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.
Prosody refers to the ‘music’ of speech — the rhythm, pitch, stress, and volume that convey meaning and emotion beyond the literal words themselves. Think about a monotone statement like ‘Really?’ compared to one with a rising inflection, expressing genuine curiosity.
When I work with children on producing speech sound sequences, we focus on mastering individual sounds and then putting them together into target words. A crucial element that can significantly impact a child’s speech production is ‘prosody’.
In CAS, where the difficulty lies in planning and executing the motor movements for speech, prosody can be a powerful tool for producing clearer words and phrases.
Here’s why working on prosody is an essential tool in CAS speech therapy:
1. It aids Motor Learning:
Apraxia of Speech means that the planning and execution of speech movements are impaired. When we use exaggerated intonation or stress patterns while modelling words, we are providing additional prosodic variation and, therefore, additional auditory cues. These cues often help my student to carry out the correct motor movements for a word or syllable sequence.
For instance, I might say ‘ball’ with a high-pitched emphasis on the ‘b’ sound. This auditory cue might be more effective in guiding the child’s tongue placement than simply repeating the word without variation.
In this little video clip I get my student to say the word ‘snuggle’ (since we were working on that particular sound sequence: snuggle, snout, snore and sneeze) with a high voice and then a lower voice ‘like a bear’ — again it provides that extra auditory cue, but, in addition, the fun aspect also helps to take away the intense focus on a tricky movement pattern.
By now the new pathways have been laid through repeated practice and now automaticity takes over and without too much effort my student can suddenly produce a motor pattern. It’s magical when it happens and gives me such a thrill.
2. It makes speech more engaging and natural sounding:
Children with CAS often sound robotic or flat due to challenges with prosodic elements. By incorporating variations in pitch, volume, and rhythm during therapy, we can help achieve a more natural flow of speech
3. It makes it easier to express our emotions:
Children with CAS often struggle to express themselves emotionally; partly through the difficulty of producing clear words — period, but also in addition due to the difficulties or absence of musicality and rhythm in their speech.
Therefore, it is so important to incorporate activities focused on practising different emotions with varied intonation patterns. This can really empower our students to put emotions into their words.
Good words to practise are fun words like ‘Wow!’ or ‘Yeiih’ or power words and phrases like ‘No!’ or ‘Gimme that’ etc.
Making Therapy Fun and Engaging:
Speech therapy for CAS doesn’t have to be all drills and exercises (though to be fair sometimes we can’t quite get round to making each and every word huge fun though we try…).
I aim to make all my sessions fun and have intrinsic rewards built into the speech practice where possible.
Home practice tips:
Therapy shouldn’t exist in a bubble. Working on prosody during sessions is crucial, but it’s equally important to integrate these skills into everyday interactions. Parents and caregivers can model appropriate prosody during playtime, story time, or even simple conversations. This consistent reinforcement helps our children to generalise their newfound skills and use them naturally in their daily lives.
Sing songs and rhymes: Songs naturally incorporate variations in pitch and rhythm. Singing familiar songs and creating silly rhymes can be a delightful way to practise prosody.
Use puppets and toys: Assign different voices and personalities to puppets or toys. This encourages children to experiment with pitch and volume to differentiate characters.
Read aloud with enthusiasm: Model expressive reading, varying your voice for different characters and emphasising key words. This makes reading time engaging and helps children understand the power of prosody.
Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.
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.
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.
As a speech and language therapist, I often get asked by parents what toys and books they should buy for their toddlers. It can feel overwhelming with so many options available! So, I’ve put together a list based on my experience and what I’ve found works well.
Remember, every child is unique!
Observe your toddler’s interests and play style. Some toys that are popular might not be engaging for your child.
Here are a few ideas to get you started:
Sensory Toys:
Stacking cups: These are fantastic for developing hand-eye coordination, fine motor skills, and understanding size relationships. (Various brands available) Note: You can stack many things you have around the house, like bowls or measuring cups, for a similar experience!
