Cycles Approach speech therapy: Why syllables come first

and why it matters more than you might think!

If your child’s speech is difficult to understand, it can feel tempting to focus straight away on individual sounds: those tricky /S/, /K/, or /SH/ sounds that just won’t come out clearly.

But in therapy, we don’t always start there.

When a child is very difficult to understand, and I have ruled out that the underlying cause is motor-based, I often opt for the Cycles Phonological Approach. This is helpful for those kids where we can feel like we don’t know where to start! The Cycles Approach helps to generate a broad overall increase in speech clarity by sequentially targeting a variety of speech patterns over the course of 8–10 weeks.

So rather than working on one sound until it’s ‘fixed,’ we:

  • Work on patterns (not just individual sounds)
  • Target each pattern for a short period of time
  • Then cycle to the next one
  • And come back around again later

This mirrors how speech development naturally happens: gradually, with increasing accuracy over time.

Why don’t we start by fixing erroneous sounds straight away?

To use a metaphor, if a child doesn’t have a strong syllable structure, working on individual sounds is like decorating a house that doesn’t have solid walls yet.

Many children with speech sound difficulties:

  • Drop syllables (e.g. ‘banana’ → ‘nana’)
  • Simplify longer words
  • Struggle to maintain rhythm and stress patterns

So, before we refine speech sounds, we need to build the framework of speech.

Why syllables come first in every cycle

In the Cycles Approach, we always begin with 2- and 3-syllable words, even if that’s not the main concern.

Why?

Because syllable awareness supports:

  • Speech clarity (intelligibility)
  • Word structure and sequencing
  • Prosody (rhythm and stress)
  • Motor planning for longer words

Without this, even perfectly produced sounds can still be hard to understand in real speech.

What do ‘2 and 3 beats’ mean?

When we talk about ‘beats’ we mean syllables you can clap.

Try it:

  • ‘Table’ → ta-ble (2 beats 👏👏)
  • ‘Banana’ → ba-na-na (3 beats 👏👏👏)

In therapy, we help children:

  • Hear the beats
  • Feel the rhythm
  • Produce the full word (without dropping parts)

What this looks like in therapy

In my sessions, this part of the cycle is active, visual, and repetitive.

You might see me using:

  • 👏 Clapping or tapping out syllables
  • 🧩 Using visual supports or blocks for each beat
  • 🎲 Play-based repetition of target words
  • 🎯 High-frequency practice (lots of turns!)

I also keep the focus on success and flow, rather than correction.

If you’re watching the video clip I’ve shared here, you’ll notice:

  • I’m not over-correcting every sound
  • I’m prioritising getting the whole word out
  • I’m building rhythm, confidence, and consistency

Why this stage is so powerful

It can look simple, but it’s doing a lot of heavy lifting.

Working on syllables helps children:

  • Say longer words more clearly
  • Reduce ‘mumbling’ or collapsing of words
  • Improve overall intelligibility quickly
  • Prepare for more precise sound work later

Often, parents notice early wins like:

✨ ‘They’re easier to understand already’

✨ ‘They’re saying longer words!’

✨ ‘They’re more confident speaking’

And that’s before we’ve even fully targeted specific sounds.

But will my child still learn their sounds?

Yes. Absolutely.

The Cycles Approach is structured so that after syllables, we move into:

  • Early developing sounds
  • Then more complex patterns (like fronting or clusters)

And  importantly, we come back around again.

Nothing is missed. It’s just sequenced in a way that supports success.

A different way of thinking about progress

One of the biggest mindset shifts with the Cycles Approach is this:

👉 We’re not aiming for perfection straight away

👉 We’re aiming for gradual system-wide change

That means:

  • Your child doesn’t need to ‘master’ something before moving on
  • Progress builds across cycles
  • Speech becomes clearer over time, not overnight

So, to sum up

Starting with syllables might seem unexpected but it’s one of the most powerful foundations we can give a child whose speech is hard to understand.

By building rhythm, structure, and confidence first, we make everything that comes next more effective.

