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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    • · ·

      Why pointing matters: Unpacking the power of this simple gesture

      ByLondon Speech and Feeding

      As a speech and language therapist, I’m often asked about the significance of seemingly simple gestures in child development. One question that comes up frequently is, ‘Why is pointing so important?’ It might seem like a trivial action, but pointing is a powerful communication tool and a critical milestone in a child’s development.

      Why is pointing so important?

      Let’s delve into the theory behind why pointing matters:

      1. Pointing as pre verbal communication:

      Before children can use words, they use gestures to communicate their needs and interests. Pointing is one of the earliest and most important gestures. It allows children to:

      • Request: ‘I want that!’
      • Protest: ‘No, not that!’
      • Direct attention: ‘Look at that!’
      • Share interest: ‘Wow, cool!’

      2. Pointing and language development:

      Pointing is not just about communicating in the here and now; it also plays a crucial role in language development. Research shows that:

      • Early pointing predicts later language skills: Children who point more often tend to have larger vocabularies and better grammar later on.
      • Pointing helps children learn new words: When children point at something, adults tend to label it, providing valuable language input.
      • Pointing supports joint attention: Joint attention, or the shared focus of two individuals on an object or event, is essential for language learning. Pointing helps establish joint attention, creating opportunities for communication and learning.

      3. Pointing and social-emotional development:

      Pointing is not just about language; it’s also about social interaction. It allows children to:

      • Engage with others: Pointing invites others to share their focus and participate in their world.
      • Express emotions: Pointing can convey excitement, curiosity, or concern.
      • Develop social understanding: By observing how others respond to their pointing, children learn about social cues and communication.

      4. Pointing and cognitive development:

      Pointing is linked to cognitive skills, such as:

      • Understanding object permanence: The ability to know that objects exist even when they are out of sight.
      • Categorisation: The ability to group similar objects together.
      • Problem-solving: Pointing can be used to ask for help or to indicate a problem.

      5. Types of Pointing:

      It’s important to note that there are different types of pointing, each with its own significance:

      • Imperative pointing: To request something.
      • Declarative pointing: To share interest or direct attention.
      • Informative pointing: To provide information.

      If you have concerns about your child’s pointing or overall communication development, don’t hesitate to seek professional guidance from a speech-language therapist. Early intervention can make a significant difference in supporting your child’s communication journey.

      How can we create opportunities for pointing?

      • ‘Where’s the…?’ games:
        • Play games like ‘Where’s the doggy?’ or ‘Where’s the ball?’ and encourage your toddler to point to the object.
        • Start with familiar objects and gradually introduce new ones.
      • Reading together:
        • When reading picture books, ask your toddler to point to specific objects or characters on the page.
        • Use phrases like, ‘Can you point to the puppy?’
      • Everyday activities:
        • During daily routines, ask your toddler to point to things they want or need.
        • For example, ‘Do you want the apple or the banana?’
        • When walking outside say ‘LOOK’ and encourage pointing.
      • Use of toys:
        • Use toys that have buttons or points of interest that when pressed make a noise. Encourage your toddler to point to the area that makes the noise.
        • Use toys that have many different parts, and ask the toddler to point to a specific part.

      Model pointing:

      • Point yourself:
        • When you see something interesting, point to it and say the name of the object.
        • For example, ‘Look! A bird!’
      • Point to show choices:
        • When offering choices, point to each item as you name it.
        • For example, ‘Do you want the blue cup or the red cup?’ (Point to each cup).
      • Point to indicate direction:
        • When giving directions, point in the direction you want your toddler to go.
        • For example, ‘Let’s go that way!’ (Point).

      Make it rewarding:

      • Respond to pointing:
        • When your toddler points, immediately respond to their communication.
        • Give them the object they want, or acknowledge what they are pointing at.
      • Use positive reinforcement:
        • Praise and encourage your toddler when they point.
        • Say things like, ‘Good pointing!’ or ‘You showed me the car!’
      • Show excitement:
        • When they point to something, show excitement, this will encourage them to point again.

