If your child is using echolalia and/or has a diagnosis of autism, then your child’s way of processing language is most likely different to the classic way children typically learn language. We call this process Natural Language Acquisition or Gestalt Language Processing.
Step by Step guide to Gestalt Learning
Let’s explore the following stages of Gestalt Processing:
Stage 1: communicative use of whole language gestalts
(e.g., “let’s get out of here”)
Children and young people in this stage use echolalia. They need to hear more gestalts or scripts. So, your job is to model, model, model and to use functional language that your child can repeat back.
Stage 2: mitigated into chunks and re-combining these chunks
(e.g., “let’s get” + “some more”) and (e.g., “let’s get” + “out of here”)
This is when you take parts of gestalts or phrases and then combine it with other parts.
Stage 3: further mitigation (single words recombining words, formulating two-word phrases)
(e.g., “get…more”)
They are going beyond their gestalts. Furthermore, they may begin to label different objects.
Stage 4: formulating first sentences
(e.g., “let’s get more toys”)
You may see more grammatical errors during this phase as they are creating unique sentences. Please don’t worry about this, it means they are playing and experimenting with language. As communication partners, you could model the correct form of the sentence.
Stages 5 & 6: formulating more complex sentences
(e.g., “how long do you want to play inside for?”)
You can see that language learning is a process, that is trialled and tested, used in different contexts for children to be able to learn and use language appropriately.
My next blog will give you activities ideas and how you might use them specifically with a Gestalt Language Processor.
Remember early intervention is vital. So, if you have any concerns, please seek the advice of a Speech and Language Therapist.
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 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.
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.
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.
When most people think about speech or feeding difficulties, they picture the tongue, lips, or chewing skills, but how a child breathes at rest plays a surprisingly big role too.
Mouth breathing and open mouth resting posture can quietly influence everything from how a child’s face grows to how clearly they speak, to how confidently they chew and swallow. It’s something many parents never think about, until they start noticing the subtle signs.
Let’s explore why this happens, what to look for, and how to gently support better breathing and oral posture.
Recent research supports this link between mouth breathing and speech difficulties. For example, a 2022 study by Alhazmi et al., published in the Journal of Pharmacy and Bioallied Sciences, found that 81.7% of children aged 9–17 who breathed primarily through their mouths presented with speech sound disorders. The study highlights how mouth breathing can significantly influence orofacial development and articulation patterns.
💨 Why we’re designed to breathe through our nose
Our bodies are made for nasal breathing. When we breathe through the nose, the air is filtered, warmed, and humidified before reaching the lungs. The tongue naturally rests against the roof of the mouth, the lips close gently, and the jaw stays relaxed, all of which encourage healthy oral development.
In contrast, mouth breathing often means the tongue rests low in the mouth and the lips stay apart. Over time, this posture can subtly reshape how the muscles and bones of the face grow.
Children who breathe through their mouths most of the time may develop:
A longer face and narrower palate
Forward head posture
Slightly open lips and low tongue position at rest
A tendency toward drooling or noisy breathing
A dry mouth and consequently bad breath
At times the tongue pushes constantly against the front teeth causing them to grow forward (buck teeth)
These changes are not anyone’s fault, as they often start because of blocked noses, allergies, enlarged adenoids, low facial muscle tone or habits formed when a child was younger. But understanding the pattern helps us know how to support change.
🗣 How mouth breathing affects speech
Speech depends on precise coordination between the lips, tongue, and jaw. The resting position of these structures affects how ready they are to move.
Reduced tongue strength and placement, i.e. the tongue rests low in the mouth (as it does in mouth breathing), it’s harder for children to lift it efficiently for sounds like /T/, /D/, /N/, /L/, and /S/. This can lead to speech that sounds slightly slushy or unclear, or a frontal lisp.
Open mouth posture and resonance: An open mouth at rest may affect how air vibrates in the oral and nasal cavities. Children might have speech that sounds a bit ‘muffled’ or lacks crispness because the lips and jaw aren’t fully supporting articulation.
Fatigue and breath control: Mouth breathing can lead to drier mouths and less efficient breath support. That can make longer sentences or conversations feel tiring, especially in noisy environments.
🥄 How mouth breathing affects feeding and chewing
Feeding involves the same structures that control speech, so posture and breathing patterns matter here, too.
