What to do when words don’t come fast enough

ByLondon Speech and Feeding
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What to do when words don’t come fast enough

When children find talking hard, parents often face a difficult question: ‘Should we wait and keep encouraging speech? Or introduce something like AAC?’

AAC (Augmentative and Alternative Communication) can sound intimidating, but it simply means any way we support or replace spoken words, from simple gestures and picture boards to high-tech speech-generating devices. Far from ‘giving up on speech,’ AAC often becomes the bridge that helps children find their voice, in whatever form that takes.

💡 What is AAC, really?

AAC is a spectrum of tools and strategies that help people express themselves when speaking is difficult. It might include:

  • Low-tech supports: Gestures, key word signs (like Makaton), picture symbols, or printed boards
  • High-tech systems: Apps on tablets that speak aloud when pictures or words are tapped

AAC is not just for children who will never talk. It’s for anyone whose speech isn’t meeting their communication needs right now.

🤔 When to introduce AAC

There’s a common myth that you should only try AAC after ‘exhausting’ other speech therapy options. In fact, AAC can be introduced at any stage, even alongside speech development.

Here are some helpful signs that AAC might support your child:

  • Your child understands much more than they can say.
  • They rely on gestures, sounds, or behaviour to communicate.
  • They become frustrated trying to express themselves.
  • You find yourself ‘reading their mind’ to interpret needs.
  • Speech progress feels slow or inconsistent.

If you recognise these patterns, AAC isn’t a ‘last resort’. It’s a communication support, not a replacement for speech.

Recent research consistently shows that AAC does not stop children from talking. In fact, it can encourage speech to develop. A 2024 systematic review and meta-analysis published in the Journal of Autism and Developmental Disorders found that children who received interventions combining naturalistic developmental behavioural approaches with aided AAC showed improved language outcomes, and that AAC ‘does not negatively impact speech development and may even facilitate spoken language growth’ (Smith et al., 2024).

🌉 How AAC supports speech development

Speech and AAC aren’t competing paths: they’re parallel tracks that often feed each other.

Here’s how AAC helps speech grow:

  1. Reduces frustration: When a child can express their needs, they’re more relaxed and ready to learn.
  2. Provides a visual model: Seeing symbols or words while hearing spoken language strengthens understanding and word recall.
  3. Builds consistent language structure: AAC systems follow the same grammar and word order as speech, helping children internalise how sentences work.
  4. Encourages turn-taking and social connection: AAC lets children join conversations even before speech is fluent, giving them more practice in real communication.

AAC is not ‘giving up on speech’. It’s giving a child more ways to succeed while speech continues to develop.

🧩 How to introduce AAC gently and effectively

  1. Start small and meaningful: Begin with a few key messages your child wants to say, not just what adults want to hear. Think ‘I want’, ‘stop’, ‘help’, ‘more’, ‘all done’, ‘no’, ‘again’. These are powerful words for real interaction and autonomy.
  2. Model, model, model: The most important part of AAC success is modelling—using the system yourself as you talk. For example: ‘You want banana 🍌’ and you tap the ‘want’ and ‘banana’ symbols. Children need to see and hear AAC used naturally before they try it themselves.
  3. Use it throughout the day: AAC isn’t a therapy tool to take out once a week. It’s a living part of communication. Model a few words during mealtimes, play, and routines. The more consistently it’s embedded, the more fluent both you and your child will become.
  4. Keep it accessible: If using a device or picture board, make sure it’s always nearby. If it’s in a bag or drawer, it can’t be used in real moments.
  5. Celebrate all communication: If your child points, signs, uses a sound, or taps a symbol, it all counts. Respond warmly and naturally to reinforce communication in any form.

🧠 What parents often worry about

  • ‘Won’t AAC stop them from talking?’: No. Research shows AAC use either has no negative effect on speech or leads to increased spoken output (Smith et al., 2024). When children feel understood, their motivation to communicate grows.
  • ‘What if I model it wrong?’: There’s no perfect way to start. Your effort and consistency matter far more than accuracy.
  • ‘Will they get ‘stuck’ using pictures?’:  Some children do continue using AAC long-term; others move naturally toward more spoken language. The goal is always functional communication, not replacing one form with another.

