How do we know our Gestalt Learner is moving to Stage 2?

ByLondon Speech and Feeding
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Image by Freepik

Is our student ready to move to NLA 2 (Natural Language Acquisition stage 2)?

We know that the GLP (Gestalt Language Processor) will move into the next stage when they are ready. But are they now ready you might think? When are they ready? How do I know? If you are not sure whether your child is ready to move forward then go and see your GLP trained Speech Therapist. Together you can work out what the next steps are and how to help your child settle into NLA 2. It’s very exciting!!

Tip

The first useful tip: keep a language sample of phrases your child says. This is very helpful!

You might want to check with your Speech Therapist and offer some language sampling you have taken so they can help you figure out where your child is currently. Always keep an Utterance Journal that you can share with your Speech Therapist and with others who look after your child.

Basically, we want to listen out for phrases our child says that you or nursery don’t say routinely; that way you can presume that this is not an echo but a mixing together of two chunks of gestalts. Watch out for those coco melon phrases though: double check it really isn’t an NLA 1 gestalt that is copied verbatim from a favourite you tube video.

You can best support your child best by listening, and thus figuring out what your child is TRYING TO SAY. Often your child might skip over the parts of gestalts they don’t want to say. This is common in older kids who have long gestalts, sometimes even whole episodes or whole stories!

Try and tease out their shorter mitigations and then focus on practicing and modelling those as they are so much more useful!

So back to our question: are they ready?

Are their gestalts covering a variety of situations and contexts?

Make a note in your journal to see what the backgrounds are to each phrase you ear, so for example:

  • Transitioning: ‘it’s time for the park’ ‘what’s next’ ‘shoes on’
  • Bed Time: ‘we need to wash’ ‘let’s get in (bath/bed)’ ‘ready for our book’
  • Toilet/nappy: ‘we need the potty’ ‘where’s the potty’ ‘let’s wash hands’
  • Mealtime: ‘time to eat’ ‘go get a spoon’ ‘yummy num num’
  • Park/going out: ‘look at the squirrel’ ‘funny doggy’ ‘I wanna swing’
  • At the shops: ‘let’s get the trolley’ ‘lots of veggies’ ‘no tomatoes’ ‘ooh long queue’ ‘back to the car’

And… does the child use the phrases for a variety of functions?

  • labelling
  • providing information
  • calling out
  • affirming
  • requesting
  • protesting
  • directing

We need to offer lots of similar language models so that in their own time our children can extract/mitigate useful phrases for what they want to express. The more similar utterances a child hears around him the more he/she can discover the communalities. Once the child has a small range of phrases, he/she can mix them up and create semi-original own phrases.

If the answer is YES!! our child has perhaps not all but a range of functions and a range of situations where they use a variety of easily mitigable gestalts then yes they are ready for moving to stage 2 of NLA!

Hurrah!

Keeping a journal of what your child is saying and in what circumstance is crucial to help with our ongoing detective work!

Next time I will be looking at how we can help our NLA 2 GLP produce even more of their own mix and match phrases.

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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  • · ·

    Living life with a lisp

    ByLondon Speech and Feeding

    You may be questioning ‘will my child grow out of having a lisp?’ There are so many myths out there that it’s sometimes difficult to find your way out of a complex maze of information.

    The good news: lisps can be successfully treated by a Speech and Language Therapist and the earlier it’s resolved, the better. We know from the evidence base that some children’s lisps will resolve and, as always, it is completely age appropriate to have this speech pattern up until aged 4 ½.

    As with any speech and language targets your child will need to be motivated to practise their newly acquired techniques, at home and in other settings. They will eventually be able to generalise this skill, but it takes lots of practice. So, think carefully about if your child is ready and motivated before commencing Speech and Language Therapy.

    There are essentially two ways in which your child has acquired a lisp. It’s key here to mention that parents have no blame in this.

