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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      Transforming Mealtimes

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      The answer is extremely complex and multi-faceted and this little blog is not covering any factors in detail (we would be here all night) -I mentioned sensory processing difficulties earlier on. These are mostly still present but often not acknowledged or recognised by parents. And it is certainly the case that one of the contributors is parental anxiety; this tends to run very high and has been for many months, sometimes years. This in turn often leads to very tense and unpleasant, endlessly long meal times and many times children are force-fed several times a day in order to “get something down there” as otherwise they would probably starve themselves.

      Additionally, parents end up only offering a very narrow range of foods because that is all their child will eat. This ends up in a vicious cycle of children being fed porridge-style food for all meal times and of course they won’t progress to more mature foods if these mature foods are never on offer.

      In order to help address and disentangle some of the issues I often introduce the “Division of Responsibility in Feeding” as researched and recommended by Ellyn Satter (The Satter Feeding Dynamics Model)

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      Please note: this model is only appropriate for children where the original physical cause is no longer present!

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      Discover more about Verbal Dyspraxia

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      Children with verbal dyspraxia can make great progress!

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      We design carefully tailored programmes focusing on words that have a lot of power (e.g., NO, GO, UP, IN, OUT, LET’S GO, STOP).

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      The most difficult phase of verbal dyspraxia is initiation, that is to start talking, to start producing a word. Frequent “automatic” repetition supports children with initiation because it removes the element of “thinking to start”. I often ask a child to repeat a word 5-10 times (with rewards at the end. A little game works well). You can see that with repetition the act of initiating is taken out of the equation as you are “on a roll “as it were.

      Once a child starts to find their voice, we will be able to hear them talk lot… And if we give them credit and presume that what they are saying has meaning, we will find in time that their words become clearer and more intelligible. If we listen carefully, we can detect real words and phrases.

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      Empowering non-speaking children: the power of AAC Core Boards

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      Communication is the essence of human interaction, allowing us to express thoughts, feelings, wants and needs. For non-speaking children and their families finding an avenue to communicate effectively can be a really challenging journey.

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      Let’s discover and understand AAC Core Boards

      Firstly, let’s look at what a Core Board looks like…

      AAC Coreboards
      Credit: Saltillo Word Power

      Why not have a go and download your own copy (and other boards) for free on the Saltillo Word Power website.

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      Building literacy skills

      AAC Core Boards are not only tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-verbal children engage with words and symbols. It reinforces their understanding of language structure and grammar.

      As they consistently play with and then use their boards, they naturally absorb language patterns, laying the foundation for improved literacy skills. This immersive learning experience paves the way for future language acquisition and communication growth.

      Customisation for individual needs

      Every child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind, allowing for customisation to suit individual preferences and abilities. The boards can be adapted to include specific vocabulary relevant to a child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of your child’s personality and needs, making communication more motivating, engaging and effective.

      Collaboration between AAC Core Boards and Speech Therapy

      AAC Core Boards are an excellent tool but we need to know one important aspect: they only work well when used regularly by the child’s family and key people in the first place.

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      Collaborating with your child’s Speech and Language Therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best put them in place, so that your child can reach their communicative potential.

      For non-speaking children, AAC Core Boards are more than just tools. They are bridges to a world of communication, connection, and empowerment. These boards harness the power of visual communication, foster language development, social interaction, and personal expression. They can be tailored to individual needs with the support of skilled professionals. AAC Core Boards offer a beacon of hope, helping to break through communication barriers and thrive in a world that is waiting to hear your child’s voice.

      For answers to your questions and to explore the most effective support for your child, feel free to contact us.

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      Are the Gestalts I model easy to mix and match later on?

      ByLondon Speech and Feeding
      Image by bearfotos on Freepik

      Here are some examples of great phrases and Gestalts that we could use:

      • Let’s get a banana / Let’s go out / Let’s play lego / Let’s go see daddy
      • That’s nice! / That’s really good! / That’s a green one / That’s a submarine
      • Need more help / Need a wee wee / Need that / Need to run
      • How about a biscuit / How about a cuddle / How about watching tv
      • We love bananas / We love a monkey / We love a cuddle

      Why or how could these examples be mixed and matched?

      You can see I have given several examples for each, that is how later a child can take one chunk (let’s) and add another (go out) or (need) + (go out).

      What about our own grammar? Should we be using grammatical phrases?

      In general for NLA 1 (Natural Language Acquisition stage 1) we want to use short phrases and keep them quite generic, something like:

      ‘Let’s go’ or ‘let’s play’ and pick 2-3 phrases per communicative function (see next point below).

      And if we are going to say longer sentences, for example: ‘let’s go and feed the ducks now’, then we should do so with good grammar and really varied intonation. It sometimes helps me to make up a little song/jingle on the spot that has a lot of intonation, more than I would perhaps use just by speaking.

      How many varied communicative functions do we cover with our modelling?

      We want to model a variety of Gestalts other than just requesting for example. In general, we are looking at our child having one or two Gestalts in the following areas before they are ready to move on into stage 2.

