Speech and Language Therapy

  • Help! My child has a lisp. What can we do about it?

    ByLondon Speech and Feeding

    What is a LISP?

    There are different types of LISPS. Let me explain:

    A lisp is the difficulty making a clear ‘S’ and ‘Z’. Other sounds can also be affected by the tongue protruding too far forward and touching the upper teeth or the upper lip even. ‘T’ and ‘D’ can be produced with ‘too much tongue at the front’ and this can also have an impact on ‘CH’ and often also ‘SH’.

    1. Interdental lisp

    Protruding the tongue between the front teeth while attempting ‘S’ or ‘Z’ is referred to as interdental lisp; it can make the speech sound ‘muffled’ or ‘hissy’. Often, we associate a lisp with the person sounding a bit immature. The good news is that this type of lisp is the easiest to correct and, in my practice. I have a 100% success rate with this type of lisp.

    1. Lateral lisp

    In a lateral lisp the person produces the ‘S’ and ‘Z’ sounds with the air escaping over the sides of the tongue. This renders the ‘S’ as sounding ‘slushy’ or ‘wet’. This type of lisp is a bit harder to correct than the interdental lisp. In my experience this can be fixed but it might need a bit longer, more intensive therapy than the interdental lisp.

    1. Palatal lisp

    With a palatal lisp the ‘S’ sound is attempted with the tongue touching the palate, much further back than it should be. The ‘S’ sounds ‘windy’ and ‘hissy’. This is a quite rare lisp production but it is also not difficult to correct.

    These types of speech difficulties come under the category of ‘speech delay of unknown origin’ and may persist into adolescence and adulthood as ‘residual errors‘.

    Some thoughts on Treatment in general:

    Lisps can be treated successfully by a Speech and Language Therapist. However, for the treatment to work well, a student needs to be able to cooperate and want to improve his or her speech. Lisp remediation entails a fair amount of repetitive work and very young children or unmotivated older children don’t make the best candidates for treatment for this reason. Often students present with other speech, language or social communication difficulties and here the lisp might not be the priority for treating. For example, it might be that due to a student’s Attention Deficit Disorder they are simply not able to focus on speech practice in their daily life.

    When should treatment of lisp begin?

    Waiting well past 4½ years is not advisable as the longer we wait and do nothing the stronger engrained the erroneous tongue/speech habit will become. The ‘right’ age for therapy for one child may be different from the ‘right’ age for another child even within the same family. So do make an appointment with a speech and language therapist to assess and see whether your child might be ready to start therapy.

    Do lots of children lisp—is it normal?

    Until the age of about 4–4.5 years old it can be a perfectly normal developmental phase for some children to have the interdental lisp. But when we see and hear a lateral or palatal lisp we ought to act and see a speech and language therapist for sure.

    After the age of 4.5 or 5 years old most speech therapists would agree on at least having a look to see if treatment could be started. The longer we wait the harder it is to retrain the brain pathways to adopt new speech habits.

    What happens during the first Speech and Language Consultation?

    The first consultation takes about an hour and involves screening relevant areas of communicative function. We take a detailed history, examine the anatomy of the child’s mouth and tongue movements. We check for tongue tie, teeth formation, palate structure and function, as well as swallowing patterns.

    Then we begin straight away to try and see if any of the alveolar sounds (T/D/L/N) can be produced correctly with the right tongue placement as that would be the starting point from where to shape a good, clear ‘S’ sound.

    The first consultation usually ends with home practice being given, explained to parents and another appointment being made for follow up.

    Therapy – what does a session look like?

    Each therapy session consists of:

    1. Listening to sounds, discriminating sounds, identifying sounds, listening to rhyming sounds, sound awareness. We call this Auditory discrimination of single sounds: can the student hear the difference between two words that are the same apart from the first sound: ‘sing’ and ‘thing’ or ‘sigh’ and ‘thigh’?
    2. Sound production: using a variety of different prompts and cues we will teach how to physically make the new sound. Often, we work on making a NEW sound, instead of correcting the OLD one. We work on imitation of single sounds then gradually we try and make new sounds in short words, then longer words and then phrases and sentences.
    3. Games! We play games and try and have fun in between listening and producing our new sounds to help students stay motivated and even enjoy the therapy session and process.

    How long does it take to ‘fix up’ a lisp?

    It tends to take about one term with weekly sessions to help a student make good ‘S’ sounds in phrases and sentences. If the student can do the home practice every day in between the weekly sessions, then in most cases I am able to pronounce the lisp as ‘fixed’ after about one term.

    After that the student needs to practise, practise, practise, at home and in daily life to keep reminding themselves of their new skills and their new sound production.

    It is a matter of reminding and wanting to get it right. Occasionally a student returns to me for another term of simply practising their skills together with me as they are finding it hard for any number of reasons to practise at home. But generally, 8/10 students will be fine after some 12–13 sessions and their speech will be perceived as perfectly typical by family and friends.

    If your child has a lisp or any other speech error, please do not hesitate to contact me.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

    0
  • ·

    How to model AAC with our minimally speaking students?

