Speech Therapy

  • · ·

    Explaining pronoun reversal: A window into gestalt language processing

    ByLondon Speech and Feeding
    Explaining pronoun reversal: A window into gestalt language processing

    Have you noticed your child referring to themselves as ‘you’, or calling you ‘me’? This seemingly confusing mix-up of pronouns, known as pronoun reversal, often raises concerns for parents. Below I outline why your child does this and want to reassure you that it is to do with his or her unique language learning style.

    Gestalt language processing: Learning in chunks

    Many children, particularly those on the autism spectrum, use a gestalt language processing approach. Unlike analytic language processors who learn individual words and build sentences, gestalt language processors learn language in whole ‘chunks’ or ‘gestalts’. Think of these gestalts as pre-packaged scripts they pick up from their environment — phrases, sentences, even snippets of songs or movie lines.

    As Marge Blanc, author of Natural language acquisition on the autism spectrum, explains, ‘When a child picks up an entire gestalt (script), he’s got the pronoun of the original speaker. So ‘pronoun reversal’ is nothing more than that.’

    So your child is simply repeating what they’ve heard, without yet understanding the individual word meanings or grammatical functions.

    Imagine your child hearing ‘You want a rice cake?’ repeated frequently. They might then use this phrase to express their own desire for a rice cake, even though it doesn’t grammatically fit. So they are thinking and saying ‘You want a rice cake?’ and the meaning of this phrase is: ‘I want a rice cake’. This isn’t a sign of confusion, but a natural step in their language development. They’re working with the tools they have: the scripts they’ve acquired.

    How can we support their natural language journey

    Instead of trying to ‘correct’ pronoun usage, our role as caregivers and speech therapists is to support the child’s natural language progression. Here’s how we can do this:

    1. Learn about their gestalt stage and run with it: In the early stages (1–3) of gestalt language development, correcting pronouns can be counterproductive. These children are still processing language as whole units, not individual words. Direct corrections can lead to frustration and hinder their natural language exploration.
    2. Patience and trust: Gestalt language processing follows a predictable, albeit sometimes non-linear, path. By understanding their current stage, we can provide targeted support. Language sampling and scoring, guided by the Natural Language Acquisition framework, help us pinpoint their stage and tailor our approach.
    3. Model language strategically: In the early stages, avoid using pronouns like ‘you’ and ‘you’re’. Instead, model language from the child’s perspective or use joint perspectives. For example, instead of ‘Are you thirsty?’, try ‘I’m thirsty!’ or ‘Let’s get some water’,

    The big picture: Language unfolds naturally

    Pronoun reversal is a stepping stone, not a stumbling block. As gestalt language processors progress, they begin to break down these gestalts into smaller units and develop their own self-generated language. This is when their understanding and use of pronouns naturally emerge.

    By shifting our perspective from ‘error correction’ to ‘developmental support’, we create a nurturing environment for these children to thrive. We empower them to navigate their unique language journey, ultimately leading to more meaningful and independent communication.

    So, to summarise:

    • Pronoun reversal is a typical characteristic of early-stage gestalt language processing.
    • Focus on modelling language from the child’s perspective or a joint perspective.
    • Avoid correcting pronouns in the early stages.
    • Trust the process and support the child’s natural language development.

    Let’s celebrate the diverse ways our children learn to communicate and empower them to find their unique voice!

    If you have any questions or would like some help with understanding your little gestalt language learner, please get in touch with me via my contact form.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

    1
  • · ·

    Why pointing matters: Unpacking the power of this simple gesture

    ByLondon Speech and Feeding

    As a speech and language therapist, I’m often asked about the significance of seemingly simple gestures in child development. One question that comes up frequently is, ‘Why is pointing so important?’ It might seem like a trivial action, but pointing is a powerful communication tool and a critical milestone in a child’s development.

    Why is pointing so important?

    Let’s delve into the theory behind why pointing matters:

    1. Pointing as pre verbal communication:

    Before children can use words, they use gestures to communicate their needs and interests. Pointing is one of the earliest and most important gestures. It allows children to:

    • Request: ‘I want that!’
    • Protest: ‘No, not that!’
    • Direct attention: ‘Look at that!’
    • Share interest: ‘Wow, cool!’