Chewing efficiency: Children who habitually keep their mouths open often have low tongue tone and reduced jaw stability. They may prefer softer foods, chew slowly, or struggle with mixed textures.
Swallowing pattern: A tongue that rests low may push forward when swallowing. This ‘tongue-thrust swallow’ can interfere with efficient chewing and even affect dental alignment over time.
Breathing while eating: Since it’s hard to chew, swallow, and breathe through the mouth simultaneously, children who can’t comfortably nasal breathe may rush bites or pause to catch their breath. This can contribute to coughing, choking, or food refusal.
Common signs to watch for
Parents often notice subtle clues before realising mouth breathing is a pattern. Some red flags include:
Lips habitually open at rest
Drooling after the toddler years
Snoring or noisy breathing during sleep
Preference for soft foods or grazing eating habits
Dark circles under the eyes due to allergies
Frequent colds, congestion, or mouth odour
Speech that sounds slushy or unclear despite good effort
If several of these sound familiar, it’s worth mentioning them to your child’s GP, dentist, or speech and language therapist.
👩⚕️ What can help
Address the underlying cause: If nasal blockage, allergies, or enlarged adenoids are making nasal breathing difficult, a medical assessment is the first step. ENT specialists can rule out or treat physical causes.
Encourage closed mouth rest: Gentle reminders like ‘Lips together, tongue up, breathe through your nose’ can help older children become aware of their resting posture. For younger ones, visual cues (stickers or mirrors) can make it a game.
Build oral-motor strength and awareness: Speech therapists can design activities to strengthen the tongue and lips, improve jaw stability, and encourage balanced breathing. This might include blowing games, tongue-tip lifts, use of dental-palatal devices or oral-motor exercises disguised as play.
Support good posture: Sometimes mouth breathing goes hand-in-hand with forward-head posture. Encouraging upright sitting during meals and screen time helps keep the airway open and supports better breathing habits.
Make nasal breathing part of daily routines: Gentle nose-breathing practice during calm times (reading, bedtime, car rides) helps normalise it. Avoid making it a battle: calm, consistent reminders work best.
🌱 A gentle note on change
Patterns of mouth breathing develop over time, and change doesn’t happen overnight. It’s important to approach this with curiosity, not criticism. The aim isn’t ‘perfect breathing,’ but to give your child the tools and awareness to breathe comfortably and efficiently.
Small improvements in nasal breathing and resting posture can lead to big gains in speech clarity, eating confidence, and even sleep quality.
💡 The takeaway
Breathing seems automatic, and it is! but how we breathe matters. Mouth breathing and open-mouth posture can quietly shape how a child speaks, eats, and grows.
By noticing early signs, addressing underlying causes, and building supportive habits, you can help your child move toward stronger, clearer speech and more comfortable mealtimes.
Just like every area of development, progress starts with connection, patience, and gentle consistency, one calm breath at a time.
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.
Communication is a fundamental human right, a bridge that connects us to the world and each other. For many, spoken language is the primary mode, but for individuals with complex communication needs, Augmentative and Alternative Communication (AAC) offers a powerful pathway to expression and connection. This guide will demystify AAC, highlight the crucial role of modelling, and provide practical examples of how low-tech AAC can be seamlessly integrated into everyday activities.
What is AAC in a nutshell?
AAC encompasses a wide range of tools and strategies that supplement or replace spoken language. It’s not about replacing speech, but rather about providing additional ways for individuals to communicate effectively. Think of it as a spectrum:
Unaided AAC: This involves using only your body, such as gestures, facial expressions, body language, and sign language.
Aided AAC: This involves external tools or devices. These can range from low-tech options like picture boards and communication books to high-tech speech-generating devices (SGDs) and apps on tablets.
The beauty of AAC lies in its flexibility and personalisation. It empowers individuals to express their wants, needs, thoughts, and feelings, fostering independence and participation in all aspects of life.
Modelling is KEY: Showing, not just telling
Imagine trying to learn a new language without ever hearing it spoken. It would be incredibly difficult, right? The same principle applies to AAC. Modelling is the single most important strategy for teaching and supporting AAC users. It means actively using the AAC system yourself while talking, demonstrating how to navigate the system and express messages.
