What’s the big deal with echolalia?
“She is echolalic – she doesn’t communicate.”
“He has autism – it is just echolalia.”
“Oh, she does not talk…” (“Mommy pig! Daddy pig… Oh no!”, the child murmured in the background)
“He only talks in movie scripts!”
“She is just repeating – it does not mean anything!”
“Echolalia means autism – no further investigation is required.”
“When will they actually communicate and stop repeating?”
These are all phrases I had heard from professionals and parents alike when I started my journey as a Speech Pathologist. Over the last few years, however, there has been rumbling in the speech pathology and language research community.
Echolalia may in fact be communication.
The way speech pathologists allied health professionals and educators teach and support our students who present as echolalia should change.
There are two ways that humans process and develop language – analytical language processors and gestalt language processors.
So, what is echolalia?
Well, that truly depends on whom you ask! If you ask Google the definition of echolalia, it will tell you that echolalia is “meaningless repetition of words just spoken by another person, occurring as a symptom of mental conditions” or “repetition of speech by a child learning to talk”. Yikes…!
If you ask a speech pathologist, you will also get a range of definitions, but the general consensus is that there are two types of echolalia – immediate and delayed. Immediate echolalia is when the script, gestalt or chunk of language is repeated immediately after it is heard or after a very brief delay. Delayed echolalia is when that script or chunk of language is repeated after a longer time. “How are you?”, “,1,2,3, jump!” and “see you later” are all examples of scripts or gestalts that many of us would use every day!
A little history…
Previous to the boom of research in the 1980s and 1990s, echolalia; especially delayed echolalia, was thought of as a “deviant behaviour” associated with autism which was meaningless at best and a self-stimulatory behaviour that needs to be eliminated at worst. Parents, educators, and therapists were ignoring it in the best-case scenario or actively trying to stop or extinguish it at worst. To take the script or gestalt’s place, it was thought that children could be taught “appropriate language” (whatever that means!).
But in 1984, following the analysis of hundreds of delayed echolalic remarks, two researchers published a paper identifying that echolalia could fall into 14 functional categories, 7 of which showed communicative intent (Rydell & Perizant, 1984). And as researchers in 1995 found that “at least 85% of children with autism who acquire speech” use echolalia, it was good to see some recognition that echolalia could be communication (Rydell and Prizant, 1995).
However, during the 1990s through to the early 2000s, we were also seeing a boom of children being diagnosed with autism with echolalia being used as a marker and behaviour rather than recognising, researching and supporting echolalia as communication. Behavioural therapies saw a steep growth but the research into language development and supporting echolalia into spontaneous language seemed to be placed on the back burner.
“Echolalia as communication” resurgence…
My experience at university, when learning about echolalia, reflected the research that started in the 1980s and 1990s. Yes, it was associated with a diagnosis of autism spectrum disorder, yes it may have some limited communication intent, but it needed to be stopped or fixed. Children presenting with echolalia had delayed language acquisition and needed language intervention, just as any other child presenting to me with a language delay did.
But the more I worked with these families, the more I saw that echolalia did have communication intent and that teaching them with the same strategies I used with my other children presenting with language delays was not leading to the same growth. I was not seeing the generalisation of goals.
So, I went on a journey researching echolalia and I found a community of speech pathologists who were exploring that there were two ways that children learn language. They were advocating for the children they worked with who were echolalic and were identifying these children as Gestalt Language Processors. I found the work of Marg Blanc and the research of Barry Prizant, Ann Peters and all their colleagues. It opened my eyes to a new way of seeing language development.
What is Analytical Language Processing?
Analytical language processors learn a language in the “standard” way of learning language, using words first as the building blocks to develop sentences and communication. This was the type of language acquisition I was familiar with where they first learn words, then combine them in two-word combinations. Next, we would observe grammar in phrases followed by their first sentences. The last stage is the use of more complex sentences and grammar.
This style of language learning was the one I was introduced to in my studies and there are a plethora of interventions and strategies that can be used to support those who experience challenges as they move through the hierarchy to learn a language.
What is Gestalt Language Processing or Natural Language Acquisition?
Gestalt language processors, on the other hand, don’t start their language learning journey with words, but rather with chunks of language where the melody or intonation is what they tune into rather than the words themselves. A gestalt language processor will first use echolalia to communicate. They will then break apart those language chunks to communicate more flexibly with smaller chunks. The next stage of the language learning process involves isolating single words and using self-generated two-word phrases, followed by adding pre-sentence grammar structures. They will then begin to use advanced grammar in sentences they have generated themselves. The last step is the use of more complex grammar and sentences.
Echolalia is the first step in a Gestalt Language Processors’ journey to language learning.
So, what next?
I hope I have at least answered the question of – if we should ignore echolalia? Echolalia communicates and is a part of language development. Please don’t ignore it or try to stop a child from using it. It is not something to be feared or ignored or frustrated by or stopped! Echolalia points towards a different style of language development which just means that these children need different language supports.
If you meet, work with, support, know or hear a child communicating with echolalia, here are a few tips to support your interactions:
- Acknowledge the script! Nod your head, smile at the child and repeat back the script (even when you don’t understand what it means!)
- Be a detective! Many gestalts or scripts can’t be taken literally as they come from dramatic and emotional experiences for the child (like their favourite TV show or movie). Model back what you think the script may mean to the child.
- Eliminate questions from your communication. Most Gestalt Language processors, until they can self-generate language, are not ready to answer questions. Instead, narrate, pause with expectant looks or comment.
- Follow the child’s lead! Model language based on what they want to play.
- Most importantly – Don’t ignore it or try to stop it – echolalia IS COMMUNICATION!
Blanc, M. (2012). Natural Language Acquisition. Communication Development Center, Inc.
Oxford Languages (n.d.). Echolalia. In Oxfordlanguages.com. Retrieved March 6th, 2023 from [Link]
Prizant, Barry M. And Rydell, P.J. (1984). An analysis of the function of delayed echolalia in autistic children. Journal of Speech and Hearing Research, 27
Rydell, Patrick J. And Prizant, B.M. (1995). Educational and communication approaches for children who only use echolalia. In K.Quill (Ed.), Teaching Children with Autism to Increase Communication and Socialization. Albany NY: Delmar Publishers
About the author
Emily is a Speech Pathologist with experience working with individuals across the lifespan. Her speech pathology journey started in rural private practice before moving into the community space. She has worked with families and individuals to support communication skills, swallowing management, play skills, speech sound development, voice craft, eating skills, literacy skills, stuttering and social skills. In her role at KEO, Emily works mainly in the paediatric and swallowing spaces with a keen interest in neurodiverse-affirming practice.