    2. Pointing and language development:

    Pointing is not just about communicating in the here and now; it also plays a crucial role in language development. Research shows that:

    • Early pointing predicts later language skills: Children who point more often tend to have larger vocabularies and better grammar later on.
    • Pointing helps children learn new words: When children point at something, adults tend to label it, providing valuable language input.
    • Pointing supports joint attention: Joint attention, or the shared focus of two individuals on an object or event, is essential for language learning. Pointing helps establish joint attention, creating opportunities for communication and learning.

    3. Pointing and social-emotional development:

    Pointing is not just about language; it’s also about social interaction. It allows children to:

    • Engage with others: Pointing invites others to share their focus and participate in their world.
    • Express emotions: Pointing can convey excitement, curiosity, or concern.
    • Develop social understanding: By observing how others respond to their pointing, children learn about social cues and communication.

    4. Pointing and cognitive development:

    Pointing is linked to cognitive skills, such as:

    • Understanding object permanence: The ability to know that objects exist even when they are out of sight.
    • Categorisation: The ability to group similar objects together.
    • Problem-solving: Pointing can be used to ask for help or to indicate a problem.

    5. Types of Pointing:

    It’s important to note that there are different types of pointing, each with its own significance:

    • Imperative pointing: To request something.
    • Declarative pointing: To share interest or direct attention.
    • Informative pointing: To provide information.

    If you have concerns about your child’s pointing or overall communication development, don’t hesitate to seek professional guidance from a speech-language therapist. Early intervention can make a significant difference in supporting your child’s communication journey.

    How can we create opportunities for pointing?

    • ‘Where’s the…?’ games:
      • Play games like ‘Where’s the doggy?’ or ‘Where’s the ball?’ and encourage your toddler to point to the object.
      • Start with familiar objects and gradually introduce new ones.
    • Reading together:
      • When reading picture books, ask your toddler to point to specific objects or characters on the page.
      • Use phrases like, ‘Can you point to the puppy?’
    • Everyday activities:
      • During daily routines, ask your toddler to point to things they want or need.
      • For example, ‘Do you want the apple or the banana?’
      • When walking outside say ‘LOOK’ and encourage pointing.
    • Use of toys:
      • Use toys that have buttons or points of interest that when pressed make a noise. Encourage your toddler to point to the area that makes the noise.
      • Use toys that have many different parts, and ask the toddler to point to a specific part.

    Model pointing:

    • Point yourself:
      • When you see something interesting, point to it and say the name of the object.
      • For example, ‘Look! A bird!’
    • Point to show choices:
      • When offering choices, point to each item as you name it.
      • For example, ‘Do you want the blue cup or the red cup?’ (Point to each cup).
    • Point to indicate direction:
      • When giving directions, point in the direction you want your toddler to go.
      • For example, ‘Let’s go that way!’ (Point).

    Make it rewarding:

    • Respond to pointing:
      • When your toddler points, immediately respond to their communication.
      • Give them the object they want, or acknowledge what they are pointing at.
    • Use positive reinforcement:
      • Praise and encourage your toddler when they point.
      • Say things like, ‘Good pointing!’ or ‘You showed me the car!’
    • Show excitement:
      • When they point to something, show excitement, this will encourage them to point again.

    Use specific techniques:

    • Use gestures and verbal cues:
      • Combine pointing with verbal cues and other gestures.
      • For example, say ‘Look!’ while pointing and nodding your head.
    • Simplify the environment:
      • Reduce distractions to help your toddler focus on the object you want them to point to.
    • Use exaggerated movements:
      • Use large, exaggerated pointing movements to draw your toddler’s attention.

    Consider developmental factors:

    • Age-appropriate expectations:
      • Remember that pointing develops at different rates for different children.
      • Be patient and supportive.
    • Underlying issues:
      • If your toddler is not pointing by 18 months, or if you have any concerns about their development, consult with a speech and language therapist.
      • There may be underlying sensory or motor issues.

    Key points:

    • Consistency is key. Practise these strategies regularly.
    • Make it fun and engaging for your toddler.
    • Celebrate every success, no matter how small.
    • If you have any concerns about your child’s development, contact your local health services.

    Great toys and items for pointing

    1. Interactive books:

    • Touch-and-feel books: Books with different textures, flaps to lift, and sounds encourage interaction and pointing. ‘Where’s the…?’ questions prompt pointing to specific features.
    • Books with simple pictures: Clear, uncluttered pictures make it easier for toddlers to focus and point to objects or characters.

