Neurodiversity

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    Following your child’s lead: A playful path to AAC success

    ByLondon Speech and Feeding

    Unlocking playtime: A guide to child-led learning

    Does your child struggle to focus on toys or activities? Do they dart away as soon as you approach? You’re not alone!

    The key to unlocking your child’s potential lies in following their lead. Let them guide the play session, and watch their engagement and focus soar.

    Why Child-Led Play Works:

    • Empowerment: Children feel in control, sparking their curiosity and motivation.
    • Focused attention: They’ll stay engaged with activities for longer periods.
    • Reduced frustration: By stepping back and observing, you eliminate the pressure and stress that often comes with directed play.

    How to Implement Child-Led Play:

    1. Prepare the environment: Set out a limited selection of engaging toys.
    2. Observe and wait: Sit back, watch, and listen to your child’s interests.
    3. Embrace the moment: Resist the urge to direct or question; simply enjoy the process.

    Remember: This simple approach can transform playtime and support your child’s development. Give it a try for a week and see the difference!

    #OWLing #hanenmorethanwords

    Observe, Wait, Listen. It’s a powerful formula for unlocking your child’s potential.

    You will likely see:

    • Your child will stay put with any toy for longer whilst you are near them.
    • Your child will tolerate you being nearby and he/she won’t move away.
    • Your child will start giving you brief glances of enjoyment, or perhaps they will hand things to you, or they might take your hand and lead it to something that needs opening etc.
    • In other words, you will see that there suddenly is JOINT PLAY. Yes, granted it may not be according to your adult agenda, but there will be more togetherness than there was before. And this is the START of communication and social engagement.

    USE Core words and a coreboard — to help your child understand the power of words

    Core words are the building blocks of communication. Try using a coreboard like the one below, they are versatile and can be used in countless ways. By modelling these words naturally during play, you expose your child to their meaning and function in context. This approach is far more effective than isolated drill and practice, more powerful than flashcards!

    Using AAC coreboard
    Photo by lemonlenz

    A Winning Combination

    Combining child-led play and AAC modelling creates a magic effect. To summarise:

    • Increased engagement: When you follow your child’s lead, they are more likely to be engaged and receptive to learning. This creates optimal conditions for introducing AAC core words.
    • Natural learning: By modelling AAC core words in the context of play, you help your child understand their meaning and purpose naturally. This fosters generalisation and spontaneous use.
    • Building relationships: Shared play experiences strengthen the bond between you and your child. This trust and connection are essential for successful communication.
    • Reduced pressure: Modelling AAC core words without expectation removes the pressure to produce language. This allows your child to explore communication at their own pace.
    • Expanded vocabulary: As your child becomes more comfortable with AAC, they will begin to incorporate core words into their own communication. This leads to vocabulary growth and increased independence.

    Practical Tips

    • Observe and respond: Pay close attention to your child’s interests and actions. Respond to their cues with enthusiasm and support.
    • Keep it simple: Start with a few core words and gradually introduce new ones as your child’s skills develop.
    • Be patient: Language learning takes time. Celebrate small successes and avoid frustration.
    • Have fun: Remember, play is supposed to be enjoyable for both you and your child. Relax and have fun together!

    Example:

    Photo by lemonlenz

    Let’s say your child is playing with a pop-up toy like you see me do in the above photograph. Here, I followed my child’s lead by waiting to see what she wanted to do with the toy. You are now OWLING! (Observe Wait and Listen)

    Once I noticed that there was repetitive opening of the flaps going on I then pointed to OPEN and MORE on the board, as I said: ‘let’s OPEN this one’ / let’s see MORE animals’ / ‘MORE cow! it says moo!’ ‘OPEN another one’ and so on.

    Important to know, we are not expecting our child to respond verbally or with AAC, but we are providing language input and demonstrating how these words can be used with enthusiasm.

    Naturally in time your child will look at the board and at your pointing and they will eventually want to copy you!

    By incorporating these strategies into your daily interactions, you can create a supportive environment that fosters language development and communication growth.  If you would like more guidance please get in touch and book in for a consultation, some individual therapy and/ or some parent coaching.

    I look forward to supporting you. Please contact me and let’s see how.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

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    The power of containment: A therapeutic approach for autistic children

    ByLondon Speech and Feeding
    Photo by lemonlenz

    The practice of wrapping or swaddling children, often referred to as ‘containment,’ has been used for centuries to soothe and comfort infants. I use this therapeutic approach with autistic children at the London Speech and Feeding Practice. While it might seem counterintuitive, the act of being tightly wrapped can provide significant benefits for children who struggle with sensory processing, emotional regulation, and communication.

