The working of echolalia in the brain:
A proposal
Date: 16-12-2021
Title: The working of echolalia in the brain: A proposal
Name and student ID: Kiki Boumans – i6199324
Course coordinator: Jansma, B.
Course: PSY3373 – The Cognitive Neuroscience of Language
Faculty: Faculty of Psychology and Neuroscience (FPN)
,Boumans (2021) How echolalia works in the brain.
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by
intellectual impairments and impaired language development. A very common impairment for
children with autism is echolalia, which is defined as the repetition of utterances produced by
others. Echolalia is thought to have no purpose in language development. However, recent
findings suggest that echolalia might reflect an intention to communicate and in this way
could be a beneficial tool for children with ASD to develop alternative communication
strategies. Since there is no clear theory on the exact function of echolalia, this is a relevant
topic of research. As such, the aim of this proposal is to find out in what ways and using what
underlying mechanisms, a child with ASD engages in echolalia. In order to answer this
question, the proposal takes a deeper look into the dual-stream model of speech processing.
This proposal outlines a study population divided into three groups; (1) children with ASD
and echolalia, (2) children with ASD and without echolalia, and (3) a healthy control group.
These groups of participants will carry out three experiments after baseline measurement. The
first will be a dorsal stream localizer, which will independently measure the location of the
motor speech network in the brain. The second experiment will be a ventral stream localizer,
which will independently measure the ventral lexical-conceptual network in the brain. The
third experiment, the main experiment, will try to evoke echolalic speech in the first group to
identify what areas are active in the brain and may be involved in producing echolalia. During
all three experiments, BOLD level activations will be measured with fMRI scans. The results
from the fMRI scans will be compared with each other to find matching brain areas. Finding
out what brain areas are correlated with production of echolalia, could provide more insight in
the purpose of echolalia. Based on evidence of previous studies, it is hypothesized that there
is lower BOLD activation levels in the ventral lexical-conceptual network, which is involved
with speech comprehension, in children with echolalia compared to children without
echolalia. This would indicate that children with echolalia have more difficulties in finding
the meaning of words or phrases. The information obtained from this research may be a
helpful tool in developing better interventions and therapies for children with ASD and
echolalia.
Key words: echolalia, Autism Spectrum Disorder (ASD), language development, fMRI, dual-
stream model of speech processing.
2
, Boumans (2021) How echolalia works in the brain.
1. Introduction
Nearly 1 in 68 people suffer from autism spectrum disorder and this number increases with
time (Marlborough & Welham, 2021). This increase drives a greater demand for better
treatment and understanding of the disorder. Autism spectrum disorder (ASD) is a
neurodevelopmental disorder, characterized by functional deficits in communication and
interaction skills, and by stereotypical patterns of behaviour (Mash & Wolfe, 2018). Because
children with ASD experience these deficits, they suffer from significant difficulties in
relating to other people. One of the most characteristic deficits experienced in ASD, is
delayed language development and other language impairments. Up to 30-40% of all children
diagnosed with ASD do not develop useful language skills (Mash & Wolfe, 2018). An
example of such language impairment occurring in ASD, is echolalic speech, which entails
the repetition of words or statements, uttered by someone or something else (American
Psychiatric Association, 2013).
Until now, there is a standing belief that echolalia has no purpose in speech or language
development. This meaninglessness of echolalia has been challenged over time, and now it
becomes more and more clear that echolalia is significant in language development for both
children with autism spectrum disorder, and in the development of normal communication in
non-autistic children. Prizant and Duchan (1981) identified 7 main functions of echolalia,
including: request, turn-taking, declarative, yes-answer, self-regulatory, rehearsal, and non-
focused. Even though, they established that non-focused, rehearsal and self-regulatory
functions indicated no interaction to communicate, the greater part of these functions indicate
an intentional communicative act (specifically; turn-taking, declarative, yes-answer and
request) in both immediate and delayed echolalia. They established that the greater part of
echolalic speech was produced with significant evidence of underlying language
comprehension. Hence, they suggested that echolalia cannot just be written off as pathological
or non-communicative, but preferably should be viewed as a continuum stretching from
automatic to intentional behaviour (Prizant & Duchan, 1981).
To further challenge the meaninglessness of echolalia, it is of great importance to
critically evaluate the conditions under which children engage in echolalic speech, with a
focus on behavioural and paralinguistic features, to rule out the fact that echolalia has no
communicative value. Namely, echolalia in children with autism spectrum disorder (ASD)
appears to have specific functional qualities, which distinguishes it from other speech
stereotypies. Echo phenomena conceivably represent an active method to language
3
A proposal
Date: 16-12-2021
Title: The working of echolalia in the brain: A proposal
Name and student ID: Kiki Boumans – i6199324
Course coordinator: Jansma, B.
