Complex tics related to speech include coprolalia, echolalia and palilalia. Klazomania is similar to other complex tics including echolalia, palilalia and coprolalia. With more severe impairment there may be echolalia or mutism. Mitigated echolalia can be seen in dyspraxia and aphasia of speech. Examples of mitigated echolalia are pronoun changes or syntax corrections. Vocal repetition can be done immediately as in speech shadowing and echolalia. Palilalia must be differentiated from other complex tic disorders (such as echolalia), stuttering, and logoclonia. Their language may develop using echolalia, often repeating words and sentences. Moreover, such vocal imitation can occur without comprehension such as in speech shadowing and echolalia. An oculogyric spasm then developed, during which he demonstrated echolalia. In mitigated echolalia some language processing is occurring. Echolalia may be an immediate reaction to a stimulus or may be delayed. The person may repeat questions rather than answer them ("echolalia"). During the explorations of the house, Daisy is described as suffering from echolalia. Echolalia can be the result of left hemisphere damage.