What is Total Communication, and why your child might need it more than just speech

Sonja smiling

When a child’s speech is difficult to understand, it can feel overwhelming for everyone involved. As a parent, your instinct is often to focus on helping your child ‘talk properly’. And that makes complete sense. Speech is important. But here’s the key message I want to share with you:

Speech is just one way to communicate.

And when speech is not yet clear, not yet reliable, or not yet available, children need other ways to get their message across.

This is where Total Communication comes in.

What is Total Communication?

Total Communication is an approach that encourages the use of all available ways to communicate, not just speech.

This can include:

  • spoken words
  • gestures and pointing
  • facial expressions
  • signing (such as Makaton)
  • pictures or symbols
  • drawing
  • electronic AAC (Augmentative and Alternative Communication), such as apps like LAMP Words for Life

It’s not about replacing speech. It’s about supporting communication in every possible way.

Think of it like this: if speech is currently unclear or limited, why restrict a child to the hardest route? Why not give them more tools to succeed?

‘But won’t this stop my child from talking?’

This is one of the most common concerns I hear in clinic.

Parents often worry that if a child starts using signs or a communication device, they will become ‘dependent’ on it and stop trying to talk.

The research tells us something very different.

Studies consistently show that AAC does not prevent speech development. In fact, it often supports it.

  • A review by Millar, Light & Schlosser (2006) found that AAC interventions do not reduce speech production and may actually increase it.
  • Romski & Sevcik (2005) demonstrated that children given AAC often develop stronger overall communication skills, including spoken language.
  • More recent work continues to show that providing AAC early can accelerate language development, not delay it.

So rather than ‘giving up on speech’, using AAC is actually building the foundations that speech needs.

Why Total Communication matters, especially for unintelligible children

When a child is very difficult to understand, they are often experiencing a hidden frustration:

‘I know what I want to say, but no one understands me.’

Over time, this can lead to:

  • reduced confidence
  • behavioural frustration
  • withdrawal from communication
  • fewer opportunities to practise language

If a child cannot successfully communicate, they communicate less. And when they communicate less, their language development slows down.

Total Communication breaks this cycle.

By giving a child reliable ways to be understood, we:

  • reduce frustration
  • increase interaction
  • build confidence
  • create more opportunities for language learning

And importantly, we allow them to show us what they already know.

AAC is a bridge, not a barrier

Using AAC (whether that’s pointing to pictures, signing, or using a device) does something powerful:

It separates language from speech.

A child might have lots of ideas, vocabulary, and understanding but their speech system (especially in cases like phonological disorder or childhood apraxia of speech) cannot yet keep up.

AAC allows the child to:

  • express complex ideas now
  • practise sentence structure
  • develop vocabulary
  • take part in conversations

All while their speech is still developing.

In other words, AAC doesn’t replace speech. It keeps language moving forward while speech catches up.

What does this look like in real life?

In therapy, I often use a combination of approaches:

  • modelling simple signs alongside speech
  • pointing to symbols while talking
  • encouraging children to gesture or show
  • using drawings to support understanding
  • incorporating an AAC device such as LAMP Words for Life

You might see a child:

  • say part of a word
  • point to a symbol
  • use a gesture
  • and look at you expectantly

That is communication success.

And success builds motivation.

‘I just want them to talk’

Of course you do. And I do too!! That’s always the goal.

But here’s the important shift in thinking:

Children learn to talk by communicating, not by waiting until speech is perfect.

If we hold out for clear speech before allowing other communication methods, we risk:

  • limiting their ability to interact
  • reducing practice opportunities
  • increasing frustration

But if we support all communication, we give them:

  • more chances to express themselves
  • more positive communication experiences
  • more input and feedback

And that is what drives progress.

A balanced approach

Total Communication doesn’t mean ‘speech is no longer important’.

It means:

  • we continue targeted speech therapy
  • we work on sounds and clarity
  • and we support communication in the meantime

It’s not either/or.

It’s both/and.

Final thought

If your child’s speech is difficult to understand, the most important question is not:

‘Are they talking clearly yet?’

It’s:

‘Can they successfully communicate?’

Because communication is the foundation of:

  • relationships
  • learning
  • confidence
  • wellbeing

And every child deserves a voice, in whatever form that voice takes right now.