If your child is starting speech therapy and you notice we’re clapping words like ‘banana’ or ‘elephant’, there’s a very good reason for it.

We’re not going backwards.

We’re building from the ground up.

We’re making later sound work more effective and more likely to generalise into everyday talking.

Next steps:

If you’re concerned about your child’s speech clarity or wondering whether they might benefit from a structured approach like this, feel free to get in touch. I offer individualised assessments and therapy plans tailored to each child’s speech profile whether that’s early sound development, phonology, or motor speech difficulties.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.


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.

Parent FAQ section

Why is my child practising words like ‘banana’ instead of sounds like /K/ or /S/?

Because your child first needs to be able to hold and produce the full shape of a word. If they’re dropping syllables (e.g. ‘banana’ → ‘nana’), working on individual sounds won’t carry over into real speech. We build the structure first, then refine the sounds.

What if my child can already say some long words?

That’s great. But we’re looking for consistency and clarity across many words, not just a few familiar ones. This stage helps stabilise that skill so it becomes reliable in everyday talking.

How long will we stay on syllables?

Usually, this is a short but important phase within each cycle. We revisit it regularly, but we also move on to other patterns (like specific sounds or sound processes) within the same therapy block.

Will this delay my child learning their sounds?

No. In fact, it often speeds things up overall. Once the syllable structure is in place, children are much more able to use correct sounds in longer words and sentences.

What can I do at home?

Keep it simple and playful:

  • Clap out words together (e.g. ‘el-e-phant’)
  • Emphasise full words naturally in conversation
  • Repeat back what your child says with the full structure (without pressure)

Consistency and exposure matter more than correction.

My child gets frustrated. Will this help?

Yes. Many children become frustrated when they’re not understood. Improving syllable structure often leads to quick wins in clarity, which can boost confidence and reduce that frustration.

Building clearer speech: Why we practise syllables first

What are syllables?

Syllables are the ‘beats’ in words.

  • ‘Table’ = 2 beats (ta-ble)
  • ‘Banana’ = 3 beats (ba-na-na)

Why is my child working on this?

If your child:

  • Drops parts of words (‘banana’ → ‘nana’)
  • Mumbles longer words
  • Is hard to understand

…then we need to build the structure of words first.

This helps your child:

✔ Say longer words clearly

✔ Be easier to understand

✔ Feel more confident speaking

What does this look like in therapy?

We practise:

  • Clapping or tapping out beats 👏
  • Saying full words with rhythm
  • Repeating target words through play
  • Using visuals or actions to support learning

How you can help at home

Keep it light and playful, little and often!

Try this:

  • Clap words together أثناء play (e.g. toys, food, animals)
  • Model full words naturally (‘Yes, ba-na-na!’)
  • Repeat and expand what your child says

Example:

Child: ‘nana’

You: ‘Yes! Ba-na-na‘

Important to know

  • This is a key first step in speech therapy
  • We will move on to sounds—but this helps them stick
  • Small changes here can make a big difference in clarity
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    Managing mealtime sensory overload at holiday gatherings: Supporting children with allergies and feeding differences

    Managing mealtime sensory overload at holiday gatherings: Supporting children with allergies and feeding differences

    Holiday meals are meant to be joyful and something we all look forward to. But for many children and their families, these occasions can be overwhelming and be the cause of dread and worry. The combination of new smells, unfamiliar foods, loud environments, social expectations, and allergy anxieties can quickly turn what should be a festive time into a stressful one.

    For parents of children with sensory processing differences, selective eating challenges, or food allergies, holiday gatherings often require careful planning and a big dose of tolerance and compassion. The good news is that with awareness and a few gentle strategies, you can support your child to feel safe, regulated, and included during festive meals without pressure, tears, or discomfort.

    Let’s explore how to make holiday mealtimes calmer, safer, and more connected this season.

