Gestalt Language Processing and AAC: A Comprehensive Guide for SLPs

Marisha (00:01.304)

Hello there, and I am super excited to continue our series, our GLP series today. We have Laura Hayes with us. She is a speech language pathologist who specializes in augmentative and alternative communication. And she has over 15 years of experience, AAC experience, in both school and medical settings. And...

I'm not going to be able to do her background justice, so we're going to turn it over to her in just a second. But a couple of things I wanted to highlight, she helped author the GLP and AAC course for meaningful speech. And so we just got to chat with Alex last week, which was awesome. And then you can also find her on Instagram at AAC underscore innovations. She has a great account with a ton of great resources. I'll add the link to the show notes too, but

If you're listening to her as we go through and like, I need to find out more. Definitely go to AAC underscore innovations to find out more. but without further ado, hello, Laura.

Laura Hayes, MS, CCC-SLP (01:08.828)

Hi, thanks so much for having me. So glad to be here.

Marisha (01:10.67)

Thanks for being here. And so I did like super quick intro, but I'm really curious. Can you tell us just a little bit more about your story? Like what led you to focus in on AAC and specific, like what was your process for like the entering into the GLP world too?

Laura Hayes, MS, CCC-SLP (01:29.608)

Yeah. So I always tell people that I started kind of doing the SLP thing when I was a kid. I was like an honorary SLP. I have a sister who has complex communication needs. She's speaking, but very low intelligibility. And I kind of just naturally fell into that role. So when I went off to university, I was kind of exploring different things. did like the complete opposite to start. I was an international marketing major and was like, this is not for me. So when I was exploring, said, oh.

Communication disorders. What's this? And then the rest is history. So I went down that path I started in the medical field of pediatrics and I started as an outpatient therapist and I just kind of felt like I start well Let me step back for a second because I remember taking an AAC class in college and I was like, my god I'm never gonna do AAC. This is not for me There's too many things like this doesn't feel like something that's natural and so I kind of pushed it aside

Fast forward to when I was an outpatient therapist and I had this just kind of curiosity and draw to working with autistic patients and their families. And turns out a lot of them had complex communication needs too. So what does that equal? It equals AAC. And so then I started learning from our AAC team and I started having more and more patients that needed AAC and speech generating devices.

And so then I kind of fell into that role on the inpatient and outpatient AAC team at the hospital. Did that for several years before transitioning into a role for a local school district here in St. Louis. And I'm now a facilitator for them where I support multiple districts and training staff and families and supporting students there with communication devices and doing a lot of trainings. Well, COVID hit.

And when COVID hit, you know, the world shut down and I just felt this draw to, well, there are so many people out there that have nothing like a facilitator to help them learn and coach. we know coaching is so important with devices and with AAC, there's a lot of knowledge gaps. And so I was like, well, why don't I just do that? Why don't let me try to educate and to provide resources for that family that's

Laura Hayes, MS, CCC-SLP (03:50.927)

maybe out there on an island and feeling like they just need something to help them. So that's how it started. And that's how I got to connect with Alex because I was kind of doing, I was doing a presentation on stimming in AAC for AAC in the cloud, which is a great free, if you want more information in general on AAC, it's a free conference that they do every year. So I did that presentation.

And one of the things I talk about in that presentation is about scripting and how it can equate to gestalt language processing. But that was kind of the tip of the iceberg. I didn't dive into it. I didn't have the strategies to talk about it and supports. But within that, I kind of went down some educational rabbit holes and digging. And that's how I found Alex. And we connected. I had her on my podcast and kind of the rest is history. We just kept being in contact and

I learned from her, she learned from me. We kind of built this relationship and that is how I became the author of the meaningful speech course for AAC and GLPs. And so we're continually learning, continually finding resources and just trying to kind of give back those supports and how it relates to Gestalt language processing. Cause it's another layer. It's another layer of how we can support them.

