Cued Articulation – using hand gestures to show how a sound is made

ByLondon Speech and Feeding October 16, 2024October 17, 2024

Watch how cued articulation can transform your child’s speech and language skills!

Cued Articulation involves using specific handshapes and placement cues to guide the speaker’s articulators, such as the tongue, lips, and teeth, to produce accurate sounds. It was originally conceptualised by Jane Passy, a speech-language pathologist. But it is important to know that we can, and often do, also use other speech cues which help our student visualise what they need to do. In other words, we can mix and match our cue pictures depending on what works best with each student.

In the beginning of my speech therapy practice I would stick religiously to Jane Passy’s method but over the years I have learned and used many different visual hand cues which all have worked with individual students.

It is important to remember that this is not an exact science, rather than an art! The art is to find the key to each individual student’s understanding and inspire motivation to try out a sound which they find hard to do.

As an example, the hand signs used by Caroline Bowen’s method, an Australian Speech-Language Pathologist, are quite different to Jane Passy’s signs but they can equally work very well. Caroline Bowen’s visual for the /r/ sound is the ‘rowdy rooster’ — a crazed rooster on a motorbike — and the hand signal is that of revving up the motor bike engine with both hands whilst trying out the /r/ sound! I have a good handful of students who really loved this rooster image and were able to eventually produce a good /r/ using this cue.

So, it is horses for courses with many things, and visual images and hand cues are no exception!

Sound picture cards:

Again, there are a host to choose from and I tend to collect a number of different images for each sound I want to practise with my student. As an example, below are a couple of different examples I use for the sound /p/:

The Nuffield Programme suggests to use this popper card, which works well with a student who knows these poppers and perhaps has one on their trousers.

As an alternative, and especially for younger students, I like using the Popper Pig Card – which I also have in my room so I can quickly show how it pops. Or we can have a popping game in between saying the /p/ sound at times. (The popper card is great as I can use the real toy to help with conveying the /p/ sound as it pops.)

Each card has its own merit and I choose the right card for the individual student.

How I use cued articulation and the visuals in Speech Therapy

Cueing and practice: I introduce the appropriate card and handshapes for the targeted sounds. We then practise producing the sounds.
Reinforcement and feedback: Positive reinforcement encourages progress and builds confidence.
Fading out the cues: Once my student is able to say the sound more easily, we can gradually fade out the speech cues.

Benefits and effectiveness

Using Cued Articulation and Speech Image Cards has been shown to be effective in improving speech production for individuals with various speech and language disorders, including:

Articulation disorders: Difficulty producing specific sounds accurately.
Apraxia of speech: A motor planning disorder that affects the ability to sequence and coordinate movements involved in speech.
Phonology disorders or delays: Confusion and delays in how sounds are organised in categories to convey meaning, errors in sound patterns, for example front sounds are produced at the back, or long sounds are produced as stops.
Stuttering: A fluency disorder characterised by interruptions in speech, such as repetitions and prolongations.

Tips for parents and student speech therapists

Parents can play a crucial role in supporting the implementation of cued articulation at home and in therapy sessions. Here are some tips:

Collaborate with your SLT: Good feedback and communication with the Speech and Language Therapist creates consistency and progress..
Practise Regularly: Encourage consistent practice of cued articulation at home to reinforce learning.
Use Visual Aids: Use the same visuals that your therapist uses in the speech clinic to help your child at home with recall and practice.

Feel free to contact me if you need help with your child.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

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.

Practical tips for speech and language development

ByLondon Speech and Feeding September 16, 2024September 24, 2024

As parents, we all want our children to develop strong communication skills. This starts early, with the simple sounds and babbles of a new-born baby. Here are some practical tips to help you encourage your baby or toddler’s speech and language development through play and everyday activities.

General tips for creating a language-rich environment

Talk to your child frequently throughout the day: Even when they’re young, they’re absorbing information. Describe what you’re doing, name objects around the house, and respond to their babbling.
Read aloud regularly: Books are a great way to introduce new words and concepts. Choose books with simple language, bright pictures, and repetitive phrases.
Sing songs and nursery rhymes: These provide a fun way to practise pronunciation and rhythm.
Label objects: Put labels on toys, furniture, and everyday items to help your child associate words with objects.

Engage with your child in their play activities

Pretend play: Encourage imaginative play by pretending to be different characters or animals.
Build and create: Use blocks, Legos, or playdough to build and create different structures.
Outdoor activities: Explore the world around you. Talk about different plants, animals, and weather conditions.

Tips for effective communication

Get down to their level: When talking to your child, get down on their level to make eye contact and show that you’re listening.
Use simple language: Avoid using too many complex words or long sentences. In the early years (0–3 years) try and make things concrete, stay in the ‘here and now’ — point and gesture lots to help your child understand what you say
Be patient: Give your child time to respond and don’t rush them.
Model good language: Use clear and correct language yourself.
Speak in your native, natural Language: If English is your second language try and speak to your child in your native language: it is more natural and your will probably know better how to speak and sing to young children in your own native language.

Reading to your child

Reading to your child is a powerful way to boost their language skills and create lasting memories.

Reading to your child is more than just a bedtime ritual; it’s a powerful tool for fostering their language and literacy skills. Studies have shown that children who are read to regularly develop larger vocabularies, stronger comprehension skills, and a greater love of learning.

Why is reading so important?

Vocabulary expansion: When you read to your child, you expose them to new words and concepts. This helps them build a strong vocabulary, which is essential for effective communication and learning.
Improved comprehension: Reading aloud helps children understand the meaning of words and sentences. This improves their comprehension skills, making it easier for them to learn and understand new information.
Enhanced cognitive development: Reading stimulates a child’s brain and helps them develop critical thinking skills, problem-solving abilities, and imagination.
Stronger emotional bonds: Reading together creates a special bond between you and your child. It’s a time for cuddling, bonding, and sharing stories.
The Reach Out and Read Foundation found that children who are read to regularly have significantly larger vocabularies and better language skills than those who are not.
A study published in the journal Paediatrics revealed that reading to children can have a positive impact on their academic achievement, even years later.

