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Echolalia is the term used to describe when a child repeats or imitates what someone else has said. For example, if you ask the child “Do you want a cookie?”, the child says “cookie” instead of “yes”. There is also a type of echolalia called “delayed echolalia” which is when the child repeats something he has heard before even though he did not just hear it. For example, a child may repeat a line from a favorite movie even though that movie is not playing currently.
Is Echolalia Normal?
In short: sometimes.
Echolalia, or repeating what is heard, is a very normal part of language development. Children that are learning to speak use this constantly. If I ask my 1-yr-old son if he wants a bath (one of his favorite activities), he will consistently say “baa” (he’s still working on final consonants). He doesn’t say “yes” yet, he just repeats the last word of the question. Children learn to use language by repeating what they hear around them. Then, as their language skills increase, they start making up their own utterances more and you see the use of echoing or repeating decline.
However, some children don’t move past this echolalia stage. Some children will only repeat what others have said and very rarely come up with their own thoughts or sentences. Some children don’t speak at all unless it is a movie script or tv script that they have heard before. This type of echolalia is not part of typical development and could indicate that the child is having trouble learning to use language.
When Should Echolalia Stop?
Children between the ages of 1-2 years should be echoing or imitating you a lot. That’s how they are learning. However, by age two you should see them begin using their own utterances as well. You may see them continuing to imitate you or use echolalia when you ask a complex question or when you’re giving directions but they should also be using a lot of their own utterances as well. A 2-year-old shouldn’t be only using imitated speech to talk.
By three years of age, you should see pretty minimal echolalia. 3-year-olds should be creating their own simple sentences to communicate with the world around them. You may still see a little echolalia here and there but the child’s speech should be predominantly their own thoughts.
Delayed echolalia (such as quoting movies or tv shows) is used by many children but relying on it too heavily can be a problem. You may hear movie lines or tv show quotes as your preschooler plays because he is acting out and rehearsing certain scenes that he liked. That’s ok! However, if your preschooler seems to be stuck on one scene or quote and repeats it over and over again, there may be a problem.
Now, obviously there’s nothing wrong with a kid getting SUPER excited about a certain new movie and focusing a lot of his conversations on it for a while, but it should fade as the novelty wears off. For example, there are a lot of little girls running around singing “Let it Go” from the movie Frozen right now but I wouldn’t say they have a language problem. But if a child is always quoting or scripting something or if the child doesn’t have much other language that he uses aside from these scripts, then there may be an underlying language problem.
Treatment for Echolalia
Treatment for echolalia is not as easy as it seems. That’s because echolalia can serve a lot of different purposes. In order to treat echolalia correctly, you need to know why the child is repeating or echoing. If it is because he doesn’t know the correct language to use, you will treat it differently than if it’s because he finds it soothing to repeat familiar movie lines.
For that reason, I highly recommend that echolalia be treated by a licensed speech-language pathologist who can tease out exactly why the echolalia is being used. That being said, here are some strategies that will help you reduce a child’s use of echolalia either in therapy or in conjunction with therapy.
When Echolalia is a Result of Poor Language Skills
The most common reason that I see children using echolalia is because they don’t have strong enough language skills to know what to say instead. This is the same reason my 1-yr-old is using echolalia. He doesn’t know what he should say so he just repeats me. This is not a problem for my 1-yr-old because it’s still appropriate for him to be in that stage of development. But if you have an older child who is using echolalia, he may need some therapy to increase his other language skills so he relies less on the echolalia.
If this is the case, I generally don’t “treat” the echolalia specifically. Instead, I treat the language delays. I look at which language skills the child is missing and teach those instead. For example, if the child doesn’t know enough words to be able to spontaneously use them to request, answer, etc., I will work on building that child’s vocabulary skills.
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If the child is echoing when answering questions, I will look to see if the child knows how to answer questions at all. If not, then we will work on this skill.
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Basically, I’ll work on whatever skills the child is missing and hope that the echolalia decreases as the child’s other language skills increase. If it doesn’t, then I’ll address it more specifically after we have those other skills in place.
When the Child is Echoing to Request
Have you ever had a young child come up to you and say “hold you” or ask you if you want to sit on his lap? Chances are he means that he wants you to hold him or he wants to sit on your lap, but he’s just echoing what he’s heard other say (Do you want me to hold you? or Do you want to sit on my lap?).
If you are working with a child who is doing delayed echolalia with entire phrases or sentences that you have said to him, you can correct this by modeling the correct sentence for him to repeat it. For example, if the child comes up to you and says “hold you?”. You can say “Will you hold me?” and encourage the child to repeat it back to you.
After you’ve done this for a while, you can start to respond to what your child says so he knows that it doesn’t make sense. For example, if he says “do you want a cookie?” when he means “I want a cookie”, you can say “No, I don’t want a cookie but you do. Say, ‘I want a cookie’.” This will start to bring awareness to the fact that what your child is saying is not the same as what he means.
