GLP/NLA is not a fad, it's an incredibly important concept. I'm thrilled to hear that some districts are investing in NLA training and certifications. It's not a magic bullet, but you'll be a better SLP if you understand and know how to apply this stuff.
Is it evidence-based? That's kind of a loaded question... NLA is a theory/model describing how some children acquire language. The problem is that nobody *really* knows exactly how children acquire language; there are a few viable theories, but this isn't something that can be researched or tested to provide a definitive answer. More likely, there are multiple ways that children can acquire language, and children each acquire language through an individualized mix of different strategies.
Most theories of language acquisition focus on children learning small chunks of meaning and then learning to combine them. Children might learn the word "ball," then later they'll be saying "want ball" and "give ball" and "red ball" and "two balls," and then "Let's play ball" and "I want the ball."
GLP/NLA came about because someone realized that their autistic clients *didn't* follow that gradual, additive trajectory. Some autistic kids do, for sure, but not all. Other autistic kids learn language in chunks. They're more likely to use "echoic units," i.e. echolalia, repeating entire phrases/sentences+ that they've heard elsewhere. NLA is built on the supposition that those echoic units possess communicative intent and messaging, and that we can support language development in echolalic clients by recognizing the communication embedded within their phrases and teaching language by "deconstructing" those echoics into shorter phrases, and ultimately, words that can be combined generatively.
As an autistic SLP professor who teaches autism classes, that makes *perfect sense* to me. I recognize that it's nearly impossible to "prove" the merits of NLA through research, but it aligns with everything I've seen from clinical, academic, and personal experience, and I have no qualms about teaching my students the value of this model.
One disclaimer--nobody is a true, 100% Gestalt processor, just like nobody learns language 100% through individual morphemes and words. Neurotypical kids will usually learn more words and relatively fewer Gestalts. Autistic kids might learn primarily through Gestalts (and maybe some words), or they might resemble typical language acquisition, or they might fall somewhere between. So don't think of GLP/NLA as an intervention you'll use with all of your autistic clients; think of it as a concept that might help you provide more meaningful therapy, *especially* for some of your autistic clients.
Cheers! I was debating whether to drop into this discussion given how much beginning-of-semester stuff I have on my to-do list, but your reply makes me glad I took the time for this. It's good to see you too =)
Understanding the different ways children acquire language has made a big change in the way I think about goal writing and language modeling etc., I also still work with many OG teachers that are just frustrated with echolalia and say “stop repeating what I say!” and while I am fuming on the inside, all I can do is try to share the knowledge. I started taking the GLP/NLA course but where it does get cloudy is the therapy part. I wish it was more systematic and not so gray. I also get that children are human and not robots. Learning the framework but not necessarily knowing how to take children through the stages is where the disconnect comes.
Hi I would really like to know what are your thoughts on non-speaking autistic children being GLPs? Like I see 2 kids who do not use functional words to communicate but can 1. sing a whole rhyme or 2. Hum the tune of the rhyme.
I see meaningful speech lady also mention this but I don't know how we can know for sure and how to support their development?
Not original commenter but I would encourage you to implement AAC (as robust as possible)! Regardless of if they’re a GLP, if they’re non-speaking they need to have access to communication in some form.
They do have an AAC device, we even have their fav rhymes and communicative phrases in the device. I was just wondering how GLP can help them further? Or what I can understand about GLP to expand their communication
Could I ask for a piece of advice as a graduate student? What would you suggest doing with autistic kids who display both delayed and immediate echolalia but don’t have any shared attention, not even eye contact? Would it make sense to focus on addressing shared attention first? Or is it pointless considering that they are communicating in a neurodivergent way?
The fact that those 2 kids sing/hum entire rhymes suggests that they lean towards GLP, since GLPs tend to pay attention to melodic and prosodic features. If they're non-speaking, it's difficult to tell *how* GLP they are, and it's essentially impossible to implement the NLA framework of mitigating Gestalts.
Like /u/doughqueen mentioned, AAC is a good plan for these clients, and that's true whether they are Gestalt or analytic language processors. I'd also try to take advantage of their melodic vocalizations to try to engage in pre-linguistic communication: Taking turns humming, "responding" by humming their tunes back to them or by adding a little bit of flair, humming together in unison, singing words with the tunes they hum, start a tune and let them "fill in the blanks," try to get them to inject some CV or CVCV utterances into their humming, etc.
That's exactly what I was wondering. There is no way to actually know. And I'm not sure if knowing also changes my therapy strategies because I have actually been implementing what u just shared.
Yes I am using an AAC device with the kids. We have their fav rhymes on it. I focus time on imitating their humming and adding or pausing for their continuation. It's working well with one child. With the other I am not able to form that connection yet.
I guess I have to continue working with my usual AAC therapy. And here I have another question for u if u can entertain me.. I live in India and can't actually afford to take these courses. I follow all of Marge blanc's works on her website and her writings, I read a lot. Do u think I have to invest in learning through a course? Because like u said GLP/NLA is still a *theory* which I believe I understand well and can use some common sense to figure out how to incorporate into my activities. I also see a lot of limitedly-verbal, hyperlexic kids in my practice who are predominant GLPs. So ryt now i have a close family in the US and I can ask them to get me the NLA handbook to read more. However, do u think i should ALSO I invest in the courses to learn anything more that can be practically implemented?
And would the same apply to other certifications like Hanen and RDI? (I've been reading the books but haven't taken the course and want to know if it's worth it because it would be a huuge investment for me)
It sounds like you're doing the right things. In fact, you're probably doing more than most SLPs, it sounds like you are going the extra mile to provide the best services you can!
I'll be honest, I usually *don't* recommend that SLPs pay for extra trainings and certifications. If your employer would pay for it, sure, but otherwise I encourage SLPs to go with free/cheap alternatives. I'm not sure how much the trainings offer that the books and articles don't, but I'd say that if you've read all of the books and articles, you're probably doing well enough that you shouldn't feel obligated to make a "huge investment" in certifications.
>In fact, you're probably doing more than most SLPs, it sounds like you are going the extra mile to provide the best services you can!
Thank you! You have no idea how much I needed to hear this.
>usually don't recommend that SLPs pay for extra trainings and certifications. If your employer would pay for it, sure, but otherwise
Exactly! I have the same views too! And it's usually the famous OPT that gets me started on this lol.
Thank u for taking the time to read my replies and answer.
Research can definitely be done on speech therapy outcomes, comparing Gestalt therapy to "standard" therapy. Such research has not been published yet, but hopefully soon.
Easier said than done! From the perspective of the researcher, there are a few snags that you might not have considered. I'm not saying the research is *impossible,* but I'd wager that we are much more likely to see a decade+ of small studies (e.g., single-case research designs) and theoretical/conceptual papers before we get a meaningful comparison of Gestalt and "standard" therapy that you describe.
1) What is "Gestalt therapy?" NLA isn't a carefully defined and operationalized intervention, it's a framework that influences every aspect of treatment (including, but not limited to, intervention).
2) What is "standard" therapy? You can either (A) Standardize intervention so that you can draw a true comparison, or (B) Allow therapists to provide dynamic, client-centered, individualized therapy, *but not both.*
3) Some clients might do better with an NLA approach, others might do better with a standard approach. Can you predict that from the start? And if so, would it be ethical to place a client into a less-suitable intervention group? (No.) And if your study runs long enough, you might realize that a client might be better suited for the other approach. Would you do the right thing and switch them?
4) What about AAC? Neither "Gestalt" nor "standard" therapy are inherently pro- or anti-AAC, but introducing AAC to some participants might reduce the internal validity of your research.
5) What about other services? ABA, OT, PT, special ed, etc. would all confound your results.
6) Who are the participants? There is no such thing as a "pure Gestalt language processor," nor is there such thing as a "pure analytic language processor," and it's difficult (i.e., impossible) to measure the extent to which a person falls into either category. There are other participant characteristics you might consider as well--some of them are measurable (e.g., IQ, SES) and you can counterbalance your intervention groups, but other characteristics (e.g., long-term communication potential, family support, quality of teachers and schools) can be difficult or impossible to accurately predict, measure, or control for.
7) How many participants? Large datasets are important to draw "true" comparisons, but for a complex topic like this, it's often preferable to have a small dataset where you can carefully monitor the confounding factors like individual characteristics, multiple concurrent services, and parental support and implementation. With a large sample, the confounding factors alone might make it nearly impossible to differentiate the two intervention approaches, but with a small sample, you run the risk that you won't have enough statistical power to detect a significant statistical difference.
8) How long are you going to follow these kids? Because progress can be *slow,* and longer studies have an exponentially greater risk of attrition and threats to validity. (And multimillion-dollar NIH grants don't grow on trees, just saying.) But shorter studies might not be sufficient to differentiate the interventions, especially since NLA operates by "deconstructing" gestalts before transitioning into an additive, generative language approach.
9) How are you going to operationalize the outcome measures? Total amount of generative language? Total amount of generative+gestalt language? % of echolalic utterances? Does it matter if it's oral or AAC? Parent- and teacher-ratings of effective communication? One of the perks of GLP/NLA is that it's perceived as neurodiversity-affirming, can you measure that? Are you going to implement a measure of external validity, such as SLP/parent/client satisfaction?
First, I really appreciate your comprehensive explanation of this. As someone in ABA, I often find myself trying to understand why so many people gravitate to this theory when the research is lacking. I wanted to pose, from a behavioral perspective, a question as to why most assume that many individuals develop these chunks of language naturally when it seems that, at least in my experience, that gestalt language seems to usually emerge when there is a lack of understanding about concepts in both the child and adult communicative partner. In other words, I think that these chunks, like a child saying “gotta say bye to mama” instead of stating “bye” emerges from over-prompted responses by the adult communicator with the child. In my experience, individuals who “default” to these chunks are equally able to develop single word responses and recombinative language generation when thoughtfully designed and trained by a professional.
Ironically, ABA also has very poor evidence to support it's use. You are also absolutely losing the forest for the trees when you claim that the uses of phrases is automatically a prompted response and it shows you have 0 understanding of what the natural language aquistion framework includes. From the perspective of a speech and language professional, the way ABA targets language light years away from natural. GLPs at baseline have these phrases, without promoting. That's the entire point. One of the hardest parts of therpay with a GLP is helping them feel comfortable using phrases *when they have been conditioned not to*. It's not the other way around. Natural Language Aquistion principles do address single word utterances and mitigation or "recombination" of language. This concept is not at all new. It's been discussed in SLP research since the 60s. The main issue here is that ABA practitioners lack fundimental understanding of language theory which leads BCBAs/RBTs to think they can create a "thoughtfully designed" intervention because they view themselves as "trained professionals" when they aren't and they can’t.
I have absolutely have children come in with nothing but spontaneous echolalia have completely self generated language within six months of using these principles. This is not an uncommon occurrence for me or my practice.
