Neurodiversity affirming Speech and Language Therapy

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Introduction

I am a neurodiversity affirming therapist and I love and endorse play-based therapy. I use it alongside a strengths-focused approach in all my sessions. Find out why we should use these transformative therapy methodologies in all our work and play with our children.

I always have a range of different toys and activities up my sleeve so that when one toy is no longer interesting, that’s fine. ‘Look here’s a new one, how about we try this one?’ When therapy feels like play, children are more likely to be engaged and attentive, which leads to better outcomes.

By using play as a context for Speech and Language Therapy we can create opportunities for children to use and practise their communication skills in a natural, real-life setting. This helps bridge the gap between the therapy room and everyday life.

Goals and targets

What about goals and targets I hear you say? Of course, as Speech and Language Therapists we always have our goals for any particular child. They can be speech goals (we want Bobbi to produce a ‘k’ sound at the end of words) or communication goals (we want Fatima to ask for something by pointing to it rather than grabbing it). And these goals can be achieved where there is a reciprocation and a positive, playful relationship between the adult and the child. That relationship comes through play and fun.

Play and fun

Play is how a child interacts and learns. If it’s fun, interesting, exciting or pleasurable then that is where the magic happens. And that is what we need to return to repeatedly and then see if we can fold our targets into the activity as we go.

As soon as we expect our child to do something and we try and shape their behaviours towards a certain outcome we no longer ‘play’. We are now in teaching mode, where we direct and where we are ‘in charge’. As a neurodiversity affirming therapist, I believe that all play is valid. We must not get into the trap of thinking that only functional play is valid, that there is only one way to play with that car ramp/puzzle/potato head. Our autistic children often need to play in a particular way to navigate their world and we must not try and stop that.

When we affirm and validate our child’s play and copy their play with enthusiasm and respect then, in my experience, all children regardless where they are on the neurodiversity spectrum will begin to engage with us, copy us, and learn how to communicate effectively about things that matter to them.

Play-based therapy allows therapists to tailor interventions to each child’s unique interests and abilities. This individualised approach increases the likelihood of success and progress.

Strengths-Focused Speech Therapy

Strengths-focused therapy emphasizes a child’s strengths and abilities rather than their deficits. It recognises that every person has unique strengths that can be harnessed to overcome challenges.

Focusing on strengths helps us build a positive self-image. This is especially important for children with communication disorders, as it can boost their confidence and self-esteem.

When we encourage children to play in ways that they enjoy and are good at they feel empowered and more in control of their lives and play. This can lead to increased motivation and a sense of ownership over their progress.

Now, imagine the powerful impact that can be achieved by combining play-based therapy and strengths-focused therapy in speech therapy sessions. This dynamic combination brings out the best of both worlds. It creates a therapeutic environment that is not only effective but also enjoyable for children and their families.

As Speech Therapists we can use the child’s strengths and interests as a foundation for play-based activities. This personalisation not only makes therapy more engaging but also more effective.

An example

Charlie, a 3-year-old with social communication challenges, had a deep interest in anything that spins. We used this strength and interest to create a variety of spinning activities. As he is allowed to engage in his spinners, we can practise lots of speech and language and provide great phrases alongside his interest and activities: Ready steady go! Stop! ‘another one’ ‘the red one’ ‘again again’ ‘I love it’ ‘it’s a spinner’ ‘Charlie loves this toy’ ‘it’s going fast’ ‘it’s so fun’ etc..

Over time Charlie started to copy some of these word models and then used them to create his own little phrases, such as ‘the blue one again’. When this occurred, we felt like celebrating because it had come naturally and appropriately to the situation without any coercion or direction. That is what communication is about! Well done Charlie!

Conclusion

Play-based and strengths-focused speech therapy approaches are powerful tools and by combining these approaches, we create a therapeutic environment that is not only effective but also enjoyable and empowering for our clients.

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.

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    Understanding phonological processes in 3–7-year-olds: What’s typical and when to seek help

    As a speech and language therapist, one of the most common questions I hear from parents is:

    ‘They can talk, but their speech still sounds immature. Is this normal?’