    ByLondon Speech and Feeding
    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.

    0
  • · ·

    AAC Systems and Speech and Language Development

    ByLondon Speech and Feeding

    Introduction

    I see a lot of minimally speaking or non-verbal children in my practice. Some children are autistic and others are severely challenged with motor planning and some are both. Some children are simply delayed in their spoken language for reasons that we don’t quite know yet.

    Regardless of the causes, what is always apparent pretty quickly is that apart from the odd gestures or Makaton signs (mainly ‘more” ‘finished’ and “biscuit) we don’t have a robust alternative for speech in place. Instead, what we often have is a child with lots of frustration and tantrums and some behaviours we really don’t want like: hitting, biting, pushing, grabbing and often throwing… There are others, too many to mention, but we don’t enjoy watching our children in these states. And we are often fearful of what might happen next if we don’t find a way to calm our child.

    Fear not

    In my work, before I get to offer an alternative means of communication, I often have to work with a fair amount of resistance on the parents’ side as parents tend to feel that allowing such a system into their lives will prevent their child from speaking. They fear that their child will so enjoy pressing those buttons that they will become lazy and not talk at all.

    I totally get it!

    Parents often feel overwhelmed by the task of getting their own heads round how to use AAC, either in paper form or a computerised system. This can be a great turn-off for lots of people who feel they are not very “techy” – like myself actually! Indeed, it is true to say that I resisted operating in this field for a long time as I didn’t feel able to navigate electronic devices. But fear not. Truly, most systems are very user-friendly. The support is great. And I have managed to become quite proficient in one or two of these systems, through using it daily. It really is as simple as that.

    Alternative and Augmentative Communication (AAC)

    There is plenty of research on the efficacy of Alternative and Augmentative Communication (AAC). It is now very well understood and proven that, once we introduce our child to a good, attractive way of communicating that they can actually do, in time children who can speak will speak. Speaking is more effective than any AAC system. It is more versatile, more fun, and when human beings have discovered how to speak, most will do so in favour of any other system.

    Many children and adults, for many reasons, were never going to speak an awful lot, or with great difficulty. Or they were not going to like to speak. Or they were going to like to speak some times but not other times… And for all those people an AAC system is invaluable and a wonderful resource.

    Neuro-diversity affirming means that we do not impose one system of communication on our children (speaking with our mouth) only because it is the one we are using and most people we know too.

    Of course, we want the best for our children, and we want them to have the easiest and most straight forward existence on Earth. Of course we do. Speaking with our mouth does help with that. But we must come to understand that not all children and people feel like that and they struggle to use their mouth for talking.

    Personal experience

    I have difficulties understanding this myself, I will be very honest here. And I will say that – shoot me down in flames SLT fraternity – but I am learning to accept that using an AAC system proficiently is a very good alternative for when speech is not coming. I am learning to accept that some people are perfectly able to speak, and might do so but not always and only when conditions are right. I came into the profession as a speech therapist with the idea that I would help anybody that came to me to speak with their mouth. But I have changed my stance on that and now am happy to help anybody that comes to me to communicate most effectively with whatever works for them. I will always try for speech if I can … Just because it’s easiest!

    Acceptance

    Now I will equally celebrate a child pointing to a symbol or making a sign for something. It is a fantastic moment when it happens for the parents and me and the child! And we can always hope for more speech to come as we go. Nothing wrong with our aspirations, is there?

    The basic premise is this: accept any mode of communication as valid, as long as your communication partner understands what it means. Don’t require individuals to repeat themselves in another modality. Do model the response in the modality you are trying to teach. So, a child can point to a symbol and I will respond with speaking (with my mouth) but I will also respond by pointing to a symbol because that way I am signalling that both are ok and that I have understood and am encouraging the person to say some more.

    Here is some research;

    Binger, C., Berens, J., Kent-Walsh, J., & Taylor, S. (2008) The effects of aided AAC interventions on AAC use, speech and symbolic gestures. Seminars in Speech and Language, 29, 101-111.

    Sennott, S.C., Light, J., & McNaughton, D. (2016). AAC modelling intervention research review. Research and Practice for Persons with Severe Disabilities, 41, 101–15.

    Dada, S., & Alant, E. (2009). The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech. American Journal of Speech-Language Pathology, 18, 50–64.

    Contact me if you would like your child to have neurodiversity affirming speech and language therapy.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

    0
  • ·

    Rethinking the PECS Approach

    ByLondon Speech and Feeding

    I want to talk about some concerns of SLTs, parents and increasingly autistic adults who explain to us how this communication method did not really work so well and why.

    What is PECS in a nutshell:

    PECS (Picture Exchange Communication System) is based on the idea of exchanging pictures in return for desired items. For more advanced users, it is used to communicate different functions such as emotions, comments, negations using the exchange of a sentence strip. It was founded on the principles of Applied Behavioural Analysis (ABA).

    How does that look in practice?

