Supporting Gestalt Language Processors to Keep Scripting

Closing The Gap Solutions e-Magazine, October / November 2024 Volume 43 - Number 4

augmentative and alternative communication (AAC)

Supporting Gestalt Language Processors to Keep Scripting Summary: This article will help the reader approach Gestalt Language Processors with a new lens. Through a strong understanding of the value of neurodiversity, we can learn to appreciate the functionality of scripting. The article will discuss identifying when someone is not getting their needs met through their current use of gestalts and scripts, and how to help them meet those needs. Self-advocacy in editing is highlighted as a necessary skill to teach.

In the world of speech-language pathology, Gestalt Language Processors (GLPs) have become a major topic of conversation. Augmentative and Alternative Communication (AAC) is a pow- erful tool that can make a real difference for both speaking and nonspeaking GLPs. Because many people are new to GLP, or AAC, or both, goals are often messy. While recognizing GLPs is ideally part of neurodiversity-affirming practice, if you’re not careful, neu- rodiversity-affirming can be a buzzword, rather than real change to your way of thinking. If we really believe that Gestalt Language Processing is sim- ply one of two equally valid ways of learning and understanding language, then we must accept that gestalts and scripting serve a valuable purpose for the GLP. We can’t assume that the best way for that person to communicate is to transition entirely into sounding and acting like a neurotypical person. We don’t just val- idate existing scripts, but encourage new ones, and continuing to script when it’s useful, even when more flexible language is avail- able. One note before we dive in: While this article attempts to be accessible to as many as possible, you will get the most out of it if you already have some knowledge of Gestalt Language Pro- cessing and some knowledge of AAC. A quick primer is available through my blog article on the AssistiveWare website.

THE PATH LESS TAKEN A gestalt is a chunk of words being processed as one unit of meaning. For example, most children (and adults!) process "you're welcome" as a gestalt. They aren't thinking about putting togeth- er the meaning "you" "are" "welcome" — they are only seeing the whole. All children have some gestalts, even if they mostly start speaking word-by-word. However, for some children, gestalts are the default rather than the exception. We can call these children Gestalt Language Processors. (Some people have features of both analytic and gestalt language processing styles. Think of catego- ries like“GLP”as useful tools to give us a starting point, rather than perfectly contained groups.) GLPs don’t necessarily need to be seen by an SLP. It is a natural development of language, even if it is less common, and many GLPs move to word-by-word generation naturally. However, some GLPs, many of them autistic, stay stalled in the earlier stages of language development. These children can be easy to identify when they are speaking because they speak mostly in ‘scripts’ or ‘delayed echolalia’. This means they repeat phrases they have heard before, often out of context, as their primary way of communicating.

LILY KONYN (she/her) is an AAC researcher and support team member with AssistiveWare. As a part-time AAC user, family member to an AAC user, and AAC professional, Lily offers a unique perspective in the field. In 2021, Lily graduated from CSUN with a degree in Assistive Technology and Human Services. Over the past three years, Lily has focused on researching AAC user perspectives, as well as adding nuance to the conversation about Gestalt Language Processors.

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his AAC sentences sounded less complex than the echolalia he spoke in, they were words of his own. - THINKING FROM A NEURODIVERSITY LENS Neurodiversity is the reality that human brains come in a great deal of variety. The neurodiversity paradigm posits that this vari- ety is a normal and beneficial part of human diversity. TIf we ac- cept this variety of brains as beneficial, the extension of this is that brains that diverge from the societal ‘norm’ (I/DD, mental health conditions, learning disabilities, etc) do not need to be changed. The neurodiversity movement started in 1990 as part of, and a re- action to, the social model of disability. Many practitioners have begun to embrace the neurodiversity movement, but have not yet fully understood the foundations of the movement. This can end up looking that using identity-first language, acknowledging GLPs, but still writing goals that aim for the GLP to look ‘indistinguishable’ from a neurotypical speaker. When setting goals for GLPs, it’s essential to think beyond typ- ical language use and focus on meaningful goals. It's about sup- porting their ability to communicate effectively and authentically, not just conforming to conventional language norms. Many ideas that we have about how a GLP will develop are straight lines from ‘echolalic speaker’ to ‘typical speaker’. Yet many of their current communication strategies might be working for them just fine, or they might be better supported by adding more gestalts even once they are able to use single words. We can set goals based on skills that really are crucial, and support those skills with scripts or single words. For instance, the first skill to learn might be repairing com- munication breakdowns. GLPs are frequently misunderstood, because their listeners don’t understand what their gestalts truly mean. Early AAC customization may be adding phrases to help them explain themselves: “that’s from my favorite TV show”, “this situation is reminding me of a quote”, or “that’s not quite what I meant”. Before changing a way that someone communicates, identify whether it is working for them or not. This means starting by be- ing a detective. What need is the script or gestalt meeting? Is it helping with sensory needs? Social? Once the need is identified, you can ask yourself: Is this scripting meeting that need? If it isn’t, that’s when it’s time to step in. A script meeting a need might look like someone walking away from interactions that start seeming happy with how the interac- tion proceeded. It might look like someone successfully getting other people to leave them alone. An unmet need can look like frustration, or like being frequently misunderstood by others. Ian’s scripting was meeting his needs . . . until suddenly it wasn’t. Ian loves to talk to people about his favorite dinosaur documenta- ries. His family knows that when he brings a quote to them, it’s likely a conversation starter. Now that he’s in school, he gets frustrated that people don’t know what to do when he talks to him, and often they

