Echolalia

Echolalia is a neurological disorder characterized by uncontrolled repetition of words and phrases. Let's consider its features, methods of treatment and prevention.

According to the International Classification of Diseases, 10th revision, echolalia is included in the group: XVIII Symptoms, signs and deviations from the norm revealed by clinical and laboratory studies, not classified elsewhere.

R47-R49 Symptoms and signs involving speech and voice

• R48 Dyslexia and other symbolic impairments, not elsewhere classified (exception: specific developmental disorders of scholastic skills):
  • R48.0 Dyslexia and alexia
  • R48.1 Agnosia
  • R48.2 Apraxia
  • R48.8 Other and unspecified disorders of recognition and understanding of symbols and signs

Very often, the disease is associated with early symptoms of autism or the peculiarities of the development of children's speech. There are two stages of development of speech skills in a child: from 6 months to 12 and from 3 to 4 years. At this age, children repeat everything they hear, and this is considered normal. Imitation of one's own speech is the only way to train and improve the pronunciation of sounds. Thus, the basis for interaction with the outside world is formed, and vocabulary is expanded. If violations begin at one of these stages, this can lead to the development of echolalia.

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Epidemiology

The incidence of neurological disorders tends to increase. The epidemiology of echolalia indicates its age-related aspect, so out of 10,000 children, 2-6 have symptoms of the pathology. Such a disorder is detected in most cases through early diagnostics, that is, in the early stages, which are best corrected.

Such a qualitative anomaly provokes disturbances in social interaction and communication. This is associated with uncontrollably repeated words and phrases, which makes the process of adaptation to society impossible. The disease may be accompanied by progressive mental retardation.

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Causes echolalia

Echolalia occurs at the stage of speech development, when the child begins to learn about the world around him and actively speak out. There are two such stages, which last from 6 months to a year and from 3 to 4 years. It is during these age periods that children actively repeat the words of others, learning the basics of speech and trying to enter into a dialogue.

Causes of echolalia:

• Mental disorders.
• Various neurological pathologies.
• Damage to the frontal lobes of the brain.
• Mental retardation.
• Autistic disorder.
• Tourette's syndrome.
• Imbecility.
• Schizophrenia.
• Rett syndrome.
• Brain cancer.
• Dyslexia.
• Dysphasia.

Any of the above disorders can be diagnosed in children, so when we talk about echolalia in adults, we mean disorders that were not identified in childhood. In addition to the main causes, the disease can be aggravated or caused by certain provoking factors:

• Self-withdrawal in the communication process – repeating what he heard, the child has a certain range of emotions and associations. If such images appear too often and are erroneous, then this becomes a problem in communication.
• Emotions in the communication process – echolalia acts as an indicator of the patient’s mood, since repeated phrases have emotional images.
• Processing and organizing information – by repeating what he heard, the patient organizes the events that occurred, shares this information and emotions with others.

Regardless of the patient's age, the disease is always accompanied by mental and neurological pathologies. In the diagnosis of autism, echolalia acts as a peculiar way of communication. This is an attempt to maintain a conversation or enter into a dialogue before the realization of what was said has occurred.

Up to 4 years of age, automatic repetition of words after others is normal. But at an older age, this symptom requires medical attention, as it indicates a serious pathology. In medical practice, there are very often cases when an illness becomes a provocateur of hysterical attacks due to the resulting misunderstanding.

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Pathogenesis

The mechanism of development of speech behavior disorder can be associated with both functional and organic changes in the brain. Pathogenesis implies a number of processes that cause the appearance of echolalia symptoms. This can be caused by existing or past diseases, congenital pathologies.

Signs of the disease appear with hyperexcitation of neurons in the motor zone of the frontal lobe of the brain. This was established using transcranial magnetic stimulation. The defect is characterized by disturbances in the functioning of the neural structures of the brain, difficulties in the social and emotional sphere under the condition of normal thinking and attention. Since echolalia can be an early symptom of autism, in some cases there is an imbalance of inhibition and excitation, an excess of local connections in certain areas of the brain and other pathologies.

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Symptoms echolalia

Uncontrolled repetition of individual words or entire sentences from the interlocutor's monologue are symptoms of echolalia. The source of repetitions can be either a person who is nearby, or a book text, television or radio broadcast.

The disease has two types, which differ in their symptoms:

• Immediate - the patient reproduces words and phrases that he has just heard. This type is necessary to maintain communication with others, that is, it acts as a kind of conversation.
• Delayed - the repetition occurs after a certain period of time, it can be 10-15 minutes, a day, a week or a month. Accompanied by various additional mental disorders.

