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

ByLondon Speech and Feeding
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Unlocking playtime: A guide to child-led learning

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

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

Why Child-Led Play Works:

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

How to Implement Child-Led Play:

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

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

#OWLing #hanenmorethanwords

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

You will likely see:

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

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

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

Using AAC coreboard
Photo by lemonlenz

A Winning Combination

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

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

Practical Tips

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

Example:

Photo by lemonlenz

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

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

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

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

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

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

Sonja McGeachie

Early Intervention Speech and Language Therapist

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

The London Speech and Feeding Practice

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

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    Hard munchables: Chewing through the weaning journey

    ByLondon Speech and Feeding

    As a Speech and Language Therapist with a specialism in paediatric feeding, I’m constantly looking for ways to support families in developing their little ones’ oral motor skills and fostering a positive relationship with food. While Baby-Led Weaning (BLW) has revolutionised how many families introduce solids, (see my previous blog in July 25) a concept that often sparks discussion and curiosity is the use of ‘hard munchables.’

    Image by Freepik

    What are hard munchables?

    The term ‘hard munchables’ refers to specific types of firm non-digestible food items that are offered to babies for oral exploration and skill development, not for nutrition. These are typically foods that babies cannot bite off or swallow in large pieces due to their texture, but which provide resistance for chewing practice.

    The phrase was coined by Marsha Dunn Klein, M.Ed., OTR/L, Occupational Therapist and feeding therapist. Well known for her work in paediatric feeding she introduced and advocated for the concept of hard munchables as part of a therapeutic feeding approach, particularly for infants learning to manage textures and develop crucial oral motor skills.

    Common examples of hard munchables include:

    • Large, raw carrot sticks: Too hard to bite through, but great for gnawing.
    • Celery sticks: Like carrots, offering firm resistance.
    • Large, raw apple slices (peeled chunks): A firm, slightly sweet option.
    • A firm, uncut pear core: With the seeds removed.
    • Dried mango cheeks (hard, unsweetened varieties): These offer a fibrous texture.
    • A large, fully cooked but firm piece of meat (like a steak bone with some meat attached): The meat provides flavour and a bit of shreddable texture, while the bone is for gnawing.
    • Hard crusts of bread or breadsticks (very firm, without soft inner crumb): These can soften slightly with saliva but offer significant resistance.
    Image by Freepik

    It’s crucial to emphasise that hard munchables are not for consumption or nutrition. They are tools for oral motor development and should always be offered under strict, active supervision.

    How do hard munchables fit into weaning?

    While weaning (traditional or Baby-Led Weaning) introduces solid foods that a baby can eventually bite and swallow, hard munchables are complementary to the weaning phase. They enhance that phase by helping a child to develop hand dexterity, hand to mouth movement, and oral development.

    It’s important to differentiate: Weaning provides the digestible food for eating, while hard munchables provide the tool for skill practice. They are not substitutes for each other but can be used together under careful guidance.

    Pros and cons from a speech therapy perspective

    As an SLT, I see both the potential benefits and the necessary precautions when incorporating hard munchables.

    Pros:

    • Enhanced oral motor development: Hard munchables provide excellent resistance training for the jaw, helping to develop the strength, endurance, and coordination needed for efficient chewing. This is foundational for moving beyond purées and very soft textures.
    • Promotes lateralisation of the tongue: The act of moving the hard item from side to side in the mouth encourages the tongue to move independently of the jaw, a crucial skill for managing food and for speech sound production.
    • Preparation for more complex textures: By strengthening the oral musculature and refining chewing patterns, hard munchables can help babies transition more smoothly to lumpy and mixed textures.
    • Sensory exploration: They offer rich sensory input (tactile, proprioceptive) that can be beneficial for oral mapping and awareness, especially for babies who might be orally sensitive.

    Cons:

    • Choking risk: While the intention is for the baby not to bite off pieces, there is always a risk. Small pieces can break off, or a baby might accidentally bite off a larger chunk than he or she can manage. Active, vigilant supervision is non-negotiable.
    • Not a replacement for digestible solids: It’s vital to remember that hard munchables are for practice, not nutrition. They should complement, not replace, the introduction of varied, digestible solid foods.
    • Not suitable for all babies: Babies with certain developmental delays, oral motor deficits, or medical conditions might not be appropriate candidates for hard munchables without highly specialised guidance. For instance, babies with an exaggerated gag reflex might find them overwhelming.