    1. They’ve mis-learned it and now incorrect production has become a habit
    2. Children have difficulties organising the sounds to make a clear production

    You may be surprised to realise that there are different types of lisps. But all the techniques will be the same.

    1. Interdental lisp

    When your child pushes their tongue too far forward, they will make a /th/ sound instead of /s/ and /z/

    1. Dental lisp

    This is where your child’s tongue pushes against their teeth

    1. Lateral lisp

    Air comes over the top of the tongue and down the sides

    1. Palatal lisp

    Your palate is the roof of your child’s mouth. Sometimes they will touch their palate when making certain sounds (e.g., /s/ and /z/)

    It’s useful for you to know what type of lisp your child has because you can then support them to make the correct production. You’ll be able to talk about where in the mouth their tongue is and where it needs to be to produce a clear sound. Your Speech and Language Therapist will be able to help you with this.

    Top therapy tips for lisps

    1. Awareness is key. Does your child know where their tongue and teeth are (i.e., are they behind their teeth)? Do they notice the air escaping? Use a mirror so that your child can see not only themselves but also you in the mirror.
    2. Repetition! As with most therapeutic intervention, practice makes perfect. So little and often is key!
    3. Make sessions fun, perhaps around your child’s interests or allow them to drink from a straw
    4. Comment on how the sound is produced (e.g., /z/ is like a bee, /s/ is like a snake)
    5. Use tactile cues. Your child’s vocal folds vibrate when they produce a sound like /z/ but not with /s/. You could use the words ‘loud’ and ‘quiet’ to describe this.
    6. Start with a /t/ sound and gradually elongate the sound to an /s/

    Having a lisp may not be problematic for some, but for other children, it can have a significant impact on their emotional wellbeing. Intervening at an early age can prevent this from happening. We always advocate for early intervention!

    Contact Sonja for support on resolving your child’s lisp.

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

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

    ByLondon Speech and Feeding

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

    Why is the /R/ so difficult?

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

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

    The importance of tongue placement

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

    Speech therapy techniques: Focusing on the tongue

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

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

    Tips for Parents:

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

    In conclusion:

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

    I hope this blog post is helpful!

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

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

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  • Quick Overview Of How To Implement Those Early Hanen Speech And Language Strategies

    ByLondon Speech and Feeding
    Quick Overview Of How To Implement Those Early Hanen Speech And Language Strategies

    First up try and get down at eye level or Face-to-Face with your child

    Try to sit so that your child can see you easily, i. e. your child does not have to look up to make eye contact with you. We call that Face to Face: try and sit opposite your child. This makes it easier for you to see facial expressions and therefore pick up nonverbal /pre-verbal communication. Now you can connect and share the moment with your child.

    OWL (Observe, Wait and Listen)

    Never skip this step as it prepares us for what happens next !

    Observe

    First, try and simply watch your child quietly and listen and observe what he/she says or does; you need to know what your little one is interested in. For example with this toy (pictured below) we could observe that your child loves the actual spinning of the marble, perhaps more than that noisy click-clacking down the run. Or perhaps he loves collecting the marble at the end and feeling it in his hand.

    You could start off with showing once how the marble goes down and say:“ look it goes round and round !” Then hold back and observe, without speaking, so that your child has time to explore the toy.

    Wait

    Just sit and avoid telling or showing your child what he or she could do with the toy. This gives your child an opportunity to explore and experiment.

    Listen

    Listen to what your child says, or look at your child’s non-verbal communication without interrupting. Your child will now feel and know that you are really present and that what they have to say is important. It’s best to avoid questions like, “What are you doing or “What’s this?” as that might be a lot of pressure when they don’t know what to say about that yet.

    Respond immediately by showing interest

    Once you have all the information from OWLing you can respond in the right way, for example: if she catches the marble at the end of the run and looks up with a smile or a sound you could respond with: you’ve got it! One marble in your hand! Nice playing!

