For many families, communication is about much more than words. It’s about connection, relationships, confidence, and being understood. A recent research study explored the experiences of parents supporting young children who use speech-generating devices (SGDs), and the findings offer powerful insight into the real-life journey of AAC (Augmentative and Alternative Communication).

At Speech Pathology By Design, these findings strongly reflect what many families experience every day — the hope, overwhelm, resilience, advocacy, and joy that come with supporting a child’s communication journey.

What is AAC?

AAC stands for Augmentative and Alternative Communication. This can include:

- gestures and signs

- picture boards

- communication books

--high-tech speech-generating devices (SGDs)

Research continues to show that AAC helps children communicate, connect socially, reduce frustration, and build language skills. Importantly, AAC does not stop children from developing speech. In fact, many children show increased communication and spoken language growth when AAC is introduced.

Parents Often Carry a Huge Mental Load

One of the strongest themes in the study was how deeply parents cared about helping their child communicate — while also feeling overwhelmed trying to balance everything else in life.

Parents described:

- juggling therapies, school, work, and family life

- learning how to use devices themselves

- advocating for services

- feeling pressure to “do enough”

- wanting to support communication without becoming their child’s “therapist”

One parent shared:

“I don’t want to be his therapist… I want to be his mum.”

This is such an important reminder for professionals. Families do not need to do therapy perfectly at home. Communication support works best when it fits naturally into everyday life — during play, meals, routines, outings, cuddles, books, and shared moments.

Early AAC Access Matters

Many parents in the study wished their child had gained access to AAC earlier. Some families experienced delays because professionals believed the child was:

-“too young”

- “not ready”

- “already saying some words”

- needing certain “prerequisite skills” first

However, current evidence does not support waiting. Young children can benefit greatly from AAC, even before they are speaking consistently.

Parents who had supportive professionals helping guide the process often described feeling relieved and empowered.

AAC Helps Reduce Frustration

A major finding across families was that AAC often reduced frustration and challenging behaviours. When children had a reliable way to express themselves, many families noticed calmer interactions and stronger connection.

One parent shared:

“I went from having a child banging his head against the wall because he couldn’t communicate, to the child that is able to tell me and point to what he wants.”

Parents also noticed:

- more social interaction

- increased confidence

- greater independence

- more participation in family and school life

- improved understanding of language

Families Need Coaching — Not Just a Device

Another important finding was that many parents were given a device but very little support in how to actually use it in daily life.

Parents wanted help with questions like:

- How do I model language naturally?

- What do I do if my child presses random buttons?

- How do we use AAC during play or meals?

- How can siblings join in?

- How do we encourage communication without pressure?

This highlights something incredibly important:
  AAC is not just about the device. It’s about relationships and communication opportunities.

The best AAC support happens when families feel confident, supported, and understood.

Every Family’s Journey Looks Different

The study also highlighted inequities in access to AAC services and supports. Families with more financial resources, knowledge, or access to specialists often found it easier to navigate the system.

Some parents described:

- long waitlists

- expensive devices

- limited provider knowledge

- lack of coordinated support

This is why family-centred care matters so much. Families deserve:

- respectful partnerships

- practical support

- emotional understanding

- clear guidance

- access to communication systems without unnecessary barriers

The Most Important Takeaway

The parents in this study were determined, resilient, and deeply committed to helping their children communicate. Even when they felt overwhelmed, they kept showing up.

And perhaps the most powerful message from the research is this:

Communication is about connection

AAC is not “giving up” on speech. It is giving children access to language, relationships, participation, and a voice.

Written by Tania Simmons

Principal Speech Pathologist CPSP-MSPA, MSpPath, BTeach

May 2026

Reference

Arserio, A. P., Biggs, E. E., & Holz, E. (2024). Experiences of parents supporting their young children who use speech-generating devices. Journal of Early Intervention, 46(4), 562–583. https://doi.org/10.1177/10538151231199898

Looking for creative ways to engage your child in speech articulation practice at home? Below are some fun, simple ideas that require no materials and no preparation. These strategies will help motivate your child and improve generalization of their skills outside the clinic room. Let’s get creative!

