Echolalia

Echolalia is a neurological disorder, which is characterized by uncontrolled repetition of words and phrases. Consider its features, methods of treatment and prevention.

According to the International Classification of Diseases of the 10th revision, echolalia is included in the group: XVIII Symptoms, signs and abnormalities found in clinical and laboratory studies not elsewhere classified.

R47-R49 Symptoms and signs related to speech and voice

• R48 Dyslexia and other violations of recognition and understanding of symbols and signs not elsewhere classified (exception: specific developmental disorders of learning skills):
  • R48.0 Dyslexia and Alexia
  • R48.1 Agnosia
  • R48.2 Apraxia
  • R48.8 Other and unspecified violations of recognition and understanding of symbols and signs

Very often, the disease is associated with early symptoms of autism or features of the development of children's speech. There are two stages of development of conversational skills in a child: from 6 months to 12 and from 3 to 4 years. At this age, children repeat what they heard, and this is considered normal. Simulating your own speech is the only way to train and improve the pronunciation of sounds. Thus, the foundations of interaction with the outside world are formed, and the vocabulary expands. If violations begin at one of these stages, it can lead to the development of echolalia.

[1], [2]

Epidemiology

The incidence of neurological disorders tends to increase. The epidemiology of echolalia points to its age aspect, so for 10,000 children 2-6 have symptoms of pathology. Such a violation in most cases is detected using early diagnosis, that is, in the first stages, which are best amenable to correction.

Such a qualitative anomaly provokes violations in social interaction and communication. This is due to uncontrolled repetitive words and phrases, which makes it impossible for the process of adaptation to the society. The disease can be accompanied by progressive mental retardation.

[3], [4], [5], [6], [7], [8], [9]

Causes of the echolalia

Echolalia occurs at the stage of speech development, when the child begins to know the surrounding world and actively pronounced. There are two such stages that last from 6 months to 1 year and from 3 to 4 years. It is in these age intervals that children actively repeat the words of others, studying the basics of speech and trying to enter into a dialogue.

Causes of echolalia:

• Disorders of the psyche.
• Various neurological pathologies.
• Defeat of the frontal lobes of the brain.
• Mental retardation.
• An autistic disorder.
• Thurret Syndrome.
• Imbecility.
• Schizophrenia.
• Rett syndrome.
• Brain cancer.
• Dyslexia.
• Dysphasia.

Any of the above disorders can be diagnosed in children, so when it comes to echolalia in adults, they imply unidentified violations in childhood. In addition to the main reasons, the disease can be aggravated or caused by certain provoking factors:

• Self-deception in the process of communication - repeating what has been heard, the child has a certain range of emotions and associations. If such images pop up too often and are erroneous, then this becomes a problem in communication.
• Emotions in the communication process - echolalia acts as an indicator of the mood of the patient, as repeated phrases have emotional images.
• Processing and ordering of information - repeating what has been heard, the patient sorts out the events that happened, shares this information and emotions with others.

Regardless of the age of the patient, the disease is always accompanied by mental and neurological pathologies. With the diagnosis of autism, echolalia acts as a peculiar way of communication. This is an attempt to maintain a conversation or enter into a dialogue before the realization of what has been said.

Up to 4 years of age, automatic repetition of words for others is normal. But in the older, this symptom requires medical attention, since it indicates a serious pathology. In medical practice, very often there are cases when the disease becomes a provoker of hysterical seizures because of the resulting misunderstanding.

[10], [11], [12]

Pathogenesis

The mechanism of development of the disorder of speech behavior can be associated with both functional and organic changes in the brain. Pathogenesis involves a number of processes that cause the appearance of symptoms of echolalia. This can be caused by existing or transferred diseases, congenital pathologies.

Signs of the disease are manifested during hyperexcitation of neurons in the motor zone of the frontal lobe of the brain. This was established by transcranial magnetic stimulation. The defect is characterized by abnormalities in the functioning of the nervous structures of the brain, complexity in the social and emotional sphere, provided normal thinking and attention. Since echolalia can be an early symptom of autism, in some cases, there is an imbalance of inhibition and excitation, an excess of local bonds in certain areas of the brain and other pathologies.

[13], [14], [15], [16], [17], [18], [19], [20], [21], [22]

Symptoms of the echolalia

Uncontrolled repetition of individual words or entire sentences from the interlocutor's monologue are symptoms of echolalia. The source for repetitions can be either the person who is near, and the book text, television or radio broadcast.

