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Echolalia

What Is It, Causes, Signs, Symptoms, and More

Author:Lily Guo

Editors:Alyssa Haag,Stefan Stoisavljevic, MD,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Sadia Zaman, MBBS, BSc


What is echolalia?

Echolalia, also known as echophrasia, refers to non-voluntary repetition of another individual’s speech. The term echolalia is derived from the Greek roots “echo” which means “to repeat” and “lalia” which means "speech." It is a common finding in toddlers, and functions as a part of  language development and language acquisition. As language skills develop, echolalia tends to become less prominent. If automatic speech imitation persists or re-emerges past the age of three years, one may begin to suspect a speech and/or developmental delay. Echolalia can be categorized as immediate, when an individual immediately repeats speech of another individual, or delayed, when an individual repeats another’s speech after some time.  Alternatively, echolalia can be categorized into communicative echolalia, where the repeated phrase(s) have a meaningful or communicative purpose; and semi-communicative echolalia, which is repetition with no clear communicative purpose. 

Man trying to speak but repeating the speech of someone else.

What causes echolalia?

The exact cause of echolalia is not known, however, speech imitation and repetition is a normal part of language development in toddlers younger than three years. After three years, self-regulation of speech and language typically develops. Echolalia that persists after the age of three may be considered pathological echolalia. Proposed mechanisms of echolalia include dopaminergic dysregulation; a broken mirror neuron system; and a “wealth of stimulus” hypothesis. 

The dopamine dysregulation theory acknowledges that dopamine serves as an important neuromodulator, and hyper- or hypo-dopaminergic signaling may underlie the pathophysiology of echolalia

The broken mirror neuron system refers to a dysfunction of a group of specialized neurons that mirrors the actions and behavior of others. 

The “wealth of stimulus” hypothesis states that during development, humans learn language by observing their socio-cultural environment. If there is a disconnect in what the infant observes in their environment and their subsequent motor action (e.g., speech), echolalia can result. Additionally, dysfunction of the frontal lobe, specifically lesions of the left medial frontal lobe and supplemental motor areas, can be responsible for deficits in language processing and production. 

Echolalia is commonly seen in those with autism spectrum disorder (ASD), with up to 75% of children with autism exhibiting echolalia. Additionally, Tourette syndrome (TS), a neurologic disorder manifested by motor and phonic tics, can be characterized by echolalia. Those with TS are thought to have disturbances in their mesolimbic circuit, which leads to disinhibition of the motor and limbic system. Other pathological states that can be characterized by echolalia include: delirium, dementia, stroke, and encephalitis. Specifically, strokes that affect areas of the brain responsible for  processing language and speech, such as  the angular gyrus or Wernicke’s area and areas of the brain responsible for producing speech, including Broca’s area can often produce echolalia. Encephalitis, an inflammatory condition of the brain, can produce language dysfunction such as echolalia, diminished language output, and mutism. 

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What are the signs and symptoms of echolalia?

The signs and symptoms of echolalia include rote repetition or imitation of words and phrases. Echolalia can be immediate, when an individual immediately repeats the speech of another individual, or delayed when an individual repeats another individual’s speech after some time. Additionally, echolalia can be unmitigated, which is when the speech is repeated exactly, or mitigated, which is when the repeated speech is altered. If echolalia is experienced as a symptom of ASD, the individual may also use odd or overelaborate words, avoid one’s gaze, and fail to initiate meaningful verbal interaction. If the individual with echolalia has TS, they may also experience coprolalia (i.e., repetition of obscene words) or palalial (i.e., repetition of words with increasing rapidity). Echolalia can also impair social interactions and learning, and can also be a barrier to forming and maintaining social relationships.

How is echolalia diagnosed?

Echolalia is diagnosed through a careful review of the individual’s experiences and past medical history. The clinician may also assess for the presence of echolalia by observation, either directly or by video recording. If the individual with echolalia is a child, they may specifically ask the parent or guardian if the child frequently repeats words spoken by others. The parent can often support the assessment by offering information about behaviors observed at home and in school. In the clinical setting, a speech-language pathologist can also diagnose echolalia by having a conversation with the individual and observing their language skills. 

How is echolalia treated?