By making reading a regular part of your child’s life, you are investing in their future success. So, grab a book, get cozy, and enjoy the wonderful world of stories together!

Here are some great books I love using in my Speech Therapy sessions:

Books for 6 months to 2 years

Touch and Feel Books

Touchy-Feely Farm by DK Books: This book features different textures to explore, such as soft fur, rough bark, and squishy mud.
Baby Touch: Animals by DK Books: This book introduces various animals and their textures, like soft feathers, scaly skin, and furry coats.

Lift-the-Flap Books

Peek-a-Boo! Animals by DK Books: This book has flaps to lift revealing different animals hiding underneath.
Where’s Spot? by Eric Hill: A classic lift-the-flap book that encourages spatial awareness and vocabulary.

Pop-Up Books

Pop-Up Farm by DK Books: This book features fun pop-up elements that bring the farm to life.
Pop-Up Jungle by DK Books: Explore a vibrant jungle with this interactive pop-up book.

Sound Books

Sound Books: Farm by DK Books: This book features sounds that correspond to different farm animals.
Sound Books: Safari by DK Books: Listen to the sounds of various safari animals in this interactive book.

Interactive Books

That’s Not My… Series by Usborne: These interactive books feature tactile elements that encourage exploration and vocabulary.
Peek-a-Boo! I Spy by DK Books: This board book with flaps encourages visual tracking and vocabulary.

These books are designed to engage young children through their senses and encourage exploration. The repetitive nature of these books helps toddlers learn new words and concepts while having fun.

Books for 2 years ++

Classic favourites

The Very Hungry Caterpillar by Eric Carle: This colourful and interactive book is a classic for a reason. It introduces simple words, colours, and days of the week.
Brown Bear, Brown Bear, What Do You See? by Bill Martin Jr. and Eric Carle: This repetitive story helps children learn colours and animals.
Where’s Spot? by Eric Hill: A simple hide-and-seek book that encourages vocabulary and spatial awareness.

Modern classics for children 3 years – 6 years

The Gruffalo by Julia Donaldson and Axel Scheffler: A fun and imaginative story that introduces more complex vocabulary and rhyming.
Room on a Broom by Julia Donaldson and Axel Scheffler: Another rhyming story that encourages counting and vocabulary.
The Tiger Who Came to Tea by Judith Kerr: A playful and imaginative story that introduces various foods and social skills.

Books for children 6 years ++

The Adventures of the Little Prince by Antoine de Saint-Exupéry: A philosophical tale that introduces complex vocabulary and themes.
Charlie and the Chocolate Factory by Roald Dahl: A whimsical and imaginative story that introduces a variety of characters and settings.
Harry Potter and the Sorcerer’s Stone by J.K. Rowling: A classic fantasy series that introduces a wide range of vocabulary and concepts.

Remember: The best books for your child are the ones they enjoy. Encourage them to explore different genres and find stories that spark their imagination.

Please feel free to contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Feeding · Speech and Language Therapy · Top tips

Feeding therapy: A guide for parents and caregivers

ByLondon Speech and Feeding September 6, 2024September 5, 2024

Feeding therapy is a specialised form of therapy and support that helps children develop healthy eating habits and overcome challenges related to food. It’s often used for children with picky eating, feeding disorders, or sensory processing issues.

What is feeding therapy?

Feeding therapy involves a series of techniques designed to improve a child’s eating skills and attitudes towards food. In the UK it’s typically provided by speech and language therapists and dietitians. These professionals work closely with parents and caregivers to create a personalised treatment plan tailored to each child’s unique needs.

How does feeding therapy work?

Feeding therapy sessions are typically 30–60 minutes long and involve a variety of techniques, including:

Family counselling: Providing support and guidance to parents and caregivers. This can help address any practical, behavioural and emotional issues that may be impacting the child’s eating.
Play-based activities: Engaging children in fun activities while introducing new foods or textures. This can help alleviate anxiety and make mealtimes more enjoyable.
Sensory exploration: Helping children become more comfortable with different tastes, smells, and textures. This can be achieved through activities like touching, smelling, and tasting various foods.
Oral motor exercises: Improving chewing, swallowing, and lip coordination. These exercises can help children develop the necessary skills for eating independently.
Behavioural techniques: Using positive reinforcement to encourage healthy eating habits. This can involve rewarding children for trying new foods or eating a variety of meals.

When is feeding therapy needed?

Feeding therapy may be beneficial for children who:

Are picky eaters: Refuse to eat a variety of foods or have strong preferences.
Have feeding disorders: Experience difficulties with eating, such as swallowing or chewing.
Have sensory processing issues: Are sensitive to certain textures, smells, or tastes.
Have medical conditions: Such as autism, cerebral palsy, or gastrointestinal disorders.

Feeding therapy strategies you can try at home

While professional feeding therapy can be invaluable, there are several techniques you can try at home to support your child’s eating development:

Create a positive mealtime environment: Make mealtimes enjoyable and stress-free by avoiding distractions, limiting screen time, and creating a calm atmosphere.
Create regular mealtimes and mealtime routines: Introduce set ways of announcing meal times, including songs or short nursery rhymes, try and involve your child with table setting, even just carrying their spoon to the table and putting the beaker next to the plate and ensure that meal time finishes after about 30 minutes, again with a set routine so that the child always knows: this is how we do it in our home, now I am finished and meal time is over.
Introduce new foods gradually: Start with small amounts and gradually increase exposure. This can help reduce anxiety and make new foods less overwhelming.
Model healthy eating: Show your child how to enjoy a variety of foods by eating a balanced diet yourself.
Avoid forcing food: Allow your child to choose and explore foods at their own pace. Forcing them to eat can create negative associations with food.

