If your child is using echolalia and/or has a diagnosis of autism, then your child’s way of processing language is most likely different to the classic way children typically learn language. We call this process Natural Language Acquisition or Gestalt Language Processing.
Step by Step guide to Gestalt Learning
Let’s explore the following stages of Gestalt Processing:
Stage 1: communicative use of whole language gestalts
(e.g., “let’s get out of here”)
Children and young people in this stage use echolalia. They need to hear more gestalts or scripts. So, your job is to model, model, model and to use functional language that your child can repeat back.
Stage 2: mitigated into chunks and re-combining these chunks
(e.g., “let’s get” + “some more”) and (e.g., “let’s get” + “out of here”)
This is when you take parts of gestalts or phrases and then combine it with other parts.
Stage 3: further mitigation (single words recombining words, formulating two-word phrases)
(e.g., “get…more”)
They are going beyond their gestalts. Furthermore, they may begin to label different objects.
Stage 4: formulating first sentences
(e.g., “let’s get more toys”)
You may see more grammatical errors during this phase as they are creating unique sentences. Please don’t worry about this, it means they are playing and experimenting with language. As communication partners, you could model the correct form of the sentence.
Stages 5 & 6: formulating more complex sentences
(e.g., “how long do you want to play inside for?”)
You can see that language learning is a process, that is trialled and tested, used in different contexts for children to be able to learn and use language appropriately.
My next blog will give you activities ideas and how you might use them specifically with a Gestalt Language Processor.
Remember early intervention is vital. So, if you have any concerns, please seek the advice of a Speech and Language Therapist.
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.
Let’s face it, introducing solids is a rollercoaster for parents. You’re bombarded with advice (solicited and otherwise) on purees, spoon-feeding, and the much-discussed ‘baby-led weaning’ (BLW). As a speech-language/feeding therapist I see the world through the lens of communication and development, as well as safe munching and swallowing. BLW can be a fantastic option for many little foodies. But is it right for yours? Let’s take a dive into the messy, hilarious world of toddler feeding.
BLW in a nutshell
Your baby, perched in their highchair, eyes wide with excitement and curiosity reaches out for a platter of food. He/She grabs a fat avocado slice, and curiously explore it with his/her lips, gums and tongue. He/She spits some of it out, mashes bits of it into his/her hair, there was a tiny swallow and the rest is smeared onto the high chair tray. Now he/she grabs a bit of the banana and rinse and repeat as before, except this one he/she keeps in his/her mouth for bit longer and takes a tiny bit more before the rest gets deposited into his/her bib.
This, in a nutshell, is BLW! It’s all about letting your little one take the lead in exploring new foods, textures, and tastes. No spoon-feeding, just pure, messy, self-directed feeding fun.
The pros of letting your little one loose on solids:
Motor Skills: BLW is a sensory party for developing motor skills. Picking up that slippery banana or gumming a chewy piece of toast strengthens those tiny hands and mouth muscles. These are the very skills they’ll need for future talking and chewing.
Texture Time: BLW exposes your baby to a variety of textures right from the start. Think soft, steamed broccoli florets or smooth, banana half-slices. This sensory exploration helps them develop an understanding of different textures in the world, which can translate to better oral motor skills needed for speech development.
Independence: BLW fosters a sense of self-feeding independence. Your toddler learns to control how much he/she eats and the pace of his/her meal. This can lead to better self-regulation later on, not just with food, but in other areas of his/her development too.
A wider variety of flavours: BLW encourages exposure to a wider variety of tastes and smells. Let your baby discover the sweetness of roasted sweet potato or the tang of mashed avocado! This early exploration can lead to less picky eating down the road.
There are some valid concerns:
Gagging vs. Choking: One of the biggest concerns parents have about BLW is choking. However, gagging is a natural reflex that helps babies learn to move food safely around their mouths. Choking is much rarer, and with proper food selection and supervision, the risk is very low. The con here really is parental anxiety more than anything else and if you can overcome this then a bit of gagging is just fine and part of the process. Choking, again most children do choke occasionally a bit! Of course, close supervision and common sense is very important here.
