PHOTO CREDIT: Arina Krasnikova
DIR® Dialogues
This marks the fifth edition of DIR® Dialogues from Affect Autism. These episodes feature practitioner panels–this one featuring five Speech-Language Pathologist DIRFloortime® Expert Training Leaders exploring Gestalt Language Processing. DIR® Dialogues is an addition to the usual podcast episodes.
You can also subscribe on your preferred podcast app by searching, “We chose play from Affect Autism”
This Episode’s Guests
This episode’s guests are five DIRFloortime® Expert Training Leaders who are all Speech-Language Pathologists (SLPs):
- Returning guest Katie Shepherd is with the International Council on Development and Learning (ICDL) and is in private practice in Chapel Hill, North Carolina with a special interest in Alternative and Augmentative Communication (AAC), apraxia of speech and motor planning, and language development.
- Returning guest Brookes Barrack has an official accredited DIR® Organization just outside of Kansas City, Kansas with Occupational Therapist Emily Tritz called Kansas City Developmental Therapies where they offer DIR® services. She originally trained in Floortime at “the Bunker” with Drs. Greenspan and Wieder in Washington, D.C. and in the PLAY Project with Dr. Rick Solomon back at his home.
- Returning guest Erin Forward is joining us from Charleston, SC where she is at a small private practice. She has advanced training in pediatric feeding and swallowing disorders, early language, AAC, and trauma–specifically for medically complex children. She is also a certified lactation counselor, a TBRI® Trained Practitioner (Trust-Based Relational Intervention), and the regular co-host of the podcast First Bite with fellow SLP Michelle L. W. Dawson.
- Dr. Joleen Fernald joins us from just outside of Tampa, Florida where she specializes in Selective Mutism and Alternative and Augmentative Communication (AAC) intervention and is the Selective Mutism Clinic Coordinator at accredited DIR® Organization Joleen R. Fernald Pediatric Therapy Services. She is also an Adjunct Professor at Granite State College and the co-founder of Reconnections Education Center. She is also the creator of a the DIR® Selective Mutism card deck, published by Bjorem Speech.
- And finally, first-time guest, Jessica Schmidt is a clinic director for a pediatric therapy practice offering occupational, physical, and speech therapy using the DIRFloortime® approach. Her professional areas of experience include AAC, GLPs, early communicators, and medically complex bodies, and she is joining us from Virginia.
What is Gestalt Language Processing?
This episode is a continuation of two earlier episodes: What is scripting all about? and Gestalt Language Processing and DIR®. If I had to define what a GLP is, I would talk about a child who will use a script from an emotional meaningful experience, which can also be from movies or videos they’ve seen. Scripting is meaningful communication. In the past episode with Jehan Shehata-Aboubakr, she talked about scripting being meaningful communication and we didn’t use GLP at all, so this is a new “buzz” word that is very popular on social media.
Joleen starts that the term back in the 1990s was “delayed” or “immediate echolalia.” For Joleen, having been in the field for about 30 years, she calls it “delayed echolalia.” SLPs Dr. Barry Prizant and Patty Prelock did work on echolalia in the 1990’s at the University of Vermont. They were some of the first folks to speak about it being meaningful, Joleen shares.
They were also talking about the purpose of echolalia at the time. It was related to an emotional experience, or a way for an individual to delay their language processing before they responded, or used to fill the space when they didn’t quite know how to respond. These three reasons seemed to be in the 1990s what has now turned into the “GLP” term that is very recent and gaining speed in the field, as far as awareness, Joleen explains.
Gestalt Language Processing is an Individual Difference
Erin continues that in DIR®, we have this unique position where we talk about individual differences–the ways in which individuals process information and learn to communicate. Everyone uses scripting in their communication. I gave a few examples of scripting in my own life. I asked Erin how she experiences GLP with her clients.
With there being so much advocacy, which is so important, and with the language being so important because it has so much meaning, sometimes we put too many labels on children, she says. She keeps GLP in mind, always, but not before the individual child in front of her.
It’s important not to overgeneralize what’s out there about GLP before getting to know each child’s individual differences, Erin says, because yes, the scripts are meaningful and come from meaningful experiences, but sometimes it’s not always communication. It’s information. One of her clients would say, “What’s that? What’s that?” over and over whenever he was dysregulated. It was his way to connect when he was anxious. It was meaningful, but maybe different than what you might expect.