Seek professional help

If you’re concerned about your child’s eating habits, consult with a feeding therapist. We can provide guidance and support.

Remember, feeding therapy is a collaborative process between parents, caregivers, and professionals. With patience, understanding, and the right strategies, you can help your child develop healthy eating habits and enjoy meals.

Would you like to know more about specific techniques or have any other questions about feeding therapy?

Please feel free to contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Autism Therapy · Neurodiversity · Speech and Language Therapy · Top tips

Following your child’s lead: A playful path to AAC success

ByLondon Speech and Feeding August 27, 2024August 23, 2024

Unlocking playtime: A guide to child-led learning

Does your child struggle to focus on toys or activities? Do they dart away as soon as you approach? You’re not alone!

The key to unlocking your child’s potential lies in following their lead. Let them guide the play session, and watch their engagement and focus soar.

Why Child-Led Play Works:

Empowerment: Children feel in control, sparking their curiosity and motivation.
Focused attention: They’ll stay engaged with activities for longer periods.
Reduced frustration: By stepping back and observing, you eliminate the pressure and stress that often comes with directed play.

How to Implement Child-Led Play:

Prepare the environment: Set out a limited selection of engaging toys.
Observe and wait: Sit back, watch, and listen to your child’s interests.
Embrace the moment: Resist the urge to direct or question; simply enjoy the process.

Remember: This simple approach can transform playtime and support your child’s development. Give it a try for a week and see the difference!

#OWLing #hanenmorethanwords

Observe, Wait, Listen. It’s a powerful formula for unlocking your child’s potential.

You will likely see:

Your child will stay put with any toy for longer whilst you are near them.
Your child will tolerate you being nearby and he/she won’t move away.
Your child will start giving you brief glances of enjoyment, or perhaps they will hand things to you, or they might take your hand and lead it to something that needs opening etc.
In other words, you will see that there suddenly is JOINT PLAY. Yes, granted it may not be according to your adult agenda, but there will be more togetherness than there was before. And this is the START of communication and social engagement.

USE Core words and a coreboard — to help your child understand the power of words

Core words are the building blocks of communication. Try using a coreboard like the one below, they are versatile and can be used in countless ways. By modelling these words naturally during play, you expose your child to their meaning and function in context. This approach is far more effective than isolated drill and practice, more powerful than flashcards!

Using AAC coreboard — Photo by lemonlenz

A Winning Combination

Combining child-led play and AAC modelling creates a magic effect. To summarise:

Increased engagement: When you follow your child’s lead, they are more likely to be engaged and receptive to learning. This creates optimal conditions for introducing AAC core words.
Natural learning: By modelling AAC core words in the context of play, you help your child understand their meaning and purpose naturally. This fosters generalisation and spontaneous use.
Building relationships: Shared play experiences strengthen the bond between you and your child. This trust and connection are essential for successful communication.
Reduced pressure: Modelling AAC core words without expectation removes the pressure to produce language. This allows your child to explore communication at their own pace.
Expanded vocabulary: As your child becomes more comfortable with AAC, they will begin to incorporate core words into their own communication. This leads to vocabulary growth and increased independence.

Practical Tips

Observe and respond: Pay close attention to your child’s interests and actions. Respond to their cues with enthusiasm and support.
Keep it simple: Start with a few core words and gradually introduce new ones as your child’s skills develop.
Be patient: Language learning takes time. Celebrate small successes and avoid frustration.
Have fun: Remember, play is supposed to be enjoyable for both you and your child. Relax and have fun together!

Example:

Let’s say your child is playing with a pop-up toy like you see me do in the above photograph. Here, I followed my child’s lead by waiting to see what she wanted to do with the toy. You are now OWLING! (Observe Wait and Listen)

Once I noticed that there was repetitive opening of the flaps going on I then pointed to OPEN and MORE on the board, as I said: ‘let’s OPEN this one’ / let’s see MORE animals’ / ‘MORE cow! it says moo!’ ‘OPEN another one’ and so on.

Important to know, we are not expecting our child to respond verbally or with AAC, but we are providing language input and demonstrating how these words can be used with enthusiasm.

Naturally in time your child will look at the board and at your pointing and they will eventually want to copy you!

By incorporating these strategies into your daily interactions, you can create a supportive environment that fosters language development and communication growth. If you would like more guidance please get in touch and book in for a consultation, some individual therapy and/ or some parent coaching.

I look forward to supporting you. Please contact me and let’s see how.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Feeding · Speech and Language Therapy · Top tips

My child won’t eat! What can we do to help?

ByLondon Speech and Feeding July 26, 2024July 26, 2024

I get lots of enquiries about this topic, parents up and down the country struggle to feed their children. Mealtimes with toddlers can sometimes feel like a war zone!

Reasons

The reasons for food refusal are many and very varied. Perhaps your child was born prematurely and had lots of tubes and things sticking to his or her face? Or maybe your child had gastro-oesophageal reflux and this caused pain every time he or she swallowed. Some children have motor problems so it was hard to coordinate swallowing with breathing and caused frustration and anxiety? Many children have sensory integration difficulties and these make it difficult for them to grasp all the different textures and colours they are eating.

When I take a case history for a new feeding client, I always try to first establish how the child learned not to feed/eat. I use the word ‘learned’ here with intent as eating is a learned behaviour. We tend to think that it must just be instinctive and natural but this is not the case. Instinct is a small part of the very beginning of feeding, in that a baby naturally roots for the breast but this only works out well and leads to more natural ‘instinctive’ feeding if that initial instinct is not interrupted or impacted on negatively by any of the above reasons.

