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AUTISM · BIRTH THROUGH HIGH SCHOOL
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Let’s give them something to gestalt about
Gestalt language processing, Natural Language Acquisition, echolalia, and scripting—it’s the hottest topic in the SLP-verse. But what does the evidence say?
February 7, 2022
Gestalt language processing (GLP): it is *everywhere* right now, and everyone is talking about it.
Why’s it so hot? We’ll get to that. What even is this? We’ll get to that too, no worries.
But the big question that’s been blowing up our email, DMs, and search engine— Is there research behind GLP? Is it EBP?
Quick answer—yes, partly…it’s complicated! So while we wish we could pull this off in a quick soundbite, you’re going to need to grab a chair or an earbud and settle in for the ride. Let’s go!
First, some definitions. It’ll be painless, I promise. You get to speak German!
Gestalt (guhSHTALT or /gəˈʃtɑlt/) comes from the German word meaning “form” or “shape.” Within psychology, it refers to processing information (visual, auditory, linguistic) as a whole that’s more than the sum of its parts.
In language, a gestalt is a multi-word “chunk” that a speaker hears, stores, and uses as a whole, before having knowledge/awareness of its internal structure. It may be defined by its prosody/intonation and have an idiosyncratic meaning related to a specific context where the person has encountered it. It may or may not be intelligible to the listener. You might have learned sentences in a foreign language as gestalts (this one?), understanding the sense of the whole meaning within a context, but not the individual words and how they fit together.
A person communicating with gestalts can also be described as using delayed echolalia (a more common term in the literature, most often in reference to autistic people). “Delayed” here means the person is echoing an utterance after a gap of time and not immediately after hearing it. Scripting is sometimes used synonymously with echolalia, but can also refer to the use of learned chunks of language as a consciously applied communication strategy (e.g., memorized answers to interview questions or those classic small talk rituals); “scripts” are not necessarily gestalts.
Gestalt language processing was named and described by the linguist Ann Peters in her 1983 book (a compilation of qualitative research) and taken up by SLP scientist Barry Prizant (who you may know from Uniquely Human and the SCERTS model) and colleagues. Much of this work is several decades old, which is why you weren’t finding “gestalt” in TISLP’s database until today. This is a model of language acquisition where a child acquires gestalts as their initial units of language, which they then can learn to break down (“mitigate”) later. You can think of this as the “large-to-small” route to developing productive grammar.
Prizant described four fluid stages of gestalt language acquisition in his subjects:
GLP is contrasted with analytic language processing, the “typical” language acquisition path we all learned about, which starts at the single word level and builds to phrases and eventually sentences—the “small-to-large” path to grammar, which gestalt language acquisition reaches at the fourth stage.
The theory wasn’t that people use all gestalt or all analytic processing, but rather a blend of the two, and that a subgroup of people (including but not limited to many autistic people) might rely predominantly on gestalt processing. The idea is that you need both routes to explain typical language acquisition, and that both represent “normal,” developmental progressions, each of which would need to be considered in language assessment and intervention. While a language delay in a mainly “analytic processor” might look like a small repertoire of single words at age two, a delay in a mainly “gestalt processor” would just look like echolalia.
To add more terms to the mix, you may have heard of Natural Language Acquisition (NLA), which is the specific work on gestalt language by SLP Marge Blanc, laid out in her 2012 book and seminars. She expands Prizant’s four stages of gestalt language learning to six (adding stages for advanced grammar) and sets out a language sampling protocol to track an individual’s operating stage(s) and grammar development using Laura Lee’s developmental sentence types and developmental sentence scoring.
While it is suggested that many people (neurotypical and neurodivergent) use gestalt processing either partially or predominantly, GLP is most often discussed in reference to autistic people. Echolalia has been associated with autistic people since autism was first described, but often through an ableist lens, where it was often seen as noncommunicative and addressed (i.e., extinguished) through behavioral approaches. Through a GLP lens, echolalia is communicative and the first step in that individual’s “natural” development of language.
Confusingly, if you’re googling around you’ll see things saying autistic people may have impaired gestalt processing. This is using the word in a different way, referring to situations where people perceive and remember many fine details while not getting the “big picture”—not seeing the forest for the trees. The “G” in the iLAUGH model stands for this sense of “gestalt.” I know SLPs love multiple meaning words, but seriously.
Most of the therapeutic principles are what any good responsive therapist would do and teach:
The key practical differences between a GLP/NLA approach and therapy-as-usual come in with how you approach assessment (with reference to the four/six stages) and then what language units you target, including, at the early stages, supplying the child with new gestalts that will be meaningful and easy to mix/match late. A frequently suggested early gestalt is “Let’s ____”. The thought is that stages generally aren’t/can’t be skipped, since grammatical development requires single words, and proponents say a child using mostly non-mitigated gestalts needs to start by mixing and matching chunks of scripts before you can work on single words.