      Use specific techniques:

      • Use gestures and verbal cues:
        • Combine pointing with verbal cues and other gestures.
        • For example, say ‘Look!’ while pointing and nodding your head.
      • Simplify the environment:
        • Reduce distractions to help your toddler focus on the object you want them to point to.
      • Use exaggerated movements:
        • Use large, exaggerated pointing movements to draw your toddler’s attention.

      Consider developmental factors:

      • Age-appropriate expectations:
        • Remember that pointing develops at different rates for different children.
        • Be patient and supportive.
      • Underlying issues:
        • If your toddler is not pointing by 18 months, or if you have any concerns about their development, consult with a speech and language therapist.
        • There may be underlying sensory or motor issues.

      Key points:

      • Consistency is key. Practise these strategies regularly.
      • Make it fun and engaging for your toddler.
      • Celebrate every success, no matter how small.
      • If you have any concerns about your child’s development, contact your local health services.

      Great toys and items for pointing

      1. Interactive books:

      • Touch-and-feel books: Books with different textures, flaps to lift, and sounds encourage interaction and pointing. ‘Where’s the…?’ questions prompt pointing to specific features.
      • Books with simple pictures: Clear, uncluttered pictures make it easier for toddlers to focus and point to objects or characters.

      2. Cause-and-effect toys:

      • Activity cubes: These often have buttons, dials, and levers that produce sounds or actions when manipulated, prompting pointing and exploration.
      • Pop-up toys: Toys where figures pop up or things happen when a button is pressed encourage anticipation and pointing to the action.
      • Simple musical instruments: A toy piano, drum, or xylophone encourages pointing to the keys/surfaces to make sounds.

      3. Toys with parts to manipulate:

      • Shape sorters: Encourage pointing to the shapes and the matching holes.
      • Stacking cups or rings: Nesting cups or stacking rings invite pointing to select the correct size or order.
      • Puzzles with knobs: Simple puzzles with large knobs are easier for toddlers to grasp and point to the pieces.

      4. Toys that encourage joint attention:

      • Bubbles: Blowing bubbles and following them with your eyes and pointing encourages joint attention (shared focus).
      • Balls: Rolling a ball back and forth and pointing to where it’s going can promote joint attention and turn-taking.
      • Wind-Up Toys: Wind-up toys that move across the floor can be exciting to follow with pointing.

      5. Pretend play toys:

      • Toy telephones: Encourage pointing to the buttons and pretending to dial.
      • Dolls and stuffed animals: Pointing to the doll’s eyes, nose, mouth, etc., or asking the child to point to these features on themselves.
      • Toy food and dishes: Pretend play with food and dishes can involve pointing to request items or indicate actions (e.g., ‘Can I have the apple?’).

      Tips for using toys to encourage pointing:

      • Get involved: Play alongside your toddler, modelling pointing and using language to describe what you’re doing.
      • Follow their lead: Observe what your child is interested in and use that to encourage pointing.
      • Limit distractions: Reduce background noise and visual clutter to help your child focus.
      • Use gestures and words: Combine pointing with words and other gestures (e.g., ‘Look!’ while pointing).
      • Be patient and positive: Celebrate all attempts at pointing and provide lots of encouragement.

      Remember, the most important factor is the interaction you have with your child while playing. Use these toys as tools to create opportunities for communication and joint attention, and your toddler will be well on their way to mastering pointing!

      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

    • What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

      ByLondon Speech and Feeding
      Kids Speech Therapist London
      What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

      Speech and language therapists provide treatment, support and care for children and adults who have difficulties with communication, eating, drinking and swallowing. We help children and adults who have problems speaking and communicating.

      How to find the perfect therapist for my child/client:

      There are a huge number of speech and language difficulties, or feeding and swallowing problems that we can help with and the first thing to think about is what age group the person is you are seeking help for. Most SLT’s specialise in a range of disorders and treatments and they often treat specific age ranges. This could be, for instance, very young children up to 3 years, or school aged children, adolescents or just adults. Once you have narrowed it down to age and general area of difficulty you can then go and seek your perfect SLT match.