    Now how to join in the play:

    First you can copy what your child is doing

    If your child puts the first marble at the top of the run you can take a turn and do exactly the same once his marble is done. Ideally you might have another marble run, perhaps a similar one, it does not have to be exactly the same! Once your child has put the first marble in you can do the exact same with your own marble on your run. Your child is likely to look at what you are doing and you might well see a smile on their face or perhaps she might say: look at mine!

    Next you can build on that

    You can respond with simple comments like: “Wow! Yes I am looking at yours now! It’s spinning on the red one lots! I love the noise!” Now wait once more to see what your child says or does.

    To summarise

    We are signalling to our child that we are really interested in what they are doing and saying so we can “collect” our child, i.e. bring him/her back into a joint interaction.

    Important

    We want to try and not direct our child but respond with interest and fun! This creates a lovely stage for interaction and joint play! And this leads in turn to practising conversation and ever more opportunities for great speech and language skills to emerge.

    Great activities we use in Speech and Language Therapy:

    • Any cause and effect toys like this Marble Run
    • Creative activities, such as mark making with crayons
    • Train tracks (building and running the trains)

    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.

  • · ·

    AAC Systems and Speech and Language Development

    ByLondon Speech and Feeding

    Introduction

    I see a lot of minimally speaking or non-verbal children in my practice. Some children are autistic and others are severely challenged with motor planning and some are both. Some children are simply delayed in their spoken language for reasons that we don’t quite know yet.

    Regardless of the causes, what is always apparent pretty quickly is that apart from the odd gestures or Makaton signs (mainly ‘more” ‘finished’ and “biscuit) we don’t have a robust alternative for speech in place. Instead, what we often have is a child with lots of frustration and tantrums and some behaviours we really don’t want like: hitting, biting, pushing, grabbing and often throwing… There are others, too many to mention, but we don’t enjoy watching our children in these states. And we are often fearful of what might happen next if we don’t find a way to calm our child.

    Fear not

    In my work, before I get to offer an alternative means of communication, I often have to work with a fair amount of resistance on the parents’ side as parents tend to feel that allowing such a system into their lives will prevent their child from speaking. They fear that their child will so enjoy pressing those buttons that they will become lazy and not talk at all.

    I totally get it!

    Parents often feel overwhelmed by the task of getting their own heads round how to use AAC, either in paper form or a computerised system. This can be a great turn-off for lots of people who feel they are not very “techy” – like myself actually! Indeed, it is true to say that I resisted operating in this field for a long time as I didn’t feel able to navigate electronic devices. But fear not. Truly, most systems are very user-friendly. The support is great. And I have managed to become quite proficient in one or two of these systems, through using it daily. It really is as simple as that.

    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.

    Many children and adults, for many reasons, were never going to speak an awful lot, or with great difficulty. Or they were not going to like to speak. Or they were going to like to speak some times but not other times… And for all those people an AAC system is invaluable and a wonderful resource.

    Neuro-diversity affirming means that we do not impose one system of communication on our children (speaking with our mouth) only because it is the one we are using and most people we know too.

    Of course, we want the best for our children, and we want them to have the easiest and most straight forward existence on Earth. Of course we do. Speaking with our mouth does help with that. But we must come to understand that not all children and people feel like that and they struggle to use their mouth for talking.

    Personal experience

    I have difficulties understanding this myself, I will be very honest here. And I will say that – shoot me down in flames SLT fraternity – but I am learning to accept that using an AAC system proficiently is a very good alternative for when speech is not coming. I am learning to accept that some people are perfectly able to speak, and might do so but not always and only when conditions are right. I came into the profession as a speech therapist with the idea that I would help anybody that came to me to speak with their mouth. But I have changed my stance on that and now am happy to help anybody that comes to me to communicate most effectively with whatever works for them. I will always try for speech if I can … Just because it’s easiest!

    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?