    2. Cause-and-effect toys:

    • Activity cubes: These often have buttons, dials, and levers that produce sounds or actions when manipulated, prompting pointing and exploration.
    • Pop-up toys: Toys where figures pop up or things happen when a button is pressed encourage anticipation and pointing to the action.
    • Simple musical instruments: A toy piano, drum, or xylophone encourages pointing to the keys/surfaces to make sounds.

    3. Toys with parts to manipulate:

    • Shape sorters: Encourage pointing to the shapes and the matching holes.
    • Stacking cups or rings: Nesting cups or stacking rings invite pointing to select the correct size or order.
    • Puzzles with knobs: Simple puzzles with large knobs are easier for toddlers to grasp and point to the pieces.

    4. Toys that encourage joint attention:

    • Bubbles: Blowing bubbles and following them with your eyes and pointing encourages joint attention (shared focus).
    • Balls: Rolling a ball back and forth and pointing to where it’s going can promote joint attention and turn-taking.
    • Wind-Up Toys: Wind-up toys that move across the floor can be exciting to follow with pointing.

    5. Pretend play toys:

    • Toy telephones: Encourage pointing to the buttons and pretending to dial.
    • Dolls and stuffed animals: Pointing to the doll’s eyes, nose, mouth, etc., or asking the child to point to these features on themselves.
    • Toy food and dishes: Pretend play with food and dishes can involve pointing to request items or indicate actions (e.g., ‘Can I have the apple?’).

    Tips for using toys to encourage pointing:

    • Get involved: Play alongside your toddler, modelling pointing and using language to describe what you’re doing.
    • Follow their lead: Observe what your child is interested in and use that to encourage pointing.
    • Limit distractions: Reduce background noise and visual clutter to help your child focus.
    • Use gestures and words: Combine pointing with words and other gestures (e.g., ‘Look!’ while pointing).
    • Be patient and positive: Celebrate all attempts at pointing and provide lots of encouragement.

    Remember, the most important factor is the interaction you have with your child while playing. Use these toys as tools to create opportunities for communication and joint attention, and your toddler will be well on their way to mastering pointing!

    Get in touch with me via my contact form if you need support

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

    1
  • · ·

    The picky eater’s plate: Introducing solids to toddlers with ARFID

    ByLondon Speech and Feeding
    Designed by Freepik

    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.
    NumNum Baby Spoons Set
    TalkTools Recessed Lid Cup with Handles
    • 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.

    Get in touch with me via my contact form if you need support

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

    1
  • ·

    A bite-sized guide to Speech and Language Therapy: feeding and swallowing

    ByLondon Speech and Feeding

    What is a Speech and Language – Feeding Therapist?

    You’ve probably heard of speech therapists helping people who stutter or struggle to pronounce words. But did you know that they also work with children and adults who have problems with eating and swallowing? This specialised area is called Speech and Language Therapy: Feeding and Swallowing, or Dysphagia Therapy.

    Why does a Speech Therapist help with eating and swallowing?

    The mouth, tongue, and throat are all involved in both speech and swallowing. When there’s a problem with any of these parts, it can affect both your ability to talk and to eat. For example:

    • Weak tongue muscles: Can make it hard to chew food and to form sounds.
    • Difficulty coordinating swallowing: Can lead to choking or aspiration (when food or liquid goes into the lungs).
    • Sensory issues: Can make certain textures or tastes feel unpleasant or overwhelming.
    • Communication: If we are not able to express ourselves we are likely to have difficulties during daily mealtimes: how do we ask for ‘more’ of something, how do we say we have had enough or we don’t like a particular food?

    How does a Speech and Language Therapist help?

    Our work involves a combination of assessment and therapy. We carefully observe how your child feeds, eats and swallows, and we look into your child’s mouth to help us see what the cause of the difficulties are: could be a very highly-arched palate, it could be a very flaccid/low tone tongue, it could be poor dentition. Then, we create a personalised treatment plan to address your specific needs.