      Generally it is my view that SLT’s with a narrow area of specialist interest are most likely to help you better if the problem you or your child/adult is having is significant and/or profound. For example, if your child has a very severe stutter/stammer but is otherwise developing fine and has good skills all round, then I would recommend to look for an SLT who only specialises in stammering/stuttering, or has only a small range of other specialist areas related to stammering , such as speech and language delay.

      The reason is that it is a tall order for any professional to stay up to date with latest research, latest clinical developments and training for more than, say, five distinct areas of interest.

      However, a more generalist Speech therapist who has lots of experience in many different areas could be a very good option for your child or adult who has more general speech and language delay in a number of areas, perhaps a global delay or a syndrome which means that their learning is delayed in general. It also means that your child might benefit from a Generalist SLT because they have many more tools in their SLT bag and your child might need a variety of approaches for several areas.

      A good place to start is www.asltip.com which is the Association for Independent Speech and Language Therapists in the UK. Any SLT registered with ASLTIP will also be registered with the HCPC (Health Care Professionals Council), as well as RCSLT (Royal College of Speech and Language Therapists). These two important UK professional regulatory bodies ensure all its members are fully qualified, and are fully up to date with latest developments within their areas of work.

      Here you can enter your post code and look for a therapist near you and you can look for specific problems such as stammering for example and narrow down your search. Most therapists have a website which you can then access too. I would recommend you speak to a few therapists on your list and then go with the person you had the best rapport with. You and the therapist will be spending a lot of time together and you will need to feel that you trust them and that you can relax into the process.

      How I can help you:

      I have 3 main areas of specialism:

      Parent Child Interaction Coaching

      Parent Child Interaction Coaching

      This is an amazing way to help children with the following difficulties:

      • Social Communication Difficulties, Autistic Spectrum Disorders and
      • Speech and Language Delay – for children under the age of 4 years old, this is my preferred way of working because it is so very effective and proven to work. If your child is not developing words or not interacting, has reduced attention and listening and you feel is not progressing or, in fact even regressing, then this way of working is the best. For anyone wanting to read a bit more about the efficacy of this method, below are some research articles. You may also like to check out www.hanen.org which is the mainstay of my work and method when it comes to Parent-Interaction Coaching. You can also look at my latest blog, entitled: Tele-therapy, does it work?

      In brief, what’s so great about Parent Coaching is that it empowers you the parent to help your child in daily life! This is where speech, language and social communication develop typically, in a naturalistic way and environment. Simple steps and strategies are discussed and demonstrated every week and you are encouraged to use these strategies with your child in daily routines: getting dressed, having breakfast, on the school run, whilst out in the park or shopping or simply playing at home or having dinner or bath time. Whatever your family routine happens to be, every strategy I teach you will help create a responsive communication environment; generally, if your child is able to develop speech then they will do so in direct response to your changed interaction style.

      Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

      Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

      I love working with children of all ages on developing their speech sounds. Whether your child has a lisp, or a couple of tricky sounds they simply cannot produce quite right, or perhaps your child is really unintelligible because he/she is having lots of different sound errors, making it really hard to understand them. I typically work on getting “most bang for your buck” , meaning I address the sounds that cause the most problems and, therefore, when they are fixed your child/person’s speech becomes that much clearer fairly quickly.

      Feeding and Swallowing Difficulties

      Feeding and Swallowing Difficulties

      Having worked for over 20 years in NHS Child Development Clinics and Special Needs Schools I trained and worked with feeding and swallowing difficulties early on in my SLT career. I later trained as a Lactation Consultant and so I am well placed helping and support all types of Infant feeding, both breast or bottle, as well as toddler weaning. I aim to ensure that your little one swallows the right kind of foods and drinks for their abilities. I am experienced in managing and supporting children with physical needs and mobility problems, Cerebral Palsy, Down Syndrome or any other type of syndrome or presentation.

      What does a speech therapy session look like?

      All sessions differ slightly depending on the age of the child and the nature of the difficulties.

      However, mostly our sessions look like FUN! After arrival and washing hands we tend to start off with the tricky work straight away whilst our child still has energy and the will to engage. So, for speech work we will focus on the target sounds first: this could be sitting at a table doing work sheets together, playing games using the target sound and really any type of activity that gives us around 70-100 repeats of the target pattern. For example, a child who is working towards saying a ‘K’ at the end of the word I will try and get around 100 productions of words like: pack/sack/lick/ pick/bike/lake and so on.

