This article discusses the benefits of using music for Gestalt Language Processors (GLPs) in speech therapy sessions. Using music for Autistic students can be an engaging way to build language for Gestalt Language Processors.

If you’d rather hear this information (instead of reading it), listen to Episode 148 of the SLP Happy Hour Podcast wherever you listen to podcasts.

Important Things to Know:

When it comes to gestalt language processors:

A gestalt is a unit of language, for example “to infinity and beyond!”
Students are tuned into the musicality of language, so the gestalts/phrases that stick are often ones that have rich intonation.
Music can be an effective way to add in musicality, intonation and fun to your sessions with gestalt language processors (GLPs)
This article provides a case study of using music in speech therapy sessions with a GLP, including our strategies, how songs were used, and the student’s progress

This is an intermediate level reading for SLPs familiar with Gestalt Language Processing. If you’d like a primer, some resources are:

Episode 99 of the SLP Happy Hour Podcast - What Works for Echolalia and Play-Based Sessions with Alexandria Zachos (Apple Podcasts, Listen in Web Browser)
Episode 144 of the SLP Happy Hour Podcast - What You Need to Know About Gestalt Language Stages 1-3 with Jessica Teixeira (Apple Podcasts)
Meaningful Speech Course (referral link)
Marge Blanc NLA Book (Title: Natural Language Acquisition on the Autism Spectrum)

Songs & Autism: Case Study

To highlight the how of using songs in sessions, today’s episode will be full of case studies and session examples so you can get some concrete takeaways for your own practice.

I have a student on my caseload (let’s call him Max) who loves watching songs on YouTube. Max is a Kindergarten student who had a lot of ABA in preschool, but now speech therapy with me (and at school) are the only specialized services he receives. Max is an Autistic student, and he’s a gestalt language learner at Stage 2, meaning he’s mixing and matching (or mitigating) some of his gestalts. For example “let’s go” and “play colors” can be mixed and matched to become “let’s play colors.”

Media use is an important part of Max’s leisure time. He loves Mickey Mouse, nursery rhymes, and other songs. These give him some auditory input he craves, and when we watch the song on YouTube, the visual input he’s seeking. He also has a few favorite songs that help calm him down when he feels upset.

Over the past 1-2 years working with Max, we’ve gone from passive media consumption with him (where he was watching YouTube clips of songs, and there wasn’t much communication) to active media use that encourages communication. As this has happened, we’ve used more and more songs in our sessions.

What does this look like?

In sessions with Max, we will take a song or nursery rhyme he likes, and play a YouTube clip. We pause as we go along where Max tells me what he thinks, or asks me to play more of the video, and I model gestalts at his NLA (Natural Language Acquisition) level. Some days we do songs for the entire session. However most days, songs are just a part of the whole session. We also incorporate play, some GoGo Speech Activities (which is a membership and is essentially a wordless story in Powerpoint), we play with toys (food toys are Max’s current favorite), and sometimes do Boom Cards with picture scenes where Max can direct me for where he wants me to place items (for example - an empty bedroom with all the furniture on the side, or an outdoor scene with bugs on the side) since Max loves to tell me what to do.

Do you need to use YouTube?

Absolutely not! Sometimes I’ll sing songs with students without a video playing. The decision to use YouTube or not should be based on the needs and preferences of the child you are working with, their development and age, and your own clinical judgment. My own rule of thumb is for students younger than 4, I’ll sing songs (without the tablet), and for kids 4 and up I’ll bring in the tablet and see how it goes. Why do I use YouTube? Many children I work with enjoy the visual input paired with the auditory input of watching a video of their song of choice.

Returning to our case study of Max, I introduced using 1-2 songs (in YouTube) into each session. I noticed especially if we started with a song (and Max loved songs), Max was calmer and happier for the rest of the session. I also noticed that he was OK with doing a song at the start of the session, but wanted things to stay quiet for the first song of the session. For subsequent songs, we could talk to our heart’s content. For quite awhile, we’d do songs for the entire session. Now that I’m more familiar with Max’s interests and preferences, we have expanded that to singing 2-4 songs per session.