No Prep, No Materials Needed

In the Car
Speech practice on the go! While driving, take turns naming words with the same beginning, middle, or ending sound. For example, you could say, “Let’s think of words that start with the /k/ sound. I’ll go first: ‘cat’.” Your child might follow with “cookie.” Continue until you run out of words. This is a fun and easy way to practice articulation during busy schedules.

I Spy at Home
Play "I Spy" with objects around the house that start with your child’s target sound. For example, “I spy something that starts with /t/… teapot!” Your child could respond with, “I spy the television.” This activity is great for practicing at both word and sentence levels.

At the Park
Incorporate articulation practice into a fun outing! If your child is working on sounds like /st/, /sw/, or /sl/, you could practice words such as “slide, swing, stop.” You can extend this idea to any environment, like the beach or the grocery store, using phrases like “push the swing” or “stop at the door.”

Interactive, Fun Activities with Minimal Setup

Paper Basketball
No materials on hand? No problem! Write down or draw your child’s target words on pieces of paper. After saying the word, scrunch the paper into a ball and try to throw it into a bin. See who can score the most points!

Book Reading
Pick a book your child loves. As you read together, find pictures or words that start with your child’s target sound. Model the correct pronunciation, then encourage your child to say the word too.

Using Speech Therapy Cards from Your Therapist

Bunny Hops
Spread your child’s articulation cards around the room and ask them to hop to each card, saying the word on the card when they land. Make it more challenging by hopping on one foot!

Memory Game
Using two sets of articulation cards, play a memory game. Turn over two cards and say the words aloud. If you find a match, take another turn. This can be adapted to practice at the sentence level by making silly sentences with the matching cards.

Go Fish
Deal out two sets of articulation cards and play Go Fish! Ask each other for matching cards while practicing target sounds. For example, you could say, “I need a shark” or “Do you have a shoe?”

Flashlight Scavenger Hunt
Hide your child’s articulation cards around the room, turn off the lights, and give them a flashlight to find the cards. As they find each one, ask them to say the word and give feedback. Add phrases like “I found a…” or “I saw a…”

Toy Cars
If your child loves cars, use toy vehicles to drive around their articulation cards placed on the floor or a car mat. As they drive to each card, encourage them to say the word or use carrier phrases like “I’m driving to the…”

Make it Fun!

These activities can be done at home, in the car, or at the park. Involve siblings or friends to make practice even more enjoyable. Choose a time and place that works for your family, and most importantly, have fun!

If you need more ideas or have questions, feel free to reach out to us!

A very natural question for parents and caregivers to ask is, ‘how long will speech therapy take?’. Any therapy is an investment requiring a financial, time and effort-based commitment. We always aim to minimise the time and cost to a family, while trying to maximise the quality and holistic nature of our therapy, supporting a child’s current social and academic needs and laying a foundation for future, ongoing progress. Some children may require speech therapy for a few sessions, some for a few months, while other families may choose to access support for several years.

Each child and family’s journey will look slightly (or significantly) different from one another. This often can arise because speech pathologists assess, diagnose and support such a wide range of communication and swallowing challenges. Furthermore, families themselves may enter the therapy process with different intentions and outcomes in mind.

Some intervention approaches – such as Lidcombe based therapy – can provide specific guidance for expected time durations. However, some variability may still arise based upon the individual child. While research and our own clinical experience can help us to approximate how much therapy a particular child or adolescent may require, treatment is ultimately an individual process and so certain time expectations can be hard to provide.

Many factors will contribute to the therapy duration for a child or adolescent. Such factors may include (but are not limited to) –

• Severity – both the severity (mild, moderate, severe) of a child’s communication difficulty and the seriousness of the impacts to their activity levels and participation within social and academic environments is vital to consider. Typically, more severe difficulties and participation impacts require more extended therapy experiences.

• How many areas of communication difficulty are present? When children are presenting with difficulties across multiple communication areas (e.g., speech clarity, language and literacy), longer, more intensive therapy durations may be needed.