With all the information around GLP, let’s now find this balance in the context of everything else we know, she asserts. Her students ask her how to write the information down after a session and Erin encourages them to take notes about what they see when they meet a child versus using labels.
Validating Parents
I shared that many parents start with labelling their children as a GLP. Brookes says that none of this is new information, but there are really good social media influencers who are talking about it, so it’s brought up by families. Brookes says her job as a Floortimer is to listen and validate what families are hearing, but making sure she puts the individual first.
She will ask, “Tell me more about why you think your child is a GLP” then wonder how to use that information. She’s concerned when people want to use a protocol in a very protocol-driven way. Instead, let’s use all of our tools. When we make the child fit the protocol instead of the protocol working for us as a tool, that’s when we take out the joy, the engagement, the reciprocity, and all that we look for.
Let’s get back to being curious about why that particular chunk of language (or as her mentor Sherri Cawn says, borrowed language) is meaningful for the child. She has seen older children as clients who might still be using “borrowed language” even though they’re using so much novel language and have a good back-and-forth, but if a child gets to a place where they are not feeling safe, or emotions are high, she sees scripting. She wants to make sure the “I” in DIR® is guiding us.
Where Does Affect Fit In?
I jokingly asked Katie if we have to watch every movie to understand all the scripts that kids use. She said it is important to be an investigator of their intent and it’s great to watch what they’re highly motivated by to understand their intent. That’s something about Natural Language Acquisition (NLA) and Gestalt Language Processing (GLP). They are really thinking about the meaning behind the script.
As DIRFloortime® providers, Katie continues, that’s what we care about most. We care about meaning and intent by using affect in every single word that we say and every single gesture we use. Affect comes in to add to the meaning so that we’re always having and sharing meaningful experiences, even if it’s a meaningful conversation without words. She worries sometimes about the awareness of pre-linguistics of practitioners who are trained in GLP.
I shared that I recently listened to an episode of The Huberman podcast with Allan Schore that mentioned that motor planning and the language centers of our brains have developed from the same area and still have a connection. The affect is right-brained and in order to have emotional regulation it is all right-brained. It doesn’t come through cognition or language. It’s all implicit and not explicit.
AAC and Language Development
I asked Jessica how she facilitates communication development with clients whose only language is gestalts or AAC. Parents always ask how to get their child to speak and they really hold on to this. Jessica graduated in 2017, and even in grad school GLP wasn’t even talked about then, she says. The way that we have the overarching conversation about GLP and the way we apply it to the kids in the clinic is really different. It’s a tool in the toolbox, she says.
She leans more on her DIR® training than her GLP training because at the basic level it’s about following the child’s lead and creating their emotional connection to see how they respond to that. She had a client who was really frustrated and couldn’t find the keyboard on his AAC device which is laid out in single words with some gestalts. His passion is the ABCs so he was getting really upset he couldn’t find the ABCs screen.
He scripted, “want to cry” and started singing “A before B” and as soon as Jessica went to the page he wanted, he was all smiles. That’s what he was using his gestalt for. She followed his emotional intent. Was it directed to her? Maybe not, but in the future it will be because she got him into joint engagement with her.
A Focus on Connection
Erin added that knowing more about and having this language around GLP gives parents a strong desire to know when their child will get to stage 2 then stage 3, etc. in the NLA protocol.
You can model more and more language and more scripts, but if we don’t pull into the DIR® piece–all of those other individual differences and building connection and relationship–it can be too overwhelming. You have to know who that child is.
Erin encourages caregivers to learn how to connect with their child and have more back-and-forth interactions, which is great in itself–even with them using the “stage 1” gestalts–because you’re building your relationship and can build off of that more than modelling more and more language.
Jessica adds that part of the information sharing with parents in mitigating the information is letting them know that we are all a mix of analytic and GLPs. Much like our neurodiversity, it’s a spectrum. Even typical language learners have gestalts like, “Ready! Set! Go!” or “3…2…1… blast off!” or what Sabrina said in the previous podcast: “Hi! How are you?” At some point, we are using both GLP in one moment then maybe an analytical in another moment. It’s ok because at that point we’re looking at the individual differences and tailoring our interaction to that.
I added that as I’ve been listening to the Autistic Culture Podcast I become very aware that non-autistic gestalts can be quite meaningless while autistic gestalts are filled with meaning and the right brain emotional content that Allan Schore talked about.