    Many children between the ages of three and seven use speech patterns that make their words sound different from adult speech. These patterns are known as phonological processes, and for younger children, they are a normal part of speech development.

    However, when these processes persist beyond the expected age, they can start to affect clarity, confidence and learning, especially once children enter school.

    This blog will help you understand:

    • what phonological processes are
    • which patterns are typical at different ages
    • and when it might be time to seek speech therapy support

    What are phonological processes?

    Phonological processes are patterns of sound simplification that children use while their speech system is developing.

    Instead of learning each sound one by one, children initially organise sounds into patterns that make speech easier to produce. This is a normal and efficient strategy for a developing brain.

    For example:

    • saying ‘tar’ instead of ‘car’
    • saying ‘poon’ instead of ‘spoon’
    • saying ‘bud’ instead of ‘bus’

    These are not ‘bad habits’. They are part of how speech develops.

    The key question is how long these patterns last.

    Common phonological processes (and when they usually disappear)

    Below are some of the most common processes parents notice in 3–7-year-olds.

    1. Final consonant deletion

    Leaving off the last sound in a word

    • ‘ca’ for cat, ‘da’ for dog
    • Typically resolved by 3–3½ years

    2. Fronting

    Replacing back sounds (k, g) with front sounds (t, d)

    • ‘tar’ for car, ‘do’ for go
    • Typically resolved by 3½–4 years

    3. Cluster reduction

    Omitting one sound in a consonant cluster

    • ‘poon’ for spoon, ‘top’ for stop
    • Typically resolves by 4–5 years (some clusters slightly later)

    4. Gliding

    Replacing /R/ or /L/ with /W/ or /Y/

    • ‘wabbit’ for rabbit, ‘yion’ for lion
    • Can be typical up to 5–6 years

    5. Weak syllable deletion

    Leaving out unstressed syllables

    • ‘nana’ for banana
    • Usually resolved by 4 years

    If these patterns continue past the expected age, speech can remain difficult to understand particularly for unfamiliar listeners such as teachers, peers, and also Auntie Karen or grandparents who visit once in a while.

    Why phonological processes matter in school-age children

    By the time children reach reception and Year 1, speech clarity becomes increasingly important.

    Persistent phonological difficulties can affect:

    • being understood by teachers and peers
    • phonics and early reading
    • spelling
    • confidence in speaking
    • willingness to participate in class

    Some children become aware that they ‘sound different’ and may speak less, avoid longer words, or become frustrated when misunderstood.

    What’s the difference between a delay and a disorder?

    This is an important distinction.

    • A phonological delay means a child is following the normal pattern of development, just more slowly.
    • A phonological disorder means the child is using atypical patterns, or continuing age-expected patterns well beyond when they should have resolved.

    A speech and language assessment helps identify:

    • which processes are present
    • how many are affecting speech
    • how consistent the errors are
    • and whether intervention is needed

    Signs it may be time to seek speech therapy

    You may want to seek professional advice if your child:

    • is 3½ years or older and still hard to understand
    • is understood well by family but not by others
    • becomes frustrated or avoids talking
    • has difficulty with phonics or spelling
    • uses several phonological processes at once
    • has not made progress despite time and encouragement

    Early support does not mean something is ‘wrong’. It simply helps speech development move forward more efficiently.Research consistently shows that unresolved phonological processes beyond the expected age can impact intelligibility, literacy and confidence (Dodd, 2014; Bowen, 2015).

    How speech therapy helps phonological development

    Phonological therapy is not about drilling individual sounds endlessly.

    Instead, therapy focuses on:

    • helping children recognise sound patterns
    • building awareness of contrasts (e.g. ‘tar’ vs ‘car’)
    • practising speech in meaningful, playful ways
    • supporting generalisation so progress carries into everyday speech

    For school-aged children, therapy is usually structured, motivating and highly targeted and progress can be very encouraging.

    A final reassurance

    Many children with phonological difficulties go on to develop clear, confident speech with the right support.

    If you’re unsure whether your child’s speech is ‘just a phase’ or something that needs attention, a professional assessment can give clarity and peace of mind.