    In my experience, having been trained in the approach myself, the overall aim is eventually for the child to spontaneously go and get their picture book (PECS book), open it, look through a range of pages to select the correct picture of what they want to have or say, then go and find their communication partner, and finally place that picture onto the communication partner’s outstretched palm to be rewarded with an item or with a response of some sort. Or the child selects a range of pictures to create a little sentence, such as: ‘the blue fish swims in the sea’, ‘the red bird flies in the sky’ or ‘I see a red bird’ for example. This can be part of a structured table top activity.

    The system follows a series of phases, starting from simple picture exchanges to eventually construction of sentences using symbols. PECS’s aim is to promote communication initiation and reduce frustration for those who struggle with speech.

    So far so good one might say, why not? Before I go into the various concerns, I would want to add my own working experience with PECS, and whilst it is my opinion, I would say I have NEVER seen a working PECS book being used spontaneously!

    My experience

    I have seen attempts of stages 1 and 2 done quite well, in schools, and where people knew that I was coming in “to have a look at how PECS is working with child X”. Yes, in those instances an effort was made of course to try and show me how it worked. I must add that have never been very impressed. I cannot recall it used for any other items than: biscuits/quavers/crisps/ raisins and bubbles/puzzle pieces or spinners.

    If we want to see a child trained to exchange for these items in a structured setting, i.e., the child sits at a little table with the adult sitting opposite enticing the child with one or other item, then yes that can be done successfully. I have seen children exchange 25 pictures with a crisp on it, for said crisp and they might have asked for another 25 of those crisps given half the chance. Yes. Good. But. I have yet to see a child go to their PECS book and go through all the motions that I mentioned above to get a crisp. In school they don’t need to: they know that crisps are only available when the PECS book is being practised. Otherwise, let’s be honest, it’s fruit at 10.30 am!

    So, they don’t get a spontaneous opportunity to ask for highly motivating items as that is not how school works, is it? ‘SIR! Can I have a crisp?’ At 10.02am, in the middle of maths? Didn’t think so… So in reality this does not get practised in my experience.

    A few concerns in no particular order:

    Limited Generalisation

    One issue often raised is the limited generalisation of skills learned through PECS. The structured nature of the program may result in a child only being able to communicate effectively within the specific contexts where they were taught to use the system (as I suggest above: crisps: yes, please let’s do the PECS for it). This limitation can pose challenges when trying to apply communication skills in new or unstructured/spontaneous situations.

    Lack of Spontaneity

    Critics suggest that PECS can sometimes lead to scripted and less spontaneous communication. This is also what I have observed. Since the method is designed to follow a structured progression, there is a concern that individuals might struggle to initiate communication outside of the established framework, potentially hindering their ability to engage in more natural interactions.

    Narrow range of communication functions being practised

    While PECS is quite successful in focusing on requesting and naming items, there are many other important communication functions, such as expressing emotions, asking questions, giving opinions or greetings for instance. We can argue that a communication core board where we have a whole range of different core words available lends itself much better to practising a range of communicative functions.

    The Pictures are movable

    They are attached to the book via Velcro. They are constantly being picked and exchanged and then returned to the book. This means that the pictures tend to be always in different places. This goes against the motor planning that takes place when one is learning a new skill: imagine you want to learn to touch type and the letters always move and are at different places? How can you be quick about finding a letter? You can never get to “automatic” with this type of approach.

    Communication is not taught via behavioural means

    Only if you say “banana” in the way that I dictate that you should will you get a piece of banana. Who does that? Nobody. Typically, child points to the counter where there is a banana and says: ‘ba’ or ‘ana’ and mother/carer will look over there and say ‘oh banana! You want a banana? Ok there you go have a piece.’ Or something like it. Mother will not say: ‘SAY BANANA or else you won’t get it.’ Child hears mum saying ‘Banana’ each time and with time will point and say ‘banana’ or ‘I want-a-nana’ or something. This is how communication is learned: through the adult modelling it cheerfully all day long and the child hearing it and then gradually copying it.

    One other gripe I personally have but I am reliably informed by all my parents that they share this about PECS:

    IT IS SO LABOUR INTENSIVE!

    There are 10, 50, 100’s of little pictures that first of all need laminating… then velcroing, then finding and replacing. As I said above, it’s a constant moveable feast for one, but also you LOSE them. Yep. You want to find the picture for “trampoline”. ‘Where is it? I saw it yesterday… We had it outside when we practised you asking for the trampoline. I am sure we put it back? Where is it??? Ok. We need to print off a new one.’

    It is also labour intensive for the first stage where you need to have TWO adults to ease the exchange (pick up and release of picture into the communication partner’s hand). Who has two adults available for what can be weeks until the child is able to pick up and release by themselves?

    YEP. So it’s really not for me you can tell! I much prefer Core boards (see my previous post on using one) or electronic speech generating AAC devices like GRID, or LAMP or TOUCHCHAT. These are all great to use and there is good support out there for introducing these.

