Echolalia : Causes, Symptoms, Diagnosis & Treatment

• General Characteristics
• Causes Of Echolalia
• Physiological Factors
• Causes Of Pathological Echolalia
• Diagnostics
• Treatment

Echolalia is a symptom of a language disorder characterized by the uncontrollable automatic repetition of words or phrases spoken by another person. Echolalaemia is normal in the development of speech before the age of two, later they are considered as a symptom of a mental or neurological disease. Signs of echolalia: repetition of the endings of the interlocutor's phrases, delayed reproduction of his requests and questions, quoting replicas from films. Diagnosis is performed by a clinical method. Treatment is based on psychocorrection.

general characteristics

According to clinical manifestations, echolalia is of two types: immediate and delayed. In the first variant, patients unconsciously repeat words and phrases they have just heard. For example, a child, to the question: “Will you be an apple or a banana?”, answers: “Banana”, even if he wants an apple (he is unable to choose an answer). In the delayed form of the disorder, information heard some time ago is repeated. Example: Reproducing phrases from dialogue in a movie.

Echolalia within the framework of normal speech development can be observed at the age of 1-1.5 years. Gradually, the need for them disappears. Pathological echolalia is clearly manifested after 2-3 years. Children do not master independent speech, but continue to repeat phrases after others. Their entire active vocabulary may consist of sentences often repeated by their mother, replicas of cartoon characters, monologues of TV presenters.

Echolalia is the automatic, but not meaningless, repetition of phrases. It performs several important functions for the patient: it helps to maintain a conversation, understand the interlocutor, designate objects and phenomena. Patients with autism use automatic repetition of words as a ritual to restore emotional balance or as a tool for self-stimulation (repeating phrases causes arousal).

Causes of echolalia

Echolalia is based on the disinhibition of the imitative (imitative) reflex, which is the easiest way for children to master complex skills and speech. Imitation of an adult is manifested by an immediate echolalic reaction. If the reflex is not replaced in a timely manner by other techniques for mastering speech, then its disinhibition is present. The causes of echolalia can be divided into two large groups: physiological and pathological.

Physiological factors

At an early stage of speech development, a child can actively use imitation when communicating with an adult. The mechanism of repetition of words and phrases is gradually replaced by independent spontaneous speech, but can be stretched out in time or returned again as a result of a number of reasons:

• Lack of language skills. When a child does not know what to say, he simply copies the words of an adult. Speech echo-repetitions occur in children who do not have sufficient vocabulary, cannot spontaneously create phrases to answer questions.
• Misunderstanding of lexico-grammatical constructions . In the development of speech, a stage is possible at which the child understands the meanings of words, but does not know how to correctly compose them into sentences. He uses repetition of questions for requests. For example, voices heard earlier; "Are you hungry?" to let your mom know you're hungry.
• Experiencing stress. A new environment and the need to communicate with strangers can cause a regression of speech in a child. In a stressful situation, echolalia returns as the easiest way to communicate.
• Habit. Sometimes the child realizes that he is repeating the phrases of an adult. He does it out of habit, following a fixed pattern. The reason for this speech behavior is the lack of self-regulation skills. To get rid of the symptom, it is necessary to point out to the child that the use of echolalia is unacceptable.

Causes of pathological echolalia

In adults and children over 2 years of age, echolalic symptoms are manifested in mental and neurological diseases. Delayed echolalia is characteristic of mental disorders and is associated with a violation of the purposefulness of cognitive processes. Immediate echolalic reactions develop as a result of damage or underdevelopment of the frontal lobes of the brain responsible for controlling activity. Pathological causes are represented by the following diseases:

• Autism Spectrum Disorders. Echolalia is a common symptom of speech disorders in early childhood autism. Automatic multiple repetition of sentences is used as a means of self-regulation of emotions and behavior. Also, a symptom can be observed with Asperger's syndrome.
• ZPR and oligophrenia. In diseases with intellectual retardation, insufficient development of speech is noted. Echolalia allows you to compensate for the lack of vocabulary, the skill of self-constructing an utterance. With mental retardation, echolalic symptoms are often combined with echopraxia - imitation of gestures, postures, movements.
• Schizophrenia. Echolalia is possible in catatonic schizophrenia. It may be of a delayed nature, not related to the current situation. There are variants with mechanical repetition without intonation, with exact repetition (“gramophone” speech), with a kind of modulation (“parrot” speech).
• Organic lesions of the brain. Echolalia occurs with pathologies affecting the frontal lobes. In Pick's disease, initially there is an inaccurate repetition of speech in combination with sensory aphasia, which is replaced by true echolalic reactions. After a stroke with sensory-motor aphasia, automatic echolalia is formed with a possible reverse development. Vascular atherosclerosis may be accompanied by intermittent inaccurate echolalia.
• Genetic psychoneurological diseases. Automatic repetitions of phrases and words are detected in the clinical picture of Rett's syndrome, they increase along with stereotypical monotonous hand movements, a general impoverishment of speech, and a decrease in intelligence. In patients with Tourette's syndrome, echolalic manifestations are vocal tics accompanied by multiple motor tics.

Diagnostics

Long-term preservation of vocabulary and syllabic speech imitation in childhood or the appearance of this symptom in adults requires an appeal to a psychiatrist and neurologist. Echolalia is diagnosed in the course of communication with the patient, observing his speech. Usually, detecting automated repetitions of sentences and words is not difficult. To establish the nature of echolalic symptoms, a comprehensive examination is performed:

• Assessment of psychoneurological status. Taking an anamnesis, a clinical conversation, a neurological examination allow doctors to assess the general condition of the patient: his ability to establish and maintain contact, navigate in space and time, and be critical of his disease. Accompanying echolalia neurological disorders, psychopathological symptoms are detected.
• Logopedic testing. The speech therapist examines the speech function, determines the degree of its formation, the presence of pronunciation defects, the loss of individual links. In conclusion, he notes whether echolalia is the result of speech underdevelopment or speech decay.
• Pathopsychological testing. A study of memory, thinking, attention and intelligence is being carried out. The results indicate the presence or absence of signs of an organic lesion of the central nervous system, intellectual underdevelopment as the cause of echolalic manifestations.
• Neuropsychological testing. Diagnosis by a neuropsychologist is aimed at analyzing higher mental functions. Testing data allow us to determine neuropsychological symptoms (various types of alalia, aphasia), to differentiate neurological diseases.

Treatment

Echolalia is eliminated with the help of psycho-correctional classes. In parallel with them, the treatment of the underlying disease that caused the symptom is carried out. Corrective work can be carried out by a psychologist, defectologist, speech therapist. Important conditions for obtaining a positive result are the patient's ability to maintain contact, the absence of pronounced emotional and behavioral disorders, and a sufficient level of intelligence to conduct a conversation.

In the classroom, visual aids, tables, audio and video materials are actively used. At the initial stage, dialogue exercises are used, in which the patient is asked to replace the echolalic "response" with the choice of a visual stimulus - pointing to a picture, an object. Gradually, the visual support is replaced by speech statements, the duration and complexity of the dialogue increases. After a dialogue speech, a monologue and communication in a group are mastered.