How can I incorporate AAC into my speech therapy sessions?

ByLondon Speech and Feeding
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Many parents are surprised when I bring AAC into a session, especially if they’ve come to see me primarily for speech sound work.

They might wonder: ‘If we’re working on pronunciation, why are we using a communication device?’

The simple answer is this: speech therapy is about communication first, and speech sounds second. Supporting a child’s ability to express themselves clearly and confidently is always the priority, and AAC can be a powerful tool alongside spoken speech.

What do we mean by AAC?

AAC stands for Augmentative and Alternative Communication.

This can include:

  • A speech-generating device (such as LAMP Words for Life or GRID as I used in the photo below)
  • A communication app on a tablet
  • A symbol board or communication book
  • Gestures, signs, or visual supports

AAC does not replace speech. Instead, it supports language development, reduces frustration, and builds communication success while speech skills are developing.

Pretend Play using Speech and AAC in my clinic room

But I mainly work on speech sounds… So how does AAC fit?

Most of the children I see are working on:

  • Articulation difficulties
  • Phonological delay
  • Motor planning challenges (including apraxia/dyspraxia)
  • Unclear speech affecting confidence

For these children, AAC isn’t a separate therapy. It’s simply woven naturally into what we are already doing.

If a child brings their device to sessions, I actively include it. If they don’t yet use AAC but could benefit from visual or symbolic support, I may introduce simple options within activities.

Using AAC to support speech practice

Let’s say we are working on early speech targets like: ‘GO’.

We might practise:

  • Saying the word verbally
  • Listening for the target sound
  • Using play (TOY TRAIN GOING ROUND A TRACK)

Now we can extend this using AAC.

On the device or communication board, we might model: ‘LET’S GO’ or ‘IT’s GOING up the hill’.

This allows the child to:

  • Practise their speech sound target
  • Build a simple sentence
  • Experience successful communication even if speech is not fully clear yet

All responses are valid and supported.

AAC helps children communicate more than they can say

Many children can understand and think in longer phrases than they can physically say.

For example:

  • A child who verbally says single words may build longer phrases on AAC.
  • A child who struggles to plan speech movements may use AAC to communicate smoothly while still practising verbal attempts.
  • A child who becomes frustrated when misunderstood gains a reliable backup system.

Rather than slowing speech progress, AAC often:

  • Reduces communication pressure
  • Increases participation in therapy
  • Encourages more attempts at speech
  • Supports language growth

When children feel understood, they usually become more motivated to try speaking.

There are no ‘prerequisites’ for AAC

One of the biggest myths I hear is: ‘My child isn’t ready for AAC yet.’

In reality, children do not need to:

  • Reach a certain speech level
  • Use pictures first
  • Prove they understand everything
  • Show immediate interest

Instead, we presume competence and introduce AAC in meaningful, playful ways.

That means:

  • Modelling words while blowing bubbles
  • Commenting during playdough activities
  • Choosing words during games
  • Building simple phrases in shared reading

AAC should never feel like extra ‘work’. It’s simply another way to join in communication.

My goal is always the same: to help each child communicate as clearly, confidently, and successfully as possible, using every helpful tool available.

If your child uses AAC (or might benefit from it)

 Please feel free to:

  • Bring the device to sessions
  • Show me how your child currently uses it
  • Share advice from school or other therapists

I am very happy to incorporate AAC into our work together so that speech practice, language development, and real communication all move forward hand-in-hand. Because ultimately, therapy isn’t just about producing perfect sounds. It’s about helping your child be heard and understood.

If you’d like support or advice, please contact me and I can help guide the next steps.

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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      Three-syllable words made fun: How I use play to build speech skills

      ByLondon Speech and Feeding

      Why spend time on syllables?

      Sounds have to be organised into syllables, words and phrases. A child needs to coordinate these parts to produce longer words successfully.

      This can be particularly relevant for children who:

      • leave out parts of longer words
      • simplify multisyllabic words
      • have reduced speech intelligibility
      • have phonological difficulties
      • have difficulty remembering or organising the sound sequence in a word
      • have suspected or diagnosed Childhood Apraxia of Speech (CAS)
      • find longer or more complex words particularly difficult.

