Latest / AAC Access All Areas / How do I set up AAC for a Gestalt Processor?
Transcript
- Ali Battye: Hello and welcome to AAC Access All Areas. My name is Ali Bhatti. Ruth: I'm Ruth Jones. Today's episode question is, how do I set up AAC tools for my Gestalt language processor? And I think, Ali, it makes sense to head to you for a really good definition of it. Ali Battye: Yeah, so what is Gestalt language processing? It's a very long term. It basically means, gestalt means whole, like the whole experience. And we often see a tendency in autistic children to really like that whole experience early on in their development especially. So they might like to collect the whole alphabet or they like to recite a story in its entirety. ⁓ If something has unfolded in a particular way the first time they did it, they kind of expect or like it to unfold in exactly that way the second time. So an example that I often give is, say you've taken your child to see the doctor and the time that they remember going, they had like a crackly chest or something and the doctor had to listen to their chest with a stethoscope. But then when you go again, say six months or a year later, It's actually they've got an ear infection this time, but they would still lift up their top for the doctor to listen to their chest and because often We see that these children have absolutely brilliant episodic memories and you might notice that in your everyday life like I've had parents say yeah, my child remembered like which hotel we stayed in five years ago and they were only like 18 months old at the time or the lay-by where we broke down on the motorway and So yeah, this brilliant memory seems to work for listening to language as well. So in Gestalt language processing, children who have this tendency might pick up like chunks of language more easily than single words. So Ruth and I were both trained as pretty much every speech and language therapist is trained that the way into language, the first step is that children will learn single words first then they'll you know about a year later they'll start to combine those single words into little phrases so you know they might have the word biscuit and sock and then they'll start combining that with like more biscuit or biscuit gone or get ⁓ sock but in gestalt language processing it doesn't really happen like that so children will pick up like whole chunks of language it may not be clear so we might hear something like... then it gets more clear, we might also realise that that actually is a line from, Peppa Pig or Hey Dougie or something that we said last week. It's just very unclear because there's child's speech is unclear at that stage. And probably for the listeners, you're thinking, what if my child is a non-speaker or if they're minimally speaking, how would I know if they're a Gestalt language processor? And really one of the key things, ⁓ a few key things but one of the key things is they might really like when they're watching YouTube kids to rewind and replay the same little clip over and over again or you might notice those like the tune of language so they might not have very clear speech sounds but you might hear that they're saying something in exactly the same tone each time like and it's always like that and it might be something like Where's my drink gone or something? But it's just really unclear at this time. And another thing just to sort of look out for would be that like really engaging with songs and music. Because I think it tends to go with a real appreciation for music and musical language. So yeah, sorry. That was a real, you can tell it's one of my favourite subjects, can't you? Ruth: Well one thing I'm also thinking about is that you know what we notice is that for a lot of our children like I quite like the concept of this being a language continuum and there's kind of that really analytical language that single words two words together three words together at one end and our gestalts at the other and some children will kind of move along that continuum in different places some sit really heavily at one end some might be at the other some might sit sort of a bit of a crossover but Ali Battye: Yeah. Yes. No. Ruth: I think what I notice a lot with our Gestalt language process is at that end of the continuum is that sort of musicality and that intonation. But I think also when I sing, they tell me to stop and it's because I'm not very good at singing. And so you might find if you've got a child who seems to like music but doesn't like you singing, if you are not pitch perfect, you could be, that could also be an indicator that actually really sees it with me singing. Ali Battye: Amen. Yeah. Yes. It could. Yes, yes. And that's a bit confusing, isn't it? So the analogy I like to give is think about your absolute favourite song. recorded song. Do you ever like anybody to do a cover version of it or would you like to hear someone murder it on karaoke? And you probably wouldn't because the original is just so perfect and expresses that emotion that we're really wanting to tune into and somebody else doing it in a different voice or different instrumentation or just something else that feels a bit off, it's too slow, it's too fast, it's too high pitched or low pitch, wrong kind of ⁓ vocal, timbre, the sound of the voice, it's just not the same. ⁓ So particularly like for children's favourite Gestalt, their favourite songs or phrases, the most