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.
Have you ever thought about how difficult it can be to produce certain speech sounds? Some sounds are definitely trickier than others. This is especially true for children with speech sound disorders like Childhood Apraxia of Speech (CAS).
My student with CAS has been working hard on producing the /L/ sound especially when it was followed by an /O/ or /OO/ like, ‘log’ or ‘look’. We’ve practised lots and now that he’s got a good handle on /L/, he’s started replacing another difficult sound, /Y/, with it. So, ‘yes’ becomes ‘less’ and ‘yuck’ becomes ‘luck.’
This is a common pattern in speech development. Once a child masters a new sound, they may start using it in place of other sounds they find even more challenging.
Minimal Pair therapy
I use different evidence-based methods to help my students. And I often like to start out with phonemic awareness and then I move to contrasting the error sound with another sound to make completely different words. This approach is called ‘minimal pair’ therapy: both words are the same except for the initial/final sound which has the error sound, and this is contrasted with the correct sound.
Below is an example of this:
After we have worked on sound awareness, listening and becoming aware of small units of sound matter, then we can move to working on tongue placement and movement.
Tongue placement and movement to produce correct /L/ and /Y/ sounds
To produce these sounds correctly, the tongue needs to be in specific positions and make specific movements.
/L/ sound:
Tip of the tongue touches the alveolar ridge (the bony ridge behind your upper teeth)
Sides of the tongue are raised to the sides of the upper teeth
Airflow escapes through the sides of the tongue
/Y/ sound:
Tip of the tongue touches the roof of the mouth behind the alveolar ridge
Sides of the tongue are raised to the sides of the upper teeth
Airflow escapes through the centre of the mouth
I also use:
Auditory bombardment: Auditory bombardment is a technique that involves repeatedly listening to a target sound. This can help children to develop a better understanding of the sound and how to produce it.
Visual cues: Visual cues can be helpful for children who are having difficulty producing a particular sound. Here I use the image of a ‘standing tongue’ versus a ‘sitting tongue’.
Physical cues: I use my hands to show a ‘standing tongue’ for the /L/ versus a ‘sitting tongue’ for the /Y/. But what worked even better and sadly I don’t have the video clip for it:
Semantic cues: For example a picture of an ‘EAR’ to make the sound /Y/ so we shape the sound /EA/ to /Y/.
Parent involvement: Parents play an important role in their child’s speech sound development by providing opportunities for them to practise their speech sounds at home. This can be done through activities such as reading books, singing songs, and playing games.
Reinforcement: It is important to praise children for their efforts, even if they are not perfect. This will help them to feel motivated to keep practising. Important here for speech correction is concrete reinforcement: I feed back to my student what exactly they were doing correctly with their tongue or lips. Rather than saying ‘well done’, I mention what my student has just done with the tongue to change the sound: ‘I saw you lowered your tongue! That made a good /Y/’.
Another great way of reinforcing positively is to ask the student how they feel they have done? For the older ones I often ask them to self-rate their sound production out of 10. Then we can work towards the next incremental number upwards. This is very effective and gives the student control over their own work.
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.
Book corner with Oi Frog! by Kes Gray and Jim Field.
Books are an engaging way to support your child’s communication development. Even if your little one dislikes reading in the traditional sense. They will become immersed in this adventure, without realising they are taking in language and developing vital communication skills. This is one of my favourite series for children.
Increase fun and interaction
These books are made for fun and excitement! It may seem silly putting on different voices for different characters, but this is one way in which you can engage your child. Why not try to use different intonation patterns (e.g., you may use a deep voice for the dog, and a higher pitch for the cat)? Make your story interactive: you could ‘rawww’ like a lion and see who can make the loudest noise. Make noises to encourage interaction (e.g., when scratching his chin, make a squeaky sound!). You could also relate the experience back to your child (e.g., ‘can you scratch your chin?’).