It’s ever so messy!: Be prepared for mashed banana on the highchair tray, rogue peas flung across the room, and a general sense of chaos. But then again, this is an important part of the learning process! I would encourage you to embrace the mess (within reason and your personal tolerance level) and focus on the fun of exploration.
Nutritional Concerns: Some parents worry that babies won’t get enough nutrients with BLW. While it might take a while for them to master the art of self-feeding, a healthy child’s body is pretty good at self-regulating. Offer a variety of healthy options, and he/she will eventually get the hang of it.
BLW: Is it right for your Little One?
BLW isn’t a one-size-fits-all approach. Here are some things to consider:
Developmental Milestones: Babies should be able to sit up with good head control and show an interest in food before starting BLW.
General good health and absence of food intolerances, allergies, or other significant health issues which might dictatea more controlled feeding regime.
Gag Reflex: A strong gag reflex is a good sign. It shows your baby’s natural ability to move food safely around their mouth. If, however, your baby’s gag is overly sensitive and causes frequent bouts of vomiting please consult your health care professional for an assessment (GP, Paediatrician, Dietician, Speech and Language – Feeding Therapist).
Your Comfort Level: BLW requires a relaxed and patient approach. If you’re feeling stressed about the mess or potential choking hazards, it might not be the right fit for you.
A final mouthful:
BLW can be a fantastic way to introduce your baby to solids. It promotes exploration, independence, and a love for food. Remember, there’s no pressure to go all-in on BLW. You can always combine it with spoon-feeding or purees to find an approach that works for your family and your child. The most important thing is to create a positive and relaxed mealtime environment where your little one can explore the wonderful world of food at their own pace.
P.S. As an SLT, I always recommend chatting with your health care professional. This way you can address any concerns you might have and ensure your baby is developmentally and physically on track for this exciting new chapter.
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.
You (as parents) often describe yourselves as being under constant pressure and stress when looking after your children and young people with Special Educational Needs and Disabilities (SEND). You may find going out to do the simplest of tasks a challenge. And you will try to avoid social situations out of fear and anxiety. One of the most important factors to you is having like-minded people who understand your position as a parent with a young person with additional needs. Let’s look at some of the challenges you face and how I can support you and your family.
1. Challenging behaviour and going out to the shops
When your child displays challenging behaviour and won’t go into a shop without buying a toy that they insist on having, it can be tough on your family. You see people around you staring as you try to manage the situation. They do not understand the pressures you face, or that the simplest of tasks are a huge challenge.
I can support you by giving strategies to use when out and about. I know that using visuals is important for your child. They may not understand or take in language when they are in a heightened state of anxiety or feeling overwhelmed. You could print pictures of the places you’re going to and put them on an easily accessible chain. Then you could use that chain when out and about at the shops. You may want to introduce a visual timetable at home. That way your child or young person understands where they are going. This may lessen their anxiety and subsequent behaviour.
2. Your child is not able to communicate their needs to an unfamiliar communication partner
When your child has difficulty communicating to an unfamiliar person it can be hard to manage. You feel yourself explaining your situation repeatedly. I can provide your child with individualised strategies or communication aids which support your child to communicate with both familiar and unfamiliar communication partners. We’ll work together to find which communication methods work in different situations and how your child will use these to help their independence.
3. Being overwhelmed
Your child or young person may easily be overwhelmed which may contribute to behaviour changes. I’ll work with your family to understand what the behaviour means, looking at what happened before and what happened afterwards. We’ll not only look at the behaviour but at the environment as well. This can inform how you can support your child or young person in the future, to reduce sensory stimuli (if needed) and for them to feel emotionally regulated.
4. People avoid engaging with you
One of the hardest things as a parent is for others to avoid you. You see them crossing the street because they don’t know what to say to you. All you want is them to accept you, to maintain your identity as a person and not as a SEND parent. I can support you emotionally. I can give you advice on local support networks where you can find other parents in a similar situation.
