Echolalia

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Echolalia
Other namesEchologia, echophrasia [1]
Autism Aspect Echolalia 1.png
Specialty Psychiatry, neurology

Echolalia is the unsolicited repetition of vocalizations made by another person; when repeated by the same person, it is called palilalia. In its profound form it is automatic and effortless. It is one of the echophenomena, closely related to echopraxia, the automatic repetition of movements made by another person; both are "subsets of imitative behavior" whereby sounds or actions are imitated "without explicit awareness". [1] Echolalia may be an immediate reaction to a stimulus or may be delayed. [1]

Contents

Echolalia occurs in many cases of autism spectrum disorder and Tourette syndrome. [1] [2] It may also occur in several other neurological conditions such as some forms of dementia or stroke-related aphasia. [1] [3]

The word "echolalia" is derived from the Greek ἠχώ (ēchō), meaning "echo" or "to repeat", [4] and λαλιά (laliá) meaning "speech" or "talk" [5] (of onomatopoeic origin, from the verb λαλέω (laléo), meaning "to talk").

Signs and symptoms

Echolalia can be categorized as either immediate (occurring immediately after the stimulus) or delayed (some time after the occurrence of a stimulus). [1] [6] Immediate echolalia results from quick recall of information from the short-term memory and "superficial linguistic processing". [7] A typical pediatric presentation of immediate echolalia might be as follows: a child is asked "Do you want dinner?"; the child echoes back "Do you want dinner?", followed by a pause, and then a response, "Yes. What's for dinner?" [8] In delayed echolalia the patient repeats words, phrases, or multiple sentences after a delay that can be anywhere from hours to years later. [9] Immediate echolalia can be indicative that a developmental disorder exists, but this is not necessarily the case. Sometimes echolalia can be observed when an individual echoes back a statement to indicate they are contemplating a response and fully heard the original statement.

Mitigated echolalia refers to a repetition in which the original stimulus is somewhat altered, [1] and ambient echolalia refers to the repetition (typically occurring in individuals with dementia) of environmental stimuli such as a television program running in the background. [1]

Examples of mitigated echolalia are pronoun changes or syntax corrections. The first can be seen in the example of asking the patient "Where are you going?" and with patient responding "Where am I going?" The latter would be seen in the clinician asking "Where am I going?" and the patient repeating "Where am I going?" In mitigated echolalia some language processing is occurring. Mitigated echolalia can be seen in dyspraxia and aphasia of speech. [10]

Associated disorders

Echolalia can be an indicator of communication disorders in autism, but is neither unique to, nor synonymous with syndromes. [6] Echophenomena (particularly echolalia and echopraxia) were defining characteristics in the early descriptions of Tourette syndrome (TS). [1] Echolalia also occurs in aphasia, schizophrenia, dementia, catatonia, epilepsy, [1] after cerebral infarction (stroke), [3] closed-head injury, [11] in blind children, children with language impairments, as well as certain developing neurotypical children. [6] Other disorders associated with echolalia are Pick's disease, frontotemporal dementia, corticobasal degeneration, progressive supranuclear palsy, as well as pervasive developmental disorder. [10]

In transcortical sensory aphasia, echolalia is common, with the patient incorporating another person's words or sentences into his or her own response. While these patients lack speech comprehension, they are still able to read. [12] [13]

Anatomical correlates

Echolalia can be the result of left hemisphere damage. Specifically, damage to the frontal lobe of the left hemisphere has been linked to effortful echolalia. Cases of echolalia have appeared after lesions of the left medial frontal lobe and supplemental motor areas. Unintentional or nonfunctional echolalia shows similarities to imitation behavior seen after disinhibition of the frontal network and is most likely related to mirror neurons. [2] In cases where echolalia is a part of mixed transitory aphasia, the perisylvian language area remains intact, but the surrounding anterior and posterior association cortexes degenerate or experience infarction.

