Echolalia is a term used when assessing or treating children with Autism. The term refers to the repetition or echoing of utterances, either our own or others’. It can also be echoing phrases heard on television, advertising jingles or catchy repeat phrases used in tv programmes or nursery rhymes and songs. Whilst we all use echolalia occasionally and it can be observed in typically developing children, we tend not to see/hear it beyond the age of 2.5 years old. Children with ASD, however, do use echolalia often into late childhood.
There are generally two types of Echolalia:
Immediate echolalia
Here the repeated phrases or words are produced immediately after someone has spoken the original words or within two conversational turns of the original utterance.
Delayed echolalia
The repeat echoing of the original utterance occurs sometime later, more than two conversational turns or with a much longer time delay. Due to the delay it can be hard to interpret the meaning of the echolalic utterance as it may refer to something that happened long ago and in a different context to the originally utterance.
(Stiegler, 2015, Fay 1967, Blanc 2014)
There are other unconventional speech behaviours which include:
Perseveration of Speech – persistent repetition of speech
Repetitive questioning – persisting even though answers were given
Vocalisations such as: humming, whistling, clicking, squealing etc.
Much research has gone into the meaning and treatment of Echolalia and the following list consists of possible functions that have been identified:
Information sharing
Responding to answers
Labelling
Drawing attention to self
Protesting
Requesting
Giving instructions
Self-regulation, calming
(Stiegler 2015, Prizant 1983)
Echolalia does have a function and is part of the Gestalt Learning Process (where longer units of speech are memorised and then used as a whole without the individual words being meaningful).
As a Speech and Language Therapist I promote sound and proven Intervention based on the Hanen Programme which helps provide a highly facilitative Interaction Style and I will tell you a bit more in my next blog how the “More Than Words” approach can help children with echolalia move through their Gestalt Learning into more analytic processing of language, grammar and meaning.
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.
As a speech and language therapist, one of the most common questions I hear from parents is:
‘They can talk, but their speech still sounds immature. Is this normal?’
Many children between the ages of three and seven use speech patterns that make their words sound different from adult speech. These patterns are known as phonological processes, and for younger children, they are a normal part of speech development.
However, when these processes persist beyond the expected age, they can start to affect clarity, confidence and learning, especially once children enter school.
Phonological processes are patterns of sound simplification that children use while their speech system is developing.
Instead of learning each sound one by one, children initially organise sounds into patterns that make speech easier to produce. This is a normal and efficient strategy for a developing brain.
For example:
saying ‘tar’ instead of ‘car’
saying ‘poon’ instead of ‘spoon’
saying ‘bud’ instead of ‘bus’
These are not ‘bad habits’. They are part of how speech develops.
The key question is how long these patterns last.
Common phonological processes (and when they usually disappear)
Below are some of the most common processes parents notice in 3–7-year-olds.
1. Final consonant deletion
Leaving off the last sound in a word
‘ca’ for cat, ‘da’ for dog
Typically resolved by 3–3½ years
2. Fronting
Replacing back sounds (k, g) with front sounds (t, d)
‘tar’ for car, ‘do’ for go
Typically resolved by 3½–4 years
3. Cluster reduction
Omitting one sound in a consonant cluster
‘poon’ for spoon, ‘top’ for stop
Typically resolves by 4–5 years (some clusters slightly later)
4. Gliding
Replacing /R/ or /L/ with /W/ or /Y/
‘wabbit’ for rabbit, ‘yion’ for lion
Can be typical up to 5–6 years
5. Weak syllable deletion
Leaving out unstressed syllables
‘nana’ for banana
Usually resolved by 4 years
If these patterns continue past the expected age, speech can remain difficult to understand particularly for unfamiliar listeners such as teachers, peers, and also Auntie Karen or grandparents who visit once in a while.
Why phonological processes matter in school-age children
By the time children reach reception and Year 1, speech clarity becomes increasingly important.