• A client’s engagement and participation within the therapy sessions – how well a child can engage within therapy appointments will impact how much they get out of their appointments. We always strive to best support a child’s individual differences and engagement levels to maximise their participation and therefore outcomes from therapy appointments.

• Consistency and intensity of appointments – Consistency is critical for any learning and also the therapy process. Regularly missing appointments will reduce the ‘dose’ of therapy and also the intensity. This, in turn, will impact the rate of progress.

• Consistency with home-based practice – Home practice is a critical factor for maximising outcomes and progress.

• What are we working towards? Another factor to consider is that families have different outcomes and goals in mind. While some may wish to target very discrete skills and abilities, others may choose a holistic approach that supports specific skills and activity and participation levels across several environments (school, home, extra-curricular events). We will always work to frame our outcome measures with holistic, ongoing, functional progress in mind.

Following your child’s initial assessment, time will be taken to discuss the results and our clinical recommendations for particular intervention approaches. At this stage, we will set an approximate therapy duration based upon the significance of a child’s communication difficulty, unique personal factors and the intervention approach(es) that are required. While this will be an approximate time frame, it will provide us with an upcoming time point to formally discuss and celebrate progress and confirm plans for discharge or additional support.

Take home messages:

• Therapy durations vary from child to child and are based upon severity, the number of communication difficulties that are present and a child’s unique individual factors.

• We strive to balance the most efficient therapy process with holistically supporting a child’s needs while planning and laying the foundation for their future success.

• Appointment consistency and dedication to home practice are two ways that you can make your child’s therapy experience as efficient as possible.

https://www.speechclinic.com.au/how-long-speech-therapy/

While many people do not necessarily realise, humour is actually a skill that draws upon many language areas. As a result, many children that present with language delays and disorders can have a significant difficulty both understanding and using humour with their peers – and this is essentially because many areas of their higher level language development may be still progressing.

Many higher-level language areas are critical for understanding and using humour – such as:

• Inferencing – that is, the ability to “read between the lines” or understand and appreciate the grey information that is not explicitly stated but is rather implied.

• Higher, complex vocabulary development: understanding and using words emerges very early in childhood development, however as children age they need to be able to appreciate and understand that words can have different meanings depending upon context and that subtleties exist.

• Phonological awareness: phonological awareness refers to a group of skills that involve listening to, detecting and manipulating sounds in words. Many jokes require us to detect rhyming words and also to combine different sounds in different ways. Children and adolescents with phonological awareness difficulties may have difficulties understanding these types of jokes.

• Theory of mind – theory of mind essentially refers to the ability to appreciate and anticipate the thoughts, emotions and mental states of others’. This skill is also often critical to jokes that leave pieces of information unsaid.

• Discourse gist and central coherence: Big picture reasoning is often central to jokes that hint toward or refer to larger concepts that are not necessarily immediately apparent in the small, concrete details.

Speech pathologists support the functional language abilities that allow children and adolescents to understand and engage in humour. However, we also give lots of thought and priority to higher level language development more generally as we know that these skills are critical not only for social development but also academic success. Generally speaking, if children or teens are having difficulties with their higher level language development, they may experience:

Difficulties with understanding relationships and forming connections between words, sentences and stories

• Difficulties with academics

• Challenges with social development (particularly pragmatic abilities)

• Poor comprehension of oral and written language

• Difficulties with writing

• Challenges understanding humour, riddles, and sarcasm.

Take home messages:

• Humour is a higher level language skill.

• Humour is dependent upon many areas of language (e.g., inferencing, vocabulary).

• Higher level language abilities are critical for social skills development and academic success.

If you are having any concerns for your child’s or adolescent’s ability to any of these skills, please contact us today!

Understanding Phonological Awareness Skills and Their Impact on Language and Literacy Development

Phonological awareness is a critical foundational skill for language and literacy development. It's often discussed in early childhood education as a key indicator of future reading success, but what exactly are phonological awareness skills? How do they influence language and literacy development? In this blog, we'll dive into the concept of phonological awareness, explore its components, and highlight its significance in shaping a child’s journey into reading and language proficiency.