    Understanding sensory processing and autism

    Autistic persons often experience challenges with sensory processing, which is their brain’s ability to interpret and respond to sensory information. This can lead to sensory overload or under-responsivity. Containment can be a valuable tool in helping children regulate their sensory input.

    Photo by lemonlenz

    To summarise, here are some of the benefits of containment:

    • Sensory Regulation:
      • Provides deep pressure input: The tight, enveloping sensation of being wrapped can provide deep pressure input, which is calming and organising for many children.
      • Reduces sensory overload: By creating a controlled sensory environment, containment can help to reduce overstimulation and promote a sense of safety.
    • Emotional Regulation:
      • Containment creates a sense of security: Being wrapped tightly can mimic the feeling of being in the womb, providing a sense of security and comfort.
      • Facilitates calming: The deep pressure input can help to calm the nervous system and reduce anxiety.
    • Improved Body Awareness:
      • Enhances proprioception: Containment can improve the child’s awareness of their body in space, which is essential for motor development and sensory integration. I often provide extra pressure on a child’s arms and legs sticking out of the yoga mat; this helps my child understand where their limbs are in space: I can feel my legs and I can feel my arms and I can feel where they are right now, i.e. they are under Sonja’s hand, I can feel them.
    • Facilitates Communication – and this is obviously where I come in as a Speech and Language Therapist:
      • Swaddling creates a safe space: When a child feels calm and secure, they are more likely to engage in communication.
      • Enhances joint attention: The shared experience of being wrapped can foster joint attention, which is essential for language development. You can see this one in my highlights where I swaddle my student in the yoga mat (picture above). She absolutely loves it, and what is more she is calm and steady when usually this child likes to be on the move constantly. Here we have a wonderful moment of joint engagement. She looks at me, she can listen to what I say or sing, and she can tell me in her own way to carry on rolling her or to carry on singing or providing calming pressure to her legs and arms or to stop.

    A few pointers for when you try this at home: How to practise containment safely and effectively

    • Create a safe environment: Ensure the wrapping material is soft, breathable, and free from any hazards.
    • Observe your child’s cues: Pay attention to your child’s body language and verbal cues to determine their comfort level.
    • Respect your child’s boundaries: If your child shows signs of distress, stop the containment immediately – this might seem obvious but sometimes we adults get so carried away with some ‘great idea’ that we have seen work elsewhere. And so we can be a little too ‘determined’ sometimes to ‘make it happen’… perhaps this rings a bell with some of my readers.
    • MAKE IT FUN: Start carefully and take it step by step. See if the student is having a nice time. It is all about trust and therefore it might not work the very first time you do it.

    It’s important to remember that containment is not a one-size-fits-all approach. Some children may respond better to other sensory-based interventions. However, for many autistic children containment can be a valuable tool in their journey towards improved communication and emotional regulation.

    For more information follow me on Instagram, Facebook or LinkedIn.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

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    Speech Sounds Practice at home

    ByLondon Speech and Feeding

    Speech therapists use a variety of tools to help children master specific sounds, and then the students are sent home with some practice sheets to use daily. Parents are able to observe what we do in the session, but I know that back at home three days later they can’t quite remember what it was all about and how to do the practice.

    Here I explain the importance of visual cues, finger shapes, pictures, and semantic prompts (fancy speech therapy term for word clues!). By understanding these tools, you can turn practice time into a fun and engaging experience for both of you.

    Why Visual Cues matter?

    Imagine learning a new language just by listening. It’s tough, right? Young children learning new speech sounds face a similar challenge. Visual cues act like flashcards for their minds, giving them a clear picture of how to position their mouth and tongue.

    • Mirrors: Encourage your child to watch your face (and theirs) in the mirror as you make the sound together. This helps them see the tongue placement and lip movements required.
    • Mouth pictures: Speech therapy sheets often have pictures of mouths making specific sounds. Point to the picture and explain how the tongue and lips look, then have your child try to imitate it.
    • Your face is the best cue! Don’t underestimate the power of your own face. Over-enunciate the sound and let your child observe your mouth movements. Watch this little video clip where I am teaching the /SH/ sound to my little student. You cannot see him but we are both sitting on the floor opposite one another so that he can see me easily.

