What factors do we think about when considering high-tech AAC?

This blog post comes thanks to a Parent who asked me a question on Twitter.  Thankyou for all your questions, it helps me to understand what you need from me.

In this case, the child was using a low-tech AAC system, but being considered for transition to a high-tech system.  The Parent wanted to know what sort of things a Therapist is going to be thinking about if they think a child is ready for high-tech AAC.

First, an overview:  If you live in England, your child may be able to access funding for a high-tech device through one of the specialised AAC assessment centres across the country.  If your Speech Therapist is considering requesting funding for a device through this system, then there will be specific criteria that need to be met, which will form part of the assessment that your local Speech Therapist is carrying out.  One of the jobs of an assessment is to make a decision about which funding ‘pot’ would be appropriate if we do decide to pursue getting a device. In our area, key criteria are that children can combine more than one symbol in a message, and that they show some navigation skills using low-tech systems (e.g. they can navigate to the right page to build the message they want).   This does not mean that there are not options for children who do not meet these criteria, but that we will be thinking about different funding options.

Each child is a little bit different, but some general principles we will be thinking about if we are considering moving to a higher-tech device:

  • Does the child understand the purpose of communication yet?  Are they making intentional attempts to communicate with other people?

A child who is not yet an intentional communicator is very likely to need more practise at this cognitive skill before we consider a device.  A device is a means to communicate, but cannot compensate for other areas which a child needs to be an active communicator, such as motivation to communicate.

  • Does the child consistently access a low-tech means of communication (whatever that might look like)?  Is there some reason that this does not meet the child’s needs, or do we have reason to suspect that their needs will be better met with a high-tech device?

It can take time to get an AAC system right.  We need to explore and assess various factors in low-tech form so that we can make better decisions about which high-tech device and software will best suit a child’s needs.  In addition, we will always need a low-tech alternative to a device, for times when tech goes wrong or is not available for various reasons.

But there is definitely a point where a high-tech device will be a better ‘fit’ for your child.  Some potential reasons that this might be the case are:

    • Your child needs much more vocabulary available to them than we can reasonably keep on top of in a book
    • Your child would benefit from the wider communication options that can be available to them in a high-tech device, for example, they could use their device to communicate, but it would also open up the potential for accessing email or social media for example, which some software enables.
    • The physical access to a book is a challenge for various reasons.  A device would therefore make communication quicker and/or more independent.
    • Where a high-tech device would considerably reduce the barriers to communication for the child, for example, it would allow them to communicate with a wider range of people in their community and be understood (but we can’t forget that an electronic device can also be a barrier to inclusion if it creates fear of the technology and reduces interactions with other people)


  • Is there commitment from the team around a child to use a device?

This is a really big one for me – devices are typically highly reliant on everyone in an environment to be successful.  We look for signs of commitment to and understanding of a child’s communication using low-tech before we pursue high-tech.  There is often a perception that a high-tech device is ‘better’ than low-tech (not necessarily the case at all).  If a class team or family are not commited to using, updating and modelling a child’s low-tech system, then they are not likely to be able to maintain motivation to support a high-tech system.  There is often a lot of excitement when a high-tech device is being discussed, and a lot of motivation is created in the short-term.  But the truth is that using a high-tech system requires a lot of learning, thought and maintenance from everyone around a child.  It is not inherently easier to implement or use.

  • Are expectations of a high-tech device realistic?

We need to make sure that our expectations of a high-tech system are realistic. A child who has very few motivators to communicate may find a high-tech device more motivating than a low-tech one, and this may be a reason to consider a move to high-tech.  But they will not become a child who suddenly wants to chat and communicate as any other person of their age.  If we do not make sure that this is understood, then we may be setting a child up to ‘fail’ at a system because we have not had shared understanding of what our own expectations are.

  • What is the child’s response to technology generally, and a high-tech device in particular?

I would usually be interested in a child’s interest in technology, and want to trial a high-tech device with them (even of it is not necessarily what will be their system in the end), as this will give us lots of information about their readiness for high-tech.

This is a general picture of the kinds of information we will be gathering as Therapists, I hope that is helpful!


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If you would like to ask any other questions about AAC or any other communication issue, please come and find me on Facebook (www.facebook.com/findthekeyslt), in my Facebook group (www.facebook.com/groups/findthekeyfamilies), on Twitter (@FindthekeySLT) or drop me a message via email findthekeyslt@hotmail.com







What if the best Speech Therapy was your Physiotherapy?

You may notice that all the blogs I am writing this month are loosely arranged around a theme of  “do your best, don’t beat yourself up”.  This is because this pretty much summarises how I encourage families to think about their child’s Speech Therapy.  I truly believe that beating yourself up is a waste of your precious emotional bandwidth, and it’s not the best way to get things done.