Nonspeaking GLPs can be more difficult to identify. You may find lists of traits that suggest someone is a GLP when they are nonspeaking. These lists often overlap with behaviors that are typical of most children. By building a true foundation of what it means to process via gestalt, it becomes easier to understand the difference. For example, most children like music, but a GLP might insist that “The Wheels on the Bus” be played every time they hear a baby crying and be inconsolable if the singer is partic- ularly off-pitch. The good news is that you don’t have to be per- fect at identifying a nonspeaking Gestalt Language Processor. If you’re not sure, it doesn’t hurt to try different strategies and see what works, especially since many AAC strategies stay the same for GLPs. Liza watches game shows at the same time every night. During the day, she shares that she wants to transition to a new activity by singing the closing song of Jeopardy! and imitates the buzzer sound when she has made a mistake. A few times, she has found an old epi- sode of a game show online while her family is talking, only for them to see that the moment Liza has chosen from the episode is related to their story. - AAC BENEFITS ALL GLPS We have improved immensely as a field at making sure non- speaking people have access to robust AAC, although there’s a lot of room to grow in this regard. However, we are still in the infancy of understanding the benefits of AAC to speaking people. AAC can significantly improve auditory processing by provid- ing a visual representation of language. Auditory processing is- sues make it more difficult to find word boundaries and to hear a word the same way every time, which are vital parts of learning to understand and produce words. By visually demonstrating the building blocks of language, AAC can help GLPs actively see word boundaries, grammar conjugations, and how concepts may be categorized into groups. Many AAC users have expressed that there are times they are only able to use echolalia via speech, while with AAC they can express significantly more. This suggests that someone’s brain might not be “stuck” in a stage of GLP; rather, their vocal system hasn’t caught up to their receptive understanding. My personal experience as an AAC user who mostly speaks is that sometimes echolalia comes out much more smoothly than other words. There are times when the echolalia “stuck in my head” is too loud to let the authentic words come out. There are other times when I can’t twist my tongue around any words but ones I’ve used before. This doesn’t mean my overall language pro- cessing or language development is delayed. It means I need my AAC. When Aaron’s aide started modeling AAC, it was a relief. He could focus on the letters and pictures, and stop struggling to differentiate her words from the background sounds. His performance in class im- proved, but Aaron’s teachers were more excited by his AAC use. While