Feel free to contact me if your child needs help with speech and communication.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

References (parent-friendly):


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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    Example on how to use AAC at story time

    Feel free to contact me if you need help with your child.

    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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    • Sensory sensitivities: Heightened sensitivity to taste, smell, texture, or appearance of food.
    • Lack of interest in eating: May show little interest in food or mealtimes.

    2. Seek professional guidance:

    • Paediatrician and/or gastroenterologist: Rule out any underlying medical conditions.
    • Registered dietitian: Assess nutritional needs and create a balanced meal plan.
    • Speech and language therapist (SLT): If oral-motor skills or sensory sensitivities are contributing to feeding difficulties.
    • Occupational therapist (OT): If sensory processing challenges are affecting mealtime behaviours.
    • Child psychologist: If anxiety or emotional factors are contributing to ARFID.

    3. Strategies for introducing solids:

    • Start small: Introduce one new food at a time, in small amounts, alongside familiar favourites.
    • Patience is key: It can take multiple exposures (up to 10–15 times!) for a child to accept a new food. Don’t give up!
    • Positive reinforcement: Praise and encouragement for any interaction with the new food, even just touching or smelling it.
    • No pressure: Avoid forcing or pressuring the child to eat. This can create negative associations with food.
    • Make it fun: Present food in playful ways, use cookie cutters for fun shapes, or involve the child in food preparation.
    • Sensory exploration: Encourage exploration of food through touch, smell, and sight before tasting.
    • Role modelling: Show the child that you enjoy eating a variety of foods.
    • Use fun utensils: your child might like characters from ‘Frozen’ or ‘Dinosaurs’ or ‘Diggers’ there are a host of character-based cutlery and cups/plates to be had. Also, I really rate these two items very highly they are so good so I want to share these with you. Both are available online. But warning: the cup is outrageously expensive as it comes from the United States and is sold by a small scale company. But I feel this is cup very worth trying, I have had good results with this.
    • Gradual desensitisation: Start with foods that are similar in texture or taste to accepted foods, then gradually introduce more challenging options.
    • Food chaining: Introduce new foods that are similar in taste, texture, or appearance to accepted foods.

    4. Mealtime Environment:

    • Positive and relaxed: Create a calm and enjoyable mealtime atmosphere.
    • No distractions: Minimise distractions like TV or toys.
    • Consistent schedule: Offer meals and snacks at regular times.
    • Child-sized portions: Offer small, manageable portions to avoid overwhelming the child.
    • Involve the child: Let the child choose their utensils, plate, or cup.

    5. Remember:

    • Every child is different: What works for one child may not work for another.
    • Progress takes time: Be patient and celebrate small victories.
    • Focus on the positive: Praise any positive interaction with food.
    • Seek support: Connect with other parents or support groups.

    Introducing solids to toddlers with ARFID can be challenging, but with patience, persistence, and professional guidance, you can help your child develop a healthier relationship with food.

    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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    Let’s relax about making EYE CONTACT already…

    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.

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    What to do when words don’t come fast enough

    What to do when words don’t come fast enough

    When children find talking hard, parents often face a difficult question: ‘Should we wait and keep encouraging speech? Or introduce something like AAC?’

    AAC (Augmentative and Alternative Communication) can sound intimidating, but it simply means any way we support or replace spoken words, from simple gestures and picture boards to high-tech speech-generating devices. Far from ‘giving up on speech,’ AAC often becomes the bridge that helps children find their voice, in whatever form that takes.

    💡 What is AAC, really?

    AAC is a spectrum of tools and strategies that help people express themselves when speaking is difficult. It might include:

    • Low-tech supports: Gestures, key word signs (like Makaton), picture symbols, or printed boards
    • High-tech systems: Apps on tablets that speak aloud when pictures or words are tapped

    AAC is not just for children who will never talk. It’s for anyone whose speech isn’t meeting their communication needs right now.

    🤔 When to introduce AAC

    There’s a common myth that you should only try AAC after ‘exhausting’ other speech therapy options. In fact, AAC can be introduced at any stage, even alongside speech development.

    Here are some helpful signs that AAC might support your child:

    • Your child understands much more than they can say.
    • They rely on gestures, sounds, or behaviour to communicate.
    • They become frustrated trying to express themselves.
    • You find yourself ‘reading their mind’ to interpret needs.
    • Speech progress feels slow or inconsistent.