So just as a baby learns to eat or drink the milk it can also learn not to do so. The baby can learn to avoid eating in order to bypass discomfort, or — and this is another important factor — in order to gain more positive attention from the caregiver!

Research shows that we learn about food in two ways:

A connection is made between a food and a physical reaction. This needs to happen only once and it can stick: think about feeling sick after a binge on a certain food/drink… You won’t want to go near that very food again for some time, if ever! If a certain food causes pain then that connection can be made quickly and we won’t want to touch this food again.
We learn through reinforcement and punishment:

Reinforcement:

If we get praised for eating our plate with a pudding, then we tend to eat more to get the pudding.
Equally if granny sits with us for hours at the table reading us a story because we do not eat or don’t eat much/quickly, we will continue this because we want granny to keep reading for us.

Punishment can work in two ways:

Child gets punished for not eating and will eat more to avoid punishment.
Child eats less as the fear of punishment is so unpleasant and leads to total lack of appetite.

As speech therapists we do not endorse any of those above strategies because none of them give us the desired effect.

What do we want to achieve? We want our children to eat naturally, with enjoyment. We don’t want them to over eat, to binge eat, or to starve themselves. Eating needs to become a joyful, natural and organic behaviour if our child is to be healthy and thrive.

Recommendations

Here are three top recommendations I make regularly with good effect:

Structure: have a routine at mealtimes, eating at the table, in the same room with our favourite utensils. Always helping in food preparation, perhaps setting out the table placemats etc, and then tidying up — taking the plate to the kitchen counter, scraping left overs into the recycle bin can be part of this. This way we can introduce repetition to our food/eating learning.

Positioning: the right chair with a good footrest, supporting our child’s trunk well, and facilitating our child eating at the table (instead of sitting in a high chair with a tray) is one of my first and favourite tips. I do favour a Tripp Trapp style chair (I have no association with that company).

Tube fed children ought to also sit at the table with the rest of the family and first of all be offered foods and drinks to handle or play with. Some tube fed children are able to eat a small amount of pureed foods and they ought to be offered this first before being topped up with their tube feeds, whilst sitting down. Lying down for your tube feed is not a normal way of eating. Tube feed infants should be offered a pacifier whilst being tube fed and be in an upright position so that they start having an association between getting full/feeling satiated and their mouth.

Sociability: I encourage family mealtimes, or at least the caregiver eating with their child together, so that the child is able to copy and observe what normal eating looks like. We need to be super positive about eating and food consumption so that our child can see and copy this. If the parent is a fussy eater then this may cause the child to copy exactly the same behaviour. Many parents who come to me with their fussy children are themselves also picky about food.

There are many other tips and strategies and I will be more than pleased to assist, please contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Neurodiversity · Speech and Language Therapy · Top tips

Speech Sounds Practice at home

ByLondon Speech and Feeding July 15, 2024July 17, 2024

Speech therapists use a variety of tools to help children master specific sounds, and then the students are sent home with some practice sheets to use daily. Parents are able to observe what we do in the session, but I know that back at home three days later they can’t quite remember what it was all about and how to do the practice.

Here I explain the importance of visual cues, finger shapes, pictures, and semantic prompts (fancy speech therapy term for word clues!). By understanding these tools, you can turn practice time into a fun and engaging experience for both of you.

Why Visual Cues matter?

Imagine learning a new language just by listening. It’s tough, right? Young children learning new speech sounds face a similar challenge. Visual cues act like flashcards for their minds, giving them a clear picture of how to position their mouth and tongue.

Mirrors: Encourage your child to watch your face (and theirs) in the mirror as you make the sound together. This helps them see the tongue placement and lip movements required.
Mouth pictures: Speech therapy sheets often have pictures of mouths making specific sounds. Point to the picture and explain how the tongue and lips look, then have your child try to imitate it.
Your face is the best cue! Don’t underestimate the power of your own face. Over-enunciate the sound and let your child observe your mouth movements. Watch this little video clip where I am teaching the /SH/ sound to my little student. You cannot see him but we are both sitting on the floor opposite one another so that he can see me easily.

Finger fun: making sounds with our hands

Finger shapes are another powerful tool in my speech therapy arsenal. Think of them as fun reminders of how to position the tongue.

‘Open Wide’ fingers: For sounds like /AH/ and /OH/, hold your fingers wide apart, mimicking an open mouth.
‘Tongue Up’ fingers: For sounds like /T/ and /D/, touch the tip of your thumb to your other fingers, creating a little ‘wall’ like the tongue tip touches the teeth ridge.
‘Snake Tongue’ fingers: For the /S/ sound, wiggle your pinky finger to represent the snake-like tongue tip.
In this little video clip I am demonstrating the C-shape moving forward which I had taught my child, showing how the windy sound (/SH/) travels forward with lips open and slightly pursed.

Bringing sounds to life with pictures

Pictures serve as visual prompts to connect the sound with a familiar word.

Video clip: I am using the WINDY SOUND picture and the FLAT TYRE sound picture to represent /SH/ and /S/ respectively
Point and Say: Point to each picture and say the word clearly, emphasising the target sound. Encourage your child to repeat.

Unlocking sounds with semantic prompts

Semantic prompts are fancy words for clues that help your child guess the target sound. They can be simple questions or descriptive words.

‘Can you feel the wind whooshing?’ (/SH/)
Think of tyre going flat, or a balloon losing air, or a train coming to a slow halt (/S/)

Practice makes progress, but fun makes it funnier!

Remember, the key is to keep practice sessions light and engaging. Here are some extra tips:

Short and sweet: Stick to short practice times (5-10 minutes) to avoid frustration.
Make it a routine: Integrate practice time into your daily routine, like after breakfast or before bedtime.
Positive reinforcement: Celebrate your child’s efforts with praise and high fives!
Make it multisensory: Incorporate sensory activities like blowing bubbles for /F/ or feeling the wind for /SH/.