Self-stimulation is characteristic of neurological pathology, i.e. repetition of phrases associated with certain emotions. In this way, the patient is immersed in an atmosphere that is comfortable for him. The repeated phrases cause surprise in those around him, as they have no relation to current events.

Another symptom of the disease is the function of transmitting mood through positive or negative experiences. For example, the phrase "no candy" causes negative emotions, and in any unpleasant situation the patient will repeat it. Systematization of information is also mandatory. Before going to bed, everything heard during the day is spoken out, that is, the patient shares emotions and experiences with others. This looks like an incoherent story, a set of words and phrases.

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First signs

In most cases, the first signs of echolalia become noticeable at the age of 3-5 years. They appear more often in boys, in girls the disease has a more complex course. Thus, when answering any question, the patient repeats a fragment or the whole question. Quiet or loud speech, lack of response to one's own name and incorrect intonations are also considered signs of a speech disorder.

If the defect is one of the signs of autism, then in addition to social behavior and communication disorders, a number of other pathological symptoms are observed. The patient does not perceive the interlocutor, therefore eye-to-eye contact is disrupted. There is scanty facial expression, which very often does not correspond to the situation, gestures are used to indicate any needs. The child does not understand the emotions of others and does not show interest in peers. Stereotypical behavior manifests itself in the form of daily rituals, fixation on certain activities, multiple repetitions of movements.

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Echolalia in adults

There are a number of pathological conditions that can cause the development of echolalia. In adults, the disease is acquired. Its symptoms appear in schizophrenic disorders, various brain lesions, neurological and mental illnesses. Due to difficulties in communicating with strangers, the inability to express their own emotions and work, patients are subject to disability.

Echolalia in adults most often develops against the background of schizophrenia. In this case, automatic repetition is accompanied by scanty gestures and facial expressions. Patients are unable to perceive elementary rules and norms, do not understand their behavior and the intentions of others. All this makes it impossible to build friendly or romantic relationships. Attachment to a certain environment and daily routine may also be observed. The slightest changes cause serious worries and hysterical attacks.

Echolalia in children

A disorder characterized by uncontrolled repetition of other people's words, phrases or complete sentences is echolalia. In children, it comes in two forms: immediate and delayed. It is often mistaken for the first signs of autism, as in some cases it is possible. The disease is associated with a disruption in the process of speech development.

There are two age periods in which a child begins to speak, repeating everything he or she hears - from 6 months to 1 year and from 3 to 4 years. Such imitation is necessary for practicing pronunciation of sounds, expanding vocabulary and mastering the basics of interaction with society through communication.

If the speech disorder persists or occurs in older children, this indicates echolalia. It can have varying degrees of severity. Therefore, the earlier it is diagnosed, the better it can be corrected. This method of treatment allows you to find understanding with the patient and try to adapt him to society.

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Forms

Today, there are two types of echolalia: immediate and delayed. The first is an immediate repetition of words heard. It is a demonstration that the adult has heard someone else's speech, but needs time to accept and understand it. With normal development, the process of forming an understanding of what was heard takes several months. But with a speech disorder, this can drag on for years. Delayed repetition is characterized by the reproduction of words and phrases after a certain period of time. They can be pronounced in any situation and at any time.

Let's take a closer look at the main types of echolalia:

1. Immediate

The patient repeats what he or she has just heard, demonstrating the physical ability to reproduce speech and remember sounds. The next stage is the process of understanding what has been said, which takes from several months to several years. Many scientists interpret this as a peculiar way of communication, an attempt to maintain a dialogue and respond before comprehending what has been said. It looks something like this: “I hear you, but I’m still trying to understand what you said.”

Very often, with this form of speech disorder, hysterical attacks occur. They develop against the background of misunderstanding. For example, when a patient is asked whether he wants water or juice. In most cases, the answer will be the last word, that is, juice. When the patient receives it, hysteria begins, since the answer was given before the understanding of the proposed options.

2. Delayed

Repeating memorized phrases in a certain social context is the norm. In this case, we are talking about quoting poems, interesting statements, or excerpts from works. Delayed echolalia is the repetition of someone else's phrases after a long period of time. This can happen after several minutes, days, months, or even years, regardless of time or place.