We can contrast this with:
There is, of course, a huge, philosophical difference between all of these approaches just mentioned and ones that—wrongly and harmfully—see echolalia/scripting as meaningless or treat it as something to simply eliminate for the comfort of others or to allow the person to appear more neurotypical—i.e., teaching them to mask.
Let’s break it down, EBP-triangle style!
Client/family/community values and expertise: This gets into why GLP/NLA is *everywhere* right now. These ideas and the work they are based on aren’t new, but what’s changed recently is a GLP explosion with SLP influencers and content creators on social media. We believe this reflects GLP’s alignment with the broader neurodiversity movement and the growing understanding among SLPs—led by autistic advocates—that autistic cognition and communication patterns are valid and don’t need to be “fixed” to look neurotypical. As many families and professionals are moving away from behavioral approaches, they’re seeking out alternatives that are neurodiversity affirming. Approaching echolalia functionally through the principles of GLP/NLA, which not only normalizes but values the functions of echolalia and scripting, fits that bill. Caregivers and therapists are also finding that the concept of gestalt language processing “clicks” with their knowledge and observations of their children/clients and gives them a path forward. Finally—and critically—we’re hearing first-person accounts from autistic people that it describes their own experiences of learning language.
Clinical evidence and expertise: Marge Blanc’s book includes extensive longitudinal language samples demonstrating her autistic clients’ progression through the stages over time given GLP-based intervention. She elected to publish these in a book geared toward caregivers instead of a peer-reviewed publication.
Then, the thing that probably brought you here in the first place…
External research evidence:
First, let’s acknowledge that there are hefty barriers to clinical research on delayed echolalia. While some scripts are easy to ID (think: the kid who can perform whole episodes of Barney, or our staffer V. Tisi’s client who calls cake “happybirthdaytoyou”), some are really, really not, even for familiar listeners. Language sampling in these cases is not an exact science, which is a challenge in the context of… well, science. This is why the work to date in this area has been qualitative, instead of quantitative in nature. With that in mind, here’s the rundown on the evidence we have—and don’t.
What we know:
What we don’t know:
The idea of gestalt processing has the ingredients for being a useful model for approaching the assessment and treatment of some individuals who communicate through echolalia. Models are helpful to the extent that they capture/explain specific observations about the world (or in this case, about an individual’s language system) in an easy-to-understand way and provide testable predictions that can be supported or undermined through data collection (aka longitudinal language sampling). But without a lot more data, a model is just a model, like those styrofoam-ball solar systems you maybe made in school. They don’t explain everything—and weaken if we overextend them—so notice if you are doing lots of mental gymnastics to make things fit the model that would be better explained another way.
As these ideas continue to filter through the field, we’re likely to see oversimplifications and other problematic applications of these concepts to practice. Watch out for quick fixes: an approach that requires deep knowledge of the child and their language environment, extended language sampling and analysis in collaboration with familiar listeners, and individualization of targets and therapy is tough to translate to, for example, a school caseload and timelines, and people will be apt to look for shortcuts that don’t align with evidence.
You do not need to be specially certified to begin practicing using these principles—NLA is a protocol, but the concepts behind it are not owned by any single person or program.
It can be tough to know whether or how to integrate “new” ideas into our practice, especially when we see them coming primarily from a single source, or a group of people who are all professionally associated with one another. As always, we have to:
Whew—we made it to the end, and hopefully with some food for thought. We’d love to keep the conversation going in the comments; please share your thoughts and lingering questions below so we can all continue learning from one another.
Arnold, C. (2019). Flipping the Script: Prioritizing the Autistic Voice in the Understanding of Scripting as “Key to the Autistic Identity.” [Doctoral Dissertation, University of San Francisco] USF Scholarship Repository. https://repository.usfca.edu/diss/499/ [open access]
Blanc, M. (2012). Natural Language Acquisition on the Autism Spectrum: The Journey from Echolalia to Self-Generated Language. Communication Development Center.
Peters, A.M. (1983). The Units of Language Acquisition. Cambridge University Press.
Prizant, B. (1983). Language acquisition and communicative behaviors in autism: Toward an understanding of the “whole” of it. Journal of Speech and Hearing Disorders. https://doi.org/10.1044/jshd.4803.296 [available to ASHA members]
Prizant, B. M., & Rydell, P. J. (1984). Analysis of functions of delayed echolalia in autistic children. Journal of Speech & Hearing Research. https://doi.org/10.1044/jshr.2702.183 [available to ASHA members]
Stiegler, L. (2015) Examining the echolalia literature: Where do speech-language pathologists stand? American Journal of Speech-Language Pathology. https://doi.org/10.1044/2015_AJSLP-14-0166 [available to ASHA members]
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