Parents you’re a vital part of your child’s speech development, and together we can make huge progress quickly.

Please contact me if your child has speech sound difficulties.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Neurodiversity · Speech and Language Therapy · Top tips

Why ‘Prosody’ Matters in Childhood Apraxia of Speech (CAS)

ByLondon Speech and Feeding June 17, 2024June 25, 2024

Prosody refers to the ‘music’ of speech — the rhythm, pitch, stress, and volume that convey meaning and emotion beyond the literal words themselves. Think about a monotone statement like ‘Really?’ compared to one with a rising inflection, expressing genuine curiosity.

When I work with children on producing speech sound sequences, we focus on mastering individual sounds and then putting them together into target words. A crucial element that can significantly impact a child’s speech production is ‘prosody’.

In CAS, where the difficulty lies in planning and executing the motor movements for speech, prosody can be a powerful tool for producing clearer words and phrases.

Here’s why working on prosody is an essential tool in CAS speech therapy:

1. It aids Motor Learning:

Apraxia of Speech means that the planning and execution of speech movements are impaired. When we use exaggerated intonation or stress patterns while modelling words, we are providing additional prosodic variation and, therefore, additional auditory cues. These cues often help my student to carry out the correct motor movements for a word or syllable sequence.

For instance, I might say ‘ball’ with a high-pitched emphasis on the ‘b’ sound. This auditory cue might be more effective in guiding the child’s tongue placement than simply repeating the word without variation.

In this little video clip I get my student to say the word ‘snuggle’ (since we were working on that particular sound sequence: snuggle, snout, snore and sneeze) with a high voice and then a lower voice ‘like a bear’ — again it provides that extra auditory cue, but, in addition, the fun aspect also helps to take away the intense focus on a tricky movement pattern.

By now the new pathways have been laid through repeated practice and now automaticity takes over and without too much effort my student can suddenly produce a motor pattern. It’s magical when it happens and gives me such a thrill.

2. It makes speech more engaging and natural sounding:

Children with CAS often sound robotic or flat due to challenges with prosodic elements. By incorporating variations in pitch, volume, and rhythm during therapy, we can help achieve a more natural flow of speech

3. It makes it easier to express our emotions:

Children with CAS often struggle to express themselves emotionally; partly through the difficulty of producing clear words — period, but also in addition due to the difficulties or absence of musicality and rhythm in their speech.

Therefore, it is so important to incorporate activities focused on practising different emotions with varied intonation patterns. This can really empower our students to put emotions into their words.

Good words to practise are fun words like ‘Wow!’ or ‘Yeiih’ or power words and phrases like ‘No!’ or ‘Gimme that’ etc.

Making Therapy Fun and Engaging:

Speech therapy for CAS doesn’t have to be all drills and exercises (though to be fair sometimes we can’t quite get round to making each and every word huge fun though we try…).

I aim to make all my sessions fun and have intrinsic rewards built into the speech practice where possible.

Home practice tips:

Therapy shouldn’t exist in a bubble. Working on prosody during sessions is crucial, but it’s equally important to integrate these skills into everyday interactions. Parents and caregivers can model appropriate prosody during playtime, story time, or even simple conversations. This consistent reinforcement helps our children to generalise their newfound skills and use them naturally in their daily lives.

Sing songs and rhymes: Songs naturally incorporate variations in pitch and rhythm. Singing familiar songs and creating silly rhymes can be a delightful way to practise prosody.
Use puppets and toys: Assign different voices and personalities to puppets or toys. This encourages children to experiment with pitch and volume to differentiate characters.
Read aloud with enthusiasm: Model expressive reading, varying your voice for different characters and emphasising key words. This makes reading time engaging and helps children understand the power of prosody.

Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Autism Therapy · Speech and Language Therapy · Top tips

Using AAC during play with your child

ByLondon Speech and Feeding June 7, 2024June 6, 2024

Playtime! It’s a magic time for exploration, learning, and connection.

If your child is struggling to use words with his/her mouth, we can always use a robust Augmentative and Alternative Communication (AAC) device to help find their words. We know that using such a device does never stop or delay children to speak with their mouths. On the contrary it helps, enormously!

Can playtime still be a blast? Absolutely! In fact, incorporating AAC into play can be a powerful way to boost communication skills, build confidence, and create a truly inclusive play experience. Here’s how to make it happen, with a focus on core words and core scripts for our GLP’s (the building blocks of communication used by everyone). In this video I am using the core word ‘IN’ and ‘MORE’.

The Magic of Core Words

Core words are the most frequently used words in everyday communication. They might be verbs like ‘want’, ‘more’, ‘go’, or ‘stop’, or adjectives like ‘happy’, ‘sad’, and ‘hot’. These words are the foundation for building sentences and expressing needs and desires. They’re perfect for children using AAC because they’re simple to understand and use.

Let’s Play! Here’s How

1. Choose Your AAC System

Many options exist! It could be a low-tech picture board with core words, such as the one you see pasted on my cabinet door in the background, or it can be a dedicated AAC app on your tablet. Here I am using the GRID app but I also love using others, such as LAMP Words for Life.

2. Make it Fun and Functional

No pressure! Integrate your AAC system seamlessly into your play routine. Here are some ideas:

Car/trains: Use core words to describe what the cars are doing: (‘down’, ‘go’, ‘stop’, ‘again’ ‘fast’ ‘slow’).
Dress-up: Use core words to choose clothes (‘want’, ‘hat’, ‘shoes’).
Tea Party: Use core words to ask for and share (‘more’, ‘juice’, ‘give’).
Building Blocks: Use core words to describe what you’re building (‘tall’, ‘big’, ‘house’).
Dolls/Stuffed Animals: Use core words to act out scenarios (‘sleep’, ‘eat’, ‘cry’).
Arts and Crafts: Use core words to describe colours (‘red’, ‘blue’), actions (‘draw’, ‘paint’), and feelings (‘happy’, ‘sad’).