    🎄 Why holiday meals feel so overwhelming

    Holiday gatherings usually combine several sensory triggers all at once:

    • Noisy, chaotic rooms
    • Strong smells from a mix of foods we don’t normally cook
    • Multiple conversations happening at once
    • Bright lights, Christmas décor, flickering candles
    • Unfamiliar foods with unexpected textures
    • Expectations to ‘try everything’ or ‘enjoy it’s sooo good!’
    • New environments, seating arrangements, or routines

    For children with sensory sensitivities, this can feel like a tidal wave of input. Research shows that children who are sensory-sensitive often have heightened responses to smell, taste, and texture, which may lead to avoidance or distress at mealtimes (Cermak, Curtin, & Bandini, 2010).

    Add food allergies into the picture and anxiety increases even further for both children and parents. A 2020 study by DunnGalvin et al. found that children with food allergies experience significantly higher stress in shared eating environments, especially when food preparation or contamination risk is hard to control.

    So, if your child becomes tearful, shuts down, or refuses to sit at the festive table, it isn’t ‘bad behaviour.’ It’s sensory overload, heightened vigilance, or discomfort communicating through their body.

    🌟 Preparing your child for a calmer festive meal

    Preparation is especially important for sensory-sensitive or allergy-aware children. Here’s how to set them up for success:

    1. Offer predictability through previewing

    Before the event, show your child pictures of:

    • where you’re going
    • who will be there
    • the types of foods that might be served
    • where they might sit

    A visual schedule or social story can help reduce anxiety and give your child a sense of control.

    2. Pack safe foods without apology

    If your child has allergies or selective eating, bring:

    • ‘Safe foods’ you know they will eat
    • Backup snacks
    • A separate (their own) plate, if needed
    • Emergency medication

    Announce clear, firm boundaries such as:

    ‘Ok people, these are Jamie’s safe foods — we’ll stick with these today.’ This will help relatives understand without pressure or judgement.

    3. Choose seating that supports sensory regulation

    If possible, seat your child:

    • at the end of the table
    • near a familiar adult
    • away from the kitchen (strong smells)
    • away from noise clusters
    • give them their favourite toy or fidget whilst waiting

    Let them take breaks when needed. This isn’t ‘rude,’ it’s self-regulation.

    🍽️ Supporting children during the meal

    1. Focus on connection, not consumption

    The holidays are not the time to expand your child’s food range. Keeping mealtimes low-pressure actually supports long-term progress.

    In fact, the research is clear: pressuring children to eat decreases acceptance and increases refusal (Galloway et al., 2006).

    So instead of ‘Just try it!’ try:

    • ‘You don’t have to eat it, you can look at it.’
    • ‘You’re in charge of what goes in your mouth.’
    • ‘You can keep your safe foods on your plate.’

    2. Protect your child’s allergy safety

    Holiday meals often include:

    • cross-contamination risks
    • shared utensils
    • buffets
    • homemade dishes without ingredient lists

    Use gentle but firm scripts:

    • ‘Because of Ellie’s allergies, we’ll keep her plate separate.’
    • ‘We’ll serve her food ourselves to make sure she stays safe.’

    Confidence in your boundary helps others respect it.

    3. Manage sensory load in real time

    Offer:

    • headphones
    • a small chew or fidget toy
    • a designated ‘calm corner’
    • time outside for fresh air
    • a predictable signal for breaks (e.g., a hand squeeze or card)

    Remember, sensory regulation is healthcare, not ‘giving in.’

    4. Model calm eating

    Children learn most from watching.

    Slow, happy bites and relaxed facial expressions tell the nervous system: ‘This environment is safe’.

    💛 What to say to well-meaning relatives

    Families often have big feelings about food. You can prepare nice phrases like:

    • ‘We’re focusing on helping him feel safe around food today.’
    • ‘She has allergies, so we’re sticking to our plan.’
    • ‘We’re avoiding pressure because it helps him eat better long term.’
    • ‘We’re celebrating together, eating is not the goal today.’

    Setting expectations ahead of time can reduce awkward moments later.

