Echolalia and Autism
Gary J. Heffner, M.A.
Judevine® Autism Program at ECRH
July, 2000
Note: Most of this information is based upon the work and research of Barry M. Prizant. To see what Barry M. Prizant is up to lately, go to: www.barryprizant.com.
What is echolalia?
Echolalia is the repetition or echoing of verbal utterances made by another person. According to Prizant (1983) up to 75% of verbal persons with autism exhibit echolalia in some form. There are two types of echolalia: immediate echolalia and delayed echolalia. Immediate echolalia was once defined as "the meaningless repetition of a word or word group just spoken by another person" (Fay & Schuler, 1980). However, Prizant & Duchan (1981) and others have begun to see that echolalia may serve many functions for the person with autism (therefore, it is not "meaningless"). The researchers determined that immediate echolalia often was used with clear evidence of purposeful communication. Table 1 (below) lists seven different functions of immediate echolalia, identified by Prizant and Duchan (1981). Immediate echolalia appears to tap into the person's short-term memory for auditory input. For our purposes, immediate echolalia is defined as the repetition of a word or phrase just spoken by another person. Persons with autism who repeat what you just said (including the questions you ask) come to mind when we think of immediate echolalia. The child who responds to, "Do you want a cookie?" with "Do you want a cookie?" may or may not want a cookie. This is the maddening, confusing world of immediate echolalia for the parent or teacher.
Table 1. Functional categories of immediate echolalia (Prizant & Duchan, 1981).
| Category | Description |
| A. Interactive | |
| 1. Turn taking | 1. Utterances used as turn fillers in an alternating verbal exchange. |
| 2. Declarative | 2. Utterances labeling objects, actions, or location (accompanied by demonstrative gestures). |
| 3. Yes answer | 3. Utterances used to indicate affirmation of a prior utterance. |
| 4. Request | 4. Utterances used to request objects or others' actions. Usually involves mitigated echolalia. |
| B. Noninteractive | |
| 1. Nonfocused | 1. Utterances produced with no apparent intent and often in states of high arousal (e.g., fear, pain). |
| 2. Rehearsal | 2. Utterances used as a processing aid, followed by utterance or action indicating comprehension of echoed utterance. |
| 3. Self-regulatory | 3. Utterances which serve to regulate one's own actions. Produced in synchrony with motor activity. |
As Table 1 shows, immediate echolalia may be used with no intent or purpose or may have a very specific purpose for the individual. Immediate echolalia may also be used to initiate or maintain interaction or may be used in a noninteractive manner. Knowing the person very well would appear to be the key to understanding their specific use of immediate echolalia.
Delayed echolalia has been defined as the "echoing of a phrase after some delay or lapse of time" (Simon, 1975). Persons with autism who repeat TV commercials, favorite movie scripts, or parental reprimands come to mind when we think of delayed echolalia. You may recall Dustin Hoffman's portrayal of a man with autism who would repeat the Abbott and Costello comedy routine: "Who's on First?" over and over. He did not understand the humor of the routine and appeared to have no purpose in repeating it. Delayed echolalia appears to tap into long-term auditory memory, and for this reason, may be a different phenomenon from immediate echolalia. Because it can involve the recitation of entire scripts, delayed echolalia, is often thought to denote evidence of near-genius intellect. This may or may not be the case. Wolf and Chess (1965) found that delayed echolalia can serve a communicative function for the person with autism but it is not always indicative of high intelligence. They described two categories of delayed echolalia: noncommunicative repetition and communicative repetition. Prizant (1983) listed 14 possible functions of delayed echolalia (see Table 2).
Table 2. Functional categories of delayed echolalia (Prizant, 1983).
| Category | Description |
| A. Interactive | |
| 1. Turn taking | 1. Utterances used as turn fillers in alternating verbal exchange. |
| 2. Verbal completion | 2. Utterances which complete familiar verbal routines initiated by others. |
| 3. Providing information | 3. Utterances offering new information not apparent from the situational context (may be initiated or respondent). |
| 4. Labeling (interactive) | 4. Utterances labeling objects or actions in the environment. |
| 5. Protest | 5. Utterances protesting actions of others. May be used to prohibit others' actions. |
| 6. Request | 6. Utterances used to request objects. |
| 7. Calling | 7. Utterances used to call attention to oneself or to establish/maintain interaction. |
| 8. Affirmation | 8. Utterances used to indicate affirmation of previous utterance. |
| 9. Directive | 9. Utterances (often imperatives) used to direct others' actions. |
| B. Noninteractive | |
| 1. Nonfocused | 1. Utterances with no apparent communicative intent or relevance to the situational context. May be self-stimulatory. |
| 2. Situation association | 2. Utterances with no apparent communicative intent which appear triggered by an object, person, situation, or activity. |
| 3. Self-directive | 3. Utterances which serve to regulate one's own actions. Produced in synchrony with motor activity. |
| 4. Rehearsal | 4. Utterances produced with low volume followed by a louder interactive production. Appears to practice for subsequent production. |
| 5. Label (noninteractive) | 5. Utterance labeling objects or actions in the environment with no apparent communicative intent. May be a form of practice for learning language. |
As Table 2 shows, delayed echolalia may be interactive or noninteractive and may be used with no intent or purpose or may have a very specific purpose for the individual. There appears to be more potential functions for delayed echolalia than were found for immediate echolalia. A key to understanding the specific use of delayed echolalia in any individual is a keen awareness of the individual's daily behavior and familiarity with their verbalizations.