🪞 Bringing AAC into daily life

Here are a few simple, parent-friendly ideas:

  • Create visual spaces: Post symbols or core words on the fridge, mirror, or play area.
  • Narrate routines: Use AAC during toothbrushing, dressing, or mealtimes; consistent contexts build understanding.
  • Pair speech and touch: Always say the word aloud when you point to or tap a symbol.
  • Involve siblings and friends: Model how they can respond to AAC too. ‘Oh, you said go! Let’s go fast!’
  • Use shared books and songs: Pause and model key words in stories or songs.

🌱 The takeaway

AAC doesn’t mean giving up on speech; it means opening more doors to communication. When words don’t come easily, AAC gives children a way to connect, share, and be heard.

It helps parents move from guessing to understanding, and gives children the power to express themselves on their own terms.

If you’re unsure where to start, reach out to a speech and language therapist experienced in AAC. Together, you can find a system that fits your child’s strengths, build confidence in modelling, and help every word (spoken or tapped) feel like a step forward.

And download and print my one page summary.

Because when communication is possible, everything else begins to grow.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

📚 Reference

Smith, K., et al. (2024). The Effect of Naturalistic Developmental Behavioral Interventions and Aided AAC on the Language Development of Children on the Autism Spectrum with Minimal Speech: A Systematic Review and Meta‑Analysis. Journal of Autism and Developmental Disorders, 55, 3078–3099. https://doi.org/10.1007/s10803-024-06382-7

Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

2

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    ByLondon Speech and Feeding

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    • It demonstrates purpose: Modelling shows that AAC is a functional and effective way to communicate, not just a set of pictures.

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    Low-tech AAC in action: Everyday activities

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    AAC mornings symbol examples

    2. Breakfast Time

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    Example symbols:

    AAC meal times symbol examples

    Activity example:

    ‘What do you want to eat for breakfast?’ (point to EAT). ‘Do you want cereal or toast?’ (point to CEREAL or TOAST). If they finish their milk, you could say, ‘Are you ALL DONE or do you want MORE MILK?’ (point to symbols).

    3. Catching the Bus

    Even routine transitions like catching the bus can be communication rich. A small, portable ‘Travel’ board can be useful.

    Example symbols:

    AAC catching the bus symbol examples

    3. Being on the playground

    The playground is a dynamic environment perfect for commenting, requesting actions, and engaging in social play.

    AAC playground symbol examples

    Activity example:

    ‘Let’s PLAY!’ (point to PLAY). ‘Do you want to go on the SWING or the SLIDE?’ (point to symbols). If they are on the swing, you can say, ‘Do you want to go FAST or SLOW?’ (point to symbols) and ‘Push AGAIN!’ (point to PUSH) You can also model social language like ‘It’s MY TURN.’

    Beyond the symbols: Key takeaways

    • Consistency is key: Use AAC consistently across all environments and with all communication partners.
    • Be patient: Learning a new language takes time. Celebrate small successes.
    • Make it fun: Integrate AAC into play and enjoyable activities.
    • Follow the individual’s lead: Respond to all communication attempts, even if they are imperfect.

    In the video below I model how to integrate AAC into everyday activities with a few more examples and I discuss the difference between AAC and PECS.

    If you need some inspiration with using AAC or would like your child assessed for the right type of AAC then please get in touch.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    After thirty years of helping children with lisps, you’d think very little would still surprise me. And yet…

    Girl looking at herself in a mirror and looking at her tongue

    Every few weeks, a lovely, and well-informed parent will describe their five, six, or seven year-old’s slushy, sideways /S/ and then ask ‘So, how many sessions do we need to fix this? Perhaps five–six? ‘

    And every time, I have to resist the urge to laugh, cry, and reach for the biscuits all at once. Because the honest answer, for an established lateral lisp in a school-aged child, is usually twenty sessions or more. Wait! Hear me out!…

    ‘Why so many?!’ … once you understand what’s actually going on inside your child’s mouth, the number 20+ does no longer sound outrageous and starts sounding rather reasonable.

    First: not all lisps are equal

    Most people picture a lisp as the gentle, even endearing /TH/ for /S/ — ‘thnake’ instead of ‘snake’. That’s an inter-dental lisp, where the tongue pokes forward between the teeth. It’s common, it’s developmentally normal in younger children, and this is the important bit, it’s usually visible. It’s still a bit tricky to correct at first but I often can show a child what to do, they can watch themselves in a mirror, and quite often we’re away. But it still takes a lot longer than parents think because just fixing the sound does not mean it will be produced correctly in normal, daily speech and conversation.

