As professionals, when diagnosing young children with an Autistic Spectrum Condition, it is vital we work as a multi-disciplinary team, so you will likely see many professionals. This may include Educational Psychologist, Dietician, General Practitioner, Occupational Therapist, Paediatrician, Special Educational Needs Coordinator, Speech and Language Therapist and Social worker. Once the evidence is collated, then a diagnosis may be made.
You may be wondering what are some of the early signs of social communication difficulties? Whilst no autistic child is the same and we know Autism is very much a very wide spectrum of abilities and needs there are some autistic spectrum characteristics we do typically see in the early years of childhood. You may wish to think about these areas or presentations to help you prepare for the Speech and Language Therapy appointment.
Twelve questions
Does your child respond to their name?
Are they fixated with watching their hands?
Do they have sensory processing difficulties such as bright lights, food textures, or loud noises?
Are they meeting their milestones or are they delayed?
Do they flap their arms or legs when excited?
Have you noticed any rocking back and forth?
Do they blink excessively or display any facial tics?
Do they play with a particular sort of toy e.g. spinning toys?
Have you noticed that they lack interest in toys?
Have they regressed in their language? Perhaps you’ve noticed they are not using words that they have previously learnt.
Do they use gestures to communicate their needs? How do they communicate their wants and needs?
Do they appear to be in their own world?
You are not alone
These questions are by no means exhaustive and there are many more factors to consider. But it is important to trust your instincts as you are the expert on your child and know your child the best. Regardless of whether you see all of the above points or none, do not hesitate to have an assessment if you are concerned as, even if it turns out to be nothing to worry about, there is always at least one or two great pieces of advice I can offer you on the way and you will leave feeling hopeful and empowered. It’s always best to seek early intervention with communication difficulties. This allows strategies and support to be put in place. Never feel alone, always speak 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.
Why is joint engagement important for communication development?
It has been well-documented that the development of joint attention is impaired in children who have social communication difficulties or autism. It is, in fact, this impairment which distinguishes children with ASD from children who have other developmental delays.
A lack of joint attention in very young children is an early sign of autism as it is a signal that there is a disruption in the motivation to connect socially with others. Since this is a crucial element, I thought I would outline what we mean by Joint Attention as supported by the research undertaken at Hanen.org.
In typically developing children, the ability to shift attention between a person and an object for the purposes of connecting socially or for requesting develops around the same time. However, for children with ASD, these components emerge one at a time and in a linear fashion. Children with ASD usually start with requesting something and later they may learn to share attention for social sharing. (see pattern below as a general guide).
As with typical development, there is variation in the order that these skills emerge but the following patterns of development is commonly seen:
Reaching, taking adult’s arm/hand or pointing to ask for something — but without looking at the adult
Gradually alternating looking between person and object of desire
Then learning to follow the point of another — which is responding to joint attention initiated by another
Directing attention to share interests — without looking at the adult: pointing to a truck on the road/ helicopter circling above
Then directing attention to share interest by alternating gaze shift between person and object — here the child is now initiating joint attention.
What is important to note is that in order to fulfil the criteria for true joint attention, the purpose of directing the attention of another person must be social in nature. In other words, it must not be exclusively to obtain a desirable object or event/action. True Joint Attention is seen verbally or non-verbally; we want to share a thought with another person and direct them to something we are interested or excited or spooked by.
For example: we can see an amazing firework display in the distance and we want to quickly direct our friend’s attention to this. In order to do this we might be tugging their sleeve/arm whilst pointing to the display in the distance, and perhaps we might add “wow look over there!” We are doing so simply to share an interest without obtaining anything, we are just being social with each other. So True Joint Attention is not just looking at what we want to have, then look at the person who can get this for us and then point to the item. We can say that this is the precursor to true joint attention, which is purely social in nature.
Because true joint attention is an essential precursor to typical language development, the absence of joint attention in children with ASD contributes to difficulties with language learning. Beuker, K., Rommelse, N., Donders, R. & Buitelaar, J. (2013).
The Hanen programme for Parent Child Interaction teaches parents of children with Social Communication Difficulties step by step how to enable their children to learn to pay attention to an object and the parent at the same time.
We learn how to enable a child to:
engage take turns
shift eye gaze between toy and adult
copy adult’s actions, gestures and then words
play with toys in different, new ways
interact and for longer periods of time
have fun whilst playing
If you would like to know more about the Hanen programme please get in touch. I look forward to exploring the topic with you and help guide you forward if this is something your child is struggling with.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
December is often presented as a time of perfect, reciprocal play. Children are supposed to be unwrapping toys, sharing, and engaging in imaginative scenarios with family. But for parents of young autistic children, this high-pressure, socially demanding period can often feel like a battleground.