    If you’d like support or advice, please contact me and I can help guide the next steps.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Research references


    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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  • ·

    Let’s live and breathe AAC

    We all have the right and want to express thoughts, feelings, and needs. For non-speaking or minimally speaking children, finding an avenue to communicate effectively can be a challenging journey. Parents are often at a loss as to where to start. Sometimes a little bit of Makaton signing has been used here and there but we mostly find that gradually signing fades as parents feel that it just doesn’t seem to get copied and used by the children.

    They live and breathe their system

    This is where we need to pick up the pieces and start again: because all successful families where children start using their boards or their electronic AAC (Augmentative and Alternative Communication) systems do this one thing: THEY LIVE AND BREATHE THEIR SYSTEM.

    • They have boards in every single room of the house;
    • They have a board in the car, attached to the side of car door so their child can point to it as they need to;
    • They have a smaller board in their handbag/rucksack when out and about;
    • They have a board for shopping and attach it to the shopping trolley;
    • They are never ever without their board.

    Because they realise that a child should never be without their mouths to speak, should never be without a means to speak. They use their own board to model and the child has always access to their board to model back or to just look.

    This is where success begins

    Success begins at consistent and joyful use of the board/AAC system throughout the entire day. If we think about it, doesn’t it make sense? Of course, it does! We talk to our child for the first two years of their life continuously wherever we are and our child is continuously encouraged to use their mouths for talking in all situations.

    Same goes for Signing: Makaton or any other sign system is a very powerful means to aid communication and I certainly advocate and use it in practice. Though much like words, signs are very elusive and temporary—as soon as the sign has been made it is gone and no longer present. Same with words of course. This can be difficult for people who need longer to process information.

    The beauty of symbols or photographs is that they are permanent: they don’t vanish, they stay and with the core board they stay in the same place! This is very reassuring. We can learn where a symbol is and we can be assured that it will still be there the next time we look at the board.

    AAC core board

    Here is a picture of a core board:

    AAC board

    You can download this and other boards for free on the Saltillo Word Power website.

    It has 48 cells and we can see the most frequently used core words on here, words that we use 80% of the day when talking with our non-speaking/minimally speaking children, younger children and children with cognitive delay. We keep our sentences short and we say phrases pertaining to their daily lives;

    • Let’s GET your toy
    • PUT it here, PUT it away, PUT it IN
    • Let’s READ a book
    • UP you get
    • WANT some MORE?
    • That’s GOOD isn’t it?
    • Let’s OPEN the box and LOOK

    And so on… All these phrases can be aided with the above board. Your child will learn OVER TIME and OVER CONTINUOUS USE where GET/PUT/MORE/WANT/IN—where these symbols are. For children who are slow to process this is so helpful, to have a visual representation of what has just been said. It aids understanding in the first place. Gradually as a child starts to copy they will point to powerful symbols themselves and if they want to speak they can also speak of course:

    A child might point to WANT + MORE and then say with their mouths: BANANA!

    Board examples

    Here are some other boards I have made specifically for daily situations and preferences of some of my students. Here is one for toileting:

    AAC toileting board

    And another one:

    These boards incorporate high-frequency and versatile words, enabling us to make little sentences.

    Building Language and Literacy Skills

    AAC Core Boards are not just tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-speaking children engage with words and symbols, reinforcing their understanding of language structure and grammar.

    Over time they naturally absorb language patterns, laying the foundation for improved literacy skills.

    Customisation for Individual Needs

    Every non-speaking child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind. The boards can be adapted to include specific vocabulary relevant to the child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of the child’s personality and needs, making communication more engaging and effective.

    Collaboration between AAC Core Boards and Speech Therapy

    While AAC Core Boards are an incredible tool, they are only used effectively by the non-speaking child when the board is used BY ALL COMMUNICATION PARTNERS around the child.

    Again, I know I am being repetitive here, but the board needs to be used and modelled by the adults constantly in the first place and for a period of time before we can expect our children to take an interest and use the boards themselves. Think how long it typically takes for a child to learn their first word: around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.

    Collaborating with your child’s speech-language therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best implement them.