    Lateral lisp

    A lateral lisp on the other hand is an entirely different animal. Instead of the air flowing in a neat central stream down a groove in the middle of the tongue, it spills out over the sides, around the molars. The result is that wet, slushy, quality. It affects not just /S/ and /Z/, but very often /SH/, /CH/ and /J/ too which is a big chunk of English.

    Here’s the snag: it’s happening where nobody can see it. There’s no mirror in the world that shows you the sides of your tongue as you are speaking, or chewing for that matter. We’re teaching a child to control a movement they can’t see, can’t easily feel, and have never once performed correctly in their life.

    By five, six or even seven years old your child has said the /S/ sound about several hundred times a day, every day, for several years. It’s one of the most frequent sounds in English: it makes our plurals, our possessives, our verb endings. Every ‘cats’, ‘let’s’, ‘she runs’.

    So we are now talking about a deeply ingrained motor habit, rehearsed tens of thousands of times, that now feels completely normal and correct to the child producing it. We’re not teaching a new skill onto a blank page; we’re overwriting a very strong habit. Think of a tennis player with a flawed serve who’s played for five years… You don’t fix that in a fortnight, and nobody expects you to.

    The good news is: school children, seven-year-old and up, are brilliant at this work. They can self-monitor, they can practise independently, they can hear the difference. It just takes time.

    The quiet culprit: where the tongue lives at rest…

    Here’s the piece that most parents have never heard, and it explains a lot.

    When the mouth is at rest, the tongue should sit up — tip resting lightly behind the top front teeth, body gently suctioned to the roof of the mouth, lips together, breathing through the nose.

    Many children with a lateral lisp have a low, forward resting tongue posture. The tongue sits on the floor of the mouth, often with the lips slightly apart. This is frequently associated with a history of mouth breathing, blocked noses and allergies, enlarged tonsils or adenoids, prolonged dummy or thumb-sucking, and sometimes dental or orthodontic differences such as an open bite.

    Why does this matter so much? Because a good /S/ requires the tongue’s sides to brace firmly against the upper back teeth to form that central channel. A tongue that spends 23 hours a day flopped on the floor of the mouth simply doesn’t have the habitual strength, position or awareness to do that on demand. We can teach a beautiful /S/ in the clinic — but if the tongue’s default setting is ‘down’, we’re swimming upstream all week.

    So, for many children, part of the work is establishing a better resting posture alongside the sound itself. That’s foundational and it’s slow.

    So what does twenty-plus sessions actually achieve?

    Therapy for a lateral lisp moves through a strict hierarchy, and you cannot skip a rung:

    • Auditory discrimination: Can they hear the difference? (Often, initially, no.)
    • Eliciting the sound: Sometimes a single session, can be six.
    • Stabilisation: Building consistency in isolation, then syllables, then single words (beginning, middle, end).
    • Blends: Mastering challenging combinations like ‘spoon’, ‘street’, and ‘smile’.
    • Sentences: Moving to phrases, full sentences, and structured conversation.
    • Generalisation: Using it naturally with family, at school, when tired, or when telling a long story.
    • Self-monitoring: Training them to catch and correct themselves without therapist intervention.

    Rushing a level guarantees a collapse two levels later. I’ve never once regretted going slowly; I’ve frequently regretted going fast.

    The bit that decides everything: home practice

    Let me be blunt in a nice way 😊 The child who practises five to ten minutes a day, six days a week, will finish in half the time of the child who practises the night before their session.

    An hour with me per week is roughly 1% of your child’s waking life. The other 99% is where habits are made or unmade. What I need at home is:

    • Short and daily beats long and occasional: Five focused minutes, ideally at a consistent time.
    • Practise only at the set level: If we’re on words, don’t leap to sentences. That’s how we go backwards.
    • Give specific feedback: Say ‘that one was lovely and sharps or ‘that one slipped sideways, try again’.
    • Hold back on everyday corrections: Don’t correct them in normal conversation until we’re ready.
    • Record them occasionally: Children love hearing their own tangible progress.

    The bottom line

    I’m good at this. I’ve been doing it for thirty years and I love it. But I’m a therapist, not a magician, and the parents who get the best outcomes are the ones who view this as a partnership. When we work together—combining expert clinic guidance with steady, gentle practice at home, that ‘twenty-plus’ number isn’t a sentence. It’s simply the guideline to giving your child a clear, confident voice for the rest of their life.