If you’ve been told to interrupt your child’s stimming, push for eye contact, or force them to play ‘functionally’ with toys, it’s time to take a deep breath. Those traditional approaches are not only stressful—they often miss the point of your child’s communication.
As a neurodiversity-affirming Speech and Language Therapist, I want to encourage you this December: You are allowed to follow your child’s lead, validate his or her unique interests, and trust that his or her play and movement are profoundly meaningful.
1. Stimming: not a distraction, but a regulator 💡
Stimming is short for self-stimulatory behaviour and includes repetitive movements or sounds like hand flapping, humming, rocking, finger flicking, or repeating phrases (called echolalia).
For years, parents were incorrectly advised to block or eliminate these behaviours. The neurodiversity-affirming view tells us the exact opposite: Stimming is a vital and essential tool for your child’s self-regulation.
Think of stimming as an internal volume dial:
Too loud/overwhelmed: Your child may stim to reduce incoming sensory input (e.g., rocking to ground himself or herself in a busy room).
Too quiet/under-stimulated: Your child may stim to increase sensory input and focus (e.g., running back and forth to maintain alertness).
The shift: validate, don’t block
Instead of saying, ‘Stop flapping your hands’, try to understand the message behind the movement.
Observe: When does the stimming happen? Is it before a meltdown? When your child excited? When your child is bored?
Validate: Name the need, not just the behaviour. You might say, ‘I see your body needs to move fast right now. That helps you calm down!’
Co-regulate: If the stim is unsafe (e.g., head-banging), help your child find a safer, alternative stim that meets the same sensory need (e.g., pushing hard against a wall, squeezing a stress ball).
By validating your child’s need to regulate, you are building trust, reducing anxiety, and teaching him or her critical self-awareness.
2. Autistic play: Meaningful, even if it’s monologue
The traditional idea of ‘good play’ often involves turn-taking, pretending, and specific toy functions (e.g., pushing a train around a track). When an autistic child spends 30 minutes lining up cars, spinning their wheels, or scripting whole scenes from a favourite movie, it can often be dismissed as non-functional or repetitive.
In neurodiversity-affirming practice, we recognise that autistic play is authentic play. These activities are crucial for learning, deep focus, and imaginative development.
Lining up toys may be an exploration of patterns, visual organisation, and order.
Spinning wheels may be a deep interest in cause-and-effect and visual sensory input.
Scripting is often a way to process language, regulate emotions, and practise complex social situations in a safe, controlled way.
Make a change: Join your child’s world, don’t drag them to yours.
Stop trying to force the ‘right’ way to play. Instead, try these neuro-affirming strategies:
Be a co-regulator, not a director: If your child is lining up cars, sit down next to him or her. Instead of moving a car, try handing him or her another car to line up. Focus on the shared interest rather than forcing interaction.
Narrate (don’t question): Avoid constantly asking, ‘What are you doing?’ or ‘What does this car say?’ This puts pressure on your child to perform. Instead, narrate your observations using his or her interest: ‘I see you made a long, straight line of red cars. Look at all the wheels spinning!’
Validate the interest: Show genuine appreciation for your child’s focus. ‘Wow, you know so much about how magnets stick together! That’s incredible.’
3. The communication revolution: Honouring gestalt language processing
Many young autistic children communicate in ways that don’t fit the traditional model of building language word-by-word. Many use Gestalt Language Processing (GLP).
A gestalt language processor learns language in chunks or scripts (e.g., ‘what’s-in-there?’ or ‘ready-go!’). These chunks (or gestalts) are not random; they are often tied to an emotional memory or meaning. Over time, the child breaks down these big chunks into individual words then learns to recombine those words creatively.
If your child repeats movie phrases or whole sentences that seem unrelated, he or she is likely a gestalt language processor!
Affirm the script, then model something useful.
Affirm the script: When your child says a script, respond to the meaning or emotion behind it, not the literal words. If he or she says, ‘We’re going to need a bigger boat’, and he or she is looking at a messy toy pile, he or she may be trying to express overwhelm or a need for help. You can affirm: ‘That pile is too big! I can help you move it.’
Model new ‘mix and match’ scripts: To help your child move from whole scripts to single words, you can model shorter, slightly changed versions of the script, also called ‘mitigated gestalts’. If they say, ‘I want to go home now’, you might model, ‘Let’s go home, now’ or ‘I wanna go home’.