      For children with speech sound disorders, phonological awareness is important because speech sound development and awareness of the sound structure of words are connected areas of development.

      When creating new habits, new motor plans,new anything repetition is important!

      But the way we get to that repetition can be playful and creative.

      Today I give you a little window into one of my recent speech therapy sessions. I was working on three-syllable words, words such as ladybird, butterfly and other longer words that contain three ‘beats’.

      I used five very simple activities:

      • playdough
      • two different versions of Snap
      • an online activity
      • stickers.

      None of these activities are complicated or expensive. What matters is how the activity is being used and what the child is practising within it.

      Video examples

      Here are five little clips from the session so you can see what I mean.

      Squashing the syllables with playdough

      In my first clip, you can see me using three blobs of playdough with picture cards.

      The child places or squashes one blob onto each part of the word.

      For example:

      LA – DY – BIRD

      Three blobs. Three beats.

      This gives the child something very concrete to see and feel while they are listening to the word.

      We can squash:

      • 🟢 LA
      • 🟢 DY
      • 🟢 BIRD

      And then say the whole word: LADYBIRD.

      Next came Snap.

      I used cards containing the target words and played two different versions of the game.

      This is where something very simple becomes surprisingly useful.

      The child isn’t just practising ‘ladybird, ladybird, ladybird…’

      Instead, they are playing a game.

      They have to look. They have to listen. They have to wait. They take a turn.

      And, importantly, they have a reason to say the word.

      When a card appears, we can practise the three syllables: LA – DY – BIRD

      Then we might say it again naturally: ‘I got ladybird!’

      This gives us repeated opportunities to practise the target word while keeping the activity meaningful.

      Taking the practice online

      The fourth clip shows an online activity.

      Here, the online pictures provide another opportunity to look at a picture, identify the word and break it into its three syllables.

      My child taps each syllable.

      Thun-der-storm

      👏 👏 👏

      The visual presentation can be particularly helpful for children who benefit from seeing exactly what we are talking about.

      And we can move between levels of difficulty.

      First:

      How many beats can you hear?

      Then:

      Can you say the word with me?

      Then:

      Can you say it by yourself?

      That progression is important. We build the steps.

      This time, I used a sticker sheet

      We practise:

      TAKE – IT – OFF

      👏 👏 👏

      Three syllables.

      And then we can reverse the action:

      PUT – IT – ON

      👏 👏 👏

      Three syllables again.

      This is a lovely example of why I like to work on speech within real actions and little phrases, rather than only isolated words.

      The child has an actual reason to communicate.

      They want the sticker. They want to take it off. They want to put it somewhere.

      And suddenly our three-syllable practice is also helping with:

      • verbs
      • little phrases
      • following an action
      • understanding language
      • turn-taking
      • functional communication.

      So although my clinical focus might be syllable structure and speech production, I am still thinking about the whole child and the whole communication experience.

      And eventually we want those words to become part of everyday communication rather than something that only happens during therapy.

      That is the real goal.

      A little bit of research

      A useful recent article by Brosseau-Lapré and Roepke (2024) looked at phonological awareness skills in preschool children with speech sound disorders. Through three case studies, the authors highlighted that children with speech sound disorders can have very different profiles of phonological and pre-literacy skills, and that children with more atypical and omission-type speech errors were more likely to show phonological awareness difficulties.

      It is another reminder that speech development is wonderfully complex, and that sometimes a seemingly simple activity, such as putting three blobs of playdough onto a picture, can have a very specific clinical purpose behind it.

      If you are concerned about your child’s speech, a speech and language therapist can help identify whether the difficulty is primarily related to speech sounds, phonological patterns, syllable structure, motor planning, language development, or a combination of factors.

      Any questions please contact me via my contact form.

      Sonja McGeachie

      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.

      Reference

      Brosseau-Lapré, Françoise & Roepke, Elizabeth. (2024). Beyond Sounds: Decoding Speech Errors and Phonological Awareness in Preschoolers. Perspectives of the ASHA Special Interest Groups. 9. 922-934. 10.1044/2024_PERSP-24-00001.

