Additional Handout December 1 2022

Empowering Communication
through Echolalia:
An Introduction to Gestalt Language

Processing
Adrienne Koenig, M.S.,CCC-SLP
Long Island Speech-Language Hearing Association
December 1, 2022
Introduction
Adrienne Koenig, M.S.,CCC-SLP
Director of Speech Language Pathology at Children's Center for
Communication/Beverly School for the Deaf in Beverly, MA
Certified in Natural Language Acquisition, Completed additional
courses including NSS NLA 1 & 2
Previous collaboration with and teaching by Alexandria Zachos and
Marge Blanc
Previous presentations through Federation for Children with Special
Needs, and Public Lunch & Learn through The Clinic at CCCBSD
I am providing this presentation independently, and have no financial disclosures to report.
Koenig, LISHA Workshop, December 2022

What brought me here

What brought you here?

Agenda
1. Introduction, history & research
2. Understand & identify gestalt vs. analytic development
3. Identification Practice
-BREAK-
4. Support for gestalt processors: starting out
5. Understand & identify stages of gestalt language processing
6. Identification Practice
7. Therapy Application
8. Therapy Practice
9. Resources & Conclusion
10. Questions

Learner Objectives:
Understand background and research
Contrast and identify gestalt vs. analytic processing
Describe shifts in interaction style & therapy approach for gestalt language
processors
Identify 4 main stages of gestalt processing
Outline appropriate therapy goal areas for each stage
Apply concepts to activity & case examples
Identify resources for continued learning

Introduction, History & Research

"delayed echolalia"
"scripting"
"movie talk"
"vocal stereotypy"

"Map says, we have to balance beam walk
over crocodile lake, trampoline jump over
the flowery garden, and swing on the rings
to get to the gym...wow!"

History & Perspectives
Historically.... However....
Scripting & echolalia

was thought of as Delayed echolalia is
"meaningless" part of a
or meaningful, natural
"nonfunctional" developmental
pattern
(Koegel, Lovaas, Schreibman, 1974)

The Research
Language begins not necessarily with words, but with

units of meaning
Babies pull these units from the sound stream
Qualitative research studying bedtime soliloquies
found word babies and intonation babies
Analysis proposed a gestalt pattern in addition to the
traditional analytic acquisition pattern
(Peters, 1977) (Peters, 1983)
The Research
7 immediate echolalia 14 delayed echolalia 4 Stages of Gestalt

Functions: functions: development
Request Direct Non-interactive label
Yes-answer Protest Verbal completion
Declarative Request Turn-taking
Turn-taking Affirm Self-directive
Rehearsal Call Rehearsal
Self-regulatory Situation-association
Provide info
Non-focused Non-focused/ self-
Interactive label

regulatory

(Prizant & Rydell, 1984)

The Research
Synthesis of extensive longitudinal clinical research

Extending to 6 stages of gestalt language development,
incorporates Laura Lee's Developmental Sentence Scoring
Development of Natural Language Acquisition framework
Describing application of research, through therapy and
assessment
(Blanc, 2012)

The Research
Review of existing literature: Examining the Echolalia

Literature: Where Do Speech-Language Pathologists Stand?
(Steigler, 2015)
ASHA, and increasing discussion in the field

The Research
Meaningful Speech Course based on this research
Collaboration between clinicians and families
First hand accounts of Autistic adults of their own gestalt

language processing journeys
Repeating purposefully: Empowering educators with functional
communication models of echolalia in Autism (Cohn et. al, 2022)
The Research

So WHY are we just learning about it now?
GLPs frequently eliminated from studies due to
unintelligibility
Logistically challenging to do controlled
quantitative studies - needs to be longitudinal
Behaviorism -most popular, documented as
nonfunctional & worked to extinguish - lack of
connection w/linguists
(Zachos & Steigler, 2022)

Scripting is not a maladaptive behavior.

Scripting is the first stage of gestalt

language development.

Our kids need our help to advance to the

next stage.


Self-generated language
Analytic Gestalt

Gestalt vs. Analytic Language Processing:

Understanding the characteristics, and learning to

identify your child's processing style.