Here’s why modelling is so vital:
It’s how we learn language: Typically developing children learn language by hearing it constantly around them. AAC users need the same immersion.
It reduces pressure: When you model, you’re not asking the individual to communicate, you’re just showing them how it’s done. This takes the pressure off and makes learning more enjoyable.
It expands vocabulary and concepts: By modelling a variety of words and phrases, you introduce new vocabulary and demonstrate how to combine symbols to create more complex messages.
It demonstrates purpose: Modelling shows that AAC is a functional and effective way to communicate, not just a set of pictures.
So, how do you model? It’s simple: point to the symbols on the communication board or device as you speak the words. For example, if you say, ‘Time to eat breakfast,’ you might point to ‘time’, ‘eat’, and ‘breakfast’ on the board.
Low-tech AAC in action: Everyday activities
Low-tech AAC, such as communication boards, books, or single-page displays, is incredibly versatile and can be easily incorporated into daily routines. These can be as simple as printed pages with symbols, laminated for durability.
Let’s explore how low-tech AAC can be used throughout a typical day, with examples of symbols:
1. Getting ready for nursery
Mornings can be busy, but they also offer rich communication opportunities. A ‘Getting Ready’ communication board can help sequence activities and offer choices.
Activity example:
‘Time to get up!’ (point to GET UP). ‘What do you want to wear today, the blue shirt or the red shirt?’ (point to GET DRESSED) ‘Then, we brush teeth’ (point to TOOTHBRUSH) and so on.
2. Breakfast Time
Mealtimes are perfect for making choices, expressing preferences, and commenting. A ‘Breakfast’ communication board can focus on food items, actions, and social comments.
Example symbols:
Activity example:
‘What do you want to eat for breakfast?’ (point to EAT). ‘Do you want cereal or toast?’ (point to CEREAL or TOAST). If they finish their milk, you could say, ‘Are you ALL DONE or do you want MORE MILK?’ (point to symbols).
3. Catching the Bus
Even routine transitions like catching the bus can be communication rich. A small, portable ‘Travel’ board can be useful.
Example symbols:
3. Being on the playground
The playground is a dynamic environment perfect for commenting, requesting actions, and engaging in social play.
Activity example:
‘Let’s PLAY!’ (point to PLAY). ‘Do you want to go on the SWING or the SLIDE?’ (point to symbols). If they are on the swing, you can say, ‘Do you want to go FAST or SLOW?’ (point to symbols) and ‘Push AGAIN!’ (point to PUSH) You can also model social language like ‘It’s MY TURN.’
Beyond the symbols: Key takeaways
Consistency is key: Use AAC consistently across all environments and with all communication partners.
Be patient: Learning a new language takes time. Celebrate small successes.
Make it fun: Integrate AAC into play and enjoyable activities.
Follow the individual’s lead: Respond to all communication attempts, even if they are imperfect.
In the video below I model how to integrate AAC into everyday activities with a few more examples and I discuss the difference between AAC and PECS.
If you need some inspiration with using AAC or would like your child assessed for the right type of AAC 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.
The summer holidays can be tricky for parents as there is so much to do: organising childcare, the actual holiday, and trying to have some all-important ‘me time’. Speech therapy for your little one might be the last thing on your mind. But …. If we can prioritise only a small amount of time every day then we are maximising time and finances spent thus far and can continue your child’s Speech and Language Therapy sessions throughout the summer, no problem. Have a look at this blog. We’ll take you through good reasons why you shouldn’t ignore Speech and Language Therapy sessions this summer.
1. Building communication skills takes time
You’ve worked so hard throughout the year to support your child’s speech, language and communication. Now is the time to continue, not to stop! You will watch your child’s communication and confidence grow and flourish over the next couple of months. All the different experiences your child will have on holiday or just even pootling about in your local park with you, or granny/nanny will help expand their capacity for learning and using language and words to communicate with you. If you have time during the summer, you can embed the skills your child has learnt into everyday life which is vital . If in doubt ask how you can use the strategies you have learned in any new environment. Together we can workshop all eventualities and make them fun and doable. There is no end of fun and opportunities with a bucket, spade and a bit of sand!