      Then we often play a fun game where I might try for a ‘rhyming’ activity or other sound awareness type activities, for perhaps 10 minutes and within that time I aim to trial the next sound pattern we need to improve on; I will test which sound your child can do with help from me. During he last 10 minutes we might look at a book, again listening to and producing whatever sound we are working on. If I did not get 100 sounds earlier on in the session I will try and practice them now as part of the story. In total I aim to have about 40-45 minutes of activities, all aimed at the target sound we are working on.

      What does a Coaching session look like?

      During a Parent Coaching Session we meet online for about an hour and we discuss how the week has been for you trying out the strategies. Typically parents start off recalling what went well, what progress was made and what had been more tricky. We work through it all, and then follow on to the next strategies: I will show you examples and demonstrations of each strategy and I will get you to think about how you can use this with your child and in what situation you might use it. I will explain what we are doing and what the purpose is. You might want to write down what you are going to work on for the week. Over the course of about sessions we can cover all the major strategies that are proven to help kickstart spoken language and/or help your child to connect more with you. Through that connection spoken words most often develop.

      Research Papers on the Efficacy of Parent Child Interaction Coaching

      Research Papers on the Efficacy of Parent Child Interaction Coaching

      • The It Takes Two to Talk Program has been shown to be effective in changing how parents interact with their children, and that children’s communication and language skills improve as a result.
      • Baumwell, L.B., Tamis-LeMonda, C.S. & Bornstein, M.H. (1997). Maternal verbal sensitivity and child language comprehension. Infant Behavior and Development, 20(2), 247-258.
      • Beckwith, L. & Cohen, S.E. (1989). Maternal responsiveness with preterm infants and later competency. In M.H. Bornstein (Ed.). Maternal responsiveness: Characteristics and consequences: New directions for child development (pp. 75-87). San Francisco: Jossey Bass.
      • Bronfenbrenner, U. (1974). Is early intervention effective? (Publication No. (CDH) 74-25). Washington, DC: Department of Health, Education, and Welfare, Office of Child Development.
      • Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders, 53, 156-167.

      Sonja has been a real help for my 5 year old daughter. Due to her support, my daughter is now able to clearly and correctly enunciate ‘th’ ‘f’ and ’s’. She was also helpful in making positional changes to her seating to help her concentrate better and kept her engaged throughout all the lessons which is a feat in itself on zoom!

      Helen, Mother of Catherine Age 5.

      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.

    • ·

      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.

      0
    • · ·

      A helpful addition in my toolbox for lisp correction

      ByLondon Speech and Feeding

      Meet the MUPPY – a vestibular orthodontic plate

      I have become very well versed in Lisp Correction because so many children come to me with this problem! And I absolutely love lisp correction and Articulation Therapy! Please take a look at my blog on tips and tricks for correcting a lisp.

      The MUPPY

      Over the years I have created my unique style of remediating an Interdental Lisp and as part of my treatment I sometimes use an Orthodontic Tool, called the ‘MUPPY’, which I purchase directly from Germany. I first discovered it some years ago when working with a child with Down Syndrome. Back then I was searching for additional support with my student’s jaw grading and mouth closure difficulties and that’s when I first came across this little tool as recommended by one of my colleagues, a specialist orthodontist in Germany.

      I was a bit sceptical at first but I have used it now many times for three years on a variety of clients with varying degrees of lisps. I find it really helps together and in addition to all my other techniques which are language and motor based.

      How do I use it?

      The MUPPY is a custom-made mouth plate that gently repositions the tongue, encouraging correct tongue placement for clearer speech. It sits comfortably between the lips and teeth; a thin wire sits right behind the teeth, inside the oral cavity.

      The plate I like to use for lisp correction has a pearl in the middle. As soon as it is in situ the tongue starts fishing for the pearl and thereby keeps on moving up towards the correct place on the hard palate, just behind the front teeth. This is the place where the tongue tip needs to be for all the alveolar sounds our students find so hard to make.