Time to talk
Talk about what you can see on the front cover (e.g., There’s a frog on a log, how funny!) You could also ask your child to choose the rhyming words on a page in the book. Can your child tell you what rhymes with certain words (e.g., can you guess what a parrot sits on?)? Make use of every page. You could comment on your favourite frog and see if your child can talk about their favourite. You can support them by giving them an example (“my favourite frog is the one swimming backwards because he looks funny”). Then you could use this scaffold to support their answer. Your favourite is [________________] because [_________________]
If your child is reluctant to use language, the use of commenting can take the pressure of them (“look at all those frogs” or “he’s climbing up the stool”) is a powerful way in which you (as parents) can take the pressure off your child. A top tip I like to give is to make sure you pause regularly, which creates opportunities for your child to use language.
This book uses a subject-verb-object sentence structure (e.g., ‘hares sit on chairs’) which allows your child to hear a good model of a sentence. You could also talk about things in the book that belong in a certain category (e.g., animals, food) or begin with a specific sound. See if your child will name any more.
Reap the reward of repetitive language
Oi Frog uses repetitive rhyming language and puts emphasis on these words. This is important because the more your child hears a word, the more likely they are to remember, understand and use it in the correct context.
Emotions matter
Talk about how the animals feel and why they may feel this emotion (e.g., the cat’s feeling annoyed because…, Lions sit on irons, how does the lion feel?). Reasons can be difficult for children with communication difficulties. Support them by giving an example or by giving them an option (e.g., “does the lion feel happy or sad? I think the lion feels sad because he’s burnt his bottom on the iron! It’s too hot!”)
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 speech and language therapists, some of the most effective moments in therapy don’t come from flashcards, worksheets, or even drilling sounds (though to be fair I do drill quite a lot too! needs must…😊).
By and large they happen in natural interaction — during shared attention, laughter, storytelling, and connection.
This short video clip captures that.
In under two minutes, while simply reading a book together with a three-year-old child, we naturally work on:
Speech sounds
Vowel production
Early phonological patterns
Motor planning
Signing and total communication
Visual cueing
Repetition and practice
Confidence building
And engagement through play
To many people, it may just look like ‘reading a book’.
But underneath that moment are years of specialist training, clinical decision-making, preparation, and therapeutic skill.
Therapy hidden inside play
One of the most important parts of paediatric speech therapy is knowing how to embed targets into meaningful interaction.
Books are one of my favourite therapy tools! Why: because as speech therapists we need to prepare for our child and our sessions. And having a book gives me the structure to know beforehand what kind of sounds or words might be coming up. Then I can be prepared for providing extra support for them. As you can see in this clip, I had the sound cards just there because I had anticipated what might be coming up!
A single story can provide opportunities for:
Speech sound practice
Vocabulary development
Sentence building
Turn-taking
Symbolic understanding
Attention and listening
Gesture and signing
Motor speech cueing
And social communication
In this clip, I follow my little one’s interests while carefully weaving in her individual therapy targets.
It looks relaxed and spontaneous — and it is — but it is also highly intentional.
Catching opportunities in the moment
One lovely example in the clip is when she says ‘yes’.
She is now starting to say the final /S/ sound, so I immediately model and draw attention to it using the ‘snake sound’ visual cue, giving her positive feedback that she can now also try using this sound at the start of words.
My gently shaping the word ‘yeSSSS.’ gives her:
Auditory feedback
Visual support
And an achievable opportunity to try again
A few seconds later, we naturally practise it again.
That’s responsive therapy.
Speech therapists are constantly listening, analysing, adapting, and deciding:
When should I model?
When should I pause?
When should I repeat?
When should I let it go?
How can I keep confidence high while still targeting speech?
These decisions happen in seconds.
Working on speech without ‘stopping the play’
Another moment in the clip focuses on the word ‘out’, where the vowel sound is one of her speech targets.
Then we move into practising the word ‘open’, a word she has previously found difficult.
Within this one word, we can support:
Sequencing
Motor planning
Lip shape
Vowel production
And speech sound accuracy
We also briefly practise the /K/ sound — a sound produced at the back of the mouth which can be particularly tricky to produce.
Instead of explaining it verbally (which is often too abstract for young children), I use:
Visual demonstration
Exaggerated mouth movements
Gesture/sign support
And playful modelling
Children learn through seeing, hearing, doing, and experiencing.
That is why Speech Therapists use multiple layers of cueing simultaneously.
