A 3.5-year-old male came to clinic with his mother because of large reactions to bug bites for the past 2 days. The mother was concerned because he kept scratching and had no relief from an over the counter steroid cream. There was some increased redness around a couple of them with one looking like it was particularly irritated. There were no systemic symptoms.
The pertinent physical exam showed a well-appearing male with normal vital signs and growth parameters. The skin examination revealed several reddened lesions on his extremities, neck and face. His lower legs had 2 lesions that appeared more erythematous than the others with a central area that had drainage and a small scab. This was more tender also than the central parts of other lesions.
The diagnosis of bug bites with two lesions with localized mild cellulitis was made. He was started on mupirocin for the cellulitis and oral cetirizine for pruritis. “I also wanted to followup on his language since we last talked. His repeating of words doesn’t seem to be getting better. His teacher at daycare says the same thing. He’s a happy kid, but some people think he’s a little quirky. He still plays by himself mostly, and still does more playing next to the other kids rather than with them. His teacher says he does get frustrated with toys, or changing some routines but not that is a lot different from the other kids. At home I see him repeating things, but I keep talking to him. I talked with my husband and we’re ready now to see someone about this,” she stated. The pediatrician replied, “I noticed today that he seems to be a happy child, but he was repeating a lot of what we said like “bug bites” and “get up on the table.” “Yes, he does that and at home sometimes he gets frustrated with me not really understanding what he is trying to say. If I ask, “Can you tell me?” he’ll just repeat that and it’s hard to help him,” she said. The pediatrician responded, “We talked before about having him seen by the developmental specialist and I’m also going to send you to a speech-therapist to see how they can help him be less frustrated with his language. We already tested his hearing before so we know that is not the problem with his speech.”
Discussion
Echolalia is the repetition of a part of whole of what was said, whether or not it was understood by the person. It is “echoed” or borrowed speech from someone else. “Echolalia has many forms heard in everyday speech, such as quoting or mimicking one another, doing comedic impressions, acting out dialogue in plays or counselors reflecting utterances of clients….It is also common to use literal and partial repetitions as turn-taking strategies to maintain conversational discourse….Echolalic speech, although most common before 36 months in typical language development, can have appropriate communicative functions across the lifespan in all speakers.” Immediate imitation of speech may be helpful for learning vocabulary, while recombining phrases may be helpful for learning syntax. Echolalic speech is very common up to 3 years and then disappears gradually as the child reaches linguistic proficiency. Echolalic speech can be normal or atypical behavior depending on the situation.
Learning Point
Echolalia may be the only term for repetitive speech patterns that a non-specialist provider may know when a more specific- or other diagnosis is more accurate or actually the case. Referral to a speech-language pathologist for further evaluation of repetitive speech past the normal developmental age, or that is causing communication problems is important. Little is lost and much is potentially gained with referral if there is any suspicion of a speech-language problem.
Immediate echolalia is when the utterance is produced within 2 conversational turns, while delayed occurs after more than two conversational turns or is of a higher linguistic complexity than the individual would speak themselves or is a learned routine. Echolalic utterances need to be differentiated from those that are self-generated and produced independently and creatively. “Nonlingistic vocalizations (e.g. humming, laughing, crying, whistling, vegetative sounds such as burping, ticlike squeals, grunts, hoots) are not echolalia.” Vocal stereotypies may include echolalia and nonlinguistic vocalizations and are unrelated to the current situational context. For example, when interacting in the office setting, the patient says “Let’s swing” when not at the playground. The patient is using the verbal stereotypy to express being happy or excited to be playing with the examiner. Palilalia is the repetition of an entire word (“I’m Marie, Marie, Marie,…”). Logoclonia is the last syllable of the word being repeated (“I’m Marie, re, re, re, …”). Echologia is the echoing of a question but using different words/wording. Verbigeration is when one or more sentences or sentence fragments are repeated.
Echolalic speech is often thought of as a compensatory communication strategy for people whose linguistic proficiency is too weak to respond spontaneously. While echolalic speech is very common in all young patients, after age 3 the frequency of echolalic speech increases for patients with autism and decreases for those that are neurotypical. Echolalia is one of the main characteristics in patients with autism. It can be used by autistic patients to “…affirm, call, request, label, protest, relate information, perform verbal routines and offer instructions….[it can also be used] as a turn-taking device in maintaining social interactions, to serve a declarative (labeling) function, as a form of cognitive rehearsal, and as a means of self-regulation.” While echolalia may not be a socially appropriate response in all situations, and its meaning may not be understood by all listeners, it often is an important part of communication and should be respected. Treatment is usually centered not on extinction but on improvement of functional use and overall communication. Behavioral therapy, often today as ABA or applied behavioral analysis therapy, is used to assist patients to increase functional skills and interactions. There are speech-therapy techniques which can be used within this framework to assist patients with their functional communication needs. ABA is not the only treatment, one other example is Gestalt Language Processing.
Patients with other neurodivergent diagnoses than autism may have echolalia. Patients who may be neurotypical, but exposed to many hours of language through computers and not through human interaction, may also have atypical speech development which may include echolalia.
Questions for Further Discussion
1. What are indications for referral to a speech-pathologist? A review can be found here
2. What are stereotypies? A review can be found here
3. At what age are articulation problems not considered normal? A review can be found here
Related Cases
- Disease: Echolalia | Speech and Communication Disorders
- Symptom/Presentation: Infections | Developmental Delay
- Specialty: Developmental Disabilities | Speech and Hearing
- Age: Preschooler
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at Cochrane Database of Systematic Reviews. Information prescriptions for patients can be found at MedlinePlus for these topics: Speech and Language Problems in Children and Autism Spectrum Disorders.
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Stiegler LN. Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand? Am J Speech Lang Pathol. 2015;24(4):750-762. doi:10.1044/2015_AJSLP-14-0166
Kaufmann C, Agalawatta N, Malhi GS. Catatonia: Stereotypies, mannerisms and perseverations. Aust N Z J Psychiatry. 2018;52(4):391-393. doi:10.1177/0004867418765669
Gladfelter A, VanZuiden C. The Influence of Language Context on Repetitive Speech Use in Children With Autism Spectrum Disorder. Am J Speech Lang Pathol. 2020;29(1):327-334. doi:10.1044/2019_AJSLP-19-00003
Dinello A, Gladfelter A. Intervention Techniques Targeting Echolalia: A Scoping Review. Am J Speech Lang Pathol. 2025;34(3):1528-1543. doi:10.1044/2025_AJSLP-24-00211
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa