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What you need to know about Echolalia

One day I was hanging out with some friends and we were all swapping funny autism stories.  I shared my story with the punchline, “And that’s why delayed echolalia is a mom’s best friend!” But there was one person who didn’t laugh.  She looked confused.  She asked,

“What’s Echolalia?”

Echolalia is the repetition of phrases, words or parts of words.  Echolalia may be a sign of autism, another neurological condition, a visual impairment or a developmental disability. Almost all toddlers go through a stage in which they “parrot” words and phrases that they overhear.  Mimicry is an efficient way to experiment with different sounds and practice emerging social language skills.  This is a normal and critical stage in language development. But what does it mean when this stage goes far beyond the toddler years?  What is the function of echolalia? In her book Helping Children With Autism Learn, author Bryna Siegel writes, “There are two basic forms of echolalia: immediate echolalia and delayed echolalia.  The presence of these tells us something about how the child is trying to process language.”

Immediate Echolalia

When a person repeats back something that he or she has just heard, that is immediate echolalia.  For example, if a parent says, “It’s time for a bath,” the child may repeat, “Time for a bath.”  Siegel comments that by repeating back the words, the child is demonstrating that she can hear accurately, can physically produce speech and can remember it long enough to reproduce it.  The next step is comprehension of speech, which may take months or years to develop.

The Reason for immediate Echolalia

Some adults with autism explain that immediate echolalia is a way of communicating, “I heard what you said, and I’m still processing it.”  Immediate echolalia is an attempt to remain in a conversation and give an on-topic answer, before the meaning of the conversation is fully grasped. One way to increase comprehension during a conversational exchange is to offer visual or tactile supports - or to involve as many senses as possible. For example, my kids love the story about Curious George getting sprayed by a skunk, but no matter how much I explained with words, they didn’t understand what that smell was...until I stopped the car one afternoon and rolled down the windows.  “Boys, that’s the smell of skunk spray,” I said.  My children were overjoyed, because they finally understood!

Meltdown Potential

A common scenario in the autism community is the meltdown caused by a misunderstanding of immediate echolalia.  A caregiver will ask a child, “Do you want grapes or apples?”  The response is almost always the second choice, “Apples,” and the caregiver assumes that is what the child actually wants.  The child then starts screaming uncontrollably when presented with apples, because the child responded while still trying to comprehend the two choices -- and preferred the grapes all along. PECS or picture cards are a great way to introduce choices or transitions, and thus prevent meltdowns.

A Desire for Conversation

Siegel concludes, “For most children, immediate echolalia is a developmental phase that occurs when they begin to understand the function of words but can’t always decode what a word means soon enough to give a specific and relevant reply.”  It is important to realize that immediate echolalia represents a desire for inclusion in conversation.  Even more importantly, immediate echolalia is a desire to comprehend and learn language.

Delayed Echolalia

Many people like to memorize and recite “catch phrases,” or sometimes whole paragraphs - perhaps scriptural verses, inspirational or historic speeches, or funny scenes from the movies.  As long as the phrases are repeated in an appropriate social context, this is a widely accepted social behavior.  Delayed echolalia is the repetition of phrases after a period of time - several minutes or a year after the phrase was originally heard - and the phrases may pop up any time, any place. Here are three possible reasons for delayed echolalia.

1. Self Stimulatory Behavior

Delayed echolalia is sometimes a self-stimulatory behavior with the sole purpose of satisfying the speaker.  My older son has always enjoyed reciting sentences that he reads in books.  I came to realize that he sees the book in his mind, and entertains himself by “reading” his favorite sections over and over.  The line “George, what’s that smell?” came from the Curious George story about the skunk, and leads to hysterical laughter. He also repeats sections from his favorite videos, as if watching the video inside his head.  When delayed echolalia is used for personal entertainment in this way, it can prevent real-life interactions.  The caregiver can take this as a cue to re-direct gently to a more constructive activity.

2. Communicating the Mood

In my experience as a parent, delayed echolalia is often an impressionistic way of communicating mood.  If my son hears a sentence such as, “The pool is closed today,” and experiences disappointment, he will repeat that sentence every time he feels disappointed. A sentence that inspires a feeling of joy and elation such as, “Our hotel room is on the 17th floor,” will be repeated every time he feels joy and elation.  If he does not fully understand the content of a conversation, but wishes to participate, he will pick up on the general mood of the conversation and repeat sentences that he associates with that mood. In these situations, my strategy is to acknowledge his emotions (“I remember how happy you were at the hotel in Niagara Falls, and I see that you also feel happy now”) and re-direct him to the present circumstances.

3. A Day in Review 

Delayed echolalia can also be a way to process memories as they come bubbling up to the surface of the mind.  My son used to come home from preschool and recite phrases and sentences that he heard during the day: the good, the bad and the ugly. He especially liked to repeat what the teacher said to other children who misbehaved - he even captured his teacher’s tone of voice: “Kevin, we keep our shoes on in school.”  “Joey, we use gentle hands.”  “Tommy, we don’t stick our hands in the urinal.  It’s not a waterfall.” For me it was like getting a daily news report of the major events at preschool.  My son was communicating to me that his school was a loving, supportive environment, and that he enjoyed his teachers and classmates.  And that’s why delayed echolalia is a mom’s best friend.