When introducing songs with new students, here are signs I look for that using media is dysregulating:

Can the student tolerate pausing the media for a few moments to talk about the action?
Can the student tolerate moving away from media - or do they get so dysregulated that if you do bring in media, you need to use it for the whole session?
How old is the child?
What is the attention span of the child?
Can you model gestalts or otherwise be working on communication goals with the media use?
Does the student want to engage in media use together, or is it dysregulating for them unless they are doing it alone?
What does the child’s media consumption look like at home? (I notice that if they typically have a lot of time using YouTube alone and at home, they usually don’t want to do it together in sessions, and it’s become a solo leisure activity.)

In the case of Max, I noticed that (with the exception of that first song of the session) he really enjoyed discussing the action of the songs but often didn’t seem to know what to say to talk about. That showed me that modeling gestalts during this music time might be a productive use of our time. Furthermore, I knew he was watching these videos at home with his family as a leisure activity, so I wanted him to have chances to discuss the videos with his family at home.

Music and Speech Therapy: Research

Knowing a student is interested in music is a great reason to incorporate songs into your speech and language sessions. What does the research say? Like many areas of speech and language research, there are some promising initial studies and more research is needed.

A summary of some of the research:

A systematic research review (by van Tellingen et al.) summarized that using music in sessions for students (this research wasn’t done with Autistic students) can result in gains in a variety of developmental areas (not just speech and language) including: speech and language, cognitive, social emotional skills, and motor skills. The studies had small sample sizes, and poor methodological rigor, according to Tellingen and associates. (Study link.)
ASHA’s evidence map for music and speech therapy (link) summarizes that based on limited studies, there is some promising evidence of the benefits of using music in speech therapy, although not enough high-quality studies have been completed to consider the evidence robust.

When looking at the research, I also remind myself of the Evidence Based Practice (EBP) triangle (and that that triangle has 3 sides). According to ASHA’s rendering of the EBP triangle, one side of the triangle is evidence (such as research studies - ASHA clarifies internal and external evidence should be considered), as well as the other 2 sides of the triangle: client perspectives and clinical expertise.

When I’m considering client perspectives (again one of the three sides of the EBP triangle), I often ask myself:

What does a student love most?

What do they love about it?

When is the student joyful and engaged?

For many of my students, they are joyful and engaged when they are listening to music, singing, or watching a song on YouTube. So, when considering client perspectives, I want my sessions to be child-led and based on the interests of the child I’m working with.

The third side of the EBP triangle is clinical expertise. As an SLP, I can take ongoing data of how sessions go when I use music. I’ve found that for the most part students are engaged, attentive to language models, and are interested when songs are a part of the session. Furthermore, my students are more regulated and in the “learning zone” when we incorporate songs. I can take data like: amount of time spent per session on task, level of regulation and attention, and use language samples to document growth over time as we use songs in sessions.

5 Tips for Incorporating Music into Speech and Language Sessions for Gestalt Language Processors:

Consider the Child’s Age & Attention Level

Media Use Guidelines from the American Academy of Pediatrics:

Under 18 months - no screen time (video calls don’t count)
Ages 2-5 - one hour per day
Ages 6-17 - two hours per day

Although it’s important to be familiar with these guidelines, it’s also important to consider the limitations of using these as blanket guidelines. Especially for Autistic children whose interest areas are media use, media use is regulating for them, and/or media use allows them to access their interests, we don’t want to be too heavy handed about limiting media. Children should have access to learning more about their interests and engaging in activities that are leisure for them. We don’t want to limit access to this, although there may be times where we choose not to have it be a part of speech and language sessions.

As you consider adding media into sessions, I like to start small with an initial song to get used to being in the speech room or a song at the end of the session. That said, I wouldn’t do this if a child had difficulty transitioning away from media and this would cause more stress to them than it would benefit them. Starting with a few minutes of a song in your sessions won’t make or break that media usage limit.

How realistic are these media guidelines? My guess is that most families are exceeding this media limit. This is based on conversation with the families I work with in my own clinic. I believe that for many families, these guidelines are unrealistic. When parents ask me about media use, I ask them what it looks like at home. If media use is mostly something the child is doing solo, I encourage the family to make media use a family event (where everyone is engaged together, rather than a child being alone in their room on an ipad). I also ask them how much media use a child currently has, and we use that as a baseline to reduce from there as needed.