    🎁 The bigger picture: It’s about safety, not ‘picky eating’

    Children with allergies, sensory differences, or feeding challenges aren’t trying to be difficult. They are trying to stay safe, regulated, and comfortable.

    Your calm presence, gentle boundaries, and preparation create the conditions for a holiday that feels peaceful, not pressured.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.


    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.

    📚Research References

    Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246.

    DunnGalvin, A. et al. (2020). APPEAL-2: A pan-European qualitative study to explore the burden of peanut-allergic children, teenagers and their caregivers. Clinical & Experimental Allergy, 50(11), 1238–1248.

    Galloway, A. T., Fiorito, L. M., Francis, L. A., & Birch, L. L. (2006). ‘Finish your soup!’ Counterproductive effects of pressuring children to eat on intake and affect. Appetite, 46(3), 318–323.

    2
  • · ·

    Using AAC in daily life

    Communication is a fundamental human right, a bridge that connects us to the world and each other. For many, spoken language is the primary mode, but for individuals with complex communication needs, Augmentative and Alternative Communication (AAC) offers a powerful pathway to expression and connection. This guide will demystify AAC, highlight the crucial role of modelling, and provide practical examples of how low-tech AAC can be seamlessly integrated into everyday activities.

    What is AAC in a nutshell?

    AAC encompasses a wide range of tools and strategies that supplement or replace spoken language. It’s not about replacing speech, but rather about providing additional ways for individuals to communicate effectively. Think of it as a spectrum:

    • Unaided AAC: This involves using only your body, such as gestures, facial expressions, body language, and sign language.
    • Aided AAC: This involves external tools or devices. These can range from low-tech options like picture boards and communication books to high-tech speech-generating devices (SGDs) and apps on tablets.

    The beauty of AAC lies in its flexibility and personalisation. It empowers individuals to express their wants, needs, thoughts, and feelings, fostering independence and participation in all aspects of life.

    Modelling is KEY: Showing, not just telling

    Imagine trying to learn a new language without ever hearing it spoken. It would be incredibly difficult, right? The same principle applies to AAC. Modelling is the single most important strategy for teaching and supporting AAC users. It means actively using the AAC system yourself while talking, demonstrating how to navigate the system and express messages.

    Here’s why modelling is so vital:

    • It’s how we learn language: Typically developing children learn language by hearing it constantly around them. AAC users need the same immersion.
    • It reduces pressure: When you model, you’re not asking the individual to communicate, you’re just showing them how it’s done. This takes the pressure off and makes learning more enjoyable.
    • It expands vocabulary and concepts: By modelling a variety of words and phrases, you introduce new vocabulary and demonstrate how to combine symbols to create more complex messages.
    • It demonstrates purpose: Modelling shows that AAC is a functional and effective way to communicate, not just a set of pictures.

    So, how do you model? It’s simple: point to the symbols on the communication board or device as you speak the words. For example, if you say, ‘Time to eat breakfast,’ you might point to ‘time’, ‘eat’, and ‘breakfast’ on the board.

    Low-tech AAC in action: Everyday activities

    Low-tech AAC, such as communication boards, books, or single-page displays, is incredibly versatile and can be easily incorporated into daily routines. These can be as simple as printed pages with symbols, laminated for durability.

    Let’s explore how low-tech AAC can be used throughout a typical day, with examples of symbols:

    1. Getting ready for nursery

    Mornings can be busy, but they also offer rich communication opportunities. A ‘Getting Ready’ communication board can help sequence activities and offer choices.

    Activity example:

    ‘Time to get up!’ (point to GET UP). ‘What do you want to wear today, the blue shirt or the red shirt?’ (point to GET DRESSED) ‘Then, we brush teeth’ (point to TOOTHBRUSH) and so on.

    AAC mornings symbol examples

    2. Breakfast Time

    Mealtimes are perfect for making choices, expressing preferences, and commenting. A ‘Breakfast’ communication board can focus on food items, actions, and social comments.

