Echolalia in ADHD: Types, Causes, Treatment

Echolalia is a non-voluntary behavior that causes someone to repeat what other people say. It is also referred to as echophrasia. The term echolalia is derived from the Greek words ‘echo’ and ‘lalia’ meaning ‘repeat’ and ‘speech’ respectively. 

While echolalia is commonly associated with autism (approximately 75% of autistic children display symptoms of echolalia), echolalia can also be present in ADHD.

Many people associate ADHD with poor concentration, disorganization, forgetfulness, and difficulties with attention. However, these are just some of the symptoms of this neurodevelopmental disorder. Also observed in those with ADHD are repeated speech patterns, otherwise known as echolalia. 

Types of Echolalia

There are different classifications of echolalia. Two of the major groupings of this condition are immediate and delayed echolalia.

Immediate and Delayed Echolalia

Two types of echolalia are:

• Immediate echolalia: A person will repeat what someone else has said immediately after they've said it.
• Delayed echolalia: In this instance, speech repetition follows after considerable time has passed. 

While some phrases might be repeated without any clear meaning behind them, they do have communicative value. Both immediate and delayed echolalia can communicate with a purpose (i.e., delivering meaningful information).

In some cases, however, the words may be repeated without truly intending to communicate new information.

Unmitigated and Mitigated Echolalia

Echolalia may also affect the way in which someone repeats someone else's words. 

• Unmitigated echolalia: A person will repeat someone else's words word for word with no changes.
• Mitigated echolalia: Marked by a change in intonation or speech, rather than verbatim repetition. In children with this condition, mitigated echolalia is observed as language and comprehension abilities develop.
  

Echolalia Caused By a Stimulus

• Ambient Echolalia: A child may repeat sounds heard in the environment such as the television, a bike, a fan, etc.
• Echoing Approval: With echoing approval, a person’s response to a question will mimic the negative or positive structure of the query. This happens without repeating the whole or part of the question asked.For example, patients asked about their symptoms may say ‘exactly’, or ‘that’s right’ to positive questions. Negative questions can receive ‘no, and ‘definitely not’ responses regardless of the true state of symptoms. 

Causes of Echolalia

The exact cause of echolalia remains hard to pin down. Some researchers suggest that the mirror neuron system might play a role in the development of echolalia. Among other functions, this neuron system responds to or mirrors actions and behaviors observed in others. Echolalia can impact speech and actions because of the mirror neurons in neurodivergent brains,

Likewise, dopamine dysregulation may have ties to echoing behaviors. Research has shown that the neurotransmitter dopamine is released during speech production. This chemical messenger can influence brain circuitry and speech control. 

Other studies link echolalia to dysfunctions of the frontal lobe. The condition has been reported where lesions occur in the left medial frontal lobe and other areas that support motor functioning. 

Echolalia is also common in Tourette's syndrome and other tic disorders such as vocal tic disorder.

How Echolalia Manifests

As stated, echolalia is commonly observed in children. It may be considered persistent when it occurs past the age of three.

Echolalia may also be observed in severe cases of head trauma, such as stroke, closed head injury, encephalitis, dementia, or confused states—echoing statements may be present.

When echolalia is featured with ADHD, it is usually the result of self-stimulation or stimming. Self-stimulation refers to behavior that helps an individual cope with anxiety or stress.  These repeated behaviors help to improve focus and the way the brain processes information. Stimming may also improve mood.

Diagnosis of Echolalia

To determine whether a child has echolalia, a healthcare provider will usually spend time interacting with them. Parents and guardians will also be consulted for their experiences when relating with the child.

This examination will likely evaluate a child for speech impediments or developmental delays as well.

Benefits of Echolalia

Echolalia can provide benefits to children who engage in the behavior. As mentioned, echolalia is a type of stimming.

Repeating phrases can help calm a child down. Particularly with ADHD and autism, echolalia can provide relief when a child is feeling sensory overwhelm. In fact, recognizing when your child uses this coping mechanism can help you can better understand when they may be experiencing anxiety or when they're triggered by their environment in some way.

For instance, your child might repeat what they hear in a fast food commercial to communicate that they're hungry. Or, they might repeat something you said when you were angry to let you know that they are feeling angry.

Over time, you can make the connections between what phrase your child is repeating and what they may be asking for in that moment. Letting your child know when you understand what they're expressing and what they need is beneficial for their sense of well-being and safety.

Treatment of Echolalia

Echolalia isn't necessarily something that needs solving. When children lack sufficient ways to communicate, trying to "fix" their echolalia may limit their ability to express themselves.

Instead, children should be taught expressive and receptive ways to communicate. This is achieved through speech therapy and medication.

Speech Therapy

A speech-language pathologist can help with addressing echolalia in childhood. In autistic children, behavioral interventions such as cues-point-training, gestalt learning, script training, visual cues, self-monitoring training, etc—can reduce cases of repetition.  

Likewise, music therapy has shown promise in assessing and improving symptoms of echolalia.

Medication

In older children who experience echolalia from stress and anxiety, medicine is trusted to manage their symptoms. Selective serotonin reuptake inhibitors which increase serotonin (the "happiness hormone") levels in the brain are used in cases caused by stroke. 

A Word From Verywell

The signs are echolalia are common in young children, as well as in children with ADHD or autism. Echolalia can be a useful way for your child to express themselves or to self-soothe. If echolalia is frustrating to your child or disruptive to their daily life, you can speak with a healthcare provider about options to help your child manage their condition such as speech or music therapy.