Heather J. Forbes, PhD, CCC-SLP, BCBA-D1, Marina Crain, MS, CCC-SLP2, and
Lina Slim, PhD, BCBA-D, CCC-SLP3
1Department of Communication Sciences and Disorders, West Chester University
2Department of Special Education and Clinical Sciences, University of Oregon
3Lina Slim Consulting, Department of Applied Behavior Analysis, Endicott College

Description:

Autism Treatments SummaryIn 1977, Ann Peters proposed that some children may process and develop language in a way that is different from previous descriptions of language development. She conceptualized gestalt language processing (GLP) to distinguish learners who purportedly develop language in whole chunks/phrases as the smallest unit. Peters contrasted GLP with analytic language processing, a term she used to describe learners who develop language with single words as the smallest unit (consistent with traditional descriptions of language development). Later, Prizant (1983) and Blanc (2012) extended Peters’ proposal to learners with autism and hypothesized that many learners with autism fall in the GLP profile. Blanc suggested learners with autism acquire language by progressing through six stages of gestalt language development (see Table 1). In this framework, a gestalt is a chunk of language such as a phrase, sentence, or script that a user assigns meaning.

Table 1
Blanc’s (2012) Stages of Gestalt Language Development

Stage Description Examples
1 Gestalts Unsegmented language chunks “Are you okay?”
“That sun’s so bright.”
“Ohana means family.”
2 Mitigations Segmented and mixed portions of gestalts from Stage 1 “Means family. Okay?”
“Sun’s bright.”
3 Isolated single word and two-word combinations Stage 2 mitigations broken down into single words and combined “Sun”
“Family”
“Me okay”
4 Original phrases and beginning sentences Simple, grammatically correct phrases and sentences “I see the sun.”
“Mommy is family.”
5 Original sentences with more complex grammar Beginning acquisition of helping verbs, contractions, negatives, and other parts of speech “I did see the sun outside.”
“He’s not okay.”
6 Original sentences using a complete grammar system Complete acquisition of mature grammar “My family wears sunscreen whenever we go outside, and I know why we do.”

Using her personal data and experiences working with learners with autism, Blanc (2012) developed the Natural Language Acquisition (NLA) protocol, an intervention protocol designed to align with the GLP developmental profile. The proposed goal of the NLA protocol is to help learners progress through the six stages to produce original, grammatically correct utterances. This protocol is made up of recommended supports for interacting with GLP communicators within each of the six stages. These supports include broad practices such as building strong rapport and using naturalistic and motivating contexts (e.g., instruction during play). Supports also include specific practices for interpreting and modeling language at each stage. Examples of supports across stages include modeling new gestalts or “chunks” (stage 1), modeling ways to mitigate (i.e., segment and/or recombine) gestalts (stage 2), modeling two-word phrases without regard for grammar (stage 3), and modeling targeted grammatical structures (stages 4 through 6). The NLA protocol emphasizes interpreting the nonliteral “meanings” of a learner’s gestalts and modeling language at each stage without expectation of an immediate response (i.e., indirect modeling). Notably, the NLA protocol is not a manualized intervention; rather, it is a series of broad suggestions and recommended practices that proponents claim will facilitate progression through the six stages of gestalt language development.

Research Summary:

To date, there have been no scientific studies on the NLA protocol for learners with autism. Although the NLA protocol includes some strategies that are evidence-based interventions, like building rapport and using naturalistic and motivating contexts (Schreibman et al., 2015; Steinbrenner et al., 2020), the specific practices suggested at each stage of the NLA protocol (e.g., modeling mitigations) have not been subjected to experimental research methods. This leaves the effects of the NLA practices unknown. Consequently, studies specific to the NLA protocol have not been included in comprehensive systematic reviews of autism interventions (e.g., National Autism Center, 2015; Steinbrenner et al., 2020). Current published literature on the NLA protocol include a book (Blanc, 2012) and viewpoint article (Blanc et al., 2023) that describe specific practice recommendations without corresponding empirical research on their effectiveness. Therefore, there is currently no scientific evidence that indicates that the specific practices recommended in the NLA protocol contribute to language development for learners with autism. Moreover, Hutchins et al. (2024) suggested some of the practices included in the NLA protocol contradict existing research on supporting language development for children with and without autism.

The existing literature also does not provide a clear demonstration that the six stages of gestalt language development accurately describe the trajectory of language development for learners with autism. Prizant (1983) was first to propose the early stages of gestalt language development for learners with autism. Although he presented no direct research support for the stages, Prizant called for future longitudinal research to investigate the stages for learners with autism. Blanc (2012), in her self-published book on NLA, presented select language sample data from children with autism in her practice. While Blanc’s clinical observations may be considered preliminary findings, they should be interpreted with caution due to lack of peer review, the limited amount of data, and notable limitations in methodology. There is currently no high-quality research that shows learners with autism predictably progress through the six stages of gestalt language development.