Marisha (05:08.844)

Yeah, it is a whole other layer. And first of all, I love your story. That's super inspiring. like your passion just like, it's like, I don't know how to say that, but your passion really shows. So, I'm so excited to continue diving into this conversation. and so hopefully this is a good place to start, but how do you know, like kind of backing up? Cause we've been talking about salt language processors.

this whole series, but how do we know if a GLP needs AAC?

Laura Hayes, MS, CCC-SLP (05:43.709)

Yeah, so let's, I know if you, let's say you haven't listened to any of the other episodes, if this is your first time, of, well, let's go, I know about, a little bit about it. know, AAC is augmentative and alternative communication. And then, let's start with gestalt language processing. We need to remember that gestalt language processing is not a diagnosis. It's more than just spoken scripts. It's how someone actually processes language.

It's a natural process of how someone can learn language, right? Like I always talk about left-handedness and right-handedness. It's natural. It's just how our brain is processing the language. It's not a treatment method, but it's really important to understand it because it impacts how we can provide implementation supports and strategies and how someone might move to flexible, autonomous language, what that journey might look like.

All of that is still true for someone with complex communication needs, right? Their barrier is that they're struggling with expressive language and expressive spoken communication. So if we think, well, there's two kind of groups that I talk about with GLP that might benefit from AAC. The first is someone with spoken language and that we know they're a gestalt language processor. We've taken language samples. We feel like, hmm, yeah, they are.

But how do we know they benefit from AAC? Well, I always say we all use forms of AAC. We all do. We all use texts and writing and emails and all of those things. So good chance if you're asking yourself the question, would my student or son or daughter or patient, would they benefit from AAC? The chances are yes in some form. But the questions you can really dive into and ask yourself, like do we need to trial robust?

AAC and maybe a speech generating device or app. We need to ask ourselves, are they not really developing spoken language despite good positive GLP strategies? Are they not intelligible all the time where we're not understanding their spoken language or scripts? Are they not easily understood by maybe even unfamiliar communication partners? We know what they mean, but then someone else who's in the community doesn't.

Laura Hayes, MS, CCC-SLP (08:04.328)

Excuse me. Are they not able to achieve self-generated language? And that's really important because that could be something consistent or that could be intermittently depending upon their regulation level or the environment. And really the crux of what I think of is are they showing signs of frustration or communication breakdowns that they're not repairing successfully? That is what I really think of when I think of someone who has spoken words but

could still benefit from AAC. I'm sorry, I'm gonna grab a drink.

Laura Hayes, MS, CCC-SLP (08:45.065)

Hold on, I think it's Okay. Nope, hold on. So sorry. So sorry, my friend. You'll edit all this out, I hope. Okay.

The other category that we might think of when we think of a GLP who could use AAC is someone who is non-speaking or minimally speaking. How do we know they're a GLP? So that's kind of like a different subset of individuals, right? So I would ask myself these questions. Well, how do I know? They may already have robust AAC and they may not, but if you're answering these questions, like they could be a GLP.

chances are they're gonna need AC and we're gonna need GOP strategies. So some of those would include, are they showing gestalt cognitive processing signs overall where they have hold apart thinking, they have episodic memory where they're thinking about an event as a whole, if something breaks from a whole event, they get really upset or dysregulated. Those are kind of cognitive processing signs that show that they are a hold apart thinker. They also could show that

within their gestures. So there's something called eco-praxia where they could actually act out scripts with whole body movements. Lots of, I shouldn't say lots, but some of my kids actually will do that with scenes from their favorite shows. They may be highly musical where they're drawn to songs and melodies and maybe even replaying some of the media that they have access to. That can be a really good indicator. They could be a GLP or jargon.

jargon that's not understood, but rich in intonation. This is one that I'm constantly telling SLPs and teachers that I support. I'm like, did you hear that? Like it's really rich in intonation. It kind of sounded like happy birthday, or it kind of sounded like door of the Explorer. Are you hearing that too? These are things to me that just go, Ooh, maybe, maybe they're a GLP. And last but not least is if I have been giving them positive AAC supports, and I know that they've had those supports for a while.