Persistent phonological difficulties can affect:
being understood by teachers and peers
phonics and early reading
spelling
confidence in speaking
willingness to participate in class
Some children become aware that they ‘sound different’ and may speak less, avoid longer words, or become frustrated when misunderstood.
What’s the difference between a delay and a disorder?
This is an important distinction.
A phonological delay means a child is following the normal pattern of development, just more slowly.
A phonological disorder means the child is using atypical patterns, or continuing age-expected patterns well beyond when they should have resolved.
You may want to seek professional advice if your child:
is 3½ years or older and still hard to understand
is understood well by family but not by others
becomes frustrated or avoids talking
has difficulty with phonics or spelling
uses several phonological processes at once
has not made progress despite time and encouragement
Early support does not mean something is ‘wrong’. It simply helps speech development move forward more efficiently.Research consistently shows that unresolved phonological processes beyond the expected age can impact intelligibility, literacy and confidence (Dodd, 2014; Bowen, 2015).
How speech therapy helps phonological development
Phonological therapy is not about drilling individual sounds endlessly.
Instead, therapy focuses on:
helping children recognise sound patterns
building awareness of contrasts (e.g. ‘tar’ vs ‘car’)
practising speech in meaningful, playful ways
supporting generalisation so progress carries into everyday speech
For school-aged children, therapy is usually structured, motivating and highly targeted and progress can be very encouraging.
A final reassurance
Many children with phonological difficulties go on to develop clear, confident speech with the right support.
If you’re unsure whether your child’s speech is ‘just a phase’ or something that needs attention, a professional assessment can give clarity and peace of mind.
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.
This particular student has a mild motor planning difficulty and six weeks ago he came to me with a very strong lisp. In addition to the lisp he is struggling to produce a number of sounds, SH and L on its own and all the clusters (FL/BL/KL/PL) but also CH together with some vowel difficulties.
Here I use the ‘Flat Tyre’ Sound, to offer as an image for a new S sound and the ‘Tick Tock’ Sound for a new image of the T sound. Both cards are from the Bjorem Speech Sound Deck, which I love and use almost daily.
Gestural Cues
I like to use all the ‘cued articulation’ hand cues by Jane Passy for consonants and fricatives. Here we use our fingers and hand to illustrate what our tongue does, and we also show whether a sound is voiced or voiceless. When I use one finger it is voiceless (k/f/s/p) and when I use two fingers for the same cue it means that the voice needs to be turned on: (g/v/z/b/n/m). For vowels I like to use Pam Marshalla’s cue system.
Simultaneous production
We say the word together.
Direct imitation
I say the word and my student copies me directly.
Imitation after a delay
I say the word and then after a little wait my student says the word.
Spontaneous production
My student has now learned to say the word by him/herself.
Offering feedback
It sounds like… I just heard… I didn’t hear the first sound there? Can you try again?
Letting the student reflect
By just shaking my head or by looking quizzical so that my student realises something didn’t quite go right.
Postitive reinforcement
‘Yes that was it, do it again, nice one…’
Cognitive reframing
This is a technique where we identify different semantic cues and metaphors or imagery cues, so instead of teaching or focusing on a sound we try out viewing each syllable from a different point of view.
For example: ‘yellow’. I have had great success with this one: we start with just saying ‘yeah yeah yeah’. I might make a little joke and say something like ‘imagine your mum says tidy your bedroom, what do you say or what do you think?’ Answer: ‘yeah yeah yeah’. Then we practice ‘low’ together, I might blow some bubbles high and low and we talk about ‘low’. And then we put ‘Yeah’ and ‘Low’ together and now we have YELLOW!! It might at first still sound a bit odd, like ‘yea-low’ but we soon shape that up and have the real word.
Each student is different and having a great rapport is crucial to our success.
Then a little game break after some 7–10 or so repetitions and always trying to finish on a positive note.
What game breaks do I use:
Very quick ones! Students can post something, place a counter in a game, take out a Jenga block from the tower, pop in a counter for ‘connect 4’, stick a sword into the Pop the Pirate barrel or add a couple of Lego blocks to something they are building.
