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.

    3

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      References

      • Hall, N. (2011). Vowel Epenthesis. In The Blackwell Companion to Phonology (eds M. Oostendorp, C.J. Ewen, E. Hume and K. Rice). In this work, epenthesis is defined as the insertion of a vowel to break up complex consonant clusters into simpler, more manageable syllables. This is often viewed as a ‘repair strategy’ used by the brain when a transition between sounds is too complex to execute quickly.
      • Aichert, I., & Ziegler, W. (2004) Brain and Language 88(1):148-59. Syllable frequency and syllable structure in apraxia of speech. This research highlights that children with Apraxia often struggle specifically with word-onset clusters, leading to distortions like the schwa.
      • Browman, C. P., & Goldstein, L. (1992) Phonetica 1992;49(3-4):155-80. Articulatory Phonology: An Overview. This paper explains that fluent speech requires ‘gestural overlap,’ where the movements for two different sounds happen simultaneously. This supports the ‘Best Friends’ method of keeping sounds close together.
      Health Professions Council registered
      Royal College of Speech & Language Therapists Member
      Member of ASLTIP

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      I totally get it!

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      Alternative and Augmentative Communication (AAC)

      There is plenty of research on the efficacy of Alternative and Augmentative Communication (AAC). It is now very well understood and proven that, once we introduce our child to a good, attractive way of communicating that they can actually do, in time children who can speak will speak. Speaking is more effective than any AAC system. It is more versatile, more fun, and when human beings have discovered how to speak, most will do so in favour of any other system.

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      Personal experience

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      Acceptance

      Now I will equally celebrate a child pointing to a symbol or making a sign for something. It is a fantastic moment when it happens for the parents and me and the child! And we can always hope for more speech to come as we go. Nothing wrong with our aspirations, is there?

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      Here is some research;

      Binger, C., Berens, J., Kent-Walsh, J., & Taylor, S. (2008) The effects of aided AAC interventions on AAC use, speech and symbolic gestures. Seminars in Speech and Language, 29, 101-111.

      Sennott, S.C., Light, J., & McNaughton, D. (2016). AAC modelling intervention research review. Research and Practice for Persons with Severe Disabilities, 41, 101–15.

      Dada, S., & Alant, E. (2009). The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech. American Journal of Speech-Language Pathology, 18, 50–64.

      Contact me if you would like your child to have neurodiversity affirming speech and language therapy.

      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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      Image by freepik

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      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’

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      2. The second one is STRESS

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      3. The third one is GO SLOW

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      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.

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      Why tongue lateralisation matters: The hidden feeding skill that every toddler needs

      ByLondon Speech and Feeding

      When parents think about feeding milestones, they often focus on what their child is eating. Are they accepting lumps? Will they eat vegetables? Are they managing finger foods?

      However, one of the most important skills happening behind the scenes is something many parents have never heard of: tongue lateralisation.

      Tongue lateralisation simply means the tongue’s ability to move from side to side inside the mouth. Although this sounds like a small movement, it is one of the key building blocks for safe chewing, efficient eating and later speech development.

      As a Speech and Language Therapist specialising in infant feeding, I frequently assess children who have delayed or absent tongue lateralisation. The encouraging news is that this skill can often be developed. But like many areas of development, there is an optimal window during which children learn it most naturally.

      What does the tongue actually do during eating?

      Eating is an incredibly complex process involving the lips, jaw, cheeks, tongue and swallowing muscles all working together.

      For mature chewing, the tongue needs to:

      • move food from the centre of the mouth onto the back gums and molars
      • keep the food positioned while the jaw chews
      • collect scattered pieces of food from around the mouth
      • reform the chewed food into a single cohesive bolus
      • move that bolus safely to the middle of the tongue before swallowing.

      Without good tongue lateralisation, food often stays in the middle or front of the mouth where it cannot be chewed effectively.

      Children may compensate by:

      • swallowing pieces whole
      • mashing food with the front teeth only
      • relying on sucking instead of chewing
      • holding food in their cheeks
      • gagging frequently
      • refusing more challenging textures altogether.

      These children are often described as ‘fussy eaters’, when in reality they may simply lack the oral motor skills needed to manage more advanced textures comfortably.

      When should tongue lateralisation develop?

      Tongue lateralisation begins to emerge during the second half of the first year of life as babies start exploring textured foods.