By honouring your child’s communication style, you validate his or her experience and naturally support his or her path to language development—a core part of neurodiversity-affirming SLT.
Your December gift to your little one:
This December, stop trying to make your child fit into a neurotypical box. Instead, make your home a safe space where he or she can be his or her authentic selves.
Prioritise regulation and connection over compliance.
Trust that when your child is regulated, his or her communication, learning, and engagement will flourish naturally. This is the true gift of neurodiversity-affirming 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.
Have you ever thought about how difficult it can be to produce certain speech sounds? Some sounds are definitely trickier than others. This is especially true for children with speech sound disorders like Childhood Apraxia of Speech (CAS).
My student with CAS has been working hard on producing the /L/ sound especially when it was followed by an /O/ or /OO/ like, ‘log’ or ‘look’. We’ve practised lots and now that he’s got a good handle on /L/, he’s started replacing another difficult sound, /Y/, with it. So, ‘yes’ becomes ‘less’ and ‘yuck’ becomes ‘luck.’
This is a common pattern in speech development. Once a child masters a new sound, they may start using it in place of other sounds they find even more challenging.
Minimal Pair therapy
I use different evidence-based methods to help my students. And I often like to start out with phonemic awareness and then I move to contrasting the error sound with another sound to make completely different words. This approach is called ‘minimal pair’ therapy: both words are the same except for the initial/final sound which has the error sound, and this is contrasted with the correct sound.
Below is an example of this:
After we have worked on sound awareness, listening and becoming aware of small units of sound matter, then we can move to working on tongue placement and movement.
Tongue placement and movement to produce correct /L/ and /Y/ sounds
To produce these sounds correctly, the tongue needs to be in specific positions and make specific movements.
/L/ sound:
Tip of the tongue touches the alveolar ridge (the bony ridge behind your upper teeth)
Sides of the tongue are raised to the sides of the upper teeth
Airflow escapes through the sides of the tongue
/Y/ sound:
Tip of the tongue touches the roof of the mouth behind the alveolar ridge
Sides of the tongue are raised to the sides of the upper teeth
Airflow escapes through the centre of the mouth
I also use:
Auditory bombardment: Auditory bombardment is a technique that involves repeatedly listening to a target sound. This can help children to develop a better understanding of the sound and how to produce it.
Visual cues: Visual cues can be helpful for children who are having difficulty producing a particular sound. Here I use the image of a ‘standing tongue’ versus a ‘sitting tongue’.
Physical cues: I use my hands to show a ‘standing tongue’ for the /L/ versus a ‘sitting tongue’ for the /Y/. But what worked even better and sadly I don’t have the video clip for it:
Semantic cues: For example a picture of an ‘EAR’ to make the sound /Y/ so we shape the sound /EA/ to /Y/.
Parent involvement: Parents play an important role in their child’s speech sound development by providing opportunities for them to practise their speech sounds at home. This can be done through activities such as reading books, singing songs, and playing games.
Reinforcement: It is important to praise children for their efforts, even if they are not perfect. This will help them to feel motivated to keep practising. Important here for speech correction is concrete reinforcement: I feed back to my student what exactly they were doing correctly with their tongue or lips. Rather than saying ‘well done’, I mention what my student has just done with the tongue to change the sound: ‘I saw you lowered your tongue! That made a good /Y/’.
Another great way of reinforcing positively is to ask the student how they feel they have done? For the older ones I often ask them to self-rate their sound production out of 10. Then we can work towards the next incremental number upwards. This is very effective and gives the student control over their own work.
Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice
The London Speech and Feeding Practice
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
Feeding therapy is a specialised form of therapy and support that helps children develop healthy eating habits and overcome challenges related to food. It’s often used for children with picky eating, feeding disorders, or sensory processing issues.
What is feeding therapy?
Feeding therapy involves a series of techniques designed to improve a child’s eating skills and attitudes towards food. In the UK it’s typically provided by speech and language therapists and dietitians. These professionals work closely with parents and caregivers to create a personalised treatment plan tailored to each child’s unique needs.
How does feeding therapy work?
Feeding therapy sessions are typically 30–60 minutes long and involve a variety of techniques, including:
Family counselling: Providing support and guidance to parents and caregivers. This can help address any practical, behavioural and emotional issues that may be impacting the child’s eating.
Play-based activities: Engaging children in fun activities while introducing new foods or textures. This can help alleviate anxiety and make mealtimes more enjoyable.
Sensory exploration: Helping children become more comfortable with different tastes, smells, and textures. This can be achieved through activities like touching, smelling, and tasting various foods.