    Key Considerations for Parents

    Here are my top recommendations:

    1. Consult with a professional: Always discuss this with your Paediatric Feeding SLT first before you introduce hard munchables. We can assess your baby’s individual readiness and guide you on safe practices.
    2. Strict supervision: Never leave your baby unsupervised with a hard munchable, even for a second. Your full attention is required.
    3. Appropriate size: Ensure the item is large enough that the baby cannot fit the whole thing in their mouth. It should extend well beyond their fist.
    4. No biting off: The goal is gnawing and scraping, not biting off pieces. If your baby is consistently breaking off chunks, stop using them.
    5. Focus on skill, not consumption: Reiterate to yourself that this is for practice, not for eating.

    In conclusion, hard munchables, when used appropriately and under guidance, can be a very valuable tool to support oral motor development during the weaning journey. However, always be safe and consult with a specialist to ensure your little one develops his or her feeding skills effectively and joyfully.

    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.

    References:

    Rapley, G., & Murkett, T. (2008). Baby-Led Weaning: The Essential Guide to Introducing Solid Foods. Vermilion.

    Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for feeding development. Pro-Ed.

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  • · · ·

    The purpose and nature of a speech and language therapy assessment

    ByLondon Speech and Feeding

    If you have ever wondered what happens when you bring your child to a speech and language therapy assessment, then this blog will shed light on the ins and outs of it for you.

    At its heart, a speech and language therapy assessment is a systematic and thorough evaluation of your child’s communication or eating/swallowing abilities. It’s more than just asking a few questions. It is a carefully constructed process designed to identify strengths, pinpoint challenges, and ultimately pave the way for effective intervention.

    Establishing a detailed profile – a few bullet points:

    • Identification of communication and swallowing difficulties: I aim to determine if a communication or swallowing disorder exists. I will establish if the difficulty is a delay or a more complex disorder.
    • Diagnosis of the specific disorder/autism: The assessment delves deeper to pinpoint the specific type and nature of the difficulty. For instance, is your child’s language delay due to a specific learning disability, a developmental delay, or another underlying condition?
    • Knowing the aetiology or what is causing a difficulty is crucial for targeted intervention. And whilst we are on the topic let’s talk about an autism assessment: I am trained and experienced in assessing and diagnosing autism. However, when it comes to the diagnosis of autism I provide a preliminary ‘working hypothesis’ rather than giving a definite final diagnosis. The reason for this is that it is considered the ‘gold standard’ and ‘best practice’ to diagnose autism in a multi-disciplinary setting and context. Since I work on my own, I always refer to highly recommended multi-disciplinary clinics for the ultimate diagnostic assessment.
    • Determination of severity: Understanding the severity of the difficulty is essential for prioritising intervention and measuring progress. Is your child’s difficulty mild, moderate, or severe? This helps me choose a particular approach and then tailor it to suit each individual child.
    • Identification of underlying strengths and weaknesses: An assessment doesn’t just focus on what’s wrong. It also highlights your child’s strengths and areas of relative ease. This information is invaluable for building upon existing skills during therapy. Understanding weaknesses provides specific targets for intervention.
    • Guiding intervention planning: The assessment provides the crucial information I need to develop an individualised intervention plan. The findings directly inform the selection of therapy goals, strategies, and techniques. Without a thorough assessment, therapy would be a shot in the dark.