We know the stresses that being a parent with a child with SEND comes with. Please know I am always here to support you, to find solutions so that when you’re next out and about. Your experience will be a little easier and you’ll feel less isolated.
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.
As a speech and language therapist, I’m often asked about the significance of seemingly simple gestures in child development. One question that comes up frequently is, ‘Why is pointing so important?’ It might seem like a trivial action, but pointing is a powerful communication tool and a critical milestone in a child’s development.
Why is pointing so important?
Let’s delve into the theory behind why pointing matters:
1. Pointing as pre verbal communication:
Before children can use words, they use gestures to communicate their needs and interests. Pointing is one of the earliest and most important gestures. It allows children to:
Request: ‘I want that!’
Protest: ‘No, not that!’
Direct attention: ‘Look at that!’
Share interest: ‘Wow, cool!’
2. Pointing and language development:
Pointing is not just about communicating in the here and now; it also plays a crucial role in language development. Research shows that:
Early pointing predicts later language skills: Children who point more often tend to have larger vocabularies and better grammar later on.
Pointing helps children learn new words: When children point at something, adults tend to label it, providing valuable language input.
Pointing supports joint attention: Joint attention, or the shared focus of two individuals on an object or event, is essential for language learning. Pointing helps establish joint attention, creating opportunities for communication and learning.
3. Pointing and social-emotional development:
Pointing is not just about language; it’s also about social interaction. It allows children to:
Engage with others: Pointing invites others to share their focus and participate in their world.
Express emotions: Pointing can convey excitement, curiosity, or concern.
Develop social understanding: By observing how others respond to their pointing, children learn about social cues and communication.
4. Pointing and cognitive development:
Pointing is linked to cognitive skills, such as:
Understanding object permanence: The ability to know that objects exist even when they are out of sight.
Categorisation: The ability to group similar objects together.
Problem-solving: Pointing can be used to ask for help or to indicate a problem.
5. Types of Pointing:
It’s important to note that there are different types of pointing, each with its own significance:
Imperative pointing: To request something.
Declarative pointing: To share interest or direct attention.
Informative pointing: To provide information.
If you have concerns about your child’s pointing or overall communication development, don’t hesitate to seek professional guidance from a speech-language therapist. Early intervention can make a significant difference in supporting your child’s communication journey.
How can we create opportunities for pointing?
‘Where’s the…?’ games:
Play games like ‘Where’s the doggy?’ or ‘Where’s the ball?’ and encourage your toddler to point to the object.
Start with familiar objects and gradually introduce new ones.
Reading together:
When reading picture books, ask your toddler to point to specific objects or characters on the page.
Use phrases like, ‘Can you point to the puppy?’
Everyday activities:
During daily routines, ask your toddler to point to things they want or need.
For example, ‘Do you want the apple or the banana?’
When walking outside say ‘LOOK’ and encourage pointing.
Use of toys:
Use toys that have buttons or points of interest that when pressed make a noise. Encourage your toddler to point to the area that makes the noise.
Use toys that have many different parts, and ask the toddler to point to a specific part.
Model pointing:
Point yourself:
When you see something interesting, point to it and say the name of the object.
For example, ‘Look! A bird!’
Point to show choices:
When offering choices, point to each item as you name it.
For example, ‘Do you want the blue cup or the red cup?’ (Point to each cup).
Point to indicate direction:
When giving directions, point in the direction you want your toddler to go.
For example, ‘Let’s go that way!’ (Point).
Make it rewarding:
Respond to pointing:
When your toddler points, immediately respond to their communication.
Give them the object they want, or acknowledge what they are pointing at.
Use positive reinforcement:
Praise and encourage your toddler when they point.
Say things like, ‘Good pointing!’ or ‘You showed me the car!’
Show excitement:
When they point to something, show excitement, this will encourage them to point again.
