When you have a child who uses Gestalts it is often difficult to think and adapt clinic activities into those to use at home. More importantly, you find that individualising your activities for your child who uses Gestalt are time-consuming. But you value its importance for their communication development.
You feel so busy, you are taking them to other appointments, or trying to get through your daily activities, all whilst still ensuring your child’s emotional needs are met. You know life should not get in the way of your child’s therapy activities at home, but it does. We know your spare time is precious and limited, so let us achieve your child’s or young person’s goals in the allotted time you have which meets their way of learning (using Gestalts).
We wanted to support you by exploring items which you may have at home, and we will give you some key phrases which you can start to model with your child. Whereas our last blog introduced the idea of gestalt language processors, we are now developing ideas to give you the tools to implement activities at home. We recognise how overwhelming it may feel, and this is one of the reasons to make activities as straight forward as possible. Therapy does not need to be complicated; it just needs to be carried out on a regular basis.
Explore the samples I’ve created to give you an idea of how this might look but please consult with a Speech and Language Therapist who knows about Gestalt Language Processing so that you can work together to develop great home activities for your child.
Want to learn more about gestalt language processing?
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
As a speech and language therapist, I’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!
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.
We use powerful motor learning principles to help children with CAS (Childhood Apraxia of Speech) learn how to produce better, clearer speech sounds in words, phrases and sentences.
What are these principles?
Principle 1: MASSED PRACTICE
This is where you see a child for lots of sessions in a shorter period of time, so for instance six weeks of three times weekly for 30 minutes.
This leads to motor performance or automaticity.
Principle 2. DISTRIBUTED PRACTICE
This is what I use, as most of my clients are not able to come and see me that often on a weekly basis. It is hard to travel in London and life is hectic. So I favour one session a week over say a term or two terms and a session is usually 45 minutes long.
This leads to improved Motor Learning and good generalisation.
During either Massed or Distributed Practice, we choose between 4 variables:
Principle 3: Constant vs Variable
Principle 4: Blocked vs Random
To explain:
Constant Practice is where we repeat the practice of a small handful of target words.
We practise the same target sound in the same word position, e.g. at the beginning of a word: ‘bee’, ‘bye’, ‘bow’, ‘baa’ or ‘key’, ‘car’, ‘cow’, ‘Kaye’ etc.
We keep the rate, pitch and intonation constant.
Variable Practice is where we vary the rate, volume, pitch and intonation of the targets
We use a larger number of sounds, and words that are motivating to say for the child.
For example, if a child loves Peppa Pig then I might choose the words: ‘Peppa’, ‘Daddy Pig’, ‘George’, ‘Mummy Pig’ and a couple of other favourite characters. My child might struggle with a number of sound sequences there but we will target them one by one.
We can also select simpler words like ‘cape’ and ‘cake’ or ‘tick’ and ‘tip’.
Blocked Practice is where we practise one target word for say five minutes then we move to another target word for the next five minutes and then we revert back to the first target word again and so on, so blocks of practice.
RandomPractice means we practise several target words at the same time.
How do I decide on what to use?
Good question!
I always opt for distributed practice (weekly for up to 45 minutes).
Within that, I tend to find it most successful to start out with constant practice when a child is finding a certain sound sequence really hard and we need to just ‘nail it’. Bearing in mind I only pick sounds that my student can actually make in isolation, so we are not working on articulation! (where we focus on trying to elicit single sounds correctly – or even at all sometimes) Here in CAS work, we are working with sounds the student can make but is having trouble to add together, into a sequence that is needed to make a word sound right.
As soon as I feel we have some traction I will go to variable practice, i.e. I pick words that are either funny or interesting for the child and it can be a slightly larger number.
I tend to use blocked practice in the beginning or when working on vowels. That’s because it is more important we get our vowels right. They carry a word and are very important for overall speech intelligibility. Once we are on a roll, I tend to go more for random practice.
Example
Here in the video clip, we try and work the /e/ vowel in short words likes ‘bell’, ’fell’, ‘dell’, ‘sell’, ‘smell’ and I am using an AAC device to give a child’s voice as auditory feedback as well as using the PROMPT approach to help my student shape his vowels.
So this is:
Distributed (1 x week for 45 minutes)
Constant – we are practising the /e/ vowel in the same position in six different words
Blocked – we did this: several repetitions of each word and after the sixth we moved to another sound, and then later we came back to this.
Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.
Sonja McGeachie
Early Intervention Speech and Language Therapist
Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice
The London Speech and Feeding Practice
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
Feeding our child can be the most satisfying time of the day or it can be the worst, stressful and hardest thing to do. Parents usually contact a Feeding Therapist once things have become totally stressful and unmanageable as often parents feel that ‘it will get better’ and ‘let’s wait and see’. Whilst this is generally a good, relaxed way of thinking, when it comes to feeding, eating and drinking, it does not take much to completely put a child off a particular food or texture. Once refusal has set in and not been responded to in quite the right way then feeding rarely gets better without intervention and support.