    Do get in touch with me. I would love to hear from you and help you and your child.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

    3

  • Submucous cleft palate: What is it and how does it impact on speech?

    ByLondon Speech and Feeding
    Submucous cleft palate: What is it and how does it impact on speech?

    What exactly is a submucous cleft palate?

    A submucous cleft palate (SMCP) is much less obvious than its counterparts, cleft of lip and/or palate, and can profoundly impact a child’s speech development. It leads to often extreme hyper nasal speech and difficulty with producing many sounds (/K/ /G/ /T/ /D/ /P/ /B/ /S/ /Z/ /F/ /V/).

    In short, the muscles and bone of the soft palate, and sometimes the hard palate, do not fuse completely during foetal development and the mucous membrane that lines the roof of the mouth remains intact, effectively camouflaging the underlying muscular and bony deficit.

    So, while the surface of the palate appears normal, the essential muscle and functions responsible for sealing off the nasal cavity from the oral cavity during speech are compromised. This cleft (or lack of muscle) can be seen as a bluish midline discoloration of the soft palate, often a bifid (split) uvula, and at times a notch in the posterior border of the hard palate can be felt upon palpation. However, these signs aren’t always present or easily discernible, contributing to the difficulty arriving at a diagnosis.

    Diagnosing a submucous cleft palate is often akin to searching for a needle in a haystack, especially for the untrained eye. Unlike overt clefts that are visually apparent at birth, an SMCP can go undiagnosed for years, sometimes well into childhood or even adolescence. Paediatricians and even ENT surgeons have been known to miss it during routine checks due to the intact mucosal lining. Parents might notice their child’s speech sounds ‘different’ or ‘nasal’ but struggle to pinpoint the cause. Children might undergo extensive speech therapy without a proper diagnosis, as the underlying structural issue continues to hinder progress.

    My experience as a speech therapist in private practice:

    Over my years of practice, I have encountered several children presenting with persistent hyper-nasal speech and significant difficulties producing plosive and fricative sounds.

    It has been incredibly rewarding, though at times challenging, to successfully diagnose SMCP in a number of these children. My approach often involves:

    • a meticulous oral motor examination,
    • careful listening for the specific qualities of hypernasality,
    • and a deep understanding of the physiological requirements for clear speech sound production.

    When I suspect an SMCP, I refer these children to Great Ormond Street Hospital where a fantastic multidisciplinary team, typically including ENT surgeons and a specialist speech-language therapist can conduct more definitive assessments. These assessments often involve instrumental analyses such as videofluoroscopy or nasoendoscopy, which provide objective measures of velopharyngeal function and visual confirmation of the anatomical deficit.

    The path to resolution: surgery, therapy, and successful outcomes

    Surgery

    The journey for these children, once diagnosed, often involves surgical intervention. It’s not uncommon for children with SMCP to undergo multiple operations to achieve optimal velopharyngeal closure. These procedures aim to reconstruct or augment the velopharyngeal mechanism, enabling it to effectively separate the oral and nasal cavities during speech. The specific surgical approach depends on the individual child’s anatomy and the severity of the velopharyngeal insufficiency. It’s a testament to the skill of these specialised surgeons that such intricate repairs can be performed with remarkable success.

    Speech therapy

    Following surgery these children embark on the crucial phase of speech therapy. While surgery addresses the structural problem, speech therapy helps a child learn to utilise their newly improved anatomy. It involves intensive work on developing oral airflow, establishing correct articulatory placement, and reducing learned compensatory strategies that have developed due to the original structural deficit. It is immensely gratifying to witness the transformation. Children who once struggled to produce basic sounds, whose speech was difficult to understand, gradually develop clear speech.

    Next steps?

    If you’re a parent concerned about your child’s speech and feeding, you’re not alone. The journey can feel confusing, but professional guidance can make all the difference. Never hesitate to have a second opinion when you have that niggling feeling that there is something that has not yet been explored. At London Speech and Feeding I specialise in being thorough and thinking outside the box.

    I am here to provide the support you need. Reach out to schedule a consultation and take the first step towards helping your child communicate and thrive.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

    1
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    Navigating the exciting 9–18 months journey: Your baby’s communication milestones

    ByLondon Speech and Feeding

    Between 9 and 18 months, your little one undergoes a remarkable transformation, blossoming from a curious explorer into a budding communicator. This period is filled with exciting milestones in speech, language, and social development. Let’s delve into what you can expect.