Laura Hayes, MS, CCC-SLP (10:55.079)

and they're just stuck, they're stuck in single words and they're having a really hard time with two word combinations or they're stuck and those words are not generalized across an activity. So for example, they're saying goldfish every time snack is presented to them, even though they don't really want the goldfish, they actually want something different. That tells me that they might be a GLP because we know in language,

once we have about 50 words, 50 to 100 words, we should start combining those words. And if I see a lot of single words and they're not combining them, it tells me, hmm, what something, something that's not connecting for them. Maybe they are not a bottom-up processor. Maybe they are a GLP or maybe we just need to explore it.

Marisha (11:43.982)

Yeah, that makes a lot of sense. You did such a great job breaking that down. That was amazing. And so you broke down kind of why we might want robust AAC for our kiddos who are.

Like you gave us a bunch of reasons for the kiddos who are producing that communication as well as what to see for our non-speaking GLPs. And then you kind of touched on this already, but what are some common issues with kind of like the mainstream AAC or like how would a GLP approach look different?

Laura Hayes, MS, CCC-SLP (12:28.914)

So mainstream AAC is kind of, it's a really loaded question too, kind of like the first question, right? Because when we think about our AAC systems, there's a lot of components on the backend that I don't think people realize. Even SLPs, they're like, I never realized that this was set up this way because, and so that can take learning on its own. So then you have this added layer of, well, now they process language differently. So I'm not really fully understanding.

how this AAC device was chosen or why the symbols look the way they do, why it's organized this way. We could talk just about Lampwords for Life and that probably in its own podcast because it's so complex and unique to the AAC system itself. So the first thing you need to know is that all AAC apps are designed differently. They have different pragmatic organizations or different types of organizations. So some are organized syntactically, some are organized

with motor planning in mind and how someone might learn or acquire language can be different. And so we feature match to figure out, well, what components of a system would really benefit this individual? And so they all look different. And so we might teach them differently. But we also need to know that for Gestalt language processors,

who might be in early stages, let's say stage one or stage two, where their scripts are highly individualized, highly, not customized, but highly experiential. So again, thinking about how they might have had an emotional tie to an event that's very specific and individualized for that person who's learning language and attaching meaning to something. That is not necessarily or not likely

that individualization is not going to be found in any of our AAC systems that come standard out of a box. And we don't know what that individual is tying meaning to because they are not able to autonomously tell us that yet. so oftentimes we'll see them trying to creatively communicate with us. So it's really our job, especially for early Gestalt language processors, to

Laura Hayes, MS, CCC-SLP (14:50.717)

try to help both build connection and also figure out how they are creatively communicating with us. And I think that is at the crux of like why it's so complex and hard for us to wrap our minds around because it's just not, it's not out of the box, right? When we have someone with spoken scripts, we're like, okay, I know exactly what to acknowledge. I can build off of this. can really figure out what their interests are and follow that lead.

It's not as simple and straightforward when it comes to AAC. They also have the added component of learning a new language. Some AAC users are processing spoken language and are just kind of deciphering where those words are on a device. Like that's kind of the individual where you pull it out of the box and you're like, wow, they just took off because they're seeing where the words are. They might take an entire page of a device and hit all the buttons on there and they're learning that and they're learning that to memory.

and then figuring out, okay, this is where this word is, I heard this word. And then other individuals who are learning AAC devices are not processing that language as easily. And so it takes time to learn that new AAC language. They are not simultaneously processing it with the spoken word. And so we have to teach that. So we have to teach the new language system while also acknowledging how we think they're processing and showing us communication.

It's a lot of things that we have to figure out simultaneously to see, and we're figuring out which features they need in a device. So a lot of components. The last thing I'll say is just that prosody and intonation are super duper important when we're thinking about early GLPs. We talk about them learning and experiencing the soundtracks of their lives. They're tuning into the prosody and intonation. They're the intonation babies.