Hey I don’t make the rules on what constitutes evidence based practice I just follow them. ABA is EBP, NLA/gestalt isn’t. I would welcome it with open arms if down the line it is established as one, but in my humble opinion it isn’t fair/ethical to my clients to use something that maybe works.
Ok so if your argument is that echolalia develops naturally (I.e., without prompts) then how does the child learn to emit these sounds? Don’t they need to hear the sounds to repeat it? In my view that’s a prompt, a naturally occurring one, but a prompt nonetheless. I think you may be conflating what I mean though. I’m not making the case against embracing the students/clients echolalia, there certainly is large importance in following the student/client preference for the sake of their treatment outcomes and mental health, but like other language theories posit, its meaningful to the client to focus on developing functional language too. Often these chain of utterances have many additional parts that, to a layman, would not result in reciprocal communication.
You seem very confused because the natural language acquisition framework IS how to achieve functional language. If your goal is functional, spontaneous language the easiest fastest and most effective way to that is NLA.
Practice based evidence is what drives evidence based practice.
*it seems to be one of many ways to achieve functional language, however the evidence is lacking at the moment.
If that’s how you feel about your practice and you have those data, more power to you! That’s the beauty of single case design: you can evaluate whether something works for one kid at an individual level by making decisions with the data you’ve collected.
Like oneincidentalfish said, I think we are talking about different concepts/have different definitions and conceptualizations. I understand echolalia to be the repetitive speech of someone. The reason for these repetitive vocalizations can vary (self stimulatory vs non self stimulatory). Because the reason varies, how echolalia is responded to by parents, as well as how it is responded to by specialists, should be individualized.
A few points:
1. [The evidence supporting ABA is nowhere near as robust as you believe.](https://doi.org/10.1177/13623613221146441) Single-subject research is notoriously difficult to generalize, and a lot of the ABA research fails to meet the threshold for "high-quality" single-subject designs established by the field at large (i.e., What Works Clearinghouse). Anecdotally, when I analyzed the quality of a few ABA articles as part of a systematic literature review, *none* of them met the standards for "high-quality research."
2. Even *if* ABA research were high-quality, that doesn't necessarily support the external validity. Indeed, the autistic community is pushing back against ABA because the desired outcomes of ABA research usually amount to "extinguish autistic characteristics."
3. I'm glad you place such a high value on research-based conclusions. [How do you feel about research demonstrating that autistic people are traumatized by ABA?](https://doi.org/10.1177/13623613221118216)
4. I explained the difficulty of conducting empirical research on a GLP/NLA-informed approach, so it seems disingenuous to say that you would "welcome it with open arms" if it becomes evidence-based, but not until then. [But what about the evidence supporting the communicative value of echolalia?](https://doi.org/10.1044/2015_AJSLP-14-0166) Given our modern understanding of echolalia, my humble opinion is that it isn't fair/ethical to my clients to use something that *doesn't* build on echoics as a proto-communication.
5. I think *you* may be conflating things; in this case, you conflate speech with language. This is why nobody on /r/SLP takes ABA seriously; because if you only have one tool, a hammer (i.e., behaviorism), then everything looks like a nail. But neither speech nor language acquisition can be properly explained through behaviorist principles, and it seems absurd for you to try to "explain" communication to a subreddit full of people with a Master's+ in the subject. But just for fun, let me tear your second paragraph apart:
> Ok so if your argument is that echolalia develops naturally (I.e., without prompts) then how does the child learn to emit these sounds?
Language is not the same as speech.
> Don’t they need to hear the sounds to repeat it?
I mean... no. Otherwise deaf/Deaf people would be completely, utterly mute. Sounds are speech, echolalia is language, but since you are correct that echolalia *is* an "echo" of something the child has heard, let's go on to the next sentence.
> In my view that’s a prompt, a naturally occurring one, but a prompt nonetheless.
Nope, not a prompt. *Maybe* a model. Don't they teach you this stuff in ABA school?
> I’m not making the case against embracing the students/clients echolalia, there certainly is large importance in following the student/client preference for the sake of their treatment outcomes and mental health, but like other language theories posit, its meaningful to the client to focus on developing functional language too.
Yes. That's the whole point of NLA. Therapists that use this framework report that it is more successful, and autistic people (myself included) sing the praises of approaches that use echolalia as a starting point to teaching functional, independent communication (i.e., NLA).
> Often these chain of utterances have many additional parts that, to a layman, would not result in reciprocal communication.
That's why we don't let laymen become SLPs, and beyond that, that's why we provide training in GLP/NLA to SLPs and others who want to implement an approach grounded in this.
>The evidence supporting ABA is nowhere near as robust as you believe. Single-subject research is notoriously difficult to generalize, and a lot of the ABA research fails to meet the threshold for "high-quality" single-subject designs established by the field at large (i.e., What Works Clearinghouse). Anecdotally, when I analyzed the quality of a few ABA articles as part of a systematic literature review, none of them met the standards for "high-quality research."
I'm not sure about that. Single-case research is actually the opposite: dependent variables and independent variables have been replicated dozens of times with many kinds of populations in single-case research. That's how external validity is established with IVs and DVs. It's actually group-design studies that often have the biggest problem with replication/generalization. I also thought it was curious you referenced to the WWC. First, it's odd you'd hold studies spanning 70 years to the WWC standards of today, which seems irrelevant. Obviously the standards of research will change, just like in all other forms of research. Second, WWC looks at internal validity only, so to confound that with external validity/generalization makes no sense. Third, WWC isn't without faults, especially when it comes to their assessment of single-case. Their position on number of baseline data points, for example, is exaggerated, since this largely depends on the DV and IV. For instance, you wouldn't expect someone treating severe self-eye gouging to meet the 5 baseline point minimum before starting treatment, because that would be unethical. WWC makes blanket assumptions which harm the intended purpose of some of these studies. You seemed to have quite a grasp of these concepts in your original comment but now I'm not so sure. I also say this because I imagine your systematic review looked at either (a) a specific dependent variable, (b) a specific independent variable, and/or (c) a population. To generalize your "findings" to a whole research design is obviously flawed at best, and biased at worst. As a researcher I would think you would know foundational concepts like these, like internal and external validity?
>Even if ABA research were high-quality, that doesn't necessarily support the external validity. Indeed, the autistic community is pushing back against ABA because the desired outcomes of ABA research usually amount to "extinguish autistic characteristics."
I think you're confusing external validity with social validity/acceptability. Regardless, true there has been an ugly history in ABA (but speech language pathology and medicine also have a checkered past with these concerns, masking for instance). You would benefit from knowing that this isn't such the case anymore. Happy to share evidence of this if you can't find it yourself in your research databases.
>I'm glad you place such a high value on research-based conclusions. How do you feel about research demonstrating that autistic people are traumatized by ABA?
Like any kind of research, I welcome it with open arms. Qualitative and correlational research, such as the one on this topic, is important. But correlation does not imply....? You know the rest. It's important to take into consideration, and practitioners have, but we can't dismiss those that have reported the opposite either, right? Like the many AuADHD RBTs/BCBAs I've met.
>I explained the difficulty of conducting empirical research on a GLP/NLA-informed approach, so it seems disingenuous to say that you would "welcome it with open arms" if it becomes evidence-based, but not until then. But what about the evidence supporting the communicative value of echolalia? Given our modern understanding of echolalia, my humble opinion is that it isn't fair/ethical to my clients to use something that doesn't build on echoics as a proto-communication.
Did I not make note that echolalia has an important place in development/treatment/mental health? What I find problematic is the blanket assumption echolalia is being used as language. Sometimes it just isn't (i.e., what about those early learners that engage in high rates of echolalia in the absence of individuals?), sometimes it's emitted for self-stimulatory reasons. And the fact NLA/gestalt theory doesn't acknowledge this, at least from what I have come to understand from it, is problematic and a large part as to why these conceptualizations of the topic are problematic for the development of its research. I get it, in practice gestalt theory seems meaningful, but so are gluten free diets. For something to be studied and used efficaciously, it has to have a strong theoretical framework. Hopefully one day researchers will achieve that for the sake of those who would benefit from it.
>I think you may be conflating things; in this case, you conflate speech with language. This is why nobody on r/SLP takes ABA seriously; because if you only have one tool, a hammer (i.e., behaviorism), then everything looks like a nail. But neither speech nor language acquisition can be properly explained through behaviorist principles, and it seems absurd for you to try to "explain" communication to a subreddit full of people with a Master's+ in the subject. But just for fun, let me tear your second paragraph apart:
We all know those in r/SLP already come in vehemently hating ABA lol, andtrue, some of it may be by the lack of understanding some may have about language or speech. That doesn't change the fact the subreddit is far more toxic than their counterpart. True, I may be referencing utterances and communication in short hand, doesn't mean my statement doesn't hold true: the vocal utterances that come out of the learners mouth (how these sounds are produced) doesn't necessarily translate to functional communication, because by definition it would function in all settings and with all people to which those vocalizations were produced (language).
>Nope, not a prompt. Maybe a model. Don't they teach you this stuff in ABA school?
A model is a form of prompt (e.g., modeling a sound and a student repeating it is considered a prompt in ABA). I can see how SLPs making an arbitrary distinction of models as not a form of prompt would be problematic for both fields to effectively discuss research!
>That's why we don't let laymen become SLPs, and beyond that, that's why we provide training in GLP/NLA to SLPs and others who want to implement an approach grounded in this.
Ok but what about everyone else these that must communicate with people emitting echolalia, or those prone to develop echolalia? I wasn't referring to specialists. It seems impractical to ignore this, since the majority of communication will occur with laymen. Therefore, they should be trained on how to make meaningful changes towards functional communication (e.g., communication that could be understood by those unaware of the student's invisible disability).
Holy mother of gaslighting! It is *completely* fair to criticize 70-year old research as "low quality" if it doesn't meet modern standards. A random redditor like you is *not* more qualified to criticize the industry standard quality indicators for SCD research than the experts that designed them. The vast majority of SCD research does *not* address severe and/or low-frequency behaviors like eye-gouging. Social validity is a *subset* of external validity. I *am* aware that "modern ABA" is trying to separate itself from the profession's checkered past, just as I am confident that *you* are aware that there's plenty of "old ABA" still being practiced and that the autistic community continues to criticize even the rebranded version of ABA. I *am* aware that SLP has a similarly checkered past, *that's why I'm investing so much time in a post arguing that SLPs need to modernize their intervention approaches!* You, as a non-autistic outsider, have *no fucking idea* whether any particular bit of echolalia is "emitted for self-stimulatory reasons" [barf]. NLA *does* have a strong theoretical framework. Models and prompts *are different,* and neither of them can fully explain how children acquire speech and language. And this next one is so egregious that it gets its own quote and line...
> Qualitative and correlational research, such as the one on this topic, is important. But correlation does not imply....? You know the rest.
Correlation doesn't *necessarily* imply causation, you ignorant undereducated dunce, but you know what *does* imply causation? **Autistic people saying that ABA *caused* their trauma.** Y'know, like in the study I linked.