meaningful ones, they probably don't appreciate a change to that. It's just too perfect already. Ruth: Yeah, absolutely. ⁓ And I think the other thing I'm also thinking about is kind of those indicators is when we think about children with spoken language, we might think about them being quite stuck in like a particular phrase and a particular script that they use, or it might be they have some single words that kind of they seem to be using in context, but they never really grow that. So it doesn't that kind of process where They've got a single word, they're not really attaching anything else to it. And I think we can see the same if you have a child who's already got an AAC device where they kind of get a bit stuck in the same sorts of I want this or just single words. And so if you've been doing lots of modeling and you kind of not necessarily seeing that growth in their language with a single words sort of teaching method with AAC systems. Ali Battye: you Ruth: I think sometimes that might just be a moment where you could then sort of reflect and think, ⁓ I wonder, you know, so some of the things that, that you've talked about there, Ali, as people are listening and kind of thinking, ⁓ well actually my child does like to watch that same sequence out of Peppa Pig, or they do listen to that same bit of a song or that chunk of a movie. And you're thinking how much progress are they making with their AAC? It could be worth listening on to the rest of this episode as we go into what things might you be thinking about as you're setting up an AAC. Ali Battye: Yes. Ruth: system for a GLP-er. Ali Battye: Yes, yes, yes. And it's worth saying at the outset that we're not going to take anything away from one of those standard AAC app vocabularies. So all of the ones that we talk about probably in every episode. So, you know, grid for iPad, TD snap, proloquo, proloquo to go. ⁓ They already have the vocabulary and like a really full rich vocabulary for future language growth. So we don't want to remove that at this stage. This child is going to need that. But we might consider adding some more gestalt like language to offer alongside it. And you know, if you've got a minimally speaking child or a child who has unreliable speech, which means sometimes they have access to speech, but sometimes when they're dysregulated and they may not or very tired or coming down with illness they may not have such good access to their speech. So they may already have some spoken gestalt so you might consider programming those spoken gestalt onto their AAC as well. What I haven't said, which is useful to just note, is ⁓ echolalia is what we're talking about here. So we were trained to use the term echolalia with autistic children. immediate echolalia is where children copy back language straight away or part of what we said straight away. And then delayed echolalia is when they use that language chunk elsewhere. And it's often used really cleverly because there's something about the Ruth: and Ali Battye: situation which is reminding them of that previous time they've heard it. So it's almost like referencing, you know like we do with movies or a song line or something. You know if we're in a situation a song line might come to us or I'm just going to give an example here. Me and my daughter were grooming our dogs like clippering. We've invested in a clipper and a grooming table because our dog groomer has got pregnant and we can't find another one. So we're having lots Ruth: you Ali Battye: of fun with our dogs pretending to be dog groomers and we both thought of a line from Charlie and Lola that we used to watch. My daughter's like 19 now but one of our favourite episodes is when Sizzles the sausage dog is being petted by Lola and Lotta and Lola and Lotta are saying dogs just love to feel pretty and they clearly don't love to feel pretty they're having boos put in and they're hating every moment. Ruth: Yeah. Ali Battye: you know, if there's a situation like that and a line comes to you, a line from a song, a line from a movie, a line from friends, that is essentially what a Gestalt language processor tends to do. They pull language from previous experience and it's deeply meaningful. Ruth: Yeah, and I think what is also quite, we often hear lots of examples, don't we, from that kind of media, those sorts of things. And it just takes me to the fact that actually it's often grounded in that meaningful experience. And I used to work with a child and the bit I'm taking back to this was years ago, but we used to record bits of sessions for assessments and things. And one of my OT colleagues had recorded their assessment and this child's trying to put little pegs, some sort of assessment they do, fine motor. into a thing and you can hear the child saying, nearly all done, nearly all done, just one more, nearly all done, nearly all done. And the tone and the pitch is exactly mum trying to get that child at some point in their history, clearly through something that they didn't want to do. Just one more, just one more, nearly all done. And this kind of scripting that was coming out. And so it doesn't necessarily have to be from media. Ali Battye: Mm. Ruth: We do know that that carries a lot of meaning for our Gestalt language processes, but it can be things like that that they've heard in a particularly heightened moment when something was very meaningful, very emotional, and they kind of hang their hat on the language