    Finding a Balance

    While the concerns surrounding the PECS approach are valid, it’s fair to note that the method also has some merits. There is anecdotal evidence of many individuals who have successfully improved their communication skills and quality of life through PECS. But, finding a balance between using PECS as a stepping stone and ensuring the development of more comprehensive and SPONTANEOUS communication is key.

    As educators and therapists, we need to extend the focus beyond requesting and labelling by incorporating symbols that represent emotions, actions, and more complex ideas. This expansion encourages a broader range of communication functions. When the time is right, gradually transitioning from PECS to more advanced communication methods such as Core boards or electronic AAC tools and speech-generating devices is the way forward.

    We want to value all communication equally and our approach ought to be playful and child-led and to focus on intrinsic motivation instead of extrinsic rewards and reinforcers.

    If you have any questions or if you are looking for a therapist who endorses play-based and child-led therapy approaches, please do reach out.

    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.

    0
  • ·

    Empowering non-speaking children: the power of AAC Core Boards

    ByLondon Speech and Feeding

    Communication is the essence of human interaction, allowing us to express thoughts, feelings, wants and needs. For non-speaking children and their families finding an avenue to communicate effectively can be a really challenging journey.

    Augmentative and Alternative Communication (AAC) offers a solution: with AAC Core Boards as a powerful ally and tool to empower and express more than requests: ideas, comments, surprise and delight, as well as saying no to something! Very important!

    “AAC is a set of tools and strategies that an individual uses to solve every day communicative challenges. Communication can take many forms such as: speech, a shared glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, and speech-generating devices” (RCSLT, 2023) to name just some.

    AAC Core Boards are a powerful tool to empower non-speakers to express ideas. In this blog, we’ll explore the significance of AAC Core Boards and how they can unlock the world of communication for non-speaking children.

    Let’s discover and understand AAC Core Boards

    Firstly, let’s look at what a Core Board looks like…

    AAC Coreboards
    Credit: Saltillo Word Power

    Why not have a go and download your own copy (and other boards) for free on the Saltillo Word Power website.

    AAC Core Boards are a specific type of AAC system that employs a grid-style board. This grid contains a set of core vocabulary words or symbols, which serve as a foundation for all communicative functions (e.g., initiating, greeting, requesting, negating, commenting, asking a question, and expressing surprise).

    These boards incorporate high-frequency (most used) and versatile words. They enable us to construct sentences, express emotions, and take part in conversations, fostering a sense of independence and autonomy. By enabling communication, we also remove some of the frustration (from not being able to communicate) which contributes/or often leads to behavioural difficulties.

    Building literacy skills

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

    As they consistently play with and then use their boards, they naturally absorb language patterns, laying the foundation for improved literacy skills. This immersive learning experience paves the way for future language acquisition and communication growth.

    Customisation for individual needs

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

    Collaboration between AAC Core Boards and Speech Therapy

    AAC Core Boards are an excellent tool but we need to know one important aspect: they only work well when used regularly by the child’s family and key people in the first place.

    The board needs to be used and modelled by adults consistently and regularly across environments. This is so our children know what to expect, take an interest and begin to use the boards themselves. Modelling the use of AAC Core boards is vital. Think how long it typically takes for a child to learn their first word. Around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.

    Collaborating with your child’s Speech and Language Therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best put them in place, so that your child can reach their communicative potential.

    For non-speaking children, AAC Core Boards are more than just tools. They are bridges to a world of communication, connection, and empowerment. These boards harness the power of visual communication, foster language development, social interaction, and personal expression. They can be tailored to individual needs with the support of skilled professionals. AAC Core Boards offer a beacon of hope, helping to break through communication barriers and thrive in a world that is waiting to hear your child’s voice.

    For answers to your questions and to explore the most effective support for your child, feel free to contact us.

    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.

    0
  • ·

    Discover more about Verbal Dyspraxia

    ByLondon Speech and Feeding

    What is Verbal Dyspraxia?

    Apraxia or dyspraxia is a difficulty in motor planning, which sometimes can be seen in both gross and fine motor skills, as well as speech. Gross motor refers to difficulties in coordinating the whole body (e.g., bumping into things frequently, often falling over hurting themselves or others through being “clumsy” or unsteady). Fine motor movements refer to smaller, more precise movements (e.g., difficulties doing anything with their hands such as holding a spoon or pen).

    Verbal dyspraxia

    In Dyspraxia of Speech, instead of seeing a coordinated smooth way of talking, we see the articulators (tongue, lips, cheeks) and voice coordinating very smoothly. The voice can be very quiet or very loud. Muscle tone can be weaker at times. Speech sounds are very unintelligible, with a flat voice that can sound forced. It may be that the timings of verbalisation appear random and that children can say a certain word once and never again. This is often what we hear from parents.

    It is interesting to note that many of our autistic clients are either non-speaking or are reluctant speakers. Sometimes they say a word once and then never again. Others say lots of words but the words are very hard to make out. Did you know that about 40% of autistic people have verbal dyspraxia? (Richard, 1997). Because the problem is one of motor planning, not of automatic motor execution, once a plan has become automatic, it is easier to get back to it and this is why we often see repetitive patterns that can be called ‘stims’ (Marge Blanc, 2004).