    The basic premise is this: accept any mode of communication as valid, as long as your communication partner understands what it means. Don’t require individuals to repeat themselves in another modality. Do model the response in the modality you are trying to teach. So, a child can point to a symbol and I will respond with speaking (with my mouth) but I will also respond by pointing to a symbol because that way I am signalling that both are ok and that I have understood and am encouraging the person to say some more.

    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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  • · ·

    Great toys and books for our toddlers (around 1–2 years old)

    ByLondon Speech and Feeding

    As a speech and language therapist, I often get asked by parents what toys and books they should buy for their toddlers. It can feel overwhelming with so many options available! So, I’ve put together a list based on my experience and what I’ve found works well.

    Remember, every child is unique!

    Observe your toddler’s interests and play style. Some toys that are popular might not be engaging for your child.

    Here are a few ideas to get you started:

    Sensory Toys:

    • Stacking cups: These are fantastic for developing hand-eye coordination, fine motor skills, and understanding size relationships. (Various brands available) Note: You can stack many things you have around the house, like bowls or measuring cups, for a similar experience!
    • Shape sorters: Help with shape recognition, hand-eye coordination, and problem-solving. (Melissa & Doug, Vtech)
    • Sensory balls: Balls with different textures (soft, bumpy, squishy) provide tactile stimulation. (Various brands)
    • Push and pull toys: Encourage gross motor development and exploration. (Vtech, Fisher-Price)

    Communication-focused toys:

    • Picture books with flaps: Engage curiosity and encourage language development. (Various brands)
    • Talking toys: Introduce new vocabulary and encourage imitation. (Vtech, Fisher-Price)
    • Simple puzzles: Develop hand-eye coordination, problem-solving, and spatial awareness. (Melissa & Doug, Ravensburger)
    • Musical instruments: Encourage exploration of sounds and develop auditory skills. (Bright Starts, Fisher-Price)

    Now, let’s talk about books:

    • The Very Hungry Caterpillar by Eric Carle: A classic with repetitive text and vibrant illustrations, great for introducing vocabulary and concepts like days of the week.
    • Brown Bear, Brown Bear, What Do You See? by Bill Martin Jr. and Eric Carle: Simple, repetitive text and engaging illustrations make this a favourite for many toddlers.
    • Goodnight Moon by Margaret Wise Brown: A soothing bedtime story with calming illustrations.
    • Pat the Bunny by Dorothy Kunhardt: An interactive book with textures and flaps to engage young children.
    • Corduroy by Don Freeman: A heartwarming story about a teddy bear who loses his button.

    Remember:

    • Observe your child’s interests: Choose toys and books that capture their attention and encourage exploration.
    • Engage with your child: Play with the toys together and read books aloud with enthusiasm.
    • Keep it simple: Start with a few toys and books and gradually introduce new ones.
    • Rotate toys: Keep playtime fresh by rotating toys and books regularly.
    • Most importantly, have fun! Reading and playing with your child should be a joyful experience for both of you.

    Also consider the power of open-ended play

    In today’s world filled with electronic gadgets, it’s easy to overlook the value of open-ended play. Open-ended toys lack specific functions or prescribed outcomes, allowing children to use their imaginations to explore and create. Unlike toys with pre-determined ways to play, open-ended toys encourage:

    • Creative thinking: Children can use them in countless ways, developing their own rules and narratives. A block can become a car, a house, or a spaceship, depending on the child’s imagination.
    • Problem-solving skills: Children learn to figure out how to use the toys, experimenting and adapting as they go. Don’t immediately rush in and fix things for your little one, let them think for themselves and then communication incentive: let them come and find you!
    • Fine motor skills: Many open-ended toys, like blocks, encourage the development of fine motor skills like grasping, stacking, and building.
    • Cognitive development: Children learn about cause and effect, spatial relationships, and problem-solving as they play with open-ended toys.
    • Social-emotional development: Open-ended play can foster social interaction and cooperation as children play together and share ideas.