Why I use signs alongside speech
Throughout the clip, I also use signs such as ‘book’ and ‘pig’.
Using signs does not stop children talking.
In fact, for many children, signs:
Reduce frustration
Support understanding
Increase participation
Reinforce vocabulary
And help bridge the gap while speech is developing
Communication always comes first.
Speech is only one part of communication.
When children feel successful communicating, they are far more likely to keep trying.
The skill behind ‘natural’ therapy
One thing I often hear from parents is:
‘You make it look so easy.’
That is actually one of the biggest compliments a therapist can receive. (Though we also often feel we need to justify our very existence with these thoughts because we don’t just play/just read but we know it can look like that!) 😊 this is the reason for this blog…
High-quality paediatric therapy should feel warm, playful, responsive, and natural.
But underneath that natural interaction is:
Clinical knowledge
Phonological analysis
Motor speech understanding
Language development expertise
Sensory awareness
Relationship-building
And careful session planning
Before this session even began, I already knew:
Which speech patterns to target
Which words would likely appear in the book
What visual cues might help
Which signs to model
And how to adapt depending on the child’s responses
That preparation allows therapy to stay child-led without losing therapeutic focus.
Following the child while leading the therapy
The best therapy is rarely rigid.
Children do not learn communication through pressure or endless correction. They learn through interaction.
That is exactly what this short clip demonstrates.
One book. One conversation. Hundreds of tiny therapeutic decisions.
And all within a joyful moment shared together.
Because good speech therapy should never feel like hard work for a child.
It should feel like connection, confidence, success — and fun.
If you’re concerned about your child’s speech and language or wondering whether they might benefit from speech therapy, feel free to get in touch.
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of 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.
When a child’s speech is difficult to understand, it can feel overwhelming for everyone involved. As a parent, your instinct is often to focus on helping your child ‘talk properly’. And that makes complete sense. Speech is important. But here’s the key message I want to share with you:
Speech is just one way to communicate.
And when speech is not yet clear, not yet reliable, or not yet available, children need other ways to get their message across.
This is where Total Communication comes in.
What is Total Communication?
Total Communication is an approach that encourages the use of all available ways to communicate, not just speech.
This can include:
spoken words
gestures and pointing
facial expressions
signing (such as Makaton)
pictures or symbols
drawing
electronic AAC (Augmentative and Alternative Communication), such as apps like LAMP Words for Life
It’s not about replacing speech. It’s about supporting communication in every possible way.
Think of it like this: if speech is currently unclear or limited, why restrict a child to the hardest route? Why not give them more tools to succeed?
‘But won’t this stop my child from talking?’
This is one of the most common concerns I hear in clinic.
Parents often worry that if a child starts using signs or a communication device, they will become ‘dependent’ on it and stop trying to talk.
The research tells us something very different.
Studies consistently show that AAC does not prevent speech development. In fact, it often supports it.
A review by Millar, Light & Schlosser (2006) found that AAC interventions do not reduce speech production and may actually increase it.
Romski & Sevcik (2005) demonstrated that children given AAC often develop stronger overall communication skills, including spoken language.
More recent work continues to show that providing AAC early can accelerate language development, not delay it.
So rather than ‘giving up on speech’, using AAC is actually building the foundations that speech needs.
Why Total Communication matters, especially for unintelligible children
When a child is very difficult to understand, they are often experiencing a hidden frustration:
‘I know what I want to say, but no one understands me.’
Over time, this can lead to:
reduced confidence
behavioural frustration
withdrawal from communication
fewer opportunities to practise language
If a child cannot successfully communicate, they communicate less. And when they communicate less, their language development slows down.
Total Communication breaks this cycle.
By giving a child reliable ways to be understood, we:
reduce frustration
increase interaction
build confidence
create more opportunities for language learning
And importantly, we allow them to show us what they already know.
AAC is a bridge, not a barrier
Using AAC (whether that’s pointing to pictures, signing, or using a device) does something powerful:
It separates language from speech.
A child might have lots of ideas, vocabulary, and understanding but their speech system (especially in cases like phonological disorder or childhood apraxia of speech) cannot yet keep up.
