We are all aware that Autism is on a spectrum. By the very nature of this, it means that every child will present differently, so an individualised approach is required. We need to remember to use a child’s strengths to support their needs. By using a person-centred approach, you’ll see your child’s literacy develop and thrive.
I hear many parents concerns about literacy as well as communication. Will they be able to read, write and spell? How will they manage their literacy independently? The questions are endless, so let’s look at how you can support your child’s literacy skills and how together we can provide a scaffold to them becoming independent learners.
The one thing we know is that Autistic children are visual learners. They succeed by us sharing pictures and demonstrating how the narrative is shown.
Start reading to your child at an early age. You can never start too early. This creates a love for books and supports vital pre-literacy skills (such as increasing vocabulary, following narratives, awareness of sounds in words, and letter recognition and awareness). By supporting pre-literacy skills, you’re starting the process to create confident young readers.
There are many ways to use books. You can narrate the story using different voices and tones to increase interest. You can do this even if your child isn’t interested. They are still listening and learning vital skills. You may even ask and answer questions and voice the skills that they will need for internal monitoring.
Use their interests to select appropriate reading material. In addition, you can then create questions on the book and provide a scaffold to support your child with the answer.
Use technology to spark their interest in reading. Demonstrate how they can read online. This is often successful as it becomes an individual activity as opposed to needing social interaction.
Provide them with a choice of texts (e.g., would you like ‘Perfectly Norman or when things get too loud’) rather than an open-ended question such as ‘What book would you like to read?’
Write key pieces of information down on paper. Research suggests that Autistic learners understand written text better than speech.
You could have a ‘word of the day’ from chosen reading material that you explore together.
Reading aloud to your child can have many benefits which include understanding vocabulary to how the book is read, with appropriate intonation.
I highly recommend the boom decks as they are a great resource!
The ethos at London Speech and Feeding:
“If they can’t learn in the way we teach, then we teach the way they learn”
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.
Apraxia or dyspraxia is a difficulty in motor planning, which sometimes can be seen in both gross and fine motor skills, as well as speech. Gross motor refers to difficulties in coordinating the whole body (e.g., bumping into things frequently, often falling over hurting themselves or others through being “clumsy” or unsteady). Fine motor movements refer to smaller, more precise movements (e.g., difficulties doing anything with their hands such as holding a spoon or pen).
In Dyspraxia of Speech, instead of seeing a coordinated smooth way of talking, we see the articulators (tongue, lips, cheeks) and voice coordinating very smoothly. The voice can be very quiet or very loud. Muscle tone can be weaker at times. Speech sounds are very unintelligible, with a flat voice that can sound forced. It may be that the timings of verbalisation appear random and that children can say a certain word once and never again. This is often what we hear from parents.
It is interesting to note that many of our autistic clients are either non-speaking or are reluctant speakers. Sometimes they say a word once and then never again. Others say lots of words but the words are very hard to make out. Did you know that about 40% of autistic people have verbal dyspraxia? (Richard, 1997). Because the problem is one of motor planning, not of automatic motor execution, once a plan has become automatic, it is easier to get back to it and this is why we often see repetitive patterns that can be called ‘stims’ (Marge Blanc, 2004).
How can Speech and Language Therapy help?
Children with verbal dyspraxia can make great progress!
We provide frequent and appropriate speech movement opportunities and with time and the right support, children will move forward and begin to speak more fluently and with greater intelligibility. It is important to know this can take time.
We provide Oral Motor Therapy using a variety of approaches to practise breathing, vocalising on the outbreath, and sequencing our speech movements.
We design carefully tailored programmes focusing on words that have a lot of power (e.g., NO, GO, UP, IN, OUT, LET’S GO, STOP).
We offer shared enjoyment, and laughter. This helps a child find their voice. Other ways of finding our voices include singing or humming, or even yelling/shouting!
The most difficult phase of verbal dyspraxia is initiation, that is to start talking, to start producing a word. Frequent “automatic” repetition supports children with initiation because it removes the element of “thinking to start”. I often ask a child to repeat a word 5-10 times (with rewards at the end. A little game works well). You can see that with repetition the act of initiating is taken out of the equation as you are “on a roll “as it were.
Once a child starts to find their voice, we will be able to hear them talk lot… And if we give them credit and presume that what they are saying has meaning, we will find in time that their words become clearer and more intelligible. If we listen carefully, we can detect real words and phrases.