The disease has two types, which differ in their symptoms:

• Immediate - the patient reproduces the words and phrases just heard. This kind is necessary to maintain communication with others, that is, it acts as a kind of conversation.
• Delayed - repetition occurs after a certain period of time, it can be 10-15 minutes, a day, a week or a month. It is accompanied by various additional mental disorders.

Neurological pathology is characterized by self-stimulation, that is, the repetition of phrases associated with certain emotions. Thus, the patient is immersed in a convenient atmosphere for him. Repeated phrases cause surprise to others, since they are not relevant to current events.

Another symptom of the disease is the function of transmitting mood through positive or negative experiences. For example, the phrase "no sweets" causes negative emotions, and in any unpleasant situation the patient will repeat it. It is also obligatory to systematize information. Before going to sleep, everything that has been heard for a day is uttered, that is, the patient shares his emotions and experiences with others. It looks like a disjointed story, a set of words and phrases.

[23]

First signs

In most cases, the first signs of echolalia become noticeable at the age of 3-5 years. More often they appear in boys, girls have a more complex disease. So, when answering any question, the patient repeats its fragment or completely. Quiet or loud speech, lack of response to one's own name and wrong intonations, are also considered signs of speech disorder.

If the defect is one of the signs of autism, then in addition to violations of social behavior and communications, there are a number of other pathological symptoms. The patient does not perceive the interlocutor, therefore the eye-to-eye contact is broken. There is a scant facial expression, which very often does not correspond to the situation, gestures are used to indicate any needs. The child does not understand the emotions of others and does not show interest in peers. Stereotyped behavior manifests itself in the form of daily rituals, fixation in certain occupations, repeated repetitions of movements.

[24], [25], [26]

Echolalia in adults

There are a number of pathological conditions that can cause the development of echolalia. In adults, the disease has acquired character. Its symptoms appear in schizophrenic disorders, various brain lesions, neurological and mental illnesses. Because of difficulties in communicating with outsiders, inability to express their own emotions and conduct work, patients are subject to disability.

Echolalia in adults most often develops on a background of schizophrenia. In this case, automatic repetition is accompanied by a meager gesture and mimicry. Patients are not able to perceive the elementary rules and norms, do not understand their behavior and the intentions of others. This all makes it impossible to build a friendly or romantic relationship. Also, there may be an attachment to a particular situation and the regime of the day. The slightest changes cause serious experiences and hysterical fits.

Echolalia in children

An upset that is characterized by uncontrolled repetition of other people's words, phrases or complete sentences is echolalia. In children, it can be of two types: immediate and delayed. It is often taken for the first signs of autism, as in some cases this is not excluded. The disease is associated with a violation of the process of speech formation.

There are two age periods in which the child begins to be reprimanded, repeating everything he has heard - this is from 6 months to 1 year and from 3 years to 4. This simulation is necessary for training pronunciation of sounds, expanding vocabulary and learning the basics of interaction with the society through communication.

If the verbal disorder persists or occurs in older children, this indicates echolalia. It can have a different degree of severity. Therefore, the sooner it is diagnosed, the better it can be corrected. This method of treatment allows you to find understanding with the patient and try to adapt it to the society.

[27], [28], [29]

Forms

To date, there are two types of echolalia: immediate and delayed. The first is an immediate repetition of the words you hear. It is a demonstration that the big one heard someone else's speech, but needs time to accept and understand it. At normal development process of formation of comprehension heard is several months. But with speech disorder, this can drag on for years. For the delayed repetition, the reproduction of words and phrases is typical after a certain period of time. They can be pronounced in any situation and at any time.

Let us consider in more detail the main types of echolalia:

1. Immediate

The patient repeats what he has just heard, demonstrating the physical ability to reproduce speech and memorize sounds. The next stage is the process of understanding what has been said, which takes from several months to several years. Many scholars interpret this as a peculiar way of communication, an attempt to maintain dialogue and respond to the realization of what has been said. It looks something like this: "I hear you, but still trying to understand what has been said."

Very often, with this form of speech disturbance, hysterical fits occur. They develop against a background of misunderstanding. For example, when a patient is asked about the fact that he wants water or juice. In most cases, the answer is the last word, that is, juice. When the patient receives it, hysteria begins, as the answer was even before the realization of the proposed options.

2. Deferred

The repetition of learned phrases in a particular social context is the norm. In this case, we are talking about quoting poems, interesting utterances or excerpts from works. The delayed form of echolalia is a repetition of someone else's phrases after a long period of time. This can happen in a few minutes, days, months and even years, regardless of time or place.