Use specific techniques:
Use gestures and verbal cues:
Combine pointing with verbal cues and other gestures.
For example, say ‘Look!’ while pointing and nodding your head.
Simplify the environment:
Reduce distractions to help your toddler focus on the object you want them to point to.
Use exaggerated movements:
Use large, exaggerated pointing movements to draw your toddler’s attention.
Consider developmental factors:
Age-appropriate expectations:
Remember that pointing develops at different rates for different children.
Be patient and supportive.
Underlying issues:
If your toddler is not pointing by 18 months, or if you have any concerns about their development, consult with a speech and language therapist.
There may be underlying sensory or motor issues.
Key points:
Consistency is key. Practise these strategies regularly.
Make it fun and engaging for your toddler.
Celebrate every success, no matter how small.
If you have any concerns about your child’s development, contact your local health services.
Great toys and items for pointing
1. Interactive books:
Touch-and-feel books: Books with different textures, flaps to lift, and sounds encourage interaction and pointing. ‘Where’s the…?’ questions prompt pointing to specific features.
Books with simple pictures: Clear, uncluttered pictures make it easier for toddlers to focus and point to objects or characters.
2. Cause-and-effect toys:
Activity cubes: These often have buttons, dials, and levers that produce sounds or actions when manipulated, prompting pointing and exploration.
Pop-up toys: Toys where figures pop up or things happen when a button is pressed encourage anticipation and pointing to the action.
Simple musical instruments: A toy piano, drum, or xylophone encourages pointing to the keys/surfaces to make sounds.
3. Toys with parts to manipulate:
Shape sorters: Encourage pointing to the shapes and the matching holes.
Stacking cups or rings: Nesting cups or stacking rings invite pointing to select the correct size or order.
Puzzles with knobs: Simple puzzles with large knobs are easier for toddlers to grasp and point to the pieces.
4. Toys that encourage joint attention:
Bubbles: Blowing bubbles and following them with your eyes and pointing encourages joint attention (shared focus).
Balls: Rolling a ball back and forth and pointing to where it’s going can promote joint attention and turn-taking.
Wind-Up Toys: Wind-up toys that move across the floor can be exciting to follow with pointing.
5. Pretend play toys:
Toy telephones: Encourage pointing to the buttons and pretending to dial.
Dolls and stuffed animals: Pointing to the doll’s eyes, nose, mouth, etc., or asking the child to point to these features on themselves.
Toy food and dishes: Pretend play with food and dishes can involve pointing to request items or indicate actions (e.g., ‘Can I have the apple?’).
Tips for using toys to encourage pointing:
Get involved: Play alongside your toddler, modelling pointing and using language to describe what you’re doing.
Follow their lead: Observe what your child is interested in and use that to encourage pointing.
Limit distractions: Reduce background noise and visual clutter to help your child focus.
Use gestures and words: Combine pointing with words and other gestures (e.g., ‘Look!’ while pointing).
Be patient and positive: Celebrate all attempts at pointing and provide lots of encouragement.
Remember, the most important factor is the interaction you have with your child while playing. Use these toys as tools to create opportunities for communication and joint attention, and your toddler will be well on their way to mastering pointing!
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.
Bilingualism is a beautiful aspect of our diverse world. Growing up in a bi- or multi-lingual household is a wonderful gift, allowing children to communicate with a broader range of people and access many cultures.
My own two children grew up in a bilingual German-English speaking household. They have both been so enriched by this experience, not only language- and learning-wise but of course also culturally: their world has always been so open and colourful. Growing up in inner London and having their German family and mum’s friends as well, this has been a wonderful experience. Both my boys speak German well (not quite like native speakers but like very good second language speakers) and both have very easily learned 3rd and 4th languages additionally when in secondary school.
Whilst bilingualism has untold benefits, it’s not uncommon for bilingual children to take slightly longer to reach certain speech milestones. This should not be automatically mistaken for speech disorders but rather seen as a natural part of bilingual language development.