    Here are some of the things we might do:

    • Teach swallowing techniques: We can help your child learn strategies to improve or facilitate a safe swallow.
    • Recommend dietary modifications: We may suggest changes to your child’s diet to make it easier to eat and swallow.
    • Provide sensory therapy: If your child has sensory needs we can help your child become more comfortable with different textures, tastes, and smells.
    • Work on oral motor skills: We can help to encourage more effective chewing, or drinking skills, or we can help your child to close his/her mouth more during chewing or drinking from a straw.
    • Collaborate with other professionals: We often work closely with doctors, nurses, occupational therapists, and dietitians to provide comprehensive care.

    What kinds of problems do Speech and Language Therapists help with?

    We see a wide range of feeding and swallowing difficulties, including:

    • Delayed feeding: Children who are slow to develop feeding skills or who have difficulty transitioning to solid foods.
    • Tongue-ties: Babies can have significant difficulties with feeding when the tongue is very tightly tethered to the floor of the mouth.
    • Refusal to eat: Children who refuse to eat certain foods or textures.
    • Aspiration: When food or liquid goes into the lungs, which can lead to pneumonia and other serious complications.
    • Chewing difficulties: Problems with chewing food, such as difficulty breaking down food or keeping food in the mouth.
    • Swallowing difficulties: Problems with swallowing, such as feeling like food is stuck or choking.
    • Neurological conditions: Conditions like cerebral palsy, down syndrome or other genetic syndromes can affect feeding and swallowing.
    • Developmental delays: Children with developmental delays may have difficulties with feeding and swallowing.

    Is there hope?

    If your child is struggling with feeding or swallowing, know that there is help available. Speech and Language Therapy can make a significant difference in your and your child’s quality of life. We’re here to support you every step of the way.

    Remember, you don’t have to suffer in silence. If you’re concerned about your child feeding or swallowing, please reach out. You can find a Speech and Language Therapist with a Feeding/dysphagia qualification near you via www.asltip.co.uk or contact me.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

    1
  • · ·

    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.

    1
  • ·

    Let’s live and breathe AAC

    ByLondon Speech and Feeding

    We all have the right and want to express thoughts, feelings, and needs. For non-speaking or minimally speaking children, finding an avenue to communicate effectively can be a challenging journey. Parents are often at a loss as to where to start. Sometimes a little bit of Makaton signing has been used here and there but we mostly find that gradually signing fades as parents feel that it just doesn’t seem to get copied and used by the children.

    They live and breathe their system

    This is where we need to pick up the pieces and start again: because all successful families where children start using their boards or their electronic AAC (Augmentative and Alternative Communication) systems do this one thing: THEY LIVE AND BREATHE THEIR SYSTEM.

    • They have boards in every single room of the house;
    • They have a board in the car, attached to the side of car door so their child can point to it as they need to;
    • They have a smaller board in their handbag/rucksack when out and about;
    • They have a board for shopping and attach it to the shopping trolley;
    • They are never ever without their board.

    Because they realise that a child should never be without their mouths to speak, should never be without a means to speak. They use their own board to model and the child has always access to their board to model back or to just look.

    This is where success begins

    Success begins at consistent and joyful use of the board/AAC system throughout the entire day. If we think about it, doesn’t it make sense? Of course, it does! We talk to our child for the first two years of their life continuously wherever we are and our child is continuously encouraged to use their mouths for talking in all situations.

    Same goes for Signing: Makaton or any other sign system is a very powerful means to aid communication and I certainly advocate and use it in practice. Though much like words, signs are very elusive and temporary—as soon as the sign has been made it is gone and no longer present. Same with words of course. This can be difficult for people who need longer to process information.

    The beauty of symbols or photographs is that they are permanent: they don’t vanish, they stay and with the core board they stay in the same place! This is very reassuring. We can learn where a symbol is and we can be assured that it will still be there the next time we look at the board.

    AAC core board

    Here is a picture of a core board:

    AAC board

    You can download this and other boards for free on the Saltillo Word Power website.