They're not focused on the words in those early stages yet. So if they're focused on the sound train and they're focused on that original audio source, our AAC systems out of the box are not set up with that in mind. They're not yet really that great. Even if you listen to the voices on AAC devices, they're getting better. They're definitely better than they were 20 years ago. But they're still not.

Laura Hayes, MS, CCC-SLP (17:11.386)

as nuanced as someone who is an early stage GLP might need. And so that might also require customizations too.

Marisha (17:22.178)

That was such a great overview of some things to consider. And again, you did such a beautiful job explaining that. So thank you. Gosh, and I feel like this, because how many hours is your AAC course?

Laura Hayes, MS, CCC-SLP (17:36.969)

So currently, it's over 11 with all of the bonus modules, and we're adding a new one soon. So depending upon when this is released, there's another new bonus module coming. So that's one of the nice things about it is that we're constantly adding. So as we grow and as we learn and as new updates come out, we're staying on top of that so that anyone who is in the course has access to all of those updates.

Marisha (18:03.15)

Yeah. And Alex was saying that it's lifetime access, so you can revisit at any time, which is amazing. But I'm just, cause we try to keep these episodes pretty short and sweet. And I feel like I have 5 million different questions, but it's like, we're not going to cover everything. We can go to the course if we want to learn more. And that is a phenomenal resource. Um, and then yeah, for people who aren't ready for the course, like just following Laura on Instagram, I think is a great.

step two, just to like get your feet wet and start wrapping your head around this. But okay, so there is so much that we could cover, but maybe we can wrap up this episode just by chatting about just some suggestions to help SLPs kind of get started and to like start wrapping their heads around this. Do you maybe have like...

one or two tips or suggestions or things to think about, because I feel like you did a really great job of setting the stage for us. I'm just curious, what would you like to leave SLPs with?

Laura Hayes, MS, CCC-SLP (19:12.167)

Yeah.

Marisha (19:12.204)

like other than go take the course and learn all of the things. There's so much into this.

Laura Hayes, MS, CCC-SLP (19:14.984)

You know, it's so funny. There's so much and that when we were creating the course, I said, I feel like we need different people to contribute to this. So like, just know that if you take that course, you're not just going to be listening to me, you're going to be listening to a variety of AAC experts who have many, many years in the field. I've been honored to be alongside them to help write some of those bonus modules and

I just, can't say enough how important those bonus modules are because we really dive into, well, if you have Proloquo2Go, how does that look? Because that looks very different than what we might do in support and even just what's templated in the devices already that we might explore when we're getting started. Then let's say a Lambo for life or a TD snap. And I know, you know, even parents, it's overwhelming. And like, how do we incorporate it into our daily?

routines, like all that, we really try to dive into that and give people some actionable steps in the course. So if I was coaching someone and I was like, okay, like we're in this together, you're my SLP in the line of fire, we're ready to go, what do you need in your toolbox? So a couple things, I try to make it digestible, right? So like if I was starting and I needed something in my AAC toolbox,

to with a GLP, the first thing I would do is make sure they have access to robust AAC. It sounds very simple. It can be a long process or a quick process depending upon funding, but we have to have access to robust AAC. We just have to. Having just like a simple core board or a flip book or even a phrase based overlay is just not gonna be enough. Like we really need to have access to robust AAC.

We also need to model rich intonation child led within child led activities that we can, especially if we think they're in early stages around those meaningful experiences. They could be a combination. Oftentimes what I'm doing is I'm modeling a combination of words that exist on that homepage of the device or near the homepage, something like, I got it or I like it. This is so fun. Something like that.