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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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    • ·

      Explore how Intensive Interaction develops Autistic children’s communication

      ByLondon Speech and Feeding

      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.

      There are other programmes that overlap with Intensive Interaction such as Hanen with following your child’s lead and the Gina Davies Curiosity Programme.

      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.

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    • The tricky /R/: Mastering tongue placement for clear speech

      ByLondon Speech and Feeding

      The /R/ sound is notoriously challenging for many children (and even some adults!). It’s one of the most complex sounds in the English language, with various pronunciations depending on its position in a word. If your child is struggling with their /R/s, you’re not alone. As Speech and Language Therapists (SLTs), we frequently work on this sound, and a key component of our therapy is focusing on proper tongue placement.

      Why is the /R/ so difficult?

      The /R/ sound requires precise coordination of the tongue, jaw, and lips. Unlike sounds like /P/ or /B/ that involve simple lip movements, the /R/ involves intricate tongue movements and tension. There are also different ways to produce the /R/ sound, which adds to the complexity:

      • Retroflex /R/: The tongue tip curls up and back towards the roof of the mouth.
      • Bunched /R/: The body of the tongue bunches up towards the roof of the mouth, while the tongue tip remains down.

      The importance of tongue placement

      Regardless of which /R/ variation is being targeted, accurate tongue placement is crucial. Even a slight deviation can result in a distorted or inaccurate sound. That’s why SLTs dedicate significant time to teaching and practising tongue positioning.

      Speech therapy techniques: Focusing on the tongue

      Here’s a glimpse into how I address /R/ sound difficulties, with a focus on tongue placement:

      • Visual aids:
        • Mirrors: I use a mirror to help children see their tongue movements and make adjustments.
        • Tongue diagrams and models: These visual tools provide a clear representation of where the tongue should be positioned.
      • Tactile cues:
        • Tongue depressors: These can be used to gently guide the tongue into the correct position.
        • Food-grade tools: Sometimes, I use flavoured tongue depressors or other tools to provide tactile feedback and increase awareness of tongue placement.
      • Auditory discrimination:
        • I help children distinguish between correct and incorrect /R/ sounds.
        • I use auditory cues and verbal feedback to reinforce proper pronunciation.
      • Exercises and drills:
        • Tongue strengthening exercises: Strengthening the tongue muscles can improve control and coordination.
        • Tongue placement drills: We practise positioning the tongue in the desired location and holding it there.
        • Sound approximation techniques: Sometimes we use other sounds to help approximate the /R/ sound. For example, I use the /L/ sound, to help achieve the correct tongue placement. Once my child has found the /L/ sound it is then a matter of pulling back just slightly to get a good /R/.
      • Contextual practice:
        • Once the child can produce the /R/ sound in isolation, we gradually introduce it into syllables, words, phrases, and sentences.
        • We also practise the /R/ sound in different contexts, such as at the beginning, middle, and end of words.

      Tips for Parents:

      • Be patient and supportive: Learning the /R/ sound takes time and practice.
      • Practise regularly: Short, frequent practice sessions are more effective than long, infrequent ones.
      • Make it fun! Use games, stories, and other engaging activities to keep your child motivated.
      • Work with an SLT: A qualified SLT can provide personalised guidance and support.

      In conclusion:

      The /R/ sound can be challenging, but with targeted speech therapy and a focus on tongue placement, most children can achieve clear and accurate pronunciation.

      I hope this blog post is helpful!

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

      Sonja McGeachie

      Early Intervention Speech and Language Therapist

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

      The London Speech and Feeding Practice

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

      1

    • Tongue-Tie: A complex issue requiring careful assessment

      ByLondon Speech and Feeding

      Tongue-tie, or ankyloglossia, is a condition where the lingual frenulum, the thin piece of tissue that connects the underside of the tongue to the floor of the mouth, is too short or tight. Tongue-tie is quite common in babies and is often not detected after birth. Tongue-tie can lead to a difficult start with breast feeding as it makes it very difficult for the baby to latch effectively.