What can have started as a physical, concrete problem can quickly develop or acquire a psychological and sensory aversion aspect as well. A child may have started out with an allergy to cow milk protein or gastro-oesophageal reflux for example or perhaps our child has an oral motor difficulty such as the tongue not rotating well, or lips not closing tightly enough around a bottle teat. Because those difficulties were not understood we now have a combination of both physical discomfort, oral weakness and sensory aversion making it a heady cocktail of feeding difficulty and refusal, which needs careful unpicking before each issue can be addressed sensitively and effectively.
A dyad
We call the relationship between the feeder and the child a dyad: both individuals play their part and both need ‘to work together’ to ensure meal times are happy events. The parent/feeder is responsible for offering and providing the meal and the child is ‘responsible’ for taking the food, spoon or drink and swallowing it.
Formation
For the past few years Speech and Language Therapist Students in the UK have received basic feeding/swallowing training as part of their undergraduate degree courses. However, relatively few SLTs in the UK end up specialising in this area and take further professional courses to develop this area of specialist knowledge and input. To be sure that an SLT is able to work in the complex field of eating, drinking and swallowing they must undertake further training and complete increasing levels of competency in this field. This is something to bear in mind for parents when looking for a suitable feeding therapist for their child.
Important to know
Parents are not alone. Many families are experiencing the same difficulty and there is help available both in the NHS and in the private sector.
Children’s feeding can be improved greatly and the best approach is a joint team centred around the child between the parents, the dietician, medical and therapy professionals.
By working closely together we can build confidence and skill and find ways of making mealtimes enjoyable and free of stress.
What happens in my feeding clinic
Parents feed their child and I coach them, model strategies, and support the feeding process.
I provide information on their child’s developmental skill level, oral motor skill. I advise on appropriate food consistencies, optimal positioning. We talk about self-feeding and parent feeding. And we look at strategies during feeding that will improve feeding skills.
I can help with mealtime planning and scheduling. And we decide together on when to practise what type of strategy.
We create our meal goals together based on what is important to the families.
Parents are invited to videotape strategies and advice I give to serve as reminders for home practice.
I offer episodes of follow-up which sometimes can be online. Or parents can bring their child back to the clinic for another mealtime and practice of certain strategies, to follow on from our current status, and take things forward gently and steadily.
If I can be of help with your child’s feeding journey, please get in touch on via my contact form.
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.
One of my favourite pieces of advice I give to parents is the ‘4 S’, a strategy coined by the Hanen Program® which I teach, particularly the ‘More than Words’ programme which is designed for and aimed at parents of children with Social Communication Difficulties or Autism. It is honestly one of those golden nuggets that I use myself in my practice and I highly recommend it to all my parents. There is something about terms like the ‘4 S’ that is easy to recall and therefore use.
Introduction
The ‘4 S’ is a strategy that helps to clarify the words we use with our children so that they can notice us, hear us and understand what we are saying.
Research shows that we use on average 120-200 words per minute during everyday conversation. That’s a lot! And our children who are still learning to communicate are often bombarded with endless speech coming at them all day long. If we take into account that many of our students are Gestalt Language Processors, we can see that picking out relevant chunks of what we are saying is not at all easy, and this contributes to our children’s delays.
So let’s look at the ‘4 S’
1. The first one is SAY LESS
This means we should use shorter, simpler sentences with good grammar, for example, something like: ‘let’s get ready, time to put our shoes on’ instead of what we might be saying: ‘come on then darling, let’s put your shoes on we need to get going it’s dark outside’ or similar.
Good grammar helps to give clues about what words mean and how they are used in sentences. So, instead of ‘shoes on’ say ‘let’s put our shoes on’.
2. The second one is STRESS
I hear you think ‘I am stressed!‘. – NO! here it means ‘highlight’. We use our voice to highlight the important words in our sentence or phrase. For example, when you say ‘this banana is so yummy’ you can stress the word ‘yummy’ by saying it a bit louder and you can make a gesture, like rubbing your tummy as you say it.
3. The third one is GO SLOW
This means to speak a bit slower than you normally would and add pauses. By slowing down the pace of our speaking we give our child time to think and understand what we are saying. When we allow for pauses after we have spoken, we are inviting our child to say something in response.
4. The last one is SHOW
Always remember to show actions, gestures, objects, and point to pictures while speaking to help support your child’s understanding. We can show our child what words mean by pointing to things or holding up objects whilst describing or talking about them.
At this point I would also like to recommend the use of Core Boards, and particularly Electronic AAC devices, such as LAMP Words for Life or PODD. I have written about this in other blogs but can always be persuaded to say a bit more on the matter… 😊 It is such a big help to have an AAC talker available for both the child and the adult so we can find words and pictures to help support the words we are saying.
For example, today when reading a book like The Hungry Caterpillar (so good!) I used my LAMP AAC talker to make comments as we were looking at the pages together with my student. Example: ‘Look! He is eating more cake he is very hungry’ using my AAC talker I was able to supplement my speech and at the same time I was inviting my minimally speaking child to press a button or two and reply with ‘cake!’ which they would not have said with their mouth otherwise.