that's used in the moment. I've also worked with children who, when they become quite distressed and dysregulated, will then kind of use that echolalia, that Gestalt-like chunk of language. Ali Battye: you Ruth: So you might hear them saying things like, ⁓ it's time to be calm, it's time to be calm or like, I'm calm or quiet hands. And they'll be saying it because actually when they've been distressed, that's the language they've been given for that experience that they're having. And so I think we can see it both from the media scripts, can't we? And things that might be, but also then at times maybe with that anxiety, with that distress, that dysregulation. Ali Battye: in them. Yes. Good. Ruth: that might be adult language models because they've often been very emotional times for children and they then hang on to the language that they're hearing. So I think we get lots of ideas, don't we, about what chunks of language children are hanging on to and making meaningful. And then the next step is thinking about how do we get that AAC system ready for them if we know that that single word of core vocab and that fringe vocab that we've talked about Ali Battye: Yes. Yeah. Ruth: isn't necessarily going to meet their language learning profile at this point in time. Ali Battye: and Yes, yes. So there are several ways to think about the development in Gestalt language processing. But the most commonly used sort of framework is Marge Blanc's natural language acquisition. And it was first, I think the first four stages were first coined by Barry Prison, who is the absolutely brilliant researcher and academic and writer and advocate for autistic children who wrote uniquely human and also has a brilliant podcast called Uniquely Human. So Barry Prasant came up with four stages of potential Gestalt language processing where children would move through from stage one where they're picking up language holes, language Gestalt. So these would be produced in exactly the same way. So the same intonation or, you know, nothing changes about that language chunk. So you get used to hearing it and you know, okay, that is one of their Gestalt. If we're supporting them well, if we are responding to their Gestalt, maybe offering some new pieces of language that reflect their potential thoughts and feelings in the moment, so they're getting richness of language, we can help them to move into stage two, which is where they start breaking those chunks down. So they're able to trim down a longer chunk and then perhaps recombine it with a new piece of language. all then gets a bit more meaningful and more obvious to other people what they're meaning. So for example, if they have an original chunk which is, we need to get our shoes on or something like that. Stage two might be that they analyse that enough to start mixing and matching with other language chunks. We need to get our socks on. We need to get in the car. We need to eat dinner. of like recognising the patterns in language and then able to play with that a little bit. So that's stage two where the original Gestalt has been changed, sometimes called mitigation. It's been mitigated or changed in some way. ⁓ Stage three is where they truly understand that a word carries a very particular meaning. So car means the thing that we get in and drive or as distinct from bike or sock is different from shoe. So they've had enough experience using stage one stage two language to start to realize, ⁓ that's what that bit, that word is referring to. And that's what we call, we as speech and language therapists call referential language. A word refers to a thing or a symbol refers to a thing in the real world. ⁓ And so that's a really momentous stage. That's where if you're not a gestalt language processor, most children start at those single words and knowing the meaning of the single word. And then stage four is they can then start creating those word plus word or word plus word plus word plus word combinations from there and grammar starts to develop. ⁓ So in AAC, AAC is already perfectly set up for stage three and four because it's got lots of single words and it's got you know nouns, verbs, adjectives, locations, pronouns, conjunctions, all those different types of words already in a good core and fringe vocabulary package. So that's why I we'll need that later when they get to stage three and four they'll need that language. But the ways that we can support stages one and two are we can offer more sort of whole phrases chunks of language. So we might have sort of like some dedicated pages for particular communication intentions. So we, you know, when we think about why do we communicate, we communicate for lots of different reasons and they might include to expressing joy and connection, protesting when something goes wrong, so to say something like, don't like it or that's not fair. ⁓ To describe something like, that's hot or ⁓ I got wet. ⁓ Another reason that we might communicate could be to express our regulation needs like need to move or need a squeeze or self advocacy like give me space or I can do it. So lots and lots of different reasons why children communicate and we want to model those different communication intentions. So we might, one way of doing it is having a page for each different communication intention. We might create a page for sharing joy, a page for sharing ideas, a page for protesting, et cetera, and put a few phrases on there. Or if we go into