    A multi-faceted approach

    A speech and language therapy assessment is not a ‘one-size-fits-all’ procedure. The specific tools and techniques used will vary depending on a child’s age, the nature of the suspected difficulty, and other relevant factors. However, most comprehensive assessments incorporate several key components:

    • Case history: This involves gathering information about your child’s developmental, medical, social, and educational background. We will go through all the relevant milestones and throughout the process I will make notes which will help bring all the puzzle pieces together.
    • Observation: I will observe how parent and child play together and we also look at how the child plays by themselves. Additionally of interest is how a child plays with me, the therapist. Through discussion I will also endeavour to find out how your child plays with other children, be it at the nursery or within the family.
    • Standardised assessments: These are commercially available tests with specific administration and scoring procedures. They provide norm-referenced data, allowing to compare the individual child’s performance to that of his or her peers. Examples include articulation tests, language comprehension and production tests, and fluency assessments. I tend not to use these assessments a lot.
    • Instead, I use non-standardised assessments: These are more flexible and allow to probe specific areas of concern in more detail. This might include language samples (analysing spontaneous speech), dynamic assessment (testing and teaching to identify learning potential), and informal observation of play or interaction.
    • Immediate feedback and report writing: During and thenfollowing the assessment, I will bring all the gathered information together and I will discuss with the parents what my findings are and what my recommendations in the short term are. Parents always go home with a good handful of useful strategies that they can implement at home right away. In addition, I provide a comprehensive report outlining the findings, diagnosis (if applicable), severity, strengths and weaknesses, and recommendations for intervention.

    In conclusion, a speech and language therapy assessment is a dynamic and essential process. It is a journey of discovery, aiming to understand a child and the child’s family and his or her unique communication or feeding profile. The assessment is usually the start of our wonderful learning journey together.

    Below is a short video clip of an assessment where you see me in action explaining a particular therapy approach to a set of parents. It perhaps shows a tiny bit of how relaxed we are in our sessions and that assessment is not at all daunting, but a hugely informative event overall which will leave you feeling empowered and hopeful.

    What happens after an assessment?

    Please feel free to get in touch with me via my contact form if you wish to have an assessment for your child’s communication difficulties or feeding difficulties.

    An assessment is always a stand-alone event and does not mean you need to automatically book follow up sessions at all. It will give a lot of information and based on this you can decide if you would like more therapy or follow up for you and your child. Many times ongoing therapy is not needed! I only recommend a course of therapy if it is really needed and where it would be immediately beneficial for your child.

    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.

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  • ·

    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.

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  • ·

    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.

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  • Attention Autism Therapy

    ByLondon Speech and Feeding
    Sonja is kneeling on a multicoloured carpet holding a bucket in one hand and a toy in the other
    Sonja

    “Attention Autism” is an Early Years Intervention designed by Gina Davies, Specialist Speech and Language Therapist. Gina created this amazing therapy approach based on her many years of working with children on the autism spectrum. It aims to develop natural and spontaneous communication through the use of highly motivating activities. These activities offer your child an IRRESISTABLE INVITATION to engage and attend to.

    I love using this approach and have trained in all of the stages including the Curiosity Stage which is for another blog. I use it frequently with all children who have trouble attending, listening, sitting or waiting regardless of whether they are neuro-diverse or neuro-typical, this activity and method is so great for all children!!

    Why is it important for our children to attend and listen?

    It is commonly assumed that, as our child has passed their hearing tests he/she will be able to listen and respond to being called, being questioned or asked to do something. However, all children I see in my practice have reduced joint attention skills, which means that whilst their hearing is often good, even brilliant to the point that they can often hear a faint noise somewhere outside the house like a distant train rushing by – but strangely they can’t seem to hear their name being called. Parents often ask me why this is the case, why can my child not turn round when I call him?

    The reason lies in the difference between hearing and listening. Listening is a skill that needs to be learned and practiced. As a child develops, their hearing tunes into (listening) the sounds and noises they hear on a daily basis. This is how a child develops understanding of the speech sounds they hear every day (which then form the basis of their native language); they also get to know “their door bell, dog barking next door, daddy coming up the stairs” and so on. They tune into those common every day sounds and noises and gradually start to copy speech sounds to form words. So listening is tuning our ears to the sounds that surround us. In contrast, many of us have to work in large office spaces or noisy environment, perhaps even a café, etc, where we are able to tune out those environmental noises and sounds that surround us, for otherwise we will not get that report/piece of work done in time! Our focus means that we become single-minded and single-channelled concentrating on our work and so we do not hear people chat and clutter all around us.