If your child is a Gestalt Language Processor you will want to model meaningful, fun scripts instead of single words! As above, but use phrases:

Car/trains: Use scripts to describe what the cars are doing: (‘it’s going down’, ‘let’s go’, ‘make it stop’, ‘want it again’, ‘that was fast’, ‘it’s so slow’).
Dress-up: Use scripts to choose clothes (‘I’m gonna wear this’ ‘that’s a lovely hat’, ‘let’s choose shoes’).
Tea Party: Use scripts to ask for and share (‘I want more’, ‘more juice’, ‘give me this’).
Building Blocks: Use scripts to describe what you’re building (‘a tall one’, ‘that’s so big’, ‘it’s a house’).
Dolls/Stuffed Animals: Use scripts to act out scenarios (‘it’s time to sleep’, ‘let’s eat’, ‘he’s crying’).
Arts and Crafts: Use scripts to describe colours (‘a red crayon’), actions (‘let’s draw’, ‘I’m gonna paint’), and feelings (‘I’m happy’, ‘that’s so sad’).

3. Model, Model, Model

This is key! As you play, constantly model using your child’s AAC system.

Point to the picture or word or script you’re using.
Speak clearly and slowly while pointing.
When using core words for either Analytical or Gestalt Language Processors, try using good phrases. For example, instead of just saying ‘juice’, say, ‘you want more juice?’

4. Make it a Team Effort

Get everyone involved! Encourage siblings, grandparents, and caregivers to use the AAC system with your child during playtime. The more consistent the approach, the faster your child will learn and feel confident using their voice.

5. Celebrate Progress, Big and Small!

Every step counts! Acknowledge and celebrate your child’s efforts, whether it’s reaching for their AAC system or successfully using a core word. This positive reinforcement will keep them motivated.

Remember

Playtime should be fun, not stressful. Don’t force your child to use their AAC system. Let them lead the way and follow their interests.
Every child develops at their own pace. Celebrate your child’s unique communication journey.
Seek professional help when needed. Your SLT can provide tailored strategies and resources to support your child’s development.

By incorporating AAC and core words into playtime, you’re not just fostering communication; you’re creating a space for your child to thrive, explore, and build strong connections.

So, grab those toys, power up your AAC system, and get ready for a playtime adventure filled with fun, connection and, therefore, communication!

Don’t hesitate to contact me!

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Lisp · Speech and Language Therapy · Top tips

Speech prompts and strategies I use in Speech Sound Therapy

ByLondon Speech and Feeding May 14, 2024May 13, 2024

This particular student has a mild motor planning difficulty and six weeks ago he came to me with a very strong lisp. In addition to the lisp he is struggling to produce a number of sounds, SH and L on its own and all the clusters (FL/BL/KL/PL) but also CH together with some vowel difficulties.

The prompts are a mix partially from the DTTC (Dynamic Temporal and Tactile Cueing) model by Dr Edythe Strand as well as phonological models I have learned over the years, and some of them are my own.

Visual/picture prompts and Images

Here I use the ‘Flat Tyre’ Sound, to offer as an image for a new S sound and the ‘Tick Tock’ Sound for a new image of the T sound. Both cards are from the Bjorem Speech Sound Deck, which I love and use almost daily.

Gestural Cues

I like to use all the ‘cued articulation’ hand cues by Jane Passy for consonants and fricatives. Here we use our fingers and hand to illustrate what our tongue does, and we also show whether a sound is voiced or voiceless. When I use one finger it is voiceless (k/f/s/p) and when I use two fingers for the same cue it means that the voice needs to be turned on: (g/v/z/b/n/m). For vowels I like to use Pam Marshalla’s cue system.

Simultaneous production

We say the word together.

Direct imitation

I say the word and my student copies me directly.

Imitation after a delay

I say the word and then after a little wait my student says the word.

Spontaneous production

My student has now learned to say the word by him/herself.

Offering feedback

It sounds like… I just heard… I didn’t hear the first sound there? Can you try again?

Letting the student reflect

By just shaking my head or by looking quizzical so that my student realises something didn’t quite go right.

Postitive reinforcement

‘Yes that was it, do it again, nice one…’

Cognitive reframing

This is a technique where we identify different semantic cues and metaphors or imagery cues, so instead of teaching or focusing on a sound we try out viewing each syllable from a different point of view.

For example: ‘yellow’. I have had great success with this one: we start with just saying ‘yeah yeah yeah’. I might make a little joke and say something like ‘imagine your mum says tidy your bedroom, what do you say or what do you think?’ Answer: ‘yeah yeah yeah’. Then we practice ‘low’ together, I might blow some bubbles high and low and we talk about ‘low’. And then we put ‘Yeah’ and ‘Low’ together and now we have YELLOW!! It might at first still sound a bit odd, like ‘yea-low’ but we soon shape that up and have the real word.

Each student is different and having a great rapport is crucial to our success.

Then a little game break after some 7–10 or so repetitions and always trying to finish on a positive note.

What game breaks do I use:

Very quick ones! Students can post something, place a counter in a game, take out a Jenga block from the tower, pop in a counter for ‘connect 4’, stick a sword into the Pop the Pirate barrel or add a couple of Lego blocks to something they are building.

I hope this is helpful, please contact me for any questions.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Speech and Language Therapy · Top tips · Toys

How can we support babbling and early speech development? SLT tricks and tips

ByLondon Speech and Feeding May 3, 2024May 3, 2024

My baby isn’t babbling and developing speech – what can I do to support?

While every baby develops at their own pace, if your child isn’t babbling by nine months, it’s worth seeking help from an Early Intervention Health Professional, such as a doctor and a speech therapist. Don’t panic! There are many reasons for delayed babbling, and early intervention is key.