    9–12 months: The world opens up

    Communication takes flight

    • Babbling becomes more complex with a wider range of sounds. By babbling we mean syllables like: pa ga ka ma da and then ‘baba’ gohgoh’. First we hear one and two syllables together and then longer and longer strings! This is so exciting!
    • First words! One day around the 12 months–14 months mark we hear a first word! My older son’s first word was ‘Licht’ which is the German word for ‘light’ as literally every time I carried him along the corridors in our home, I pointed out the light switches to him and turned them off and on a few times. And each time I said ‘Licht!’ and it stuck! PS: sadly I cannot remember what my younger son’s first word was… poor second and third babies they just have to muddle along and call loudly to get noticed!
    • Understanding grows! Baby now understands simple instructions like ‘where is your ball’ and responds by looking to the ball across the room!

    Social butterflies

    • Your baby now starts to show interest in other children, and may try to copy their actions. Now we are getting proper traction with simple social games like peek-a-boo and patty-cake. Whilst your baby is generally interested in other people and children he or she may show separation anxiety when mum or dad or other familiar person suddenly leaves the room and they feel alone with strangers.

    Fine motor skills

    • Pincer grasp develops. This is where your child puts an index finger to the thumb in order to pick up of small objects, hold them and transfer them to either a box, back on the floor or into the other hand.
    • Your baby may start to explore objects by banging, shaking, and mouthing.

    12–15 months: Words are taking shape

    • Language explosion: From our early words we now suddenly see baby’s vocabulary expanding, with new words added each week. I would highly recommend parents keep a little journal of all the words they hear. If nothing else this is a wonderful aide-memoire for years down the road when you might like to reminisce about the first ten words. I promise you otherwise you won’t recall! (especially for second and third babies; I would do this now, had I the time again).
    • Understanding grows:
      • By about 15 months our baby can follow simple two-step instructions like ‘Go get your shoes and bring them here.’
      • Begins to understand the concept of ‘no.’ and that’s a very useful thing. Though before you breathe a sigh of relief… your toddler may well show you that he is understanding a ‘no’ though he may not stop doing what he is doing or come down off the table!
    • Playtime gets interactive:
      • Now we engage in more complex play, such as stacking blocks, pretending to eat with a spoon, and imitating actions.
      • Many toddlers now start showing an interest in picture books.

    15–18 months: Communication blossoms

    • Words combine: Towards 18 months or around about then your toddler may start to put two words together, such as ‘more milk’ or ‘bye-bye dada.’
    • Gestures and sounds: Now we also use gestures to communicate, such as pointing, shaking head ‘no,’ and waving ‘bye-bye.’
    • Exploration and curiosity:
      • Your toddler is now EVERYWHERE! Turn your back and he or she is gone! Your toddler now shows a strong sense of curiosity and explores their environment with enthusiasm.
    • Copying
    • Look out for actions and gestures your toddler will copy such as clapping hands or patting a cushion or banging a spoon on the table .

    Remember

    • Every child develops at his or her own pace.
    • These are just general guidelines, and some children may reach certain milestones earlier or later than others.
    • If you have any concerns about your child’s development, please consult with your speech and language therapist. We are always keen to hear from parents and happy to help promote all those lovely early skills.

    General tips to encourage communication if you feel your child needs a little more help

    • Talk, talk, talk! Engage in frequent chatting with your child.
    • Listen to your child: Allow for periods of silence when playing with your child to allow them to say something or make sounds which you can then copy and respond to.
    • Read aloud regularly. Use books with simple words and pictures.
    • Play interactive games: Hickory Dickory Dock, Row Row the boat, Old McDonalds, 5 little monkeys jumping on the bed, chasing and catching, tickling games.
    • Respond to your child’s babbling and gestures. You can copy them or if your toddler says long strings of babbling you cannot understand you could just say: ‘Oh ok!? ‘yes that’s great!’ ‘who knew!’ ‘wow you’ve got much to say!’ as if you understood.
    • Limit screen time or if your child is very passionate about watching clips then sit and watch with your child so that you can see what is the best bit, which songs they like the best and what sort of phrases they love hearing.

    This exciting period of rapid growth and development is a precious time for both you and your child.

    By providing a loving, stimulating, and responsive environment, you will naturally nurture their communication skills! Any more questions, please get in touch!

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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