I also think this is a good theme for January, the time of year when you are supposed to be most motivated and coincidentally – a cosmic joke – the time of year you most fancy staying in your pyjamas in the house.

Obviously, I think Speech Therapy is important.  In fact it can be a transformative force in a child’s life.  But the fact is, especially when you have a child with complex medical, developmental or learning needs, it can be just another thing on your list.

So I hope this blog brings you good news when I tell you that there are many children that I work with where I advise families to focus on their Physiotherapy if they want to support a child’s feeding and communication.

Oral skills for feeding and for talking are fine motor skills, growing out of the underpinning gross motor skills such as head control and trunk control.  In addition, movement is an important foundation for:

  • Motivation (if you can move, you can explore, which gives you lots to talk about)
  • Body awareness – the use of your body sensations to understand where your body is in space.  An important underpinning skill for our sensory learners, for children with feeding aversions and for many children with Autism diagnoses.

We need the best skills in the body that we can if we want to support children’s communication.  So next time you are carrying out your child’s Physiotherapy, you might just have their communication work covered too.  And next time you see your Physiotherapist, ask them if you can see them with your Speech Therapist, so they can enhance each other’s work.

Angharad   key trans


If you would like support and information about your child’s communication and feeding, I would love to see you in my Facebook group for Families

In March we will be having a Physiotherapist come into the group to talk about the impact of low muscle tone (hypotonia) on children’s learning


What if you DON’T do the big heroic thing for your child’s communication development?

It is traditional at the beginning of the year to either set a big audacious goal, or to shrug and say you won’t be bothering (has anyone noticed that the world seems to have got together and decided to have a ‘word of the year’ instead of resolutions, when did that happen?  Was there a meeting?).

It can feel like either we need to make heroic life-changing efforts to affect change, or we should just accept things as they are, with nothing much in between.

No-one seems to know exactly who said it, but it is a truism that

most people overestimate what they can do in a year, and underestimate what they can do in ten years’. 

This is as true in working with your child with communication needs as in any other life area.

Some people respond to their child’s communication needs by buying into programmes that take hours every day to deliver.  This is fine, but I am a bit suspicious of approaches that promise huge results, but only work if you deliver them for 5 hours a day.  It has been my experience that these are unsustainable in terms of time and the impacts on family life.  When you are unable to maintain the efforts involved, then it can be easy to feel bad about this and feel like you have let your child down.  But this was not your fault, that programme was unfeasible by any reasonable measure!

More commonly, families get as much done as they can, as often as they can, quietly beating themselves up about not spending more time devoted to their child’s communication.

The fact is that small amounts of regular effort add up.  They might not add up in the big showy heroic ways that we might wish for, but they add up in the way that matters:  your child’s progress.  I often have the conversation that a child has made loads of progress, but a family can’t see it because it has happened so gradually.

The tiny things you do every day to support your child add up to real progress.  They even add up to progress when it looks like nothing is changing in your child.  I know that weeks and months can go by where you see no change, but every day you have spent even a little time prioritising a communication strategy or activity for your child, you have strengthened the foundations of their future progress.

So I hope 2020 is the year you do tiny things, as often as possible! (If I had to make this into a word of the year, I guess it would be ‘incremental’).  I happen to think turning up and trying your best is pretty heroic too.


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For pragmatic but effective ways to help your child with their communication, I’d love to see you in my Facebook group,‘Find the Key for Families’.  Practical information and advice from an experienced Speech and Language Therapist, and the support of other families who know what you are going through.




Stories we tell ourselves

I have been ill all over Christmas.  One of those bugs that deceives you into thinking it is going and then just moves to a slightly different part of your head and throat.

I am usually pretty good at being ill- I am a big believer in resting and hydrating and letting your body do what it needs to.  But I confess that when I woke up still ill this morning, two weeks in, feeling worse than yesterday, I very much reached the feeling sorry for myself stage.

I was very tired going in to the holiday, and feeling a bit demotivated.  I was hoping a really good rest would re-enliven me for the New Year and that I would start with a boost of energy and motivation.

You wouldn’t have known it to look at me, but internally I was in full toddler tantrum mode about being ill.   It occurred to me that part of what I was feeling sorry about was that I hadn’t really been able to fulfil this storyline- yes, I had rested, but not in that restorative way, more in a ‘being immobolised against my will’ sort of way.  I hadn’t managed to catch up with the household jobs I had planned for between Christmas and the New Year.  And so I was telling myself that now I wouldn’t have the energy I needed to start the New Year, and this was a bad start to it etc etc.

