Gestalt language

[Sunshinejoll]

Hi - I’ve been told my 6 year autistic son is a gestalt language processor. Does anyone know if normal speech and language can be acquired? I can’t seem to get any answers anywhere. There is a book by Marge blanc has anyone found this useful?

The short answer is yes - it is possible for GLPs to develop full, flexible language skills, although they will always be a GLP. This primarily means they will learn language in "chunks", but it doesn't have to stop them from developing full and flexible language.

I did the online training course based on Blanc's research - Meaningful Speech https://www.meaningfulspeech.com/ aimed at parents and professionals to help support GLP kids to develop language skills. According to Blanc and the MS resources, 6 years old is by no means "too late" to do this.

I wasn't able to get hold of Marge Blanc's book (not available in the UK last time I checked), but I found the MS resources - first on instagram and then via the training course - hugely useful. My DS is just over 4yo and it's made me completely change the way I look at his language development trajectory and what I should be doing to support him. He's still using a lot of echolalia but his original, flexible speech is increasing at a much faster rate now (almost literally every day he's piecing new original sentences together, with new communicative functions). I now feel really confident about his ability to get to full, flexible language skills, which I wasn't when he was 2yo because I just didn't know what I was looking at.

Have a look at MS's instagram content https://www.instagram.com/meaningfulspeech/, or https://www.instagram.com/bohospeechie/ another SLT specialising in GLP kids. You can glean a ton of useful info for free before considering whether to fork out for actual training.

Hi Scratchybaby - thank you so so much for this. I will definitely check this out and go on the course. Really appreciate the information.

It depends on how much you can/want to spend and to what end. I'm definitely not their sales rep lol! You can get loads of free pointers on instagram, but I did find the training course really useful as they talk about GLP language development in terms of Stages, and each Stage requires a slightly different approach to support, so there's a module for each. They also have a community message board where you can ask other parents and professionals for advice and guidance if you need it.

The MS people are actually holding their first event in the UK this summer, so hopefully more SLTs in the UK will be familiar with this as part of their offer for autistic children. From my (extremely) limited contact with an NHS SLT, she made it sound like it wasn't widespread, common practice yet.

Following with interest! Also I've already following meaningfulspeech on Instagram I saw the courses online is us dollars but wouldn't if you're able to do them in UK ?!

AndnextcomesL on insta also has a lot on gestalt language.

I'm a UK independent speech and language therapist, listed on the Meaningful Speech registry.

Marge Blanc's book wasn't available in the UK for a good while but you can get it now from Ann Arbor.

I'd recommend her website, Communication Development Center, as it has lots of info on it for free. Meaningful Speech and Bohospeechie instagram accounts are great, but obviously have to make things short and snappy so some of the detail gets lost.

There's loads more UK SLTs learning about GLP and it's honestly not as big a shift for practice here compared to the US where ABA is so prevalent. The main issue here is SLT shortage and waiting lists overall.

Some GLP children develop flexible language without any therapy, others need support. Lots of reason to be optimistic!

@NamechangedSLT That's so great to hear that this is becoming easier to find in the UK! And thanks for the tip re: Marge Blanc's book. I'd only been checking on Amazon and hadn't had any luck.

Having paid for the full Meaningful Speech course, I'd definitely agree - the instagram content is short and snappy and skims over the detail, but it's so over the top positive and encouraging (very American), which is a huge boost when you're staying up at night worrying about whether your child will ever get there! The training content has more detail, but is still pitched well for parents who aren't experts.

And yes - I found that the recommended approaches at the various stages weren't actually too much of a leap from what you'd instinctively do anyway in a normal day (if you weren't attempting ABA approaches). Key things for me were letting go of the idea that DS needs to be able to answer questions from the get go (he's not quite there yet) and stop focusing on building his vocabulary of nouns through endless flashcards and naming games and instead model flexible phrases that include verbs, adverbs and adjectives.

I am an SLT but have named changed due to confidentiality.

I think it's very important to be honest to parents and to let them decide which therapeutic route to take.

As it stands, there is no diagnostic criteria or a clear definition to indicate whether an Autistic Child is a Gestalt Language Processor or not. Where are not even there yet with typical development let alone for Autistic Children. The study done on Gestalt Language processing was noted by Prizant in the 80's and possibly earlier than that, he also claimed that it is was a useful analogy for such children but not a definitive yes or not (e.g., whether a child strictly fit in the gestalt or analytical "box"). Also all adults, and is mostly seen in younger children, process language in whole chucks. For example, when you visit a new county and first learning the new language, you may likely use phrases but not necessarily understand what each part of the words in the phrase means, also younger children my use phrase such as "Thank you, Let's go" and over time begin to understand what the individuals words mean.