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.
Before reading this blog, it’s important to understand what we mean by ‘social communication’ and ‘imitation’. Social communication is more complex than it first appears. It refers to many aspects of communication such as body language, voice, conversational skills, social ‘rules’ (such as being polite and using manners), interpersonal skills (such as developing friendships), and emotional literacy (such as appropriacy and developing self-awareness). Imitation refers to the simple act of copying.
You may have noticed that your child has difficulties in some of the areas mentioned above. They might be less responsive to you and appear to be quite happy in their own world. Whilst we do not want to change their unique characteristics, we do need to prepare them for future experiences, and what is socially acceptable.
How will copying my child develop their social communication?
If your child is already engaged with a certain activity, they are already interested and motivated. You’re not competing for their attention.
Both yours and your child’s attention is on the same activity which makes imitating for you (as the parent) easier.
Studies have demonstrated that when a parent imitates a child, they are more likely to look at the adult.
Imitation not only supports eye contact but supports facial expressions (such as smiling), may increase vocalisations, and encourages your child to sit closer to you.
Children learn through trial and error. They may start to try to perform new actions to gain their parents attention. Let your child lead the play!!
How do I start imitating my child?
Start with observing them. Take the time just to watch. You don’t need to make notes. Sit back and observe their actions, movements, and sounds they make.
Wait for your child’s reaction when they realise you are copying their actions. Remember they may not notice, you don’t need to remind them, simply copy them again.
Having the same set up as your child allows them to feel in control. So, you may have two sets of the same activity rather than copying using their set of toys.
This may sound daunting, but it doesn’t have to be. Start with a ten-minute time frame where you choose to copy your child. This is where you can practise your imitation strategy. Ten minutes a day is far more effective than an hour every two weeks. You may feel self-conscious but trust the process. Build your confidence, whilst exposing your child’s to increased language and communication, enabling them to develop vital social communication skills.
Look at the video above to watch the strategy in action!
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
Mealtimes can be a battleground for parents of picky eaters, especially toddlers with Avoidant/Restrictive Food Intake Disorder (ARFID). I see a great number of toddlers with Autism traits and many of my clients are picky eaters from mild to severe. Take a look at my blog for an outline of what the issues are and how to try and help.
ARFID goes beyond typical ‘picky eating’ and can significantly impact a child’s growth, nutrition, and social-emotional well-being. If your toddler is resistant to trying new foods or has a very limited diet, here are some strategies to navigate the introduction of solids:
1. Understand ARFID:
ARFID is a diagnosable eating disorder characterised by:
Limited food variety: Eating only a small range of foods, often with specific textures or colours.
Fear of new foods: Intense anxiety or aversion to trying unfamiliar foods.
Sensory sensitivities: Heightened sensitivity to taste, smell, texture, or appearance of food.
Lack of interest in eating: May show little interest in food or mealtimes.
2. Seek professional guidance:
Paediatrician and/or gastroenterologist: Rule out any underlying medical conditions.
Registered dietitian: Assess nutritional needs and create a balanced meal plan.
Speech and language therapist (SLT): If oral-motor skills or sensory sensitivities are contributing to feeding difficulties.
Occupational therapist (OT): If sensory processing challenges are affecting mealtime behaviours.
Child psychologist: If anxiety or emotional factors are contributing to ARFID.
3. Strategies for introducing solids:
Start small: Introduce one new food at a time, in small amounts, alongside familiar favourites.
Patience is key: It can take multiple exposures (up to 10–15 times!) for a child to accept a new food. Don’t give up!
Positive reinforcement: Praise and encouragement for any interaction with the new food, even just touching or smelling it.
No pressure: Avoid forcing or pressuring the child to eat. This can create negative associations with food.
Make it fun: Present food in playful ways, use cookie cutters for fun shapes, or involve the child in food preparation.
Sensory exploration: Encourage exploration of food through touch, smell, and sight before tasting.
Role modelling: Show the child that you enjoy eating a variety of foods.
Use fun utensils: your child might like characters from ‘Frozen’ or ‘Dinosaurs’ or ‘Diggers’ there are a host of character-based cutlery and cups/plates to be had. Also, I really rate these two items very highly they are so good so I want to share these with you. Both are available online. But warning: the cup is outrageously expensive as it comes from the United States and is sold by a small scale company. But I feel this is cup very worth trying, I have had good results with this.