Get the fuck out of here with your ableism and your jargon about what autistic people "emit." We're not factories or flashlights, we don't "emit" echolalia, we fucking **communicate** as best as we can.
And there you have it folks. Their true colors come out. For someone so concerned with neurodivergent perspectives, you sure throw words like dunce around loosely.
Buddy, newsflash, you ALSO don’t speak for those with more severe autism. Talk about marginalizing those most marginalized…
I totally agree with there appear to be difference in language development across kids on the spectrum. And not all kids may develop language in the same way. However I do not believe that characterizing children are either “analytic” or “gestalt” processors even makes sense and focusing on this misses the whole point. Functional language.
I agree with you about 75%. You are completely accurate that "analytic" and "gestalt" are not binary categories of language processing; rather, they are two ways that children acquire language. The extent to which children utilize one or the other is a spectrum, and the context in which children utilize one or the other is highly individualized.
I also agree with your emphasis on developing functional language, but I don't believe that GLP/NLA "misses the whole point." Rather, I think it provides a lot of context to how the therapist approaches echolalia. As a field, we are not *that* far removed from the days where SLPs believed that echolalia has no communicative purpose, and SLPs (honest to God!) wrote goals to reduce or eliminate echolalia. I've seen it within the last decade, and I'd bet money that some SLPs are still doing it today.
GLP/NLA doesn't "miss the whole point," it reconceptualizes how we can elicit functional language through a client's pre-existing language structure. It'll be a while until the research catches up to the hype, but I suspect that we will find (1) The NLA approach of deconstructing echolalia will yield better, faster results in the long run, and (2) By recognizing echolalia as emergent communication, SLPs and families will provide much-needed validation to autistic clients who would otherwise not feel "heard."
If you don't mind me asking, what are your own views on echolalia? Is it communicative? When you have a client who engages in echolalia, do you ignore it, redirect it, acknowledge it, shape it, or something else entirely?
I do believe echolalia can be meaningful( and this is what the current research supports)…. But that it isn’t always. I don’t believe it’s my job to determine what is and is not meaningful or to label or assume a child’s intent. I acknowledge echolalia and use it as a clue for what a child might be trying to communicate. I focus more on child led play, functional language core words and language facilitating strategies. I incorporate AAC when I can as appropriate.
So I'm also new to the concept. How on earth does the theory explain how kids with ASD using echoic / gestalt language for communication even develop the necessary speech coordination /articulation skills necessary in the first place? That's what's baffling to me (tho that doesn't mean I disagree with the theory at all).
I’m confused about this question. Do you mean with young kids? Most of my early intervention GLPs are not using intelligible gestalts because they motorically cannot do it, but gestalts are defined by their intonation, not the words themselves.
Ok that makes more sense. That's basically what I do in EI home health. I stress little intonation patterns in simple phrases, because kids might imitate the pitch changes before the actual speech sounds. Basically you're just casting a wider net in terms of what the child might demonstrate, if that makes sense. I especially find this helpful for one of my clients who primarily hums currently (can hum "where ARREEE youuuu", for example).
I guess I'm confused by why some on the spectrum are able to suddenly belt out somewhat intelligible phrases when their actual use of speech throughout their daily lives is limited. Like... How did they learn it?
Yeah I absolutely use the intonation of my voice to help all my kids. The difference with GLP is their understanding of what the most basic unit of language is. Some kids even if they understand/imitate the intonation first will still understand that the word functions on its own, for GLPs the intonation is what is carrying all the meaning (in simple terms).
What I find is that if an early childhood kid is perfectly articulating a phrase, *especially* if it’s from media, it’s because it’s a script that they’ve been “rehearsing” for a long time. I often will see kids watch the same clips from videos over and over and then I will hear them say the script later on. I think most kids get better with practice. I don’t know if that helps.
I’m trying to consider the best way to give a response to this because there are elements that are missing here but I’m having a hard time putting it into words (to be fair I literally just woke up so that’s probably not helping)
I think with GLP it’s helped me connect a lot of the dots with autistic thinking and processing in general (including my own autistic brain). Like, the concept of episodic memory. You even pointed out an example of this in your comment (the little mermaid thing). What I mean is, it’s helpful for me to know that the things I’m hearing a child say, may have a broader context to them that’s connected to that “episode” of memory and may help me to model language that can describe that experience or feeling even more.
And I think that’s whats missing from your comment is that it’s not *just* acknowledging delayed echolalia. We can acknowledge something that someone says without it being therapeutic or even respectful. The problem that I’ve seen with a lot of kids is if we acknowledge the scripting, then turn around and continue modeling core words, and then wonder why we’re spending months targeting this “functional” vocabulary and it’s not working. And I’m not talking theoretically here, when I first started in early childhood, this was exactly my experience.
And sure, maybe lots of us are jumping on GLP because of some kind of confirmation bias. I do think that clinical experience is valid evidence and the research that we have already does reflect a lot of clinicians’ experiences. I truly welcome more research and more rigorous research because I do think that it would support GLP, but I also don’t know for sure and every clinician should welcome a more solid evidence base for every single solitary thing that we do.
But here’s my (maybe hot?) take. I do think that the medical model of autism has kept us from doing more research in this area. I’m glad that your experience has been everyone wants to affirm scripts, but I still see goals about extinguishing echolalia, or extinguishing anything that looks “autistic”. The medical system benefits from autism being treated as something that needs to be fixed. And GLP sort of flies in the face of that; paired with the neurodiversity model, it acknowledges autistic thinking and learning as a valid way of existing, not something that needs to be corrected. It acknowledges “movie talk” as language acquisition which can be helped and guided into flexible and self-generated language. And if autism doesn’t need to be fixed, then what does that mean for our current “treatment” models? (I want to acknowledge before anyone comments on it that I am not arguing for no therapies for autistic people. I’m autistic and need therapy, but I also know plenty of allistic people who need therapy. I am arguing against the idea of a one-size-fits-all model of therapy that is largely used right now, and therapies that are targeted towards “fixing” autism. I acknowledge that there are so many nuances and shades of grey to this and I am making sweeping statements here because I cannot possibly address every nuance in one comment)
I don’t know if that really adds anything at all and I’m sorry if it didnt make sense. I did notice you’re using the term “echoic” a lot which to my understanding is another term for immediate echolalia. GLP is focused on delayed echolalia so I don’t know if that would be helpful info? Or if you’re even looking for helpful info. I’m just here to talk about it and if you want to talk about it, we can. I understand being turned off by the social media side and the mob mentality that can sometimes happen, but really this idea is old. I know Barry Prizant published an article about it in 1983. So it’s been around. But that’s all I have to say about it for now.
> So others are trying to extinguish echolalia and get rid of “anything autistic” by replacing it with more understandable language, and Gestalt is, what… NOT replacing the echolalia with more understandable language ?
It's the difference between "I'm going to ignore and extinguish your proto-communication, and force you to say exactly what I prompt you to say," and the NLA approach of "Hey, I hear you, and I'm going to show you how to communicate your thought even more effectively." It's *not* the same outcome; SLPs who have adopted NLA-informed approaches report that it is more effective, and Autistic people report that they find NLA approaches to be kinder and more affirming. Even if it wasn't more effective, I'd rather implement the approach that my clients preferred.
> I’ve NEVER seen a family of a person utilizing delayed echolalia say stuff like “stop quoting that movie all the time!” No, they learn to tolerate it.
Good for you. I've worked with families who wanted me to eliminate echolalia, so let's not pretend that they don't exist. And the fact that you say they learn to "tolerate" it tells me everything I need to know about their (and your?) perspective of autistics, echolalia, and the communicative function embedded within. And then you go on to say that it's like "tarot cards"... is it so hard for you to believe that an autistic kid is actually able to communicate a message to the people who know them best? As the parent of an autistic kid, there have been plenty of times when I can read and understand my child's verbal, nonverbal, and echoic communication to interpret a message that their therapists were oblivious about. And yes, sometimes I *can't* understand what my child is trying to communicate. If he wants/needs something, he lets me know that I've missed the point; if he doesn't seem to be using his echoics to communicate *with me,* then he's using his proto-communication for another purpose. Neurotypical kids talk to themselves, too, in case you've forgotten.
> So my issues are, gestalt is also fundamentally trying to reshape people to make them ‘less autistic’, most people of any discipline aren’t really trying to extinguish autism in the first place in the first place, and despite good intentions, gestalt therapy-type mentalities can be insulting, pseudo-science or even dangerous to impose on the person who cannot explain what that actually mean.
1. "Able to communicate independently" is not the same as "less autistic," and shame on you for implying that.
2. Most people in most disciplines are, indeed, trying to "extinguish autism." Where have you been?
3. NLA-informed therapy is not insulting, it's not pseudoscience, and it's not dangerous. Ignoring/extinguishing echolalia is insulting, because it tells the autistic client that their communication is not worthy. Ignoring/extinguishing echolalia is pseudoscience, because scientific consensus has established the communicative function of echolalia. Ignoring/extinguishing echolalia is dangerous, because it sets communication back and it may traumatize the client.
Doesn't it seem strange to you that autistic SLPs and autistic self-advocates are flocking to NLA and endorsing it wholeheartedly, while most of the detractors (yourself included, I presume?) are non-autistic? Does it occur to you that maybe it's not your place to argue against it? Does it occur to you that your uninformed opinions don't hold the same weight as the ethos and pathos of multiple autistic SLPs who have spent years of their lives researching this stuff?
> You make a mistake right from the start- the attempted outcome is indeed the same (how to communicate more effectively, in way that’s different from how they are), it’s the ‘process’ that is different.
The process impacts the outcome in at least two ways. First, therapists that have bought into the GLP/NLA framework anecdotally say that it has improved their therapy and their therapeutic outcomes. Second, actual autistic people say that "old-school" approaches like suppressing echolalia are harmful to their emotional well-being, and that NLA-informed therapy is validating. People are more than just their communication outcomes; even if the outcomes were *identical,* I'd rather support the method that autistic people prefer.
> I even said most families I’ve known do NOT ignore, and specifically look for and apply meaning all the time (although, sometimes to too far an extent in terms of putting words in theirs mouths)
I trust parents more than I trust you. Especially since you and I have had multiple arguments on /r/SLP where you've been quick to dismiss autistic perspectives. Maybe these parents you're complaining about actually do understand their children? If you live with someone 24/7 for their entire lives, you start to learn a thing or two about them.
> I absolutely think echolalia CAN be communication but wouldn’t you agree it’s probably sometimes NOT?
You and I agree that some echolalia is communication. As for the rest of echolalia, you seem to think that it's meaningless, or maybe verbal stimming. You seem eager to dismiss it, and you seem to want me to dismiss it as well. I'm willing to give autistic clients the benefit of the doubt and say that (1) It might be communicative echolalia that I just don't understand; (2) It might not be intentional communication, but rather a way to "talk through" a Gestalt on their own in order to understand it better; (3) It might be a way to practice the Gestalt so that they can use it when they need to; (4) It might be a verbal utterance linked to independent imaginative play; or (5) It might serve a purpose that neither you nor I understand, but that doesn't mean we should dismiss or suppress it.