What is Phonological Awareness?

Phonological awareness refers to a child’s ability to recognize and manipulate the sound structures in spoken language. These skills involve understanding that words are made up of individual sounds (phonemes), syllables, onsets, and rimes, and the ability to break down, blend, and play with these sound units.

Phonological awareness is entirely auditory, meaning it does not involve letters or print. It’s all about listening to, hearing, and manipulating the sounds in spoken language. Once children develop this ability, they are better prepared to connect these sounds to written language when learning to read and spell.

Key Components of Phonological Awareness

• • Rhyming: Recognizing and generating words that rhyme. For example, knowing that "cat," "bat," and "hat" are all part of the same rhyming family.

  • Alliteration: The ability to hear when multiple words begin with the same initial sound, such as in the sentence, "Sally sells seashells by the seashore."

  • Syllable Segmentation: The ability to break words into syllables, like clapping out the syllables in “ap-ple” or “el-e-phant.”

  • Onset and Rime: Onset refers to the initial sound in a syllable (e.g., /b/ in "bat"), and rime refers to the string of letters that follow the onset (e.g., /-at/ in "bat"). Children need to be able to distinguish and manipulate these units of sound.

  • Phoneme Segmentation: Breaking words into their individual sounds, such as recognizing that the word "dog" is made up of the sounds /d/, /o/, and /g/.

  • Blending: The ability to hear a series of sounds and blend them together to form a word. For example, hearing /k/ /a/ /t/ and knowing that it forms the word “cat.”

  • Phoneme Manipulation: Adding, deleting, or substituting phonemes in words. For example, if you take away the /m/ in "mat" and replace it with /h/, you get the word "hat."

The Impact of Phonological Awareness on Language and Literacy Development

Phonological awareness is considered one of the best predictors of how easily a child will learn to read once they enter school. Here’s why it’s so essential:

• • Developing Strong Decoding Skills: Phonological awareness helps children understand the sound structure of language, which is crucial for decoding words when learning to read. Decoding involves breaking down words into their sounds and blending those sounds together to form words. Without a solid grasp of phonological awareness, this process becomes much more difficult.

  • Supporting Spelling Ability: Phonological awareness also plays a significant role in spelling. Children who can segment words into sounds (phonemes) are better able to map those sounds to letters and spell words correctly. It aids in understanding that each sound corresponds to a letter or group of letters (graphemes).

  • Enhancing Vocabulary Growth: By focusing on the sounds of language, phonological awareness also supports vocabulary development. Children become better listeners, more attuned to the subtle differences in how words sound, which helps them distinguish between similar-sounding words and expand their vocabulary.

  • A Bridge to Phonics Instruction: Phonological awareness is a precursor to phonics, which involves the connection between sounds and letters in written language. A strong foundation in phonological awareness sets the stage for phonics instruction, where children learn to connect the sounds they hear with the letters they see in print.

  • Boosting Comprehension: While phonological awareness is primarily related to reading mechanics, it also indirectly supports reading comprehension. Children who struggle with decoding tend to spend more mental energy on simply reading the words, leaving fewer cognitive resources available for understanding what they read. A solid foundation in phonological awareness reduces the cognitive load of decoding, freeing up space for comprehension.

Supporting Phonological Awareness Development

There are many ways to foster phonological awareness in young children, especially through playful, engaging activities. Some of these include:

• • Rhyming games: Singing songs and reading books with rhymes help children become aware of the sound patterns in language.

  • Syllable clapping: Encourage children to clap out the syllables in their names, the names of animals, or other common words.

  • Sound scavenger hunts: Ask children to find objects that start with a specific sound, such as finding items that begin with the /s/ sound.

  • Segmenting and blending games: Play games where children break apart or blend together the sounds in words, such as “What word am I saying? /k/ /a/ /t/.”

Conclusion

Phonological awareness is a powerful predictor of a child's future success in reading and literacy. By helping children develop strong phonological awareness skills early on, we provide them with the essential tools they need to become fluent readers, confident spellers, and effective communicators. These skills can be nurtured through fun, everyday activities that engage children in listening to, recognizing, and playing with the sounds in language. In doing so, we set the stage for a lifelong love of reading and learning.