    Finger fun: making sounds with our hands

    Finger shapes are another powerful tool in my speech therapy arsenal. Think of them as fun reminders of how to position the tongue.

    • ‘Open Wide’ fingers: For sounds like /AH/ and /OH/, hold your fingers wide apart, mimicking an open mouth.
    • ‘Tongue Up’ fingers: For sounds like /T/ and /D/, touch the tip of your thumb to your other fingers, creating a little ‘wall’ like the tongue tip touches the teeth ridge.
    • ‘Snake Tongue’ fingers: For the /S/ sound, wiggle your pinky finger to represent the snake-like tongue tip.
    • In this little video clip I am demonstrating the C-shape moving forward which I had taught my child, showing how the windy sound (/SH/) travels forward with lips open and slightly pursed.

    Bringing sounds to life with pictures

    Pictures serve as visual prompts to connect the sound with a familiar word.

    • Video clip: I am using the WINDY SOUND picture and the FLAT TYRE sound picture to represent /SH/ and /S/ respectively
    • Point and Say: Point to each picture and say the word clearly, emphasising the target sound. Encourage your child to repeat.

    Unlocking sounds with semantic prompts

    Semantic prompts are fancy words for clues that help your child guess the target sound. They can be simple questions or descriptive words.

    • ‘Can you feel the wind whooshing?’ (/SH/)
    • Think of tyre going flat, or a balloon losing air, or a train coming to a slow halt (/S/)

    Practice makes progress, but fun makes it funnier!

    Remember, the key is to keep practice sessions light and engaging. Here are some extra tips:

    • Short and sweet: Stick to short practice times (5-10 minutes) to avoid frustration.
    • Make it a routine: Integrate practice time into your daily routine, like after breakfast or before bedtime.
    • Positive reinforcement: Celebrate your child’s efforts with praise and high fives!
    • Make it multisensory: Incorporate sensory activities like blowing bubbles for /F/ or feeling the wind for /SH/.

    Parents you’re a vital part of your child’s speech development, and together we can make huge progress quickly.

    Please contact me if your child has speech sound difficulties.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

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    Principles of motor learning in Childhood Apraxia of Speech (CAS)

    ByLondon Speech and Feeding

    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.

    Random Practice 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:

    1. Distributed (1 x week for 45 minutes)
    2. Constant – we are practising the /e/ vowel in the same position in six different words
    3. 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.

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    Why ‘Prosody’ Matters in Childhood Apraxia of Speech (CAS)

    ByLondon Speech and Feeding

    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.

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    Unveiling the hidden spectrum: Why girls and autism often go unseen

    ByLondon Speech and Feeding
    Unveiling the hidden spectrum: Why girls and autism often go unseen
    Image by Freepik

    Autism is a complex neurodevelopmental condition characterised by social-communication challenges, restricted and repetitive behaviours, and sensory processing difficulties. While the prevalence of autism is estimated at 1 in 54 children, research suggests a significant disparity in diagnoses between genders. Boys are diagnosed with autism roughly four times more often than girls, leading us to question: Why are girls so much harder to diagnose with autism?

    The answer lies in a complex interplay of factors, including:

    1. Different presentations of autistic traits:

    • Socialisation: The stereotypical image of autism often portrays boys with aloofness and a lack of interest in social interaction. However, autistic girls may exhibit more subtle social difficulties. They may appear interested in socialising but struggle with understanding social cues, maintaining eye contact, or navigating complex social dynamics. This ability to ‘camouflage’ their challenges can lead to misinterpretations of their intentions and abilities.
    • Restricted interests: While autistic boys may have intense interests in stereotypically ‘masculine’ topics like dinosaurs or trains, girls might gravitate towards interests traditionally associated with girls, like specific characters or activities. These interests, often deemed ‘typical’ might be overlooked as potential indicators of autism.
    • Repetitive behaviours: Repetitive behaviours are another core diagnostic feature of autism. However, autistic girls may exhibit these behaviours in more subtle ways, such as intense focus on specific routines, scripting conversations, or engaging in repetitive social interactions. These subtle expressions can easily go unnoticed.

    2. The ‘camouflage’ effect:

    Autistic girls, particularly those with higher cognitive abilities, may develop coping mechanisms to mask their challenges in social situations. This ‘camouflaging’ can involve mimicking social behaviours they observe in others, leading to significant internal distress and exhaustion. This effort to appear ‘normal/typical’ can further hinder accurate diagnosis.