    Example symbols:

    AAC meal times symbol examples

    Activity example:

    ‘What do you want to eat for breakfast?’ (point to EAT). ‘Do you want cereal or toast?’ (point to CEREAL or TOAST). If they finish their milk, you could say, ‘Are you ALL DONE or do you want MORE MILK?’ (point to symbols).

    3. Catching the Bus

    Even routine transitions like catching the bus can be communication rich. A small, portable ‘Travel’ board can be useful.

    Example symbols:

    AAC catching the bus symbol examples

    3. Being on the playground

    The playground is a dynamic environment perfect for commenting, requesting actions, and engaging in social play.

    AAC playground symbol examples

    Activity example:

    ‘Let’s PLAY!’ (point to PLAY). ‘Do you want to go on the SWING or the SLIDE?’ (point to symbols). If they are on the swing, you can say, ‘Do you want to go FAST or SLOW?’ (point to symbols) and ‘Push AGAIN!’ (point to PUSH) You can also model social language like ‘It’s MY TURN.’

    Beyond the symbols: Key takeaways

    • Consistency is key: Use AAC consistently across all environments and with all communication partners.
    • Be patient: Learning a new language takes time. Celebrate small successes.
    • Make it fun: Integrate AAC into play and enjoyable activities.
    • Follow the individual’s lead: Respond to all communication attempts, even if they are imperfect.

    In the video below I model how to integrate AAC into everyday activities with a few more examples and I discuss the difference between AAC and PECS.

    If you need some inspiration with using AAC or would like your child assessed for the right type of AAC then please get in touch.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.


    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.

    1
  • Could mouth breathing be affecting your child’s speech, sleep and development?

    Could mouth breathing be affecting your child's speech, sleep and development?

    Understanding Orofacial Myofunctional Disorders (OMDs)

    Many parents contact me at London Speech and Feeding because they are worried about their child’s speech. Perhaps their child is difficult to understand, has a persistent lisp, struggles with feeding, snores at night, or always seems to have their mouth open.

    What many families don’t realise is that these concerns may all be connected.

    Increasingly, research and clinical experience are highlighting the important role of Orofacial Myofunctional Health, the way the muscles of the face, mouth, tongue and airway work together to support breathing, eating, sleeping and communication.

    When these muscles are not functioning optimally, children may develop what are known as Orofacial Myofunctional Disorders (OMDs).

    What Is Orofacial Myofunctional Health?

    Orofacial Myofunctional Health refers to the healthy function and coordination of the:

    • lips
    • tongue
    • jaw
    • cheeks
    • facial muscles
    • airway.

    These structures play a vital role in:

    • breathing
    • swallowing
    • chewing
    • speaking
    • facial growth
    • dental development
    • sleep quality.

    When everything is working well, the lips remain gently closed at rest, breathing occurs through the nose, and the tongue rests against the roof of the mouth.

    This seemingly simple posture has a profound influence on how a child’s face, teeth and airway develop.

    What is an Orofacial Myofunctional Disorder?

    An Orofacial Myofunctional Disorder occurs when there is an abnormal pattern of muscle function involving the face, mouth, tongue or airway.

    Children with OMDs may experience difficulties with:

    • speech
    • feeding
    • swallowing
    • sleep
    • breathing
    • dental development
    • facial growth.

    In many cases, these difficulties are linked to chronic mouth breathing.

    Signs your child may have an Orofacial Myofunctional Disorder

    Breathing and sleep signs

    • mouth open at rest
    • mouth breathing during the day
    • snoring
    • noisy breathing
    • restless sleep
    • frequent waking
    • dark circles under the eyes
    • chronic congestion
    • fatigue despite a full night’s sleep.

    Speech signs

    • lisping
    • unclear speech
    • distorted speech sounds
    • difficulty producing certain sounds
    • persistent articulation difficulties
    • reduced speech intelligibility.

    Feeding and swallowing signs

    • picky eating
    • messy eating
    • food remaining in the cheeks
    • gagging easily
    • difficulty chewing
    • long mealtimes
    • tongue thrust swallowing.