To date, there is no evidence (research) on whether the Natural Language Acquisition leads to flexible language (the meaningful speech course). The intervention is intensive which may perceive to work for some Autistic children, but let's face it, the majority of children do not receive intense speech and language therapy.

If you notice an improvement with your child's speech with this therapeutic approach, then carry on doing it. But be mindful on the following;

1. If a child appears stuck on any of the stages for a considerable amount of time and are unable to progress to the subsequent stages in the approach. It may not mean that the child is not ready to progress, it could mean that the approach is useless for your child and you need to move on.

1. Be weary of SLT's who approach all there interventions in a gestalt like manner. This is lazy and does not take into account individuality approach- us SLT's like packages and it's easy to use packaged approaches in therapy (I'm being honest). But this is not ideal. Language is complex and needs to be specific and individualised.

1. If any of your children use AAC- (high tec or low tech... particularly high tec) please please please do not use these as it is in accordance to the Natural Language Acquisition. You can put phrases if you want. But it's so important to not add these phrases on the Core Vocabulary's.

More information. Take a look at this blog by Assistive aware on Gestalt language and AAC and my favourite research article by informed SLP.

www.assistiveware.com/blog/gestalt-language-processing-aac

www.theinformedslp.com/review/let-s-give-them-something-to-gestalt-about

@Scratchybaby

DS needs to be able to answer questions from the get go (he's not quite there yet) and stop focusing on building his vocabulary of nouns through endless flashcards and naming games and instead model flexible phrases that include verbs, adverbs and adjectives

Sorry you experienced this but as you clearly illustrated here. This type of language intervention is "lazy". Naming flash cards, learning about nouns is ineffective and is not the best way how to build vocabulary. You work on functional Common vocabulary used in the curriculum and/words used by the vocabulary and you clear want to stay away from nouns (which are important but not as functional as verbs, adjectives or even adverbs). There's more but what you really need is an SLT who really knows her language stuff. SLT's who specialised in Literacy are amazing but hard to find in the UK, it's more of a US thing.

I’ve been reading up on this subject recently as my daughter is also a Gestalt Language processor, I actually found a free online link to the Marge Blanc book..

https://online.flippingbook.com/view/814527865/5/

Also there is a podcast called ‘uniquely human’ by Dr Barry Prizant who is an expert in the field, he has an episode called ‘Echolalia and Unconventional Verbal behaviour’ which I just listened to and found really interesting. I’ve just ordered his book too (also called Uniquely Human) but can’t comment on that as it hasn’t arrived yet! As someone mentioned above there is loads of good info on the meaningfulspeech Instagram.

Hope some of that is helpful!

@redinthenose It's funny you mention learning a new language - learning about this GLP stuff and the NLA recommendations reminded me in some ways of the Beginners Spanish language tapes I had that focused on key verbs and pronouns in particular that could help you get by in the broadest range of circumstances, and form the building blocks for more complex Level 2 language skills.

I'd never heard of SLTs who specialise in literacy - what does that mean? We are currently in the languishing-on-waiting-lists stage of the autism journey so literally the only support DS is getting right now is what I manage to learn about and pay for myself. The NHS SLT just recommended the Hanen books over a video call and we're awaiting whenever our next appointment may be. I feel like I've found some good stuff so far (his language is absolutely progressing, but is it due to the Meaningful Speech course? And at the rate he's capable of? I don't have the expertise to know) - is an SLT who specialises in literacy appropriate for a 4yo who is, according to the NLA stages, a combo primarily of stages 2 and 3 (a mixture of breaking down and combining scripts to make new phrases, and original sentences with bad grammar)?

amazing - thank you @Amelia891 !

@Scratchybaby

A Speech and Language Therapist who specialises in Literacy basically has an additional qualification akin to your English Teacher. Not only will they work on communication and language, they will also work on book reading, narratives, phonics, literacy, grammar etc. SLT's in this area are difficult to find in the UK as Literacy is not a taught syllables in speech and language courses in the UK (we do learn about grammar, language acquisition etc but not on reading or writing). SLT's who specialise in literacy is more of a US thing.