Bilingualism and speech delays
Sometimes, of course, we do see speech delays or disorders where a child’s speech development lags significantly behind their peers. We often see a delay in both languages equally, making it extra hard for to communicate effectively. BUT PLEASE KNOW the family speaking in multi-lingual languages never caused the delay/disorder!
If there is a delay or a disorder any number of other reasons could have caused it, such as:
hearing impairments,
reduced phonological awareness,
sensory processing issues,
reduced attention and reduced joint attention,
neuro-developmental delays or difficulties,
general or specific learning difficulties
or sometimes other genetic factors.
So, to say that the difficulty is due to a child being exposed to several languages is a red herring. (no offence to herrings!)
Speech therapy
Speech therapy can be powerful to help bilingual /multilingual children with speech delays unlock their full linguistic potential. By providing individualised assessments, targeted interventions, and involving families, speech therapy can bridge the gap between speech delays and bilingualism. It’s essential for the therapist and parents to work together to support the children in their unique linguistic journeys, helping them communicate effectively and thrive in both of their languages.
Image by Freepik
Speak your home language at home
Many parents report that they worry about speaking their home language at home and instead they have been focusing on just speaking English at home. They now rarely use their home language with their child. They fear that speaking a language other than English with their child will cause further delay and hinder their progress. All parents want the best for their child and often parents fear that their child won’t fit in or will be seen as ‘different’. So we can understand why parents feel that the English language is the only one worth having.
But the opposite is the case: it is crucial to speak in both languages freely, both at home and outside the home! Both languages will benefit your child, no matter what the delay or difficulty is. Acquiring a ‘mother tongue’ or native language is absolutely vital for children to have a good, solid linguistic grounding on which to build other languages. Bilingual children may mix languages during speaking and parents may equally mix their languages. This does not hinder language development and is a natural part of linguistic development.
Speak freely and naturally
What is far more important than the question: ‘which language should I say this in?’ Instead think: ‘let me speak freely and naturally, let me respond naturally, in good intonation and let communication flow freely to the child.’
Speech therapy can be a crucial resource for bilingual or multilingual children and their families.
We work on targeted interventions to address speech and language difficulties, helping your child develop essential communication skills. For home practice between therapy sessions, we can recommend tailored treatment plans to help you help your child in daily life. Our input could be focusing on articulation, phonological awareness, attention and listening, vocabulary development and grammar.
Family support is crucial in speech therapy. We like to work closely with parents to provide guidance and strategies for fostering language development in both languages at home.
If you have any worries about your child being delayed in a bilingual or multilingual household do get in touch and we will be happy to support you in your journey.
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.
Child-led therapy is essentially what it says, therapy sessions that are directed by your child. You may think how can my child’s Speech and Language Therapist focus on goals if sessions are led by my child.
Let us explain…
Your child will be more receptive and motivated to take part in therapy if they have some form of input. E.g., they can choose what toys they want to play with, or how they want to play with the resources available. If sessions are child-centred then they are much more likely to engage and reach their goals, making intervention valuable. They will also be able to regulate their emotions, and use movement to support their need for regulation. E.g., some children like to jump whilst others like to run. As Speech and Language Therapists we need to use what is meaningful to your child to get the most out of intervention. By focusing on child-led therapy, we can build trust, which will allow us, in time, to use new techniques and activities that your child may enjoy. We want children to be themselves, to show their true personality. Therapy is about enhancing their skills in their own individualised way and child-led therapy allows for this.
This way of working may seem daunting to some, but it doesn’t have to feel this way. Parents often feel if they are prepared then activities may go smoother. It might be the case, but perhaps it doesn’t give your child the opportunity for spontaneity. We’d like to suggest something that may lead to some surprises. Put out an activity that is your child’s favourite and then a completely new activity. Remember these activities don’t have to be complicated. Often, the simpler the better!