Imitation and learning

Echolalia is common in young children who are first learning to speak. Echolalia is a form of imitation. Imitation is a useful, normal and necessary component of social learning: imitative learning occurs when the "observer acquires new behaviors through imitation" and mimicry or automatic imitation occurs when a "reenacted behavior is based on previously acquired motor (or vocal) patterns". [1] Ganos et al (2012) define echolalia as an "automatic imitative action without explicit awareness". [1] Children often first babble syllables and eventually words they hear. For example, a baby may often hear the word "bottle" in various sentences. The baby first repeats with only syllables such as "baba" but as their language skills progress the child will eventually be able to say the word "bottle". Echolalia becomes less and less common as a child's language skills develop. It is not possible to distinguish the imitative learning form of echolalia that occurs as part of normal development from automatic imitation or echolalia characteristic of a disorder until about the age of three, when some ability for self-regulation is developed. [1] A disorder may be suspected if automatic imitation persists beyond the age of three. [1]

Function

Before the 1980s, echolalia was regarded as negative, non-functional behavior. [6] However, researchers such as Barry Prizant and colleagues have emphasized the communicative function of echolalia. [6] Among the communicative functions noted are turntaking, requesting, self-regulation and rehearsal to aid comprehension. [6] Echolalia can be categorized as communicative (in context and with "apparent communicative purpose") vs. semicommunicative (an "unclear communicative meaning"). [1]

The use of echolalia in task response to facilitate generalization is an area that holds much promise. [14] Research in this area is certainly needed. Marjorie H. Charlop performed a series of task experiments with autistic children. The results suggest that perhaps in certain tasks (i.e., receptive labeling), echolalia should not be eliminated, but taken advantage of as it may facilitate acquisition and generalization for autistic children. [14]

Tourette syndrome

Echolalia and echopraxia are distinguishing tics of Tourette syndrome (TS); [1] the echolalic repetitions of individuals with TS are mainly echoes from within their own "tic repertoire". [1] Evidence points to a healthy mirror neuron system (MNS), but "inadequate imitation-control mechanism, which make them vulnerable to interferences".

Autism

A symptom of some autistic children is the struggle to produce spontaneous speech. Studies have shown that in some cases echolalia is used as a coping mechanism allowing an autistic person to contribute to a conversation when unable to produce spontaneous speech. [2] Studies in the 1980s showed that there may be communicative intent with delayed echolalia, "depending on the context in which it occurs"; [15] this research on autistic children "raised questions related to behavior modification programs that defended the revocation or replacement of immediate echolalia". [15]

Uta Frith, Prizant and others have interpreted echolalia as evidence of "gestalt" processing in autistic children, including in the acquisition of language. [6] However, a 1990 study on the acquisition of grammar by Tager-Flusberg and Calkins found that echolalia did not facilitate grammatical development in autistic children. [6]

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Formerly recognized neurodevelopmental condition

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a diagnosis formerly used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer considered a diagnosis. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.

<span class="mw-page-title-main">Hyperlexia</span> Significantly advanced reading ability in children

Hyperlexia is a syndrome characterized by a child's precocious ability to read. It was initially identified by Norman E. Silberberg and Margaret C. Silberberg (1967), who defined it as the precocious ability to read words without prior training in learning to read, typically before the age of five. They indicated that children with hyperlexia have a significantly higher word-decoding ability than their reading comprehension levels. Children with hyperlexia also present with an intense fascination for written material at a very early age.

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. This also encompasses deficiencies in verbal and non-verbal communication styles. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language. This article covers subjects such as diagnosis, the DSM-IV, the DSM-V, and examples like sensory impairments, aphasia, learning disabilities, and speech disorders.

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), was a group of disorders characterized by delays in the development of multiple basic functions including socialization and communication. It was defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Diseases (ICD).