From my own clinical experience, young kids (under the age of 4) can tend to get sucked into media use and really not have the attention or self regulation to pause a video and talk about the song. In that case, it’s not a communication activity but is better suited to a leisure activity to be completed outside of speech and language sessions.

Envision your Session & Make it Interactive

Incorporating music into sessions should bring in music in a way that supports modeling of gestalts for your learner.

Consider:

What are the child’s favorite songs?
What sensory input does the child like? How would those sensory actions fit into a song?
What are the child’s favorite figurines, toys, and play routines? How could we play with those within the context of a song?

Case Examples:

A student I work with loves saying the gestalt “I love + animal” (such as “I love cow” and “I love sheep”.) This student not only loves using this gestalt but wants more opportunities to use it. We go to YouTube and watch Old MacDonald. While I model a variety of gestalts at his NLA level, and we also pause to say “I love + animal,” resulting in joy and engagement for that child.
Another student loves letters, so we sing BINGO but replace the letters of BINGO with the letters in the child’s name, personalizing the activity and getting to sing about letters, resulting in a joyful experience with the child.
A student who loves PJ Masks figurines and playing with them and the song 5 Little Monkeys Jumping on the Bed, so we make the figurines jump off the table Ex) “Romeo fell off and bumped his head”
A student who loves jumping and crashing on a soft surface, and also loves the song Wheels on the Bus, so we sing the song and jump on the crash mat whenever we get to the repetitive “all through the town,” pausing between each verse so the student chooses which to sing next (the parents, the baby, the wipers, etc.)
Have a Goal In Mind (And Be Flexible)

While there are SLPs who have been providing child-led therapy for GLPs for years, I am not one of those SLPs. Since you’ve read this far into this post, I’m guessing you aren’t either. If that’s the case, having an idea of some activities and gestalts you may model in a session (prior to the session) is helpful. If you are more experienced in play-based sessions for GLPs, perhaps you can skip this step.

If you want to purchase the packet I’ve designed for Autism and Music, there are lesson planning sheets included (with lesson ideas).

Some tips to have a goal in mind and remain flexible:

Outline songs and activities that the student likes
Consider gestalts you’d like to model at their NLA level, and examples of gestalts to model at that level
Consider areas of communication or communication functions - are they using communication to advocate for their needs (including sensory needs such as “let’s jump”), express preferences and desires (“let’s do more” “not that one”), reject (ask to stop), make a choice (show they want to do something different), and more? If there are areas within that you’d like to target in your session, that can help you think of some gestalts you might model.

Case Example - Peter

When we do anything in sessions, we have a goal in mind, so let’s bring in another case study. One day per week I co-treat with a private practice OT in her sensory gym. One of the students we see together is NLA stage 2, let’s call him Peter.

Before we start sessions together, I consider what activities are interesting to Peter. Currently his favorites include: spinning in a chair, climbing up the ladder to the monkey bars (he sometimes drops down onto a crash mat below but usually hangs and goes back to the stairs), and swinging. His gestalts for the chair are “push me” and “push me please,” and his gestalts for the monkey bars are “let's go up” and “let's go down.”

Some mitigated gestalts I could model based on this are: let’s spin, let’s go around, let’s do it again, let’s climb up, let’s play monkey bars and more. Before I start sessions with him, I have some ideas of these preferred activities and the gestalts I might model.

Side Note: If you have an opportunity to co-treat with an OT - do it. I spend less time lesson planning and absolutely love having access to a sensory gym and learning from the OT I work with.

Last week, my plan didn’t work. Peter came into the session hungry and wanted a snack and tickles. He let me know he was hungry by saying “open the door” (to get into the room with snacks), so we started there. After a snack, Peter laid down on the crash mat and said “tickle.” So I modeled “tickle + feet” and “tickle + hands” and other body parts. He already had gestalts with body parts and “tickle me” so this was a great opportunity to model these mitigated gestalts.

