Echolalia…What It Is and What It Means
Echolalia is repeating or “echoing” what another person has said. Children who are echolalic imitate what they have heard someone say in everyday life, lines they’ve listened to from a book, lyrics to a song, or a script from a show or movie. Professionals most often characterize children as “echolalic” when many of the words or phrases a child uses seem to be repetitions from a previous activity rather than new utterances a child comes up with on their own.
Children with echolalia use what many parents describe as “more advanced language” than they can typically generate. For example, a toddler who is exhibiting echolalia can quote long segments from a favorite TV show or sing an entire song word for word, but he can’t ask for milk when he needs it or answer a question his dad asks him. Even though this child “talks,” since he can technically say lots of words, he doesn’t seem to completely understand what he’s saying. In essence, he’s just repeating words without really being able to “use” them.
Echolalia is one of the characteristics sometimes noted in children with autism. In fact, researchers have found that up to 85% of people with autism who are verbal exhibit echolalia in some form. The silver lining in this is that echolalia is actually a positive sign that children with autism may eventually be able to learn to use language to communicate.
Echolalia is also a part of normal language development. This phase begins around 18 months of age when a child has mastered imitating words and is just beginning to imitate phrases. Experts tell us that echolalia peaks around 30 months of age, and declines significantly by the time a toddler turns three. This coincides with a child becoming conversational and truly beginning to talk on his own, generating his own original thoughts, asking new questions, and responding to questions appropriately.
In children with autism, echolalia occurs with greater frequency and lasts for a longer period of time than it does in children with typically developing language. For example, a child with typically developing language may be able to quote a few phrases from a favorite TV show, sing a song, or learn to count to ten by rote. However, he doesn’t do this repetitively several times a day, and when he does do this, it seems to “fit” what’s happened rather than leaving adults or other children around him wondering, “Okay…what’s that about?”
Children with motor planning issues, or apraxia, also can “get stuck” in this phase for a couple of different reasons. First of all, children with apraxia begin speech therapy with very poor imitation skills. Once they learn how to repeat what they’ve heard, they seem to want to hang onto this phase for a very long time. Secondly, repeating may become the “motor plan” they learn best, and it may be easier for some of these children to map a previously rehearsed message than to come up with a new one. (Although it is true with apraxia that children can come up with spontaneous utterances better than imitated ones, this is not usually the case once they have been in therapy for a while. It may be easier to pull out a tried-and-true phrase or sentence than learn a whole new one.)
Echolalia is classified as immediate echolalia or delayed echolalia.
Immediate echolalia is the repetition of words or phrases that occur immediately or very soon after the original words are spoken. An example of immediate echolalia is the child who repeats a question such as, “Do you want some juice?” rather than responding yes or no.
Delayed echolalia is the repetition of words or phrases that are echoed after the fact, even hours, days, weeks, or months later. An example of delayed echolalia is a child who might sing, “Happy Birthday” when someone new enters her home.
Echolalia can also include not only the words spoken, but the exact imitation of a person’s inflection, tone of voice, and volume.
Professionals used to view echolalia as something that should be eliminated. However, current researchers tell us that many times echolalic speech can serve a purpose for children with autism. For example, a child who wants to go outside may say to his mother, “Let’s put your shoes on,” as his way of requesting this activity since he’s heard his mother say this many times just before he gets to leave the house. A child may say, “Want me to hold you?” when he’s crying or “It’s okay, Ben,” when he’s upset since his parents have said this to him in this context over and over again.
I’ll give you another real-life example. A darling little boy on my caseload last Christmas called Santa Claus “It’s Santa,” all season long because the first time his mother taught him this word, she declared enthusiastically, “It’s Santa!” He lifted the whole phrase and his mother’s elevated and joyful tone of voice as this character’s name. When his teacher at preschool asked him, “Who’s that?” it was appropriate for him to respond in this way, but during a speech therapy session when I gave him a choice for play by asking, “Do you want Santa or this reindeer?” and he replied, “It’s Santa,” it didn’t make much sense.
In these cases echolalia is representative of the way these children process information. They learn in “chunks” without processing meanings of individual words. This learning style is called a “gestalt” style of language acquisition. Children who learn this way also process the sensory and emotional components of the event. In the previous example with Santa, the little boy processed “It’s” as a part of Santa’s name, along with the enthusiasm in his mother’s voice. Every time he said this, he repeated it in just the way she originally said it to him, beginning shortly after Thanksgiving and lasting well into January.
Sometimes echolalia does not serve an identifiable purpose. For example, consider the child who repeats every line from the book “Go Dog Go” for no apparent reason while in the grocery store. There’s no dog in sight and no link to associating this book, but she recites it while riding in the cart while her mother selects food.
I try to teach parents with children who seem to be stuck in echolalia to look at this as an opportunity for us to know exactly what he or she is having difficulty learning. Echolalia can serve a purpose for us. For example, the child who is walking around aimlessly quoting a movie or book may need help in finding an appropriate activity, or he may be feeling stressed or anxious and use this routine to calm himself. A child who asks her mother, “Do you want a cookie?” needs help in learning to initiate requests in a more appropriate way. A child who repeats a question needs help learning the meaning of the words so he can accurately process the question, or he may need specific cues to learn exactly how to answer. A child who repeats, “Good job (her own name)” needs to learn a declarative phrase such as, “I did it!” A child who repeats his brother’s words may just be trying to take a turn in conversation and doesn’t know what else to say.
By taking a moment to determine if the echolalic utterance serves a purpose, discovering what the child’s intent is, and then finding ways to teach your child what he should say in this context, you’ll be much more effective than trying to eliminate echolalia.
Look for a follow-up article this week for more specific ideas to work on functional language for children with echolalia at home and during speech therapy sessions. Laura