This is an interesting thread and indeed links back to what Rachel posted and the inspiring first hand examples Gillian shared.
I’m having a bit of a shift philosophically and think I am seeing children differently than I used to. I feel increasingly uncomfortable focusing on discrete outward difficulties or ‘symptoms’ (be they attention and listening, speech, language, fluency, communication, interaction) separately from the whole of a child’s general development, emotional wellbeing and resilience.
You’ve outlined a variety of presenting challenges for your little one Joanna, and also what’s emerging for her strengths wise. Sounds to me as if she would benefit from an approach that looks at supporting her as a whole: her regulation, play, communicative intent (which as Jo stressed is hugely important) her face watching (and for me this would be my focus before introducing any AAC visuals) her engagement, understanding and her use of voice (sounds ,babble, self-talk and communicative talk). They are all part of her underlying physiological system. I no longer see them as distinct entities that we can ‘teach’ as separate skills in a hierarchical fashion. They also happen within the context of an interaction, so it’s crucial to harness the natural skills of the parent’s own communicative patterns in the process.
I’ve been challenged by what I’ve read (and much of it is cross – pollinating from other disciplines) about underlying physiological state, regulation and the fundamental role of mutual face watching in supporting and influencing development, including communication. For me the natural step here would also be video reflection therapy using VERVE, a fabulous and impactful approach to support this little one and her key adults. It’s led to the biggest shift in my practice since I started my SLT journey back in the late 80’s!