Developmental disorders comprise a group of psychiatric conditions originating in childhood that involve serious impairment in different areas. There are several ways of using this term. The most narrow concept is used in the category "Specific Disorders of Psychological Development" in the ICD-10. These disorders comprise developmental language disorder, learning disorders, developmental coordination disorders, and autism spectrum disorders (ASD). In broader definitions, attention deficit hyperactivity disorder (ADHD) is included, and the term used is neurodevelopmental disorders. Yet others include antisocial behavior and schizophrenia that begins in childhood and continues through life. However, these two latter conditions are not as stable as the other developmental disorders, and there is not the same evidence of a shared genetic liability.

Pervasive developmental disorder not otherwise specified (PDD-NOS) is a historic psychiatric diagnosis first defined in 1980 that has since been incorporated into autism spectrum disorder in the DSM-5 (2013).

Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset of developmental delays—or severe and sudden reversals—in language, social engagement, bowel and bladder, play and motor skills. Researchers have not been successful in finding a cause for the disorder. CDD has some similarities to autism and is sometimes considered a low-functioning form of it. In May 2013, CDD, along with other sub-types of PDD, was fused into a single diagnostic term called "autism spectrum disorder" under the new DSM-5 manual.

Transcortical sensory aphasia (TSA) is a kind of aphasia that involves damage to specific areas of the temporal lobe of the brain, resulting in symptoms such as poor auditory comprehension, relatively intact repetition, and fluent speech with semantic paraphasias present. TSA is a fluent aphasia similar to Wernicke's aphasia, with the exception of a strong ability to repeat words and phrases. The person may repeat questions rather than answer them ("echolalia").

High-functioning autism (HFA) was historically an autism classification to describe a person who exhibited no intellectual disability but otherwise showed autistic traits, such as difficulty in social interaction and communication, as well as repetitive, restricted patterns of behavior. However, many in medical and autistic communities have called to stop using the term, finding it simplistic and unindicative of the difficulties some autistic people face.

The following outline is provided as an overview of and topical guide to autism:

Palilalia, a complex tic, is a language disorder characterized by the involuntary repetition of syllables, words, or phrases. It has features resembling other complex tics such as echolalia or coprolalia, but, unlike other aphasias, palilalia is based upon contextually correct speech.

This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe.

Echopraxia is the involuntary repetition or imitation of another person's actions. Similar to echolalia, the involuntary repetition of sounds and language, it is one of the echophenomena. It has long been recognized as a core feature of Tourette syndrome, and is considered a complex tic, but it also occurs in autism spectrum disorders, schizophrenia and catatonia, aphasia, and disorders involving the startle reflex such as latah. Echopraxia has also been observed in individuals with epilepsy, dementia and autoimmune disorders; the causes of and the link between echopraxia and these disorders is undetermined.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

Pivotal response treatment (PRT), also referred to as pivotal response training, is a naturalistic form of applied behavior analysis used as an early intervention for children with autism that invented by Robert Koegel and Lynn Kern Koegel. PRT advocates contend that behavior hinges on "pivotal" behavioral skills—motivation and the ability to respond to multiple cues—and that development of these skills will result in collateral behavioral improvements. It's an alternative approach to ABA from the more common form, sometimes called discrete trial training (DTT).

<span class="mw-page-title-main">Classic autism</span> Former neurodevelopmental disorder now classified under autism spectrum disorder

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

<span class="mw-page-title-main">Speech repetition</span> Repeating something someone else said

Speech repetition occurs when individuals speak the sounds that they have heard another person pronounce or say. In other words, it is the saying by one individual of the spoken vocalizations made by another individual. Speech repetition requires the person repeating the utterance to have the ability to map the sounds that they hear from the other person's oral pronunciation to similar places and manners of articulation in their own vocal tract.

Echophenomenon is "automatic imitative actions without explicit awareness" or pathological repetitions of external stimuli or activities, actions, sounds, or phrases, indicative of an underlying disorder.

Nonverbal autism, also called nonspeaking autism, is a subset of autism spectrum disorder where the person does not learn how to speak. One study has shown that 64% of autistic children who are nonverbal at age 5 are still nonverbal 10 years later.