Gradual desensitisation: Start with foods that are similar in texture or taste to accepted foods, then gradually introduce more challenging options.
Food chaining: Introduce new foods that are similar in taste, texture, or appearance to accepted foods.
4. Mealtime Environment:
Positive and relaxed: Create a calm and enjoyable mealtime atmosphere.
No distractions: Minimise distractions like TV or toys.
Consistent schedule: Offer meals and snacks at regular times.
Child-sized portions: Offer small, manageable portions to avoid overwhelming the child.
Involve the child: Let the child choose their utensils, plate, or cup.
5. Remember:
Every child is different: What works for one child may not work for another.
Progress takes time: Be patient and celebrate small victories.
Focus on the positive: Praise any positive interaction with food.
Seek support: Connect with other parents or support groups.
Introducing solids to toddlers with ARFID can be challenging, but with patience, persistence, and professional guidance, you can help your child develop a healthier relationship with food.
Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice
The London Speech and Feeding Practice
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
I have been avoiding the use of the Empty Set approach for the longest time as I was not sure if it would work seeing that I am challenging two sounds my student struggles with at the same time. But I decided to give it a go and it works a treat!
With this approach, we use two sounds that our student is struggling with. For example, in my video this student cannot produce /sh/ and /r/. Both sounds have different rules, so I decided to contrast them with each other.
The rules of /sh/ are: no voice, air is pushed out through teeth, produced at the front.
The rules for /r/ are: use your voice, produce the sound in the middle of the mouth by shaping your tongue in a particular way.
So I chose the words ‘shoes’ and ‘ruse’ as their rules are quite different. Contrasting two sounds the student does not know has been shown to lead to greater change in the child’s articulation. And I can certainly vouch for this as my student is making the best progress with this approach.
Phonology Therapy – what is it, why and how?
Phonology is the study of the sound system of a language. It’s distinct from articulation therapy which focuses on the physical production of sounds.
Phonology therapy focuses on rules. For example, sounds that are produced at the front of the mouth, in contrast to sounds that are produced at the back of the mouth, or sounds that are produced with a long air stream: /s/ or /f/ versus short sounds like /p/ or /t/; sounds are produced with voice or without voice.
Many children, and sometimes adults, are unaware of some of the speech rules and confuse and replace individual sounds. They might say TAT instead of CAT or SIP instead of SHIP.
A quick overview of phonology approaches I use:
Minimal Pairs:
This approach is good for single sound substitutions. We offer word pairs that differ by only one sound, like ‘ship’ and ‘sip.’ One of our first goal in therapy is to highlight the difference between the target sound (e.g., /sh/) and the sound the child uses (e.g., /s/). This helps discriminate and eventually produce the correct sound.
Multiple Oppositions:
A child might replace lots of sounds with a single sound like a /d/. So instead of ‘four’, ‘chore’ and ‘store’ our child says ‘door’, making speech very unintelligible.
The approach is typically geared towards shaking up the phonological system. Our goal is to choose two to four targets that are different from each other, and different from the substituted sound. If our child’s favourite sound is /d/ they can use their voice and make a short sound by stopping their airflow. So I will choose a different target sound to change up the speech system. For example I might choose an /f/, a /m/ and a /k/ sound. So I would contrast: ‘door’ with ‘four’, ‘more’ and ‘core’.
Maximal Oppositions:
In the Maximal Oppositions approach the treatment sets consists of words that are minimally contrasted and that have maximal or near maximal feature differences between each word pair. One word in a pair represents a sound the child ‘knows’ (can say at word level) and the other represents a sound the child does not know (cannot say).
For example, a child may ‘know’ /m/ and be able to say words like ‘man’, ‘mat’ and ‘mine’. However, the same child may be unable to say /f/ as in ‘fan’, ‘fat’ and ‘fine’. The consonants /f/ and /m/ are maximally opposed as follows.
I am always delighted to work on speech sound disorders, I love the challenge and the successes we can celebrate together. Get in touch with 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.
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
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?
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…
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…
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?
ASK FOR A RESPONSE
I might say ‘GO’ followed by ‘LOOK! LET’S POINT TO GO HERE ON THE PICTURE.’
STILL NO RESPONSE?
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.
‘What kind of speech difficulty does my child have?’
It’s a very understandable question. We often hear different terms such as phonological delay, articulation difficulties, or Childhood Apraxia of Speech (CAS), and it can be confusing.