In the meantime, it is highly recommended that we talk, sing, and read to our baby often. Exaggerate sounds and expressions, and respond to their coos and smiles. This playful interaction helps stimulate their communication skills.

Below are some tips and tricks from my experience of working with babies and toddlers who need a little bit of help and support to develop.

The benefits of imitating your baby

Copying your baby’s sounds and gestures isn’t just silly fun, it’s a powerful learning tool! By mimicking their babbles and actions, you activate “mirror neurons” in their brain that help them connect sounds with meaning. This playful back-and-forth teaches turn-taking, a foundation for conversation. Plus, it encourages them to copy you, building their own language skills and social interaction abilities.

This is a nice clip on youtube showing how copying/imitating your baby looks like:

Here are some fun ways to imitate your baby:

Matchmaker: Grab two of the same, or two similar toys your child loves, like rainmakers or shakers. Give one to your baby and keep the other for yourself. When your child plays with his/her toy, mirror his/her actions with yours! This creates a fun, interactive game.
Face Time: Get down to your baby’s level, sitting opposite him/her on the floor or kneeling. This makes eye contact easy and encourages him/her to look at you during your playful imitation.
Be the Funniest You: Go all out with silly faces, exaggerated sounds, and big gestures. The goal is to capture your baby’s attention and make you irresistible to watch. This playful energy encourages him/her to interact and potentially imitate you back!

By incorporating these tips, you can turn imitation into a fun and engaging way to boost your baby’s communication skills. I have seen this happen numerous times over the past decades. It is very powerful, go ahead and try it! You cannot be silly and goofy enough!

Great toy ideas:

Organza Veil Fabric good for hide and seek

Bubbles – always handy keep in every room

Antic Duck Peekaboo Knob Puzzle Suction Cup Spinner toys

Did you know that speech and language development starts with how we talk to our babies?

Adults naturally use a special way of speaking called motherese. It involves a higher pitch, slower pace, and exaggerated sounds compared to regular conversation. Sentences are simpler, with shorter words and repetition. This grabs babies’ attention, helps them distinguish sounds, and reinforces word meaning.

Imitation is a key part of motherese. We wait for our baby to make a sound or gesture, then playfully imitate it with exaggeration. Babies notice this right away and often respond with more vocalisations, creating a mini conversation. This back-and-forth teaches turn-taking, a foundation for future conversations.

By responding warmly and engaging in these playful interactions, we encourage our babies to keep exploring the world of communication. Talking, singing, reading and, of course, imitating, these simple actions can have a big impact on a baby’s language development.

Once your conversation is underway then try and keep it going for as long as possible. It’s a beautiful dance of turn-taking, even without words!

A last word on oxytocin

There’s evidence suggesting early non-verbal communication with your baby can increase a mother’s oxytocin levels, often called the ‘love hormone’. This hormone plays a key role in bonding and social connection. Positive interactions, touch, and stress reduction all contribute to oxytocin release, strengthening the mother–baby bond.

For parents of babies with extra needs

The stress of caring for a child with medical needs or developmental delays can be difficult. Stress can lower oxytocin levels, creating a cycle of sadness for both parent and child.

Breaking the cycle:

Knowledge is Power: Understanding the importance of communication can empower parents.
Seek Support: Speech therapists and other healthcare professionals can provide valuable guidance on communication strategies.
Start Small, Celebrate Big: Even small interactions can boost oxytocin. Focus on playful imitation and positive reinforcement. Remember, friends, family and healthcare professionals are there to encourage you.

This approach can help reverse the negative cycle and create a more positive and connected relationship between parent and child.

I hope this is helpful! Don’t hesitate to reach out with any questions.

Kind regards

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Feeding · Top tips

Answers to very common questions I get as a Feeding Therapist

ByLondon Speech and Feeding April 2, 2024March 19, 2024

What are hunger cues in newborn babies? How do we recognise when our baby is hungry? How often should we feed our baby?

These are very common questions I get as a Feeding Therapist. And so I thought I would write a blog on it.

A mother holding her baby on one arm in her lap while holding a cup — Image by Freepik

First-time parents’ journey

First-time parents often imagine that feeding, particularly breastfeeding, will be an easy and natural process without too many problems. It can be a rude awakening to find that feeding our newborn is not at all easy and can be fraught with complications. It is fair to say that in most cases by the time our baby is about eight weeks old most mums have got the hang of feeding, either by breast and/or bottle, and things are falling into place.

But until that time it can be a difficult journey:

getting to know one’s baby,
getting to know their feeding rhythm,
falling in with it,
TRUSTING that baby knows what they need and knows when they have had enough,
TRUSTING and not going crazy with going down an on-line rabbit hole of information and guidance mostly unnecessary and often quite simply FALSE!

Many mums I have met set out with the best intentions to breastfeed for as long as possible. However, they arrive in my clinic anxious and often have given up with the breast; now we are on bottle feeds and things are still very tricky for several reasons. There are too many reasons for this blog to cover but I thought I would start with the basics and ‘reading hunger cues’ is one of those early basics.

Reading hunger cues

So let’s dive in:

Newborns communicate hunger through a variety of cues. Here are some early signs to look for:

Early hunger cues: These are the best times to respond to baby’s hunger for a more peaceful feeding. Look for things like:
- Becoming more alert and active
- Turning head from side to side in the cot
- Rooting (turning their head towards your breast or a bottle, especially when stroked on the cheek)
- Putting hands/fists to mouth
- Sucking on fists or lips
- Opening and closing mouth, smacking sounds

TOP TIP: THIS IS WHERE YOU SHOULD GET READY TO FEED. Breast or bottle. Either way get ready. We do not want our baby to get into later hunger cues, which are below:

Later hunger cues: If we miss the early cues, babies will progress to more insistent hunger cues. These include:
- Fussiness or whimpering
- Rapid sucking motions
- Increased squirming
- Head bobbing

Generally, remember that we do not want our baby to cry for their food. Because once they are riled and cry they are not relaxed enough to latch, especially when latching is hard!