Shape sorters: Help with shape recognition, hand-eye coordination, and problem-solving. (Melissa & Doug, Vtech)
Sensory balls: Balls with different textures (soft, bumpy, squishy) provide tactile stimulation. (Various brands)
Push and pull toys: Encourage gross motor development and exploration. (Vtech, Fisher-Price)
Communication-focused toys:
Picture books with flaps: Engage curiosity and encourage language development. (Various brands)
Talking toys: Introduce new vocabulary and encourage imitation. (Vtech, Fisher-Price)
Musical instruments: Encourage exploration of sounds and develop auditory skills. (Bright Starts, Fisher-Price)
Now, let’s talk about books:
The Very Hungry Caterpillar by Eric Carle: A classic with repetitive text and vibrant illustrations, great for introducing vocabulary and concepts like days of the week.
Brown Bear, Brown Bear, What Do You See? by Bill Martin Jr. and Eric Carle: Simple, repetitive text and engaging illustrations make this a favourite for many toddlers.
Goodnight Moon by Margaret Wise Brown: A soothing bedtime story with calming illustrations.
Pat the Bunny by Dorothy Kunhardt: An interactive book with textures and flaps to engage young children.
Corduroy by Don Freeman: A heartwarming story about a teddy bear who loses his button.
Remember:
Observe your child’s interests: Choose toys and books that capture their attention and encourage exploration.
Engage with your child: Play with the toys together and read books aloud with enthusiasm.
Keep it simple: Start with a few toys and books and gradually introduce new ones.
Rotate toys: Keep playtime fresh by rotating toys and books regularly.
Most importantly, have fun! Reading and playing with your child should be a joyful experience for both of you.
Also consider the power of open-ended play
In today’s world filled with electronic gadgets, it’s easy to overlook the value of open-ended play. Open-ended toys lack specific functions or prescribed outcomes, allowing children to use their imaginations to explore and create. Unlike toys with pre-determined ways to play, open-ended toys encourage:
Creative thinking: Children can use them in countless ways, developing their own rules and narratives. A block can become a car, a house, or a spaceship, depending on the child’s imagination.
Problem-solving skills: Children learn to figure out how to use the toys, experimenting and adapting as they go. Don’t immediately rush in and fix things for your little one, let them think for themselves and then communication incentive: let them come and find you!
Fine motor skills: Many open-ended toys, like blocks, encourage the development of fine motor skills like grasping, stacking, and building.
Cognitive development: Children learn about cause and effect, spatial relationships, and problem-solving as they play with open-ended toys.
Social-emotional development: Open-ended play can foster social interaction and cooperation as children play together and share ideas.
Simple toys with big impact
Some of the best toys for toddlers are often the simplest ones. Here are a few examples:
Wooden blocks: Building towers, bridges, and forts encourages creativity and problem-solving.
Balls: Throwing, kicking, and rolling balls promote gross motor skills and hand-eye coordination.
Fabric: Bits of fabric can be draped, draped, and used for imaginative play.
Empty boxes: From cardboard boxes to tissue boxes, these can be transformed into anything a child can imagine: a car, a house, a spaceship!
Natural materials: Sticks, leaves, pinecones, and rocks can be used for imaginative play and sensory exploration.
Remember, the key to open-ended play is to let children explore and discover
Step back and observe, allowing your child to use his or her imaginations without too much direction. You might be surprised at the creative ways he or she uses simple toys!
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.
Mealtimes can be a battleground for parents of picky eaters, especially toddlers with Avoidant/Restrictive Food Intake Disorder (ARFID). I see a great number of toddlers with Autism traits and many of my clients are picky eaters from mild to severe. Take a look at my blog for an outline of what the issues are and how to try and help.
ARFID goes beyond typical ‘picky eating’ and can significantly impact a child’s growth, nutrition, and social-emotional well-being. If your toddler is resistant to trying new foods or has a very limited diet, here are some strategies to navigate the introduction of solids:
1. Understand ARFID:
ARFID is a diagnosable eating disorder characterised by:
Limited food variety: Eating only a small range of foods, often with specific textures or colours.