a topic folder, say we're in the animals folder, we might add some phrases that we might need when we're around, say, farm animals. Let's stroke it or give it some food or look at that one so that we've got some whole phrases alongside the single words. And that is setting us up really nicely for stage two because we can start mixing and matching those phrases. with the single words and show how we can swap a word in and out of that sort of. ⁓ language frame. So sometimes stage two is referred to frame and slot. We've got a language frame. So for example, let's stroke the, that's the frame and we can slot in goat or rabbit or snake into that and really make that language structure explicit for a child. They can really see how language works in that way. I've done it again. You've gone on and on and on. It's your turn to speak now, Ruth. Sorry. Ruth: Yeah. Not at all, I'm sitting laughing it up like wow this is like one-to-one supervision or like a training session, this is fabulous. But I think, ⁓ yeah I think you're right there are different ways of doing it and sometimes what I recommend to families particularly of non-speaking children where they might have some of those indicators that they could potentially be more towards the Gestalt language processing end of the continuum but we're maybe not so confident in a real out-and-out way is that you can set up a bit of both so Ali Battye: Yeah. Ruth: I quite like on Supercore, on the homepage, there's a button called messages. And if you open that up, it has folders by a broad range of different functions. And so what we sometimes might look at is what's in there, what kind of chunks are children using and what are they trying to communicate with those chunks and then kind of programming some vocab around the language that they use. So if, for example, we take that. Ali Battye: and Ruth: that earlier child I was talking about and said, nearly all done, nearly all done. That was them basically saying like, can we hurry up or I don't want to do this or I don't like this or this is tricky. What you might do is then go into that folder and say, actually that's the something's wrong or that's the help folder. And you might say nearly all done and then have another one like it's tricky. So you've kind of got that chunk of language, which is related to them, but you've also got that frame and slot model that you were talking about. Ali Battye: Yeah. Thank you. Ruth: So I quite like programming some of those chunks that they're already using into the same page alongside the frame and slot. I don't know what you normally do with their phrases, but I think that can be quite a helpful way because you might know. Ali Battye: Yes, no, absolutely. you know, their media preferences, so if they are rewinding and rewatching certain clips on Bluey or Hey Dougie or whatever, ⁓ those are good to programme in as well, because we know that that is the language that they're already finding delightful and meaningful in some way. So I give you an example, actually, which was going to be my glimmer, but I'll use it now. ⁓ So I was with a child yesterday and and we started off, I I've got like a Fisher Price record player, which is the best toy ever. It's like a retro one. It's been reissued. I had it when I was a child in the late seventies and they've reissued an updated version of it, but it's just as robust as it was in the seventies. So you can play records. So I was with a child and so I went into the music page on their AAC and they started really engaging with the favourite songs. Ruth: and Ali Battye: they'd got on there. So they'd got things like Hakuna Matata and one of the songs that they were pressing the button for it was Trust In Me. They did lots of songs but then they were really focusing in on Trust In Me and that became really meaningful throughout our whole session yesterday actually. then we moved on to the child's playing with a spinner and it was quite a complicated spinner with two parts. where they've got to put the handle into the base, turn the handle ⁓ and keep it all together and then press the button and then it would spin. And this is a child who really values their independence. They don't like ⁓ an adult interfering or, you know, they have to be really desperate to ask for help because they just like to feel competent in the world. And I noticed that he was saying trust in me again when he was doing that. And so that became like a real repeated refrain throughout the session. So I was repeating that, that trust in me and also offering, I've got this, I can do it. So we'd got ⁓ those two phrases already on the AAC, I can do it. So I was modeling that, but I was also modeling trust in me, because that was his chosen chunk of language for that moment. So I guess we're offering richness, like variety in the AAC. offering what they've already got language-wise, it's what they're showing us that they've got from YouTube or that they are sometimes able to access through speech, but we're also offering somewhere new to go, so some new phrases or some new frame and slot language as well. And once they've got that variety, that will help them move into stage three where they really truly have that referential language. Ruth: Thank you. Ali Battye: you Ruth: Yeah, I think that's the piece isn't it when we're thinking about our children who are more at that GLP end of the continuum that AAC has to be meaningful, which is what we say with