What is gestalt language development?
A distinct & well researched WHOLE - TO - PART development process

Unit of meaning is a connected chunk (gestalt)
Directly pulled from the environment
Defined by rich intonational contours
Rather than from the words themselves, meaning derived by the emotional
experience
May include lines from movies, TV, songs, video games, books, life
experiences
(Steigler, 2015) (Blanc, 2012)

Stages of "traditional" analytic language development
First words 2 word Simple phrases

combinations growing into
sentences
"mommy "mommy want

"up"
up"
up"

Stages of gestalt language development
1 2 3 4
Whole gestalts Mitigated Isolated words Original simple
gestalts & sentences
(connected units)
(mix & match chunks) recombinations
(Blanc, 2012)
1. 2. 3. 4.
Don't worry, I'll Don't worry, I'll Help me finded

girls playground
help you find your help you find the girls
mama girls
(Zachos, 2021)
The zipper is zipper...backpack!

stuck!
The wheel is
stuck!
backpack...stuck!
It not stucked
anymore!
stuck!


"...as I get more and more phrases

on the hard drive, I can recombine
them in different ways, and then it's
less tape recorder-like..."
(Grandin, 2005)

Who are gestalt processors?
Can occur in ANY child, with or without developmental differences
Occurs in typical & Late talkers Nonspeaking

Common in
diverse prolonged use of children who:
Autistic children,
development jargon vocalize with
as 75% of Autistic
Often not noticed in specific phrases
children use inflection
typical development rich intonation
echolalia replay specific
Requires additional stuck single words sections of
support in
neurodiverse
videos
children preference for
sets
(Blanc, 2012) (NIH, 2021) (Blanc, 2012) (Zachos, 2021)

How do I know my child's style?
Analytic Processing Gestalt Processing

1 word 2 words 3 words Large language bundles, rich intonation
Specific phrases, always said the same

Language is flexible and varies way - inflexible at first
depending on context
Language is tied to emotional
Language is literal, tied to concrete experiences, not concrete referents
referents
Grammar has typical errors Grammar appears accurate

(Blanc, 2012)

Analytic language development
"Ball" > "Red ball" >

"Play red ball" "Fall down!"
"Big dog"

Gestalt language development
"I know where to go to

"The wheel is
find blueberries! stuck!"
Blueberry Hill. To get
"We had such a fun trip
to blueberry hill, first
today. What was your
you go across the icy favorite part!"
cold river....

Analytic Gestalt

Identification Practice

Identification Practice: Gestalt or Analytic?
"3, 2, 1, blast "Be careful!

off!" Not too high
Millie!"
"Let's go fly a kite up

to the highest height
let's go fly a kite..."

Gino is nonspeaking.
He uses AAC and his language has
progressed linearly from 1-2-3 word
combinations, which are primarily
combinations of referential
content words.
His language is literal, and as long
as he and his communication
partners have shared context, most
people understand what he means
right away.

"Dad, park" "Dad, go park"

"Dad, let's go
to the park"
"Park"

Hallie is nonspeaking. Hallie
vocalizes frequently, and it sounds
like jargon. Using her AAC, she
expresses some single words but
has not been observed to combine
words.
Hallie loves to watch her favorite
video clips on YouTube, and her
parents have noticed that she
scrolls to particular parts of videos
based on how she is feeling.

-BREAK-

Supporting gestalt processors: Starting out

Big picture: what's our role?
Listen, acknowledge, find meaning -do the detective work
Work with the child's existing language repertoire AND add to it-
become a language source for the child!
Expand the child's repertoire of useful, flexible gestalts
Break down language to support flexible communication

How can I support gestalt development?
Listen to your Use their voice & Repeat & respond Educate & Collaborate
child & find the intonational style
Validate the meaning in Determine your child's stage of
meaning their scripts - do detective gestalt development
work!
Learn to model gestalts
Model new, useful & according to their stage
easily mitigable gestalts

"Gestalts are the language that fits the context
from which they were derived. And that's all. We
have to remind ourselves often there is nothing
literal about any of this!"
-Marge Blanc
(Zachos, 2021)

Starting out: Doing the Detective Work
What they might say What they might mean
"We made it to the gymnastics show!" "I finished what I was working on"
"I'm nervous to walk down these steep stairs"

"I can't get over the canyon"
"I don't want to do this anymore"

"Game over!"
"Coming soon to a theater near you!" "Something exciting is about to happen"

Starting out: Shifting the approach
Instead of... Try...
Asking direct questions Model language to narrate from their

point of view.
Model options, wait and listen!

