How can I incorporate AAC into my speech therapy sessions?

ByLondon Speech and Feeding
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Many parents are surprised when I bring AAC into a session, especially if they’ve come to see me primarily for speech sound work.

They might wonder: ‘If we’re working on pronunciation, why are we using a communication device?’

The simple answer is this: speech therapy is about communication first, and speech sounds second. Supporting a child’s ability to express themselves clearly and confidently is always the priority, and AAC can be a powerful tool alongside spoken speech.

What do we mean by AAC?

AAC stands for Augmentative and Alternative Communication.

This can include:

  • A speech-generating device (such as LAMP Words for Life or GRID as I used in the photo below)
  • A communication app on a tablet
  • A symbol board or communication book
  • Gestures, signs, or visual supports

AAC does not replace speech. Instead, it supports language development, reduces frustration, and builds communication success while speech skills are developing.

Pretend Play using Speech and AAC in my clinic room

But I mainly work on speech sounds… So how does AAC fit?

Most of the children I see are working on:

  • Articulation difficulties
  • Phonological delay
  • Motor planning challenges (including apraxia/dyspraxia)
  • Unclear speech affecting confidence

For these children, AAC isn’t a separate therapy. It’s simply woven naturally into what we are already doing.

If a child brings their device to sessions, I actively include it. If they don’t yet use AAC but could benefit from visual or symbolic support, I may introduce simple options within activities.

Using AAC to support speech practice

Let’s say we are working on early speech targets like: ‘GO’.

We might practise:

  • Saying the word verbally
  • Listening for the target sound
  • Using play (TOY TRAIN GOING ROUND A TRACK)

Now we can extend this using AAC.

On the device or communication board, we might model: ‘LET’S GO’ or ‘IT’s GOING up the hill’.

This allows the child to:

  • Practise their speech sound target
  • Build a simple sentence
  • Experience successful communication even if speech is not fully clear yet

All responses are valid and supported.

AAC helps children communicate more than they can say

Many children can understand and think in longer phrases than they can physically say.

For example:

  • A child who verbally says single words may build longer phrases on AAC.
  • A child who struggles to plan speech movements may use AAC to communicate smoothly while still practising verbal attempts.
  • A child who becomes frustrated when misunderstood gains a reliable backup system.

Rather than slowing speech progress, AAC often:

  • Reduces communication pressure
  • Increases participation in therapy
  • Encourages more attempts at speech
  • Supports language growth

When children feel understood, they usually become more motivated to try speaking.

There are no ‘prerequisites’ for AAC

One of the biggest myths I hear is: ‘My child isn’t ready for AAC yet.’

In reality, children do not need to:

  • Reach a certain speech level
  • Use pictures first
  • Prove they understand everything
  • Show immediate interest

Instead, we presume competence and introduce AAC in meaningful, playful ways.

That means:

  • Modelling words while blowing bubbles
  • Commenting during playdough activities
  • Choosing words during games
  • Building simple phrases in shared reading

AAC should never feel like extra ‘work’. It’s simply another way to join in communication.

My goal is always the same: to help each child communicate as clearly, confidently, and successfully as possible, using every helpful tool available.

If your child uses AAC (or might benefit from it)

 Please feel free to:

  • Bring the device to sessions
  • Show me how your child currently uses it
  • Share advice from school or other therapists

I am very happy to incorporate AAC into our work together so that speech practice, language development, and real communication all move forward hand-in-hand. Because ultimately, therapy isn’t just about producing perfect sounds. It’s about helping your child be heard and understood.

If you’d like support or advice, please contact me and I can help guide the next steps.

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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      Hard munchables: Chewing through the weaning journey

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      As a Speech and Language Therapist with a specialism in paediatric feeding, I’m constantly looking for ways to support families in developing their little ones’ oral motor skills and fostering a positive relationship with food. While Baby-Led Weaning (BLW) has revolutionised how many families introduce solids, (see my previous blog in July 25) a concept that often sparks discussion and curiosity is the use of ‘hard munchables.’

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      What are hard munchables?