      How does this help reduce a lisp?

      A lisp results mainly from incorrect tongue placement during sound production – though at times atypical dentition also contributes to the problem. Specifically, an interdental lisp occurs when the tongue protrudes between the teeth during the production of sounds like /S/ and /Z/. The tongue is often described by parents as ‘thrusting forward’ but I find that is rarely the case. Most often the tongue simply protrudes forward, which is different to tongue thrusting, a more forceful and involuntary movement. Most often I see a habitual tongue protrusion not only for /S/ and /Z/ but also for /T/, /D/, /L/ and /N/. Often /SH/ and ZH/ are also affected.

      To visualise this:

      1. A correct /S/ sound looks like this: The tongue tip is raised and touches the alveolar ridge (the bony, slightly uneven ridge behind the upper teeth). The sides of the tongue touch the upper molars.
      2. Interdental lisp: The tongue tip protrudes between the front teeth, creating a /TH/ sound.
      3. Lateral lisp: Here the mechanics of the tongue are different. But using the MUPPY can help here too. To visualise a lateral lisp, the sides of the tongue are not raised high enough, allowing air to escape over the sides. This results in a ‘slushy’ or ‘wet’ sound.

      Understanding the specific type of lisp is crucial for targeted therapy and successful correction.

      The Vestibular Plate (Muppy) HELPS to guide the tongue towards the right place from where we shape the NEW SOUND.

      Methods

      Most important to my articulation work re lisping are the motor- and language-based techniques I use, as broadly described below:

      • A thorough oral examination, tongue movements, lip closure, dentition, jaw grading, breath coordination, cheek tonicity, palatal form
      • Discussion on awareness and motivation of child to work on their speech
      • Contrasting sounds at the beginning and end of words: sing vs thing / sink vs think / mess vs mesh etc to raise awareness that it matters what sounds we use in speech and that just one sound can change the meaning of a word completely
      • Mirror work, pulling faces, moving our tongue voluntarily
      • Exploring the oral cavity and thinking about all the parts of the tongue and the palate
      • Finding the alveolar ridge and placing the tongue there at rest
      • Then working towards a good baseline of the other alveolar sounds: /T/ /D/ /L/ /N/ and from there we work towards our NEW /S/ SOUND.

      I use a variety of picture clues depending on what is most meaningful for my student:

      The child likes a train set, I use the TIRED TRAIN SOUND.

      The child knows about bike or car tyres, I use the FLAT TYRE SOUND.

      With a student who loves a balloon I might use the FLAT BALLOON SOUND.

      And we work our way from correct tongue placement to these long /SSSSSSSSS/ sounds with the help of these visual cues, but also gestural and hand cues such as Jane Passy’s Cued Articulation sound for /S/.

      I really love helping children correct their speech sound, be it an articulatory difficulty like the lisp or a phonological difficulty such as ‘fronting’ or ‘gliding’ and I also love working with motor-based speech difficulties we see in Childhood Apraxia of Speech. Feel invited to get in touch if your child needs help in these areas.

      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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      Discover more about Verbal Dyspraxia

      ByLondon Speech and Feeding

      What is Verbal Dyspraxia?

      Apraxia or dyspraxia is a difficulty in motor planning, which sometimes can be seen in both gross and fine motor skills, as well as speech. Gross motor refers to difficulties in coordinating the whole body (e.g., bumping into things frequently, often falling over hurting themselves or others through being “clumsy” or unsteady). Fine motor movements refer to smaller, more precise movements (e.g., difficulties doing anything with their hands such as holding a spoon or pen).

      Verbal dyspraxia

      In Dyspraxia of Speech, instead of seeing a coordinated smooth way of talking, we see the articulators (tongue, lips, cheeks) and voice coordinating very smoothly. The voice can be very quiet or very loud. Muscle tone can be weaker at times. Speech sounds are very unintelligible, with a flat voice that can sound forced. It may be that the timings of verbalisation appear random and that children can say a certain word once and never again. This is often what we hear from parents.