    3. Societal biases and diagnostic tools:

    • Gender bias: The current diagnostic criteria for autism were largely developed based on studies of boys, leading to a potential bias towards male presentations of the condition. This can result in girls who don’t exhibit the ‘typical’ symptoms being missed altogether.
    • Lack of awareness: Healthcare professionals and educators may have limited awareness of how autism manifests differently in girls. This lack of understanding can lead to misinterpretations of their behaviours and missed opportunities for diagnosis and support. I must say that this is really common in my working day. I see a child—girls or boys in this case to be fair, but mainly girls—where parents tell me: the doctor/health visitor/paediatrician has said it was ‘just a little delay’ and I am thinking ‘Really!??? What did they look at? How did they not see X Y Z’… It really is still very common.

    4. Co-occurring conditions:

    Autistic girls are more likely to experience co-occurring conditions like anxiety and depression, which can overshadow the core features of autism. This makes it even more challenging to identify the underlying autism diagnosis.

    The consequences of missed diagnoses and this goes of course for both, autistic girls AND boys!:

    The consequences of undiagnosed autism can be significant. Children may experience:

    • Lack of access to appropriate support: Without a diagnosis, children may miss out on crucial interventions and therapies that can help them manage their challenges and thrive.
    • Increased vulnerability to mental health issues: The stress of masking and navigating social complexities can lead to anxiety, depression, and other mental health challenges.
    • Difficulty forming meaningful relationships: Social difficulties and communication challenges can hinder their ability to build and maintain healthy relationships.

    Moving forward: Towards a more inclusive diagnosis:

    To ensure all individuals on the spectrum receive the support they need, it’s crucial to:

    • Increase awareness and education: Healthcare professionals, educators, and the general public need to be educated about the diverse presentations of autism in girls and of course also in boys. Let’s not forget that we are still seeing older autistic boys with diagnoses given aged 12 years and older who have slipped through the net.
    • Develop gender-neutral diagnostic tools: Diagnostic criteria and assessments should be revised to encompass the broader spectrum of autistic traits, regardless of gender.
    • Encourage open communication: Parents, caregivers, and individuals themselves should be encouraged to voice their concerns and seek evaluations, even if their experiences don’t perfectly align with stereotypical presentations of autism.

    By acknowledging the complexities of diagnosing autism, particularly in girls, and working towards a more inclusive approach, we can pave the way for earlier diagnoses, appropriate support, and a brighter future for all individuals on the autism spectrum.

    Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

    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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    Creating your calm: containment strategies for Sensory Processing Difficulties

    ByLondon Speech and Feeding

    The world can be a beautiful and stimulating place, but for individuals with Sensory Processing difficulties (SPD), it can also be overwhelming and even painful. Everyday sights, sounds, smells, touches, and tastes can be amplified to uncomfortable or even unbearable levels. This can lead to anxiety, meltdowns, and a constant feeling of being on edge.

    One important coping mechanism for SPD is containment. Containment strategies are techniques that help individuals manage their sensory experiences and create a sense of calm and safety.

    Understanding containment needs:

    Containment needs vary greatly from person to person. Some individuals might find comfort in deep pressure, while others might crave quiet and solitude.

    Common containment strategies:

    Here are some examples of containment strategies that can be helpful for individuals with SPD:

    • Deep pressure: This can involve activities like wearing weighted vests, using weighted blankets, getting firm hugs, or applying deep pressure massage.
    • Movement: Engaging in rhythmic movements like rocking, swinging, or jumping can be calming for some individuals.
    • Proprioceptive input: Activities that involve proprioception, the sense of body awareness, can be grounding. Examples include yoga, stretching, and proprioceptive toys like chewy necklaces or fidget spinners.
    • Visual calming: Utilising calming visuals like nature scenes, dimmed lights, or fidget toys with visual patterns can provide a sense of peace.
    • Auditory modifications: Noise-blocking headphones, earplugs, or white noise machines can help block out distracting or overwhelming sounds.
    • Oral motor activities: Chewing gum, crunchy snacks, or chewy toys can provide sensory input and help regulate emotions.
    • Sensory bottles: Watching calming visuals move within a liquid-filled bottle can be visually stimulating and promote focus.
    • Creating a safe space: Having a designated quiet area at home or school where individuals can retreat to self-regulate can be invaluable. This space should be free from clutter and overwhelming stimuli and can include calming sensory items.

