What Is Echolalia and How Is It Related to ADHD? (2024)

Echolalia, a disorder that occurs when a person repeats speech they've heard (either right away or later on) is common in people diagnosed with attention deficit hyperactivity disorder (ADHD). ADHD and its traits of hyperactivity, impulsivity, or inattention (depending on ADHD type) typically begin in childhood and continue into adolescence.

Echolalia is part of neurotypical language development but usually stops by about age 3 when a child's language skills are more developed. If a person over age 3 is still regularly engaging in echolalia, ADHD or another neurodevelopmental disorder (like autism) may be at play. Other language issues like dyslexia can be associated with ADHD, too.

This article will explain why people diagnosed with ADHD often show signs of echolalia, along with other ADHD traits. It discusses types of echolalia, their diagnosis, and echolalia treatment options.

What Is Echolalia?

Echolalia describes the repetition of language that's heard. It isn't a one-off episode, or the occasional quote to make a specific point. It's an oft-repeated behavior that may seem meaningless but is believed to have several purposes.

Echolalia is most associated with ASD, but it isn't limited to it and can occur with ADHD, too.

Types of Echolalia

Echolalia is categorized in multiple ways. Types can be characterized by time frame, such as:

• Immediate echolalia: Phrases or words repeated immediately or after a brief delay
• Delayed echolalia: Phrases or words repeated after a significant period of time

Echolalia also can be characterized by its purpose, such as:

• Functional/interactive echolalia: Used as a way to communicate with others
• Noninteractive echolalia: For personal use or benefit, not generally as a means to communicate with others

Echolalia can also be mitigated, meaning the person changes the wording to some extent when repeating it. It's common for people who use echolalia to mislabel pronouns. For example, they may say, "You want to watch cartoons?" as a way to indicate they want cartoons themselves.

Traits and Symptoms

Echolalia usually develops when a person doesn't have or doesn't use the typical language for communication. The echolalia trait largely depends on the purpose behind it. Someone exhibiting echolalia may repeat phrases they've heard on television, as if from a favorite script. Or, they may simply repeat words in response to what someone else just said.

This can affect the ability to make and communicate decisions. It doesn't mean people who use echolalia can't indicate their preferences, but that they tend to merely "echo back" is something to consider when asking between choices. Other examples include:

• When asked, "What did you have for dinner?" the person may repeat the question and then wait for another to be asked that is more specific. Or the person may say, "Don't slurp your spaghetti," repeating something that was said to them during the meal.
• The person may sing the jingle of a product to indicate that's what they would like for lunch, or ask, "Do you want juice?" to indicate that they would like juice or are thirsty.
• A child may say to another child, "We don't take our friend's toys," when another child is doing something they don't like, even if it doesn't match the action. They are repeating a phrase they have heard that indicates an admonishment of a behavior. They may also repeat it to themselves to self-direct their own behavior.
• A person may rehearse what they are going to say by repeating the sentence quietly to themselves before addressing another person.

Echolalia can manifest in myriad ways beyond these examples but is usually done as a way to communicate with others, to reinforce information for themselves, or to self-regulate behavior.

Echolalia and ADHD

Children with ADHD can experience language delays. While this may not result in echolalia, language delays are one cause of echolalia.

Echolalia is not common in children with ADHD, but it can occur. One way it presents in people with ADHD is as a stim (self-stimulation behavior). Echolalia can also be a way to self-stimulate (called stimming) or self-soothe by repeating songs or phrases they heard in a movie or a TV show.

Stimming is common in both ASD and ADHD, though it isn't expressed in the same way in both conditions. For people with ADHD, stimming is typically used for a short period of time (generally under an hour) and usually while trying to concentrate. An autistic person may stim for several hours at a time.

Stims associated with ADHD tend to be physical, such as hand/pencil tapping, or hair twisting—but stims come in a variety of behaviors and include all of the senses.