      The term ‘hard munchables’ refers to specific types of firm non-digestible food items that are offered to babies for oral exploration and skill development, not for nutrition. These are typically foods that babies cannot bite off or swallow in large pieces due to their texture, but which provide resistance for chewing practice.

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      • Celery sticks: Like carrots, offering firm resistance.
      • Large, raw apple slices (peeled chunks): A firm, slightly sweet option.
      • A firm, uncut pear core: With the seeds removed.
      • Dried mango cheeks (hard, unsweetened varieties): These offer a fibrous texture.
      • A large, fully cooked but firm piece of meat (like a steak bone with some meat attached): The meat provides flavour and a bit of shreddable texture, while the bone is for gnawing.
      • Hard crusts of bread or breadsticks (very firm, without soft inner crumb): These can soften slightly with saliva but offer significant resistance.
      Image by Freepik

      It’s crucial to emphasise that hard munchables are not for consumption or nutrition. They are tools for oral motor development and should always be offered under strict, active supervision.

      How do hard munchables fit into weaning?

      While weaning (traditional or Baby-Led Weaning) introduces solid foods that a baby can eventually bite and swallow, hard munchables are complementary to the weaning phase. They enhance that phase by helping a child to develop hand dexterity, hand to mouth movement, and oral development.

      It’s important to differentiate: Weaning provides the digestible food for eating, while hard munchables provide the tool for skill practice. They are not substitutes for each other but can be used together under careful guidance.

      Pros and cons from a speech therapy perspective

      As an SLT, I see both the potential benefits and the necessary precautions when incorporating hard munchables.

      Pros:

      • Enhanced oral motor development: Hard munchables provide excellent resistance training for the jaw, helping to develop the strength, endurance, and coordination needed for efficient chewing. This is foundational for moving beyond purées and very soft textures.
      • Promotes lateralisation of the tongue: The act of moving the hard item from side to side in the mouth encourages the tongue to move independently of the jaw, a crucial skill for managing food and for speech sound production.
      • Preparation for more complex textures: By strengthening the oral musculature and refining chewing patterns, hard munchables can help babies transition more smoothly to lumpy and mixed textures.
      • Sensory exploration: They offer rich sensory input (tactile, proprioceptive) that can be beneficial for oral mapping and awareness, especially for babies who might be orally sensitive.

      Cons:

      • Choking risk: While the intention is for the baby not to bite off pieces, there is always a risk. Small pieces can break off, or a baby might accidentally bite off a larger chunk than he or she can manage. Active, vigilant supervision is non-negotiable.
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      Key Considerations for Parents

      Here are my top recommendations:

      1. Consult with a professional: Always discuss this with your Paediatric Feeding SLT first before you introduce hard munchables. We can assess your baby’s individual readiness and guide you on safe practices.
      2. Strict supervision: Never leave your baby unsupervised with a hard munchable, even for a second. Your full attention is required.
      3. Appropriate size: Ensure the item is large enough that the baby cannot fit the whole thing in their mouth. It should extend well beyond their fist.
      4. No biting off: The goal is gnawing and scraping, not biting off pieces. If your baby is consistently breaking off chunks, stop using them.
      5. Focus on skill, not consumption: Reiterate to yourself that this is for practice, not for eating.

      In conclusion, hard munchables, when used appropriately and under guidance, can be a very valuable tool to support oral motor development during the weaning journey. However, always be safe and consult with a specialist to ensure your little one develops his or her feeding skills effectively and joyfully.

      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.

      References:

      Rapley, G., & Murkett, T. (2008). Baby-Led Weaning: The Essential Guide to Introducing Solid Foods. Vermilion.

      Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for feeding development. Pro-Ed.

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      Let’s relax about making EYE CONTACT already…

      ByLondon Speech and Feeding

      There’s been a long tradition with teaching staff and with Speech and Language Therapists working in schools that eye contact should be a goal. It is well known that Autistic individuals (whether that be children or adults) mostly avoid eye contact. Whilst it’s part of the way we communicate, it shouldn’t be used as a necessity for an individual who feels that it is uncomfortable. Whilst it does show that you’re listening and showing an interest, it’s not a fair expectation for neurodiverse children.