    Additional tips:

    • Be patient and understanding: It takes time and practice to find what works best for each individual. Be patient with yourself or your child as you explore different strategies.
    • Consistency is key: Once you find effective strategies, use them consistently in different settings to create a sense of predictability and comfort.
    • Communicate openly: Talk to teachers, caregivers, and others about individual needs and how they can support containment strategies.
    • Celebrate progress: No matter how small, acknowledge and celebrate successes in managing sensory experiences.

    Remember:

    Containment is not about suppressing sensory experiences altogether. It’s about creating a sense of control and reducing overwhelming sensations to a manageable level. By exploring different strategies and working with a qualified professional, individuals with SPD can develop the tools they need to navigate the world and experience life to the fullest.

    Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

    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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    Stage 2 NLA

    ByLondon Speech and Feeding
    Image by Freepik

    Last time we asked: is our child ready tp move to Stage 2 NLA (Natural Language Acquisition stage 2) and we looked at how we can know. Now we know: he/she is ready, they are mixing and matching those scripts quite liberally! Hurrah!

    So for example we hear phrases like:

    • ‘let’s go’+ ‘downstairs’
    • ‘it’s’ + ‘downstairs’
    • ‘I see it’ + ‘downstairs‘
    • ‘I want to’ + ‘shoes downstairs’ (I want to put my shoes on downstairs)

    To recap, it’s important to listen out to a variety of contexts because if we only hear the single version of a gestalt —this is so great, hurrah!— but that’s not yet Stage 2.

    What we can now do on a daily basis to help and support at this time:

    1. We need to offer more ‘mix and match’ phrases to help our child establish this new way of communicating.

    Good phrases:

    • It’s … raining / cooking / eating / washing / brushing
    • That’s … great / cool / amazing / wow / so good
    • Let’s … see / look / go / run / chase
    • How’bout … some food / playing / I’ll chase / sleeping / we read a book
    • I see a … bird / large car / fire engine
    • I wanna … have a biscuit / have a book / have a snuggle
    • We’re … going out / going home / going in the car / going upstairs

    Here in my video clip of train play I use:

    • Let’s go
    • It’s going up the hill
    • It’s coming down
    • Ooops it falls!
    • It’s stopping
    • Let’s put on another parcel
    • Ready steady go
    • Off we go
    • It’s come off!
    • Let’s fix it
    • I can do it
    • I don’t need help

    You can offer these gestalts either with an AAC as you can see me do in the video clip or you can just verbally offer these.

    2. Watch out for Pronoun confusion or reversal:

    Gestalt kids repeat gestalts, so we don’t want to create ‘pronoun reversal’.

    Instead model from a:

    • first person perspective: ‘I’ / ‘Our’ / ‘Us’
    • joint perspective: ‘We’ / ‘Let’s’ or a
    • neutral perspective: ‘It’

    You can turn almost any sentence into a good language model once you get used to it. And you can avoid ‘you’ and ‘your’ at the same time!

    So instead of saying, ‘Do you want to go to the park?’

    You could say:

    • We wanna go to the park?
    • Let’s go out?
    • Shall we go out / to the park?

    3. Start providing ‘variation’ in your language modelling:

    Instead of just modelling something one way, start thinking about offering a pattern in a couple of other ways, in a couple of different situations, then several ways in several different situations.

    Example: once you hear your child saying: ‘it’s raining’ and you know it’s a mitigation, because you don’t often say ‘it’s raining’, or haven’t said it in a while and you know your child says other ‘it’s’ phrases.

    Repeat: ‘it’s raining!’

    Then: ‘it’s’ + ‘raining hard’ / ‘it’s wet out there’ / ‘It’s’ + ‘raining lot’s’.

    Then later think of other combinations for ‘it’s’ + ‘something’:

    • (rice) ‘It’s’ + ‘cooking’
    • (water/tap) ‘It’s’ + ‘running’
    • (radio) ‘It’s’ + ‘singing
    • (dog) ‘It’s’ + ‘peeing’ / ‘it’s’ + ‘running’ / ‘it’s’ + ‘jumping’

    In my train video clip:

    • Let’s go
    • It’s going
    • Let’s make it go
    • Ready steady go
    • Oops its gone

    4. Use natural intonation that shows you really mean what you’re saying.

    You can be animated or try for musical if your child prefers that / doesn’t mind you singing —they might not like it if their hearing is pitch perfect and your singing is off key…—