      Between approximately 6 and 12 months, babies naturally begin learning to move food sideways towards their gums for early chewing. As molars develop during the second year, these movements become more refined and efficient.

      This period represents an important developmental window because babies are biologically programmed to experiment with increasingly varied textures. Repeated opportunities to chew different foods strengthen the tongue, jaw and cheek muscles while building the complex movement patterns needed for mature eating.

      If a child remains on smooth purées or very soft foods for too long, they may miss hundreds of opportunities to practise these essential movements.

      Why does this developmental window matter?

      Like learning to crawl, walk or ride a bicycle, oral motor skills develop through repeated practice.

      Children who do not experience enough chewing opportunities during infancy can sometimes continue to rely on immature sucking and munching patterns well into toddlerhood.

      This does not mean the opportunity is completely lost after infancy. Many toddlers can still learn tongue lateralisation successfully with the right support. However, the longer an immature pattern is used, the more established it becomes, making change more challenging.

      That is why early assessment is so valuable.

      Signs your toddler may have poor tongue lateralisation

      You may notice your child:

      • chews mainly with the front teeth
      • bites but does not chew efficiently
      • keeps food in the centre of the mouth
      • pockets food in the cheeks
      • frequently spits out textured foods
      • gags on lumps
      • prefers soft foods
      • swallows before food has been adequately chewed
      • takes a very long time to finish meals.

      Not every child showing these signs has an oral motor difficulty, but they do warrant further assessment.

      How can we encourage tongue lateralisation?

      The good news is that the tongue learns through experience.

      One of the best ways to encourage side-to-side movement is by offering long, resistive foods that naturally encourage the tongue to move food towards the side gums for chewing. We also call them sometimes HARD MUNCHABLES – they look like on the following image.

      Hard munchablers

      Examples include:

      • mango pits with most of the flesh removed
      • pineapple core strips
      • thick steak strips
      • cooked pork strips
      • peeled celery sticks
      • thick cucumber spears
      • roasted pepper strips
      • corn on the cob cut into manageable rounds
      • dehydrated apple rings
      • large clean cooked rib bones with a little meat remaining for supervised chewing practice.

      These foods are not intended for children to consume large pieces quickly. Instead, they provide resistance that encourages the jaw, cheeks and tongue to work together while giving valuable sensory feedback.

      A simple technique that can help

      Some toddlers struggle because they never naturally move food to the side of their mouths.

      In these cases, placing a long strip of food gently onto the side gums can sometimes trigger the chewing pattern automatically. This gives the tongue an opportunity to experience where chewing should occur.

      This should always be done calmly, with the child sitting upright and under close adult supervision.

      Every child develops differently

      Some children are more likely to experience delayed tongue lateralisation than others.

      This may include children who:

      • remained on purées for an extended period
      • have developmental delays
      • have low muscle tone
      • were born prematurely
      • have significant sensory processing differences
      • have experienced prolonged tube feeding or medical conditions affecting feeding.

      A feeding assessment can identify whether tongue movement, jaw stability, sensory processing or another factor is contributing to the difficulty.

      Early intervention makes a difference

      One of the biggest misconceptions I hear is:

      ‘They’ll grow out of it.’

      Some children do. Others don’t.

      Without intervention, inefficient chewing patterns can persist for years, affecting food variety, mealtime confidence and nutritional intake. In some cases, immature oral motor patterns may also contribute to unclear speech production later on, although feeding and speech skills do not always develop at the same rate.

      The earlier we identify a problem, the easier it usually is to help children develop more mature, efficient chewing patterns.

      Final thoughts

      Tongue lateralisation may not be a term many parents recognise, but it is one of the foundations of successful feeding.

      By offering opportunities to chew a variety of safe textures during infancy, parents help build the complex tongue movements needed for efficient eating throughout childhood.

      If your toddler still struggles with chewing, gags on textured foods, or seems unable to move food around their mouth, don’t simply wait and hope they will outgrow it. A comprehensive feeding assessment can identify exactly where the difficulty lies and provide practical strategies tailored to your child’s needs.

      Sometimes a few small changes at the right time can make a lifetime of difference. Do get in touch with me. I would love to hear from you and help your little one develop good chewing skills and eating habits.

      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.

      3
    • · ·

      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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