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      Following this, I often reflect on this question ‘Should we make eye contact as a goal?’

      It very much depends on the situation. If it places more demands on the child and becomes stressful. Then no. There are many strategies we can use which gain eye contact without placing extra demands on the child. We need to be mindful to adapt the environment and not place neurotypical expectations to meet the needs of neurodiverse children.

      How can you encourage eye contact without demand?

      • If you’re using toys, try holding them up to your eye level.
      • You can adjust your position, try sitting face to face during play.
      • Always get down to your child’s level. This might mean that you lay on the floor if your child is positioned in this way.
      • During play, waiting is extremely powerful. Before a key part of the activity, wait and see if your child looks at you. Remember silence is golden!
      • The best way I find is: do something unusual during play. It might be that you spray shaving foam with the lid still on. Or you bring out a wow toy and make it spin/light up or make a noise. A balloon can be good – see video clip. Use the excitement of the activity, and wait to see if you achieve that ‘BINGO’ moment.
      • Create opportunities when there are no toys involved such as during ‘tickles’ or ‘hide and seek’. Autistic children find it difficult to shift their attention between a toy and an adult. So by removing one option, you’re setting them up to succeed.

      Remember, it takes practice and time for you to develop these skills. Try one at a time and experiment, see which works best for your child. If you need speech, language or communication support or advice, I am always here to help.

      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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    • Can AI help my child’s speech delay? What it can do and what it can’t

      ByLondon Speech and Feeding

      If you’re worried about your child’s speech, you are absolutely not alone. Many parents I work with tell me the same thing:

      ‘I’ve been Googling…’
      ‘I asked ChatGPT what activities to try…’
      ‘TikTok said we should practise this sound every day…’

      It makes complete sense. When waiting lists are long, evenings are quiet, and your child is struggling to communicate, it’s natural to look for help wherever you can find it.

      AI tools can actually be helpful in some ways. But they also have clear limits especially for children with significant speech delays or speech sound disorders.

      Here’s an honest, balanced guide to what AI can do, and what it simply can’t.

      ✔️ What AI can help with

      1. Explaining things in simple language

      AI can be very helpful for explaining speech and language terms in a way that’s easy for parents to understand for example, what a phonological delay is, or what Childhood Apraxia of Speech means. It can also suggest possible reasons for a child’s speech delay based on the information you provide.

      The difficulty is that parents (or teachers) can only ask questions based on what they notice or perceive to be the problem. In practice, this doesn’t always tell the full story. For example, parents often report that their child ‘can say certain words’, but during an assessment we may find those words are actually produced with consistent error patterns. These patterns give important clues about the underlying nature of the difficulty, whether it’s a delay or a disorder and they guide the speech therapist in choosing the most effective targets to improve intelligibility.

      2. Suggesting games and activities

      AI is very good at suggesting ideas for games and practice, such as word lists, simple play activities, sound practice games, book suggestions, and ways to encourage talking within everyday routines. These can be especially helpful when you feel stuck or want some fresh inspiration for supporting your child at home. It can help to think of AI as a big ideas bank, somewhere to dip into when you need new, playful ways to keep practice engaging.

      3. Helping you prepare questions for a therapist

      Some parents use AI to list questions before an assessment, understand reports and organise concerns.

      This can make therapy feel less overwhelming and more collaborative.

      Used this way, AI can actually support the therapy process.

      ❌ Where and why AI cannot replace real life speech therapy

      There is substantial research supporting the effectiveness of real-life speech therapy compared to generic online resources or AI-generated suggestions. Here are some key points highlighting why in-person therapy is often more beneficial:

      • Personalisation: Speech therapists assess each child’s unique needs, strengths, and challenges through direct observation and interaction. This personalised approach allows for tailored interventions that address specific issues, which generic resources cannot provide.
      • Nuanced understanding: Therapists are trained to recognise subtle cues in speech production, including the nuances of sound articulation, language comprehension, and social communication. This expertise enables us to identify underlying issues that may not be apparent through generic assessments.
      • Motivational support: A speech therapist can provide encouragement, motivation, and emotional support, which can significantly enhance a child’s willingness to participate and engage in therapy. This relational aspect is crucial for building confidence and reducing anxiety around communication.
      • Evidence-based practices: As a highly trained and specialised speech therapist I utilise evidence-based practices that are grounded in research, ensuring that the techniques used are effective and up to date. This contrasts with generic online information, which may not always be reliable or validated.
      • Progress monitoring: In-person therapy allows for ongoing assessment and adjustments to the treatment plan. We track progress over time and modify strategies as needed, ensuring that the therapy remains effective and relevant.

      Research studies consistently show that individualised, face-to-face interventions lead to better outcomes in speech therapy than generalised approaches. For parents and caregivers, seeking professional help tends to provide a more effective path toward improving their child’s communication skills.

      The healthiest way to think about AI

      AI works best as a starting point, not a substitute. You might use it to understand your child’s report and learn how speech develops,

      But if your child has significant delay or difficulty being understood, what makes the real difference is:

      • A tailored assessment
      • A clear therapy plan
      • Expert target selection
      • Ongoing adjustment
      • Support for both child and you the parent!

      Dear parents,

      If you’ve been turning to AI for help, it doesn’t mean you’re doing anything wrong. It means you care!

      But please know the best outcomes usually come from combining your daily support at home with guidance and support from your speech therapist who knows you and your child.

      Many of my past and present clients tell me that they really value my ‘handholding’ and me guiding them in between the sessions. A quick check in is often all that is needed but it makes a huge difference!

      If you’d like support or advice, please contact me and I can help guide the next steps.

      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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      How do we play with our Gestalt Language Processors?

      ByLondon Speech and Feeding
      Image by Freepik

      Child-led therapy

      When working with Gestalt Language Processors, it is always advisable to use child-led therapy. What does that mean? Child led therapy involves following a child’s interests and allowing her/him to lead the play activity throughout the speech and language therapy session. In other words, instead of having my own ideas of what we might want to play with or what activities I might try and use, I provide a range of toys I know the child likes or has played well with before; then I wait for the child to pick what she/he enjoys doing.

      Play can be very repetitive and we can often see our child cycling back to the same one or two toys throughout the session. But this is what she/he needs to do at that time and it means that we have focused attention and engagement. This in turn is very helpful for the therapeutic process, which is to offer great scripts and phrases/words alongside what she/he is playing with.

      Monotropic minds

      Often the mind of autistic children is more strongly pulled towards a smaller number of interests or hobbies as I like to call them. Dr Dinah Murray, Dr Winn Lawson and Mike Lesser have found in 2005 that autistic people have ‘monotropic’ minds. They explain that autistic children focus their energy on a narrow range of activities as the energy required to switch between several toys is much higher than we would see in the neuro-typical population.

      Gestalt Language Processors are often also Gestalt Cognitive Processors. This is when experiences are retained as episodic events and memories. An event is remembered by specific parts of the same event. And, therefore, these specific parts should always be part of that event, when the event is repeated.

      Should any of the specifics be changed or are missing, then this can cause great upset to Gestalt Cognitive Processors. So, for example, if the last two times in speech therapy we had the train set out and this was played with happily, then this becomes a specific part of the whole session. If, I then don’t offer the train set the third time a child comes to see me, this could be very upsetting.

      This is why I tend to try this out and see what happens. Usually in the 3rd or 4th session: I might not bring out the car run that has hitherto been super successful to see if we are able to transition well to other toys. If yes, then we can have new experiences but if not then I will re-offer the car run/or whatever toy pretty quickly so as not to cause complete dysregulation.

      A few pointers below which help with child-led play:

      Introduce a few new toys and see what happens

      Parents are encouraged to bring some familiar toys their child likes to the session. We can then introduce a couple of different toys to see how we go. Try offering a new toy alongside the familiar one; try offering new toys without the familiar one present, but be prepared to re-offer the “old” toy should our child get upset.