There are a number of reasons that cause delayed speech disorder:

• Self-stimulation – its main goal is to get pleasure from what is said. That is, the patient repeats words and phrases that he likes. These can be quotes from films, programs, books and much more. If delayed echolalia is used as entertainment, then it disrupts real communication. Therefore, the main goal of therapy is aimed at switching attention to constructive activities.
• Mood communication – automatic repetition can convey certain emotions. These can be phrases associated with disappointment or joy, as well as words that fit the general tone of the conversation.
• Summarizing is a method of processing information received during the day, that is, grouping memories through repetition.

Today, several methods have been developed to correct the communication process. For this, visual and tactile practices are used, that is, connecting different senses to improve understanding.

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Echolalia and echopraxia

Involuntary repetition of movements or words of others is echokinesia. Like many psychoneurological pathologies, it has no clear etiology. Echolalia and echopraxia are its forms, which depend on the symptoms that appear. Let's consider each of them in more detail:

• Echopraxia

Automatic repetition of actions and movements of other people. It has several forms, most often the patient repeats elementary movements that he sees with his own eyes. This can be clapping hands, raising hands, tugging clothes, etc. It is observed in schizophrenia, organic diseases of the brain and damage to its frontal lobes.

• Echolalia

Involuntary repetition of words, carried out by complete duplication or weaving of individual lines into one's speech. Most often, patients repeat questions addressed to them. Despite the mechanical nature of the disorder, patients are able to understand and process the information received. It has two forms: delayed and immediate, and is found in both children and adults. It can occur after traumatic brain injury, schizophrenia, imbecility, mental retardation, and organic brain diseases.

In some cases, echolalia and echopraxia occur simultaneously. With early and correct diagnosis of these disorders, there is a chance to correct the patient's behavior.

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Complications and consequences

Echolalia, like a number of other psychoneurological diseases, leads to various consequences and complications. First of all, these are difficulties with the process of socialization, education, work, the ability to make friends or create a family.

Even with timely and correct treatment, the speech defect remains for life. If the disorder occurs against the background of autism, then such patients have an increased threshold of pain sensitivity. This leads to the fact that a person does not react to painful stimuli. Sometimes children with such pathologies engage in self-torture, which leads to various injuries to the body.

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Diagnostics echolalia

At the first symptoms of speech disorder in a child or an adult, it is necessary to consult a neuropsychiatrist and a psychologist. Diagnosis of echolalia begins with collecting anamnesis and examining the patient. This allows us to determine whether there are deviations in mental development. If automatic repetition of words is not associated with age-related features, then additional studies and tests are carried out.

Approximate examination algorithm for suspected echolalia:

• Analysis of complaints and collection of anamnesis – questioning the baby’s mother about the course of pregnancy, studying heredity.
• Neurological examination to detect abnormalities.
• Examination by a speech therapist – the doctor evaluates the child’s speech, incorrect pronunciation, confusion of syllables, and frequency of repetitions.
• Instrumental and laboratory studies.

The same methods are used to detect neurological pathology as for diagnosing autism. This is due to the fact that echolalia can be one of its symptoms. Using special questionnaires (ADI-R, ADOS, CARS, ABC, CHAT), various tests and studies of the patient's behavior in his usual environment are carried out. Laboratory and instrumental methods are also used, that is, blood tests, ultrasound examination of the brain, electroencephalogram and others.

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Tests

In case of speech disorder, as well as other psychoneurological pathologies, a thorough diagnosis is necessary. The tests are included in the mandatory complex of studies and consist of the following procedures:

• Neuropsychological tests.
• Testing mental abilities.
• Questionnaire surveys and observations.
• Laboratory research.

The following tests are mandatory: blood, urine, DNA analysis, EEG and others. They are necessary to exclude diseases with similar symptoms and to identify concomitant pathologies. Based on the results obtained, the doctor makes a plan for further research and treatment options.

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Instrumental diagnostics

To clarify the diagnosis and more thoroughly study the patient's condition, various medical approaches are used. Instrumental diagnostics consists of a number of procedures that allow visualization and assessment of the condition of the brain and other organs and systems that can provoke symptoms of pathology:

Instrumental methods:

• Ultrasound examination of the brain is performed to identify and determine the extent of its damage.
• Electroencephalogram – reveals symptoms that may accompany echolalia and early autism. These may include epileptic seizures, convulsions, loss of consciousness, etc.
• Magnetic resonance imaging – reveals developmental anomalies of the brain, corpus callosum and temporal lobe. Allows for the diagnosis of speech pathology and autism at early stages.
• Hearing test – the patient undergoes a consultation and examination by an audiologist. This is necessary to rule out hearing loss and the accompanying speech delay.