      These are the most common ones I see in my practice:

      • Requesting ‘want a banana/biscuit’ ‘Wanna play ball’
      • Transitioning: ‘what now?’ ‘what next?’
      • Ask for help: ‘need help’ ‘help me’ ‘mummy help’
      • Commenting: ‘it’s big’ ‘it’s red’ ‘it’s fast’ ‘too loud’
      • Speak up for self: ‘not that one’ ‘go now’ ‘stop it’

      Is the Gestalt I am modelling meaningful to my child?

      We don’t use all available Gestalts for every child. It has to be meaningful to the individual and has to match their interests. If our child is a big fan of feeding the ducks in the park then we can think about Gestalts like:

      • I see ducks!
      • They’re over there
      • Let’s feed them?
      • Let’s get some seeds
      • They’re coming!
      • They want food / They wanna eat!
      • That’s a big one
      • It’s so hungry
      • It loves the seeds!
      • No more! All done! Finished! Let’s go home

      What is my child actually trying to tell me?

      We have to be become word/phrase detectives! Is the phrase/script/Gestalt they are using right now actually meaning what they said or does it mean something else, and if so, what?

      Here is an example from my own personal experience in my practice:

      The little boy I was working/playing with was building a tall tower with blocks. When it finally fell with a great big bang he said in a sing-song voice ‘ring-a-ring-a roses’ … then he began to collect the blocks again to make a fresh tower. I sat there and thought: why ‘ring-a-ring-a roses’? What does that mean in this context? I then sang the song (silently) to myself with my detective hat on and realised as I came to the end that it finishes with ‘we all fall down’! it was a real AHA!!! moment for me as I saw right there what the meaning of his Gestalt was. He sang the first line of the song to say ‘all fall down!’

      So realising this I waited for the next tower to fall, and there it was again, he sang the first line of the song. I replied thus, copying him at first:

      ‘RING-A-RING-A ROSES – WE ALL FALL DOWN!…

      FALL DOWN

      WE LOVE IT FALLING DOWN.’

      The process to find what we should say is not always straight forward or easy at all, and often we don’t quite know in the moment what our child is trying to say. But we can try and get to know their interests and then gradually we do know more and more what the meaning behind the Gestalt is or could be.

      What pronouns should we use?

      This can be a tricky one.

      We don’t want to use language that uses the pronouns ‘you’ or ‘you’re’. The reason is that our child will likely copy us exactly as we have said it. Therefore, using pronouns ‘you’ and ‘you’re’ will then sound wrong.

      Always try to model language that is from the child’s perspective or in other words how they would say it if they could.

      Alternatively, you can model using WE or US. For example, if the child is tired, rather than saying ‘you are so tired’ model language from his or her point of view: ‘I’m tired’ or ‘let’s go have a lie down’.

      There is so much more to talk about. Stay tuned for a blog on NLA stage 2 coming soon.

      If you need help with your child, please do not hesitate to contact me.

      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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    • ·

      How we can help shape smooth consonant blends

      ByLondon Speech and Feeding

      For many children, especially those navigating Childhood Apraxia of Speech (CAS), the challenge isn’t just making individual sounds. It’s the ‘speech gymnastics’ required to move smoothly from one sound to the next.

      You might notice that instead of saying ‘Train’, your child says ‘Ter-ain’, or for ‘Frog’, you hear ‘Fer-og’. That sneaky little ‘uh’ sound in the middle is what we call a schwa vowel. In the world of speech science, this is known as epenthesis. It’s essentially a ‘repair strategy’ the brain uses to break up a difficult cluster of sounds into two easier pieces.

      While it might seem like a small detail, that tiny vowel makes a big difference in how fluent and clear a child’s speech sounds. In today’s post (and the video below), I am working with my student on ironing out that schwa by focusing on co-articulation—the art of getting the mouth ready for the second sound while still finishing the first.

      The ‘best friends’ strategy

      To help my student understand this complex movement, I use visual cues and a story. There are many ways to portray two sounds living closely together, but for this session, I used the ‘Best Friends’ story.

      In our story, the /T/ and the /R/ are older brother best friends who want to play together. The ‘schwa’ sound is represented by a little sister who keeps trying to jump in the middle of their game! Because my student has a younger sister, this scenario was instantly familiar and helped him visualise why we needed to ‘close the gap’ between those two sounds.

      Alternative methods I often use:

      Beyond stories, I often use other visual and tactile methods to show the closeness of two sounds:

      • The sliding finger: I draw two dots on a paper—one for /T/ and one for /R/. We slide a finger quickly from one to the other. I might say, ‘Don’t let the ‘uh’ monster jump in the gap!’
      • The rubber band: We stretch a rubber band as we speak. I tell my student that the word is one long, smooth stretch, rather than two separate ‘pops’.
      • Visual cues for ‘quiet’ sounds: I often put my finger to my lips or tap my throat to remind a child to keep the first sound voiceless. If the voice stays ‘off’ during the /T/, it’s much harder for that schwa vowel to creep in.