Laura Hayes, MS, CCC-SLP (21:38.811)

It's awesome while also considering what are some more customizable things that have high meaning, high intonation and programming those again, depending upon the device organization, programming them somewhere where I can easily model them in a variety of routines and child led experiences. And then last, we can't take for granted just acknowledging the communication. I mentioned earlier that

AC users are still communicating. They're just creating, communicating creatively. So if I see them using media and rewinding it, if I see them using gestures, if I see them using eye gaze out of their periphery, I'm going to honor that. And I'm going to provide symbolic language to accompany that so that they, they feel acknowledged. They know that we are communicating and that we can then support them through.

symbolic communication on a device. So if you have the potential to take a language sample, great. If not, you can take something called an unaided communication sample, which I walk you through in the course, which looks at how they are communicating, how they're using their body, how they're using their eye gaze, how they're using their gestures and facial expressions, and maybe even just what we call proxemics, body awareness within their environment, how they're using that to communicate. And I think

there's little nuance things that we can look at that show us that they are responding to a device, whether it be eye contact, direct or indirect, returning to the device, returning to something that you're talking about on the device. All those can show us that they're connecting, even if it's not in the way we might expect in like a traditional analytic language session. So I think that, and then just, you know, again, don't try to...

Figure everything out all at once. Know that it'll be overwhelming and AAC is a marathon. So start slow, have your family start slow, try to be consistent, pick a few things to start off with, and then see how they respond. And that's just part of dynamic assessment. That's something that we all learn about as therapists, and it's something that, you know, it helps us to take those meaningful steps to where we need to go.

Marisha (24:00.374)

gosh, that's so helpful. So just a quick recap, some action items based on what we talked about. So we want to make sure that kiddos have access to robust AAC. We want to model rich intonation in child led activities, incorporating that AAC, and then always acknowledge communication. And I feel like those are things that are super doable. Like we can do this. We got this.

Laura Hayes, MS, CCC-SLP (24:26.024)

Yep.

Marisha (24:26.766)

And then we want to look for signs that students are responding to the device, even if it's not the way that we'd expect. And you gave some really nice examples of what that looks like. And I love how you said AAC is a marathon, not a sprint. And so just take it slow and one step at a time. wow, that was like, feel, I was like, there's no way we're gonna leave feeling like.

I don't know, but you just did such a great job of giving us some strategies. I was like, okay, we can, there's a lot to learn and there's a lot of complexity here, but there's some simple things that we can do right off the bat. And then hopefully if we have, especially if we have a lot of these kiddos on our caseload, I think it is really important to take some time to learn more and to build our strategies. And, you've shared some really great resources.

Laura Hayes, MS, CCC-SLP (25:25.224)

Let me add one little final takeaway, one final takeaway just because I'm an SLP. I can't help myself. I want to say, like I kind of alluded to it. It's almost more important. I know we're all about taking quantitative data, right? And we're all about percentages and like I got to have my data. Also consider qualitative data. It can be so important to think about.

Marisha (25:25.454)

Yeah, okay, go ahead. Let's do it.

Laura Hayes, MS, CCC-SLP (25:49.287)

I always tell my teams, it can be more important about what happens before or after someone activates something on a device than what they actually said on the device. Like, what did they do before they told you Goldfish? Or what did they do before they said goodbye? And what did they do after they said goodbye? Did they look at you and smile? Did they look at you out of the corner of their eye? Did they walk up and leave the room? Like, these are things that you're not gonna take a percentage point on necessarily.

But I'm going to document it because it shows intent. It shows progress. It shows that they're engaged. It shows meaningful connections, even if it's not a quantitative, like, I got 20 % out of the opportunities that I was given. So.

Marisha (26:34.914)

Yeah. And that can help be huge in like navigating treatment and figuring out strategies and just like that data could be way more impactful than having the number of they activated this many symbols. So I love that you added that. my goodness. Thank you so much, Laura. This was incredible. Like so many great resources. I feel like I could talk to you for.

hours and hours and hours on this. But hopefully this was a nice primer for SLPs listening. Again, check out the show notes for the link to Laura's Instagram and her course and all the things. But yeah, this was phenomenal. Thank you so much. Yeah, and thanks to everyone for listening and I'll see you in the next one.

Laura Hayes, MS, CCC-SLP (27:21.18)

Thanks so much for having me.