There are a number of reasons that cause a delayed speech disorder:

• Self-stimulation is its main goal to enjoy the said. That is, the patient repeats the words and phrases that he likes. These can be quotes from movies, programs, books and much more. If delayed echolalia is used as entertainment, it disrupts real communication. Therefore, the main goal of therapy is to switch attention to constructive activities.
• Mood communication - automatic repetition can convey certain emotions. It can be some phrases associated with disappointment or joy, as well as words that fit the general tone of the conversation.
• Summing up is a method of processing information received during the day, that is, grouping memories with repetitions.

To date, several methods have been developed that allow you to correct the communication process. To do this, use visual and tactile practices, that is, connect different senses to improve understanding.

[30], [31], [32], [33]

Echolalia and echopraxia

The involuntary repetition of the movements or words of others is echokinesia. Like many neuropsychiatric pathologies, it does not have a clear etiology. Echolalia and echopraxia are its forms, which depend on the manifested symptoms. Let's consider each of them in more detail:

• Echopraxia

Automatic repetition of actions and movements of other people. It has several forms, most often the patient repeats elementary movements, which he sees with his own eyes. It can be clapping hands, raising hands, pulling up clothes and more. It is observed in schizophrenia, organic diseases of the brain and damage to its frontal lobes.

• Echolalia

Involuntary repetition of words, carried out by full duplication or interweaving of individual replicas in his speech. Most often, patients repeat the questions that are addressed to them. Despite the entire mechanical nature of the disorder, patients are able to understand and process the information they receive. It has two forms: delayed and immediate, occurs in both children and adults. It can occur after suffering craniocerebral injuries, with schizophrenia, imbecility, mental retardation and organic brain diseases.

In some cases, echolalia and echopraxia are manifested simultaneously. With early and correct diagnosis of these disorders, there is a chance to correct the patient's behavior.

[34], [35], [36]

Complications and consequences

Echolalia, as well as a number of other neuropsychiatric diseases, leads to various consequences and complications. First of all, these are difficulties with the process of socialization, training, work, the opportunity to make friends or start a family.

Even with the condition of timely and proper treatment, the speech defect persists for life. If the disorder occurs against a background of autism, then such patients have an increased threshold of pain sensitivity. This leads to the fact that a person does not react to painful stimuli. Sometimes children with such pathologies are engaged in self-torture, which leads to various injuries of the body.

[37], [38], [39], [40], [41], [42], [43], [44]

Diagnostics of the echolalia

At the first symptoms of violation of speech behavior in a child or adult, it is necessary to consult a psychoneurologist and a psychologist. Diagnosis of echolalia begins with the collection of anamnesis and examination of the patient. This allows you to determine whether there are deviations in mental development. If automatic repetition of words is not related to age, then additional studies and tests are carried out.

An approximate algorithm for examinations with suspicion of echolalia:

• Analysis of complaints and collection of anamnesis - a survey of the mother of the baby about the course of pregnancy, the study of heredity.
• Neurological examination to detect abnormalities.
• Examination at the speech therapist - the doctor evaluates the speech of the baby, improper pronunciation, confusion of syllables, frequency of repetition.
• Instrumental and laboratory studies.

For the detection of neurological pathology, the same methods are used as for the diagnosis of autism. This is due to the fact that echolalia can be one of its symptoms. Using special questionnaires (ADI-R, ADOS, CARS, ABC, CHAT), various tests are carried out and the behavior of the patient is studied in a familiar environment. Laboratory and instrumental methods, that is, blood tests, ultrasound of the brain, electroencephalogram and others are also used.

[45], [46], [47]

Analyzes

With verbal disorder, as with other neuropsychiatric pathologies, a thorough diagnosis is necessary. Analyzes are included in the compulsory complex of studies and consist of such procedures:

• Neuropsychological analyzes.
• Verification of mental abilities.
• Questionnaires and observations.
• Laboratory research.

They must pass blood, urine, DNA analysis, EEG and others. They are necessary for the elimination of similar diseases and the identification of concomitant pathologies. Based on the results, the doctor makes a plan for further research and treatment options.

[48], [49]

Instrumental diagnostics

To clarify the diagnosis and a more thorough study of the patient's condition, various medical approaches are used. Instrumental diagnostics consists of a number of procedures that allow you to visualize and evaluate the state of the brain and other organs and systems that can provoke symptoms of pathology:

Instrumental methods:

• Ultrasound examination of the brain - is performed to identify and determine the extent of its damage.
• Electroencephalogram - identifies the symptoms that can accompany echolalia and early autism. These can be epileptic seizures, convulsions, loss of consciousness, and so on.
• Magnetic resonance imaging - reveals anomalies in the development of the brain, corpus callosum and temporal lobe. It allows to diagnose speech pathology and autism in the early stages.
• Hearing test - the patient is consulted and examined by a hearing therapist. This is necessary to exclude hearing loss and accompanying speech delay.