It’s Developmental
Brookes adds that she thinks that if we were to talk to Marge Blanc, whom she doesn’t know, she would find that she and Dr. Barry Prizant, whom she has met, and Dr. Amy Wetherby never would have thought that we would start categorizing where children are in these “stages” of Natural Language Acquisition. It becomes an oversimplification. If you read Marge’s and Barry’s work, she says, they are developmental language therapists, Brookes states.
We’re listening to autistic lived experiences and that’s why we’re hearing about it and it’s so exciting. We’re happy that people are talking about it, but what are we doing about it? What Brookes likes about the GLP crowd is the understanding that language is a cognitive task versus language being a behaviour to be reinforced.
We’re always thinking about meaning and understanding, and how we can build on that understanding, which supports regulation.
Language Development is Complex
We think so much about development in DIR®, Katie says. Katie appreciated how Joleen talked about “content, form, and use” in a course and that when we think about language, we think about these components. At times, SLPs put too much focus on the form, but we put emphasis on the content and use. Despite this, we can’t forget about form because that is developmental as well, Katie adds.
At times, SLPs put too much focus on the form, but we (Floortimers) put emphasis on the content and use.
It’s so valuable to understand GLP and what Marge brings to the table, including the work of Laura Lee, Dr. Ann Peters and Dr. Barry Prizant, who have been developmental clinicians, Katie stresses. She does want to understand grammar and its development. That is also the process and in DIR® we are always thinking about the process, so she wants to appreciate that individual difference. We want to think of this in an integrated way.
Jessica adds that it is complex. We are really thinking about where this child is developmentally, and where they might be is only scripting song lyrics. We can talk about emerging language and meeting them where they’re at, which impacts regulation. Having that right-brain implicit connection and affect, joining each other and feeling safe, and that emotional regulation allows you to engage and have that back-and-forth, as Dr. Allan Shore explained so well.
A Holistic Picture
Joleen says that the easy way to talk about GLP with parents is educating them about the DIR® model itself. She talks about the Functional Emotional Developmental Capacities (FEDCs) and the “I” and the “R”, and not one part is more important than the other, she states. She files the information that the child is a GLP in the “I” category and keeps it in mind. She holds that “D” while celebrating their “I” and she’s constantly referring to the foundational aspects of the model.
She is constantly assessing where the “D” is and assessing how the “I” is contributing to the constriction in the interaction in that moment, and as her clinical hat is on, she’s assessing how to nudge the child towards that zone of proximal development. It sounds easier than it is. Maybe at their level of skill a DIR-Expert makes it looks easy, but they really have that full understanding that no one individual difference supersedes the other.
The DIR® model itself is looking at the emotional side while looking at the individual differences, and just because this panel is made up of all SLPs, they’re not ignoring the motor planning, sensory processing, dietary restrictions or challenges, the child’s glucose levels, or anything else. They’re holding that the whole time and constantly reviewing the whole picture with the family. If a client wants Joleen to focus on the stage 1 in GLP, she doesn’t feel like a good fit because she wants to hold that holistic piece.
When the Learning Happens
While Sabrina gave examples of how to provide children with mitigable phrases, that’s secondary to what we’ve talked about here. Erin adds that we have to remember that while we can be part GLP and part analytic in our language development, it doesn’t mean children can’t develop more independent language without a very distinct intervention. What she loves about DIR® is that as you’re building the capacities, the language or communication will come in its own trajectory as well. We are supporting this, she insists.
It allows us to take a deep breath and understand that this is how they’re engaging in language, Erin continues. When we know they’re connecting with affect and intonation, we have to be very intentional with the language and words we’re using in the emotionally charged interactions, she offers. Those are the moments where you need to focus on the language that you’re modelling. We have to hold those experiences very carefully.
I stressed that as a parent, something Erin said is so important. When we get triggered as the emotions go up, we might snap and say things. Our kids remember what is said in those emotionally-charged incidents. It’s a hard thing to put on parents, but it’s something to be aware of. As a professional SLP, you can focus on that to promote that communication going forward.
Looking at their motor planning and their praxis is also huge, Erin says. This is being talked about as well and there’s a lot of misunderstanding around this. Language is impacted by a child’s sequencing and motor planning.
Considering the Parent
Brookes added that as a parent, there is a fear of hearing about some new thing and having to pursue it. Acknowledge the fear of “Am I doing enough?” and “If I don’t do it this exact way, am I failing my child?” that the parent feels. Acknowledge the parents’ “I.” The sensorimotor and affect is part of the “I.” Even when we think about AAC, maybe having some phrases is a good thing, but what language system and device will fit this child, Brooke wonders.
