Continuing the conversation about echolalia and gestalt language development: A response to Haydock,Harrison,Baldwin,and Leadbitter

Abstract

Although gestalt language development incorporates some neurodiversity-affirmative strategies (e.g. embracing echolalia), it is also associated with numerous ideas, assertions, and clinical strategies that lack theoretical and empirical support. For this reason, we believe it is premature to embrace gestalt language development as a neurodiversity-affirmative practice. Given the potential for miscommunication, we must strive for clarity and precision in our terminology (e.g. making a clear distinction between delayed echolalia and the broader set of ideas that comprise gestalt language development). The field of autism will benefit from in-depth discussions about the relationship between neurodiversity-affirmative practices and evidence-based practices.

Lay Abstract

It was recently suggested that a set of ideas known as gestalt language development be embraced as a neurodiversity-affirmative practice. Neurodiversity refers to the idea that people interact with the world in many different ways and that there is not a single right way to do so. Some aspects of gestalt language development, such as embracing autistic communication, are consistent with neurodiversity. However, gestalt language development is also associated with numerous ideas, assertions, and clinical strategies that lack theoretical and empirical support. For this reason, we believe it is premature to embrace gestalt language development as a neurodiversity-affirmative practice. We propose that it is important to make sure we use language that differentiates between delayed echolalia and the broader set of ideas that comprise gestalt language development. We also suggest that it is important to discuss the relationship between neurodiversity-affirmative practices and practices supported by research evidence.

We start by noting that we are non-autistic researchers and speech-language pathologists. Although there is much that we bring to the conversation, there are many experiences we have not had. We come not with answers, but with ideas we hope will inform ongoing conversations.

Haydock and colleagues (2024) recently proposed that embracing gestalt language development (GLD) is a fundamental neurodiversity-affirmative practice. Like many discussions of GLD, they focused largely on the importance of valuing autistic communication, including delayed echolalia. They stressed that echolalia is an important form of communication; that it is harmful to pathologize echolalia and try to reduce or eliminate it; and that interventions should help non-autistic people recognize and value autistic communication. We wholeheartedly agree that valuing autistic communication, including echolalia, is a fundamental neurodiversity-affirmative practice. However, we believe it is premature to embrace GLD.

Although embracing echolalia is one aspect of GLD, the concept of GLD goes far beyond valuing autistic communication (Blanc et al., 2023; Communication Development Center, 2024; Meaningful Speech, 2024; Prizant, 1982, 1983). ¹ It proposes that there is a distinct category of children who are gestalt language processors (GLPs); that GLPs move through developmental stages, starting with production of gestalts (i.e. chunks of language), progressing to single words, and ending with generative multi-word utterances; and that GLPs commonly do not understand the words that make up the gestalts they produce. In fact, Marge Blanc, a speech-language pathologist widely viewed as the authority on GLD (Haydock et al., 2024), recently stated that GLD is “not just a euphemism for child-led therapy that honors echolalia” (Blanc & Carter, 2024). Thus, embracing echolalia is not synonymous with embracing GLD. This is an important distinction because many of the core ideas associated with GLD lack theoretical and empirical support (Hutchins et al., 2024). Here, we describe five issues that we believe are important for the field to consider in continued discussions about echolalia and GLD.

There is a lack of empirical research on GLD

Haydock and colleagues describe GLD as an alternative developmental pathway wherein children “. . . learn language in longer chunks, known as gestalts: whole phrases, sentences or conversations heard in real life or through media, memorised and reproduced verbatim . . .” (Prizant, 1982; Prizant & Rydell, 1984) (p. 1055). To our knowledge, however, no empirical, peer-reviewed research studies have investigated the existence of a gestalt language acquisition style, evaluated criteria for identifying GLPs, or attempted to characterize what such an alternative developmental pathway might look like (also see Hutchins et al., 2024). ² As stated by Evans (2022), there is a lack of “. . . clear criteria for designating someone as a gestalt processor . . .” and, “It’s unclear whether it even makes sense to talk about kids as either analytic or gestalt processors . . .” Although clinical language samples and anecdotal observations are valuable sources of information, empirical studies play a unique and necessary role in evaluating hypotheses about pathways of language development in autistic children.