    It has 48 cells and we can see the most frequently used core words on here, words that we use 80% of the day when talking with our non-speaking/minimally speaking children, younger children and children with cognitive delay. We keep our sentences short and we say phrases pertaining to their daily lives;

    • Let’s GET your toy
    • PUT it here, PUT it away, PUT it IN
    • Let’s READ a book
    • UP you get
    • WANT some MORE?
    • That’s GOOD isn’t it?
    • Let’s OPEN the box and LOOK

    And so on… All these phrases can be aided with the above board. Your child will learn OVER TIME and OVER CONTINUOUS USE where GET/PUT/MORE/WANT/IN—where these symbols are. For children who are slow to process this is so helpful, to have a visual representation of what has just been said. It aids understanding in the first place. Gradually as a child starts to copy they will point to powerful symbols themselves and if they want to speak they can also speak of course:

    A child might point to WANT + MORE and then say with their mouths: BANANA!

    Board examples

    Here are some other boards I have made specifically for daily situations and preferences of some of my students. Here is one for toileting:

    AAC toileting board

    And another one:

    These boards incorporate high-frequency and versatile words, enabling us to make little sentences.

    Building Language and Literacy Skills

    AAC Core Boards are not just tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-speaking children engage with words and symbols, reinforcing their understanding of language structure and grammar.

    Over time they naturally absorb language patterns, laying the foundation for improved literacy skills.

    Customisation for Individual Needs

    Every non-speaking child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind. The boards can be adapted to include specific vocabulary relevant to the child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of the child’s personality and needs, making communication more engaging and effective.

    Collaboration between AAC Core Boards and Speech Therapy

    While AAC Core Boards are an incredible tool, they are only used effectively by the non-speaking child when the board is used BY ALL COMMUNICATION PARTNERS around the child.

    Again, I know I am being repetitive here, but the board needs to be used and modelled by the adults constantly in the first place and for a period of time before we can expect our children to take an interest and use the boards themselves. Think how long it typically takes for a child to learn their first word: around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.

    Collaborating with your child’s speech-language therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best implement them.

    Conclusion

    For non-speaking children, AAC Core Boards are bridges to their world.

    These boards foster language development, social interaction, and personal expression. AAC Core Boards offer a beacon of hope, helping non-speaking children break through communication barriers and thrive in a world that is waiting to hear their voices. Boards are simple for anyone to use and understand. Have a go! You will be surprised how lovely it is to use a board with ease and once your child sees you do this, you have a chance for your child to start copying you…and express something! HOW ABOUT THAT! I look forward to hearing your stories!

    The London Speech and Feeding Practice

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

    1
  • ·

    How to model AAC with our minimally speaking students?

    ByLondon Speech and Feeding
    modelling AAC

    How should we start? Should we use prompts? What kind of prompts? hand-over-hand or just pointing? Should we wait, and, if so, how long? Introducing an alternative communication system (AAC) to our child is for many of us a confusing and sometimes scary prospect, but it needn’t be! Let me reassure you and share some tricks of my practice in this area.

    Once we have decided to try for a picture based communication system, I usually start with a paper-based single page with between 48–88 core-words. I choose the number of words depending on where the child is developmentally and also verbally.

    If a child does have a small handful of words already, I might start with the 88-cell board below. If, on the other hand, my student is completely non-speaking and still quite little then I might go for the 48-cell below here or I might have even less cells to start with. Again, sometimes I start with an electronic device in my clinic just to trial and introduce the idea and to see if, or how, a student responds. 

    Below are some samples: a 49-cell board which I made for a child in a nursery setting

    Below a Saltillo WordPower board that can be downloaded from the Saltillo website:

    Example of a slightly more advanced board, again from the Saltillo Website

    And here below one example of a board I made for a specific activity for a child who loves water and sand play:

    It is perfectly possible to be very flexible and create a suitable board for any student, starting with as few as 2–5 cells and working up to over a 100 (very small ones) on a sheet of A4 or A3 paper.

    So once we have a good board for our child, what now? How do we start introducing this into our daily life?

    We can start by showing/pointing to the word GO within a play activity. For example:

    • a car run,
    • or a marble run,
    • or a spinner activity,
    • a wind-up toy,
    • anything that can be stopped and started easily.

    How to start?

    I will talk us through each of the steps using the example for the word ‘GO’.

    First phase

    The first phase is a TEACHING/ LEARNING PHASE. In this phase we do not expect our student to do anything, to copy us or to point to the board. If they do that it is of course a huge bonus and we will celebrate it.