This got me thinking about storylines.  In my experience, it is often not the thing that has actually happened that causes you the pain, more the narrative that you attach to it.

What storylines are you carrying about your child’s communication needs, their learning or their eating?  What storylines are you maintaining about your role as a Parent? Are your stories helping, or are they wearing you out?

Stories are a natural by-product of being human, they are our attempt to create sense out of events, and they can help us when they motivate us.  But when we are weighed down by our emotional responses to our stories and so often, completely unaware that those stories are playing out in our minds, then we can be making things much harder for ourselves.

As a Speech Therapist, it is not unusual for me to be trying to support children to develop their ability to sequence and explain events in stories.  But also as a person working with families, it is my wish for you that perhaps you can become aware of and let go of some of the stories that might be getting in your way.



If this post resonates with you, I’d love it if you would join the Facebook group that I run for families of children with complex communication needs.

Lots of practical stuff about supporting your child, and a chance to talk with a Speech Therapist and with other families about communication.  I like to talk about the emotional aspects of being a Parent or family member  to a child with communication needs too, so we are here for whatever you need at the time.



Inclusion is for life, not just for Christmas

In the UK, it’s the week where the John Lewis Christmas advert comes out.  This is something of a pre-Christmas tradition these days, and the ads have a reputation for being heart-warming.

In this year’s ad, Edgar the excitable dragon tries hard to join in with the same things that everyone else likes, but he just keeps getting himself into trouble by accidentally setting things on fire.

At one point he ties a scarf around his face, hoping to stay out of trouble this time, but to no avail.  Edgar ends up unhappy and alone. Until a friend finds a role he can play (lighting the Christmas pudding), and all is well.  Consider your heart warmed.


Image by John Lewis and Partners

I know I am not alone in seeing this as a metaphor for inclusion.  The part where he wraps his face with the scarf felt heart-breakingly like masking to me (masking is a term for inhibiting your natural tendencies in order to fit in, quite possibly at the cost of your mental health).

And while the ending was heart-warming, what I actually thought was, “what’s he going to do for friends the rest of the year then?”.  It reminded me of the children who are not being well-supported in school, but who everyone feels appropriately gooey about when they are given angel wings and a halo in the Nativity.

Inclusion means providing environments that are open to making the most of everyone’s gifts, all year round.  Appreciating what they have to offer, not only when it’s convenient or heart-warming.  And accepting all parts of a person, even when that is difficult for the rest of us.

So next time you see the John Lewis ad, think about making these inclusive gestures an all-year-round thing – that would be a real Christmas miracle.

If you are looking for practical help with supporting your child’s communication, I’d be glad to see you on my Facebook page (Find the Key Speech and Language Therapy), or in my new group, Find the Key for Families.

Or think about signing up to my newsletter here, for monthly tips, resources and offers.

No hard sell, just the stuff you need to help your child!


key trans



Why you are missing out on ideas and support for your child’s communication

I am an NHS Speech and Language Therapist, and run my business on the side at the moment.  When you work in the NHS, you don’t really need to worry about ‘finding your market’, because we all know that there is way too much work for our NHS Speech Therapists to do!

It’s a bit different when you are a private Therapist though, and you need to ‘find your people’ who are a good fit for your skills and knowledge.  This is a bit of a learning curve for me.

One of the things you do to get yourself ‘out there’ is to put out free content and help people to find your social media and website pages.  So with this in mind, I was writing a ‘freebie’ yesterday, about things you could do to support your child whilst you waited for a Speech Therapy appointment.  I posted it in one of my online business groups, to see if the Parents in the group felt I had hit the mark.  The feedback I got really got me thinking.

The feeling was that the information would be valuable but that in order to get people to read it, I would need to present it to a very niche group.   So for example, ‘Things you can do to support your child who is a late talker whilst you wait for a Speech Therapy appointment’, ‘Things you can do for your child with Down Syndrome whilst you wait for a Speech Therapy appointment’.  The advice wouldn’t be any different, I would just be changing the front cover and title to attract the groups who needed the freebie.

This made me feel frustrated.  I want to get my knowledge out in front of people who need it.  If I was going to have to market this information to every individual group of people, it will take me all year just to get it to the families who would benefit.  Now, there is a thought process, business-wise that says this is a good thing, because I can repackage the same information endlessly and sell it over and over again.  I see this, business-wise.  But I’m telling you, when you know families are desperate to be doing the right things for their children’s communication, and you know you have the information they need, this feels a bit depressing.

The internet is a wonderful place, full of information.  But I have lost count of the conversations I have had with families who have been online and either failed to find the info they needed to support their child, or have been overwhelmed with information.  People are often looking for information based on their child’s diagnosis, or their suspected diagnosis.