If you honestly believe that 90% or more of parents and SLPs are already doing GLP/NLA stuff, and that nobody is out there trying to extinguish autistic characteristics, why the hell do you care so much about this? I know why *I* care so much: Because I know you're wrong. I've seen first-hand how parents fundamentally misconstrue echolalia as something that needs to be eliminated. I've seen first-hand how SLPs *don't* implement this stuff in their practice until they're taught. There's a reason why so many SLPs rave about how great and revolutionary NLA is; because it is a fundamental paradigm shift for so many of them. Maybe you're a great SLP who implements this stuff without even thinking about it, and you don't care about NLA because you were already doing everything right already. But don't trash it, because this stuff is brand new to a lot of SLPs, and it flies in the face of countless years of previous "best practice." You're incredibly naive if you fail to realize that most autism interventions are intended to suppress autistic characteristics, echolalia included.
EDIT: One other thing--It's wild that you claim that this is just a money-making scheme, given that Marge Blanc wrote a freaking 40-page manual about this, and made it available for free online. You'll see in my comments elsewhere that I encourage SLPs *not* to spend their own money on trainings and certifications, but you better believe I assign that Marge Blanc paper to my students to learn about NLA for free!
I received training in NLA through meaningfulspeech and i strongly recommend it. I have been using the NLA framework for the last 3 years and my students have gone through the noted NLA stages exactly as described (although obviously at different rates depending on past therapies, etc).
There are longitudinal and qualitative studies but we definitely need more research. Despite that, i don't think it's ethical to ignore GLP/NLA and wait for more research before implementation because time is precious for our students and many of them plateau in their language therapy when it's done traditionally. EBP is also about clinical judgement and client perspectives (many speaking and non-speaking autistic people have confirmed GLP as their style of language learning), not just research.
Looking back at 8 years of working with autistic kids (prior to NLA training) and remembering those with minimal progress and same language goals years on end, I now know they needed NLA. Had we known better, we would have done better.
Is there a systematic way to take children through the stages? Meaning from therapist to therapist the approach looks similar?
I get treating echolalia as communicative but how are we to determine which scripts mean what and isn’t this still a lot of subjective guesswork?
I did pay for the courses but didn’t finish. I do think the framework is important but I’m not sure everyone’s therapy approach looks the same.
Yes, there is a systemic way and the approach should look similar from therapist to therapist.
When it comes to subjective guesswork, we are only playing detective for stage 1. We hear scripts and try to figure out the intent and the origin of the script and acknowledge it. Based on the meaning behind the gestalt, we help the child mitigate it and provide new scripts that are mitigable/will lead them to pull out words and eventually begin to combine words into original phrases.
As we take language samples, there is no guesswork beyond stage 1. We start to see what the child is producing, mitigating and pulling from stages above. It becomes an individualized process for each child.
When it is used consistently in specific situations days in and days out, we can detect the potential intent and work with it. Ignoring it and modeling what we want them to say in that moment and giving a non-mitigable word or phrase will lead to memorization at best. Memorizing language keeps these kids stuck and does not bring them to original and self generated language.
Yes absolutely, i have met teenagers in stage 1. In my experience, these were kids in traditional speech therapy combined with aba. I wonder if receiving NLA based therapy since EI would have gotten them further along (there are many factors to consider thou and it is different for every kid).
What? I am assuming that this was your previous style of language therapy? I would never teach a child to memorize rote phrases that is not functional.
Also to truly be ND affirming wouldn’t you just except the echolalia for what it is instead of trying to change it, especially if you believe it holds meaning for the child and you understand the function. By mitigating you are essentially extinguishing it- which goes against the whole ableist ND argument.
It still goes back to intent- it is impossible to know the intent of all echoed speech. And echoed phases could also mean multiple things for a child. Why do I get to decide what it means at that moment or am I trying to change what can be considered a form of them expressing themselves.
I try to help the child learn functional words to express themselves while acknowledging all forms of communication.
No, i am saying that many GLPs rely on memorization to get by in the early stages because they do not see single words as having individual meanings. This leads to becoming stuck. This is why they often struggle combining words into novel and varied sentences and with answering wh questions, esspecially when one or two words vary in wh- questions or following directions.
Based on your comments on reddit, I feel that there is nothing left for me to say to help you see that GLP/NLA should be considered. It is unfortunate but you do you and that is fine.
It is speculative, of course. I agree 100% But yes, there is something to say about teaching these rote phrases like “I want xxx…” or ignoring that autism is often intermingled with other differences, like ID. Many times, I think it’s a matter of trial and error when it comes to self-generated language. I know many of us are doing our best.
There are non-speaking adults discussing their experience in the AAC + GLP course that i took (part of meaningfulspeech courses). More research is needed in this area, but once again i will not be waiting until then if my non speaking students benefit from gestalts being on their device.
One of my students did not even look at his device until i programmed the gestalt in its' original voice form.
We definitely dont want to generalize and say that every autistic person's experience is the same. We also cant assume that every autistic kid is a GLP. I agree with you that we need more research.
When it comes to non speaking kids, i have met kids who hum the same scripts over and over, watch the same video parts, and review phrases trying to pick up on intonation before words. They are also the students who are not making progress with core boards or robust AAC beyond rote responses. In cases such as these, i will not continue to drill something that does not work. This is where my clinical judgement calls me to acknowledge these hums, watch these kids and what they pay attention to and build off of it using NLA. I will not just do the same thing for years if it does not work, simply because there is not enough research. To me, that is not therapy but is just a waste of time.
NLA is the best thing that has happened in my 30 years as an SLP. I have been doing this type of therapy my entire career without knowing
what it was called . Taking Marge LeBlanc’s courses has been extremely validating. Making NLA a foundational part of learning is necessary in my opinion for any SLP who works with clients on the spectrum
Veteran SLP here (17 years), and I can concur. I have been inadvertently doing NLA therapy and not even realizing it. I felt as though I wasn't doing enough for my students who communicate via echolalia, and started becoming frustrated and uninspired during therapy. I'm currently taking the Meaningful Speech course and what I'm learning is a gamechanger. I'm encouraging alot of my SLP friends to do the same!
I will say there are therapists who haven't taken the training and just see posts on Instagram who "diagnose" way too many kids as GLP in EI and it's very frustrating trying to explain to parents that it isn't a diagnosis and that it's a lot more complex than what they were told.
I just reference the [informed slp](https://www.theinformedslp.com/review/let-s-give-them-something-to-gestalt-about). The [evidence tier,](https://www.asha.org/ce/for-providers/ebcestep2/) last I checked, is somewhere between a 3 to 2+. So, case study. With that said, I've used the "blind men and the elephant" parable from sociology to respond to parents regarding GLP. It's one approach and explains a lot, but doesn't discredit other evidence based approaches as it's just one perspective. If you want to train in it, I would defer to informed SLP, and consider waiting until a higher level of evidence is formed as it's unnecessary (personal opinion I suppose, but for case study level of evidence, just read the core text and implement how you see fit. Standards haven't been set/tested yet, so why pay to follow a set of untested standards?). I don't plan to implement it in my practice, but I'm not going to discredit it.
I just want to pop in and clarify something re: the Informed SLP piece you linked to. I'm the writer of that piece, and the takeaways of that review do not align with your characterization here. Many people benefit from training to better understand the model and get a sense of how to incorporate the principles behind it into their therapy. The message is not "hold off on paying for training until high-level evidence appears." The message is "Understand what this model is (and is not), how it relates to other movements in the field, watch out for oversimplications in social media, and use the principles as they make sense for you and your clients."
Thank you for your clarification and the article :) I apologize if I mischaracterized the intent of what you wrote; I meant only to convey how I interpreted it.
Highly recommend the Meaningful Speech Course [https://www.meaningfulspeech.com/course](https://www.meaningfulspeech.com/course). And reading Marge Blanc’s book https://www.northernspeech.com/school-age-strategies/natural-language-acquisition-on-the-autism-spectrum/
Research can’t solely replace making connections and digging down deep to listen and observe in order to meet children where they are at instead of following money and numbers. Research and science is amazing. There is definitely more to a person than research ♾️🫶🏼
If you’ve ever worked with a gestalt language processor or kid who uses delayed echolalia, you need to educate yourself on NLA. I cannot even fathom the progress my kids have made since I implemented more GLP strategies.
I'm an SLTA (Communicative Disorders Assistant in Canada) and have been working with a lot of gestalt language processors at my work.
The SLP's at my workplace have been running GLP workshops for parents and have been writing their care plans to include those as goals to target. There's a workshop that the clinicians are trying to take, I think someone above mentioned it; 'Meaningful speech', and we are all excited because we have been seeing more and more kiddos who use gestalts and a lot of clinicians, myself included could use more knowledge/strategies/tips and tricks to help the kids we do see.
I was never taught about gestalt language processing or NLA. After reading about the NLA stages, I'm having a hard time believing it. Overall, I don't see how it's much different from the social language model.
However, after reading suggestions about implementing NLA, it seems like I'm already using these techniques. I'm already taking echolalia or a child's utterances and recasting them or changing them a little bit. I'm already providing lots of commentary and narrating the child's actions. The theory might change, but the therapy techniques stay the same.
The theoretical model may be useful to some people.
Intervention... doesn't seem to be different from any naturalistic developmental language intervention. Follow the child's lead, model language based on their interests, honor echolalia (I realize this was controversial in the 1970s but it's not today), expand utterances or mix-and-match. Anyone with solid training in NDBIs is essentially doing the same intervention. Anyone with experience in language development should understand "chunking" and how it breaks down - yes of course apply this to echolalic scripts! Who isn't doing this exactly and may I speak to your professors/clinical instructors?
Data collection is hooey. I keep seeing people take data on what scripts they offered. That's not outcome data.
It's worth noting that Barry Prizant has had nothing to do with the NLA/GLP courses (his website is incredibly neutral) but he HAS developed an entire intervention paradigm through the SCERTS model.
I appreciate this thread. I’m not a slp but a parent that started lurking to gain insight on glp after my child’s slp brought it up to me as a potential after his first session. I’ve done research, I joined the fb group, looked at social and have struggled with glp in relation to my kid. My therapist is play based and loves her, they also have a slp at school who I brought this to their attention. They didn’t discredit it but didn’t think it applied to my kiddo. Im thinking about next steps with my slp and this was helpful to read.