    Facial and dental signs

    • narrow palate
    • crowded teeth
    • open bite
    • overbite
    • underbite
    • long face appearance
    • receding chin
    • poor lip seal.

    If several of these signs sound familiar, a comprehensive assessment may be worthwhile.

    Why does mouth breathing matter?

    Many parents assume mouth breathing is simply a habit.

    In reality, mouth breathing is often a symptom that something is preventing efficient nasal breathing.

    Common causes include:

    • enlarged tonsils
    • enlarged adenoids
    • allergies
    • chronic nasal congestion
    • recurrent infections
    • structural airway differences
    • tongue tie
    • prolonged dummy use
    • thumb sucking
    • poor oral posture.

    When nasal breathing becomes difficult, children naturally begin breathing through their mouths.

    Over time, this can affect how the face, jaws and airway develop.

    What does healthy oral posture look like?

    Healthy oral posture is surprisingly simple:

    • lips
      • gently closed
    • tongue
      • resting against the roof of the mouth
    • teeth
      • slightly apart
    • breathing
      • through the nose.

    This posture helps guide healthy jaw growth, facial development and airway formation.

    Think of the tongue as a natural orthodontic support system. When it rests in the correct position, it helps shape the upper jaw and supports healthy facial growth.

    The consequences of chronic mouth breathing

    1. Speech difficulties

    Children who breathe through their mouths often have altered tongue posture and reduced oral stability.

    This can contribute to:

    • lisping
    • distorted sounds
    • reduced speech clarity
    • difficulty learning new speech sounds.

    2. Feeding and swallowing difficulties

    A low tongue posture may affect:

    • chewing efficiency
    • swallowing patterns
    • food management
    • oral motor coordination.

    Many children develop a tongue thrust swallow, where the tongue pushes forward instead of moving efficiently during swallowing.

    3. Poor sleep quality

    Mouth breathing can contribute to:

    • snoring
    • restless sleep
    • frequent waking
    • daytime fatigue
    • reduced concentration.

    Poor sleep can have a significant impact on learning, behaviour and emotional regulation.

    4. Changes to facial growth

    Over time, chronic mouth breathing may influence:

    • jaw development
    • facial proportions
    • dental alignment
    • airway size.

    This can result in:

    • narrow palates
    • crowded teeth
    • long facial appearance
    • increased orthodontic needs.

    5. Oral health concerns

    The nose acts as a natural filter and humidifier.

    When children breathe through their mouths:

    • The mouth becomes dry.
    • Saliva protection is reduced.
    • Risk of tooth decay increases.
    • Gum health may be affected.

    Why this matters for speech therapy

    Speech does not develop in isolation.

    The tongue, lips, jaw and airway work together to support clear communication.

    At London Speech and Feeding, we look beyond speech sounds alone.

    A child who presents with:

    • persistent speech difficulties
    • lisping
    • feeding challenges
    • open mouth posture
    • snoring
    • poor sleep

    may benefit from an assessment that explores underlying orofacial myofunctional factors.

    Addressing these foundations can often support more effective progress in speech and feeding therapy.

    How London Speech and Feeding can help

    A comprehensive assessment may include observation of:

    • breathing patterns
    • lip posture
    • tongue posture
    • swallowing function
    • feeding skills
    • speech sound development
    • sleep concerns
    • oral structures.

    Where appropriate, recommendations may include:

    • orofacial myofunctional therapy
    • speech therapy
    • feeding therapy
    • home programmes
    • ENT referral
    • orthodontic referral
    • collaborative multidisciplinary support.

    The good news

    Orofacial Myofunctional Disorders are often highly treatable when identified early.

    Supporting healthy breathing, tongue posture and oral muscle function can positively influence:

    If your child regularly breathes through their mouth, snores, struggles with speech clarity or has feeding difficulties, a specialist assessment may help identify the underlying cause.

    • speech clarity
    • feeding skills
    • sleep quality
    • facial growth
    • dental development
    • overall wellbeing.

