types of echolalia are steps toward developing their language skills and learning how to communicate.

If you're not sure how to make sense of your child's use of echolalia (or even if it is useful to them), it can help to work with a speech therapist. They can help you understand echolalia and support your child as they learn to communicate with you.

Frequently Asked Questions

  • Is echolalia a disorder?

    Echolalia is a feature of several conditions or disorders rather than being one in and of itself. Echolalia is actually a normal stage of language development in early childhood, but kids typically outgrow it around their third birthday.

  • Does echolalia mean someone has autism?

    In older children and adults, echolalia is a common sign of autism. However, it can also occur in people with aphasia, dementia, traumatic brain injury, and schizophrenia.

  • Can echolalia be treated?

    Echolalia does not necessarily need to be treated, but many children benefit from speech and play therapy. Talk to your child's provider about seeing a speech-language pathologist who treats echolalia.

  • What are examples of echolalia?

    There are three types of echolalia: immediate, delayed, and mitigated. Here are a few examples of each:

    • Immediate: You ask your child if they want to go to the park. Instead of answering "yes" or "no," they just repeated "park" back to you.
    • Delayed: Your child heard a TV character say, "That's super!" They repeat the phrase "That's super" frequently, sometimes in contexts that make sense (like when you tell them you are going to the park) but also at times that may seem random (like when they are in the car with you).
    • Mitigated: When your child is a little older, you might ask them if they want to go to the park. Instead of repeating "park" or saying "That's super!" they might start putting these ideas together and respond by saying: "The park? Well, that's super!"
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By Lisa Jo Rudy
Lisa Jo Rudy, MDiv, is a writer, advocate, author, and consultant specializing in the field of autism.