    Conclusion

    For non-speaking children, AAC Core Boards are bridges to their world.

    These boards foster language development, social interaction, and personal expression. AAC Core Boards offer a beacon of hope, helping non-speaking children break through communication barriers and thrive in a world that is waiting to hear their voices. Boards are simple for anyone to use and understand. Have a go! You will be surprised how lovely it is to use a board with ease and once your child sees you do this, you have a chance for your child to start copying you…and express something! HOW ABOUT THAT! I look forward to hearing your stories!

    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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  • Attention Autism Therapy

    Sonja is kneeling on a multicoloured carpet holding a bucket in one hand and a toy in the other
    Sonja

    Attention Autism” is an Early Years Intervention designed by Gina Davies, Specialist Speech and Language Therapist. Gina created this amazing therapy approach based on her many years of working with children on the autism spectrum. It aims to develop natural and spontaneous communication through the use of highly motivating activities. These activities offer your child an IRRESISTABLE INVITATION to engage and attend to.

    I love using this approach and have trained in all of the stages including the Curiosity Stage which is for another blog. I use it frequently with all children who have trouble attending, listening, sitting or waiting regardless of whether they are neuro-diverse or neuro-typical, this activity and method is so great for all children!!

    Why is it important for our children to attend and listen?

    It is commonly assumed that, as our child has passed their hearing tests he/she will be able to listen and respond to being called, being questioned or asked to do something. However, all children I see in my practice have reduced joint attention skills, which means that whilst their hearing is often good, even brilliant to the point that they can often hear a faint noise somewhere outside the house like a distant train rushing by – but strangely they can’t seem to hear their name being called. Parents often ask me why this is the case, why can my child not turn round when I call him?

    The reason lies in the difference between hearing and listening. Listening is a skill that needs to be learned and practiced. As a child develops, their hearing tunes into (listening) the sounds and noises they hear on a daily basis. This is how a child develops understanding of the speech sounds they hear every day (which then form the basis of their native language); they also get to know “their door bell, dog barking next door, daddy coming up the stairs” and so on. They tune into those common every day sounds and noises and gradually start to copy speech sounds to form words. So listening is tuning our ears to the sounds that surround us. In contrast, many of us have to work in large office spaces or noisy environment, perhaps even a café, etc, where we are able to tune out those environmental noises and sounds that surround us, for otherwise we will not get that report/piece of work done in time! Our focus means that we become single-minded and single-channelled concentrating on our work and so we do not hear people chat and clutter all around us.

    Tuning in and out is a skill that we learn and some of us are better than it that others, it comes largely with practice but also with motivation – I go back to the report that needs doing by end of the day – my motivation is strong and I can now focus and blend out all around me so that I get the work done. Other times when I am not so motivated I might doodle and tune into what is being said at the table next to me, because my focus is not that strongly dedicated to my work.

    Many children who are delayed in their development and especially children on the neuro-diverse continuum have difficulty with tuning in. By contrast, they are very good at being single-minded, single focused on what it is they are wanting/needing to do at any one point. And so they cannot listen to sounds, speech, noises around them very easily at all. They are fully absorbed in their activity and are not able to look and listen to mum/dad calling their name. Once we understand this we can start helping our children to practise tuning in a bit more bit by bit and day by day.

    Enter the Attention Autism approach!

    There are 4 stages to this method:

    Stage 1: The Bucket to Focus Attention

    The first stage involves filling a bucket with visually engaging toys that aim to help children learn how to focus their attention. Three toys will be presented to the child/group one at a time and the therapist will make simple comments about each toy to help introduce them to the children and expand their vocabulary.

    Important to know: the Attention Autism approach does not require the child to look at the adult, or to sustain eye-gaze on the objects. Instead engagement may be indicated by non-verbal signals such as seeming alert and interested, and looking frequently at the object.