Diagnosis

Echolalia is usually diagnosed by a healthcare provider by interacting with the child and by listening to the observations of the parent or guardian. Echolalia is a clue to look further to determine why the child is engaging in it and if there are any underlying conditions or speech delays.

There are no tests to diagnose ADHD per se, but your healthcare provider may order tests to rule out another condition. They may include brain imaging tests like computed tomography (CT scans) or magnetic resonance imaging (MRI). They also may order blood tests.

Treatment

Trying to immediately extinguish echolalia is not often advised, as it serves a purpose. People using it do so as a way to communicate, self-regulate, self-soothe, and engage in it as a helpful behavior.

Treatment usually involves building communication skills that gradually replace the echolalia. The first step in the process is determining why the person uses echolalia so that you know what needs must be met and which tools to give them to do so.

Speech Therapy

Treatment for echolalia usually involves a speech therapist. A speech therapist has a variety of tools at their disposal, including play therapy, to assess language skills and promote the building of new ones.

A speech therapist can also look for and address other language difficulties that may or may not be related to echolalia.

If echolalia is comforting or purposeful to the person, a speech therapist can teach them appropriate times and ways in which to use it.

Music Therapy

Music therapy relies on listening and interacting with music, in order to connect with feelings or build an alternate "language" for communication. It's often used in treating autistic people (including those who are nonverbal and lack language skills) and may be useful in building communication skills beyond echolalia.

Multiple studies suggest music therapy benefits in treating people diagnosed with ADHD, or in co-occurring conditions like depression. There may be a role for music applied through video game play, too, with research under way to assess these impacts.

Music can be used to help people with ADHD to build memory, just as musical jingles are used in advertising to create memory pathways. Music also can serve as an area of competence, with many neurodivergent people showing strong skills in music, theater, and other creative arts.

Medication

Medication is not considered a first-line treatment at all for people with echolalia symptoms of any cause. When it is tried, the medication is meant for a specific underlying condition that leads to the echolalia, such as stroke, seizures, or schizophrenia.

Fintepla (fenfluramine) is an older drug that has been used to treat echolalia symptoms in autistic people, but with mixed results. Some beta blockers show promise in treating autism-related echolalia. Other treatments (antidepressant or antianxiety medication) may be prescribed.

ADHD medication such as stimulants can reduce the need for stimming in a person with ADHD, including echolalia.

ADHD and Language Development

People diagnosed with inattentive ADHD often have trouble paying attention or listening, which can affect language development. Those with hyperactive ADHD, or a combination of the two, may talk or interrupt often but still struggle with appropriate communication.

Parents or guardians can help build communication skills by gently redirecting and correcting when echolalia occurs. For example, if the child says, "Hold you?" you can model the correct sentence, "Will you hold me?" and have the child repeat it back to you before you pick them up.

After some practice, you can expand upon it. If the child indicates they want juice by saying, "Do you want juice?" try responding, "No, I don't want juice, but you do. Say 'I want juice.'"

If echolalia is happening in a way that is disruptive to themselves or others, try to find out what is making the person with ADHD feel anxious, uneasy, or bored when they do it, and work on other ways they can calm down or engage that are less disruptive.

Other Conditions

Echolalia is associated with autism traits. It's uncommon after childhood, but autistic adults may use echolalia just as autistic children do. It also may arise in people with certain psychiatric conditions (like catatonia), or a history of head trauma that makes relearning language necessary.

It's worth noting that in some people, when echolalia does occur, it's only when they're anxious or stressed and may be associated with these conditions.

Summary

Echolalia is the repetition of words or phrases, either immediately after the person hears it or at a later time. Echolalia is part of early language development, but usually stops by age 3.

Echolalia is a common autism trait but also can occur with ADHD. Some people with ADHD use echolalia as a stimming behavior to self-stimulate or self-soothe.

Treatment for echolalia involves helping the person to expand on their language skills to communicate in more diverse and direct ways, and is typically administered by a speech therapist. Music therapy also is a treatment option to discuss with your healthcare provider.