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turn away. He works with his SLP and family to start off with “can I tell you something cool?”, so that more people will have dinosaur conver- sations with him. - PRIORITIZE SELF-ADVOCACY IN EDITING Involving AAC users in choosing and editing their vocabulary is crucial. Even early AAC users should have a say in the words and phrases available on their devices. This involvement can be facil- itated through direct input from the user or by observing their interests and preferences. Even very young people or very emergent AAC users should be allowed to make changes to their device. Their first changes may come from their supporters observing what they are satisfied with and when they seem frustrated with the device. For example, if a child consistently shows interest in certain activities or top- ics, incorporating related phrases and even audio recordings into their AAC system can make it more engaging and relevant. The next step might be modeling and teaching them to ask for additions. “I need something added to my AAC” is an import- ant phrase to have available, allowing the user to point to books, videos, and things in their environment. This can greatly reduce the addition of useless or counter-productive phrases, as the AAC user determines what is important to them. Eventually (and earlier than you think!), a user must be allowed to edit their device themself. Don’t be afraid to let them make mis- takes! Save frequent vocabulary backups, and teach skills such as word prediction and audio recording. Leanore loves to talk about SpongeBob and have people join in her SpongeBob scripts. She often walks up to people and scripts about SpongeBob, but is disappointed when they don’t reply. Lea- nore is learning to use a symbol-based AAC app on a tablet. Lenore’s dad offers a few different phrases to add, and Lenore shows the most enthusiasm when they try out “do you want to talk about SpongeBob with me?” and “this is my favorite part!”. - AVOIDING MISTAKES IN GOAL-SETTING Valuing scripting and gestalts does not necessarily mean add- ing lots of phrases to single buttons in their AAC system without the input of the user. Before applying advice meant for speaking GLPs to AAC users, it’s important to understand the principles behind the advice. What works for speaking GLPs might not always be appropriate for those using AAC. My long term goal for a GLP is that they be able to formulate their own novel utterances. I have to be able to see how the path there might vary between speech and AAC. One example is that, in Stage 1, with a speaking GLP, we are offering them lots of phrases to pick up as gestalts. When I really pause to think about what this does for them, I start to question adding a lot of phrases on buttons. If I am a speaking GLP and pick up a gestalt that is offered to me, my mouth and vocal folds are practicing not only that gestalt, but each word and sound within

that gestalt. This makes it simple when I am ready to break up that gestalt - I already have the motor memory of each word in me, all that needs to be developed is my language processing systems. In contrast, if I am a nonspeaking GLP and someone puts a whole phrase on one button, I have learned none of the skills I need to break that gestalt up later. I haven’t learned the locations of each word, and I haven’t seen how to conjugate in my system. I haven’t practiced navigating folders or using the message win- dow. This makes it unlikely that I’ll show when my language devel- opment is ready to move to new stages, because I don’t have the motor memory or operational competency. Professionals might better support nonspeaking GLPs by choosing a set of phrases to model word-by-word. It can feel com- plex to have multiple button presses to say one thing, but that’s what speech is as well - a sequence of complex motor movements. When phrases are added, they should be phrases that will contin- ue to serve the user even as they are transitioning to new stages of language development, or phrases that the GLP is already us- ing vocally (because that indicates to us that the GLP themself has decided that that phrase is important). NOTHING IN A VACUUM AAC doesn’t happen only in the speech room. Families play a critical role in supporting AAC users and ensuring the system is used consistently and effectively. However, it’s easy to end up talking past one another when you’re trying to teach the family how to support their AAC user. Take a step back if you need to, and engage in some perspective-taking. Involving families in goal setting and vocabulary creates fam- ily ownership over the device. Encourage families to participate in these processes by seeking their input and permission before making changes. Families can offer valuable insights into prefer- ences and routines, making the AAC system more personalized and effective. Often families are already engaging in communi- cation repair for their GLP, by saying things like “he’s telling you about his favorite movie” or “that means he’s happy”. Use those things for communication repair phrases and communication re- pair practice with the GLP. For the nervous family, this role of vocabulary editing means new confidence and ownership, which creates more use of the device. For the confident family, you show that you believe they are the expert in their child, and you channel their energy to a very useful place. Sometimes a family who is confident in editing is secretly very uncertain about their ability to implement. When they see that you value their editing, it can be easier to suggest that editing time may be taking away from modeling time. Talk together about what goals they are trying to achieve with their editing. You may learn that they are really trying to fill a gap in a certain communication function.

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CASE STUDY PRACTICE Try out being a detective, asking what need is being met, and whether it is being met effectively, with this example client. Think how you might meet the needs that are not met, whether through providing a script, single words, or changing the environment. • Vida recites whole episodes of her favorite television shows loudly when it is noisy. People who know her well know they should quiet down the room and back off, because this warms of a meltdown. • Vida smiles and laughs when others join her in reciting fa- vorite TV lines. • After years of non-GLP customized therapy, Vida uses single words to tell others where she’s going or to request specific things. • Vida has not been offered an AAC device, but really likes computer and iPad games Positive attitudes towards neurodiversity have been growing in the past few years. It’s wonderful to see more people acknowl- edge the value in having a diversity of minds in our world. The process of learning to be neurodiversity-affirming in your work means questioning your assumptions about what your goals should be. With any client, take a step back and work with them to picture their ideal future for themself. The goals will follow. Language throughout this article follows the preferences ex- pressed by AAC community members in research conducted by my- self and my research partner Alyssa Hillary Zisk at AssistiveWare. You can read more about this research here: (https://www.assistiveware. com/blog/how-to-talk-about-aac).

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