Course: PSY3373 – The Cognitive Neuroscience of Language
Faculty: Faculty of Psychology and Neuroscience (FPN)
,Boumans (2021) How echolalia works in the brain.
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by
intellectual impairments and impaired language development. A very common impairment for
children with autism is echolalia, which is defined as the repetition of utterances produced by
others. Echolalia is thought to have no purpose in language development. However, recent
findings suggest that echolalia might reflect an intention to communicate and in this way
could be a beneficial tool for children with ASD to develop alternative communication
strategies. Since there is no clear theory on the exact function of echolalia, this is a relevant
topic of research. As such, the aim of this proposal is to find out in what ways and using what
underlying mechanisms, a child with ASD engages in echolalia. In order to answer this
question, the proposal takes a deeper look into the dual-stream model of speech processing.
This proposal outlines a study population divided into three groups; (1) children with ASD
and echolalia, (2) children with ASD and without echolalia, and (3) a healthy control group.
These groups of participants will carry out three experiments after baseline measurement. The
first will be a dorsal stream localizer, which will independently measure the location of the
motor speech network in the brain. The second experiment will be a ventral stream localizer,
which will independently measure the ventral lexical-conceptual network in the brain. The
third experiment, the main experiment, will try to evoke echolalic speech in the first group to
identify what areas are active in the brain and may be involved in producing echolalia. During
all three experiments, BOLD level activations will be measured with fMRI scans. The results
from the fMRI scans will be compared with each other to find matching brain areas. Finding
out what brain areas are correlated with production of echolalia, could provide more insight in
the purpose of echolalia. Based on evidence of previous studies, it is hypothesized that there
is lower BOLD activation levels in the ventral lexical-conceptual network, which is involved
with speech comprehension, in children with echolalia compared to children without
echolalia. This would indicate that children with echolalia have more difficulties in finding
the meaning of words or phrases. The information obtained from this research may be a
helpful tool in developing better interventions and therapies for children with ASD and
echolalia.
Key words: echolalia, Autism Spectrum Disorder (ASD), language development, fMRI, dual-
stream model of speech processing.
2
, Boumans (2021) How echolalia works in the brain.
1. Introduction
Nearly 1 in 68 people suffer from autism spectrum disorder and this number increases with
time (Marlborough & Welham, 2021). This increase drives a greater demand for better
treatment and understanding of the disorder. Autism spectrum disorder (ASD) is a
neurodevelopmental disorder, characterized by functional deficits in communication and
interaction skills, and by stereotypical patterns of behaviour (Mash & Wolfe, 2018). Because
children with ASD experience these deficits, they suffer from significant difficulties in
relating to other people. One of the most characteristic deficits experienced in ASD, is
delayed language development and other language impairments. Up to 30-40% of all children
diagnosed with ASD do not develop useful language skills (Mash & Wolfe, 2018). An
example of such language impairment occurring in ASD, is echolalic speech, which entails
the repetition of words or statements, uttered by someone or something else (American
Psychiatric Association, 2013).
Until now, there is a standing belief that echolalia has no purpose in speech or language
development. This meaninglessness of echolalia has been challenged over time, and now it
becomes more and more clear that echolalia is significant in language development for both
children with autism spectrum disorder, and in the development of normal communication in
non-autistic children. Prizant and Duchan (1981) identified 7 main functions of echolalia,
including: request, turn-taking, declarative, yes-answer, self-regulatory, rehearsal, and non-
focused. Even though, they established that non-focused, rehearsal and self-regulatory
functions indicated no interaction to communicate, the greater part of these functions indicate
an intentional communicative act (specifically; turn-taking, declarative, yes-answer and
request) in both immediate and delayed echolalia. They established that the greater part of
echolalic speech was produced with significant evidence of underlying language
comprehension. Hence, they suggested that echolalia cannot just be written off as pathological
or non-communicative, but preferably should be viewed as a continuum stretching from
automatic to intentional behaviour (Prizant & Duchan, 1981).
To further challenge the meaninglessness of echolalia, it is of great importance to
critically evaluate the conditions under which children engage in echolalic speech, with a
focus on behavioural and paralinguistic features, to rule out the fact that echolalia has no
communicative value. Namely, echolalia in children with autism spectrum disorder (ASD)
appears to have specific functional qualities, which distinguishes it from other speech
stereotypies. Echo phenomena conceivably represent an active method to language
3