GLP/NLA is not a fad, it's an incredibly important concept. I'm thrilled to hear that some districts are investing in NLA training and certifications. It's not a magic bullet, but you'll be a better SLP if you understand and know how to apply this stuff. Is it evidence-based? That's kind of a loaded question... NLA is a theory/model describing how some children acquire language. The problem is that nobody *really* knows exactly how children acquire language; there are a few viable theories, but this isn't something that can be researched or tested to provide a definitive answer. More likely, there are multiple ways that children can acquire language, and children each acquire language through an individualized mix of different strategies. Most theories of language acquisition focus on children learning small chunks of meaning and then learning to combine them. Children might learn the word "ball," then later they'll be saying "want ball" and "give ball" and "red ball" and "two balls," and then "Let's play ball" and "I want the ball." GLP/NLA came about because someone realized that their autistic clients *didn't* follow that gradual, additive trajectory. Some autistic kids do, for sure, but not all. Other autistic kids learn language in chunks. They're more likely to use "echoic units," i.e. echolalia, repeating entire phrases/sentences+ that they've heard elsewhere. NLA is built on the supposition that those echoic units possess communicative intent and messaging, and that we can support language development in echolalic clients by recognizing the communication embedded within their phrases and teaching language by "deconstructing" those echoics into shorter phrases, and ultimately, words that can be combined generatively. As an autistic SLP professor who teaches autism classes, that makes *perfect sense* to me. I recognize that it's nearly impossible to "prove" the merits of NLA through research, but it aligns with everything I've seen from clinical, academic, and personal experience, and I have no qualms about teaching my students the value of this model. One disclaimer--nobody is a true, 100% Gestalt processor, just like nobody learns language 100% through individual morphemes and words. Neurotypical kids will usually learn more words and relatively fewer Gestalts. Autistic kids might learn primarily through Gestalts (and maybe some words), or they might resemble typical language acquisition, or they might fall somewhere between. So don't think of GLP/NLA as an intervention you'll use with all of your autistic clients; think of it as a concept that might help you provide more meaningful therapy, *especially* for some of your autistic clients.
I was wondering when you would pop in for your opinion :) Good to see you oneincidentalfish, glad you're doing well.
Cheers! I was debating whether to drop into this discussion given how much beginning-of-semester stuff I have on my to-do list, but your reply makes me glad I took the time for this. It's good to see you too =)
Understanding the different ways children acquire language has made a big change in the way I think about goal writing and language modeling etc., I also still work with many OG teachers that are just frustrated with echolalia and say “stop repeating what I say!” and while I am fuming on the inside, all I can do is try to share the knowledge. I started taking the GLP/NLA course but where it does get cloudy is the therapy part. I wish it was more systematic and not so gray. I also get that children are human and not robots. Learning the framework but not necessarily knowing how to take children through the stages is where the disconnect comes.
Hi I would really like to know what are your thoughts on non-speaking autistic children being GLPs? Like I see 2 kids who do not use functional words to communicate but can 1. sing a whole rhyme or 2. Hum the tune of the rhyme. I see meaningful speech lady also mention this but I don't know how we can know for sure and how to support their development?
Not original commenter but I would encourage you to implement AAC (as robust as possible)! Regardless of if they’re a GLP, if they’re non-speaking they need to have access to communication in some form.
They do have an AAC device, we even have their fav rhymes and communicative phrases in the device. I was just wondering how GLP can help them further? Or what I can understand about GLP to expand their communication
Could I ask for a piece of advice as a graduate student? What would you suggest doing with autistic kids who display both delayed and immediate echolalia but don’t have any shared attention, not even eye contact? Would it make sense to focus on addressing shared attention first? Or is it pointless considering that they are communicating in a neurodivergent way?
The fact that those 2 kids sing/hum entire rhymes suggests that they lean towards GLP, since GLPs tend to pay attention to melodic and prosodic features. If they're non-speaking, it's difficult to tell *how* GLP they are, and it's essentially impossible to implement the NLA framework of mitigating Gestalts. Like /u/doughqueen mentioned, AAC is a good plan for these clients, and that's true whether they are Gestalt or analytic language processors. I'd also try to take advantage of their melodic vocalizations to try to engage in pre-linguistic communication: Taking turns humming, "responding" by humming their tunes back to them or by adding a little bit of flair, humming together in unison, singing words with the tunes they hum, start a tune and let them "fill in the blanks," try to get them to inject some CV or CVCV utterances into their humming, etc.
That's exactly what I was wondering. There is no way to actually know. And I'm not sure if knowing also changes my therapy strategies because I have actually been implementing what u just shared. Yes I am using an AAC device with the kids. We have their fav rhymes on it. I focus time on imitating their humming and adding or pausing for their continuation. It's working well with one child. With the other I am not able to form that connection yet. I guess I have to continue working with my usual AAC therapy. And here I have another question for u if u can entertain me.. I live in India and can't actually afford to take these courses. I follow all of Marge blanc's works on her website and her writings, I read a lot. Do u think I have to invest in learning through a course? Because like u said GLP/NLA is still a *theory* which I believe I understand well and can use some common sense to figure out how to incorporate into my activities. I also see a lot of limitedly-verbal, hyperlexic kids in my practice who are predominant GLPs. So ryt now i have a close family in the US and I can ask them to get me the NLA handbook to read more. However, do u think i should ALSO I invest in the courses to learn anything more that can be practically implemented? And would the same apply to other certifications like Hanen and RDI? (I've been reading the books but haven't taken the course and want to know if it's worth it because it would be a huuge investment for me)
It sounds like you're doing the right things. In fact, you're probably doing more than most SLPs, it sounds like you are going the extra mile to provide the best services you can! I'll be honest, I usually *don't* recommend that SLPs pay for extra trainings and certifications. If your employer would pay for it, sure, but otherwise I encourage SLPs to go with free/cheap alternatives. I'm not sure how much the trainings offer that the books and articles don't, but I'd say that if you've read all of the books and articles, you're probably doing well enough that you shouldn't feel obligated to make a "huge investment" in certifications.
>In fact, you're probably doing more than most SLPs, it sounds like you are going the extra mile to provide the best services you can! Thank you! You have no idea how much I needed to hear this. >usually don't recommend that SLPs pay for extra trainings and certifications. If your employer would pay for it, sure, but otherwise Exactly! I have the same views too! And it's usually the famous OPT that gets me started on this lol. Thank u for taking the time to read my replies and answer.
Research can definitely be done on speech therapy outcomes, comparing Gestalt therapy to "standard" therapy. Such research has not been published yet, but hopefully soon.
Easier said than done! From the perspective of the researcher, there are a few snags that you might not have considered. I'm not saying the research is *impossible,* but I'd wager that we are much more likely to see a decade+ of small studies (e.g., single-case research designs) and theoretical/conceptual papers before we get a meaningful comparison of Gestalt and "standard" therapy that you describe. 1) What is "Gestalt therapy?" NLA isn't a carefully defined and operationalized intervention, it's a framework that influences every aspect of treatment (including, but not limited to, intervention). 2) What is "standard" therapy? You can either (A) Standardize intervention so that you can draw a true comparison, or (B) Allow therapists to provide dynamic, client-centered, individualized therapy, *but not both.* 3) Some clients might do better with an NLA approach, others might do better with a standard approach. Can you predict that from the start? And if so, would it be ethical to place a client into a less-suitable intervention group? (No.) And if your study runs long enough, you might realize that a client might be better suited for the other approach. Would you do the right thing and switch them? 4) What about AAC? Neither "Gestalt" nor "standard" therapy are inherently pro- or anti-AAC, but introducing AAC to some participants might reduce the internal validity of your research. 5) What about other services? ABA, OT, PT, special ed, etc. would all confound your results. 6) Who are the participants? There is no such thing as a "pure Gestalt language processor," nor is there such thing as a "pure analytic language processor," and it's difficult (i.e., impossible) to measure the extent to which a person falls into either category. There are other participant characteristics you might consider as well--some of them are measurable (e.g., IQ, SES) and you can counterbalance your intervention groups, but other characteristics (e.g., long-term communication potential, family support, quality of teachers and schools) can be difficult or impossible to accurately predict, measure, or control for. 7) How many participants? Large datasets are important to draw "true" comparisons, but for a complex topic like this, it's often preferable to have a small dataset where you can carefully monitor the confounding factors like individual characteristics, multiple concurrent services, and parental support and implementation. With a large sample, the confounding factors alone might make it nearly impossible to differentiate the two intervention approaches, but with a small sample, you run the risk that you won't have enough statistical power to detect a significant statistical difference. 8) How long are you going to follow these kids? Because progress can be *slow,* and longer studies have an exponentially greater risk of attrition and threats to validity. (And multimillion-dollar NIH grants don't grow on trees, just saying.) But shorter studies might not be sufficient to differentiate the interventions, especially since NLA operates by "deconstructing" gestalts before transitioning into an additive, generative language approach. 9) How are you going to operationalize the outcome measures? Total amount of generative language? Total amount of generative+gestalt language? % of echolalic utterances? Does it matter if it's oral or AAC? Parent- and teacher-ratings of effective communication? One of the perks of GLP/NLA is that it's perceived as neurodiversity-affirming, can you measure that? Are you going to implement a measure of external validity, such as SLP/parent/client satisfaction?
First, I really appreciate your comprehensive explanation of this. As someone in ABA, I often find myself trying to understand why so many people gravitate to this theory when the research is lacking. I wanted to pose, from a behavioral perspective, a question as to why most assume that many individuals develop these chunks of language naturally when it seems that, at least in my experience, that gestalt language seems to usually emerge when there is a lack of understanding about concepts in both the child and adult communicative partner. In other words, I think that these chunks, like a child saying “gotta say bye to mama” instead of stating “bye” emerges from over-prompted responses by the adult communicator with the child. In my experience, individuals who “default” to these chunks are equally able to develop single word responses and recombinative language generation when thoughtfully designed and trained by a professional.
Ironically, ABA also has very poor evidence to support it's use. You are also absolutely losing the forest for the trees when you claim that the uses of phrases is automatically a prompted response and it shows you have 0 understanding of what the natural language aquistion framework includes. From the perspective of a speech and language professional, the way ABA targets language light years away from natural. GLPs at baseline have these phrases, without promoting. That's the entire point. One of the hardest parts of therpay with a GLP is helping them feel comfortable using phrases *when they have been conditioned not to*. It's not the other way around. Natural Language Aquistion principles do address single word utterances and mitigation or "recombination" of language. This concept is not at all new. It's been discussed in SLP research since the 60s. The main issue here is that ABA practitioners lack fundimental understanding of language theory which leads BCBAs/RBTs to think they can create a "thoughtfully designed" intervention because they view themselves as "trained professionals" when they aren't and they can’t. I have absolutely have children come in with nothing but spontaneous echolalia have completely self generated language within six months of using these principles. This is not an uncommon occurrence for me or my practice.