    At London Speech and Feeding, we are passionate about looking beyond symptoms and understanding the whole child. Contact me!

    Sometimes the key to clearer speech starts with a simple question:

    ‘Is my child breathing through their nose?’

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Frequently Asked Questions

    Can mouth breathing cause speech problems?

    Yes. Mouth breathing can alter tongue posture, lip strength and oral stability, which may contribute to articulation difficulties and lisps.

    Should I be worried if my child snores?

    Regular snoring is not considered normal in children and may indicate airway obstruction or sleep-disordered breathing.

    Can enlarged tonsils affect speech?

    Yes. Enlarged tonsils may affect resonance, tongue positioning, swallowing and breathing patterns.

    What age can children be assessed?

    Children of all ages can be assessed if parents have concerns about speech, feeding, breathing or oral development.

    What is Orofacial Myofunctional Therapy?

    Orofacial Myofunctional Therapy focuses on improving breathing patterns, tongue posture, lip seal and oral muscle function to support overall health and development.


    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.

    3
  • ·

    How to model AAC with our minimally speaking students?

    modelling AAC

    How should we start? Should we use prompts? What kind of prompts? hand-over-hand or just pointing? Should we wait, and, if so, how long? Introducing an alternative communication system (AAC) to our child is for many of us a confusing and sometimes scary prospect, but it needn’t be! Let me reassure you and share some tricks of my practice in this area.

    Once we have decided to try for a picture based communication system, I usually start with a paper-based single page with between 48–88 core-words. I choose the number of words depending on where the child is developmentally and also verbally.

    If a child does have a small handful of words already, I might start with the 88-cell board below. If, on the other hand, my student is completely non-speaking and still quite little then I might go for the 48-cell below here or I might have even less cells to start with. Again, sometimes I start with an electronic device in my clinic just to trial and introduce the idea and to see if, or how, a student responds. 

    Below are some samples: a 49-cell board which I made for a child in a nursery setting

    Below a Saltillo WordPower board that can be downloaded from the Saltillo website:

    Example of a slightly more advanced board, again from the Saltillo Website

    And here below one example of a board I made for a specific activity for a child who loves water and sand play:

    It is perfectly possible to be very flexible and create a suitable board for any student, starting with as few as 2–5 cells and working up to over a 100 (very small ones) on a sheet of A4 or A3 paper.

    So once we have a good board for our child, what now? How do we start introducing this into our daily life?

    We can start by showing/pointing to the word GO within a play activity. For example:

    • a car run,
    • or a marble run,
    • or a spinner activity,
    • a wind-up toy,
    • anything that can be stopped and started easily.

    How to start?

    I will talk us through each of the steps using the example for the word ‘GO’.

    First phase

    The first phase is a TEACHING/ LEARNING PHASE. In this phase we do not expect our student to do anything, to copy us or to point to the board. If they do that it is of course a huge bonus and we will celebrate it.

    Our job is to simply MODEL/SHOW/GIVE EXAMPLES of how we can use the board, by steadily and regularly pointing to the chosen word or words. We do so across the day and across settings:

    • play
    • meal time
    • getting dressed/undressed
    • bath time
    • going to the car/shops
    • etc

    Once we can be sure that our student has been submerged and SOAKED in seeing the coreboard being used, say after some 3–4 weeks of using it consistently…

    Second phase

    We can begin to move into the second phase which is the PRACTICE PHASE. By now the student has seen the boards and he or she has seen the word GO (as a example) modelled many times.

    Now we can start to see if we can tempt our student into trying this out for themselves.

    What sort of TEMPTING are we talking about? Take a look at the Prompt Hierarchy below, which shows us what to do to get our student to be independently communicating as soon as possible. 

    The PROMPT HIERARCHY: what sort of prompting should we do, should we expect something from our student or how should we view this stage?