The main advantage of the above-described instrumental methods is that they are non-invasive. This allows us to minimize fears and hysterical attacks in patients of all ages.

Differential diagnosis

Studies of echolalia are very important, as they allow us to distinguish it from other disorders of the brain. Differential diagnostics are aimed at identifying early signs of such pathologies as:

• Mental retardation – a progressive decline in intelligence is observed. Patients do not seek to establish emotional contacts with others, are often withdrawn and even aggressive.
• Schizophrenic disorder – manifests itself before the age of seven and is characterized by seizures, hallucinations, and delusional states. Has a hereditary predisposition. Mental abilities are not impaired.
• Deprivation disorders – appear due to severe stress as a result of a sudden change in the usual environment, that is, the appearance of something new.
• Heller syndrome – occurs at the age of 3-4 years and is characterized by pronounced behavioral disorders. Irritability, progressive decline in intelligence, loss of motor skills and speech are observed.
• Rett syndrome – occurs against the background of seemingly normal development in the period from 6 months to 3 years. Neurological symptoms, various intellectual pathologies, and movement coordination disorder appear.
• Hearing disorders - children with echolalia, like deaf babies up to 12 months, have normal development. They coo and babble. But when conducting an audiogram, severe hearing loss can be detected, causing frequent repetitions of speech after others.

Speech disorder may appear against the background of other diseases, i.e. act as their early symptom. Differential diagnostics is aimed at identifying the signs characteristic of the disorder and separating them from other pathologies.

Treatment echolalia

To date, there are still no drugs developed that would help eliminate speech disorders or other psychoneurological pathologies. Correction of echolalia is the only way to establish the process of communication with the patient. Treatment is long-term and requires regular work, so at the first symptoms of the disease, it is necessary to contact a professional psychotherapist or psychoneurologist.

If the child does not have a developmental delay, then treatment is not carried out. To eliminate speech defects, classes with a defectologist and speech therapist are recommended. The main task of parents is to follow a number of rules:

• Do not raise your voice at the child, speak calmly and clearly.
• Ask questions that can be answered with "yes" or "no".
• Protect from various stressful situations and experiences.

If echolalia occurs against the background of autism or other mental illnesses, then complex treatment is carried out (medications, exercises, physical therapy, etc.). A huge responsibility falls on the parents, they must be patient and communicate correctly with the patient:

• Regularly add new words to memorized phrases and sentences to expand your vocabulary.
• Do not stop the child when words are repeated frequently, but try to understand their meaning, that is, to grasp the information that he wants to convey.
• In order to make communication easier, it is recommended to use pictures with different images. This will allow you to make a choice without misunderstandings.

To better understand a patient with echolalia, those around him should pay attention to both the essence of the words and the situations in which they are pronounced, intonation, facial expressions and much more.

Prevention

Echolalia is a unique form of communication, that is, it cannot be called a meaningless and aimless repetition of other people's words. Prevention of the disease is aimed at normalizing the communication process, turning the disorder into a tool for interacting with others.

• Do not stop the patient when repeating, as pronouncing words is one of the ways to express oneself when there are problems with oral speech. If this opportunity is not available, the patient will not be able to practice pronunciation, maintain a conversation and minimize anxiety through verbal communication.
• Pay attention to all spoken words, even if they do not seem to make sense at first. This will allow you to study the features of echolalia in more detail and improve the communication process. Try to understand what is being said, the intonation and facial expressions of the patient. It is very important to catch the tone and rhythm of what is being said, since the same phrases can carry different information.
• Join in the conversation, repeat your child's favorite speech scripts one by one. Try to form something new, that is, expand the memorized phrases, constantly expanding your vocabulary.

Only regular classes in a calm environment will help to establish the communication process and improve the patient’s socialization.

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Forecast

If automatic repetition of words is not pathological, it goes away on its own by the age of 4. The prognosis in this case is favorable, and the entire process of peculiar speech behavior is associated with the development of speech. If the disease is caused by autism, mental retardation or schizophrenic disorder, the prognosis depends on the results of correction and the chosen treatment methods. In some cases, it occurs simultaneously with echopraxia, which complicates the treatment process.

Echolalia is a mental disorder that cannot be relieved with medication. All therapy is verbal communication aimed at socializing the patient and establishing communication. Without this, the disease worsens, the patient becomes withdrawn and aggressive. Such people need constant supervision and care, since they are unable to take care of themselves without outside help.

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