    Our job is to simply MODEL/SHOW/GIVE EXAMPLES of how we can use the board, by steadily and regularly pointing to the chosen word or words. We do so across the day and across settings:

    • play
    • meal time
    • getting dressed/undressed
    • bath time
    • going to the car/shops
    • etc

    Once we can be sure that our student has been submerged and SOAKED in seeing the coreboard being used, say after some 3–4 weeks of using it consistently…

    Second phase

    We can begin to move into the second phase which is the PRACTICE PHASE. By now the student has seen the boards and he or she has seen the word GO (as a example) modelled many times.

    Now we can start to see if we can tempt our student into trying this out for themselves.

    What sort of TEMPTING are we talking about? Take a look at the Prompt Hierarchy below, which shows us what to do to get our student to be independently communicating as soon as possible. 

    The PROMPT HIERARCHY: what sort of prompting should we do, should we expect something from our student or how should we view this stage?

    1.  TEMPT AND PAUSE

    I have the AAC near to the toy and each time the child starts another round of the activity I say clearly ‘GO’ and I point to the picture as do so. I then pause and wait to see what happens. NOTHING? Then…

    1. USE SIGNS AND BODY LANGUAGE

    Next time the child starts another round I might be very animated and do a Makaton sign for GO as I say ‘GO’ and I make a very over point to the picture again. Then I wait. STILL NOTHING? OK then…

    1. OPEN-ENDED QUESTION

    Now I might say ‘GO’ and follow with: ‘OOH I WONDER IF THERE IS A PICTURE TO POINT TO…’

    ‘OH LOOK HERE IS GO!’ I then point to GO.

     STILL NO RESPONSE?

    1. ASK FOR A RESPONSE

    I might say ‘GO’ followed by ‘LOOK! LET’S POINT TO GO HERE ON THE PICTURE.’

    STILL NO RESPONSE? 

    1.  PHYSICAL TOUCH

    Next time I say ‘GO’ I will try and take the student’s hand, help isolate their finger and help him or her to point to the actual picture.

    REMEMBER: Prompting serves a very important function in scaffolding learning for students BUT if we are constantly prompting kids, then we are teaching them to only communicate when someone tells them to. We want our student to become as independent in speaking and using words as possible.

    So once I have done Physical Prompting I will try and phase back down to number 1 where all I need to do is point to the picture or look at the board with the aim that the student will then point to the picture.

    Take away points:

    • Keep the learning phase pressure-free and model without expecting our student to jump in. In other words, let’s model first without expectation. Later we can have a little bit of expectation.
    • After they’ve been exposed to and have been ‘soaked’ in plenty of AAC input, then, YES, we can create an opportunity to help them say or point to the word on their own.
    • We can model BOTH with and without expectation.
    • Only after LOTS of exposure, use the least to most prompting hierarchy and start creating opportunities for a student to become an independent communicator.

    Do get in touch if you have any questions or comments or if you would like some practical help.

    I am always pleased to hear from you.

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

    0
  • ·

    Bilingualism – should I speak only English with my speech delayed child?

    ByLondon Speech and Feeding

    Introduction

    Bilingualism is a beautiful aspect of our diverse world. Growing up in a bi- or multi-lingual household is a wonderful gift, allowing children to communicate with a broader range of people and access many cultures.

    My own two children grew up in a bilingual German-English speaking household. They have both been so enriched by this experience, not only language- and learning-wise but of course also culturally: their world has always been so open and colourful. Growing up in inner London and having their German family and mum’s friends as well, this has been a wonderful experience. Both my boys speak German well (not quite like native speakers but like very good second language speakers) and both have very easily learned 3rd and 4th languages additionally when in secondary school.

    Whilst bilingualism has untold benefits, it’s not uncommon for bilingual children to take slightly longer to reach certain speech milestones. This should not be automatically mistaken for speech disorders but rather seen as a natural part of bilingual language development.

    Bilingualism and speech delays

    Sometimes, of course, we do see speech delays or disorders where a child’s speech development lags significantly behind their peers. We often see a delay in both languages equally, making it extra hard for to communicate effectively. BUT PLEASE KNOW the family speaking in multi-lingual languages never caused the delay/disorder!

    If there is a delay or a disorder any number of other reasons could have caused it, such as:

    • hearing impairments,
    • reduced phonological awareness,
    • sensory processing issues,
    • reduced attention and reduced joint attention,
    • neuro-developmental delays or difficulties,
    • general or specific learning difficulties
    • or sometimes other genetic factors.