Feeding on demand vs. scheduled feeds

We now know and have researched how babies are fed best and safest, how weight gain is ensured best, both for breastfed and bottle-fed babies.

It’s generally recommended to feed on demand—unless your baby is tube-fed or has some other pressing health concerns or is failing to thrive.

What are the benefits of on demand feeding?

We need to respond to baby’s individual needs and hunger cues because every person is unique!
Babies need to learn and regulate their own hunger and satiation cycles
Promotes better weight gain and growth
Leads to more peaceful feeding experiences

Scheduling can come later

A loose schedule might emerge naturally when your baby is around 2–3 months old, but it’s best to follow your baby’s lead.

Tips:

Some newborns may feed every 2–3 hours, while others go longer stretches. Pay attention to your baby’s cues and feeding habits.
Crying is a late hunger cue, and frequent crying can make feeding more difficult. Responding to earlier cues is best.
If you have concerns about your baby’s feeding patterns or weight gain, consult with a Speech and Language Therapist/Dysphagia Therapist and/or Lactation Consultant.

Check out these useful resources on the topic of Demand Feeding:

Signs That Your Baby Is Hungry, a video from baby gooroo/Amy Spangler, RN, MN, IBCLC
Newborn hunger cues video from janellevideo
Infant Hunger Cues from Lactation Education Resources
Feeding Cues from the Australian Breastfeeding Association
The Clock and Early Breastfeeding by Nancy Mohrbacher, IBCLC, FILCA
Nursing your newborn — what to expect in the early weeks by KellyMom
Should baby be on a schedule? by KellyMom
Examining the Evidence for Cue Feeding Breastfed Infants by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC

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.

Speech and Language Therapy · Top tips

Principles of motor learning in childhood apraxia of speech: A guide for parents and therapists

ByLondon Speech and Feeding March 22, 2024March 22, 2024

Childhood Apraxia of Speech (CAS) is a complex neurological disorder that affects a child’s ability to plan and coordinate the movements necessary for speech production. Children with CAS often have difficulty with articulation, prosody, and fluency, making it challenging for them to communicate effectively. While there is no cure for CAS, speech and language therapy can significantly improve a child’s communication skills and overall quality of life. Understanding the principles of motor learning is crucial for both parents and speech therapists to support children with CAS on their speech journey.

What is MOTOR LEARNING?

Motor learning refers to the process of acquiring and refining new skills through practice and experience. This applies to all aspects of movement, including speech production. The brain constantly receives sensory information about the movements being made and adjusts them based on the desired outcome. A breakdown or interruption of this process can make it difficult for children to plan, sequence, and coordinate the intricate movements involved in speech.

What key principles do we use in speech and language therapy for motor learning?

Task Specificity: Speech Therapy activities that directly target the specific speech sounds or skills your child is working on. For example, if your child is struggling with /p/, practising isolated /p/ sounds, words with /p/, and phrases with /p/ would be most beneficial.
Massed vs. Distributed Practice: We consider the optimal amount and distribution of practice sessions throughout the day. Massed practice involves concentrated practice in a single session, while distributed practice spreads practice sessions throughout the day. The best approach depends on the individual child’s learning style and attention span.
Feedback: We provide clear and immediate feedback to help your child understand the accuracy and effectiveness of their attempts. This feedback can be auditory, visual, or touch based.
Error Correction: We aim to gently correct errors so that we can help your child refine their movements and avoid developing bad habits. The focus is on providing specific cues and guidance rather than simply pointing out mistakes.
Variety and Progression: We gradually introduce new challenges and variations in speech therapy activities to prevent plateaus and maintain motivation.
Motivation and Engagement: A big part of our work is to make therapy sessions fun and engaging to keep your child motivated and actively participating. We use games, songs, and activities that your child enjoys while incorporating targeted practice opportunities.

What about home work?

Yes we need your help and here are some examples of how this could look:

Task Specificity: During story time, focus on practising target sounds present in the story. Have your child repeat words or phrases containing the sound and encourage them to identify the sound in other words.
Massed vs. Distributed Practice: Instead of one long practice session, try shorter, more frequent sessions throughout the day. This can help maintain focus and prevent fatigue. It is recommended to go for 100 repetitions of the target sound per day, every day in between the sessions. We can decide together how you can best do that through either massed or distributed practice. We can decide after the session.
Feedback: Use a mirror to provide visual feedback on lip and tongue placement during sound production. Record the child’s speech and play it back to help them self-monitor their accuracy.

I quite like this mirror below but any table top mirror will work as long as it is not too small. Your child should see their whole face easily.

Error Correction: If the child makes an error, gently model the correct sound or movement without shaming or criticising. Provide specific cues such as ‘lips together’ for /p/ or ‘tongue up’ for /t/.
Variety and Progression: We will guide you on exactly what words to practise so this is something you need not worry about.
Motivation and Engagement: Use games, songs, and activities that your child enjoys. Play a game of ‘I Spy’ focusing on words with the target sound or create silly sentences with the sound to make practice fun.

Let’s work together!

It is crucial for parents, therapists, and other caregivers to work collaboratively to ensure a consistent and comprehensive approach to supporting your child’s speech development. Speech and Language Therapists can provide guidance and resources on implementing these principles at home, while parents can share observations and progress updates to inform therapy sessions.

Remember, every child with CAS learns at their own pace. By understanding and applying the principles of motor learning, parents and speech therapists can create a supportive and stimulating environment that empowers children with CAS to reach their full communication potential.

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.