The mother says, “It's time to go.” The toddler repeats, “time to go.” The mother says, “Let's get your coat.” The toddler replies, “Get your coat.”

Children often repeat what others say, whether it's parroting an older sister, a parent, or a daycare teacher. This trait is called echolalia, which comes from the Greek roots “echo,” meaning to repeat, and “lalia,” meaning speech. Unlike a thought-out response, echolalia appears to be automatic. In some cases, a young child may utter a line from a favorite movie, TV commercial, or video game repeatedly, perhaps out of context and with a pronounced cadence or intonation.

Usually, echolalia is nothing to worry about. It's part of how children acquire language, says Jessica Goss, a speech-language pathologist and instructor in the department of communications sciences and disorders at Temple University in Philadelphia. “Kids repeat as they practice language,” she says, adding that children hear what others say and start including more of their own words.

“Children are trying to learn and understand new words. Repeating them is a functional communicative tool in early childhood. As language picks up, the frequency of echolalia drops off,” says Tyler McFayden, PhD, a clinical psychologist at the University of North Carolina Chapel Hill who has studied and written about echolalia.

In some cases, however, echolalia can be a sign of autism or developmental delay, especially if it's persistent and occurs with other behaviors, such as differences in social interaction, repetitive body movements, sensory issues, or restrictive interest in objects or activities, Goss says. Persistent echolalia is more likely to be correlated with autism after around age 3, but it can occur at any age. It also can occur in adults with autism or conditions such as Tourette syndrome, stroke, encephalitis, aphasia, schizophrenia, head injury, and dementia. It is considered more of a behavior, trait, or phenomenon rather than disease or disorder.

Speech and language experts describe two types of echolalia—immediate and delayed, says Goss. An example of immediate echolalia is when a grandparent asks a grandchild, “Did you get a new train?” and the child quickly echoes, “Get a new train?”

Delayed echolalia involves repeating words or phrases after at least two conversational turns, though it also may occur after a much longer delay. Max Wiznitzer, MD, a pediatric neurologist and director of the Rainbow Autism Center at Rainbow Babies and Children's Hospital in Cleveland, says echolalia is a possible marker for something else that may be going on.

“Normally you don't get echolalia in a 5 year old unless they are developmentally delayed,” he says, adding that a child with developmental delay involving cognitive ability may “repeat what they hear because they don't understand what is being asked.” And “Wh” questions—such as what, why, and where—are harder for a young child to understand than questions that require a simple yes or no, he says.

Another possible explanation for echolalia is autism, particularly when there is delayed echolalia, though autism shouldn't be assumed to be the case without a thorough evaluation, Dr. Wiznitzer says. He has patients with autism who have delayed echolalia in which it “seems like they've memorized a certain script.”

“It might be repeating a line from a TV show, a movie, a song,” often seemingly out of the blue, Goss says. To the listener, the meaning or context of the child's sudden utterance may not be clear. However, these phrases often have meaning to the child, who uses them to communicate with the listener, Goss says. For instance, if a child blurts out, “Time to go to lunch,” she may simply be repeating what she hears her teacher say every day. Or, the words may convey a different meaning, Goss says: “The child may actually be saying she is hungry.”

“Parents should think of echolalia not as a distinct entity but within the context of their children's development and how they are doing overall,” says Mariam Hull, MD, a pediatric neurologist at Texas Children's Hospital in Houston who specializes in Tourette syndrome and other movement disorders. Parents should discuss concerns about their children's tendency to repeat words or phrases with their pediatricians, she says. “Pediatricians do a really great job in trying to make sure children reach all of the developmental milestones,” Dr. Hull says. Physicians may refer patients to specialists, including developmental pediatricians, speech-language pathologists, or neurologists who see people with autism and other neurologic conditions.

Understanding the Phenomenon

Echolalia was first described in the research literature in the mid-1900s, says Dr. Hull, and since then, much of the focus has been on autism. Echolalia also may be a vocal tic in people with Tourette syndrome, but it is not considered a definite sign of the syndrome. At least two motor tics and one vocal tic that started at least a year prior are required for a Tourette diagnosis, she says.

It's difficult to pinpoint the incidence of echolalia among children with autism because different modes of assessment are used, says Mags McAllister, a graduate student in the field of applied behavior analysis at University of North Carolina. She just completed an investigation into echolalia and related behaviors in nearly 2,000 youth with autism based on the perspectives of parents, teachers, and clinicians. She found that up to 90 percent of children with autism exhibit echolalia. Her findings were presented at last year's American Speech-Language-Hearing Association annual meeting and will be published in Autism Research.

Multiple regions of the brain are involved in echolalia, but its underlying mechanism is not well understood, McFayden says. Traditionally, language has been thought of as a left-brain activity, but with brain imaging tools such as functional MRI, which enable researchers to see activity as it happens in the brain, the understanding of speech and language development is evolving. “We are finding some evidence that whenever the right side is overly activated in language, we are seeing more echolalia,” she says.

Treating the Trait

People once viewed echolalia as a problem to correct. The goal of therapy was to mitigate or decrease it, McAllister says. Now, though, it's recognized as a form of communication and used as a springboard to develop broader communication skills. Parents and caregivers should look for purpose and meaning in children's repeated phrases, especially if they persist.

McAllister describes the case of a boy who said, “Thank you, like and subscribe,” when leaving a pizza shop or other places he went with his family. That line may seem nonsensical, but in fact he was parroting what he heard at the end of YouTube videos. “We know what he meant. He was saying, ‘thank you and goodbye.’ He had experienced a pleasant time,” McAllister says. Another example of a not-so-obvious meaning: A child who repeatedly says, “babysitter is coming,” might mean “I am excited for someone to arrive,” or “I don't want mom and dad to leave,” McAllister says. “It may take a bit of detective work to figure out,” she adds.

Lindsey Wachtel, a speech-language pathologist who specializes in autism at Cleveland Clinic Children's in Ohio, takes a positive approach to addressing persistent echolalia in therapy. For example, she uses a child's ability to imitate to help them develop more functional skills, such as socializing, requesting, and describing, which can lead to better communication and more satisfying interactions, she says.

She encourages parents and others involved in the child's life to recast or rephrase what their child repeats, perhaps adding words to expand vocabulary or more fully articulate what the child is conveying. For example, when a child with autism uses a certain phrase to express excitement, a parent can reply with something like, “I can see you're really excited.” Wachtel also helps children expand their modes of communication, such as using gestures. Wiznitzer agrees, saying engaging a child in some activity that requires focus can help lessen the echolalia.

Absent other concerns, echolalia, or repeating words someone else has said, can be useful in everyday conversation, says McAllister. Research suggests that people who repeat or mirror phrases or patterns of speech in conversation are considered more likeable and pleasant to speak with. She says echolalia may “even be a sign of attention and listening, perhaps because it indicates engagement in the conversation.”