Prompting or requiring specific
responses
Use a voice that resonates with them-
play with intonation
Neutral tone of voice
Flexible phrases
Word by word
(Blanc, 2012)

Starting out: What language

should I model?
Personalized, engaging, and developmentally appropriate

Statements, not questions - Narrate!
Model from their point of view
Use "Let's..." "It's..." "We..."
Phrases that are easily changed or "mitigated"
Useful, cross-contextual
Common elements, with variety!
Varied functions (Blanc, 2012)

Diving into the stages

But first...Language Sampling!
Goal: spontaneous, unprompted language

Child-led context
Minimal adult questions, no prompting
After rapport has been built and family connections made- not day 1
At least 50 utterances- more is better
Multiple contexts if possible, include home videos/recordings
Record the sample
Score each utterance by stage, according to NLA
(Blanc, 2012) (Zachos, 2022)

1 2 3 4
Whole gestalts Mitigated Isolated words Original simple
gestalts & sentences
(connected units)
(mix & match chunks)
recombinations
(Blanc, 2012)

Stage 1
Whole gestalts-language is not yet flexible
This can look like...
Long scripts from movies, TV, video games, books, life experiences
Singing or vocalizations with intonation patterns
Unintelligible "jargon"
Stuck single words
In nonspeaking GLPs: Scrolling to replay portions of songs or videos

Stuck Single Words in Stage 1
"break" "outside" "goldfish"
If a child processes language as whole units to be broken down, but has a

vocabulary of only single words, they get stuck. To get "unstuck," we can
model whole chunks of language, and ways to break them down.
(Blanc, 2012)

Stage 1 Examples
"A told B and B told C,

I'll meet you at the
"Game over!!!" "phewf, we're home!"
top of the coconut
tree"
"Who do we ask for

help when we don't "To infinity and
know which way to beyond!" "Okay well, with that
go? the map! the being said..."
map!"

Stage 2
Mitigated Gestalts: Mixing & Matching
Shortened versions of stage 1 gestalts

Mixing & Matching language chunks

Stage 2 Examples
"Phewf, we're +
"To infinity and +
here!"
the swings!"
"A told B and B told

"Who do we ask for help?"
C, I'll meet you at
the top of the +
mommy's car"

Stage 3 Examples
Isolated Referential Single Words, and Noun + Noun or Noun + Adjectives

combinations
This can look like... "swings!" "help!"
"car...parking lot"
"mommy...car"

Stage 4 Examples
Noun + verb combinations growing into early sentences, with hallmark bad
grammar

"Help me up
"We wented in
playground"
mommy's car"
"go car"

Identification Practice

Stage Identification Practice
"cup"
"cup...table" "cup...juice"

"fruit salad,
yummy yummy
yummy!" "I'm rumbly in my
"Wanna drink, tumbly! Time for
Aiden?" something sweet"

"orange juice,
yummy yummy
yummy!"
"Wanna juice, "I'm rumbly in my
Aiden?" tumbly! Time for
something juice"

Therapy Application

Therapy Goals
Wh questions Stage 1 Expand repertoire of useful, mitigable gestalts w/variety
Stage 2 Mitigate! Model mixing & matching language chunks

Utterance length
Stage 3 Isolate words, model noun + noun and noun + adj
Vocabulary
Stage 4 Early sentences, hallmark bad grammar to be expected
(Zachos, 2021)

Therapy Activities
Adult-led Child-led (Hanen Early Language Program, 2011)
Movement
Tabletop
Play & varied, natural, motivating,
Flash cards & contrived tasks
contexts
(Zachos, 2021)

Therapy Example- stage 1
"come on, let's

"I see one!"
go!"
"Where'd they
"that was
go?"
awesome!"
"Let's find some "Let's do it

butterflies" again!"

"come on, let's + "Let's find some

see one!" + again! "
"Where'd + some
butterflies?" "that was +
cool!"

"butterflies...grass" "see?"
"butterflies...cool"
"Butterflies!"
"butterflies...sky"

"where's the blue

butterfly goed?"
"Did you sawed

"we finded some it?"
butterflies!"

Practice Therapy Example- stage 1




Gestalt Processing and AAC
(Zachos, 2022)
Gestalt Processing and AAC
We do not have external empirical evidence from studies yet.
We DO have client/family perspectives, and clinical expertise.
AAC systems are designed for ALPs- but our end goal is the
same
Use a robust system
Don't start from scratch, just customize!
Feature match
Program gestalts into the device!
Consider voice output/media capablities
Apply NLA and GLP reccs within your AAC therapy (Zachos & McLaughlin 2022)
(Zachos & Hayes, 2022)

Practice: What would you do?
In a team meeting, Brayden's

teachers report that he frequently
recites lines from his favorite TV
show during various parts of his
school day. They say that this is an
interfering behavior, and suggest a
behavior plan to encourage
Brayden to have a "quiet voice" and
stop his "TV talk."