Oral motor exercises: Improving chewing, swallowing, and lip coordination. These exercises can help children develop the necessary skills for eating independently.
Behavioural techniques: Using positive reinforcement to encourage healthy eating habits. This can involve rewarding children for trying new foods or eating a variety of meals.
When is feeding therapy needed?
Feeding therapy may be beneficial for children who:
Are picky eaters: Refuse to eat a variety of foods or have strong preferences.
Have feeding disorders: Experience difficulties with eating, such as swallowing or chewing.
Have sensory processing issues: Are sensitive to certain textures, smells, or tastes.
Have medical conditions: Such as autism, cerebral palsy, or gastrointestinal disorders.
Feeding therapy strategies you can try at home
While professional feeding therapy can be invaluable, there are several techniques you can try at home to support your child’s eating development:
Create a positive mealtime environment: Make mealtimes enjoyable and stress-free by avoiding distractions, limiting screen time, and creating a calm atmosphere.
Create regular mealtimes and mealtime routines: Introduce set ways of announcing meal times, including songs or short nursery rhymes, try and involve your child with table setting, even just carrying their spoon to the table and putting the beaker next to the plate and ensure that meal time finishes after about 30 minutes, again with a set routine so that the child always knows: this is how we do it in our home, now I am finished and meal time is over.
Introduce new foods gradually: Start with small amounts and gradually increase exposure. This can help reduce anxiety and make new foods less overwhelming.
Model healthy eating: Show your child how to enjoy a variety of foods by eating a balanced diet yourself.
Avoid forcing food: Allow your child to choose and explore foods at their own pace. Forcing them to eat can create negative associations with food.
Seek professional help
If you’re concerned about your child’s eating habits, consult with a feeding therapist. We can provide guidance and support.
Remember, feeding therapy is a collaborative process between parents, caregivers, and professionals. With patience, understanding, and the right strategies, you can help your child develop healthy eating habits and enjoy meals.
Would you like to know more about specific techniques or have any other questions about feeding therapy?
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.
Intensive Interaction is an approach that I might suggest for your child. Here is an overview of this approach to increase your knowledge. There are a range of approaches that overlap and having trained in them all I use them all interchangeably to tailor to each child individually. This approach is particularly good for children who work mostly to their own agenda and find it hard to engage with others.
So, what is Intensive Interaction?
According to its founder, Hewett (1980), the approach “involves mirroring a person’s actions, sounds and facial expressions.” This allows your child to recognise and form communication between themselves and another, in a fun, play-based setting. Attention and listening are the fundamentals to speech and language development. By using the Intensive Interaction approach, we can increase the time your child can attend for and with another person. We are working towards a child enjoying another person’s presence. We are hoping to make gains with playing together with a child, taking turns and achieving reciprocity. That is the platform which we need to start with to build communication, language, words and perhaps even speech.
There are many aspects that this approach supports:
such as using facial expressions
being in the presence of other people
having a shared space
attending to others
recognising and using non-verbal behaviours (e.g., gestures)
making sounds/noises (vocalisations) that have meaning
and eye contact. Although, we must be careful when suggesting ‘improving’ the use of eye contact. For some individuals making eye contact can be physically painful. So be aware that we are not making our children ‘look’ we are encouraging their natural behaviour.
Who benefits from Intensive Interaction?
Children with more complex communication and learning delay can benefit from the Intensive Interaction approach. Each session can be adapted to the needs of the individual and the sessions can be designed to use the whole or part of the approach. It is especially useful for children who are finding it hard to engage in any way socially with another person. Autistic children who tend to work to their own agenda often benefit from this approach.
How is Intensive Interaction implemented?
You need to have an environment that your child is comfortable in, and to be able to come down to their level so that you can see each other. This is why I often visit children in their own homes to ensure that they are comfortable and that they can withdraw for periods of time if they need to as well.
Ensure your child knows you’re there and you are 100% present. This is very important. I would recommend that you put your phone away for some 10 minutes or so and give your undivided attention to your child for that period of time.
Waiting
Waiting is very important: we need to give your child time to process what is happening around them. After waiting for a response, you might want to start copying any gestures they use, any facial expressions they make, or perhaps imitate any sounds. You’ll want to continue with this for a few minutes to see if the communication between you and your child changes. Remember always take the cues from your child; if they communicate a message with you, respond. It might be that they are ready to finish and that they’ve shown this by walking away or signing.
Giving your child a way to respond is vital. We can use visuals to support their communication. We can create ‘yes’ and ‘no’ symbols so they can use them in a functional way.
A top tip in these sessions is to use mirrors, so that your child can see and begin to recognise their own facial expressions.