      In my clinical experience as a feeding therapist, I have seen many babies who were not able to latch well due to the frenulum being tight. In many cases an experienced feeding speech therapist/lactation consultant can really make a difference and help a new mum to latch the baby even though the tongue is tethered to the floor of the baby’s mouth. In some cases the frenulum can be divided and once this has been done, in some cases, feeding improves immediately or soon after the division. But this is not always the case. I have seen several babies who have had as many as four tongue-tie divisions and feeding was still difficult.

      It is important to say that while tongue-tie can sometimes impact speech and feeding, it’s important to note that it’s not always the root cause of these difficulties. In recent years, there has been a surge of interest in tongue-tie division surgeries, with some cases being unnecessary. It’s crucial to understand the complexities of tongue-tie and the role of speech therapy in addressing related challenges.

      The impact of tongue-tie on speech and feeding

      When tongue-tie is severe, it can interfere with the tongue’s ability to move freely, affecting speech production and swallowing. Some common speech and feeding difficulties associated with tongue-tie include:

      • Feeding difficulties: Challenges with sucking, chewing, and swallowing.
      • Drooling: Excessive drooling due to difficulty controlling saliva.
      • Speech problems: Difficulty producing certain sounds, such as /l/, /r/, /t/, /s/ and /d/.

      The importance of comprehensive assessment

      Before considering any surgical intervention for tongue-tie, it’s essential to undergo a thorough evaluation by a qualified speech-language therapist (SLT). An SLT can assess the severity of the tongue-tie, its impact on speech and feeding, and determine if surgery is necessary.

      • Functional assessment: The SLT will assess the tongue’s range of motion, its impact on speech sounds, and the child’s overall oral motor skills.
      • Feeding evaluation: The SLT will observe the child’s feeding patterns and identify any difficulties related to tongue-tie.
      • Differential diagnosis: The SLT will rule out other potential causes of speech and feeding difficulties, such as apraxia of speech, dysarthria, or sensory processing disorders.

      The role of speech therapy

      Even in cases where tongue-tie is present, speech therapy can often be highly effective in addressing speech and feeding difficulties. Here’s how speech therapy can help:

      • Articulation therapy: Targeting specific speech sounds that may be affected by tongue-tie.
      • Childhood Apraxia of Speech (CAS): if the diagnosis by the SLT has shown that in fact the child has motor planning difficulties then there are very specific and effective treatment programmes that help with this and can make a real difference over time.
      • Feeding therapy: Strategies to improve swallowing, chewing, and oral-motor skills.
      • Sensory integration: Addressing underlying sensory processing issues that may contribute to feeding difficulties.

      London Speech and Feeding Case Study: The importance of comprehensive assessment

      One of my clients was initially diagnosed with tongue-tie and recommended for surgery at the age of eight years old. His speech had been perceived by parents and teachers as ‘mumbled and unclear’.

      However, after a thorough evaluation, I was able to determine that the child’s primary issue was apraxia of speech, a neurological disorder that affects motor planning for speech. Parents decided to wait with surgery and trust my judgment and we proceeded with weekly intensive speech therapy to address motor planning difficulties around tricky sounds and words. I am delighted to say that the child’s speech has improved significantly, demonstrating the importance of comprehensive assessment and individualised treatment. He is no longer seen as a candidate for an operation, which would have been traumatic for him at his age and, as it turned out, entirely unnecessary.

      Below is a short video clip of my working on the /l/ sound with this child.

      Using the Gingo Puppet from GingoTalk

      Conclusion

      Tongue-tie is a complex issue that requires careful evaluation and individualised treatment. While surgery may certainly be necessary in some cases, it’s essential to consider the potential benefits and risks. Speech therapy can be a highly effective approach for addressing speech and feeding difficulties associated with tongue-tie, even in cases where surgery is still required. By working with a qualified speech-language therapist, parents can ensure that their child receives the best possible care and support.

      Please feel free to contact me.