all AAC users, but what looks like meaningful interaction and language to a GLP might look very different to an analytical language processor. So it's that piece about, you know, like we have to do that detective work over what are their chunks of language telling us like that trust in me. Ali Battye: Mm-hmm. Ruth: you do the detective work, you work out what they're almost saying is like, I can do this, like I can do this for myself. So then you want to model that language. And that's where I think the power of AAC, Fugished Art Language Processes can be really exciting because you can create those language models that are meaningful to them while still offering a language model that offers some development into referential and more contextual language that they will get to. Ali Battye: Yeah. with. Yes. Ruth: ⁓ But what we do know is that kind of sticking with that analytical language often will maybe see not much progress or you kind of get that very stuck in one function of communication and that sort of stuckness in and it's often requesting, let's face it, because people go to, well, they're not really getting the language model. So we'll do something really motivating, which is they've got to ask for something to get something and it becomes a behavior award sort of thing, which is. Ali Battye: Yeah. Mm-hmm. Ruth: probably a conversation for another day because I could go on all day about that. Don't do it. And so I think there is that piece, isn't there, that if you get the programming right with AAC and actually just thinking about our paper-based users, you can still create a very similar thing where you can have that different functions on a page for a communication. board or on several pages for a communication book where you're thinking about all the functions you talked about and maybe like typing out and having pictures for a couple of their different phrases they're already using and then still that frame and slot model on the rest of the page. And I guess one thing just to think about is when you're thinking about that frame and slot model is doing a bit of research and really considering what frames you're offering because some frames are actually not very flexible. So you've given us Ali Battye: them. Yeah. Yeah. Ruth: lovely examples, haven't you, like that? It's and I'm and let's, because then you can slot in lots of different things to that frame. Whereas there are other frames that actually, if you think about them, there's not much slots in, so they're a bit limiting. I think just another sort of note for people, if you're thinking about programming, is think about what frames you're going to offer and make sure that... Ali Battye: I'll good. Yes, yes, yes. Ruth: Have a little play about with it when you're programming, like say it out loud, what are the things could you slot into that frame? And there's lots of literature out there, isn't there, choosing those frames and also thinking about them being meaningful for the child's experiences. Because actually, all children learn language through meaning and experience and emotion and fun and joy and anger and all those kind of things, but it's kind of. Ali Battye: Yeah. Ruth: even more impactful and even more important, I think, when we look at our Gestalt Processes. Ali Battye: Yes, yes. And one thing that I find useful is just to watch a child and see what they're doing when they're really engaged in an activity of their own choosing. What are they doing with that thing? So for example, I made a page for a child who really, really loves glitter, but my starting point was watching what do they really like to do with that glitter. And then that gave me the language ideas. So it was like, gather it up, sprinkle it, look at the colours, look at the sparkle. So that, yeah, I would say start with observing what a child is already doing, because that's your starting point. And then think what language might they find interesting and appealing. Because that's where we're trying to go from. What are they going to find sort of intrinsically interesting and motivating? We're not trying to shape them and sort of like make them say anything. We're looking at, what language would be useful to them? What language do they need? And it might also be in moments when they're struggling. So what language do they need to manage transitions? Like it's nearly time to go is a useful phrase to model or I'm not done yet, I need more time or what's next. So yeah, think about what language your child doesn't have but that would be useful to them. Ruth: Mm-hmm. Hmm. And I was just glancing across our questions for the future. I think the next episode we record is actually going to be what are those different reasons somebody might communicate for? So we're like, this is a little glimmer into the future for everyone, but the next episode we are going to think a little bit about what are those different functions for communication, because we can program those for our GLPers, but also thinking about our analytical language processing end of the continuum as well. So we've done a little bit of a whistle stop. Ali Battye: and Ruth: there I think on Gestalt language processes but hopefully people are going away with a few things to think about noticing what can a child who's processing language more at that Gestalt end of the continuum look like and sound like but also thinking about then what might you be putting into a child's AAC ⁓ system and