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.
We all have the right and want to express thoughts, feelings, and needs. For non-speaking or minimally speaking children, finding an avenue to communicate effectively can be a challenging journey. Parents are often at a loss as to where to start. Sometimes a little bit of Makaton signing has been used here and there but we mostly find that gradually signing fades as parents feel that it just doesn’t seem to get copied and used by the children.
They live and breathe their system
This is where we need to pick up the pieces and start again: because all successful families where children start using their boards or their electronic AAC (Augmentative and Alternative Communication) systems do this one thing: THEY LIVE AND BREATHE THEIR SYSTEM.
They have boards in every single room of the house;
They have a board in the car, attached to the side of car door so their child can point to it as they need to;
They have a smaller board in their handbag/rucksack when out and about;
They have a board for shopping and attach it to the shopping trolley;
They are never ever without their board.
Because they realise that a child should never be without their mouths to speak, should never be without a means to speak. They use their own board to model and the child has always access to their board to model back or to just look.
This is where success begins
Success begins at consistent and joyful use of the board/AAC system throughout the entire day. If we think about it, doesn’t it make sense? Of course, it does! We talk to our child for the first two years of their life continuously wherever we are and our child is continuously encouraged to use their mouths for talking in all situations.
Same goes for Signing: Makaton or any other sign system is a very powerful means to aid communication and I certainly advocate and use it in practice. Though much like words, signs are very elusive and temporary—as soon as the sign has been made it is gone and no longer present. Same with words of course. This can be difficult for people who need longer to process information.
The beauty of symbols or photographs is that they are permanent: they don’t vanish, they stay and with the core board they stay in the same place! This is very reassuring. We can learn where a symbol is and we can be assured that it will still be there the next time we look at the board.
It has 48 cells and we can see the most frequently used core words on here, words that we use 80% of the day when talking with our non-speaking/minimally speaking children, younger children and children with cognitive delay. We keep our sentences short and we say phrases pertaining to their daily lives;
Let’s GET your toy
PUT it here, PUT it away, PUT it IN
Let’s READ a book
UP you get
WANT some MORE?
That’s GOOD isn’t it?
Let’s OPEN the box and LOOK
And so on… All these phrases can be aided with the above board. Your child will learn OVER TIME and OVER CONTINUOUS USE where GET/PUT/MORE/WANT/IN—where these symbols are. For children who are slow to process this is so helpful, to have a visual representation of what has just been said. It aids understanding in the first place. Gradually as a child starts to copy they will point to powerful symbols themselves and if they want to speak they can also speak of course:
A child might point to WANT + MORE and then say with their mouths: BANANA!
Board examples
Here are some other boards I have made specifically for daily situations and preferences of some of my students. Here is one for toileting:
And another one:
These boards incorporate high-frequency and versatile words, enabling us to make little sentences.
Building Language and Literacy Skills
AAC Core Boards are not just tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-speaking children engage with words and symbols, reinforcing their understanding of language structure and grammar.
Over time they naturally absorb language patterns, laying the foundation for improved literacy skills.
Customisation for Individual Needs
Every non-speaking child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind. The boards can be adapted to include specific vocabulary relevant to the child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of the child’s personality and needs, making communication more engaging and effective.
Collaboration between AAC Core Boards and Speech Therapy
While AAC Core Boards are an incredible tool, they are only used effectively by the non-speaking child when the board is used BY ALL COMMUNICATION PARTNERS around the child.
Again, I know I am being repetitive here, but the board needs to be used and modelled by the adults constantly in the first place and for a period of time before we can expect our children to take an interest and use the boards themselves. Think how long it typically takes for a child to learn their first word: around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.
Collaborating with your child’s speech-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 implement them.
Conclusion
For non-speaking children, AAC Core Boards are bridges to their world.