    • ‘I’m’ + ‘trying to find you!’ (animated, goofy face)
    • ‘I’m’ +’ getting tired!’ (exaggerated stretch and yawn)
    • ‘I’m’ + ‘catching up with you!’ (animated goofy)
    • ‘I’m’ + ‘gonna get you!’ (animated goofy)
    • ‘I’m’ + ‘sad right now’ (exaggerated face and tone of voice)

    5. USE SILENCE!

    Important, I might not have said this before but we need to hold back sometimes (hard I know) and not constantly offer models. Let our child sit in a bit of silence with us there just observing and waiting for their own offers. This is a very important point. Silence is golden sometimes. Try it out. I am not talking about the silence that comes with a person scrolling on their phone though, we do need to be present and receptive.

    You will see this works wonders!

    Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

    You can also check my friend’s lovely handmade jewelry on her website.

    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 know our Gestalt Learner is moving to Stage 2?

    ByLondon Speech and Feeding
    Image by Freepik

    Is our student ready to move to NLA 2 (Natural Language Acquisition stage 2)?

    We know that the GLP (Gestalt Language Processor) will move into the next stage when they are ready. But are they now ready you might think? When are they ready? How do I know? If you are not sure whether your child is ready to move forward then go and see your GLP trained Speech Therapist. Together you can work out what the next steps are and how to help your child settle into NLA 2. It’s very exciting!!

    Tip

    The first useful tip: keep a language sample of phrases your child says. This is very helpful!

    You might want to check with your Speech Therapist and offer some language sampling you have taken so they can help you figure out where your child is currently. Always keep an Utterance Journal that you can share with your Speech Therapist and with others who look after your child.

    Basically, we want to listen out for phrases our child says that you or nursery don’t say routinely; that way you can presume that this is not an echo but a mixing together of two chunks of gestalts. Watch out for those coco melon phrases though: double check it really isn’t an NLA 1 gestalt that is copied verbatim from a favourite you tube video.

    You can best support your child best by listening, and thus figuring out what your child is TRYING TO SAY. Often your child might skip over the parts of gestalts they don’t want to say. This is common in older kids who have long gestalts, sometimes even whole episodes or whole stories!

    Try and tease out their shorter mitigations and then focus on practicing and modelling those as they are so much more useful!

    So back to our question: are they ready?

    Are their gestalts covering a variety of situations and contexts?

    Make a note in your journal to see what the backgrounds are to each phrase you ear, so for example:

    • Transitioning: ‘it’s time for the park’ ‘what’s next’ ‘shoes on’
    • Bed Time: ‘we need to wash’ ‘let’s get in (bath/bed)’ ‘ready for our book’
    • Toilet/nappy: ‘we need the potty’ ‘where’s the potty’ ‘let’s wash hands’
    • Mealtime: ‘time to eat’ ‘go get a spoon’ ‘yummy num num’
    • Park/going out: ‘look at the squirrel’ ‘funny doggy’ ‘I wanna swing’
    • At the shops: ‘let’s get the trolley’ ‘lots of veggies’ ‘no tomatoes’ ‘ooh long queue’ ‘back to the car’

    And… does the child use the phrases for a variety of functions?

    • labelling
    • providing information
    • calling out
    • affirming
    • requesting
    • protesting
    • directing

    We need to offer lots of similar language models so that in their own time our children can extract/mitigate useful phrases for what they want to express. The more similar utterances a child hears around him the more he/she can discover the communalities. Once the child has a small range of phrases, he/she can mix them up and create semi-original own phrases.

    If the answer is YES!! our child has perhaps not all but a range of functions and a range of situations where they use a variety of easily mitigable gestalts then yes they are ready for moving to stage 2 of NLA!

    Hurrah!

    Keeping a journal of what your child is saying and in what circumstance is crucial to help with our ongoing detective work!

    Next time I will be looking at how we can help our NLA 2 GLP produce even more of their own mix and match phrases.

    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.

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  • · · ·

    Autism – Benefits of Early Assessment and Intervention

    ByLondon Speech and Feeding
    I think my child might be autistic – how can we help?
    Image by macrovector on Freepik

    Consulting a Specialist Speech and Language Therapist can help you in several ways: assessment, informal and formal observation, discussion and advice, onward referrals, direct intervention, parent coaching, educational support and much more, all geared towards supporting you the parents, and helping your child to flourish and thrive.