      It is interesting to note that many of our autistic clients are either non-speaking or are reluctant speakers. Sometimes they say a word once and then never again. Others say lots of words but the words are very hard to make out. Did you know that about 40% of autistic people have verbal dyspraxia? (Richard, 1997). Because the problem is one of motor planning, not of automatic motor execution, once a plan has become automatic, it is easier to get back to it and this is why we often see repetitive patterns that can be called ‘stims’ (Marge Blanc, 2004).

      How can Speech and Language Therapy help?

      Children with verbal dyspraxia can make great progress!

      We provide frequent and appropriate speech movement opportunities and with time and the right support, children will move forward and begin to speak more fluently and with greater intelligibility. It is important to know this can take time.

      We provide Oral Motor Therapy using a variety of approaches to practise breathing, vocalising on the outbreath, and sequencing our speech movements.

      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).

      We offer shared enjoyment, and laughter. This helps a child find their voice. Other ways of finding our voices include singing or humming, or even yelling/shouting!

      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.

      For more tips and support, please get in touch!

      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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      Strategies to support children with eating difficulties

      ByLondon Speech and Feeding

      where the cause is NOT a swallowing problem, but we are having a “fussy eater” in the family, seeming for no obvious reason

      When parents have a child who find mealtimes or eating difficult, it can put pressure on the whole family dynamics. Once we have observed a child’s eating and drinking skills and found that they are not swallowing impaired, but are for want of a better word “fussy” or “picky”, we can then start to look at what might be underpinning the food aversions/picky eating/food avoidance. Two of the main questions parents have (of course) are:

      • ‘is my child getting the right nutrition?’
      • ‘how can I have less anxiety-provoking and stressful mealtimes?’

      We all tend to have an image in our minds about the ‘perfect mealtime’, and how mealtimes ‘should’ be. Speech and Language Therapists with a Feeding Specialism are the perfect professionals to help you unpick feeding issues. We are trained to look at swallowing and oral skills and we also know a lot about feeding behaviours and sensory difficulties which could be causing your child’s eating avoidance.

      Here are some strategies that can support children with their eating:

      1. Create and maintain a mealtime culture that suits your home and lifestyle. Then stick to that. We all need some routine in our lives to thrive. Mealtimes are no different. It might be that you eat in the same place for every meal, with the same knives and forks, concentrating on maintaining good posture. Children learn by repetition so the more familiar it is, the easier they will find it. In the physical sense, our bodies also need preparing for food, regardless of whether we are eating with our mouths or we are tube-fed. We want every child to connect all the dots of the process. It starts with their eyes, noses, expectations, memories of past experiences, feelings and then finally their mouths….
      2. Be an excellent role model. Children learn through watching others, so your child will be observing you without you knowing. Ensure that you are positive about the food you are all eating, and talk about how delicious, tasty, juicy, and yummy the foods are. Make the atmosphere around the dinner table light hearted. Even though you are secretly stressed about your child not eating, try and not show this. Instead pick a topic or put on some nice music, or talk about something your child might be interested in, and try and avoid coercing your child to eat. Leave small finger foods on their plates and have a range of foods available on the table so that your child can see that everyone is eating a range of foods and enjoying them.
      3. Use positive reinforcement. Try and think of mealtimes as fun and motivating. Children who are happy will likely be more inclined to try foods and take part in family mealtimes. Reward all interactions around food, so if your child merely touches a new food then praise this behaviour. Or if your child licks a food just once, again make a nice comment and praise your child for touching and licking the food. The takeaway here is to try and keep all messages positive around food.
      4. Keep offering all types of food. What often happens is that parents stop serving foods they know will not be eaten. This makes sense in a way; we don’t want wastage! However, try and keep the doors open and re-offer all types of foods, even the ones that your child has not wanted in the past. Try and give your child one food they will like and one food they have tasted before and liked before, even a little, and then one new food to try. So, your child always has something to fall back on and they can join in with eating. But they can also try (or at least look at and think about trying) other foods that you and perhaps the siblings are eating.

      Take a look at this website, I find it very helpful in showing parents what types of foods and how big a portion to offer

      Have a go and try and implement some of the ideas above, and should you get stuck please get in touch!

      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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