These boards foster language development, social interaction, and personal expression. AAC Core Boards offer a beacon of hope, helping non-speaking children break through communication barriers and thrive in a world that is waiting to hear their voices. Boards are simple for anyone to use and understand. Have a go! You will be surprised how lovely it is to use a board with ease and once your child sees you do this, you have a chance for your child to start copying you…and express something! HOW ABOUT THAT! I look forward to hearing your stories!
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.
Spinning and swinging are often observed behaviours in autistic children. While these actions might seem repetitive or unusual to some, they serve crucial functions for these children. Understanding the underlying reasons for spinning and swinging can provide valuable insights into how to support autistic children and incorporate these activities into therapeutic settings.
Why do children spin?
Spinning is a common sensory-seeking activity in autistic children. Sensory seeking means that the child actively looks for sensory input to regulate their nervous system. Here’s why spinning can be beneficial:
Vestibular input: Spinning stimulates the vestibular system, which is located in the inner ear and is responsible for balance and spatial orientation. For children with sensory processing difficulties, spinning can provide essential sensory input.
Calming effect: For some children, spinning can be a self-regulating strategy. The rhythmic motion can help to calm the nervous system and reduce anxiety.
Sensory exploration: Spinning allows children to explore their sensory experiences. It can help them understand their bodies and how they move in space.
The allure of swinging
The rhythmic back-and-forth motion of a swing offers several benefits:
Vestibular input: Like spinning, swinging stimulates the vestibular system, helping to improve balance and coordination.
Proprioceptive input: Swinging provides proprioceptive input, which is the sense of where your body is in space. This information is crucial for motor planning and coordination.
Calming and organising: The rhythmic motion of swinging can have a calming effect on the nervous system, helping to regulate emotions and improve focus.
Social interaction: Swinging can be a shared experience, fostering social interaction and communication.
Facilitating communication: While swinging, children are so much more relaxed and open to communication. The rhythmic motion can also help facilitate singing, humming, listening to my singing, non-verbal communication for sure but also more verbal and mouth words can be heard from children on my swing. If nothing else, it is so fun and helps build trust and rapport between my child and me.
Therapeutic Activities Combining Spinning, Swinging, and Speech and Language Therapy
Here are some therapeutic techniques that I use at London Speech and Feeding to combine movement with speech and language development:
Swinging with verbal prompts: While the child is swinging, I provide simple verbal prompts such as ‘up’, ‘down’, ‘fast’, and ‘slow.’ This helps to develop receptive language skills and improve auditory processing.
Sensory-motor play: I like to combine swinging with tactile activities like playing with textured balls or bean bags. This can facilitate language development through descriptive language, words and scripts like: ‘that’s so soft’, ‘oooh tickle tickle tickle!’
Storytelling on the swing: Often I manage to create a story while the child is swinging. This can improve narrative skills, vocabulary, and imagination. Recently I did the ‘Tiger who came to tea’ story and each time the swing stopped the tiger came and ‘ate some more cakes’ and ‘tickled their tummy’ whilst eating. It may make not much sense but my child loved it and we had ‘more tiger eat more’.
Song and rhyme time: Often I sing the ‘rumble in the jungle’ song while swinging my child to enhance phonological awareness, rhythm, and timing.
Visual supports always help: I use LAMP Words for Life AAC support during swinging and show core words such as: ‘go’ / ‘stop’/ ‘more’ / ‘tickle tickle’ etc. #lampwordsforlife #aac
Movement-based activities: We can incorporate activities that require sequencing, such as imitating animal movements or following simple commands while swinging. This can improve motor planning and language comprehension.
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.
There’s been a long tradition with teaching staff and with Speech and Language Therapists working in schools that eye contact should be a goal. It is well known that Autistic individuals (whether that be children or adults) mostly avoid eye contact. Whilst it’s part of the way we communicate, it shouldn’t be used as a necessity for an individual who feels that it is uncomfortable. Whilst it does show that you’re listening and showing an interest, it’s not a fair expectation for neurodiverse children.