    Stage 2: The Attention Builder

    At this stage the child/group is introduced to visually stimulating activities. This stage aims to build and sustain attention for a longer period of time. Activities may include ideas such as:

    • Flour castles which can be built like sandcastles, using flour, a bowl and moulds
    • Erupting volcano activity
    • Wriggly worms foam – pile shaving foam onto an upside down plastic flower pot with the holes taped over; then slowly press down another plastic flower pot over the shaving foam and the foam will come through the top holes looking like wriggly worms, especially if you have dropped a bit of food colouring on top of the foam

    Important: children are not required to make eye contact or sit still during these activities. The focus is on engagement, in whatever way the child demonstrates this.

    Stage 3: The Interactive Game – Turn-Taking and Shifting Attention

    The therapist demonstrates a simple engaging activity and invites children up to have a turn. This may be the same activity from stage 2 or something new. The aim is for children to learn to shift their attention from the group/sitting experience to doing something and then going back to sitting again.

    Stage 4: Individual Activity

    In the final stage of Attention Autism, the adult models an activity, and then each child is given the same equipment to use themselves. They do not have to copy exactly what the adult modelled. The aim is for the child watching to have a go independently with confidence, and then to take their materials back to the leading adult at the end. The activity should be engaging and enjoyable for the children. The Attention Autism approach aims to foster an interest in learning new things and to inspire communication in whatever form works for the child.

    Ideally this should be practised 4-5 times a week aside from the therapy session. But I have seen it work with just 2-3 practice repeats per week. It can be tough in the beginning until your child gets used to the “no touch just look” rule but with a little bit of practice usually children do sit well for the first part of the Bucket activity within about 10 sessions and after that you are on a roll!

    Do get in touch with me if you would like to find out more about this approach! Here is a great link to Gina Davis’s Autism Centre facebook site for more inspiration: https://facebook.com/ginadaviesautism/.


    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.

  • · ·

    Creating your calm: containment strategies for Sensory Processing Difficulties

    The world can be a beautiful and stimulating place, but for individuals with Sensory Processing difficulties (SPD), it can also be overwhelming and even painful. Everyday sights, sounds, smells, touches, and tastes can be amplified to uncomfortable or even unbearable levels. This can lead to anxiety, meltdowns, and a constant feeling of being on edge.

    One important coping mechanism for SPD is containment. Containment strategies are techniques that help individuals manage their sensory experiences and create a sense of calm and safety.

    Understanding containment needs:

    Containment needs vary greatly from person to person. Some individuals might find comfort in deep pressure, while others might crave quiet and solitude.

    Common containment strategies:

    Here are some examples of containment strategies that can be helpful for individuals with SPD:

    • Deep pressure: This can involve activities like wearing weighted vests, using weighted blankets, getting firm hugs, or applying deep pressure massage.
    • Movement: Engaging in rhythmic movements like rocking, swinging, or jumping can be calming for some individuals.
    • Proprioceptive input: Activities that involve proprioception, the sense of body awareness, can be grounding. Examples include yoga, stretching, and proprioceptive toys like chewy necklaces or fidget spinners.
    • Visual calming: Utilising calming visuals like nature scenes, dimmed lights, or fidget toys with visual patterns can provide a sense of peace.
    • Auditory modifications: Noise-blocking headphones, earplugs, or white noise machines can help block out distracting or overwhelming sounds.
    • Oral motor activities: Chewing gum, crunchy snacks, or chewy toys can provide sensory input and help regulate emotions.
    • Sensory bottles: Watching calming visuals move within a liquid-filled bottle can be visually stimulating and promote focus.
    • Creating a safe space: Having a designated quiet area at home or school where individuals can retreat to self-regulate can be invaluable. This space should be free from clutter and overwhelming stimuli and can include calming sensory items.

    Additional tips:

    • Be patient and understanding: It takes time and practice to find what works best for each individual. Be patient with yourself or your child as you explore different strategies.
    • Consistency is key: Once you find effective strategies, use them consistently in different settings to create a sense of predictability and comfort.
    • Communicate openly: Talk to teachers, caregivers, and others about individual needs and how they can support containment strategies.
    • Celebrate progress: No matter how small, acknowledge and celebrate successes in managing sensory experiences.

