Echolalia: what it is, causes and related disorders

The alterations and injuries that affect the brain structures involved in language, imitative behaviors and inhibition of behavior can cause the symptoms that we know as ecofenomena, consisting of repeating movements or words that the person has seen or heard previously.

One of these symptoms is echolalia, in which words or phrases are imitated. In this article we will describe what is echolalia, what are its most common causes and what psychological and medical disorders it is normally associated with.

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What is echolalia?

The term "echolalia" is used to refer to the involuntary repetition of words spoken by other people. It is a characteristic symptom of different psychological disorders, both organic and functional, such as autism, aphasia and schizophrenia.

The repetition can consist of a single word or, conversely, of very long messages; sometimes not only words or phrases are repeated, but monologues, conversations or entire songs. When the person imitates himself instead of others, we speak of palilalia.

Echolalia it is an ecofenomenon, that is, an imitative behavior that occurs without conscious control. Two other very common ecofenomena are echopraxia, in which actions or gestures of others are repeated, and ecomymy, consisting of the imitation of facial expressions.

Types of echolalia

The symptoms of echolalia are classified according to two criteria: the latency of the response (that is, the time it takes for the repetition to appear) and the intentionality of the behavior. Thus, we can talk about immediate or delayed echolalia and functional or non-functional echolalia.

Immediate echolalia, as the name suggests, occurs right after the person hears the vocalization. Delayed echolalia can occur at any time, sometimes with a time gap of years between the original verbalization and the imitation.

Following the criterion of intentionality, we divide the ecological manifestations into functional ones, when the person has a communicative or self-regulatory intention, and not functional, if the above conditions are not met.

Causes of this phenomenon

Imitative behavior, including echolalia, it is normal and adaptive in boys and girls, since they use it to acquire and internalize new behaviors. However, as language develops and the child learns cognitive self-regulation skills, this phenomenon becomes less common.

From the age of 3, echolalia can be a sign that there is an underlying disorder that affects the progress of language or behavioral inhibition; thus, echolalia is common in blind children, with learning difficulties or with a pervasive developmental disorder.

Echolalia in adults is generally considered pathological because it tends to be a manifestation of lesions in the brain; is particularly associated with damage to the frontal lobe of the left hemisphere caused by genetic factors, trauma, stroke, or other causes.

In this sense, the supplementary motor area and the medial part of the frontal lobe seem to have special relevance. The role of so-called “mirror neurons” has also been highlighted, which fire when we imitate the behavior of others, both externally and in the imagination.

Related disorders

There are many disorders that alter the functioning of language and behavioral inhibition and that therefore they are susceptible to cause echolalia. Below we will briefly describe the alterations that are most commonly associated with this phenomenon.

1. Autistic spectrum

The concept "autism spectrum disorders", which was introduced in DSM-5, encompasses Asperger's syndrome, the disorder childhood disintegration disorder and Rett syndrome, in addition to Kanner's own autism and other pervasive disorders of the growth.

This set of syndromes is probably due to mirror neuron dysfunctions derived from genetic causes. Autism spectrum disorders affect communication, social interaction and the breadth of the behavioral repertoire, and in many cases they present with intellectual deficits.

In the context of autism, the type of echolalia can vary depending on the intensity of the alterations and the specific situation. Thus, non-functional echolalia is more likely to occur in autistics who do not understand speech, while functional echolalia can be used to compensate for language difficulties. In these cases, immediate echolalia is common.

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2. Tourette syndrome

The Tourette syndrome is characterized by chronic and simultaneous presence of motor and vocal tics. One of the best known symptoms of Tourette syndrome is coprolalia, which consists of the emission impulsive use of obscene or socially incorrect words, although it only occurs in 10% of cases approximately.

Similarly, and although they are less frequent than coprolalia, echophenomena such as echolalia and echopraxia also occur in the context of this disorder. Palilalia is another possible symptom of Tourette syndrome.

3. Aphasia

Injuries due to stroke or head trauma often cause aphasia, a set of language disorders associated with brain damage. In these cases echolalia usually has a compulsive and non-functional character.

Echolalia is particularly common in transcortical sensory aphasia, which occurs as a consequence of injuries to the temporal lobe. In addition to echolalia, other characteristics of this type of aphasia are the presence of paraphasia (substitution of words for incorrect ones) and the maintenance of verbal comprehension.

4. Dementia

Dementias are neurodegenerative diseases that cause a progressive loss of cognitive abilities, especially memory. When the lesions affect the brain regions involved in language and self-regulation, they can cause echolalia symptoms similar to those of aphasia.

Echolalia is especially common in frontotemporal dementias, especially in Pick's disease. Degenerative disorders that affect the basal ganglia, such as Parkinson's disease, Huntington's disease, and progressive supranuclear palsy, also frequently cause ecofenomena.

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5. Schizophrenia

The DSM-IV defines schizophrenia as a chronic disorder characterized by the presence of hallucinations, delusions, disorganized language and / or affective flattening, among other symptoms.

One of the subtypes of schizophrenia is catatonic, which implies excess or default alterations in the movement. Echolalia and echopraxia are common in catatonic schizophrenia.

• Related article: "The 6 types of schizophrenia and associated characteristics"