Treatment of echolalia depends on the underlying etiology. If echolalia is a part of ASD, then treatment is focused on managing ASD, which may  include behavioral therapy, social skills training, occupational therapy, and speech and language therapy with the help of speech-language pathologists, speech therapists, and psychologists. The interdisciplinary team can use applied behavior analytic (ABA) interventions for echolalia in children with autism. The goal of ABA is to increase behaviors that are helpful and decrease behaviors that are harmful or affect learning. ABA seeks to understand the reason for speech repetition and respond in a way that helps the child learn appropriate communication skills. Various activities included in ABA are cues-pause-point training, script training, visual cues, gestalt learning, and verbal modeling. 

To treat echolalia secondary to Tourette syndrome, Comprehensive Behavioral Intervention for Tics (CBIT) is often used. CBIT involves training an individual to be more aware of their urge to tic, to perform competing behavior when they feel the urge, and make changes in daily activities that help to reduce tics. Other techniques, such as music therapy, have also been incorporated into the assessment and treatment of echolalia. Pharmacotherapy may be indicated in older children, where the echolalia is triggered by stress and anxiety and may include selective-serotonin reuptake inhibitors, or SSRIs (e.g., clomipramine, fluoxetine). 

What are the most important facts to know about echolalia?

Echolalia refers to the non-voluntary repetition of another individual’s speech. While it is a typical part of speech and language development, it should only persist until three years of age. Echolalia is commonly seen in children with developmental disorders such as autism and Tourette syndrome, however, it can also be seen in adults with medical comorbidities, such as  delirium, dementia, stroke, and encephalitis. There are various types of echolalia, including immediate or delayed, and non-mitigated or mitigated echolalia. Applied behavior analytic interventions and speech therapies are primarily used for the management of echolalia related to autism spectrum disorder, whereas Comprehensive Behavioral Intervention for Tics is used for treating echolalia related to Tourette syndrome. If the cause of echolalia is related to stress and anxiety, selective-serotonin reuptake inhibitors can be used. 

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Related links

Tourette syndrome
Autism spectrum disorder

Resources for research and reference

Abusrair, A. H, & AlSaeed, F. (2021). Echolalia Following Acute Ischemic Stroke. The Neurohospitalist, 11(1):91-92. DOI: 10.1177/1941874420958847. 

Centers for Disease Control and Prevention. (2022, March 9). Treatment and Intervention Services for Autism Spectrum Disorder. In Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/ncbddd/autism/treatment.html.

Hansen, R. L., & Rogers, S. J. (2013). Autism and other neurodevelopmental disorders. American Psychiatric Publishing. 

Lim, H. A., & Draper, E. (2011). The effects of music therapy incorporated with applied behavior analysis verbal behavior approach for children with autism spectrum disorders. Journal of Music Therapy, 48(4): 532–550. DOI: 10.1093/jmt/48.4.532

Patra, K. P., & De Jesus, O. (2022, February 19). Echolalia. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK565908/

Pringsheim, T., Okun, M. S., Müller-Vahl, K., Martino, D., Jankovic, J., Cavanna, A. E., Woods, D. W., Robinson, M., Jarvie, E., Roessner, V., Oskoui, M., Holler-Managan, Y., & Piacentini, J. (2019). Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19): 896–906. DOI: 0.1212/WNL.0000000000007466

Prizant, B. M., & Duchan, J. F. (1981). The functions of immediate echolalia in autistic children. The Journal of Speech and Hearing Disorders, 46(3): 241–249. DOI: 10.1044/jshd.4603.241

Prizant, B. M., & Rydell, P. J. (1984). Analysis of functions of delayed echolalia in autistic children. Journal of Speech and Hearing Research, 27(2): 183–192. DOI: 10.1044/jshr.2702.183

Ray, E., & Heyes, C. (2011). Imitation in infancy: the wealth of the stimulus. Developmental science, 14(1): 92–105. DOI: 10.1111/j.1467-7687.2010.00961.x

Schuler, A. L. (1979). Echolalia: issues and clinical applications. The Journal of Speech and Hearing Disorders, 44(4): 411–434. DOI: 10.1044/jshd.4404.411

Stiegler, L. N. (2015). Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand? American Journal of Speech-language Pathology, 24(4): 750–762. DOI: 10.1044/2015_AJSLP-14-0166