    How can Speech and Language Therapy help?

    Children with verbal dyspraxia can make great progress!

    We provide frequent and appropriate speech movement opportunities and with time and the right support, children will move forward and begin to speak more fluently and with greater intelligibility. It is important to know this can take time.

    We provide Oral Motor Therapy using a variety of approaches to practise breathing, vocalising on the outbreath, and sequencing our speech movements.

    We design carefully tailored programmes focusing on words that have a lot of power (e.g., NO, GO, UP, IN, OUT, LET’S GO, STOP).

    We offer shared enjoyment, and laughter. This helps a child find their voice. Other ways of finding our voices include singing or humming, or even yelling/shouting!

    The most difficult phase of verbal dyspraxia is initiation, that is to start talking, to start producing a word. Frequent “automatic” repetition supports children with initiation because it removes the element of “thinking to start”. I often ask a child to repeat a word 5-10 times (with rewards at the end. A little game works well). You can see that with repetition the act of initiating is taken out of the equation as you are “on a roll “as it were.

    Once a child starts to find their voice, we will be able to hear them talk lot… And if we give them credit and presume that what they are saying has meaning, we will find in time that their words become clearer and more intelligible. If we listen carefully, we can detect real words and phrases.

    For more tips and support, please get in touch!

    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.

    0
  • · ·

    Strategies to support children with eating difficulties

    ByLondon Speech and Feeding

    where the cause is NOT a swallowing problem, but we are having a “fussy eater” in the family, seeming for no obvious reason

    When parents have a child who find mealtimes or eating difficult, it can put pressure on the whole family dynamics. Once we have observed a child’s eating and drinking skills and found that they are not swallowing impaired, but are for want of a better word “fussy” or “picky”, we can then start to look at what might be underpinning the food aversions/picky eating/food avoidance. Two of the main questions parents have (of course) are:

    • ‘is my child getting the right nutrition?’
    • ‘how can I have less anxiety-provoking and stressful mealtimes?’

    We all tend to have an image in our minds about the ‘perfect mealtime’, and how mealtimes ‘should’ be. Speech and Language Therapists with a Feeding Specialism are the perfect professionals to help you unpick feeding issues. We are trained to look at swallowing and oral skills and we also know a lot about feeding behaviours and sensory difficulties which could be causing your child’s eating avoidance.

    Here are some strategies that can support children with their eating:

    1. Create and maintain a mealtime culture that suits your home and lifestyle. Then stick to that. We all need some routine in our lives to thrive. Mealtimes are no different. It might be that you eat in the same place for every meal, with the same knives and forks, concentrating on maintaining good posture. Children learn by repetition so the more familiar it is, the easier they will find it. In the physical sense, our bodies also need preparing for food, regardless of whether we are eating with our mouths or we are tube-fed. We want every child to connect all the dots of the process. It starts with their eyes, noses, expectations, memories of past experiences, feelings and then finally their mouths….
    2. Be an excellent role model. Children learn through watching others, so your child will be observing you without you knowing. Ensure that you are positive about the food you are all eating, and talk about how delicious, tasty, juicy, and yummy the foods are. Make the atmosphere around the dinner table light hearted. Even though you are secretly stressed about your child not eating, try and not show this. Instead pick a topic or put on some nice music, or talk about something your child might be interested in, and try and avoid coercing your child to eat. Leave small finger foods on their plates and have a range of foods available on the table so that your child can see that everyone is eating a range of foods and enjoying them.
    3. Use positive reinforcement. Try and think of mealtimes as fun and motivating. Children who are happy will likely be more inclined to try foods and take part in family mealtimes. Reward all interactions around food, so if your child merely touches a new food then praise this behaviour. Or if your child licks a food just once, again make a nice comment and praise your child for touching and licking the food. The takeaway here is to try and keep all messages positive around food.
    4. Keep offering all types of food. What often happens is that parents stop serving foods they know will not be eaten. This makes sense in a way; we don’t want wastage! However, try and keep the doors open and re-offer all types of foods, even the ones that your child has not wanted in the past. Try and give your child one food they will like and one food they have tasted before and liked before, even a little, and then one new food to try. So, your child always has something to fall back on and they can join in with eating. But they can also try (or at least look at and think about trying) other foods that you and perhaps the siblings are eating.

    Take a look at this website, I find it very helpful in showing parents what types of foods and how big a portion to offer

    Have a go and try and implement some of the ideas above, and should you get stuck please get in touch!

    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.

    0
  • · ·

    Ten games to support communication in primary school aged children

    ByLondon Speech and Feeding

    When parents visit me with their child, their stress is palpable. Often parents don’t relish or even expect to be asked to practise strategies at home with their child between sessions. Let alone to practise whilst on holiday. I understand that you don’t necessarily want anything extra added to your daily ‘to do’ lists. This is why we try our best to incorporate all speech and language therapy practice into children’s daily activities.