What you do you want is an SLT who specialises in Developmental Language Disorders- they will have more knowledge on language interventions. Ask about the trainings they had etc.

I'm a bit blah when it comes to NLA stages. Personally, I don't believe in them. I think Language is very complex and Autism is such a heterogenous population. The NLA stages appears to be another way to put these children into a box- yet again.

To support flexible language. I would really consider looking into high tec AAC and just model model model model model. The best videos are on the Assistive ware website (just Google) and they have a few relative cheap training videos for parents. The SLT who carries out the trainings and is mainly shown in the video is AMAZING. Some children do not get on with high tec aac devices, but it appears to be a success with my echolalia children

@Scratchybaby I've also been reading a book on declarative language which promoted me to looking into relationship development training- but that's more for interaction and soc comm and don't know much about it to comment further. I think we greatly lack in our interventions with children on the spectrum,

@Sunshinejoll no problem. I’m seriously considering doing the course as well.

@Scratchybaby was there a lot of info in the course that isn’t included on their Instagram? My DD attends a specialist school and has a great SALT who seems to know her stuff about Gestalt but obviously I want to do what I can to support her at home as well. You definitely feel it was worth it for the price?

Hi all - I have been reading your replies with interest following my original post. I must admit that I am not sure about gestalt language and have wondered if this word is pretty meaningless when it comes to an individual because how do you truly know? I taught my son how to speak during lockdown breaking down words and gradually increasing them. He can now put his own sentences together in function, to share something interesting and can answer a few questions. Our SLT said he was a gestalt language processor but did not seem to have any more info to give me hence my post. Our paediatrician said he should acquire flexible language as he gets older but honestly who knows. I will keep on modelling language in the hope this helps him make progress.

OP it's a journey and apologies if I caused any doubts. But I just wanted to be honest. When I started my career in SLT I thought I knew everything and was doing what the majority of my colleagues were doing. However, I became a bit perplexed as to why some of the children I was working with weren't progressing in therapy or were making very little progress. I will speak to senior SLT's and some attributed it to the therapy techniques or approaches I was using but most attributed it to the child's diagnosis's. But it wasn't enough for me and I decided to go back to the books, it was only when I read research is when I started to see changes. I'm not a hard ' I only practice evidence base' because as you know it takes a lot of money to start research projects and it's not every child that you can say 'oh we are going to do it exactly what it says in the book'- its all about monitoring and adapting therapy.

There are many good SLT's that I look up to when it comes to SLt practice. There's one SLT named Tatyana Elleseff who has many received webinars/ trainings on how to approach language, supporting social communication and she has a very good blog posts which I always readily refer to if I get stuck: www.smartspeechtherapy.com/about/elleseff-t_lt/

There's also Caroline Mussewhite who is amazing @AAC and Literacy.

I'm going to leave the thread now but anyway questions, please do not hesitate to ask me. I may not know all the answers but I'll try my best.

I don't know if it's helpful to add any more here, or if it will just muddy the waters, so apologies if it does!

@redinthenose while I agree with some of what you said there's quite a lot I would dispute.

It's such a shame that a description of autistic children's language has become something people declare a "belief" in (or not). I've been practising for over 20 years and am a pretty sceptical person - if anything I overthink. In my work I regularly ask myself "what if I'm wrong?" (about a diagnosis, therapy approach, etc) and always come back to "first do no harm".

GLP is just a descriptive label, not a diagnosis. NLA is a framework, not a package or programme. Unfortunately a lot of the content on social media about GLP is over-simplified, and maybe gives the impression its all about scripting and phrases. I'm not sure why anyone would describe NLA as intensive.

I maybe shouldn't have posted this evening as I doubt I've made much sense (post-migraine fuzzy head). But I just wanted to pop back up and say that just because a therapist finds NLA a valuable therapy framework that doesn't make them gullible, stupid, inexperienced, money-grabbing or a sheep (all things I've seen here and in other places online)

GLP as a concept has resonated with many parents because it fits with what they see in their child, and values their child's natural communication. If everyone starts jumping in with NLA for every child they meet, that could be harmful, but it would also risk harm if SLTs disregard it out of hand without a good understanding of it.

Uniquely Human is a great book. The declarative language handbook and its companion the co-regulation handbook are also good. They aren’t for language development, they are based on the RDI approach.

