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CTRI Number  CTRI/2025/08/092189 [Registered on: 01/08/2025] Trial Registered Prospectively
Last Modified On: 31/07/2025
Post Graduate Thesis  Yes 
Type of Trial  Observational 
Type of Study   Cross Sectional Study 
Study Design  Other 
Public Title of Study   Views of Indian SLPs on Language processing in autistic children 
Scientific Title of Study   Perspectives of Indian Speech Language Pathologists (SLPs) on Gestalt Language Processing (GLP) in individuals with ASD – A Qualitative Study 
Trial Acronym  NIL 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Deeksha Abrol 
Designation  Post Graduate student pursuing MSc in Speech Language Pathology 
Affiliation  Manipal College of Health Professionals 
Address  Department of speech and hearing, Manipal college of health professionals, Manipal Academy of higher education, Madhav Nagar, Manipal, Udupi

Udupi
KARNATAKA
576104
India 
Phone  7067689982  
Fax    
Email  deeksha2.mchpmpl2024@learner.manipal.edu  
 
Details of Contact Person
Scientific Query
 
Name  Dr Veena KD 
Designation  Associate Professor 
Affiliation  Manipal College of Health Professions  
Address  Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Madhav Nagar, Manipal

Udupi
KARNATAKA
576104
India 
Phone  9448824346  
Fax    
Email  r.veena@manipal.edu  
 
Details of Contact Person
Public Query
 
Name  Dr Veena KD 
Designation  Associate Professor 
Affiliation  Manipal College of Health Professions  
Address  Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Madhav Nagar, Manipal

Udupi
KARNATAKA
576104
India 
Phone  9448824346  
Fax    
Email  r.veena@manipal.edu  
 
Source of Monetary or Material Support  
nil 
 
Primary Sponsor  
Name  Deeksha Abrol 
Address  Department of speech and Hearing, Manipal College of Health Professionals, Manipal Academy of Higher Education 
Type of Sponsor  Other [self funded-minimal/no funds required] 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Veena KD  Manipal College of Health Professionals  Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Madhav Nagar, Manipal
Udupi
KARNATAKA 
9448824346

r.veena@manipal.edu 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
Kasturba Medical College and Kasturba Hospital Institutional ethics Committee - 2  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Healthy Human Volunteers  SLP professionals working with kids with Autism Spectrum Disorder 
 
Intervention / Comparator Agent  
Type  Name  Details 
Intervention  Nil  Nil 
Intervention  Nil  Nil 
Intervention  Nil  Nil 
 
Inclusion Criteria  
Age From  22.00 Year(s)
Age To  60.00 Year(s)
Gender  Both 
Details  For the study, pediatric SLPs working in clinical, private, or institutional settings will be included. Eligible participants must have a minimum of two years of professional experience.
 
 
ExclusionCriteria 
Details  SLPs working in other fields such a s voice specialist or swallow specialist will be excluded from the participation. Indian SLPs working abroad will also be excluded from the study.
 
 
Method of Generating Random Sequence   Not Applicable 
Method of Concealment   Not Applicable 
Blinding/Masking   Not Applicable 
Primary Outcome  
Outcome  TimePoints 
-Greater awareness of GLP as a typical developmental pathway among SLPs will help to shift perceptions regarding echolalia in neurodiverse population (ASD,ADHD etc.)
 
at baseline 
 
Secondary Outcome  
Outcome  TimePoints 
It will be helpful in identifying GLPs during language assessment.
It will also encourage the integration of neurodiversity-affirming intervention practices in therapeutical settings.
 
at baseline 
 
Target Sample Size   Total Sample Size="7"
Sample Size from India="7" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   N/A 
Date of First Enrollment (India)   29/08/2025 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="0"
Months="11"
Days="0" 
Recruitment Status of Trial (Global)   Not Applicable 
Recruitment Status of Trial (India)  Closed to Recruitment of Participants 
Publication Details   N/A 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - NO
Brief Summary  

Childhood language acquisition has long been a focus of research, with numerous studies highlighting diverse pathways and strategies. Ann Peters’ (1977) pioneering longitudinal study made important contributions by differentiating between analytic and gestalt processing strategies. According to Peters, children may rely on either of these acquisition strategies depending on their individual differences. However, the study had several limitations. The findings were primarily theoretical because the idea of gestalt processing was novel and lacked empirical support. Additionally, the small sample size limited the generalizability of the findings.

Prizant and Duchan (1981) draw parallels between the concept of gestalt processing and their study on echolalia in autistic children. Through their own longitudinal study, they emphasize the communicative and developmental value of echolalia. This challenges the traditional view of considering echoes as hindrance to language development. Their research shows that language learned in chunks—similar to gestalt processing—supports essential skills like turn-taking, requesting, and self-regulation. Additionally, they proposed a four-stage model that explains how echolalia evolves into more flexible and spontaneous speech in order to promote strategies that build on echolalia instead of trying to eliminate it. Manning and Katz (1989) used a case study of an 11-year-old boy to practically implement Prizant’s four stage model. Manning’s study successfully demonstrated how echolalia promotes language development when it is paired with naturalistic and interactive therapy methods. Overall, their work underscored the benefit of echolalia in developing communication skills in autistic children, rather than labelling it as a hindrance. Subsequent research reinforce this view and suggest that echolalia does play a significant role in communication development. For instance, Luca and Wotton’s (1995) case study demonstrates that "pure echoes" can at times express emotions, support social interaction, and respond to situations. A more recent study done by Xu et.al. (2024) which uses conversational analysis concludes that spontaneous echolalia follows a flexible ‘complete-incomplete-transformed’ continuum pattern. This allows autistic individuals to communicate their feelings, take turns, form responses, provide affirmations, and initiate requests. This interactive dynamic is competent to impede conversation, divert topics and affiliate interlocutions.

Building on this understanding, Blanc (2005, 2012) presented the NLA framework as a developmental process tailored to children with ASD. It emphasizes the functional role of echolalia in language development. Initially outlined in four stages and later expanded to six stages to support gestalt language processing, NLA reframes echolalia from being non-purposeful to an essential step in acquiring self-generated language. She highlights the importance of respecting autistic individuals’ unique processing styles and tailoring interventions to their strengths. She reports positive clinical outcomes where strategies aligned with NLA stages have fostered natural language development. However, Blanc et al. (2023) argues that while understanding gestalt language processing can lead to tailoring more effective interventions, their conclusions are primarily based on clinical observations, limiting their generalizability without further empirical research.

Haydock et al. (2024) further expand on the importance of gestalt language processing especially in autistic children. The authors deem it as a legitimate and significant pathway for language development and stress the fact that therapeutic practices should integrate GLP rather than suppressing these echoes. The article also highlights the need for clinicians to develop effective assessment tools to evaluate the extent of GLP in autistic individuals. It also adds on to the need to study and explore how gestalts are learned and utilized in communication by these individuals.

However, Hutchins et al. (2024) and Beals (2024) raise doubts about the framework and its usefulness in practice. They express concerns about the NLA frameworks, claiming that they lack sufficient data and precise definitions. The former challenges the NLA’s stages of language development, calling them unrealistic and unsupported, while also criticizing GLP for oversimplifying the experiences of autistic individuals. Similarly, the latter questions the validity of the GLP approach in autistic individuals, as they tend to focus on details rather than the broader picture. In this lieu, analytical processing should be more feasible to them than gestalt processing. They also believe that GLP-based therapies are vague, ineffective, and sometimes harmful compared to proven methods like structured language teaching and joint attention-focused strategies.

 

 
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