Autistic children can find making and maintaining eye contact physically and emotionally uncomfortable as well as unnatural. It adds an extra layer of stress and has been reported to increase distractions rather than reduce them. Children who engage in conversations in their own way (i.e., with reduced eye contact) are not shown to suffer with schooling, work, or social interaction.
By having fun through meaningful activities, I often experience that ‘BINGO’ moment (a phrase coined by Alex @meaningfulspeech) where the child is enjoying themselves and naturally makes eye contact. There is no demand on them, they are in a fun, engaging environment which suit their strengths and supports their needs.
Following this, I often reflect on this question ‘Should we make eye contact as a goal?’
It very much depends on the situation. If it places more demands on the child and becomes stressful. Then no. There are many strategies we can use which gain eye contact without placing extra demands on the child. We need to be mindful to adapt the environment and not place neurotypical expectations to meet the needs of neurodiverse children.
How can you encourage eye contact without demand?
If you’re using toys, try holding them up to your eye level.
You can adjust your position, try sitting face to face during play.
Always get down to your child’s level. This might mean that you lay on the floor if your child is positioned in this way.
During play, waiting is extremely powerful. Before a key part of the activity, wait and see if your child looks at you. Remember silence is golden!
The best way I find is: do something unusual during play. It might be that you spray shaving foam with the lid still on. Or you bring out a wow toy and make it spin/light up or make a noise. A balloon can be good – see video clip. Use the excitement of the activity, and wait to see if you achieve that ‘BINGO’ moment.
Create opportunities when there are no toys involved such as during ‘tickles’ or ‘hide and seek’. Autistic children find it difficult to shift their attention between a toy and an adult. So by removing one option, you’re setting them up to succeed.
Remember, it takes practice and time for you to develop these skills. Try one at a time and experiment, see which works best for your child. If you need speech, language or communication support or advice, I am always here to help.
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.
I had a mum ask me about Baby Led Weaning the other day. So I thought I would write a blog on all the useful questions she had and what we discussed as it may help lots of mums and dads out there.
As a Paediatric Feeding SLT, one of the exciting developments in recent years is the growing interest in baby-led weaning (BLW). This approach to introducing solids has gained significant traction, and for good reason. It empowers infants to take the lead in their feeding journey, fostering a positive relationship with food and supporting important developmental milestones.
What exactly is baby-led weaning?
At its core, baby-led weaning is about offering your baby appropriately sized and textured solid foods from the very beginning, allowing him or her to self-feed. Instead of spoon-feeding purées, you present whole, soft foods that your baby can grasp, bring to his or her mouth, and explore at his or her own pace. This means no mashing, no blending, and no forcing spoons into reluctant mouths. It’s a fun, messy, and intuitive process that is led by your baby’s natural instincts.
The genesis of baby-led weaning
‘Baby-led weaning’ was popularised by British health visitor Gill Rapley. In the early 2000s, Rapley observed that babies naturally develop the skills needed to self-feed and that traditional spoon-feeding might actually hinder this development. Her work, particularly her book Baby-Led Weaning: The Essential Guide to Introducing Solid Foods (co-authored with Tracey Murkett), published in 2008, brought BLW into the mainstream and provided a structured framework for parents. Her research and observations highlighted the benefits of trusting a baby’s innate ability to regulate his or her intake and explore different textures.
What’s the deal?
Implementing BLW is simpler than you might think, though it does require a shift in mindset. Here’s a breakdown of what it typically involves:
Readiness is key: The golden rule of BLW is to wait until your baby shows clear signs of readiness. This isn’t about age alone, but rather developmental milestones. Your baby should be at least six months old, able to sit unassisted, have good head and neck control, show an interest in food (e.g., reaching for yours), and have lost his or her tongue-thrust reflex (which pushes solids out of his or her mouth).