Fear of new foods: Intense anxiety or aversion to trying unfamiliar foods.
Sensory sensitivities: Heightened sensitivity to taste, smell, texture, or appearance of food.
Lack of interest in eating: May show little interest in food or mealtimes.
2. Seek professional guidance:
Paediatrician and/or gastroenterologist: Rule out any underlying medical conditions.
Registered dietitian: Assess nutritional needs and create a balanced meal plan.
Speech and language therapist (SLT): If oral-motor skills or sensory sensitivities are contributing to feeding difficulties.
Occupational therapist (OT): If sensory processing challenges are affecting mealtime behaviours.
Child psychologist: If anxiety or emotional factors are contributing to ARFID.
3. Strategies for introducing solids:
Start small: Introduce one new food at a time, in small amounts, alongside familiar favourites.
Patience is key: It can take multiple exposures (up to 10–15 times!) for a child to accept a new food. Don’t give up!
Positive reinforcement: Praise and encouragement for any interaction with the new food, even just touching or smelling it.
No pressure: Avoid forcing or pressuring the child to eat. This can create negative associations with food.
Make it fun: Present food in playful ways, use cookie cutters for fun shapes, or involve the child in food preparation.
Sensory exploration: Encourage exploration of food through touch, smell, and sight before tasting.
Role modelling: Show the child that you enjoy eating a variety of foods.
Use fun utensils: your child might like characters from ‘Frozen’ or ‘Dinosaurs’ or ‘Diggers’ there are a host of character-based cutlery and cups/plates to be had. Also, I really rate these two items very highly they are so good so I want to share these with you. Both are available online. But warning: the cup is outrageously expensive as it comes from the United States and is sold by a small scale company. But I feel this is cup very worth trying, I have had good results with this.
Gradual desensitisation: Start with foods that are similar in texture or taste to accepted foods, then gradually introduce more challenging options.
Food chaining: Introduce new foods that are similar in taste, texture, or appearance to accepted foods.
4. Mealtime Environment:
Positive and relaxed: Create a calm and enjoyable mealtime atmosphere.
No distractions: Minimise distractions like TV or toys.
Consistent schedule: Offer meals and snacks at regular times.
Child-sized portions: Offer small, manageable portions to avoid overwhelming the child.
Involve the child: Let the child choose their utensils, plate, or cup.
5. Remember:
Every child is different: What works for one child may not work for another.
Progress takes time: Be patient and celebrate small victories.
Focus on the positive: Praise any positive interaction with food.
Seek support: Connect with other parents or support groups.
Introducing solids to toddlers with ARFID can be challenging, but with patience, persistence, and professional guidance, you can help your child develop a healthier relationship with food.
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.
Your child’s speech, language and communication difficulties may impact their self-esteem. And they may show signs of increased frustration. You want them to be full of confidence, increasing their participation in school and fully engaging with their peers.
1. Practise active listening
Speech difficulties can mean that it’s more challenging to understand what your child says. It’s important to show that you’re paying attention, giving them time to express themselves. Focus on what your child says rather than how they are speaking. Remember to maintain eye contact, and actively listen. Active listening and giving time can be trickier than it sounds. I can provide strategies to support your active listening skills.
2. Give other means and forms of communication
Allowing children to express themselves in a variety of ways (e.g., gesture, signs, written, use descriptions to describe a word (e.g., sand – you find it out the beach, it can have pebbles on it, it’s not the sea), use of symbols or high-tech augmentative communication methods such as a computer). Using different ways is vital in reducing frustration and communicating their message. If you’re unsure of what other forms of communication you can use, please contact me for some top tips.
3. Praise efforts
Providing specific praise allows your child to understand what they’ve achieved. E.g., you could praise the way your child listens, or how they take turns, or their resilience (e.g., “I like the way you listened” or “good listening”). Think of different ways you could praise you child during different activities, so you are prepared with phrases that you can use.