    For example:

    1. during bath time;
    2. mealtimes;
    3. getting ready for bedtime;
    4. story time
    5. yes, playtime!

    These are activities that all parents will engage with anyway, so it seems to make sense to incorporate both. This is to avoid adding extra pressure on parents’ already stressful and time-poor daily lives. I am hoping my blog will come in handy, especially for the summer holidays.

    On holiday you are unlikely to have your usual games and toys with you – so here is a nice little list of things you can use instead of traditional games and toys:

    If you can think of any other alternatives on holiday and would like to tell me about them, I would love to see your comments below. We can never have too many holiday games!!

    If you are at home over the summer and you do have some games in the cupboard you might want to dust these ones down or buy one or two new ones (if you want to).

    Most games have multiple uses, and it’s always best to adapt a game to match your child’s interests and what motivates them.

    So let’s start…

    1. Pop up pirate: pop a sword into the barrel and watch the pirate pop up randomly. Practise social skills, speech sounds, expressive language (e.g., put a sword on a picture, say the word/sentence then pick up the sword and push it into the barrel).
    2. Word games such as ‘ISpy’, ‘I went to the shop and I bought…’, ‘describe a person and guess who they are’: perfect for when you’re on the move, whether travelling or walking. You can play this anywhere and still support speech, language and communication. You could play ISpy using your child’s special sound, or ‘I went to the shop and bought all things beginning with [insert special sound here]’.
    3. Shopping list: Orchard game is a game to practise categorising. We explain the analogy of the brain being like a filing cabinet. If information is all in the correct place, it’s easier to find, retrieve and use. You can also practise specific speech sounds in this activity. You could also put the words in a sentence to add more of an expressive language element.
    4. Wiggly worms: this Orchard game is all about phonological (awareness of sounds) awareness. Matching a letter with the word. You can also practise the sounds in the words (e.g, g-o-l-d = gold; m-a-ke = make). Talk about the elements, e.g., ‘g-o-l-d’ has 4 sounds, 1 syllable; ‘m-a-ke has 3 sounds, one syllable. You can talk about what words rhyme with the different words and what makes a rhyming word (i.e., the middle and end sounds remain the same).
    5. Sound detectives: this Orchard game allows children to identify sounds. It also has an app (if your child prefers a tech-way of learning). Children identify the sound then they can add the picture card to their path and become closer to being a successful detective. This game can also support memory skills.
    6. Conversation cubes: throw the dice and start building a story. You can also create and use ‘colourful semantics’ sentence strips to support expressive (spoken) language as support to build the narrative.
    7. Think words: ‘name it, press it, pass it’. A great game to expand word knowledge. You can talk about the words at the end of each round exploring semantic (meanings) and phonemic (sounds) links. Your child can also develop social skills (such as attention, listening and turn-taking).
    8. Poo bingo: this is perfectly disgusting but equally fun for kids of about 3.5 years plus – if your child’s target is to practise /p/ sound this is the one for you. You can also learn all about the different animal’s poo, which I am sure you have always wanted to do!! The more we know about a word, the easier it is to store, retrieve and use. Yes, even talking about poo can help!! Also, it’s great for our visual learners.
    9. Simon says: a game that can be played indoors or outdoors. Parents can take turns being “Simon” and give various commands that your child must follow. This means that your child can practise their receptive (understanding of) language as well as their expressive language, speech sounds and social skills (such as turn-taking and initiating).
    10. Ker-plunk: this is perfect for practising your child’s special sound. Repetition is very important, but also can be monotonous, so finding a game that they enjoy is vital. Take turns to pull out a stick. Next, your child can either say their special sound or word (depending on what stage they are at) or hear a good model from other players.

    Do you still have questions? Contact Sonja for support.

    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.

    0
  • ·

    Supporting children and families living with verbal dyspraxia

    ByLondon Speech and Feeding

    “It’s brill-i-ant, it’s brill-ant, it’s brillnt”

    Have you ever wondered why children may pronounce a word correctly one minute and in the next breath they struggle to say the same word? It’s equally as frustrating for you as it is for your child. The biggest question of all is WHY? Why does this happen and what causes it? Whilst there are many explanations. When it persists, it might be a condition called verbal dyspraxia.

    What is verbal dyspraxia

    Verbal dyspraxia is a neurological motor speech disorder that affects the coordination and planning of muscle movements that are needed for speech production. A child may have difficulty making the precise movements needed for speech, which may result in inconsistent and unintelligible speech. Children may also have trouble sequencing sounds and syllables, producing speech sounds accurately, and coordinating the movements of their articulators (e.g., lips, tongue, teeth, jaw). This can lead to a range of speech errors (including sound distortions, substitutions, omissions, and difficulty with rhythm and prosody).

    We know that these speech errors, and not being able to get a message across, can be frustrating for children with speech difficulties. Can you imagine talking and limited people understanding you? It’s so tough on children and the people trying to communicate with them.