Offer finger foods: Start with soft, easily graspable foods cut into finger-sized sticks or spears. Think cooked sweet potato fries, steamed broccoli florets (soft enough to mash with gentle pressure), banana sticks, or avocado slices. The goal is for babies to be able to pick it up and get some into their mouth.
Embrace the mess: BLW is inherently messy, especially in the beginning. Food will be squished, dropped, and smeared. This is a crucial part of the learning process as babies explore textures, smells, and the properties of food. A wipeable mat under the highchair and a good bib are your best friends!
Observe, don’t interfere: Allow your baby to lead. He or she will decide what to eat, how much, and how quickly. Avoid putting food into his or her mouth or pressuring him or her to eat more. This respects his or her hunger and fullness cues, laying the foundation for healthy eating habits.
Continue breastmilk or formula: Until your baby is well-established on solids, breastmilk or formula remains his or her primary source of nutrition. Solids are for exploration, taste, and developing skills, gradually increasing in quantity over time.
The benefits of baby-led weaning
The advantages of BLW extend far beyond simply getting food into your baby. From a speech and feeding perspective, the benefits are compelling:
Develops oral motor skills: Chewing, gnawing, and manipulating various food textures are crucial for developing the muscles in the mouth, jaw, and tongue. This strengthens the oral motor skills necessary for speech development.
Enhances fine motor skills and hand-eye coordination: The act of grasping food, bringing it to the mouth, and coordinating these movements significantly refines fine motor skills and hand-eye coordination.
Promotes self-regulation and intuitive eating: By allowing babies to control their intake, BLW helps them tune into their own hunger and fullness cues, fostering a healthy relationship with food and reducing the likelihood of overeating.
Encourages adventurous eating: Exposure to a wide variety of tastes and textures from the outset can lead to less picky eating later. Babies are more likely to accept new foods when they have been in control of their exploration.
Facilitates family mealtimes: BLW integrates babies into family mealtimes from an early age, promoting social interaction and making mealtime a shared, enjoyable experience.
When is baby-led weaning appropriate, and when not?
While BLW offers numerous benefits, it’s not a one-size-fits-all approach.
When BLW is appropriate:
When your baby meets all the developmental readiness signs: This is paramount for safety and success.
When you are comfortable with the mess and the learning curve: It requires patience and a relaxed attitude.
When you are committed to offering a variety of safe, appropriate foods.
When you are willing to learn about and practise safe food preparation to minimise choking hazards.
When BLW might not be appropriate (or requires extra caution and professional guidance):
If your baby has a history of prematurity or significant developmental delays: His or her oral motor skills might not be sufficiently developed.
If your baby has certain medical conditions or anatomical differences (e.g., cleft palate, severe reflux, swallowing difficulties): These may necessitate a modified approach to feeding.
If there are significant feeding difficulties, aversion, or a history of choking incidents.
If you feel overly anxious about choking: While BLW, when done correctly, is not associated with a higher choking risk than traditional weaning, parental anxiety can impact the feeding experience. Education and consultation with a professional can help alleviate these concerns.
A note on safety: Choking hazards
It’s crucial to understand the difference between gagging and choking. Gagging is a natural reflex that helps prevent choking and is very common in BLW as babies learn to manage food in their mouths. Choking is silent and serious. To minimise choking risks:
Always supervise your baby closely during mealtimes.
Offer appropriately sized and textured foods. Avoid small, round, hard foods like whole grapes, nuts, popcorn, and large chunks of meat.
Ensure your baby is sitting upright and calm.
Educate yourself on infant CPR.
Final thoughts
Baby-led weaning is a wonderfully empowering approach that celebrates a baby’s natural abilities and fosters a positive and independent relationship with food. As Speech and Language Therapists we often see the positive impact it has on oral motor development, self-regulation, and overall feeding confidence. By understanding what it entails, when it’s appropriate, and prioritising safety, you can embark on this exciting journey with your little one, helping him or her become a confident and capable eater from the very first bite.
If you would like help and support with weaning your baby whilst continuing to breastfeed then please get in touch!
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of 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.