    Remember:

    Containment is not about suppressing sensory experiences altogether. It’s about creating a sense of control and reducing overwhelming sensations to a manageable level. By exploring different strategies and working with a qualified professional, individuals with SPD can develop the tools they need to navigate the world and experience life to the fullest.

    Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.


    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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  • · · ·

    How do we play with our Gestalt Language Processors?

    Image by Freepik

    Child-led therapy

    When working with Gestalt Language Processors, it is always advisable to use child-led therapy. What does that mean? Child led therapy involves following a child’s interests and allowing her/him to lead the play activity throughout the speech and language therapy session. In other words, instead of having my own ideas of what we might want to play with or what activities I might try and use, I provide a range of toys I know the child likes or has played well with before; then I wait for the child to pick what she/he enjoys doing.

    Play can be very repetitive and we can often see our child cycling back to the same one or two toys throughout the session. But this is what she/he needs to do at that time and it means that we have focused attention and engagement. This in turn is very helpful for the therapeutic process, which is to offer great scripts and phrases/words alongside what she/he is playing with.

    Monotropic minds

    Often the mind of autistic children is more strongly pulled towards a smaller number of interests or hobbies as I like to call them. Dr Dinah Murray, Dr Winn Lawson and Mike Lesser have found in 2005 that autistic people have ‘monotropic’ minds. They explain that autistic children focus their energy on a narrow range of activities as the energy required to switch between several toys is much higher than we would see in the neuro-typical population.

    Gestalt Language Processors are often also Gestalt Cognitive Processors. This is when experiences are retained as episodic events and memories. An event is remembered by specific parts of the same event. And, therefore, these specific parts should always be part of that event, when the event is repeated.

    Should any of the specifics be changed or are missing, then this can cause great upset to Gestalt Cognitive Processors. So, for example, if the last two times in speech therapy we had the train set out and this was played with happily, then this becomes a specific part of the whole session. If, I then don’t offer the train set the third time a child comes to see me, this could be very upsetting.

    This is why I tend to try this out and see what happens. Usually in the 3rd or 4th session: I might not bring out the car run that has hitherto been super successful to see if we are able to transition well to other toys. If yes, then we can have new experiences but if not then I will re-offer the car run/or whatever toy pretty quickly so as not to cause complete dysregulation.

    A few pointers below which help with child-led play:

    Introduce a few new toys and see what happens

    Parents are encouraged to bring some familiar toys their child likes to the session. We can then introduce a couple of different toys to see how we go. Try offering a new toy alongside the familiar one; try offering new toys without the familiar one present, but be prepared to re-offer the “old” toy should our child get upset.

    Rotate toys and don’t offer out too many toys

    I find that children can get overwhelmed and overstimulated by too many items out all at once. I always talk to parents about toy rotation at home and I encourage storage and ‘tidy up’ of toys so that we can increase attention focus, and also maintain freshness and new interest in older toys.

    Some children are not yet ready to play with toys

    Here I suggest people games: these are games where the adult becomes part of a more motor-based activity. Some call it ‘rough and tumble play’ but it can be nursery rhymes such as sleeping bunnies/row row the boat or peek-a-boo for the younger ones.

    Copy/Imitation is so important – try getting two identical or similar play items

    When we are copying our child, it is often not desirable to ‘take turns’ with their toys/blogs/cars etc as our child may not be ready to let us take a turn. Instead, if we have the exact same toy that our child is having then we can play alongside our child and copy them perfectly without interrupting their play.

    References:

    Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism9(2), 139-156.

    If you need help with your child, please do not hesitate to contact me.


    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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  • · ·

    The hidden impact of mouth breathing and open mouth posture on speech and feeding

    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.

    1. 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.
    2. 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.
    3. 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.

    1. 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.
    2. 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.
    3. 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

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    References

    Alhazmi, A., Alshamrani, A., Alhussain, A., et al. (2022). Mouth Breathing and Speech Disorders: A Multidisciplinary Study. Journal of Pharmacy and Bioallied Sciences 14(5):911. https://www.researchgate.net/publication/361978128_Mouth_breathing_and_speech_disorders_A_multidisciplinary_evaluation_based_on_the_etiology


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    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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