    Creating a person-centred therapy plan is vital. This allows your child to stay motivated, as intervention is likely to be long term. This planning may include favourite words to use during their hobby or favourite activity, or person-centred goals such as ‘giving Alexa an instruction’.

    Children with verbal dyspraxia can have several different ways of producing words, which often makes it trickier for them as there’s no consistent pattern to work with. So, we’ve put together some top tips to support their communication and make their (and your) lives a little easier in the process.

    Ten ways to make communication easier for your child with verbal dyspraxia

    • Have a list of frequently used words and practise this set. Little and often is best!
    • Use cued articulation to support speech production (ask your Speech and Language Therapist for the gestures)
    • Give time and use active listening. This means showing interest and trying not to think about what is on your never ending ‘to do’ list
    • Reduce frustration in any way that you can. This might mean allowing your child to demonstrate using gestures rather than speech. You might also give top tips for other adults or children who communicate with your child when out and about
    • Talk about the structure of words with your child (i.e., there are two beats/syllables in this word)
    • Show the written form of the word to go alongside their production
    • Split down tasks, so that your child only has to respond to one question at a time, reducing their motor capacity
    • Recognise when your child is working well and when they may need support of an Alternative and Augmentative Communication device
    • Allow all environments to have the same training and equipment (i.e., at school, home, out and about)
    • Have regular periods in the day where your child can practise their specific words in different environments. This can be effective for children with verbal dyspraxia

    Do you still have questions? Contact Sonja for support.

    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.

    0
  • ·

    Explore how Intensive Interaction develops Autistic children’s communication

    ByLondon Speech and Feeding

    Intensive Interaction is an approach that I might suggest for your child. Here is an overview of this approach to increase your knowledge. There are a range of approaches that overlap and having trained in them all I use them all interchangeably to tailor to each child individually. This approach is particularly good for children who work mostly to their own agenda and find it hard to engage with others.

    So, what is Intensive Interaction?

    According to its founder, Hewett (1980), the approach “involves mirroring a person’s actions, sounds and facial expressions.” This allows your child to recognise and form communication between themselves and another, in a fun, play-based setting. Attention and listening are the fundamentals to speech and language development. By using the Intensive Interaction approach, we can increase the time your child can attend for and with another person. We are working towards a child enjoying another person’s presence. We are hoping to make gains with playing together with a child, taking turns and achieving reciprocity. That is the platform which we need to start with to build communication, language, words and perhaps even speech.

    There are many aspects that this approach supports:

    • such as using facial expressions
    • being in the presence of other people
    • having a shared space
    • attending to others
    • recognising and using non-verbal behaviours (e.g., gestures)
    • making sounds/noises (vocalisations) that have meaning
    • and eye contact. Although, we must be careful when suggesting ‘improving’ the use of eye contact. For some individuals making eye contact can be physically painful. So be aware that we are not making our children ‘look’ we are encouraging their natural behaviour.

    Who benefits from Intensive Interaction?

    Children with more complex communication and learning delay can benefit from the Intensive Interaction approach. Each session can be adapted to the needs of the individual and the sessions can be designed to use the whole or part of the approach. It is especially useful for children who are finding it hard to engage in any way socially with another person. Autistic children who tend to work to their own agenda often benefit from this approach.

    How is Intensive Interaction implemented?

    You need to have an environment that your child is comfortable in, and to be able to come down to their level so that you can see each other. This is why I often visit children in their own homes to ensure that they are comfortable and that they can withdraw for periods of time if they need to as well.

    Ensure your child knows you’re there and you are 100% present. This is very important. I would recommend that you put your phone away for some 10 minutes or so and give your undivided attention to your child for that period of time.

    Waiting

    Waiting is very important: we need to give your child time to process what is happening around them. After waiting for a response, you might want to start copying any gestures they use, any facial expressions they make, or perhaps imitate any sounds. You’ll want to continue with this for a few minutes to see if the communication between you and your child changes. Remember always take the cues from your child; if they communicate a message with you, respond. It might be that they are ready to finish and that they’ve shown this by walking away or signing.

    Giving your child a way to respond is vital. We can use visuals to support their communication. We can create ‘yes’ and ‘no’ symbols so they can use them in a functional way.

    A top tip in these sessions is to use mirrors, so that your child can see and begin to recognise their own facial expressions.

    There are other programmes that overlap with Intensive Interaction such as Hanen with following your child’s lead and the Gina Davies Curiosity Programme.

    Now you know a bit about Intensive Interaction, why not book a call to discuss how we can support your Autistic child’s communication using this evidence-based approach.

    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.

    0
  • ·

    The importance of child-led therapy

    ByLondon Speech and Feeding

    Child-led therapy is essentially what it says, therapy sessions that are directed by your child. You may think how can my child’s Speech and Language Therapist focus on goals if sessions are led by my child.