    If you recognise these patterns, AAC isn’t a ‘last resort’. It’s a communication support, not a replacement for speech.

    Recent research consistently shows that AAC does not stop children from talking. In fact, it can encourage speech to develop. A 2024 systematic review and meta-analysis published in the Journal of Autism and Developmental Disorders found that children who received interventions combining naturalistic developmental behavioural approaches with aided AAC showed improved language outcomes, and that AAC ‘does not negatively impact speech development and may even facilitate spoken language growth’ (Smith et al., 2024).

    🌉 How AAC supports speech development

    Speech and AAC aren’t competing paths: they’re parallel tracks that often feed each other.

    Here’s how AAC helps speech grow:

    1. Reduces frustration: When a child can express their needs, they’re more relaxed and ready to learn.
    2. Provides a visual model: Seeing symbols or words while hearing spoken language strengthens understanding and word recall.
    3. Builds consistent language structure: AAC systems follow the same grammar and word order as speech, helping children internalise how sentences work.
    4. Encourages turn-taking and social connection: AAC lets children join conversations even before speech is fluent, giving them more practice in real communication.

    AAC is not ‘giving up on speech’. It’s giving a child more ways to succeed while speech continues to develop.

    🧩 How to introduce AAC gently and effectively

    1. Start small and meaningful: Begin with a few key messages your child wants to say, not just what adults want to hear. Think ‘I want’, ‘stop’, ‘help’, ‘more’, ‘all done’, ‘no’, ‘again’. These are powerful words for real interaction and autonomy.
    2. Model, model, model: The most important part of AAC success is modelling—using the system yourself as you talk. For example: ‘You want banana 🍌’ and you tap the ‘want’ and ‘banana’ symbols. Children need to see and hear AAC used naturally before they try it themselves.
    3. Use it throughout the day: AAC isn’t a therapy tool to take out once a week. It’s a living part of communication. Model a few words during mealtimes, play, and routines. The more consistently it’s embedded, the more fluent both you and your child will become.
    4. Keep it accessible: If using a device or picture board, make sure it’s always nearby. If it’s in a bag or drawer, it can’t be used in real moments.
    5. Celebrate all communication: If your child points, signs, uses a sound, or taps a symbol, it all counts. Respond warmly and naturally to reinforce communication in any form.

    🧠 What parents often worry about

    • ‘Won’t AAC stop them from talking?’: No. Research shows AAC use either has no negative effect on speech or leads to increased spoken output (Smith et al., 2024). When children feel understood, their motivation to communicate grows.
    • ‘What if I model it wrong?’: There’s no perfect way to start. Your effort and consistency matter far more than accuracy.
    • ‘Will they get ‘stuck’ using pictures?’:  Some children do continue using AAC long-term; others move naturally toward more spoken language. The goal is always functional communication, not replacing one form with another.

    🪞 Bringing AAC into daily life

    Here are a few simple, parent-friendly ideas:

    • Create visual spaces: Post symbols or core words on the fridge, mirror, or play area.
    • Narrate routines: Use AAC during toothbrushing, dressing, or mealtimes; consistent contexts build understanding.
    • Pair speech and touch: Always say the word aloud when you point to or tap a symbol.
    • Involve siblings and friends: Model how they can respond to AAC too. ‘Oh, you said go! Let’s go fast!’
    • Use shared books and songs: Pause and model key words in stories or songs.

    🌱 The takeaway

    AAC doesn’t mean giving up on speech; it means opening more doors to communication. When words don’t come easily, AAC gives children a way to connect, share, and be heard.

    It helps parents move from guessing to understanding, and gives children the power to express themselves on their own terms.

    If you’re unsure where to start, reach out to a speech and language therapist experienced in AAC. Together, you can find a system that fits your child’s strengths, build confidence in modelling, and help every word (spoken or tapped) feel like a step forward.

    And download and print my one page summary.

    Because when communication is possible, everything else begins to grow.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    📚 Reference

    Smith, K., et al. (2024). The Effect of Naturalistic Developmental Behavioral Interventions and Aided AAC on the Language Development of Children on the Autism Spectrum with Minimal Speech: A Systematic Review and Meta‑Analysis. Journal of Autism and Developmental Disorders, 55, 3078–3099. https://doi.org/10.1007/s10803-024-06382-7


    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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