4. Have clear start and end points in activities
Some children with speech, language and communication needs have difficulties with transitioning from one activity to another. They also have difficulties with changes in routine. This can add to their frustration and changes in behaviour. So, how do you show a clear start and end to an activity? You can have a visual timetable, or you could have ‘start’ and ‘finish’ boxes where you place all the materials in the box labelled ‘start’. And once the activity has finished, you put the items in the box labelled ’finished’. If you need support with transitions, please contact me.
5. Use visuals
Visuals can support your child to understand routine and spoken language. Visuals can range from symbols to online images, to photographs, or a combination. Explore which type of visuals work well for your children. Using visuals can be powerful if used correctly. Make the most of the opportunities that visuals can provide for your family.
Increase confidence and reduce frustration in children with speech and language and communication difficulties today. Please feel free to contact me if you need any support or tips on maximising these opportunities.
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.
We use powerful motor learning principles to help children with CAS (Childhood Apraxia of Speech) learn how to produce better, clearer speech sounds in words, phrases and sentences.
What are these principles?
Principle 1: MASSED PRACTICE
This is where you see a child for lots of sessions in a shorter period of time, so for instance six weeks of three times weekly for 30 minutes.
This leads to motor performance or automaticity.
Principle 2. DISTRIBUTED PRACTICE
This is what I use, as most of my clients are not able to come and see me that often on a weekly basis. It is hard to travel in London and life is hectic. So I favour one session a week over say a term or two terms and a session is usually 45 minutes long.
This leads to improved Motor Learning and good generalisation.
During either Massed or Distributed Practice, we choose between 4 variables:
Principle 3: Constant vs Variable
Principle 4: Blocked vs Random
To explain:
Constant Practice is where we repeat the practice of a small handful of target words.
We practise the same target sound in the same word position, e.g. at the beginning of a word: ‘bee’, ‘bye’, ‘bow’, ‘baa’ or ‘key’, ‘car’, ‘cow’, ‘Kaye’ etc.
We keep the rate, pitch and intonation constant.
Variable Practice is where we vary the rate, volume, pitch and intonation of the targets
We use a larger number of sounds, and words that are motivating to say for the child.
For example, if a child loves Peppa Pig then I might choose the words: ‘Peppa’, ‘Daddy Pig’, ‘George’, ‘Mummy Pig’ and a couple of other favourite characters. My child might struggle with a number of sound sequences there but we will target them one by one.
We can also select simpler words like ‘cape’ and ‘cake’ or ‘tick’ and ‘tip’.
Blocked Practice is where we practise one target word for say five minutes then we move to another target word for the next five minutes and then we revert back to the first target word again and so on, so blocks of practice.
RandomPractice means we practise several target words at the same time.
How do I decide on what to use?
Good question!
I always opt for distributed practice (weekly for up to 45 minutes).
Within that, I tend to find it most successful to start out with constant practice when a child is finding a certain sound sequence really hard and we need to just ‘nail it’. Bearing in mind I only pick sounds that my student can actually make in isolation, so we are not working on articulation! (where we focus on trying to elicit single sounds correctly – or even at all sometimes) Here in CAS work, we are working with sounds the student can make but is having trouble to add together, into a sequence that is needed to make a word sound right.
As soon as I feel we have some traction I will go to variable practice, i.e. I pick words that are either funny or interesting for the child and it can be a slightly larger number.
I tend to use blocked practice in the beginning or when working on vowels. That’s because it is more important we get our vowels right. They carry a word and are very important for overall speech intelligibility. Once we are on a roll, I tend to go more for random practice.
Example
Here in the video clip, we try and work the /e/ vowel in short words likes ‘bell’, ’fell’, ‘dell’, ‘sell’, ‘smell’ and I am using an AAC device to give a child’s voice as auditory feedback as well as using the PROMPT approach to help my student shape his vowels.
So this is:
Distributed (1 x week for 45 minutes)
Constant – we are practising the /e/ vowel in the same position in six different words
Blocked – we did this: several repetitions of each word and after the sixth we moved to another sound, and then later we came back to this.
Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.
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.