    Tuning in and out is a skill that we learn and some of us are better than it that others, it comes largely with practice but also with motivation – I go back to the report that needs doing by end of the day – my motivation is strong and I can now focus and blend out all around me so that I get the work done. Other times when I am not so motivated I might doodle and tune into what is being said at the table next to me, because my focus is not that strongly dedicated to my work.

    Many children who are delayed in their development and especially children on the neuro-diverse continuum have difficulty with tuning in. By contrast, they are very good at being single-minded, single focused on what it is they are wanting/needing to do at any one point. And so they cannot listen to sounds, speech, noises around them very easily at all. They are fully absorbed in their activity and are not able to look and listen to mum/dad calling their name. Once we understand this we can start helping our children to practise tuning in a bit more bit by bit and day by day.

    Enter the Attention Autism approach!

    There are 4 stages to this method:

    Stage 1: The Bucket to Focus Attention

    The first stage involves filling a bucket with visually engaging toys that aim to help children learn how to focus their attention. Three toys will be presented to the child/group one at a time and the therapist will make simple comments about each toy to help introduce them to the children and expand their vocabulary.

    Important to know: the Attention Autism approach does not require the child to look at the adult, or to sustain eye-gaze on the objects. Instead engagement may be indicated by non-verbal signals such as seeming alert and interested, and looking frequently at the object.

    Stage 2: The Attention Builder

    At this stage the child/group is introduced to visually stimulating activities. This stage aims to build and sustain attention for a longer period of time. Activities may include ideas such as:

    • Flour castles which can be built like sandcastles, using flour, a bowl and moulds
    • Erupting volcano activity
    • Wriggly worms foam – pile shaving foam onto an upside down plastic flower pot with the holes taped over; then slowly press down another plastic flower pot over the shaving foam and the foam will come through the top holes looking like wriggly worms, especially if you have dropped a bit of food colouring on top of the foam

    Important: children are not required to make eye contact or sit still during these activities. The focus is on engagement, in whatever way the child demonstrates this.

    Stage 3: The Interactive Game – Turn-Taking and Shifting Attention

    The therapist demonstrates a simple engaging activity and invites children up to have a turn. This may be the same activity from stage 2 or something new. The aim is for children to learn to shift their attention from the group/sitting experience to doing something and then going back to sitting again.

    Stage 4: Individual Activity

    In the final stage of Attention Autism, the adult models an activity, and then each child is given the same equipment to use themselves. They do not have to copy exactly what the adult modelled. The aim is for the child watching to have a go independently with confidence, and then to take their materials back to the leading adult at the end. The activity should be engaging and enjoyable for the children. The Attention Autism approach aims to foster an interest in learning new things and to inspire communication in whatever form works for the child.

    Ideally this should be practised 4-5 times a week aside from the therapy session. But I have seen it work with just 2-3 practice repeats per week. It can be tough in the beginning until your child gets used to the “no touch just look” rule but with a little bit of practice usually children do sit well for the first part of the Bucket activity within about 10 sessions and after that you are on a roll!

    Do get in touch with me if you would like to find out more about this approach! Here is a great link to Gina Davis’s Autism Centre facebook site for more inspiration: https://facebook.com/ginadaviesautism/.

    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.

  • · · ·

    The quiet power: Why silence and responsiveness boost communication in children with delays

    ByLondon Speech and Feeding
    The quiet power: Why silence and responsiveness boost communication in children with delays
    Supplied by Sonja McGeachie, Practice Owner

    As parents and caregivers, our natural instinct when interacting with a child, especially one who struggles with communication, is often to fill every silence. We might ask lots of questions, offer constant commentary, or try to prompt him or her to speak. Our hearts are in the right place. We want to help him or her communicate! However, for children with language delays or those on the autism spectrum, this well-intentioned approach can sometimes inadvertently create more pressure and fewer opportunities for them to truly initiate and develop their own communication skills.

    What if I told you that one of the most powerful tools in your communication toolkit is often silence? And that responding to your child, rather than always initiating, can unlock incredible potential?

    Let’s explore why these seemingly simple strategies are so profoundly beneficial.