Whether you're a parent, teacher, or caregiver, incorporating activities that promote phonological awareness will undoubtedly benefit the child's language and literacy journey.

Tania Simmons 

Speech Pathologist - CPSP-MSPA, MSpPath, BTeach

Pre-intentional communication describes the natural and involuntary behaviors children display to show how they are generally feeling. Although they are not intentionally communicating, these behaviors are observed and interpreted by parents and caregivers to determine what the child may want or need.

Pre-intentional communication include: 

• Body movements 

• Bouncing to show excitement  

• Yawning when sleepy 

• Reaching towards desired person/object 

• Turning away to show disinterest 

• Facial expressions 

• Smiling to show they like something 

• Eyes wide when startled/scared 

• A neutral face to indicate disinterest 

• Sounds 

• Crying to express discomfort 

• Cooing/laughing to show enjoyment 

• Loud vocalization/scream to express dislike  

• Eye gaze 

• Looking towards object/person to indicate interest 

• Looking away to indicate disinterest

What is Pre-Linguistic Communication?

Pre-linguistic communication describes behaviors children display, both intentional and unintentional, to communicate their wants and needs. Some behaviors are natural reactions, while others are more purposeful in order to access and/or refuse items, participate in a social interactions, and give/receive more information.

Pre-linguistic communication include: 

• Body movements/simple gestures 

• Nodding/shaking head for yes/no 

• Patting chest to indicate ‘my turn’ 

• Holding out their hands to indicate they want an item 

• Waving hello/goodbye 

• Pointing  

• Facial expression 

• Smiling to welcome an interaction 

• Frowning to express dislike 

• Sounds 

• Making car sounds to indicate a car 

• Whining/crying to refuse an item 

• Laughing to indicate something is funny/show enjoyment 

• Eye gaze/Joint Attention 

• Looking towards desired object and back to parent/guardian to gain access 

• Shifting gaze between an activity/object and another person 

• Activities for Pre-linguistic and Pre-intentional Skills

Pre-intentional and pre-linguistic skills can be targeted through structured, play-based activities. Some activities to target these communication skills are listed below.

Cause and effect activities: 

• Ball pops 

• Button/lever toys 

• Instruments 

• Light up toys 

• Toys that require body movement – shaking rattles/bells, kicking balls 

• Switch controlled and/or other alternative communication device-controlled games.  

Related Reading: Must Have Cause & Effect Toys

Object permanence activities: 

• Peek-a-boo 

• Hiding & seek – Either with people or highly desired toys/objects and hiding within the child’s line of view. 

• Mystery eggs/mystery box – Paired with sounds to indicate what may be inside the egg or box 

Turn taking activities:  

• Kicking/tossing a ball back and forth 

• Taking turns with cause-and-effect toys 

• Manipulating/controlling highly preferred toys/objects to create instances where the child has no choice but to allow for turn taking.  

Imitation activities: 

• Simon Says 

• Nursery rhymes – Wheels on the bus, Old McDonald, If you’re happy and you know it, etc. Any music-based activity that creates an opportunity for the child to imitate a sound or any type of movement.  

Parallel play activities: 

• Playing with the same or similar toy/activity side by side with no demand for the child to imitate, interact, or engage with the other person.  

Associative play activities:  

• Playing with the same toy/activity with the same goal in mind, but still working separately to accomplish the goal/end of the activity or game.  

• Filling a bucket of sand together 

• Building a block city  

• Coloring a page 

Tips for Targeting Prelinguistic and Pre-Intentional Skills During Play

When targeting pre-intentional/prelinguistic skills during play, keep in mind to follow the child’s lead. It is important to build the activity around something the child highly prefers and finds fun to keep them motivated. It is also important to make sure that, during these activities, you are observing, waiting, and listening to your child. This provides them with ample opportunity to communicate something they find interesting, which then gives you with the chance to align your communication targets with their interests.  

Written by Amanda Wallace at NAPA Center.

Photo by Jonathan Borba on Unsplash