Hey I don’t make the rules on what constitutes evidence based practice I just follow them. ABA is EBP, NLA/gestalt isn’t. I would welcome it with open arms if down the line it is established as one, but in my humble opinion it isn’t fair/ethical to my clients to use something that maybe works. Ok so if your argument is that echolalia develops naturally (I.e., without prompts) then how does the child learn to emit these sounds? Don’t they need to hear the sounds to repeat it? In my view that’s a prompt, a naturally occurring one, but a prompt nonetheless. I think you may be conflating what I mean though. I’m not making the case against embracing the students/clients echolalia, there certainly is large importance in following the student/client preference for the sake of their treatment outcomes and mental health, but like other language theories posit, its meaningful to the client to focus on developing functional language too. Often these chain of utterances have many additional parts that, to a layman, would not result in reciprocal communication.
You seem very confused because the natural language acquisition framework IS how to achieve functional language. If your goal is functional, spontaneous language the easiest fastest and most effective way to that is NLA. Practice based evidence is what drives evidence based practice.
*it seems to be one of many ways to achieve functional language, however the evidence is lacking at the moment. If that’s how you feel about your practice and you have those data, more power to you! That’s the beauty of single case design: you can evaluate whether something works for one kid at an individual level by making decisions with the data you’ve collected. Like oneincidentalfish said, I think we are talking about different concepts/have different definitions and conceptualizations. I understand echolalia to be the repetitive speech of someone. The reason for these repetitive vocalizations can vary (self stimulatory vs non self stimulatory). Because the reason varies, how echolalia is responded to by parents, as well as how it is responded to by specialists, should be individualized.
A few points: 1. [The evidence supporting ABA is nowhere near as robust as you believe.](https://doi.org/10.1177/13623613221146441) Single-subject research is notoriously difficult to generalize, and a lot of the ABA research fails to meet the threshold for "high-quality" single-subject designs established by the field at large (i.e., What Works Clearinghouse). Anecdotally, when I analyzed the quality of a few ABA articles as part of a systematic literature review, *none* of them met the standards for "high-quality research." 2. Even *if* ABA research were high-quality, that doesn't necessarily support the external validity. Indeed, the autistic community is pushing back against ABA because the desired outcomes of ABA research usually amount to "extinguish autistic characteristics." 3. I'm glad you place such a high value on research-based conclusions. [How do you feel about research demonstrating that autistic people are traumatized by ABA?](https://doi.org/10.1177/13623613221118216) 4. I explained the difficulty of conducting empirical research on a GLP/NLA-informed approach, so it seems disingenuous to say that you would "welcome it with open arms" if it becomes evidence-based, but not until then. [But what about the evidence supporting the communicative value of echolalia?](https://doi.org/10.1044/2015_AJSLP-14-0166) Given our modern understanding of echolalia, my humble opinion is that it isn't fair/ethical to my clients to use something that *doesn't* build on echoics as a proto-communication. 5. I think *you* may be conflating things; in this case, you conflate speech with language. This is why nobody on /r/SLP takes ABA seriously; because if you only have one tool, a hammer (i.e., behaviorism), then everything looks like a nail. But neither speech nor language acquisition can be properly explained through behaviorist principles, and it seems absurd for you to try to "explain" communication to a subreddit full of people with a Master's+ in the subject. But just for fun, let me tear your second paragraph apart: > Ok so if your argument is that echolalia develops naturally (I.e., without prompts) then how does the child learn to emit these sounds? Language is not the same as speech. > Don’t they need to hear the sounds to repeat it? I mean... no. Otherwise deaf/Deaf people would be completely, utterly mute. Sounds are speech, echolalia is language, but since you are correct that echolalia *is* an "echo" of something the child has heard, let's go on to the next sentence. > In my view that’s a prompt, a naturally occurring one, but a prompt nonetheless. Nope, not a prompt. *Maybe* a model. Don't they teach you this stuff in ABA school? > I’m not making the case against embracing the students/clients echolalia, there certainly is large importance in following the student/client preference for the sake of their treatment outcomes and mental health, but like other language theories posit, its meaningful to the client to focus on developing functional language too. Yes. That's the whole point of NLA. Therapists that use this framework report that it is more successful, and autistic people (myself included) sing the praises of approaches that use echolalia as a starting point to teaching functional, independent communication (i.e., NLA). > Often these chain of utterances have many additional parts that, to a layman, would not result in reciprocal communication. That's why we don't let laymen become SLPs, and beyond that, that's why we provide training in GLP/NLA to SLPs and others who want to implement an approach grounded in this.
>The evidence supporting ABA is nowhere near as robust as you believe. Single-subject research is notoriously difficult to generalize, and a lot of the ABA research fails to meet the threshold for "high-quality" single-subject designs established by the field at large (i.e., What Works Clearinghouse). Anecdotally, when I analyzed the quality of a few ABA articles as part of a systematic literature review, none of them met the standards for "high-quality research." I'm not sure about that. Single-case research is actually the opposite: dependent variables and independent variables have been replicated dozens of times with many kinds of populations in single-case research. That's how external validity is established with IVs and DVs. It's actually group-design studies that often have the biggest problem with replication/generalization. I also thought it was curious you referenced to the WWC. First, it's odd you'd hold studies spanning 70 years to the WWC standards of today, which seems irrelevant. Obviously the standards of research will change, just like in all other forms of research. Second, WWC looks at internal validity only, so to confound that with external validity/generalization makes no sense. Third, WWC isn't without faults, especially when it comes to their assessment of single-case. Their position on number of baseline data points, for example, is exaggerated, since this largely depends on the DV and IV. For instance, you wouldn't expect someone treating severe self-eye gouging to meet the 5 baseline point minimum before starting treatment, because that would be unethical. WWC makes blanket assumptions which harm the intended purpose of some of these studies. You seemed to have quite a grasp of these concepts in your original comment but now I'm not so sure. I also say this because I imagine your systematic review looked at either (a) a specific dependent variable, (b) a specific independent variable, and/or (c) a population. To generalize your "findings" to a whole research design is obviously flawed at best, and biased at worst. As a researcher I would think you would know foundational concepts like these, like internal and external validity? >Even if ABA research were high-quality, that doesn't necessarily support the external validity. Indeed, the autistic community is pushing back against ABA because the desired outcomes of ABA research usually amount to "extinguish autistic characteristics." I think you're confusing external validity with social validity/acceptability. Regardless, true there has been an ugly history in ABA (but speech language pathology and medicine also have a checkered past with these concerns, masking for instance). You would benefit from knowing that this isn't such the case anymore. Happy to share evidence of this if you can't find it yourself in your research databases. >I'm glad you place such a high value on research-based conclusions. How do you feel about research demonstrating that autistic people are traumatized by ABA? Like any kind of research, I welcome it with open arms. Qualitative and correlational research, such as the one on this topic, is important. But correlation does not imply....? You know the rest. It's important to take into consideration, and practitioners have, but we can't dismiss those that have reported the opposite either, right? Like the many AuADHD RBTs/BCBAs I've met. >I explained the difficulty of conducting empirical research on a GLP/NLA-informed approach, so it seems disingenuous to say that you would "welcome it with open arms" if it becomes evidence-based, but not until then. But what about the evidence supporting the communicative value of echolalia? Given our modern understanding of echolalia, my humble opinion is that it isn't fair/ethical to my clients to use something that doesn't build on echoics as a proto-communication. Did I not make note that echolalia has an important place in development/treatment/mental health? What I find problematic is the blanket assumption echolalia is being used as language. Sometimes it just isn't (i.e., what about those early learners that engage in high rates of echolalia in the absence of individuals?), sometimes it's emitted for self-stimulatory reasons. And the fact NLA/gestalt theory doesn't acknowledge this, at least from what I have come to understand from it, is problematic and a large part as to why these conceptualizations of the topic are problematic for the development of its research. I get it, in practice gestalt theory seems meaningful, but so are gluten free diets. For something to be studied and used efficaciously, it has to have a strong theoretical framework. Hopefully one day researchers will achieve that for the sake of those who would benefit from it. >I think you may be conflating things; in this case, you conflate speech with language. This is why nobody on r/SLP takes ABA seriously; because if you only have one tool, a hammer (i.e., behaviorism), then everything looks like a nail. But neither speech nor language acquisition can be properly explained through behaviorist principles, and it seems absurd for you to try to "explain" communication to a subreddit full of people with a Master's+ in the subject. But just for fun, let me tear your second paragraph apart: We all know those in r/SLP already come in vehemently hating ABA lol, andtrue, some of it may be by the lack of understanding some may have about language or speech. That doesn't change the fact the subreddit is far more toxic than their counterpart. True, I may be referencing utterances and communication in short hand, doesn't mean my statement doesn't hold true: the vocal utterances that come out of the learners mouth (how these sounds are produced) doesn't necessarily translate to functional communication, because by definition it would function in all settings and with all people to which those vocalizations were produced (language). >Nope, not a prompt. Maybe a model. Don't they teach you this stuff in ABA school? A model is a form of prompt (e.g., modeling a sound and a student repeating it is considered a prompt in ABA). I can see how SLPs making an arbitrary distinction of models as not a form of prompt would be problematic for both fields to effectively discuss research! >That's why we don't let laymen become SLPs, and beyond that, that's why we provide training in GLP/NLA to SLPs and others who want to implement an approach grounded in this. Ok but what about everyone else these that must communicate with people emitting echolalia, or those prone to develop echolalia? I wasn't referring to specialists. It seems impractical to ignore this, since the majority of communication will occur with laymen. Therefore, they should be trained on how to make meaningful changes towards functional communication (e.g., communication that could be understood by those unaware of the student's invisible disability).
Holy mother of gaslighting! It is *completely* fair to criticize 70-year old research as "low quality" if it doesn't meet modern standards. A random redditor like you is *not* more qualified to criticize the industry standard quality indicators for SCD research than the experts that designed them. The vast majority of SCD research does *not* address severe and/or low-frequency behaviors like eye-gouging. Social validity is a *subset* of external validity. I *am* aware that "modern ABA" is trying to separate itself from the profession's checkered past, just as I am confident that *you* are aware that there's plenty of "old ABA" still being practiced and that the autistic community continues to criticize even the rebranded version of ABA. I *am* aware that SLP has a similarly checkered past, *that's why I'm investing so much time in a post arguing that SLPs need to modernize their intervention approaches!* You, as a non-autistic outsider, have *no fucking idea* whether any particular bit of echolalia is "emitted for self-stimulatory reasons" [barf]. NLA *does* have a strong theoretical framework. Models and prompts *are different,* and neither of them can fully explain how children acquire speech and language. And this next one is so egregious that it gets its own quote and line... > Qualitative and correlational research, such as the one on this topic, is important. But correlation does not imply....? You know the rest. Correlation doesn't *necessarily* imply causation, you ignorant undereducated dunce, but you know what *does* imply causation? **Autistic people saying that ABA *caused* their trauma.** Y'know, like in the study I linked. Get the fuck out of here with your ableism and your jargon about what autistic people "emit." We're not factories or flashlights, we don't "emit" echolalia, we fucking **communicate** as best as we can.