    Let us explain…

    Your child will be more receptive and motivated to take part in therapy if they have some form of input. E.g., they can choose what toys they want to play with, or how they want to play with the resources available. If sessions are child-centred then they are much more likely to engage and reach their goals, making intervention valuable. They will also be able to regulate their emotions, and use movement to support their need for regulation. E.g., some children like to jump whilst others like to run. As Speech and Language Therapists we need to use what is meaningful to your child to get the most out of intervention. By focusing on child-led therapy, we can build trust, which will allow us, in time, to use new techniques and activities that your child may enjoy. We want children to be themselves, to show their true personality. Therapy is about enhancing their skills in their own individualised way and child-led therapy allows for this.

    This way of working may seem daunting to some, but it doesn’t have to feel this way. Parents often feel if they are prepared then activities may go smoother. It might be the case, but perhaps it doesn’t give your child the opportunity for spontaneity. We’d like to suggest something that may lead to some surprises. Put out an activity that is your child’s favourite and then a completely new activity. Remember these activities don’t have to be complicated. Often, the simpler the better!

    So, no need to plan, just place two activities out and see what happens! Look out for anything which surprises you, which activity did they prefer? Do they have any sensory preferences? The freedom of choice is a wonderful thing to explore. So, just go with the flow!

    The kind of activities that are useful for child-led play can include:

    • Hide and seek
    • Cooking or baking
    • An Exercise ball
    • Small world play
    • Pretend play
    • Musical instruments (you could even have a go at making your own)

    Child-led therapy is a very useful resource. We have it at our fingertips. We don’t need special resources. You just need yourselves and your child! Sometimes, child-led therapy can be tricky to put in place. It sounds easy but is much harder in reality. So, make sure you give it time and reflect on your experiences. Ask yourselves ‘what went well’, and ‘what could be improved’. E.g., perhaps you gave your child time to lead to begin with, but you didn’t give them enough time to think about their options during the activity.

    How can parents become more child-led in the home environment?

    • Pause and use silence. This gives your child the opportunity to lead.
    • It’s perfectly natural to want to talk. Afterall, this is how adults maintain conversations. If you find yourself talking too much, count to ten! This will allow your child time to respond or initiate in the conversation or interaction.
    • Move down to your child’s level. It’s much easier to see what’s going on if you’re at the same height.
    • Videoing you and your child can really help you to see where your strengths lie. You’ll also be able to make minor tweaks to improve your communication during child-led play.

    Contact Sonja for more advice on speech, language and communication during child-led play.

    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.

    0
  • · ·

    Living life with a lisp

    ByLondon Speech and Feeding

    You may be questioning ‘will my child grow out of having a lisp?’ There are so many myths out there that it’s sometimes difficult to find your way out of a complex maze of information.

    The good news: lisps can be successfully treated by a Speech and Language Therapist and the earlier it’s resolved, the better. We know from the evidence base that some children’s lisps will resolve and, as always, it is completely age appropriate to have this speech pattern up until aged 4 ½.

    As with any speech and language targets your child will need to be motivated to practise their newly acquired techniques, at home and in other settings. They will eventually be able to generalise this skill, but it takes lots of practice. So, think carefully about if your child is ready and motivated before commencing Speech and Language Therapy.

    There are essentially two ways in which your child has acquired a lisp. It’s key here to mention that parents have no blame in this.

    1. They’ve mis-learned it and now incorrect production has become a habit
    2. Children have difficulties organising the sounds to make a clear production

    You may be surprised to realise that there are different types of lisps. But all the techniques will be the same.

    1. Interdental lisp

    When your child pushes their tongue too far forward, they will make a /th/ sound instead of /s/ and /z/

    1. Dental lisp

    This is where your child’s tongue pushes against their teeth

    1. Lateral lisp

    Air comes over the top of the tongue and down the sides

    1. Palatal lisp

    Your palate is the roof of your child’s mouth. Sometimes they will touch their palate when making certain sounds (e.g., /s/ and /z/)

    It’s useful for you to know what type of lisp your child has because you can then support them to make the correct production. You’ll be able to talk about where in the mouth their tongue is and where it needs to be to produce a clear sound. Your Speech and Language Therapist will be able to help you with this.

    Top therapy tips for lisps

    1. Awareness is key. Does your child know where their tongue and teeth are (i.e., are they behind their teeth)? Do they notice the air escaping? Use a mirror so that your child can see not only themselves but also you in the mirror.
    2. Repetition! As with most therapeutic intervention, practice makes perfect. So little and often is key!
    3. Make sessions fun, perhaps around your child’s interests or allow them to drink from a straw
    4. Comment on how the sound is produced (e.g., /z/ is like a bee, /s/ is like a snake)
    5. Use tactile cues. Your child’s vocal folds vibrate when they produce a sound like /z/ but not with /s/. You could use the words ‘loud’ and ‘quiet’ to describe this.
    6. Start with a /t/ sound and gradually elongate the sound to an /s/

    Having a lisp may not be problematic for some, but for other children, it can have a significant impact on their emotional wellbeing. Intervening at an early age can prevent this from happening. We always advocate for early intervention!

    Contact Sonja for support on resolving your child’s lisp.

    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.

    0