Social (pragmatic) communication disorder (SPCD), also known as pragmatic language impairment (PLI), is a neurodevelopmental disorder characterized by difficulties in the social use of verbal and nonverbal communication. Individuals who are defined by the acronym "SPCD" struggle to effectively indulge in social interactions, interpret social cues, and may struggle to use words appropriately in social contexts.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Ganos C, Ogrzal T, Schnitzler A, Münchau A (September 2012). "The pathophysiology of echopraxia/echolalia: relevance to Gilles de la Tourette syndrome". Mov. Disord. 27 (10): 1222–29. doi:10.1002/mds.25103. PMID   22807284. S2CID   22422642.
  2. 1 2 3 Volkmar, Fred; Paul, Rhea (2005). Handbook of Autism and Pervasive Developmental Disorders (Third ed.). John wiley and Sons. pp. 255–257.
  3. 1 2 Suzuki T, Itoh S, Hayashi M, Kouno M, Takeda K (July 2009). "Hyperlexia and ambient echolalia in a case of cerebral infarction of the left anterior cingulate cortex and corpus callosum". Neurocase. 15 (5): 384–389. doi:10.1080/13554790902842037. PMID   19585352. S2CID   40527124.
  4. ↑ Liddell HG, Scott R. "ἠχώ". A Greek – English Lexicon, on Perseus. Tufts University. Retrieved October 6, 2013.
  5. ↑ Liddell HG, Scott R. "λαλιά". A Greek – English Lexicon, on Perseus. Tufts University. Retrieved October 6, 2013.
  6. 1 2 3 4 5 6 7 8 Fred R. Volkmar; Rhea Paul; Ami Klin; Donald J. Cohen (13 May 2005). Handbook of Autism and Pervasive Developmental Disorders, Diagnosis, Development, Neurobiology, and Behavior. John Wiley & Sons. pp. 346–347. ISBN   978-0-471-72110-9.
  7. ↑ Rydell PD, Mirenda P (December 1994). "Effects of high and low constraint utterances on the production of immediate and delayed echolalia in young children with autism". J Autism Dev Disord. 24 (6): 719–35. doi:10.1007/bf02172282. PMID   7844096. S2CID   28159203.
  8. ↑ Bashe, P. R. The OASIS Guide to Asperger Syndrome; Advice, Support, Insight, and Inspiration. Crown Publishers, 2001, p. 22.
  9. ↑ Matson JL, Sturmey P, eds. (2011). International Handbook of Autism and Pervasive Developmental Disorders. Springer. p. 237. ISBN   978-1461429135.
  10. 1 2 Duffy, Joseph R. (1995). Motor Speech Disorders . Missouri: Elsevier Mosby. p.  314. ISBN   978-0-323-07200--7.
  11. ↑ Harvey S. Levin (1982). Neurobehavioral Consequences of Closed Head Injury . Oxford University Press. pp.  153–54. ISBN   978-0-19-503008-2.
  12. ↑ Benson, D.Frank (1996). Aphasia: A Clinical Perspective . New York: Oxford University Press. pp.  130–135. ISBN   9780195089349. echolalia papers.
  13. ↑ Davis, G. A. (2007). Aphasiology: Disorders and Clinical Practice. Allyn & Bacon. pp. 33–39. A type of fluent aphasia similar to Wernicke's with the exception of a strong ability to repeat words and phrases. The person may repeat questions rather than answer them ("echolalia").
  14. 1 2 Charlop, Marjorie H. (Spring 1983). "The Effects of Echolalia on Acquisition and Generalization of Receptive Labeling in Autistic Children". Journal of Applied Behavior Analysis. 16 (1): 111–126. doi:10.1901/jaba.1983.16-111. PMC   1307866 . PMID   6833164.
  15. 1 2 Saad AG, Goldfeld M (Jul–Sep 2009). "Echolalia in the language development of autistic individuals: a bibliographical review". Pro Fono. 21 (3): 255–60. doi: 10.1590/S0104-56872009000300013 . PMID   19838574.
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