I'm thinking about my glimmer this week as a young person that I've just sort of been started working with probably over the last four or five weeks. So still really getting to know them. ⁓ But we were, I was in the classroom with them yesterday and they were playing with them, you know, the little like number link cubes that have got sort of like little bits like dots and you can click them all together and they were playing with those and there was a peer came and joined. And I think, you know, it's fair to say that they're both working on taking turns and kind of Ali Battye: I love you. Ruth: sharing equipment together. But what was really, it kind of made me giggle, but they were then started taking each others from each sort of little pile. And the child that I was working with was laughing. So I kind of went to their page, they're a proloquo to go user. So I went chat positive, it's funny. And they looked at me and then looked down and pressed, I'm joking. like it's like a single but I just thought this is so incredible to see that level of language you know and that humour has been a way in and so it's kind of given me some information thinking about how do we enhance humour within the ANC experience that they're having while they're kind of starting out on their journey and we're looking at upskilling the communication partners I think it's going to be really leaning into humour because actually the stuff I was there before Ali Battye: Thank Understanding as well. Yes, amazing. Yeah. Yeah. Yeah, because children love being cheeky, don't they? Like that often has been a real win to add to AAC. Like some little cheeky phrases can be really, really powerful. So mine is I did a school visit this morning and the class teacher on our walk up to the classroom said, ⁓ we've been having a bit of hitting this week and I haven't seen that before. So I sort of did a bit of, Ruth: Yeah. Ali Battye: when's that happening? And so I was starting to think, well, there'd be a good reason behind this. And so when we were in the classroom, this child, was getting towards outdoor playtime. And I think that this child can read the clock. So I think that they are anticipating and know when it's time is my outdoor time and no one seems to be noticing. And sure enough, this child sort of like went over to the door and started getting cross and. ⁓ and there was a little bit of hitting, like nothing bad, just like a really annoyed slap like, you know, we would do if we didn't have language ⁓ accessible to us in that moment. So I had brought in a communication book which was designed for a GLP and organized into communication intentions. So use the protesting page ⁓ to say something's wrong and just instantly got that lovely sort of child stopping looking yeah something is wrong Ali. ⁓ And we had a couple more like cycles of this like ⁓ child was like okay but then went to the door again and so I I was also modelling ⁓ I don't like it and I'm upset and every time I modelled one of these phrases this child just like it was like a regulation thing like ⁓ good someone gets this ⁓ so I'm not needing to ⁓ resort to like that physical frustration because someone already gets it. So that was just... ⁓ It was a night, the reason it's a glimmer is that this child hasn't particularly ⁓ appreciated AAC up until now. ⁓ So like they've pushed it away and found it annoying, actually quite annoying to get in the way of things. So that was really nice to see this child really looking and examining this communication book and finding it clearly, finding it useful as well. Ruth: Yeah, it's lovely isn't it? That power of validation. I think all of us as adults could be listening to this and thinking about a time where we tried to share how we felt and somebody minimised that. know, ⁓ don't be silly, ⁓ it's no big deal and how difficult that can then be to process it. So I think there is so much power for children and particularly in those early AAC modelling but even actually if you're just modelling spoken language. ⁓ I was with a child just yesterday who really wanted to get involved in my speech session. I wasn't there for them and they were, and I just said, it is so hard. These games look so fun. I want a turn. And they just paused and just looked and connected. And so I think, you know, there is so much isn't there in that kind of noticing and validating when we're doing that early AAC work. It's yeah, it's really incredible. Ali Battye: Yes, yes. Yeah, whenever you hear the word behaviour, like we're seeing some behaviours, ⁓ always think, right, what's going on for this child and meet that with empathy because there is a very good reason why that child is feeling so dysregulated in that moment. Ruth: Yeah. And sometimes you might not know the answer, but just that moment of validation can be really regulating and that moment to connect and pause and then put in the regulating strategies if we can't get to the bottom of what's underneath the, you know, at the bottom of the iceberg. but yeah, conversation. Yeah, that's it. Exactly. That that moment for connection. It has been lovely. As always, Ali, thank you so much for this chat today. Ali Battye: Yeah, just showing that we're trying is helpful, isn't it? Thank you, Rose. Ruth: and we'll look forward to seeing everyone for the next episode thinking about those different language functions. Ali Battye: Excellent, yes, see you next time! Ruth: Alright, bye everyone.