Now you know a bit about Intensive Interaction, why not book a call to discuss how we can support your Autistic child’s communication using this evidence-based approach.
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.
Communication is a fundamental human right, a bridge that connects us to the world and each other. For many, spoken language is the primary mode, but for individuals with complex communication needs, Augmentative and Alternative Communication (AAC) offers a powerful pathway to expression and connection. This guide will demystify AAC, highlight the crucial role of modelling, and provide practical examples of how low-tech AAC can be seamlessly integrated into everyday activities.
What is AAC in a nutshell?
AAC encompasses a wide range of tools and strategies that supplement or replace spoken language. It’s not about replacing speech, but rather about providing additional ways for individuals to communicate effectively. Think of it as a spectrum:
Unaided AAC: This involves using only your body, such as gestures, facial expressions, body language, and sign language.
Aided AAC: This involves external tools or devices. These can range from low-tech options like picture boards and communication books to high-tech speech-generating devices (SGDs) and apps on tablets.
The beauty of AAC lies in its flexibility and personalisation. It empowers individuals to express their wants, needs, thoughts, and feelings, fostering independence and participation in all aspects of life.
Modelling is KEY: Showing, not just telling
Imagine trying to learn a new language without ever hearing it spoken. It would be incredibly difficult, right? The same principle applies to AAC. Modelling is the single most important strategy for teaching and supporting AAC users. It means actively using the AAC system yourself while talking, demonstrating how to navigate the system and express messages.
Here’s why modelling is so vital:
It’s how we learn language: Typically developing children learn language by hearing it constantly around them. AAC users need the same immersion.
It reduces pressure: When you model, you’re not asking the individual to communicate, you’re just showing them how it’s done. This takes the pressure off and makes learning more enjoyable.
It expands vocabulary and concepts: By modelling a variety of words and phrases, you introduce new vocabulary and demonstrate how to combine symbols to create more complex messages.
It demonstrates purpose: Modelling shows that AAC is a functional and effective way to communicate, not just a set of pictures.
So, how do you model? It’s simple: point to the symbols on the communication board or device as you speak the words. For example, if you say, ‘Time to eat breakfast,’ you might point to ‘time’, ‘eat’, and ‘breakfast’ on the board.
Low-tech AAC in action: Everyday activities
Low-tech AAC, such as communication boards, books, or single-page displays, is incredibly versatile and can be easily incorporated into daily routines. These can be as simple as printed pages with symbols, laminated for durability.
Let’s explore how low-tech AAC can be used throughout a typical day, with examples of symbols:
1. Getting ready for nursery
Mornings can be busy, but they also offer rich communication opportunities. A ‘Getting Ready’ communication board can help sequence activities and offer choices.
Activity example:
‘Time to get up!’ (point to GET UP). ‘What do you want to wear today, the blue shirt or the red shirt?’ (point to GET DRESSED) ‘Then, we brush teeth’ (point to TOOTHBRUSH) and so on.
2. Breakfast Time
Mealtimes are perfect for making choices, expressing preferences, and commenting. A ‘Breakfast’ communication board can focus on food items, actions, and social comments.
Example symbols:
Activity example:
‘What do you want to eat for breakfast?’ (point to EAT). ‘Do you want cereal or toast?’ (point to CEREAL or TOAST). If they finish their milk, you could say, ‘Are you ALL DONE or do you want MORE MILK?’ (point to symbols).
3. Catching the Bus
Even routine transitions like catching the bus can be communication rich. A small, portable ‘Travel’ board can be useful.
Example symbols:
3. Being on the playground
The playground is a dynamic environment perfect for commenting, requesting actions, and engaging in social play.
Activity example:
‘Let’s PLAY!’ (point to PLAY). ‘Do you want to go on the SWING or the SLIDE?’ (point to symbols). If they are on the swing, you can say, ‘Do you want to go FAST or SLOW?’ (point to symbols) and ‘Push AGAIN!’ (point to PUSH) You can also model social language like ‘It’s MY TURN.’
Beyond the symbols: Key takeaways
Consistency is key: Use AAC consistently across all environments and with all communication partners.
Be patient: Learning a new language takes time. Celebrate small successes.
Make it fun: Integrate AAC into play and enjoyable activities.
Follow the individual’s lead: Respond to all communication attempts, even if they are imperfect.
In the video below I model how to integrate AAC into everyday activities with a few more examples and I discuss the difference between AAC and PECS.
If you need some inspiration with using AAC or would like your child assessed for the right type of AAC then please get in touch.
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of The London Speech and Feeding Practice.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