So, no need to plan, just place two activities out and see what happens! Look out for anything which surprises you, which activity did they prefer? Do they have any sensory preferences? The freedom of choice is a wonderful thing to explore. So, just go with the flow!
The kind of activities that are useful for child-led play can include:
Hide and seek
Cooking or baking
An Exercise ball
Small world play
Pretend play
Musical instruments (you could even have a go at making your own)
Child-led therapy is a very useful resource. We have it at our fingertips. We don’t need special resources. You just need yourselves and your child! Sometimes, child-led therapy can be tricky to put in place. It sounds easy but is much harder in reality. So, make sure you give it time and reflect on your experiences. Ask yourselves ‘what went well’, and ‘what could be improved’. E.g., perhaps you gave your child time to lead to begin with, but you didn’t give them enough time to think about their options during the activity.
How can parents become more child-led in the home environment?
Pause and use silence. This gives your child the opportunity to lead.
It’s perfectly natural to want to talk. Afterall, this is how adults maintain conversations. If you find yourself talking too much, count to ten! This will allow your child time to respond or initiate in the conversation or interaction.
Move down to your child’s level. It’s much easier to see what’s going on if you’re at the same height.
Videoing you and your child can really help you to see where your strengths lie. You’ll also be able to make minor tweaks to improve your communication during child-led play.
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.
When your child attends Speech and Language Therapy, it can look like your child’s therapist is playing. Therapy needs to be fun, which means carrying out therapy through the medium of play. But remember every approach used has evidence behind it. We need to know that therapy will be successful, so an evidence-based approach is essential.
One of the approaches used for Speech Therapy (i.e., working on speech sound production) is the Cycles Phonology Approach. This approach focuses on the patterns and processes rather than each individual sound. For example, it may be working on final consonant deletion, so the omission of the final sound in words. As Speech and Language Therapists we understand that children can get frustrated and fatigued working on the same sound every day. This approach attempts to solve that. Hodson suggests, the approach is also useful for children with more speech sound errors, as therapists see progress in areas not targeted.
How does the Cycles Phonology Approach work?
Your Speech and Language Therapist will assess your child’s speech development and will then analyse the results. They will also look for which sounds they can produce with support (this is called stimulability). They will analyse patterns in the results and will formulate a plan.
The Cycles Phonology Approach intervention allows your child to work in blocks. This might mean they work for half a week for 30 minutes on (e.g., clusters). Then the next half they’ll work for 30 minutes on a different process (e.g., omission of sounds at the end of words).
Research has found that the following error patterns respond well to this approach:
Syllables (identifying the different parts in a word e.g., “ae-ro-plane”)
Final Consonant deletion (omission of the final sound e.g., “ca” instead of “cat”)
Initial consonant deletion (omission of the first sound e.g., “at” instead of “cat”)
Fronting (instead of making a sound at the back of the mouth, it’s made at the front e.g., “tat” instead of “cat”)
Backing (instead of making a sound at the front of the mouth, it’s made at the back e.g., “gun” instead of “bun”)
S blends (e.g., “sl, sm, sn, sk, sw”)
Gliding of liquids (e.g., “lellow instead of yellow”, “wabbit instead of rabbit”)
What does a Speech and Language Therapy session look like when using the Phonology Cycles Approach?
The format of the session remains the same for whichever speech sound pattern your child is working on. Your child’s Speech and Language Therapist will review the previous session. Then they will use an activity to work on your child hearing the sound several times (this is called ‘auditory bombardment’). Then your child will practise saying the sound. Next, the Speech and Language Therapist will check if your child can say any of the sounds which they haven’t been able to produce before, with support. This is called a stimulability check. After this, your child will take part in an activity which builds their awareness of sounds in words (such as a rhyming or syllable activity). The session will finish with another auditory bombardment task (i.e., hearing their tricky sound repeatedly).
I will give you advice for practising at home, as it’s vital that your child learns in the correct way. We aim for 100 turns in therapy sessions, so it’s vital your child is motivated.
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.