Practice: What would you do?
Nicholas is 15, and has been a student in a
traditional special education classes since
kindergarten. His school work has included many
labeling tasks and Wh question type activities. He
communicates using speech, in single words and a
handful of learned phrases which he always speaks
the same exact way, with the same intonation
pattern. He shows preferences for completing
routines in consistent ways. He has not been
observed to combine words in new ways in new
situations. In talking with his mother, you learn that
he used to recite lines from Shrek when he was
younger. Nicholas' mother shares that she feels he
has been stuck with his language for a long time.
Conclusion & Resources

Analytic Gestalt

Resources for Continued Learning
Natural Language Acquisition on the Autism Spectrum:The Journey
from Echolalia to Self-Generated Language
Marge Blanc, M.A., CCC-SLP
https://communicationdevelopmentcenter.com/
Links to many articles, handouts, videos, courses,
https://www.meaningfulspeech.com/
Links to podcast episodes, articles, courses, resources
Instagram: @MeaningfulSpeech
Alexandria Zachos, M.S., CCC-SLP

https://www.youtube.com/@meaningfulspeech
https://www.youtube.com/@NJAutismCenterofExcellence
30 Minute Educational Introduction

https://www.youtube.com/watch?v=K4geAuv1Tog
ASHA Webinar

Lilian Steigler, PhD., CCC-SLP

Examining Echolalia Literature: Where Do Speech
Language Pathologists Stand?

Available at:
https://communicationdevelopmentcenter.co
m/wp-content/uploads/2022/09/Units-of-
Language-Acquisition.pdf
Barry Prizant, Ph.D., CCC-SLP

https://barryprizant.com/resources/downloads/
Echolalia articles available for download

Questions?

Bibliography
Alexandria Zachos [@meaningfulspeech]. (2021, February 10). "Hey SLPs, Recognize this line from Dora One of my clients always said "Don't worry, I'll help you find your" [Graphic].
Instagram. https://www.instagram.com/p/CLIkOe9hYyo/
American Speech Language Hearing Association (n.d.). Echolalia and its role in gestalt language acquisition.
Blanc, M. (2012). Natural Language Acquisition on the Autism Spectrum: The Journey from Echolalia to Self-Generated Language. Madison, WI: Communication Development Center, Inc.
Blanc, M. 2005. “Finding the Words: To Tell the Whole Story—Natural Language Development on the Autism Spectrum,” Autism Asperger’s Digest, May/June, July/Aug, Sept/Oct, Nov/Dec.
Blanc, M. (n.d.) Natural Language Acquisition on the Autism Spectrum: Echolalia to Self-Generated Language, Level 1. Northern Speech Services.
https://www.northernspeech.com/echolalia-autism/natural-language-acquisition-in-autism-echolalia-to-self-generated-language-level-1/
Blanc, M. (n.d.) Natural Language Acquisition on the Autism Spectrum: Echolalia to Self-Generated Language (Treatment), Level 2. Northern Speech Services.
https://www.northernspeech.com/speech-language-acquisition/natural-language-acquisition-in-autism-echolalia-to-self-generated-language-treatment-level-2/
Blanc, M., Steigler, L., Zachos, A. (2021). From Echolalia to Self-Generated Language: Case Studies in Natural Language Acquisition. [On Demand Webinar]. ASHA.
https://apps.asha.org/eweb/OLSDynamicPage.aspx?Webcode=olsdetails&title=From+Echolalia+to+Self-Generated+Language%3a+Case+Studies+in+Natural+Language+Acquisition+
(On+Demand+Webinar)
Cohn, E. G., McVilly, K.R., Harrison, M.J., & Stiegler, L. N. (2022). Repeating purposefully: Empowering educators with functional communication models of echolalia in Autism. Autism &
Developmental Language Impairments, 7, 1-16. https://doi.org/10.1177/23969415221091928
Frawley, W., & Peters, A. M. (1985). The Units of Language Acquisition. Language, 61(1), 235. doi: 10.2307/413467
Gerber, S. 2021. "The use of scripts with children on the autism spectrum disorder: a puzzle and an opportunity." Emerging programs for Autism Spectrum Disorder.
https://doi.org/10.1016/B978-0-323-85031-5.00025-6
Grandin, T. 2005. “Conversations with Kathleen Dunn,” Wisconsin Public Radio, NPR, February 18.
Manning, A. L., & Katz, K. B. (1989). Language-learning patterns in echolalic children. Child Language Teaching and Therapy, 5(3), 249–261. doi: 10.1177/026565908900500301

