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EcholaliaWhen young children begin to speak, they often learn new words by repeating those that they just heard.  This is very typical.  As they begin to build sentences, it is also typical that some of their phrases and simple sentences may be repeated verbatim even if the wording is not applicable to the context.

For example, kids might say, “Pick you up?” when they want to be picked up because they have heard adults say, “want me to pick you up?” or “I will pick you up in a minute.”

Some children also go through a phase of repeating what is asked of them before generating an answer.  So for example, when asked, “what’s that on your shirt?”, they may respond while looking at their shirt, “what’s that on my shirt – it’s a dinosaur.”  This may also be typical if the child seems to be using the repetition to buy time to generate an answer or to assist in his processing of the question.  This behavior may be more prevalent in children with language processing disorders, but if it is clear that they are repeating to aid their processing, it still falls within the more typical realm of repeating.

Echolalia

So when does repeating become a behavior that is more concerning and less typical?  Echolalia is the term used for “automatic repetition of vocalizations made by another person”.  The notion of “automatic” implies that the child does not seem to have control over the repetition and that the repetition does not have a communicative purpose.  Frequent echolalia is not a phase of typical development and may be a symptom of an Autism Spectrum Disorder (ASD).

Echolalia is often thought of as immediate repetition of what another person just said, but there are actually three forms of echolalia.  The Immediate Echolalia is one, Delayed Echolalia is another, and Mitigated Echolalia is the third.  An individual child may use one, two or all three forms.

Delayed Echolalia is as it sounds.  The child does not imitate immediately after someone, but rather some time in the future.  For many children with diagnoses on the Autism Spectrum, this takes the form of repeating lines from favorite movies or books.

Mitigated echolalia refers to an automatic repetition that has been slightly changed in form, but still does not seem to carry a communicative purpose.

Do all children with an Autism diagnosis exhibit echolalia?  No. Echolalia is a “red flag” but is not necessarily seen in all children with this diagnosis.  Echolalia is often seen in children who are less related.  They are often the kids who seem to “be distracted by their own thoughts” and find it difficult to stay connected socially to others.

Reducing Echolalia

So what can be done to help children who are often echolalic?  There are several schools of thought when it comes to reducing echolalia.  Some view this behavior as a “vocal stim” which is believed to be a behavior to be extinguished.  Others, like myself, think of this behavior a bit differently.  I am a speech language pathologist and my approach to echolalia has been shaped by my training as such.  I specialize in working with children with a variety of social challenges, so I also work from the lens of regarding social interaction as the primary reason we all have language.  That being said, I think of echolalia as an important clue or key to connecting with a child.

How does that work? Although it is often clear that the children I work with are not trying to communicate with me through their echolalia, I still try to engage them using echolalia as a communicative vehicle.

Immediate Echolalia

If I say to a child, “do you want the train?”, they may simply repeat “do you want the train?” in the same intonation. I then try to give them a more appropriate model, such as, “I want the train!” while patting my chest and then I help them pat their chest as they say “I want the train!” and then I take out the train and begin to  play with it.

After a few seconds with the train, I would than ask, “do you want more train?” Before he can answer, I would help him pat his chest, point to my mouth which I have opened in anticipation of saying “I” and hope that they will follow my lead and say “I want more train.” Over time, and with lots of repetition, the cues can be slowly faded and this immediate echolalia may be shaped into more functional communication.

Some children repeat almost everything that is said to them, so it is not possible to provide this alternative every time.  Instead, I would ignore most of the echolalia and only focus upon a few communicative purposes which are highly motivating for the child.  Requesting is typically good to start with because it includes an inherent reward.

Delayed Echolalia

As noted above, many children with ASD diagnoses often repeat lines from favorite movies, books or songs, or they repeat something that someone has said to them over and over out of context.  These kids often seem disconnected and distracted by their own thoughts, but that doesn’t mean that they can’t be reached in a social and communicative manner.  Here are some of my tricks of the trade:

Be Animated! 

Often these kiddos are internally distracted, so we need to make our world more enticing.  I often say their name with lots of umph and as soon as they look my way, I try to engage them in a preferred activity, usually something movement based.  I say, “Hi ____!, let’s jump!” and start jumping or tickling or whatever I know this child likes.  The goal is to make me more interesting than whatever they are thinking about.

Use the Echolalia 

If I happen to know what the child is saying and I am familiar with its source, I will then join the child in his echoing.  This works especially well if it is a song or a funny line of dialogue because I can once again amp up the animation and now the echoing is a social activity.

Give Kids Alternative Words

Sometimes the echolalia has a communicative purpose that is not immediately obvious.  For example, a child might say a line from a favorite movie as a means of requesting that movie.  If this is the case, then I would give the child a more appropriate means of requesting.  I might say, “you want to watch Jungle Book, you can say…’I want Jungle Book please’” while providing some additional cues if necessary.  These cues might include the sign for “I want” or simply helping him pat his chest to break the automatic response.

Supply Kids with Carrier Phrases

For higher functioning kids, it is sometimes helpful to give them an introductory phrase to use prior to their echolalic utterance.  For example, if I bring out a familiar toy and the child says something related to the activity, but without communicative purpose, I offer a lead in.  So, if I bring out the train and the child says, “put blue boy in the back,” I might respond by saying, “you can say, ‘Karen, remember we put the blue boy in the back.”  Over time, I would fade back to gaining their attention, and saying, “You can say, K…” and they will often fill in with the rest of the utterance.

Mitigated Echolalia

Mitigated Echolalia may be either immediate or delayed and simply is a means of describing the behavior of repeating, but not verbatim.  I mention it because sometimes families wonder whether their child’s behavior is actually echolalia since the repetitions are not exact.

I respond to them that it is not the form of the repetition that is important, but rather the purpose.  If kids are repeating a lot, but seem to be doing so as a means of interacting, this is much less concerning than if they are repeating bits of something with no communicative purpose at all.  If a child is displaying mitigated echolalia, I would intervene in the ways described above dependent upon whether it is immediate or delayed.

Summary

As I have been writing, I have realized just how difficult it is to describe aspects of my therapy.  The suggestions I have described are just that… suggestions.  They certainly are not magic bullets and what works for one child, may not work for another.  I am also certain that other people who work with these kiddos would have other ideas.  I guess the bottom line that I would like to share is that my number one goal is to engage in a socially relevant way and to ensure that the kids are enjoying the interaction as much as possible.