      The importance of ‘pure’ modelling

      A major hurdle in clearing up these blends is how we, as adults, model sounds. Often, when teaching the alphabet, we say ‘Kuh’, ‘Puh’ or ‘Tuh’. But if you listen closely, you’re actually adding a vowel! If a child learns that /K/ says ‘Kuh’, it’s only natural they will say ‘Kuh-R’ for /KR/.

      To give your child a cleaner blueprint, try modeling ‘pure’ sounds. Think of whispering rather than talking:

      • The /K/ sound: A short, sharp burst of air from the back of the throat. No voice! (A quiet /K/ click).
      • The /P/ sound: Just a ‘pop’ of air from the lips. If your throat vibrates, the vowel has snuck in.
      • The /T/ sound: A tiny tap of the tongue behind the teeth.

      Why is this important?

      You might ask, ‘If I can still understand them, does it really matter if they say “ter-ain”?’

      The goal of speech therapy isn’t just functional communication; it’s building phonological awareness. When a child adds extra vowels, it can eventually impact their literacy. If they hear ‘ter-ain,’ they are much more likely to eventually spell it as ‘terain’ or ‘traint’.

      By helping them master these clusters through co-articulation now, we are setting them up for success in reading and writing. And we are giving them the confidence to speak with ease.

      Feel free to contact me if your child needs help with clusters or other difficulties either aligned with Childhood Apraxia of Speech or other articulation difficulties.

      Sonja McGeachie

      Highly Specialist Speech and Language Therapist

      Owner of The London Speech and Feeding Practice.

      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

      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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    • · · ·

      How do we play with our Gestalt Language Processors?

      ByLondon Speech and Feeding
      Image by Freepik

      Child-led therapy

      When working with Gestalt Language Processors, it is always advisable to use child-led therapy. What does that mean? Child led therapy involves following a child’s interests and allowing her/him to lead the play activity throughout the speech and language therapy session. In other words, instead of having my own ideas of what we might want to play with or what activities I might try and use, I provide a range of toys I know the child likes or has played well with before; then I wait for the child to pick what she/he enjoys doing.

      Play can be very repetitive and we can often see our child cycling back to the same one or two toys throughout the session. But this is what she/he needs to do at that time and it means that we have focused attention and engagement. This in turn is very helpful for the therapeutic process, which is to offer great scripts and phrases/words alongside what she/he is playing with.

      Monotropic minds

      Often the mind of autistic children is more strongly pulled towards a smaller number of interests or hobbies as I like to call them. Dr Dinah Murray, Dr Winn Lawson and Mike Lesser have found in 2005 that autistic people have ‘monotropic’ minds. They explain that autistic children focus their energy on a narrow range of activities as the energy required to switch between several toys is much higher than we would see in the neuro-typical population.

      Gestalt Language Processors are often also Gestalt Cognitive Processors. This is when experiences are retained as episodic events and memories. An event is remembered by specific parts of the same event. And, therefore, these specific parts should always be part of that event, when the event is repeated.

      Should any of the specifics be changed or are missing, then this can cause great upset to Gestalt Cognitive Processors. So, for example, if the last two times in speech therapy we had the train set out and this was played with happily, then this becomes a specific part of the whole session. If, I then don’t offer the train set the third time a child comes to see me, this could be very upsetting.

      This is why I tend to try this out and see what happens. Usually in the 3rd or 4th session: I might not bring out the car run that has hitherto been super successful to see if we are able to transition well to other toys. If yes, then we can have new experiences but if not then I will re-offer the car run/or whatever toy pretty quickly so as not to cause complete dysregulation.

      A few pointers below which help with child-led play:

      Introduce a few new toys and see what happens

      Parents are encouraged to bring some familiar toys their child likes to the session. We can then introduce a couple of different toys to see how we go. Try offering a new toy alongside the familiar one; try offering new toys without the familiar one present, but be prepared to re-offer the “old” toy should our child get upset.

      Rotate toys and don’t offer out too many toys

      I find that children can get overwhelmed and overstimulated by too many items out all at once. I always talk to parents about toy rotation at home and I encourage storage and ‘tidy up’ of toys so that we can increase attention focus, and also maintain freshness and new interest in older toys.

      Some children are not yet ready to play with toys

      Here I suggest people games: these are games where the adult becomes part of a more motor-based activity. Some call it ‘rough and tumble play’ but it can be nursery rhymes such as sleeping bunnies/row row the boat or peek-a-boo for the younger ones.

      Copy/Imitation is so important – try getting two identical or similar play items

      When we are copying our child, it is often not desirable to ‘take turns’ with their toys/blogs/cars etc as our child may not be ready to let us take a turn. Instead, if we have the exact same toy that our child is having then we can play alongside our child and copy them perfectly without interrupting their play.

      References:

      Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism, 9(2), 139-156.

      If you need help with your child, please do not hesitate to contact me.

      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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