We want to match that to what the caregiver can manage because they need to understand that device and modify it as needed. If we’re always supporting the D, I, and R, we’re supporting everything, she states. It’s so simple yet so complex. I shared that sometimes I reflect and think, “Thank goodness my child uses spoken language because I’d be so overwhelmed trying to figure out an AAC. My heart, respect, and amazement goes to parents who do get on top of that. Maybe things that are hard for them, though, come easier to me.”
No Child Has to Fit Inside One Little Box
I know that Occupational Therapist, Gretchen Kamke, talks about the how the whole thing with praxis is so challenging because a child might point to something they don’t mean to, so the cue sending is unreliable. Joleen feels like this could be a whole other discussion. There is still some purpose and meaning, even if inaccurate, Joleen believes, despite being challenging. They might go to a phrase on their device because the motor plan is easiest, but it might not mean what we think it means.
The best thing Joleen has found in her freedom of DIR® is that no child has to fit inside of one little box. Every kid can be multiple things in all of those categories. So that gives her as a clinician such freedom. To label any one trait a child exhibits gives freedom and power to do all of the Floortime and go from that.
When we talk about mitigable phrases, we naturally, as developmental therapists, are already building off of those phrases. We’re already changing the gestalts naturally, so it doesn’t have to be protocol-driven.
Katie feels that in DIR®, we never feel like we’re in a box or have to say any particular thing at any particular time. We’re present in the moment. That’s what’s so wonderful about this model. We can meet our clients where they are, and understand our own profile to understand where we are, so we can be genuine and present. Katie appreciates all she can learn from other approaches, but she always comes back to DIR®.
Misread Cues, Rupture, and Repair
I added that when you’re in the moment with a child, you learn to read cues. If the child is pointing “yes” when they meant to point “no,” Dr. Allan Shore talked about how the nervous system is in the eyes. The eyes get dilated when you’re dysregulated, as Dr. Stuart Shanker told us. If the child says “yes” when they meant “no,” and you treat it as “yes,” you can notice their eyes dilate. Or when a child is flapping and looking excited and you think they’re regulated, they might be completely dysregulated. So using DIR® we can say, “I think you mean this but I’m not sure,” then sit in the moment and then maybe you get more information.
Going off of this rupture and repair, Erin added that there’s always communication, and the relationship is the foundation of an individual feeling safe and understanding that “We’re going to understand this.” Let’s be together and build that relationship, Erin offers and told a great story to illustrate this point that the relationship can sustain us through the ruptures and through co-regulation, you can get through it.
They often pick up scripts from relationship and connection of the characters they’re watching, too, so when we start to connect more too, that’s when we hear them imitating what we say to them, Erin adds. The core of relationship in DIR® fuels the strength and beauty in that interaction.
Keeping Possibilities in Mind
You can never say what a child’s language will look like into the future. Every session with a child will look completely different across kids and even across sessions with the same child, Jessica explains. I added that I think about ICDL’s Board President, Dr. Emile Gouws, saying he didn’t speak until age 15 and now he has a PhD. It’s incredible how development can look so different across children. It’s hard for parents when they see all the other kids developing but every child has their own process and blooms in their own time. GLP is just a part of that, but let’s look at the bigger developmental picture.
Jessica added to just remember that language is so complex and that the complexities don’t just stay within one person. Everyone learns language differently, so when we hear terms like “typical language” or “NLA,” we think of a group of people, but individuals will have their own unique trajectory, so it’s in an SLP’s practice to look at each individual child’s development and not make gross generalizations when the child is in front of them.
This episode’s PRACTICE TIP:
This episode let’s consider if we label our children rather than considering their unique individual differences.
For example: Are we calling them “autistic” or “Gestalt Language Processors” instead of focusing on their strengths and naming their specific challenges? While this can be helpful in some circumstances, it clouds the lens through which we see them. Let’s see their unique strengths and describe them by what makes them shine.
A big “thank you” to this episode’s guests for agreeing to participate on the DIR® Dialogues panel and I hope that you found it a worthwhile listen. If so, please consider sharing it on social media!
Until next time, here’s to choosing play and experiencing joy every day!
Thank you to Danish recording artists Тhe Foreign Resort for the intro/outro song permission.