The reality is that many children don’t fit neatly into one single category.
In fact, quite often I see children whose speech profile includes a mixture of difficulties. They might have some phonological patterns (where they substitute one sound for another) alongside challenges with motor speech planning, where coordinating the movements needed for speech is harder.
When this happens, therapy needs to be flexible, responsive, and tailored to the child sitting in front of us.
Example
Recently I filmed a short clip from one of my therapy sessions which shows exactly how this works in practice.
The child I was working with has difficulties with several speech sounds. Part of the challenge relates to a phonological pattern called fronting.
Fronting is when sounds that should be made further back in the mouth (like /K/ or /G/) are produced further forward instead.
At the same time, this child also shows signs of motor speech planning difficulty, which means the brain has to work harder to organise and sequence the movements of the tongue, lips and jaw for speech.
This type of profile can sometimes overlap with characteristics seen in Childhood Apraxia of Speech (CAS).
When difficulties overlap like this, therapy cannot rely on a single approach. Instead, it needs to draw on multiple evidence-based strategies.
That is exactly what you see happening in the clip. We started out generalising the /K/ sound which until recently had been replaced by a /T/ sound. Whilst looking at a sound loaded picture of /K/ sounds we somehow got talking about a ‘dent’ (I don’t recall how we got there!) but the ‘dent’ was a ‘det’ and I decided to tackle this there and then because there are other great words that end in ‘nt’ like : ‘count’ ‘giant’ ‘point’ or ‘paint’.
Using visual cues to support motor planning
Speech is incredibly complex. For children with motor speech difficulties, the challenge is not only knowing what sound they want to say, but also how to move their mouth to produce it.
This is where visual cues can be incredibly helpful.
In the clip, you can see me using a whiteboard with pictures and simple visual prompts. These help to:
Focus attention on the target sound
Understand where the sound occurs in the word
Remember the sequence of sounds needed
Visual supports can act almost like a map for the mouth, guiding children as they practise new speech movements.
For children with motor planning difficulties, this type of cueing can make a huge difference.
Why repetition of a single word (massed practice) is so important
Another key feature you will notice in the clip is lots of repetition.
This is very deliberate.
When we are supporting children with motor speech challenges, the brain needs repeated opportunities to practise the correct movement patterns. Just like learning a musical instrument or a new sport, repetition helps the brain build stronger and more efficient pathways.
In therapy we call this massed practice.
Rather than saying a word only once or twice, we practise it many times in a structured way, helping the child stabilise the new speech pattern.
But repetition alone is not enough. The child also needs to understand why the sound matters.
Showing children that sounds change meaning
This is where another powerful therapy approach comes in: minimal pairs.
Minimal pairs are word pairs that differ by only one sound. For example:
debt
dent
In the clip, I use these two words to help the child realise that the /N/ sound makes a meaningful difference.
Without the /N/, the word becomes something else entirely.
This approach helps children recognise that speech sounds are not random: they carry meaning. If a sound is missing or substituted, the message may change.
Helping children notice these differences can be a very motivating moment in therapy. Suddenly the sound is no longer just an abstract exercise; it becomes part of real communication.
Blending approaches for the best outcomes
In this short therapy moment, I am combining:
• Visual cueing
• Motor speech practice
• High repetition (massed practice)
• Minimal pair contrasts
• Listening and awareness of sound differences
Each element supports a different part of the speech system.
Some strategies help with motor planning, others support phonological awareness, and others build accuracy and consistency.
Together they create a therapy session that is both structured and responsive.
Every child’s speech journey is unique
One of the most important things I want to convey is that speech development is not always straightforward.
Two children may both struggle with speech sounds, yet the underlying reasons may be very different.
This is why careful assessment is essential, and why therapy needs to stay flexible as we learn more about how a child’s speech system works.
Sometimes a child needs more motor-based work.
Sometimes the focus shifts towards phonological contrasts.
Often, as in this example, the most effective therapy uses both.
Small steps lead to big progress
Every session helps us understand a little more about how a child’s speech system works and what support will help them move forward.
And when the pieces start to come together, when a child realises that one tiny sound can change a whole word, that is when the real progress begins.
If you are concerned about your child’s speech sounds, clarity of speech, or possible motor speech difficulties, early support can make a significant difference. A detailed assessment can help identify the nature of the difficulty and guide a therapy approach tailored to your child’s individual needs.
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.