@NamechangedSLT

With all due respect. You may have worked in the realm of SLT for over 20 years but it does not mean that you read the evidence base.

Diagnostic/descriptive/labels does the wording really matter? They pretty much all mean the same thing. My point still stands that Autistic Children who use echolalia are automatically assumed to be a Gestalt language processor. How can we be so sure since Gestalt language processing has very little research behind it? Why do children have to 'fit' in that box solely? Can't they also 'fit' within the analytical box- or be a combination of the two? Why label it anyway? In Marg Blanc'a book the assessment procedures to determine whether a child is a Gestalt language processor is very informal, and loosely based. Not only that, are therapists really carrying out the "assessment procedures" stated in Marg Blanc's to determine whether a child's a Gestalt language processor? Not many I don't think. I am reading reports that the child is Gestalt language processor only because they use echolalia some of the time.

I believe there are gestalt and analytical language or processors but the latter processing has very little research and hence I'm uncomfortable using it to describe some of my children as present. But! There are a few aspects of it that I am willing to adopt in my practice.

I also deem a 'packaged intervention' as any intervention which requires a child to go through stages before progressing onto next stage. The NLA framework, as it currently is, has no evidence base. Zilch. The NLA stages is derived from the work of Prizant but the Natural Language Acquisition Approach to therapy has no evidence base behind it.

I don't think therapists who use the above approach are money grabbing, inexperienced :s I just don't think most are honest with parents about the lack of research behind the approach and letting parents take the informed decision to take on this approach. Also, as a profession, we are just not good at (not only conducting research) but poor at implementing evidence based practice, poor at reading research and being confident to analyse research articles and I'm sorry but it shows! A lot.

Don't really want to digress. We all have different point of views. The ultimate aim is the child and knowing what works.

@redinthenose Diagnosis and description are very different things. I doubt any SLT can honestly claim to have read all related research. I also think ignoring two of the three pillars of EBP (very much Tatyana Elleseff's way of thinking) is doing a huge disservice to our clients.

I can't speak for any SLT other than myself, but I am honest with the families I work with. I don't think it's fair for you to assume otherwise.

Thanks for engaging with the issue, happy to leave it there.

Forgot to say.

The reason why the GLP has resonated with many parents is because it is the first time that a book or an approach has really celebrated and delved deeper into the unique characteristics of children on the spectrum (aka echolalia). As a whole, Autism literature has mostly been negative but the NLA approach/ framework and GLP is really applauded in Blanc's book. This is amazing! When parents are worried about their child's echolalia, I praise this as their child has been able to pick up language and imitate it!
Also, Marg Blancs observations of children who use echolalia is very interesting and I'm sure is spot on.

But do I feel because of all the above, that I feel comfortable labelling children as Gestalt language processor. No. Do I feel comfortable implementing a therapeutic framework/ approach that has not current evidence base behind it. No. Why? The reason why is because when parents tell me that they have adopted the NLA framework and question why it does not appear to be working. I mean- what do I say to that?Just carrying on in stage 1, 2, 3- could I really alleviate the parent's concerns and tell them to keep going! Morally, I cannot. My gut instinct will just be to start from scratch and try something all together.

That is my two cence on the subject. Looking forward to any more research in this area but as of now, I will not be adopting the Natural Language Acquisition approach in my therapy.

@NamechangedSLT

I clearly stated in my first post that if a clinician or parent has seen the approach working for their children. They they should carry on! No doubt. All of our children our different and do not always fit to what we read in text books.

I can appreciate that we may not agree to the views of every clinician but I respect their contribution to their field. I highlighted Tatyana's work because she is amazing at Language therapy and looking at the evidence base. There's also another SLT named Dr Natalie (forgot her name now) who is also amazing in this area. I also respect Mary's blanc work in the field. But not confident to use it.

You may find this useful if not already discovered...https://communicationdevelopmentcenter.com/?fbclid=IwAR0mhkF3mbj0SvNQtjuv_RjyregzZzdYVpqumnd7e0n5pkzhRHcWcfsVLHI

@redredinthenose I read this previously having been on a waiting list for a Gestalt slt. We were so excited and felt we'd found someone who understood and could help. The sessions were entirely child led and then languaged analysed afterwards. Of course lo didn't speak because it was child led, there was a shed load of various toys on the floor and he was overwhelmed. I raised this with the slt who advised me this was how sessions would work but I honestly felt a little let down
The cost was also huge, imo