When the Child is Echoing on Questions
One of the most common situations that I see children using echolalia during is answering questions. This usually stems from the child not knowing how to answer the question appropriately but it can be very difficult to teach the child to answer the question if all he does is repeat the last word. Here’s what I do for that (keep in mind these steps may take weeks to master, this won’t happen all during one session):
Choose one question type (like “do you want it?” or “what’s this?”) to address at first.
Ask the question and then immediately say the answer with a single word (without pausing). It sounds like this “Do you want it? Yes.” Ideally, the child will just imitate the “yes” part of it. If not, encourage the child to imitate “yes” (or whatever the answer is). Keep doing this until the child is consistently repeating just the one-word answer.
Ask the question again but now just say the first sound of the answer, like this: “Do you want it? Yyyy-“. Encourage the child to say the word “yes” by getting her started with the first sound. If you have to say the whole word with her a few times, that’s ok, but hold out the first sound until she starts it. Keep doing this until she is consistently saying the answer after you give her the first sound.
Ask the question again but now just mouth the first sound but don’t say it out loud. You should just look like you’re about to say it. Direct the child’s attention to your mouth by pointing so she sees you starting to say the sound. Encourage the child to say the word after you mouth the first sound. Keep doing this but gradually fade the amount that you’re mouthing the sound until she will just say the answer without you needing to mouth it at all.
Once she’s mastered one question form, start over again with a different question. Keep doing this until you’ve taught a variety of questions and she starts answering them spontaneously without using echolalia.
When the Child is Echoing Your Praise
This is my favorite because it’s so darn cute. It sounds like this:
Therapist: “Kevin, what does a puppy say?”
Kevin: “Woof woof. Good job, Kevin!”
That’s the moment when you realize, “Man, I must say “good job, Kevin” every time he gets it correct!” As cute as this is, it’s not very functional so it’s important to fade it out. The first thing you need to do, is stop saying whatever it is your child has associated with the next thing that comes after his response. Instead, just repeat the correct answer, pause, and then give your praise. So it would sound like this:
Therapist “Kevin, what does a puppy say?”
Therapist: “Woof woof. A dog does say ‘woof woof’, you’re right.”
If that doesn’t fix the problem after several tries, then you can go back to the numbered steps above and use the same type of cuing system. For example, you would say “What does a puppy say? Woof woof.” Then, try to jump in and say “woof woof” again after he says it but before he can go on to say “good job”. It may take a while for him to get used to not saying the whole thing so just keep trying this and eventually it should fade out.
When Echolalia is Self-Stimulatory
Some children use echolalia because they find it comforting. We call this self-stimulatory because they are finding ways to provide themselves with stimulation that makes them feel good. Some children flap their hands or rock back and forth as a self-stimulatory behavior. We call this “stimming” for short. There are also children who use echolalia as a form of stimming.
I often see this from children when they are stressed out because they find their movie scripts or tv show scripts to be comforting because they are predictable. If a child doesn’t understand the world around him or why something is happening, he may prefer to do something that he is familiar with and that is predictable, like reciting an entire movie for memory. It’s comforting to him because he knows that movie script will always sound the same no matter what.
Other children may use this delayed echolalia as a self-stim because they are bored or are not tuned into the world around them so they retreat into their own world where Frozen is playing non-stop in their head and they can just tap into that and recite the character’s lines for entertainment.
Keep in mind that this is a pleasurable activity that the child enjoys and there’s nothing wrong with that. The child should be allowed to have some time during his day to use this echolalia as down time, just like you would allow a boy who loves playing ball some time to play with his basketball outside for some down time.
However, there are certain times when it is not OK for a child to be using echolalia. This may be while the child is in class and the teacher is talking, or when the child is in a quiet location like the library or at church. It is not fair to exclude a child from these situations because he doesn’t know how to stop using echolalia so it can be important to stop the echolalia.
The key to stopping echolalia that is self-stimulatory is to figure out why it’s happening. If the child is stimming with echolalia because he is stressed out, see if you can find alternative ways to de-stress the child. This may include reading him a social story about what’s going on around him or teaching him some calming strategies that will help him self-soothe in a quieter manner.
If the child is using echolalia because he is bored or tuned out, it may be helpful to remind him to tune back in. For example, if he’s quoting movie scripts during class time, you could have an adult sitting next to him reminding him to focus on the teacher. Or, the teacher could frequently ask the child questions about what she is talking about to focus his attention back on her. You could also give the child a small fidget toy that will allow him to move his hands so he can focus on the teacher better.
If the child doesn’t realize that he is using echolalia but is just doing it out of habit, you may need to teach the child rules about when it is ok to be talking and when it is not ok to talk. Then, have the teacher gently remind him of those rules when he is talking during a “no talk” time. Bringing his awareness to this and setting limits or rules may be enough to keep the child on track.