The common stereotype of a person with autism is that he or she is "in a world of their own." Echolalia is one of those easily identified symptoms which is so strangely different from what is termed "normal" that it seems to support the stereotype. However, when one looks at the communicative nature of their echolalia, the stereotype begins to lose credence. Persons with autism do interact and do communicate, however, they do so in different ways. One of my favorite sayings about autism is "persons with autism are more normal than abnormal." Even echolalia is a normal way to learn language. Most children use echolalia to learn language. The majority of children babble in a rhythmic way, which is actually mimicking the cadence of our language. Later, they copy sounds, words, and eventually phrases and sentences that they hear adults use in specific, repetitive contexts. This is known as the "gestalt" style of language acquisition. Gestalt means whole, therefore, learning language in gestalt form would be learning it in chunks rather than the tiny component sounds and specific meaning of each individual sound or even word. For example, "Mommy" comes to mean "Mommy" because of the whole of the experience, that is, the smell of Mommy, the house where Mommy lives, the shape of Mommy, the sound of Mommy, etc. Most children begin their language acquisition by using this gestalt form but quickly change over to an analytic form. Children begin to analyze the way language is used in other contexts and come to understand that "Mommy" is a word that can represent other things besides the whole of their experience with their specific "Mommy." Lovaas (1981) says that echolalia peaks at around age 30 months in normal children, and then decreases. Echolalia was once thought of as just another inappropriate behavior to eliminate in a person with autism, however, researchers currently see it as a developmental phenomenon that occurs within the child's normal cognitive and linguistic maturation.
The acquisition of language is not a clear-cut changeover from gestalt to analytic learning or from echolalia to spontaneous language but rather is a continuum which reflects not just the choice of words but the evolution of the way the person thinks and looks at the world. However, the point at which the "switch is flipped" can be quite dramatic. I recall the day my son seemed to "flip his switch" from gestalt learning or language acquisition to analytic. He had been taught his body parts to include his armpits. One day he cut his inner arm. When I asked him where his cut was located he said it was on his "elbowpit." Which I easily deduced was the crease between his upper and lower arm, opposite his elbow. He had moved from the gestalt or echolalic reference for words to the creative use of new word combinations to explain his experience. In order for my son to accomplish this feat, he had to break down the gestalt word, armpit, into the individual meanings of the words so that arm pit came to mean the indented place (pit) under the arm. Therefore, the indented place opposite the elbow must be an "elbowpit."
Prizant (1983) captured both the continuous nature and the transitional nature of language development in persons with autism in the following graph (see Figure 1):
Figure 1. Change over time in the number of functions served by echolalia and spontaneous language.
Prizant and other researchers see language as occurring in stages in persons with autism, however, these stages are not real delineations of time or accomplishment, rather they merely help one to see a progression from echolalic learning and language use to the use of spontaneous language. The researchers note (and personal observation affirms) that persons with autism can get "stuck" at any point in the continuum and language may not progress beyond echolalia (if even that develops). One can see that as the number of functions for echolalia declines, spontaneous language serves more and more functions for the person. However, during "Stage 3" an interesting phenomenon, indicated by the arrow on the graph, occurs when the child appears to regress because of a transition from (correct) gestalt language to immature analytic language. At this point, it is tempting for parents and teachers to correct the person with autism and have them "say it the right way." But for persons with communication disorders, this may merely be reinforcing gestalt forms rather than the "incorrect" analytic forms. The preferred method of reinforcement is to accept what the child says, but then to repeat it back to them using a more complete, adult form, and then follow this with additional information. For example, when the person with autism says, "Want milk," the parent or teacher should say, "You want a glass of milk? Okay, (getting milk) the milk is cold." This reinforces their creative use of language while also modeling for them the correct usage (Finnerty, 1995).
By the way, gestalt language acquisition does not just develop "out of the blue" in persons with autism. It is not just "lazy language." Gestalt language acquisition comes from gestalt thinking or gestalt processing. Perhaps the most famous person with autism (besides Rainman), Temple Grandin (1996), describes her thought process as "thinking in pictures." For her to recall or learn a concept like "power," she would have to visualize a "power line." Persons with autism think and learn differently. That is the reason things like echolalia develop in the first place. It is a symptom of a the way the brain of a person with autism operates. Rather than look at just the deficiencies of persons with autism, Prior (1979) categorized the frequently cited abilities of persons with autism as "nonanalytic and nonabstract." The abilities include: excellent rote memory for both visual and auditory information and proficiency in tasks demanding visual-spatial judgement and visual-spatial pattern recognition. The special abilities that some persons with autism possess (known as savant skills) are almost always right-hemisphere abilities (Rimland, 1978). Prizant (1983) noted that numerous researchers have found that the patterns of ability and disability in autism have a right-hemisphere processing preference. The right-hemisphere of the brain is thought to process information "wholistically" rather than "analytically".
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