    So, to say that the difficulty is due to a child being exposed to several languages is a red herring. (no offence to herrings!)

    Speech therapy

    Speech therapy can be powerful to help bilingual /multilingual children with speech delays unlock their full linguistic potential. By providing individualised assessments, targeted interventions, and involving families, speech therapy can bridge the gap between speech delays and bilingualism. It’s essential for the therapist and parents to work together to support the children in their unique linguistic journeys, helping them communicate effectively and thrive in both of their languages.

    Happy Islamic family sitting on the floor
    Image by Freepik

    Speak your home language at home

    Many parents report that they worry about speaking their home language at home and instead they have been focusing on just speaking English at home. They now rarely use their home language with their child. They fear that speaking a language other than English with their child will cause further delay and hinder their progress. All parents want the best for their child and often parents fear that their child won’t fit in or will be seen as ‘different’. So we can understand why parents feel that the English language is the only one worth having.

    But the opposite is the case: it is crucial to speak in both languages freely, both at home and outside the home! Both languages will benefit your child, no matter what the delay or difficulty is. Acquiring a ‘mother tongue’ or native language is absolutely vital for children to have a good, solid linguistic grounding on which to build other languages. Bilingual children may mix languages during speaking and parents may equally mix their languages. This does not hinder language development and is a natural part of linguistic development.

    Speak freely and naturally

    What is far more important than the question: ‘which language should I say this in?’ Instead think: ‘let me speak freely and naturally, let me respond naturally, in good intonation and let communication flow freely to the child.’

    Speech therapy can be a crucial resource for bilingual or multilingual children and their families.

    We work on targeted interventions to address speech and language difficulties, helping your child develop essential communication skills. For home practice between therapy sessions, we can recommend tailored treatment plans to help you help your child in daily life. Our input could be focusing on articulation, phonological awareness, attention and listening, vocabulary development and grammar.

    Family support is crucial in speech therapy. We like to work closely with parents to provide guidance and strategies for fostering language development in both languages at home.

    If you have any worries about your child being delayed in a bilingual or multilingual household do get in touch and we will be happy to support you in your journey.

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

    1
  • ·

    Rethinking the PECS Approach

    ByLondon Speech and Feeding

    I want to talk about some concerns of SLTs, parents and increasingly autistic adults who explain to us how this communication method did not really work so well and why.

    What is PECS in a nutshell:

    PECS (Picture Exchange Communication System) is based on the idea of exchanging pictures in return for desired items. For more advanced users, it is used to communicate different functions such as emotions, comments, negations using the exchange of a sentence strip. It was founded on the principles of Applied Behavioural Analysis (ABA).

    How does that look in practice?

    In my experience, having been trained in the approach myself, the overall aim is eventually for the child to spontaneously go and get their picture book (PECS book), open it, look through a range of pages to select the correct picture of what they want to have or say, then go and find their communication partner, and finally place that picture onto the communication partner’s outstretched palm to be rewarded with an item or with a response of some sort. Or the child selects a range of pictures to create a little sentence, such as: ‘the blue fish swims in the sea’, ‘the red bird flies in the sky’ or ‘I see a red bird’ for example. This can be part of a structured table top activity.

    The system follows a series of phases, starting from simple picture exchanges to eventually construction of sentences using symbols. PECS’s aim is to promote communication initiation and reduce frustration for those who struggle with speech.

    So far so good one might say, why not? Before I go into the various concerns, I would want to add my own working experience with PECS, and whilst it is my opinion, I would say I have NEVER seen a working PECS book being used spontaneously!

    My experience

    I have seen attempts of stages 1 and 2 done quite well, in schools, and where people knew that I was coming in “to have a look at how PECS is working with child X”. Yes, in those instances an effort was made of course to try and show me how it worked. I must add that have never been very impressed. I cannot recall it used for any other items than: biscuits/quavers/crisps/ raisins and bubbles/puzzle pieces or spinners.

    If we want to see a child trained to exchange for these items in a structured setting, i.e., the child sits at a little table with the adult sitting opposite enticing the child with one or other item, then yes that can be done successfully. I have seen children exchange 25 pictures with a crisp on it, for said crisp and they might have asked for another 25 of those crisps given half the chance. Yes. Good. But. I have yet to see a child go to their PECS book and go through all the motions that I mentioned above to get a crisp. In school they don’t need to: they know that crisps are only available when the PECS book is being practised. Otherwise, let’s be honest, it’s fruit at 10.30 am!