    Simple toys with big impact

    Some of the best toys for toddlers are often the simplest ones. Here are a few examples:

    • Wooden blocks: Building towers, bridges, and forts encourages creativity and problem-solving.
    • Balls: Throwing, kicking, and rolling balls promote gross motor skills and hand-eye coordination.
    • Fabric: Bits of fabric can be draped, draped, and used for imaginative play.
    • Empty boxes: From cardboard boxes to tissue boxes, these can be transformed into anything a child can imagine: a car, a house, a spaceship!
    • Natural materials: Sticks, leaves, pinecones, and rocks can be used for imaginative play and sensory exploration.

    Remember, the key to open-ended play is to let children explore and discover

    Step back and observe, allowing your child to use his or her imaginations without too much direction. You might be surprised at the creative ways he or she uses simple toys!

    Happy play times with your little one!

    Contact me via my contact form.

    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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  • ·

    There is more than one way to model communication: Using speech prompts, signs, and AAC together in therapy

    ByLondon Speech and Feeding

    One of the most important things I have learned as a paediatric speech and language therapist is this:

    Children do not all learn communication in the same way.

    Some children learn best through listening.
    Some need visual support.
    Some need movement and gesture.
    Some benefit from symbols or technology.
    And many children need multiple supports together before communication truly starts to develop.

    That is why flexible, responsive therapy matters so much.

    In this short therapy clip, I model just two simple words:
    ‘Go’ and ‘Up’.

    But underneath those tiny moments is a combination of therapeutic strategies:

    • speech sound prompting
    • visual cueing
    • Makaton signing
    • AAC (Augmentative and Alternative Communication) modelling
    • repetition
    • motor planning support
    • language modelling
    • total communication principles.

    Communication is bigger than speech alone

    One of the biggest misconceptions about speech therapy is the idea that communication only ‘counts’ if a child says the word verbally.

    In reality, communication comes in many forms:

    • speech
    • gesture
    • facial expression
    • signing
    • pointing
    • symbols
    • body language
    • AAC.

    This is particularly true for children with:

    • developmental language disorder (DLD)
    • autism
    • motor speech difficulties
    • childhood apraxia of speech (CAS)
    • phonological difficulties
    • global developmental delay
    • complex communication needs.

    These children often need communication to be presented through multiple pathways at once.

    That is where total communication approaches become so powerful.

    This is important to know: this does not confuse children. In fact, for many children, it does the opposite. It creates clarity.

    Careful sound prompting helps bridge that gap.

    Research and clinical experience consistently show that signs often support spoken language development rather than hinder it.

    Research suggests that learning signs alongside spoken language does not hinder speech development and may support overall language acquisition, communication confidence, and vocabulary growth in many children.

    For many children, signs actually help speech emerge because they:

    • reduce communication pressure
    • build confidence
    • strengthen understanding of words.

    A child who can successfully communicate is far more likely to keep attempting interaction.

    The power of AAC and LAMP Words for Life

    In the clip, I also model language using an electronic AAC system: LAMP Words for Life.

    AAC stands for Augmentative and Alternative Communication.

    AAC includes any tool that supports communication beyond speech alone, including:

    • picture systems
    • symbol boards
    • communication books
    • speech-generating devices.

    LAMP Words for Life is one of my favourite AAC systems because it focuses on consistent motor patterns and meaningful language development. Because communication is not about achieving perfection. It is about connection.

    And when children are given multiple ways to express themselves, they often become more confident, more engaged, and more willing to interact with the world around them.

    That is the true power of total communication therapy.

    Contact me via my contact form if you would like me to work with your child.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Reference

    Pontecorvo, Elana & Higgins, Michael & Mora, Joshua & Lieberman, Amy & Pyers, Jennie & Caselli, Naomi. (2023). Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language. Journal of Speech, Language, and Hearing Research. 66. 1291-1308. DOI 10.1044/2022_JSLHR-22-00505.

    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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