Did my session go how I thought it would? No. Was it still a successful session? Yes. Furthermore, the next session Peter again wanted to spin and do the monkey bars, so I didn’t feel like taking a few extra minutes to envision how the session might go was wasted. When I mentally plan my lessons, I also review the Google Doc where I have Peter’s language sample, which has been an invaluable ongoing resource.

I had a goal in mind, and I remained flexible with Peter, which is a helpful tip for sessions with GLPs.

Take Data on the Goal (The Language Sample is the Data)

Continuing with the example of Peter - what data do I take, and how? Peter’s goal was to mitigate +10 new gestalts in speech sessions, and I track that with ongoing language sampling. For me because I’m on the go, I write down utterances on my phone’s note app during the session and after the session I transfer the utterances into Peter’s language sample Google Doc, the SOAP note, and delete the note file in my phone. I’ve also used a reusable Boogie Board to write down gestalts during the session, transfer them to the Google Doc and then erase them on the Boogie Board.

When I have a goal in mind (mixing and matching 10 new gestalts to form 10 unique new gestalts) my language sample is the data and I can track progress over time. Having the Google Doc also allows me to search for gestalts the child is using by using the find feature (control F on my computer), which has saved me a tremendous amount of time in session planning as well.

Other Goal Areas for GLPs:

To open ___(number) of circles of communication in a session
Participate in ___ (number) of people/toy play activities
NLA 4-6 I typically have grammar goals
NLA 1 I typically have goals to have ___ (number) of new flexible/easily mitigable gestalts

Vary The Songs to Vary the Language Models

While students definitely have their favorite songs in sessions (Max loves the Muffin Man, Peter loves 5 Monkeys), I do try to vary the songs we use in sessions so I can vary the language models.

Let’s bring in another case example (Conner) to highlight varying songs and models. Conner is an elementary student who is NLA stage 5, so we are modeling some pronouns and negatives in sessions. He loves playing with a Fisher Price pirate ship, and we use magnatiles to make an ocean under the ship and sometimes sharks even visit.

While I can’t think of any pirate songs per se, I immediately think of baby shark and wonder if there’s a way to expand baby shark or even include it in our play routine. I end up grabbing two sharks. I know we are modeling the use of “they” and I want to model it, plus something specific to his stage 5 level - modeling the negatives isn’t and won’t.

So, during the play routine I start to sing the beginning of baby shark (and I can see I’m getting more attention and engagement), so I pause and return to the play scene
“Oh no!” I say holding one of the people “Sharks!”

Holding another person figurine I say “don’t worry, they won’t get you,” and we build a box around one of the sharks, the shark saying “This isn’t fair! I can’t get out.” We then keep singing more of the song and expand the play routine.

To review, I’m doing things I’ve seen the student do before in sessions (play with the sharks and the ship, play a routine where the sharks get the people, and enclose a toy within a box made out of magnatiles), and I’m modeling language based on his stage.

I didn’t have to sing the whole song, I didn’t have to include a device or YouTube, and I didn’t need to base my whole session on the song.

The next session I brought out 5 sharks and we did 5 little sharks to the tune of 5 little monkeys and had them (one at a time) fall off the table where the pirate ship was, and I’d model the people in the boat say “he won’t get me” “that one isn’t here.”

I’ve noticed that while I can use the same song over and over and model different gestalts, there does become a point at which it’s almost too much of a routine, and kids will get their favorite gestalts to go with the song. While that’s great (they have favorite things to say), I’ll also want to vary the songs so that I can vary my models. This is why in Conner’s case, I used the Baby Shark song for one session and 5 Little Monkeys for the subsequent session.

Final Tips for Success

As you incorporate music into your sessions, remember to:

Consider the child’s age and attention level
Envision your session and make it interactive
Have a goal in mind & keep it flexible
Take data on the goal (the language sample is the data)
Vary the songs to vary your language models

I hope incorporating songs into your sessions is as fun, engaging and as full of learning for your students as it has been for mine.

If you’d like a system to get you started (including a packet of more than 30 pages with lesson planning sheets, tips for success, and song ideas with gestalts to model for NLA stages 1-3), check out the packet on my website or on TPT.

About Me: I’m Sarah, an SLP in private practice in Oregon, and I’m also a Teachers Pay Teachers materials designer.