Spoken language samples are not sufficient for investigating language processing

From its inception, GLD been conceptualized as a style of language processing that describes how children make sense of and learn from the spoken language they hear (Blanc et al., 2023; Prizant, 1983). However, there is a discrepancy between the characterization of GLD as a language processing style, and the information that is typically used to support claims about GLD—delayed echolalia (Blanc et al., 2023; Prizant, 1983). ³ Although examining echolalia is informative (Cohn et al., 2022; Luyster et al., 2022), spoken language samples are not sufficient for addressing claims about language processing (i.e. receptive language; language comprehension). Methods that do not rely on spoken language production, including eye tracking, ERP (event-related potentials), and functional neuroimaging, can be used to measure language processing in autistic children and adults.

Increased conceptual clarity may help facilitate research on GLD

In addition to incorporating language processing measures, future studies of GLD will benefit from increased clarity around what constitutes a gestalt. Longitudinal research on GLD would presumably involve not only identifying clear instances of delayed echolalia (e.g. repetition of dialogue from a movie) but also comprehensively determining which of a child’s spoken utterances are (and are not) gestalts. Gestalts are commonly defined as verbatim repetitions (i.e. delayed echoes) of previously heard phrases, sentences, or conversations (Blanc et al., 2023; Communication Development Center, 2024; Meaningful Speech, 2024). ⁴ However, Blanc and colleagues have also stated that gestalts can be single words or sounds. Although this may appear to be only a minor adjustment, it seemingly contradicts the initial conceptualization of a gestalt as the repetition of a multi-word utterance. Furthermore, it is unclear how single-word or single-sound gestalts could be differentiated from “non-gestalt” repetitions of words or sounds that children have previously heard. ⁵ Even descriptions of multi-word gestalts contain inconsistencies (Evans, 2022; Hutchins et al., 2024; Luyster et al., 2022; Stiegler, 2015). Conceptual clarification may help pave the way for rigorous studies of GLD.

GLD may lead people to underestimate what autistic children understand

A core assumption of GLD is that gestalts are often produced “. . . without an implicit understanding of the gestalt’s lexical, semantic, or syntactic structure . . .” (Haydock et al., 2024, p. 1055). We are unaware of any research demonstrating that autistic children fail to comprehend lexical, semantic, or syntactic aspects of the delayed echolalia they produce, or that they comprehend spoken utterances as a single unit of meaning (i.e. a “chunk”). ⁶ To the contrary, numerous studies have shown that autistic children process spoken utterances word-by-word as they unfold, rather than as a single unit (Bavin et al., 2016; Brock et al., 2008; Prescott et al., 2022; Venker et al., 2019; Zhou et al., 2019). Assuming that autistic children do not understand what they say, without clear evidence that this is the case, runs counter to neurodiversity-affirmative practices.

Some clinical strategies associated with GLD lack support and contradict well-established practices ⁷

Based on how GLPs are hypothesized to learn, adults are advised to use specific language modeling strategies at different stages of GLD. Although these strategies were not explicitly discussed by Haydock and colleagues, we believe they are important to bring to the conversation because they are a central part of current descriptions of GLD and the closely linked Natural Language Acquisition protocol (Blanc et al., 2023). When working with GLPs at Stage 1, adults are instructed not to say single words. They are advised that if they do, those words “. . . will be processed as ‘unmitigable’ gestalts—and will be in [their] child’s head forever” as “stuck gestalts” (Communication Development Center, 2024). This statement is unsupported. Furthermore, there is evidence that hearing single words can be beneficial for child language development (Lew-Williams et al., 2011). For GLPs at Stage 3, adults are advised: “No grammar. No verbs. Save that for Stage 4” (Communication Development Center, 2024). Withholding verbs and grammar is inconsistent with well-established practices and is likely to be detrimental to language development.

Conclusion

Given these concerns, we believe it is premature to embrace GLD as a neurodiversity-affirmative practice. Although GLD incorporates some neurodiversity-affirmative strategies (e.g. embracing echolalia), it is also associated with numerous ideas, assertions, and clinical strategies that lack theoretical and empirical support (Hutchins et al., 2024). It is crucial to engage in deep discussions about the relationship between neurodiversity-affirmative practices and evidence-based practices in the field of autism. Such discussions may reveal that the field is not yet at the point of discussing how GLD can inform clinical practices such as assessment, goal setting, language modeling strategies, and the design of augmentative and alternative communication (AAC) systems. Given the potential for miscommunication, we must also strive for clarity and precision in our terminology (e.g. making a clear distinction between delayed echolalia and the broader set of ideas that comprise GLD). We hope the issues raised here will help facilitate constructive discussions about echolalia and GLD.