    The unspoken benefits of silence

    In our fast-paced world, silence can feel awkward, but for a child who is processing language differently, it’s a gift:

    1. Time to process: Children with language delays often need more time to process what they hear and to formulate their own thoughts or responses. When we bombard them with words, we don’t give their brains the crucial milliseconds they need to catch up. A pause of 5–10 seconds can make all the difference.
    2. Reduces pressure: Constant questioning or prompting can feel like a test. Silence removes this pressure, creating a more relaxed environment where the child feels safe to communicate without fear of being ‘wrong’ or rushed.
    3. Creates opportunity to initiate: If you’re always talking, when does your child get a turn to start the conversation? Silence opens up a space for him or her to initiate, whether it’s through a sound, a gesture, eye contact, or a word. This is vital for developing spontaneous communication.
    4. Encourages independent thinking: When a child is given space, he or she is more likely to try to figure things out himself or herself. This fosters problem-solving skills and reduces reliance on adult prompts.
    5. Prevents overwhelm (especially for ASD): Many children on the autism spectrum can be sensitive to auditory input. A constant stream of language can be overwhelming, leading to withdrawal or challenging behaviours. Strategic pauses can help them regulate and engage more effectively.

    The power of responding (not just initiating)

    Think of a tennis match: if only one person serves, it’s not a game. Communication is a rally, a back-and-forth exchange. When you primarily respond to your child’s communication attempts, you’re teaching him or her the rhythm of conversation:

    1. Follow the child’s lead: This is a cornerstone of effective language intervention, famously championed by programs like Hanen’s ‘It Takes Two to Talk’. When you respond to what your child is already interested in or doing, the interaction becomes immediately relevant and motivating for him or her.
    2. Validates his or her attempts: Every sound, gesture, glance, or partial word your child offers is a communication attempt. By responding to it, you’re telling him or her, ‘I see you. I hear you. Your communication matters.’ This builds immense confidence and encourages him or her to try again.
    3. Builds confidence and motivation: When a child feels understood and successful in his or her communication, he or she are more likely to communicate more often. It’s a positive feedback loop.
    4. Teaches turn-taking naturally: By taking your turn after his or hers, you model the natural flow of conversation. He or she learns that communication is a shared activity, not a one-sided lecture.
    5. Makes interactions meaningful: When you respond to his or her interests, you’re talking about things that are inherently motivating to him or her. This makes the language you use more easily understood and remembered.

    Practical strategies for parents: Observe, Wait, Listen (OWL)

    The Hanen Centre’s ‘Observe, Wait, Listen’ (OWL) strategy perfectly encapsulates these principles:

    • Observe: Watch your child closely. What is he or she looking at? What is he or she doing? What sounds is he or she making? What gestures is he or she using?
    • Wait: After you’ve observed, wait. Give him or her time. Resist the urge to jump in with a question or comment immediately. Count to five (or even ten) in your head. This silence is an invitation for him or her to communicate.
    • Listen: When he or she does communicate (in any way!), listen intently. Try to understand his or her message or intent.

    Beyond OWL – More tips:

    • Reduce questions, increase comments: Instead of ‘What’s that?’ try ‘Oh, a big red ball!’ or ‘The car is going fast!’ Comments provide language models without demanding a verbal response.
    • Expand, don’t just prompt: If your child says ‘Car’, you could respond with ‘Yes, That’s a big car!’ or ‘It’s really fast!’ You’re building on his or her communication with a slightly richer language model.
    • Create opportunities for communication: Place desired items slightly out of reach. This creates a natural reason for your child to communicate his or her wants (e.g., reaching, pointing, vocalising).
    • Respond to all communication: Don’t just wait for words. If your child points, look where he or she is pointing and comment. If he or she makes a sound, imitate it or respond with a related word.

    In summary

    Embracing silence and prioritising responsiveness might feel counterintuitive at first, especially when you’re eager for your child to talk. However, these powerful strategies create a nurturing, low-pressure environment that encourages spontaneous communication, builds confidence, and truly meets your child where he or she is. By giving your child the space and the meaningful responses he or she needs, you’re laying a strong foundation for his or her communication journey.

    Try incorporating these ‘quiet powers’ into your daily interactions and watch your child’s communication blossom.

    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.

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