Speech prompts and strategies I use in Speech Sound Therapy
· ·

Speech prompts and strategies I use in Speech Sound Therapy

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

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.

Teletherapy: A fun and convenient way to help your child master those sounds!

Teletherapy: A fun and convenient way to help your child master those sounds!

It can be hard to get your child to come to the clinic on a weekly basis to work on those tricky sounds. Perhaps the car isn’t working, you have had a lot on, or our student has a bit of a cold but is still able to do a little bit of sound practice?

The good news is that Teletherapy can be a fantastic option to continue your child’s speech journey from the comfort of your own home!

Even when your wifi is not working and your laptop is broken, as you can see on this clip I was able to stretch into running the session on WhatsApp video, but that is less then ideal I will say.

What is Teletherapy?

Teletherapy is speech therapy delivered virtually, through a secure video platform. I use Zoom for example, but I have also used WhatsApp Video Call on occasions where parents’ zoom was not working.

When is Teletherapy perfect?

Here’s why teletherapy can be a great fit for helping your child solidify those learned sounds:

  • Basic sound patterns have been established in clinic: Your child is now able to say those tricky sounds BUT they are not saying them in daily life yet; they are not ‘generalising’ those new sounds into the normal speech.
  • You just can’t make it today: No more fighting traffic or fitting appointments into busy schedules. Teletherapy sessions happen at home, on your time. Sometimes even in the attic or the garden shed as in my video clip here ????
  • Your child is about 7 years old or older and is motivated to work on their sounds: I use fun and interactive online tools and games to keep your child engaged during practice sessions. Due to having done teletherapy over the Covid period I have amassed lots of great games and know-how in this area. Our student needs to be mature enough to be able to sit in front of the laptop camera and participate with a minimum of adult help.
  • Your child loves gaming and is best motivated through online games: Sometimes children are best motivated when playing online games in between speech sound/language activities; in this case teletherapy is totally perfect.
  • Focus on Carryover: The familiar environment of your home can actually be an advantage! I can guide my student on practising sounds in everyday situations, like reading a book together or playing with toys, sometimes even talking to their sibling or a.n.other in the room.
  • Parental Involvement: Teletherapy allows you to be directly involved in the sessions just in same way as when I see your child in my clinic. You can learn strategies and techniques from me to continue practising with your child throughout the day. You can also make a note of the online games I have and then use them in your home sessions.

What to Expect During a Teletherapy Session

  • Initial Consultation: We start with a brief chat on how the week has gone, what gains have been made with the home exercises and we settle the student into a good learning mode; sometimes I start off with a very quick game just to set the scene.
  • Working on generalising: When asking my student about how their week has been I will remind them to remember their new sounds and to try and produce them whilst talking to me. This is already the start of therapy.
  • Practising target sounds: We practice our target sounds in different contexts, using games, visuals, and activities.
  • The teletherapy session lasts the same amount of time as do 1:1 sessions, unless I see that a child becomes very fidgety and we are not able to hold out much longer, I will cut short the session and focus on increased home practice.
  • Home Practice: Just like in 1:1 clinic sessions, I will provide you with easy-to-follow tips and activities to continue practising sounds throughout the week.

Getting Started with Teletherapy

  • Technology Check: Ensure you have a reliable internet connection and a device with a camera and microphone.
  • What device is best: Ideally the student needs to be on a laptop or PC because that way the student can actively engage with their mouse, moving game pieces, or participating in online activities using their mouse. Tablets are ok but do not allow active participation of the student as described above. However once in a while we can make it work and I do have some games and activities that do not rely on student participation.

Finally, I would say that Teletherapy is a safe, fun and effective way to continue your child’s speech therapy journey. It’s convenient, engaging, and it is perfect on a rainy day when you don’t want to or can’t come out to bring your child to clinic.

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

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

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

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

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.

Bilingualism – should I speak only English with my speech delayed child?

Bilingualism – should I speak only English with my speech delayed child?


Bilingualism is a beautiful aspect of our diverse world. Growing up in a bi- or multi-lingual household is a wonderful gift, allowing children to communicate with a broader range of people and access many cultures.

My own two children grew up in a bilingual German-English speaking household. They have both been so enriched by this experience, not only language- and learning-wise but of course also culturally: their world has always been so open and colourful. Growing up in inner London and having their German family and mum’s friends as well, this has been a wonderful experience. Both my boys speak German well (not quite like native speakers but like very good second language speakers) and both have very easily learned 3rd and 4th languages additionally when in secondary school.

Whilst bilingualism has untold benefits, it’s not uncommon for bilingual children to take slightly longer to reach certain speech milestones. This should not be automatically mistaken for speech disorders but rather seen as a natural part of bilingual language development.

Bilingualism and speech delays

Sometimes, of course, we do see speech delays or disorders where a child’s speech development lags significantly behind their peers. We often see a delay in both languages equally, making it extra hard for to communicate effectively. BUT PLEASE KNOW the family speaking in multi-lingual languages never caused the delay/disorder!

If there is a delay or a disorder any number of other reasons could have caused it, such as:

  • hearing impairments,
  • reduced phonological awareness,
  • sensory processing issues,
  • reduced attention and reduced joint attention,
  • neuro-developmental delays or difficulties,
  • general or specific learning difficulties
  • or sometimes other genetic factors.

So, to say that the difficulty is due to a child being exposed to several languages is a red herring. (no offence to herrings!)

Speech therapy

Speech therapy can be powerful to help bilingual /multilingual children with speech delays unlock their full linguistic potential. By providing individualised assessments, targeted interventions, and involving families, speech therapy can bridge the gap between speech delays and bilingualism. It’s essential for the therapist and parents to work together to support the children in their unique linguistic journeys, helping them communicate effectively and thrive in both of their languages.

Happy Islamic family sitting on the floor
Image by Freepik

Speak your home language at home

Many parents report that they worry about speaking their home language at home and instead they have been focusing on just speaking English at home. They now rarely use their home language with their child. They fear that speaking a language other than English with their child will cause further delay and hinder their progress. All parents want the best for their child and often parents fear that their child won’t fit in or will be seen as ‘different’. So we can understand why parents feel that the English language is the only one worth having.

But the opposite is the case: it is crucial to speak in both languages freely, both at home and outside the home! Both languages will benefit your child, no matter what the delay or difficulty is. Acquiring a ‘mother tongue’ or native language is absolutely vital for children to have a good, solid linguistic grounding on which to build other languages. Bilingual children may mix languages during speaking and parents may equally mix their languages. This does not hinder language development and is a natural part of linguistic development.

Speak freely and naturally

What is far more important than the question: ‘which language should I say this in?’ Instead think: ‘let me speak freely and naturally, let me respond naturally, in good intonation and let communication flow freely to the child.’

Speech therapy can be a crucial resource for bilingual or multilingual children and their families.

We work on targeted interventions to address speech and language difficulties, helping your child develop essential communication skills. For home practice between therapy sessions, we can recommend tailored treatment plans to help you help your child in daily life. Our input could be focusing on articulation, phonological awareness, attention and listening, vocabulary development and grammar.

Family support is crucial in speech therapy. We like to work closely with parents to provide guidance and strategies for fostering language development in both languages at home.

If you have any worries about your child being delayed in a bilingual or multilingual household do get in touch and we will be happy to support you in your journey.

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.