AAC allows the child to:
express complex ideas now
practise sentence structure
develop vocabulary
take part in conversations
All while their speech is still developing.
In other words, AAC doesn’t replace speech. It keeps language moving forward while speech catches up.
What does this look like in real life?
In therapy, I often use a combination of approaches:
modelling simple signs alongside speech
pointing to symbols while talking
encouraging children to gesture or show
using drawings to support understanding
incorporating an AAC device such as LAMP Words for Life
You might see a child:
say part of a word
point to a symbol
use a gesture
and look at you expectantly
That is communication success.
And success builds motivation.
‘I just want them to talk’
Of course you do. And I do too!! That’s always the goal.
But here’s the important shift in thinking:
Children learn to talk by communicating, not by waiting until speech is perfect.
If we hold out for clear speech before allowing other communication methods, we risk:
limiting their ability to interact
reducing practice opportunities
increasing frustration
But if we support all communication, we give them:
more chances to express themselves
more positive communication experiences
more input and feedback
And that is what drives progress.
A balanced approach
Total Communication doesn’t mean ‘speech is no longer important’.
It means:
we continue targeted speech therapy
we work on sounds and clarity
and we support communication in the meantime
It’s not either/or.
It’s both/and.
Final thought
If your child’s speech is difficult to understand, the most important question is not:
‘Are they talking clearly yet?’
It’s:
‘Can they successfully communicate?’
Because communication is the foundation of:
relationships
learning
confidence
wellbeing
And every child deserves a voice, in whatever form that voice takes right now.
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.
Why is joint engagement important for communication development?
It has been well-documented that the development of joint attention is impaired in children who have social communication difficulties or autism. It is, in fact, this impairment which distinguishes children with ASD from children who have other developmental delays.
A lack of joint attention in very young children is an early sign of autism as it is a signal that there is a disruption in the motivation to connect socially with others. Since this is a crucial element, I thought I would outline what we mean by Joint Attention as supported by the research undertaken at Hanen.org.
In typically developing children, the ability to shift attention between a person and an object for the purposes of connecting socially or for requesting develops around the same time. However, for children with ASD, these components emerge one at a time and in a linear fashion. Children with ASD usually start with requesting something and later they may learn to share attention for social sharing. (see pattern below as a general guide).
As with typical development, there is variation in the order that these skills emerge but the following patterns of development is commonly seen:
Reaching, taking adult’s arm/hand or pointing to ask for something — but without looking at the adult
Gradually alternating looking between person and object of desire
Then learning to follow the point of another — which is responding to joint attention initiated by another
Directing attention to share interests — without looking at the adult: pointing to a truck on the road/ helicopter circling above
Then directing attention to share interest by alternating gaze shift between person and object — here the child is now initiating joint attention.
What is important to note is that in order to fulfil the criteria for true joint attention, the purpose of directing the attention of another person must be social in nature. In other words, it must not be exclusively to obtain a desirable object or event/action. True Joint Attention is seen verbally or non-verbally; we want to share a thought with another person and direct them to something we are interested or excited or spooked by.
For example: we can see an amazing firework display in the distance and we want to quickly direct our friend’s attention to this. In order to do this we might be tugging their sleeve/arm whilst pointing to the display in the distance, and perhaps we might add “wow look over there!” We are doing so simply to share an interest without obtaining anything, we are just being social with each other. So True Joint Attention is not just looking at what we want to have, then look at the person who can get this for us and then point to the item. We can say that this is the precursor to true joint attention, which is purely social in nature.
Because true joint attention is an essential precursor to typical language development, the absence of joint attention in children with ASD contributes to difficulties with language learning. Beuker, K., Rommelse, N., Donders, R. & Buitelaar, J. (2013).
The Hanen programme for Parent Child Interaction teaches parents of children with Social Communication Difficulties step by step how to enable their children to learn to pay attention to an object and the parent at the same time.
We learn how to enable a child to:
engage take turns
shift eye gaze between toy and adult
copy adult’s actions, gestures and then words
play with toys in different, new ways
interact and for longer periods of time
have fun whilst playing
If you would like to know more about the Hanen programme please get in touch. I look forward to exploring the topic with you and help guide you forward if this is something your child is struggling with.
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.