Bibliography
Meaningful speech - echolalia education. Meaningful Speech-Echolalia Education. (n.d.), from https://www.meaningfulspeech.com/
Meaningful Speech. (2021, November). Lunch and Learn with Speech-Language Pathologist and AAC Specialist Kate McLaughlin. [Video}. YouTube. https://www.youtube.com/watch?
v=SY9T5bshCPc
Meaningful Speech. (2022, November 10). AAC + Gestalt Language Processing LIVE Q and A. [Video}. YouTube. https://www.youtube.com/watch?v=JKZ1u4QHWQ8
Meaningful Speech (2022, February 25). Lunch and Learn with Dr. Lilian Steigler. [Video]. Youtube. https://www.youtube.com/watch?v=oILlxoP5BuM
Patra, K.P. & De Jesus, O. (2021). Echolalia. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK565908/
Peters, A. (with Blanc, M.). (2021). The Units of Language Acquisition. Cambridge University Press. (Original work published 1983).
Peters, A. (1977). Language Learning Strategies: Does the Whole Equal the Sum of the Parts?. Language, 53(3). https://doi.org/10.2307/413177
Prizant, B.M. & Rydell, P.J. (1984). An analysis of the functions of delayed echolalia in autistic children. Journal of Speech and Hearing Research, 27, 183-192
Prizant, B. M. (1983). Language Acquisition and Communicative Behavior in Autism. Journal of Speech and Hearing Disorders, 48(3), 296–307. doi: 10.1044/jshd.4803.296
Prizant, B.M. (1983). Language and communication in autism: Toward an understanding of the Whole of it. Journal of Speech and Hearing Disorders 48, 296-307.
Prizant, B.M. & Duchan, J.F. (1981). The functions of immediate echolalia in autistic children. Journal of Speech and Hearing Disorders, 46, 241-249
Steigler, L. N. (2015). Examining the Echolalia Literature: Where Do Speech-Language Pathologists Stand? American Journal of Speech-Language Pathology, 24(4), 750–762. doi:
10.1044/2015_ajslp-14-0166
Zachos, A., Meaningful Speech Echolalia Education. Kajabi. www.meaningfulspeech.com

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Empowering Communication

An Introduction to Gestalt Language

I am providing this presentation independently, and have no financial disclosures to report.

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

Contrast and identify gestalt vs. analytic processing

Identify 4 main stages of gestalt processing

Outline appropriate therapy goal areas for each stage

Apply concepts to activity & case examples

Identify resources for continued learning

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

Scripting & echolalia

Koenig, LISHA Workshop, December 2022

Language begins not necessarily with words, but with

7 immediate echolalia 14 delayed echolalia 4 Stages of Gestalt

Koenig, LISHA Workshop, December 2022

Synthesis of extensive longitudinal clinical research

Koenig, LISHA Workshop, December 2022

Review of existing literature: Examining the Echolalia

ASHA, and increasing discussion in the field

Koenig, LISHA Workshop, December 2022

Meaningful Speech Course based on this research

Collaboration between clinicians and families

First hand accounts of Autistic adults of their own gestalt

Koenig, LISHA Workshop, December 2022

(Zachos & Steigler, 2022)

Koenig, LISHA Workshop, December 2022

Scripting is the first stage of gestalt

Our kids need our help to advance to the

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

Understanding the characteristics, and learning to

Koenig, LISHA Workshop, December 2022

A distinct & well researched WHOLE - TO - PART development process

(Steigler, 2015) (Blanc, 2012)

Koenig, LISHA Workshop, December 2022

First words 2 word Simple phrases

"mommy "mommy want

Koenig, LISHA Workshop, December 2022

Don't worry, I'll Don't worry, I'll Help me finded

The zipper is zipper...backpack!

Koenig, LISHA Workshop, December 2022

"...as I get more and more phrases

Koenig, LISHA Workshop, December 2022

Occurs in typical & Late talkers Nonspeaking

Koenig, LISHA Workshop, December 2022

Analytic Processing Gestalt Processing

Specific phrases, always said the same

Grammar has typical errors Grammar appears accurate

Koenig, LISHA Workshop, December 2022

"Ball" > "Red ball" >

Koenig, LISHA Workshop, December 2022

"I know where to go to

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

Koenig, LISHA Workshop, December 2022

"3, 2, 1, blast "Be careful!

"Let's go fly a kite up

Koenig, LISHA Workshop, December 2022