Echolalia is a language disorder that involves repeating the last syllables or the last words that have just been spoken by an interlocutor. Echolalia is most often caused by autism spectrum disorders, but can be found in other pathologies such as neurodegenerative dementias, Alzheimer’s disease in particular, aphasias following a stroke, and others. diseases, for example neurological or psychiatric.

Their treatment mainly involves speech therapy sessions, and sometimes behavioral and cognitive therapy. Medicines can also be used to reduce side effects, such as depression or anxiety.

Definition of echolalia

Echolalia is commonly defined as “an echoing repetition of the word“. Such repetitions may involve the last syllables or the last words spoken by another person. This linguistic phenomenon was first described in 1943. It has been reported to be a characteristic of autistic syndrome, but this language disorder can be found in other pathologies, neurological or psychiatric.

There are two main types of echolalia:

• immediate echolalia: these repetitions of syllables occur immediately after or shortly after the words heard. It is the most common form of echolalia.
• delayed echolalia: repetitions occur significantly long after repeated speech has been produced. Often, in this type of echolalia, it happens that a child repeats a sentence heard on television or other media, after a significant time interval following the production of this sentence (sometimes several days).

In addition, the mitigated echolalia was described in 1969: it implies a change of minimal structure of the repetition. For communication purposes, it can be immediate or postponed. In aphasic patients, this type of echolalia and the changes it contains are a sign of the onset of speech recovery. This type of mixed echo has also been interpreted, in autistic children, as a step in the evolution from pure echoic language to more creative and productive speech, particularly when pronouns are modified appropriately.

Some authors regard echolalia as a repetition without meaning and without apparent purpose, as an indication of the severity of the disorder, or even as a speech without connection with the other interlocutor and without possible interpretation: in such a perspective, the clinical procedure to adopt must be an attempt to stop this echolalic speech.

Other studies define echolalia as a first attempt to maintain social contact, when the individual is faced with a linguistic stimulus beyond their language skills, or as a positive prognostic factor.

In fact, from an early age, echolalia plays an important role in the interaction of a child with its mother: it is a means of bringing about initial interactions and of bringing the child into the world of the first. words, and also a way to get a response from that child. Researchers have also observed that the mother uses delayed echolalia as a means of attracting the attention of her young child. Thus, this seems to suggest that this language, even when it presents signs of pathology like those of echolalia, can still play a communicative role. Also, when the child’s echolalic language is accepted, he or she becomes more motivated and tends to use more creative language.

Causes of echolalia

Imitation, which consists of repeating the sounds heard, accents, and words, plays a fundamental role in the normal acquisition and development of language in young children. This normal language learning process in children aims to contribute to the development of fine and precise communication skills throughout life.

Echolalia will be considered a language disorder if this repetition continues after infancy, i.e. after about the age of three.

Echolalia can be caused by certain pathologies, even if it is not systematic and can affect affected individuals:

• autism spectrum disorders, in which echolalia is common: it affects up to 75% of autistic children able to speak. It also exists in patients with Asperger’s syndrome;
• intellectual disability;
• neuro-generative dementias, and particularly Alzheimer’s disease;
• aphasias following strokes;
• head trauma;
• epilepsy;
• other neurological diseases, and in particular Gilles de la Tourette syndrome;
• psychiatric illnesses, such as catatonic-type schizophrenia.
• blindness;
• aphasias, including transcortical aphasia (ie 4 to 20% of aphasias), an impairment of language which is characterized by good conservation of the ability to repeat. On the other hand, during classical peri-sylvic aphasia, echolalia has been described occasionally during the recovery process.

The neural mechanisms behind verbal imitation and repetition are beginning to be well understood. In healthy subjects, the act of understanding, imitating, and learning to speak requires orchestrated coordination of different regions of the brain, in which the mirror neuron system and the white matter tracts (or bundles) connecting its different nodes are involved.

When pathologies of the brain abolish the regulatory function of the various areas of the left hemisphere of the brain, as in patients with aphasia, their verbal repetition can become out of control and echolalia ensue, via the automatic activation of circuits of the brain. perception-action including this system of mirror neurons.

Diagnosis of echolalia

A health professional, whether it is the attending physician, or even a neurologist or a psychiatrist, can diagnose echolalia simply by talking to the person who has it.

The people concerned

Children with autism are the most affected by echolalia, which can affect up to 75% of them. It is generally believed that lower language receptivity skills in children with the autism spectrum disorder play a role in echolalia. These children produce less echolalic language as their language skills improve.

Risk factors

• Communication disorders in children can make them more likely to hold on to expressions that echo them longer.
• Children with autism spectrum disorder are particularly susceptible to echolalia.
• Following amnesia or head trauma, echolalia is common, mainly a sign that patients are trying to regain their speech ability.

The main symptom of echolalia is the repetition of syllables, words or phrases and noises that have been heard.

Echolalia can be immediate, and in this case the patient repeats something immediately after his interlocutor has just spoken, or delayed: there, the person with echolalia repeats what his interlocutor has told him for several hours, even days. after hearing it.

Other signs of echolalia

• frustrations during the conversation;
• depression;
• silence.

Exceptionally too, irritability can be expressed in a person affected by echolalia, especially when a question is asked.

Treatment of echolalia will combine:

• speech therapy sessions. In particular, during these sessions, people with echolalia learn to express their thoughts.
• in some cases, drugs such as antidepressants or anxiolytics, especially with the aim of countering the side effects of echolalia such as anxiety or even depression, can be used.
• cognitive and behavioral therapies.

If the therapy is sometimes long, it can lead to real and noticeable improvements. The therapists must first have determined the causes of echolalia, and therefore also tried to treat the pathologies linked to it.

Echolalia is part of the natural development of language in early childhood. In order to avoid permanent echolalia in children, parents should be careful to encourage multiple forms of communication, for example they can modulate these by also using manual signs. In addition, the child must be exposed to a wide variety of words, and to a wide variety of sentences.