2. Getting to know your child’s Speech and Language Therapist is vital
Here’s a plug for regular therapy sessions: building a rapport with your child’s Speech and Language Therapist is key. If our sessions together are consistent and regular, then it will be so easy for us to develop a good rapport with your little one. Trust is key. So if sessions are infrequent and irregular it is hard for your child to build up trust with their therapist and it is hard for the therapist also to get you know your child and tailor the sessions so that they really work very well. We need to know what your child loves and what activities or toys work well; so, if sessions are missed and irregular then the process just takes longer.
3. Goals are set and measured
Sometimes a break is needed and that’s fine. We measure goals within a certain time frame and whilst a few weeks holiday are great for everyone, we don’t want to lose any progress your child has made. If a child does not attend sessions, progress will often diminish as consistency in therapy is key!
4. You’ll be able to embed skills over the summer at home
Did you know you can access Speech and Language Therapy wherever you are with our remote service? Teletherapy allows flexibility which means your child’s sessions can be wherever you are. Whilst this isn’t for everyone, it does allow regular sessions to continue. If that does not work for you then let’s talk about how we can help you transfer all the therapy goals into your holiday. You will be surprised how easy it is: lots of goals can be worked into snack times for example or bath times. You will have those wherever you are so this won’t take away your holiday fun, promise!
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.
Have you ever thought about how difficult it can be to produce certain speech sounds? Some sounds are definitely trickier than others. This is especially true for children with speech sound disorders like Childhood Apraxia of Speech (CAS).
My student with CAS has been working hard on producing the /L/ sound especially when it was followed by an /O/ or /OO/ like, ‘log’ or ‘look’. We’ve practised lots and now that he’s got a good handle on /L/, he’s started replacing another difficult sound, /Y/, with it. So, ‘yes’ becomes ‘less’ and ‘yuck’ becomes ‘luck.’
This is a common pattern in speech development. Once a child masters a new sound, they may start using it in place of other sounds they find even more challenging.
Minimal Pair therapy
I use different evidence-based methods to help my students. And I often like to start out with phonemic awareness and then I move to contrasting the error sound with another sound to make completely different words. This approach is called ‘minimal pair’ therapy: both words are the same except for the initial/final sound which has the error sound, and this is contrasted with the correct sound.
Below is an example of this:
After we have worked on sound awareness, listening and becoming aware of small units of sound matter, then we can move to working on tongue placement and movement.
Tongue placement and movement to produce correct /L/ and /Y/ sounds
To produce these sounds correctly, the tongue needs to be in specific positions and make specific movements.
/L/ sound:
Tip of the tongue touches the alveolar ridge (the bony ridge behind your upper teeth)
Sides of the tongue are raised to the sides of the upper teeth
Airflow escapes through the sides of the tongue
/Y/ sound:
Tip of the tongue touches the roof of the mouth behind the alveolar ridge
Sides of the tongue are raised to the sides of the upper teeth
Airflow escapes through the centre of the mouth
I also use:
Auditory bombardment: Auditory bombardment is a technique that involves repeatedly listening to a target sound. This can help children to develop a better understanding of the sound and how to produce it.
Visual cues: Visual cues can be helpful for children who are having difficulty producing a particular sound. Here I use the image of a ‘standing tongue’ versus a ‘sitting tongue’.
Physical cues: I use my hands to show a ‘standing tongue’ for the /L/ versus a ‘sitting tongue’ for the /Y/. But what worked even better and sadly I don’t have the video clip for it:
Semantic cues: For example a picture of an ‘EAR’ to make the sound /Y/ so we shape the sound /EA/ to /Y/.
Parent involvement: Parents play an important role in their child’s speech sound development by providing opportunities for them to practise their speech sounds at home. This can be done through activities such as reading books, singing songs, and playing games.
Reinforcement: It is important to praise children for their efforts, even if they are not perfect. This will help them to feel motivated to keep practising. Important here for speech correction is concrete reinforcement: I feed back to my student what exactly they were doing correctly with their tongue or lips. Rather than saying ‘well done’, I mention what my student has just done with the tongue to change the sound: ‘I saw you lowered your tongue! That made a good /Y/’.
Another great way of reinforcing positively is to ask the student how they feel they have done? For the older ones I often ask them to self-rate their sound production out of 10. Then we can work towards the next incremental number upwards. This is very effective and gives the student control over their own work.
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.