Recommendations :

Blanc (2012) and Blanc et al. (2023) described the NLA protocol, which includes intervention practices and supports designed to align with the six stages of gestalt language development for learners with autism. As previously noted, some broad recommendations included in the NLA protocol, such as building strong rapport and using naturalistic and motivating contexts, are consistent with research evidence on autism interventions (Schreibman et al., 2015; Steinbrenner et al., 2020). However, assumptions and recommendations unique to the NLA protocol are unsubstantiated. There is currently no high-quality research validating the proposed trajectory of gestalt language development, nor is there research showing the practices recommended at each stage positively impact language development for learners with autism. Moreover, the NLA protocol lacks a systematic approach. This can make it difficult for researchers to investigate the protocol. We recommend NLA proponents support future research investigations by (1) defining clear features of GLP so that learner profiles can be reliably classified, (2) detailing objective methods for interpreting the “meanings” of gestalts, (3) operationally defining desired outcomes at each stage, (4) standardizing data analysis methods in a way that can be reliably replicated, (5) specifying what constitutes progress (versus no progress or regression), (6) clearly detailing how to implement recommended strategies, and (7) developing fidelity assessments/checklists for ensuring accurate and consistent implementation. It is imperative that independent researchers conduct studies on the NLA protocol using strong research methodologies to determine whether the stages and recommended practices are valid and effective.

Evidence-based practice (EBP) includes the integration of high-quality research evidence, data collected during intervention sessions, clinical expertise, and perspectives of learners, families, and other consumers (American Speech-Language-Hearing Association [ASHA], n.d.; Slim & Strömberg, in press). All components of EBP are considered necessary for making informed, evidence-based decisions that prioritize the well-being and values of vulnerable individuals served (ASHA, n.d.; Slim & Strömberg, in press). Although NLA proponents may draw from clinical expertise, observations from intervention sessions, and consumer perspectives, these sources alone do not sufficiently inform EBP for learners with autism. Currently, most recommendations within the NLA protocol are unsubstantiated by rigorous research. Therefore, practitioners and consumers should seek research-validated practices to target language development for learners with autism and should be cautious about adopting the NLA protocol until it is validated by research.

References

Systematic Reviews of Scientific Studies

National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. Author. https://nationalautismcenter.org/national-standards/phase-2-2015/

Steinbrenner, J. R., Hume, K., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2020). Evidence-based practices for children, youth, and young adults with autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team. https://files.eric.ed.gov/fulltext/ED609029.pdf

Selected Scientific Studies:
None

Other References

American Speech-Language-Hearing Association. (n.d.). Evidence-based practice. https://www.asha.org/research/ebp/

Blanc, M. (2012). Natural language acquisition on the autism spectrum: The journey from echolalia to self-generated language. Communication Development Center, Inc.

Blanc, M., Blackwell, A., & Elias, P. (2023). Using the Natural Language Acquisition protocol to support gestalt language development. Perspectives of the ASHA Special Interest Groups, 8(6), 1279-1286. https://doi.org/10.1044/2023_PERSP-23-00098

Hutchins, T. L., Knox, S. E., & Fletcher, E. C. (2024). Natural Language Acquisition and gestalt language processing: A critical analysis of their application to autism and speech language therapy. Autism & Developmental Language Impairments, 9, https://doi.org/10.1177/23969415241249944.

Peters, A. M. (1977). Language learning strategies: Does the whole equal the sum of the parts? Language, 53(3), 560-573. https://doi.org/10.2307/413177

Prizant, B. M. (1983). Language acquisition and communicative behavior in autism: Toward an understanding of the “whole” of it. Journal of Speech and Hearing Disorders, 48(3), 296-307. https://doi.org/10.1044/jshd.4803.296

Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., Kasari, C., Ingersoll, B., Kaiser, A. P., Bruinsma, Y., McNerney, E., Wetherby, A., & Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 2411-2428. https://doi.org/10.1007/s10803-015-2407-8

Slim, L., & Strömberg, D. (in press). Considerations for enhancing SLP and ABA practices. In S. Halder, H-T. Wang, & K. Dillenburger (Eds), Handbook of applied behaviour analysis-based interventions for autism spectrum disorder: Bridging theory and practice. Routledge Publishing.

Citation for this article:

Forbes, H., Crain, M., & Slim, L. (2024). A treatment summary of the Natural Language Acquisition protocol for gestalt language development. Science in Autism Treatment, 21(8).

Other Treatment Summaries

Related Book and Resource Reviews:

Related ASAT Clinical Corner:

Related ASAT Interviews and Perspectives

 

#Communication #Researchers #SLPs

 

Print Friendly, PDF & Email