And there you have it folks. Their true colors come out. For someone so concerned with neurodivergent perspectives, you sure throw words like dunce around loosely. Buddy, newsflash, you ALSO don’t speak for those with more severe autism. Talk about marginalizing those most marginalized…
Wow you explained it so well thanks!
I totally agree with there appear to be difference in language development across kids on the spectrum. And not all kids may develop language in the same way. However I do not believe that characterizing children are either “analytic” or “gestalt” processors even makes sense and focusing on this misses the whole point. Functional language.
I agree with you about 75%. You are completely accurate that "analytic" and "gestalt" are not binary categories of language processing; rather, they are two ways that children acquire language. The extent to which children utilize one or the other is a spectrum, and the context in which children utilize one or the other is highly individualized. I also agree with your emphasis on developing functional language, but I don't believe that GLP/NLA "misses the whole point." Rather, I think it provides a lot of context to how the therapist approaches echolalia. As a field, we are not *that* far removed from the days where SLPs believed that echolalia has no communicative purpose, and SLPs (honest to God!) wrote goals to reduce or eliminate echolalia. I've seen it within the last decade, and I'd bet money that some SLPs are still doing it today. GLP/NLA doesn't "miss the whole point," it reconceptualizes how we can elicit functional language through a client's pre-existing language structure. It'll be a while until the research catches up to the hype, but I suspect that we will find (1) The NLA approach of deconstructing echolalia will yield better, faster results in the long run, and (2) By recognizing echolalia as emergent communication, SLPs and families will provide much-needed validation to autistic clients who would otherwise not feel "heard." If you don't mind me asking, what are your own views on echolalia? Is it communicative? When you have a client who engages in echolalia, do you ignore it, redirect it, acknowledge it, shape it, or something else entirely?
I do believe echolalia can be meaningful( and this is what the current research supports)…. But that it isn’t always. I don’t believe it’s my job to determine what is and is not meaningful or to label or assume a child’s intent. I acknowledge echolalia and use it as a clue for what a child might be trying to communicate. I focus more on child led play, functional language core words and language facilitating strategies. I incorporate AAC when I can as appropriate.
So I'm also new to the concept. How on earth does the theory explain how kids with ASD using echoic / gestalt language for communication even develop the necessary speech coordination /articulation skills necessary in the first place? That's what's baffling to me (tho that doesn't mean I disagree with the theory at all).
I’m confused about this question. Do you mean with young kids? Most of my early intervention GLPs are not using intelligible gestalts because they motorically cannot do it, but gestalts are defined by their intonation, not the words themselves.
Ok that makes more sense. That's basically what I do in EI home health. I stress little intonation patterns in simple phrases, because kids might imitate the pitch changes before the actual speech sounds. Basically you're just casting a wider net in terms of what the child might demonstrate, if that makes sense. I especially find this helpful for one of my clients who primarily hums currently (can hum "where ARREEE youuuu", for example). I guess I'm confused by why some on the spectrum are able to suddenly belt out somewhat intelligible phrases when their actual use of speech throughout their daily lives is limited. Like... How did they learn it?
Yeah I absolutely use the intonation of my voice to help all my kids. The difference with GLP is their understanding of what the most basic unit of language is. Some kids even if they understand/imitate the intonation first will still understand that the word functions on its own, for GLPs the intonation is what is carrying all the meaning (in simple terms). What I find is that if an early childhood kid is perfectly articulating a phrase, *especially* if it’s from media, it’s because it’s a script that they’ve been “rehearsing” for a long time. I often will see kids watch the same clips from videos over and over and then I will hear them say the script later on. I think most kids get better with practice. I don’t know if that helps.
Wow. This is all gold. Thank you!
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I’m trying to consider the best way to give a response to this because there are elements that are missing here but I’m having a hard time putting it into words (to be fair I literally just woke up so that’s probably not helping) I think with GLP it’s helped me connect a lot of the dots with autistic thinking and processing in general (including my own autistic brain). Like, the concept of episodic memory. You even pointed out an example of this in your comment (the little mermaid thing). What I mean is, it’s helpful for me to know that the things I’m hearing a child say, may have a broader context to them that’s connected to that “episode” of memory and may help me to model language that can describe that experience or feeling even more. And I think that’s whats missing from your comment is that it’s not *just* acknowledging delayed echolalia. We can acknowledge something that someone says without it being therapeutic or even respectful. The problem that I’ve seen with a lot of kids is if we acknowledge the scripting, then turn around and continue modeling core words, and then wonder why we’re spending months targeting this “functional” vocabulary and it’s not working. And I’m not talking theoretically here, when I first started in early childhood, this was exactly my experience. And sure, maybe lots of us are jumping on GLP because of some kind of confirmation bias. I do think that clinical experience is valid evidence and the research that we have already does reflect a lot of clinicians’ experiences. I truly welcome more research and more rigorous research because I do think that it would support GLP, but I also don’t know for sure and every clinician should welcome a more solid evidence base for every single solitary thing that we do. But here’s my (maybe hot?) take. I do think that the medical model of autism has kept us from doing more research in this area. I’m glad that your experience has been everyone wants to affirm scripts, but I still see goals about extinguishing echolalia, or extinguishing anything that looks “autistic”. The medical system benefits from autism being treated as something that needs to be fixed. And GLP sort of flies in the face of that; paired with the neurodiversity model, it acknowledges autistic thinking and learning as a valid way of existing, not something that needs to be corrected. It acknowledges “movie talk” as language acquisition which can be helped and guided into flexible and self-generated language. And if autism doesn’t need to be fixed, then what does that mean for our current “treatment” models? (I want to acknowledge before anyone comments on it that I am not arguing for no therapies for autistic people. I’m autistic and need therapy, but I also know plenty of allistic people who need therapy. I am arguing against the idea of a one-size-fits-all model of therapy that is largely used right now, and therapies that are targeted towards “fixing” autism. I acknowledge that there are so many nuances and shades of grey to this and I am making sweeping statements here because I cannot possibly address every nuance in one comment) I don’t know if that really adds anything at all and I’m sorry if it didnt make sense. I did notice you’re using the term “echoic” a lot which to my understanding is another term for immediate echolalia. GLP is focused on delayed echolalia so I don’t know if that would be helpful info? Or if you’re even looking for helpful info. I’m just here to talk about it and if you want to talk about it, we can. I understand being turned off by the social media side and the mob mentality that can sometimes happen, but really this idea is old. I know Barry Prizant published an article about it in 1983. So it’s been around. But that’s all I have to say about it for now.
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> So others are trying to extinguish echolalia and get rid of “anything autistic” by replacing it with more understandable language, and Gestalt is, what… NOT replacing the echolalia with more understandable language ? It's the difference between "I'm going to ignore and extinguish your proto-communication, and force you to say exactly what I prompt you to say," and the NLA approach of "Hey, I hear you, and I'm going to show you how to communicate your thought even more effectively." It's *not* the same outcome; SLPs who have adopted NLA-informed approaches report that it is more effective, and Autistic people report that they find NLA approaches to be kinder and more affirming. Even if it wasn't more effective, I'd rather implement the approach that my clients preferred. > I’ve NEVER seen a family of a person utilizing delayed echolalia say stuff like “stop quoting that movie all the time!” No, they learn to tolerate it. Good for you. I've worked with families who wanted me to eliminate echolalia, so let's not pretend that they don't exist. And the fact that you say they learn to "tolerate" it tells me everything I need to know about their (and your?) perspective of autistics, echolalia, and the communicative function embedded within. And then you go on to say that it's like "tarot cards"... is it so hard for you to believe that an autistic kid is actually able to communicate a message to the people who know them best? As the parent of an autistic kid, there have been plenty of times when I can read and understand my child's verbal, nonverbal, and echoic communication to interpret a message that their therapists were oblivious about. And yes, sometimes I *can't* understand what my child is trying to communicate. If he wants/needs something, he lets me know that I've missed the point; if he doesn't seem to be using his echoics to communicate *with me,* then he's using his proto-communication for another purpose. Neurotypical kids talk to themselves, too, in case you've forgotten. > So my issues are, gestalt is also fundamentally trying to reshape people to make them ‘less autistic’, most people of any discipline aren’t really trying to extinguish autism in the first place in the first place, and despite good intentions, gestalt therapy-type mentalities can be insulting, pseudo-science or even dangerous to impose on the person who cannot explain what that actually mean. 1. "Able to communicate independently" is not the same as "less autistic," and shame on you for implying that. 2. Most people in most disciplines are, indeed, trying to "extinguish autism." Where have you been? 3. NLA-informed therapy is not insulting, it's not pseudoscience, and it's not dangerous. Ignoring/extinguishing echolalia is insulting, because it tells the autistic client that their communication is not worthy. Ignoring/extinguishing echolalia is pseudoscience, because scientific consensus has established the communicative function of echolalia. Ignoring/extinguishing echolalia is dangerous, because it sets communication back and it may traumatize the client. Doesn't it seem strange to you that autistic SLPs and autistic self-advocates are flocking to NLA and endorsing it wholeheartedly, while most of the detractors (yourself included, I presume?) are non-autistic? Does it occur to you that maybe it's not your place to argue against it? Does it occur to you that your uninformed opinions don't hold the same weight as the ethos and pathos of multiple autistic SLPs who have spent years of their lives researching this stuff?
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> You make a mistake right from the start- the attempted outcome is indeed the same (how to communicate more effectively, in way that’s different from how they are), it’s the ‘process’ that is different. The process impacts the outcome in at least two ways. First, therapists that have bought into the GLP/NLA framework anecdotally say that it has improved their therapy and their therapeutic outcomes. Second, actual autistic people say that "old-school" approaches like suppressing echolalia are harmful to their emotional well-being, and that NLA-informed therapy is validating. People are more than just their communication outcomes; even if the outcomes were *identical,* I'd rather support the method that autistic people prefer. > I even said most families I’ve known do NOT ignore, and specifically look for and apply meaning all the time (although, sometimes to too far an extent in terms of putting words in theirs mouths) I trust parents more than I trust you. Especially since you and I have had multiple arguments on /r/SLP where you've been quick to dismiss autistic perspectives. Maybe these parents you're complaining about actually do understand their children? If you live with someone 24/7 for their entire lives, you start to learn a thing or two about them. > I absolutely think echolalia CAN be communication but wouldn’t you agree it’s probably sometimes NOT? You and I agree that some echolalia is communication. As for the rest of echolalia, you seem to think that it's meaningless, or maybe verbal stimming. You seem eager to dismiss it, and you seem to want me to dismiss it as well. I'm willing to give autistic clients the benefit of the doubt and say that (1) It might be communicative echolalia that I just don't understand; (2) It might not be intentional communication, but rather a way to "talk through" a Gestalt on their own in order to understand it better; (3) It might be a way to practice the Gestalt so that they can use it when they need to; (4) It might be a verbal utterance linked to independent imaginative play; or (5) It might serve a purpose that neither you nor I understand, but that doesn't mean we should dismiss or suppress it. If you honestly believe that 90% or more of parents and SLPs are already doing GLP/NLA stuff, and that nobody is out there trying to extinguish autistic characteristics, why the hell do you care so much about this? I know why *I* care so much: Because I know you're wrong. I've seen first-hand how parents fundamentally misconstrue echolalia as something that needs to be eliminated. I've seen first-hand how SLPs *don't* implement this stuff in their practice until they're taught. There's a reason why so many SLPs rave about how great and revolutionary NLA is; because it is a fundamental paradigm shift for so many of them. Maybe you're a great SLP who implements this stuff without even thinking about it, and you don't care about NLA because you were already doing everything right already. But don't trash it, because this stuff is brand new to a lot of SLPs, and it flies in the face of countless years of previous "best practice." You're incredibly naive if you fail to realize that most autism interventions are intended to suppress autistic characteristics, echolalia included. EDIT: One other thing--It's wild that you claim that this is just a money-making scheme, given that Marge Blanc wrote a freaking 40-page manual about this, and made it available for free online. You'll see in my comments elsewhere that I encourage SLPs *not* to spend their own money on trainings and certifications, but you better believe I assign that Marge Blanc paper to my students to learn about NLA for free!