I’ll let you into a secret- children are all fundamentally the same.  No matter what their diagnosis (or none), all children need the same underlying communication skills, and the same approaches will often benefit children with many different diagnoses.  Your Speech Therapist doesn’t think all that much about your child in terms of their diagnosis (though that has a bearing), they think about them in terms of what skills they have and what skills they need.

If you are just looking for diagnosis-based information, you are probably missing out .  Think about what skills your child needs instead:

  • Attention skills?
  • Speech clarity?
  • Independence?
  • Learning vocabulary?
  • Social skills?

Try looking for these instead of a child’s diagnosis.  Ignore the fact that the page says ‘Autism’, and just think about whether the information might suit your child.

So, the world being how it is, I’ll market to families of children with all types of diagnosis, and none, if that means families get the information they need.  But I’m also sending the message that you can help your child, right now, if you get help to understand the skills they need to develop.

If you are looking for help filtering through all the information out there…..

If you are looking for simple things to do with your child that work…..

If you want to inform yourself and feel confident that you are doing the right things to support your child’s communcation..

Come over and see me on ‘Find the Key Speech and Language Therapy’ on Facebook, and sign up to my ‘Find the Key for Families’ group, where you can get information and support that works


Sign up to my newsletter to get monthly info and freebies


No hard sell, just the stuff you need to help your child!


key trans


Everything you wanted to know about feeding tubes but were afraid to ask

I’m squeaking in at the end of feeding tube awareness week with a post for anyone who has ever wondered why children would have feeding tubes.

My special area of interest is in working with children and families who are tube-dependent (in fact, I’m hoping I will get to do research in this area some day!), and so it is a pleasure to write this post, a quick run-down of FAQs and info about feeding tubes.

What’s a feeding tube?

A feeding tube is a way of children/adults getting nutrition into their bodies that is not via their mouths.  The one you are most likely to see (because it is most visible, and also a popular solution for more short-term needs) is an NG, or Naso-Gastric tube.  That means it goes into your nose and down into your stomach.

The other tube that is fairly common is a gastrostomy (not, as a lot of people think, a gastronomy tube, though that would be great, wouldn’t it?).  This is a tube that goes directly into the stomach.  Sometimes people call it a PEG (percutaneous endoscopic gastrostomy), though technically, that is just a term for one type of gastrostomy that is put in in a certain way.

Other less common tubes are oro-gastric (from your mouth into your stomach) and naso-jejunal/naso-duodenal tubes (from your nose, though your tummy and into different areas of your small intestine).

Why would a child need a feeding tube?

There are a few main reasons:

  • The child physically can’t eat- they do not have the necessary skills to eat, or they are too unwell to eat.  This may be temporary (e.g. if the baby is premature, or they are having an operation or treatment) or it may be permanent (e.g. if the child has an unsafe swallow, leading to food or drink entering the lungs).
  • The child is finding it difficult to eat for other reasons- this can be for lots of reasons, but some children who have had a lot of invasive medical treatment, sensory difficulties or pain associated with eating, may develop aversive behaviours in response to food that stop them eating, or stop them eating a good range of foods.  These children may need all or some nutrition through their tube to support them.
  • The child is not eating enough- this might be because they have a condition that means they require more calories than average, or perhaps their physical condition means that they eat very slowly and it is difficult to get through enough food to grow.

If a child has a feeding tube, does it mean they will never eat?

Not at all!  The long-term picture for feeding tubes depends a bit on why they have been put in in the first place, but many children are able to leave them behind and move onto oral feeding.  Some children will always need them for all or part of their eating and drinking.

Won’t a feeding tube make the child too lazy to eat?

This is not the case.  Feeding tubes help us to support children to grow and develop.  There are some children who can find it difficult to move on to oral eating, but these are children who have physcial, developmental or psychological reasons why this is the case.  These children are not lazy, and neither are their families.

When a feeding tube is introduced as a short or medium-term solution, there should always be a plan for how it is monitored and how and when decisions will be made to support the transition off the tube if it is appropriate.

Children often need therapy support to help them to build skills for future oral eating.  In an ideal world, children will have Speech and Language Therapy/Dietitian/OT/Physiotherapy/Paediatrician/Respiratory Team/Gastrointestinal team/ENT/Nursing in the right combinations for their individual needs to help them and their families.

Want to find out more?

Try http://www.feedingtubeawareness.org/  and/or https://www.feedingmatters.org/

I give thanks to all the families sharing their tube-feeding stories this week, and I hope one day that all children will get the right support to reach their feeding potential.