      Rotate toys and don’t offer out too many toys

      I find that children can get overwhelmed and overstimulated by too many items out all at once. I always talk to parents about toy rotation at home and I encourage storage and ‘tidy up’ of toys so that we can increase attention focus, and also maintain freshness and new interest in older toys.

      Some children are not yet ready to play with toys

      Here I suggest people games: these are games where the adult becomes part of a more motor-based activity. Some call it ‘rough and tumble play’ but it can be nursery rhymes such as sleeping bunnies/row row the boat or peek-a-boo for the younger ones.

      Copy/Imitation is so important – try getting two identical or similar play items

      When we are copying our child, it is often not desirable to ‘take turns’ with their toys/blogs/cars etc as our child may not be ready to let us take a turn. Instead, if we have the exact same toy that our child is having then we can play alongside our child and copy them perfectly without interrupting their play.

      References:

      Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism, 9(2), 139-156.

      If you need help with your child, please do not hesitate to contact me.

      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.

      0

    • Empty Set and Phonology approaches

      ByLondon Speech and Feeding

      I have been avoiding the use of the Empty Set approach for the longest time as I was not sure if it would work seeing that I am challenging two sounds my student struggles with at the same time. But I decided to give it a go and it works a treat!

      With this approach, we use two sounds that our student is struggling with. For example, in my video this student cannot produce /sh/ and /r/. Both sounds have different rules, so I decided to contrast them with each other.

      • The rules of /sh/ are: no voice, air is pushed out through teeth, produced at the front.
      • The rules for /r/ are: use your voice, produce the sound in the middle of the mouth by shaping your tongue in a particular way.

      So I chose the words ‘shoes’ and ‘ruse’ as their rules are quite different. Contrasting two sounds the student does not know has been shown to lead to greater change in the child’s articulation. And I can certainly vouch for this as my student is making the best progress with this approach.

      Phonology Therapy – what is it, why and how?

      Phonology is the study of the sound system of a language. It’s distinct from articulation therapy which focuses on the physical production of sounds.

      Phonology therapy focuses on rules. For example, sounds that are produced at the front of the mouth, in contrast to sounds that are produced at the back of the mouth, or sounds that are produced with a long air stream: /s/ or /f/ versus short sounds like /p/ or /t/; sounds are produced with voice or without voice.

      Many children, and sometimes adults, are unaware of some of the speech rules and confuse and replace individual sounds. They might say TAT instead of CAT or SIP instead of SHIP.

      A quick overview of phonology approaches I use:

      Minimal Pairs:

      This approach is good for single sound substitutions. We offer word pairs that differ by only one sound, like ‘ship’ and ‘sip.’ One of our first goal in therapy is to highlight the difference between the target sound (e.g., /sh/) and the sound the child uses (e.g., /s/). This helps discriminate and eventually produce the correct sound.

      Multiple Oppositions:

      A child might replace lots of sounds with a single sound like a /d/. So instead of ‘four’, ‘chore’ and ‘store’ our child says ‘door’, making speech very unintelligible.

      The approach is typically geared towards shaking up the phonological system. Our goal is to choose two to four targets that are different from each other, and different from the substituted sound. If our child’s favourite sound is /d/ they can use their voice and make a short sound by stopping their airflow. So I will choose a different target sound to change up the speech system. For example I might choose an /f/, a /m/ and a /k/ sound. So I would contrast: ‘door’ with ‘four’, ‘more’ and ‘core’.

      Maximal Oppositions:

      In the Maximal Oppositions approach the treatment sets consists of words that are minimally contrasted and that have maximal or near maximal feature differences between each word pair. One word in a pair represents a sound the child ‘knows’ (can say at word level) and the other represents a sound the child does not know (cannot say).

      For example, a child may ‘know’ /m/ and be able to say words like ‘man’, ‘mat’ and ‘mine’. However, the same child may be unable to say /f/ as in ‘fan’, ‘fat’ and ‘fine’. The consonants /f/ and /m/ are maximally opposed as follows.

      I am always delighted to work on speech sound disorders, I love the challenge and the successes we can celebrate together. Get in touch with me!

      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.

      1