    First up, we can help you with assessment and advice: with a wealth of expertise in observing childrens’ play and communication, as well as knowledge of the latest research we can see a child’s strengths and areas of struggle very quickly indeed.

    Within a short space of time, we can identify the areas we need to focus on and start guiding you towards helping your child to connect, respond, react and feel better.

    Early detection is key

    If autism is detected in infancy, then therapy can take full advantage of the brain’s plasticity. It is hard to diagnose Autism before 18 months but there are early signs we know to look out for. Let’s have a brief look at the sorts of things we look at.

    The earliest signs of Autism involve more of an absence of typical behaviours and not the presence of atypical ones.

    • Often the earliest signs are that a baby is very quiet and undemanding. Some babies don’t respond to being cuddled or spoken to. Baby is being described as a ‘good baby, so quiet, no trouble at all’.
    • Baby is very object focused: he/she may look for long periods of time at a red spot/twinkly item further away, at the corner of the room for example.
    • Baby does not make eye contact: we can often see that a baby looks at your glasses for example instead of ‘connecting’ with your eyes.
    • At around 4 months we should see a baby copying adults’ facial expressions and some body movements, gestures and then increasingly cooing sounds we make; babies who were later diagnosed with autism were not seen to be doing this.
    • Baby does not respond with smiles by about 6 months.
    • By about 9 months, baby does not share sounds in a back-and-forth fashion.
    • By about 12 months baby does not respond/turn their heads when their name is called.
    • By around 16 months we have no spoken words; perhaps we hear sounds that sound like ‘speech’ but we cannot make out what the sounds are.
    • By about 24 months we see no meaningful two-word combinations that are self-generated by the toddler. We might see some copying of single words.

    24 months plus:

    • Our child is not interested in other children or people and seems unaware of others in the same room/play area.
    • Our child prefers to play alone, and dislikes being touched, held or cuddled.
    • He/she does not share an interest or draw attention to their own achievements e.g., ‘daddy look I got a dog’.
    • We can see our child not being aware that others are talking to them.
    • We see very little creative pretend play.
    • In the nursery our child might be rough with other children, pushing, pinching or scratching, biting sometimes; or our child might simply not interact with others and be unable to sit in a circle when asked to.

    What sort of speech and language difficulties might we see?

    Our child might do any of the following:

    • have no speech at all, but uses body movements to request things, takes adults by the hand
    • repeat the same word or phrase over and over; sometimes straight away after we have said it or sometimes hours later
    • repeat phrases and songs from adverts or videos, nursery rhymes or what dad says every day when he gets back from work etc.
    • copy our way of intonation
    • not understand questions – and respond by repeating the question just asked:
      • adult: Do you want apple? child: do you want apple?
    • not understand directions or only high frequency directions in daily life
    • avoid eye contact or sometimes ‘stares’
    • lack of pointing or other gestures

    Common behaviours:

    • Hand flapping
    • Rocking back-and-forth
    • Finger flicking or wriggling/moving
    • Lining up items/toys
    • Wheel spinning, spinning around self
    • Flicking lights on and off, or other switches
    • Running back-and-forth in the room, needing to touch each wall/door
    • Loud screaming when excited
    • Bashing ears when frustrated or excited
    • Atypical postures or walking, tip toeing, can be falling over easily, uncoordinated
    • Can be hyper sensitive to noises, smells, textures, foods, clothing, hair cutting, washing etc.
    • Being rigid and inflexible, needing to stick to routines, unable to transition into new environments
    • Food sensitivity, food avoidance, food phobias

    I mentioned this to be a ‘brief’ look at the areas and it is: each topic is looked at very deeply and each area is multi-facetted therefore a diagnosis is rarely arrived at very quickly. We want to make sure we have covered all aspects and have got to know your child very well before coming to conclusions.

    Early detection is key, because we want to start helping your child to make progress as quickly as is possible. If you feel /know that your child is delayed in their speech and language development and you would like a professional opinion then please do contact me, I look forward to supporting you. It is important to know at this point, that if your child only has one or two of the above aspects it may mean that your child is simply delayed for reasons other than Autism and if that is the case, we will be able to help you iron out a few areas of need so that your child can go on thriving.

    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.

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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.

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  • · · ·

    Developing Joint Attention

    ByLondon Speech and Feeding
    Image by Freepik

    Joint attention skills — what are they and how can we facilitate those?