      Sonja McGeachie

      Early Intervention Speech and Language Therapist

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

      The London Speech and Feeding Practice

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

      1
    • · · ·

      Beyond the teddy bear picnic: Why language development doesn’t always need imaginative play

      ByLondon Speech and Feeding

      As Speech and Language Therapists (SLTs), we are taught from day one that developmental milestones follow a predictable, linear path: first comes functional play, then symbolic and imaginative play (like pretending to feed a teddy bear or talking on a toy phone), and then comes conversational speech.

      But when working with language delayed children, I have seen something that completely contradicts those textbook charts.

      Many of my students have absolutely no interest in doll play, tea parties, or imaginary scenarios. Yet, as they mature, they still manage to develop robust, meaningful, and conversational language.

      How is this possible? And what does it mean for how we approach therapy?

      Redefining the ‘rules’ of play and language

      The idea that imaginative play is a strict prerequisite for language was built entirely on neurotypical developmental data. But neurodivergent brains don’t follow neurotypical roadmaps. That is not a deficit; it’s simply a different processing style.

      When Gestalt Language Processors bypass traditional imaginative play, they aren’t ‘missing’ a step. They are often using entirely different cognitive vehicles to build their language skills.

      The power of monotropic deep interests

      Video clip 2 lining up dinosaurs

      Many autistic individuals have a monotropic cognitive style, meaning they process the world through deep, single-focused passions (think trains, space, dinosaurs or ocean creatures).

      While a neurotypical child might practise social roles by pretending a doll is going to school, a neuro-diverse child practises language by categorising, analysing, and sharing facts about their deep interest. Their language is anchored in the concrete, fascinating reality of their passion, rather than fictional symbolic play.

      Gestalt Language Processing (GLP)

      A significant number of neuro-diverse children learn language in large ‘chunks’ or ‘gestalts’ (such as movie scripts, songs, or favourite phrases) rather than building sentences word-by-word.

      When a child scripts or uses echolalia, they are storing and mapping vast amounts of conversational data. They don’t need to pretend-feed a teddy bear to practise dialogue; they are actively processing the rhythm, intonation, and structural rules of speech through the media and phrases they love. As they grow, they learn to break these scripts apart to form original sentences.

      Structural play is learning play

      Just because a child is lining up dinosaurs or cars, stacking blocks, or spinning wheels instead of making them ‘talk’ doesn’t mean they aren’t learning. This functional and structural play builds crucial foundational skills like pattern recognition, cause-and-effect, and spatial awareness, all of which directly support cognitive and language development.

      Shifting Our Goals

      Meeting our children on their home turf: if that’s dinosaurs, let’s be creative with dinosaurs!

      If imaginative play isn’t the engine driving language, forcing it in the therapy room can quickly turn into an exercise in compliance rather than connection. Instead of trying to pull a child out of their world and into a neurotypical play model, we can meet them exactly where they are!

      Here are three affirming ways to turn deep interests into conversations:

      • Swap questions for comments (declarative language): Instead of interrogating a child about their play (‘What colour is that train? Where is it going?’) make pressure-free observations (‘Wow, that train is moving fast. Look at those wheels spin.’). This lowers conversational anxiety and models natural communication.
      • Bridge and expand: Use their favourite topic to introduce new ideas and concepts. If we love dinosaurs let’s see if dinos can climb up a ladder, slide down a half pipe into some water, then need drying before making footprints across a piece of paper…
      • Validate any scripts or echolalia and find out the EMOTION underlying it: If your child uses a quote from a favourite cartoon clip, let’s try and figure out in what context this phrase was said in the movie; what is the emotion in the movie when the character says this line? Is it upset? Is it joyful? Is it big surprise or a shock? Don’t dismiss it as meaningless. Acknowledge the emotion behind the script ‘You feel worried right now.’ This way we are showing our child that their unique way of communicating is heard and valued.

      So, to sum up:

      Imaginative play is just one way to learn language, not the only way.

      Let’s stop viewing a lack of pretend play as a barrier to communication, and free ourselves to see our children’s true strengths. By embracing their deep passions, we don’t just help them find their voice. We build a real connection that makes communication possible.

      Are you looking for neurodiversity-affirming speech and language support? Contact my clinic today to learn more about how I tailor my therapy to your child’s unique strengths.

      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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