Blog by Kate M. I. Scarborough, Dr Kathy Leadbitter & Dr Katherine E. Twomey (University of Manchester)

“We never thought it was meaningless; getting to the meaning is the challenge”

Sometimes autistic children repeat sentences that they have heard from television shows, movies, music or conversations. Repeating these chunks is called ‘echolalia’ or ‘gestalt language production’ and is different from ‘analytic language production’, where individual words are used spontaneously to form new sentences. In the past, echolalia had been seen as a functionless or uncommunicative way of speaking (e.g. Kanner, 1946). Although more recent work has highlighted that autistic children’s gestalts can be communicative (e.g. Prizant & Rydell, 1984), echolalia is still sometimes misunderstood and stigmatised, and interventions have tried to stop autistic children from using this kind of language. However, researchers and autistic/autism advocates are increasingly arguing that autistic people’s gestalts are in fact often a valuable and meaningful communication tool (e.g. Haydock, Harrison & Leadbitter, 2024). In line with the neurodiversity paradigm, which views autism as a natural variation in human ways of thinking and being, this study aimed to move beyond historical views of gestalt language production as simply a ‘symptom’ of autism, by asking parents about their experiences and understanding of their autistic children’s language use.

This study was completed as part of a Master’s in Clinical & Health Psychology dissertation at the University of Manchester, and presents early findings reflecting the views and perspectives of a small group of parents whose autistic children produce gestalt language.

Our main goal was to explore how parents understood their child’s gestalts, and whether they thought their child was repeating chunks of language to communicate a need or for other reasons. We interviewed ten parents of autistic children about their feelings about their child’s language. Before the interview, they were asked to think of a few example phrases that their child would repeat, and whether their child’s repeating had changed over time. Because waiting lists for autism assessments can be long in England, children who were on a waiting list were included in the study, and there was a range of ages, diagnoses, and additional conditions (like ADHD) included.

The overarching theme that was identified was ‘Filtering of Neurodivergent Child’s Behaviour’. While parents didn’t always know exactly what their child’s gestalts meant, they were very keen to learn more and understand. They viewed gestalts as a way of their child calming themselves, gaining enjoyable sensory input, or understanding the world around them. Parents viewed their child as the expert in how they communicated, and adapted their own communication to support them. Importantly, they frequently identified instances of their children using gestalts to communicate.

Contributing to this theme were five subthemes:

‘it’s not random or meaningless at all’

In this subtheme, parents described how they found their children’s gestalts to be functional and meaningful. Parents described examples of their child’s repeating as a source of enjoyment, emotional regulation, a strategy for processing information and a way of managing stress. Sometimes, children repeated speech to tell their parent they needed or wanted something in particular, to reflect their emotional state, or to reassure themselves when distressed. One child, for example, used a phrase from Paw Patrol, “stuck in the tree”, to express frustration. Overall, gestalts were seen as communicative tools with emotional meaning, and meaning relevant to the current context, even when the phrase could be confusing to others who were less familiar with the child.

“like everything, it’s getting better”

Most of the children whose parents we spoke to had delayed speech and had not met typical language milestones. When they did start talking, they would repeat chunks of speech they had copied from other contexts. As children grew older, their parents said they used gestalts less often, and their spontaneous language increased, with some children using both gestalts and spontaneous language depending on context. In this way, autistic children’s language use, like non-autistic children’s language use, develops and changes over time. Importantly, the communicative nature of gestalts was a source of reassurance for parents, allowing them to better understand their child: “we’re able to communicate with him, I was more worried when we weren’t”.

Confidence, creativity and context

In this subtheme, parents framed their children’s gestalt language production as a flexible tool for communication. Children used gestalts as part of a creative process, often playing with phrases to reflect emotions, humour and context. Parents noted instances where their child purposely selected and repeated phrases in real-life scenarios that resembled a favoured television episode. For example, one child repeated “come on black car, you can do it!” from a television programme after a long day out to show he was tired and wanted to go home. Parents also described gestalts as a way to form bonds using humour, with children using particular gestalts with particular people as an in-joke. Again, this suggests that, like non-autistic children, autistic children who use gestalts are using language creatively. Importantly, parents said that their child was able to understand receptive language (words and sentences spoken to the child), even if their expressive language (words and sentences spoken by the child) was limited.

Bridging the communication gap

Parents described their role in working with their child to create meaning and understanding. As the person who knew their child best, parents actively worked to bridge communication differences by discovering the original context behind repeated phrases, including through watching their child’s favourite media. They adopted supportive speech and language therapy (SLT) strategies, took part in their child’s favourite verbal routines, and worked to solve the puzzle of their child’s gestalts.

Parents encouraged family members to watch the television episodes that their child drew on in their gestalt production, checked in with school staff for context, and sought clarification from their child when they could not understand. Meaning was not always clear, and not every gestalt appeared to explicitly communicate something, but parents tried a detective-like process to show they were listening to what their child had to say and accepted that sometimes they got this wrong.

One parent gave us an example of this detective work: “We offered him some food to try, and he didn’t like it, and we said, ‘oh, is it too spicy?’ and he picked up that ‘too spicy’ could be used to refuse anything. It took us a few goes, we were very confused when he came and he said [that] somebody from school was too spicy, right?… It was just [that] too spicy meant ‘it makes me have some sort of feeling that I’m not comfortable with, so I don’t want to play with that person, or do that thing, or go to school’, and those sorts of things.”

Parent as advocate, expert and researcher.

The majority of parents in our sample were non-autistic, and did not have much understanding of autism prior to their child’s diagnosis. They described the research they did to understand their child’s autism and gestalt production. In particular, they often felt the need to advocate for additional support for their child in schools or SLT provision.

Initially, their child’s repeating language was often misunderstood at school and at home, and parents dedicated time and effort to learning about autism and autistic communication. Parents sought help from speech and language therapists, advocated for their child’s diagnosis and EHCP (Education, Health and Care Plan), and became experts in their child’s speech and communication needs.

Overall, in line with recent work in the neurodiversity paradigm, parents told us that their child’s gestalt language production was a meaningful tool for communication and regulation. Parents as familiar conversation partners bridged the communication gap with their children, making meaning with their child through context and engagement. These interviews show that rather than just simple repetition, children’s gestalt language production is both complex and flexible. We also found that gestalts are important to both parent and child, sometimes as an enjoyable, self-directed activity, but also as a way of communicating meaning. Importantly, this research suggests that a neuro-affirmative approach to ‘doing the detective work’ may help bridge the communication gap between autistic children and familiar conversation partners, such as their parents.

Ultimately, exploring the experiences of parents, many of whom had no previous knowledge of autism, in advocating for and supporting their child is important for understanding what resources may be needed in the classroom or at home to better help this group. Including neuro-affirming practice in SLT or SEN (Special Educational Needs) work within the classroom to better understand and respond to gestalt language production will be vital to a more neuro-affirming mode of supporting young children’s developing ability to communicate their needs with parents and caregivers.

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