The main advantage of the above described instrumental methods is that they are non-invasive. This helps to minimize fears and hysterical fits in patients of all ages.

Differential diagnosis

Studies with echolalia are very important, as they make it possible to distinguish it from other disorders of the brain. Differential diagnosis is aimed at identifying early signs of such pathologies as:

• Mental retardation - there is a progressive decline in intelligence. Patients do not seek to establish emotional contacts with others, often closed and even aggressive.
• Schizophrenic disorder - manifested up to seven years and it is characterized by convulsive seizures, hallucinations, delusional condition. Has a hereditary predisposition. Mental abilities are not violated.
• Deprivational disorders - are manifested due to severe stresses as a result of a sharp change in the habitual situation, that is, the appearance of something new.
• Geller's syndrome - occurs at the age of 3-4 years and is characterized by severe behavioral disorders. There is irritability, progressive loss of intelligence, loss of motor skills and speech.
• Rett syndrome - occurs against the backdrop of seemingly normal development in the period from 6 months to 3 years. There are neurological symptoms, various intellectual pathologies, a disorder of coordination of movements.
• Hearing disorders - children with echolalia, like deaf children under 12 months of age have normal development. They agukayut and babbling. But when carrying out an audiogram, you can identify a strong hearing loss, which provokes frequent repetitions of speech for others.

Speech disorder can appear on the background of other diseases, that is, act as their early symptom. Differential diagnosis is aimed at identifying characteristics characteristic of the violation and separating them from other pathologies.

Treatment of the echolalia

To date, there has not yet been developed medicines, the use of which has helped to eliminate speech disorders or other psychoneurological pathologies. Correction echolalia - this is the only way to establish a process of communication with the patient. Treatment is long and requires regular work, so when the first symptoms of the disease, you need to contact a professional psychotherapist or psychoneurologist.

If the child does not have a delay in development, then the treatment is not carried out. For the elimination of speech defects, lessons with a defectologist and speech therapist are indicated. The main task of parents is to follow a number of rules:

• Do not raise the tone of the child, talk calmly and clearly.
• Ask questions, the answer to which will be "yes" or "no."
• Protect from various stressful situations and experiences.

If echolalia occurs against a background of autism or other mental illness, then a comprehensive treatment (medication, exercises, physiotherapy and others) is performed. Huge responsibility falls on the parents, they must be patient and communicate with the patient correctly:

• Regularly add new words to memorized phrases and sentences for the extension of the lexicon.
• Do not stop the child with frequent repetition of words, but try to understand their meaning, that is, to catch the information that he wants to convey.
• In order for communication to proceed more easily, it is recommended to use pictures with different images. This will make a choice without misunderstanding.

To better understand the patient echolalia, others should pay attention to the essence of words, and the situation in which they are pronounced, intonation, facial expressions and much more.

Prevention

Echolalia is a peculiar form of communication, that is, it can not be called a meaningless and purposeless repetition of other people's words. Prevention of the disease is aimed at normalizing the communication process, turning the disorder into an instrument of interaction with others.

• Do not stop the patient in repetition, since pronouncing words is one of the ways of self-expression for problems with oral speech. If this option is not available, the patient will not be able to train pronunciation, maintain conversation and minimize anxiety through verbal communication.
• Pay attention to all spoken words, even if they at first sight do not make sense. This will allow us to study the features of echolalia in more detail and to establish the process of communication. Try to understand the spoken, intonation and facial expressions of the patient. It is very important to catch the tone and rhythm of what has been said, since the same phrases can carry different information.
• Join the conversation, say alternately favorite speech scenarios of the child. Try to form a new one, that is, expand the learned phrases, constantly replenishing the vocabulary.

Only regular classes in a relaxed environment will help to establish the process of communication and improve the socialization of the patient.

[50], [51]

Forecast

If the automatic repetition of words is not pathological, it passes by itself to 4 years of the child's life. The forecast in this case is favorable, and the whole process of peculiar speech behavior is associated with the formation of speech. If the disease is caused by autism, mental retardation or schizophrenic disorder, the prognosis depends on the results of the correction and the selected treatment methods. In some cases, it occurs simultaneously with echopraxia, which complicates the treatment process.

Echolalia refers to mental disorders, for the relief of which medicines are not used. All therapy is a verbal communication aimed at the socialization of the patient and the establishment of communications. Without this, the illness is aggravated, the patient becomes withdrawn and aggressive. Such people need constant control and care, since without outside help they can not take care of themselves.

[52], [53]