    1.  TEMPT AND PAUSE

    I have the AAC near to the toy and each time the child starts another round of the activity I say clearly ‘GO’ and I point to the picture as do so. I then pause and wait to see what happens. NOTHING? Then…

    1. USE SIGNS AND BODY LANGUAGE

    Next time the child starts another round I might be very animated and do a Makaton sign for GO as I say ‘GO’ and I make a very over point to the picture again. Then I wait. STILL NOTHING? OK then…

    1. OPEN-ENDED QUESTION

    Now I might say ‘GO’ and follow with: ‘OOH I WONDER IF THERE IS A PICTURE TO POINT TO…’

    ‘OH LOOK HERE IS GO!’ I then point to GO.

     STILL NO RESPONSE?

    1. ASK FOR A RESPONSE

    I might say ‘GO’ followed by ‘LOOK! LET’S POINT TO GO HERE ON THE PICTURE.’

    STILL NO RESPONSE? 

    1.  PHYSICAL TOUCH

    Next time I say ‘GO’ I will try and take the student’s hand, help isolate their finger and help him or her to point to the actual picture.

    REMEMBER: Prompting serves a very important function in scaffolding learning for students BUT if we are constantly prompting kids, then we are teaching them to only communicate when someone tells them to. We want our student to become as independent in speaking and using words as possible.

    So once I have done Physical Prompting I will try and phase back down to number 1 where all I need to do is point to the picture or look at the board with the aim that the student will then point to the picture.

    Take away points:

    • Keep the learning phase pressure-free and model without expecting our student to jump in. In other words, let’s model first without expectation. Later we can have a little bit of expectation.
    • After they’ve been exposed to and have been ‘soaked’ in plenty of AAC input, then, YES, we can create an opportunity to help them say or point to the word on their own.
    • We can model BOTH with and without expectation.
    • Only after LOTS of exposure, use the least to most prompting hierarchy and start creating opportunities for a student to become an independent communicator.

    Do get in touch if you have any questions or comments or if you would like some practical help.

    I am always pleased to hear from you.


    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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  • Explore the relationship between poor speech, language and communication and literacy skills

    Communication skills are critical in all areas of communication throughout childhood and into adulthood. They are needed for understanding, narrating, making predictions and to develop social skills, for example in understanding everyday language or talking in the classroom or socialising with peers. Children with communication needs can experience low self-esteem, potential behavioural difficulties, lower school attendance and attainment.

    Communication skills have a strong impact on literacy. Let’s look at some of the facts:

    • 50% of children with language delays also have challenges with literacy (Burns et al, 1999).
    • 73% of poor readers in year three had a history of difficulties with phonemic awareness (the ability to hear, identify and manipulate sounds) or spoken language in pre-school (Catts et al, 1999).
    Speech Therpaist in London

    The effect of expressive language on spelling and reading

    The ability to read is very much dependent on competent language skills. Furthermore, a limited vocabulary will also have an impact on literacy skills. The more we know about a word, the easier it is to retrieve, recall, understand and use. So, if a young person has a poorer vocabulary, it’s likely that they will not have the same decoding skills as a peer with a richer set of vocabulary. By decoding we mean the ability to apply knowledge of letter-sound relationships including pronunciation of words. Decoding is a vital skill used in literacy.

    Whilst learning to read is a key skill, it’s important to remember that a solid foundation is needed for success. We need to ensure that no steps are missed, otherwise there will be gaps in knowledge.

    As your child moves further through the education system, they will be “reading to learn”. This is where young people with poorer language skills may show literacy difficulties (for example, reading comprehensions become more challenging, and their expressive language skills impact on their written abilities).

    When should I seek advice or support?

    Always seek the advice from a qualified professional such as a Speech and Language Therapist. You need appropriate advice for the age and stage of your child’s development and early intervention is of course key to success. It is never too late to ask for advice. The earlier you seek support, the better the outcome for your child in all areas (language, literacy, and emotional well-being).

    Have you still got unanswered questions? Contact me here and we can have a look at your child’s phonemic awareness, auditory processing skills, verbal understanding and assess his/her ability and likelihood of reading and literacy struggles. If we find that your child has dyslexia I can refer on to a specialist colleague who can help you further.



    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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