    Most of us want to make friends, connect with others and bond with a friend or be part of a community. To do so we need to develop an important social skill which is: initiating, responding to, and maintaining ‘shared/joint attention’ with another. When we can do this, we are able to focus on the same thing with another person or a group of people: music, hobbies, sport, art, books, toys, games or memories: remember when we did x y z…

    Many children who struggle with speech and language development are not able to share or hold attention with another person very easily. My latest blog is all about what we can do to help our children develop Joint Attention.

    So to re-cap, joint or shared attention happens when one person gets the other’s attention by either words, or gestures like pointing to something and saying ‘OMG look over there!’ – both people look at that same thing.

    What does it take to have or develop this skill?

    We need to first of all find something of interest that captivates our own attention. This part is usually not difficult for most people or children.

    Then, crucially, we need to direct our focus away from what we find interesting, for long enough to get another person’s attention onto the same topic. This could be just seconds or it could be longer if we are very determined and good at embracing others into our experience. But if we are not then it must not take longer than seconds!

    Let me give an example: if someone is in the room with me whilst I see something strange out the window, I would take that second to draw their attention to it. However, I might not be bothered to run upstairs and find someone only to show them something odd outside in the road. If I am very bored, I might do! But as I am rarely bored it is unlikely. So, unless someone else is right here with me, they are not going to be part of that particular experience, I would not share it.

    Back to our child: if we make it difficult for a child who is not naturally inclined to share an interest then it is not going to happen. We must be ready, and right there for our child to have that fleeting second to look at us before returning to their hobby/interest.

    This skill ‘to share a moment’ tends to develop around 12 months of age and starts with a child pointing to things. Prior to that, our child might give us something or come to show us a thing. Joint attention underpins language skills and is strong predictors of later language development (Law et al, 2017).

    What are the signs that my child is struggling with Joint Attention?

    • Tunes out or does not respond when I call their name
    • Cannot follow my suggestions for games or toys/play activities
    • Does not point to anything of interest, like a truck passing by, or an aeroplane in the sky
    • Ignores or does not respond to what I say, does not follow instructions, only when he/she wants to

    What can I do to help with this?

    Here are some ideas you can follow in no particular order – see which one sticks:

    1. Get down to your child’s eye/face level, we call it ‘face to face’. It does not require your child to make eye contact with you but they might just do so more easily if you are ‘just there’ and don’t have to crook their neck to look up at you. When reading a book with your child, instead of sitting behind try sitting opposite him/her.
    2. Mirror play – making funny faces together in a mirror can be fun.
    3. COPY your child: top tip!! Imitate your child’s vocalisations and actions. Even if these are repetitive, just enjoy the ride.
    4. Follow your child and let your child take the lead in the play activity. What does that look like? The adult has no agenda, does not want to teach, to ask questions (see point number 9) does not want to direct or show the child how to ‘do it better/differently’ – instead accept that the child is the boss when it comes to their play and take their lead in how a toy should be played with.
    5. Hold up objects to your face or at eye level so that your child can see your face and the item at the same time.
    6. Be the ‘funniest thing’ in the room; be hugely entertaining, watchable and offer the ‘irresistible invitation’ to look at you or play with you.
    7. Offer PEOPLE TOYS (any toy where another person is needed to have fun) so: wind-up toys, bubbles, anything that needs opening or holding or doing which is tricky for the child to do alone. I always try and hide the buttons that make something ‘go’ so that my child needs to come back to me for ‘more/again’.
    8. Do PEOPLE GAMES – as above really but games that do not need a toy, that need another person to have fun: being swung round, row row the boat, being pushed on a swing etc.
    9. REDUCE ASKING QUESTIONS – this is my favourite top tip!!! Instead of asking lots of questions try and make simple statements/comments on what is happening so there is absolutely no pressure on your child to ‘perform’. Equally, silence is actually golden sometimes! An odd bit of advice from a speech therapist? Try sitting with your child, next to them or opposite and just don’t talk but simply BE… yes easier said than done, I do know this. Turn off your phone (OMG did I just say that!?) yes, please turn it off and just be with your child for a little while, just like a comfy buddy who is just enjoying their company with no agenda. You might be very surprised how your child suddenly seeks you out!

    I will write about more ideas on this in my next blog so look out for more play ideas to encourage Joint Attention.

    Most important, try and have fun with your child. Think about what is fun for her or him. And make it EASY for your child, remember unless you are ‘right there’ it might not happen so easily.

    Happy New Year!

    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.

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