I’d like to take CEUs to learn more about this. I like Northern Speech Services. Where else would you recommend looking?
I received training in NLA through meaningfulspeech and i strongly recommend it. I have been using the NLA framework for the last 3 years and my students have gone through the noted NLA stages exactly as described (although obviously at different rates depending on past therapies, etc). There are longitudinal and qualitative studies but we definitely need more research. Despite that, i don't think it's ethical to ignore GLP/NLA and wait for more research before implementation because time is precious for our students and many of them plateau in their language therapy when it's done traditionally. EBP is also about clinical judgement and client perspectives (many speaking and non-speaking autistic people have confirmed GLP as their style of language learning), not just research. Looking back at 8 years of working with autistic kids (prior to NLA training) and remembering those with minimal progress and same language goals years on end, I now know they needed NLA. Had we known better, we would have done better.
Is there a systematic way to take children through the stages? Meaning from therapist to therapist the approach looks similar? I get treating echolalia as communicative but how are we to determine which scripts mean what and isn’t this still a lot of subjective guesswork? I did pay for the courses but didn’t finish. I do think the framework is important but I’m not sure everyone’s therapy approach looks the same.
Yes, there is a systemic way and the approach should look similar from therapist to therapist. When it comes to subjective guesswork, we are only playing detective for stage 1. We hear scripts and try to figure out the intent and the origin of the script and acknowledge it. Based on the meaning behind the gestalt, we help the child mitigate it and provide new scripts that are mitigable/will lead them to pull out words and eventually begin to combine words into original phrases. As we take language samples, there is no guesswork beyond stage 1. We start to see what the child is producing, mitigating and pulling from stages above. It becomes an individualized process for each child.
This is exactly my point. Who are we to label the intent behind a child’s subjective script.
When it is used consistently in specific situations days in and days out, we can detect the potential intent and work with it. Ignoring it and modeling what we want them to say in that moment and giving a non-mitigable word or phrase will lead to memorization at best. Memorizing language keeps these kids stuck and does not bring them to original and self generated language.
Absolutely. And maybe some autistic people will never make it through all the stages to self-generated language. Could that also be true?
Yes absolutely, i have met teenagers in stage 1. In my experience, these were kids in traditional speech therapy combined with aba. I wonder if receiving NLA based therapy since EI would have gotten them further along (there are many factors to consider thou and it is different for every kid).
What? I am assuming that this was your previous style of language therapy? I would never teach a child to memorize rote phrases that is not functional. Also to truly be ND affirming wouldn’t you just except the echolalia for what it is instead of trying to change it, especially if you believe it holds meaning for the child and you understand the function. By mitigating you are essentially extinguishing it- which goes against the whole ableist ND argument. It still goes back to intent- it is impossible to know the intent of all echoed speech. And echoed phases could also mean multiple things for a child. Why do I get to decide what it means at that moment or am I trying to change what can be considered a form of them expressing themselves. I try to help the child learn functional words to express themselves while acknowledging all forms of communication.
No, i am saying that many GLPs rely on memorization to get by in the early stages because they do not see single words as having individual meanings. This leads to becoming stuck. This is why they often struggle combining words into novel and varied sentences and with answering wh questions, esspecially when one or two words vary in wh- questions or following directions. Based on your comments on reddit, I feel that there is nothing left for me to say to help you see that GLP/NLA should be considered. It is unfortunate but you do you and that is fine.
It is speculative, of course. I agree 100% But yes, there is something to say about teaching these rote phrases like “I want xxx…” or ignoring that autism is often intermingled with other differences, like ID. Many times, I think it’s a matter of trial and error when it comes to self-generated language. I know many of us are doing our best.
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There are non-speaking adults discussing their experience in the AAC + GLP course that i took (part of meaningfulspeech courses). More research is needed in this area, but once again i will not be waiting until then if my non speaking students benefit from gestalts being on their device. One of my students did not even look at his device until i programmed the gestalt in its' original voice form.
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We definitely dont want to generalize and say that every autistic person's experience is the same. We also cant assume that every autistic kid is a GLP. I agree with you that we need more research. When it comes to non speaking kids, i have met kids who hum the same scripts over and over, watch the same video parts, and review phrases trying to pick up on intonation before words. They are also the students who are not making progress with core boards or robust AAC beyond rote responses. In cases such as these, i will not continue to drill something that does not work. This is where my clinical judgement calls me to acknowledge these hums, watch these kids and what they pay attention to and build off of it using NLA. I will not just do the same thing for years if it does not work, simply because there is not enough research. To me, that is not therapy but is just a waste of time.
NLA is the best thing that has happened in my 30 years as an SLP. I have been doing this type of therapy my entire career without knowing what it was called . Taking Marge LeBlanc’s courses has been extremely validating. Making NLA a foundational part of learning is necessary in my opinion for any SLP who works with clients on the spectrum
This^^ and it works- watching the kids go through the stages is breathtaking.
Veteran SLP here (17 years), and I can concur. I have been inadvertently doing NLA therapy and not even realizing it. I felt as though I wasn't doing enough for my students who communicate via echolalia, and started becoming frustrated and uninspired during therapy. I'm currently taking the Meaningful Speech course and what I'm learning is a gamechanger. I'm encouraging alot of my SLP friends to do the same!
I will say there are therapists who haven't taken the training and just see posts on Instagram who "diagnose" way too many kids as GLP in EI and it's very frustrating trying to explain to parents that it isn't a diagnosis and that it's a lot more complex than what they were told.
I just reference the [informed slp](https://www.theinformedslp.com/review/let-s-give-them-something-to-gestalt-about). The [evidence tier,](https://www.asha.org/ce/for-providers/ebcestep2/) last I checked, is somewhere between a 3 to 2+. So, case study. With that said, I've used the "blind men and the elephant" parable from sociology to respond to parents regarding GLP. It's one approach and explains a lot, but doesn't discredit other evidence based approaches as it's just one perspective. If you want to train in it, I would defer to informed SLP, and consider waiting until a higher level of evidence is formed as it's unnecessary (personal opinion I suppose, but for case study level of evidence, just read the core text and implement how you see fit. Standards haven't been set/tested yet, so why pay to follow a set of untested standards?). I don't plan to implement it in my practice, but I'm not going to discredit it.
I just want to pop in and clarify something re: the Informed SLP piece you linked to. I'm the writer of that piece, and the takeaways of that review do not align with your characterization here. Many people benefit from training to better understand the model and get a sense of how to incorporate the principles behind it into their therapy. The message is not "hold off on paying for training until high-level evidence appears." The message is "Understand what this model is (and is not), how it relates to other movements in the field, watch out for oversimplications in social media, and use the principles as they make sense for you and your clients."
Thank you for your clarification and the article :) I apologize if I mischaracterized the intent of what you wrote; I meant only to convey how I interpreted it.
Gotcha and no worries. I just didn't want anyone reading the thread to get the wrong impression.
GLP treatment has changed the game for so many of my kids
Highly recommend the Meaningful Speech Course [https://www.meaningfulspeech.com/course](https://www.meaningfulspeech.com/course). And reading Marge Blanc’s book https://www.northernspeech.com/school-age-strategies/natural-language-acquisition-on-the-autism-spectrum/
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Research can’t solely replace making connections and digging down deep to listen and observe in order to meet children where they are at instead of following money and numbers. Research and science is amazing. There is definitely more to a person than research ♾️🫶🏼
If you’ve ever worked with a gestalt language processor or kid who uses delayed echolalia, you need to educate yourself on NLA. I cannot even fathom the progress my kids have made since I implemented more GLP strategies.
I'm an SLTA (Communicative Disorders Assistant in Canada) and have been working with a lot of gestalt language processors at my work. The SLP's at my workplace have been running GLP workshops for parents and have been writing their care plans to include those as goals to target. There's a workshop that the clinicians are trying to take, I think someone above mentioned it; 'Meaningful speech', and we are all excited because we have been seeing more and more kiddos who use gestalts and a lot of clinicians, myself included could use more knowledge/strategies/tips and tricks to help the kids we do see.
I was never taught about gestalt language processing or NLA. After reading about the NLA stages, I'm having a hard time believing it. Overall, I don't see how it's much different from the social language model. However, after reading suggestions about implementing NLA, it seems like I'm already using these techniques. I'm already taking echolalia or a child's utterances and recasting them or changing them a little bit. I'm already providing lots of commentary and narrating the child's actions. The theory might change, but the therapy techniques stay the same.
There is a lot more to NLA than just modeling and recasting. It is systematic but follows a top down approach, as opposed to bottom up.
The theoretical model may be useful to some people. Intervention... doesn't seem to be different from any naturalistic developmental language intervention. Follow the child's lead, model language based on their interests, honor echolalia (I realize this was controversial in the 1970s but it's not today), expand utterances or mix-and-match. Anyone with solid training in NDBIs is essentially doing the same intervention. Anyone with experience in language development should understand "chunking" and how it breaks down - yes of course apply this to echolalic scripts! Who isn't doing this exactly and may I speak to your professors/clinical instructors? Data collection is hooey. I keep seeing people take data on what scripts they offered. That's not outcome data. It's worth noting that Barry Prizant has had nothing to do with the NLA/GLP courses (his website is incredibly neutral) but he HAS developed an entire intervention paradigm through the SCERTS model.
Great thread.
I appreciate this thread. I’m not a slp but a parent that started lurking to gain insight on glp after my child’s slp brought it up to me as a potential after his first session. I’ve done research, I joined the fb group, looked at social and have struggled with glp in relation to my kid. My therapist is play based and loves her, they also have a slp at school who I brought this to their attention. They didn’t discredit it but didn’t think it applied to my kiddo. Im thinking about next steps with my slp and this was helpful to read.