5. It does say ‘4 S’ but really it should be ‘5’ except the fifth is not an ‘S’
The fifth is REPEAT.
Repeat words and phrases often throughout the day. When learning a language we all need to hear words and phrases several times and in different situations before we can understand, remember, and then eventually use them. Our children are ‘new language learners’ and so we can apply the same principles that we would when learning a new foreign language ourselves.
Any questions or need help with supporting your little one’s language please contact me via my contact form, or you could also check out www.hanen.org for advice and lots of inspiration.
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.
There are various great ways to treat speech sound disorders and I use all the approaches available selectively; I decide what works with each individual child and I also vary the approach depending on the child’s frame of mind at any given time during my session.
Some of the approaches are more “drill-based” and require a child to be able to pay attention and really participate actively in the therapy, and this is what I am showing you today with this video clip.
My little student here has been working with me for some time and from only saying a handful of words which were not very easy to understand he has come a long way. He does have some features of Verbal Dyspraxia which I shall briefly outline here:
Making sounds in general is a struggle, especially when asked to copy certain sounds, example: ‘can you say: a ee ou oo?”
Repeating sound sequences or words sequences is hard, for example: “say p-t-k in sequence” or “say fish chips fish chips fish chips
When saying the same word again and again, different mistakes can be heard
Intonation difficulties: speech sounds monotonous
Vocabulary is very limited
Some therapy approaches are more play based, for example the Core Word method: here we pick a few words at a time which are very significant to the child and therefore highly motivating to try and say. These could be characters of Pokemon or Minecraft for example, or simple words like “GO!”
When you watch the video you will see that I use a lot of visual prompting, such as showing him where the tongue is moving to or from. I do this with my index finger and this approach is called Tactile Cueing or “Cued Articulation”. Part of the approach is to give a visual prompt and then reduce the prompt as the learner is more able to produce the correct sounds. Once he can produce the sound on its own, we quickly move to the sound within a word.
I do mix and match my approaches and in fact here I am drilling but I also use the Core Word which for him (YELLOW) — it’s his favourite colour and I happen to have quite a few good games where a YELLOW something or other can be asked for….. WHO KNEW!? 🙂
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.
Sometimes our kids find it hard to listen to sounds in words and hearing the difference between sounds. This is an important skill which we call “sound awareness”. A lack of it can really impact on clear speech sounds production.
Your child might be confusing similar sounding words. Or they might not notice that a TAT is not a CAT for a DOD is not a DOG. Often children with speech sound disorders or difficulties don’t tune into individual sounds or even syllables. Grow your knowledge to support your child.
Read our latest blog on hearing the difference between sounds to develop speech sound production.
Practice makes perfect
There is a lot more to speech sound production than first meets the eye. Did you know that producing the correct speech sound at sentence level is the last piece to the communication puzzle? There’s a lot of practice before your child develops this last stage of speaking clearly. Your Speech and Language Therapist will start by determining if your child can hear the difference between the sound they are producing and the correct sound. So if your child says LIT instead of LICK we might contrast those two words by perhaps using a candle and a lollypop. Each time he/she says LICK they get to have a lick (or 3) on the lolly. But if they say LIT then we light up and blow out a candle. This way your child can see that there is a difference between those words and that the sounds we make actually matter. Fancy that!!
We call this auditory awareness, which is essentially hearing the sounds in words. Don’t be surprised if you hear your child’s therapist model the sound a lot. This is to develop their awareness. The more your child hears a sound, the easier they will find production. Furthermore, your Speech and Language Therapist will work on phonemic awareness (sound structures) such as the difference between a sound (e.g. sh, is one sound) vs a syllable (e.g., shell has one syllable) vs total number of sounds in a word (shell has three sounds sh-e-ll ), like you can see in my little video clip.
Once a child is able to produce a sound on its own and they can hear and identify how a short word is said correctly we can go and repeat lots of similar words with the sound at the beginning or end until it becomes automatic and new neuro pathways are laid in the child’s brain. From there we branch out into short phrases and then eventually sentences.
Six tips to practise auditory discrimination for speech sound production
Sit opposite your child so they can see your mouth or or sit next to the child and place a mirror in front of you so they can see and hear your production.
Make it fun! Once they’ve identified the sounds in the word, play part of a game (e.g., pop up pirate, Jenga, something which allows plenty of turns).
Use car journeys or walking to school to practise (e.g., oh I see a sheep, sh-ee-p, sh-ee-p has three sounds. Can you spot something beginning with /sh/?)
Remember that spellings can differ (e.g., ‘chef’ and ‘shed’ both have the same initial sound).
Talk about what you’re doing with your mouth (e.g., my lips are rounded for /sh/). Your Speech and Language Therapist will be able to support you with this.
Make silly sentences using your child’s special sound (e.g., Sheep show shepherds shearing).
At this stage you are not expecting your child to produce the sound. This is why it’s important that they continually hear an excellent model. If your child attempts speech sound production at any stage, this is to be encouraged as it’s a great opportunity to model the correct version.
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.