    So, they don’t get a spontaneous opportunity to ask for highly motivating items as that is not how school works, is it? ‘SIR! Can I have a crisp?’ At 10.02am, in the middle of maths? Didn’t think so… So in reality this does not get practised in my experience.

    A few concerns in no particular order:

    Limited Generalisation

    One issue often raised is the limited generalisation of skills learned through PECS. The structured nature of the program may result in a child only being able to communicate effectively within the specific contexts where they were taught to use the system (as I suggest above: crisps: yes, please let’s do the PECS for it). This limitation can pose challenges when trying to apply communication skills in new or unstructured/spontaneous situations.

    Lack of Spontaneity

    Critics suggest that PECS can sometimes lead to scripted and less spontaneous communication. This is also what I have observed. Since the method is designed to follow a structured progression, there is a concern that individuals might struggle to initiate communication outside of the established framework, potentially hindering their ability to engage in more natural interactions.

    Narrow range of communication functions being practised

    While PECS is quite successful in focusing on requesting and naming items, there are many other important communication functions, such as expressing emotions, asking questions, giving opinions or greetings for instance. We can argue that a communication core board where we have a whole range of different core words available lends itself much better to practising a range of communicative functions.

    The Pictures are movable

    They are attached to the book via Velcro. They are constantly being picked and exchanged and then returned to the book. This means that the pictures tend to be always in different places. This goes against the motor planning that takes place when one is learning a new skill: imagine you want to learn to touch type and the letters always move and are at different places? How can you be quick about finding a letter? You can never get to “automatic” with this type of approach.

    Communication is not taught via behavioural means

    Only if you say “banana” in the way that I dictate that you should will you get a piece of banana. Who does that? Nobody. Typically, child points to the counter where there is a banana and says: ‘ba’ or ‘ana’ and mother/carer will look over there and say ‘oh banana! You want a banana? Ok there you go have a piece.’ Or something like it. Mother will not say: ‘SAY BANANA or else you won’t get it.’ Child hears mum saying ‘Banana’ each time and with time will point and say ‘banana’ or ‘I want-a-nana’ or something. This is how communication is learned: through the adult modelling it cheerfully all day long and the child hearing it and then gradually copying it.

    One other gripe I personally have but I am reliably informed by all my parents that they share this about PECS:

    IT IS SO LABOUR INTENSIVE!

    There are 10, 50, 100’s of little pictures that first of all need laminating… then velcroing, then finding and replacing. As I said above, it’s a constant moveable feast for one, but also you LOSE them. Yep. You want to find the picture for “trampoline”. ‘Where is it? I saw it yesterday… We had it outside when we practised you asking for the trampoline. I am sure we put it back? Where is it??? Ok. We need to print off a new one.’

    It is also labour intensive for the first stage where you need to have TWO adults to ease the exchange (pick up and release of picture into the communication partner’s hand). Who has two adults available for what can be weeks until the child is able to pick up and release by themselves?

    YEP. So it’s really not for me you can tell! I much prefer Core boards (see my previous post on using one) or electronic speech generating AAC devices like GRID, or LAMP or TOUCHCHAT. These are all great to use and there is good support out there for introducing these.

    Finding a Balance

    While the concerns surrounding the PECS approach are valid, it’s fair to note that the method also has some merits. There is anecdotal evidence of many individuals who have successfully improved their communication skills and quality of life through PECS. But, finding a balance between using PECS as a stepping stone and ensuring the development of more comprehensive and SPONTANEOUS communication is key.

    As educators and therapists, we need to extend the focus beyond requesting and labelling by incorporating symbols that represent emotions, actions, and more complex ideas. This expansion encourages a broader range of communication functions. When the time is right, gradually transitioning from PECS to more advanced communication methods such as Core boards or electronic AAC tools and speech-generating devices is the way forward.

    We want to value all communication equally and our approach ought to be playful and child-led and to focus on intrinsic motivation instead of extrinsic rewards and reinforcers.

    If you have any questions or if you are looking for a therapist who endorses play-based and child-led therapy approaches, please do reach out.

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

    0