Author: London Speech and Feeding

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    Does my child need a myofunctional therapist? Lisps, tongue posture and oral function explained

    ByLondon Speech and Feeding

    Have you ever been told that if your child’s lisp or /R/ sound isn’t improving after months of speech therapy, you should see a myofunctional therapist?

    The short answer is: possibly, but not automatically. Whether it will help depends on what is behind your child’s difficulty, and finding that out is exactly what a thorough assessment is for.

    I’m a Speech and Language Therapist with nearly 30 years’ experience in speech sound disorders, feeding and swallowing, and I have additional training in myofunctional therapy. Looking at how the mouth works has been an intrinsic part of my assessments for many years, so I’d like to explain what that involves and when it matters.

    What is myofunctional therapy?

    Myofunctional therapy (often called orofacial myofunctional therapy, or OMT) is about how the muscles of the mouth and face work. It overlaps with what speech and feeding therapists call oro-motor function, although OMT looks more specifically at things like resting posture, breathing and swallowing patterns. Depending on the therapist’s training and your child’s needs, it may include:

    • tongue movement, resting posture and positioning
    • lip closure and resting posture
    • jaw movement and coordination
    • oral habits, such as thumb sucking or dummy use
    • swallowing patterns
    • how oral function, feeding and speech affect one another.

    Some children have difficulties across several of these areas. Others have one specific speech sound difficulty and no wider problem with how their mouth works.

    Signs it may be worth having your child’s oral function checked

    You might want an assessment if your child:

    • has a lisp or a tricky /R/ that hasn’t changed with therapy
    • often has their mouth hanging open at rest
    • pushes their tongue forward against or between their teeth when speaking or swallowing (sometimes called tongue thrust)
    • is still dribbling or drooling after 18 months
    • finds chewing difficult, or struggles to move their tongue up, out or from side to side
    • breathes mostly through their mouth.

    If you are worried about tongue-tie, I can assess how your child’s tongue moves for speech and feeding. If a medical or dental opinion is needed, I will explain why, advise you on who to see and work alongside them, for example an ENT consultant or paediatric dentist.

    What does a comprehensive assessment look at?

    When a child has a speech sound difficulty, I look at their speech alongside how their mouth is built and how it works. Depending on the concern, that may include:

    • jaw: how steady it is, and how well it moves and coordinates with the lips and tongue
    • teeth and mouth structure: the position of the teeth, the bite, the palate and anything structural that may be relevant
    • lips: closure, movement and resting posture
    • tongue: how well it moves in different directions, where it rests and whether it pushes forward
    • swallowing: relevant aspects of how your child swallows and where the tongue sits
    • palate and voice: anything that may need further investigation, such as concerns about how the palate is working or an unusually nasal sound
    • habits and breathing: things like thumb sucking or mouth breathing, and any signs that a medical or dental check may be needed.

    Not every child needs every part of this. The questions we are trying to answer guide what I look at and what happens next.

    For example, a child with a lisp may find it hard to coordinate the tongue placement needed for an /S/ sound. They may rest their tongue low in the mouth, or they may have spent years making the /S/ sound with the tongue between the teeth. By looking at how the mouth moves, along with habits and history such as thumb sucking, I can understand what may be contributing and plan therapy accordingly.

    The findings help decide whether your child needs direct speech therapy, further assessment, a different approach, or input from another professional such as an ENT consultant, dentist or orthodontist. Assessment isn’t simply about spotting something that looks unusual. It is about understanding what it means for your child and deciding what, if anything, needs to be done. This kind of clinical reasoning is a natural, daily part of my work as a Speech and Language Therapist.

    What if my child isn’t making progress in speech therapy?

    If your child has been attending therapy for weeks or months without meaningful progress, it is reasonable to ask for a review. In my practice I monitor progress from one session to the next, and if things aren’t moving, I would rather review the plan than simply carry on with the same approach.

    Sometimes a child needs more time. Sometimes the approach needs to change. Sometimes we need more information or another professional’s input. Sometimes therapy needs to pause while an underlying issue is looked into.

    Whichever it is, you can expect a clear explanation of what we are working towards and how progress will be reviewed. A lack of progress should always prompt a review of the plan.

    Does myofunctional therapy help with speech difficulties?

    Sometimes. Some children have speech sound difficulties alongside differences in how their mouth works, which is why I assess both and consider whether they are related. A different tongue posture, an open-mouth resting posture or an unusual swallowing pattern is always worth noting, but it is not automatically the cause of a lisp or another speech sound disorder.

    For speech sound disorders, treatment should be chosen to match the nature of the speech difficulty and be supported by evidence. The routine use of non-speech oral-motor exercises, meaning exercises that don’t involve practising speech sounds, to improve speech is not supported by the available evidence (the Cochrane review of non-speech oral-motor treatment – Lee & Gibbon, 2015).

    That doesn’t mean work on oral function is never appropriate. The important question is what we are trying to achieve. If the aim is clearer speech, therapy needs to work on the speech itself, with plenty of practice of the relevant sounds, syllables and words. If your child also has a separate difficulty with feeding, swallowing or another aspect of oral function, such as resting posture, that may need its own assessment and targeted therapy. This is why I combine evidence-based speech practice with myofunctional assessment and therapy where a child’s oral function needs it, and I will always explain the aim and the reasoning behind what I recommend.

    Choosing the right therapist for your child

    Whoever you choose, I would encourage you to ask who will be treating your child, what their training covers and whether they are well placed to meet your child’s particular needs. Good clinical practice includes recognising the limits of your own expertise and referring on or working with others when appropriate. No practitioner should feel they have to manage every part of a child’s difficulties alone.

    When the main concern is your child’s speech sounds, speech clarity or expressive language, I would recommend starting with an experienced Speech and Language Therapist whose expertise matches your child’s needs. If that therapist also has additional training in myofunctional therapy, so much the better. You can check that any Speech and Language Therapist is registered using the HCPC online register, and it is always fine to ask about a practitioner’s original qualification, clinical experience and the scope of their training.

    So that you know who would be working with your child, here is a little about my own training: I am an HCPC-registered Speech and Language Therapist (BSc Clinical Communication Sciences, Royal Central School of Speech and Drama, 1996) with nearly 30 years’ experience, a postgraduate diploma in dysphagia (2000) and certification in the SOS Approach to Feeding (2018) and Orofacial Myofunctional Disorders training in 2026. I also completed IBCLC lactation consultant certification in 2019 (since lapsed, 2024) and worked as a neonatal Speech and Language Therapist and Lactation Consultant at Barnet Hospital in 2019–2020.

    Next steps

    If your child has a lisp, a tricky /R/, an open-mouth resting posture, a tongue thrust, dribbling or difficulty chewing, I would be happy to look at the whole picture. I assess speech and oral function together, and if your child needs a dentist, orthodontist or ENT consultant, I will tell you.

    You can find out more on my Speech and Feeding Difficulties page, or get in touch to arrange an assessment. If you’re not sure whether your child needs one, contact me and we can talk it through.

    Sonja McGeachie

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

    Reference

    Lee AS-Y, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD009383. DOI: 10.1002/14651858.CD009383.pub2.

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    Why structure, high expectations and warmth matter in speech therapy

    ByLondon Speech and Feeding

    If you were to peek through the window of one of my speech therapy sessions, you might notice two things: a room full of engaging games and activities, and a therapist who is carefully guiding a child towards a specific goal.

    Why structure, high expectations and warmth matter in speech therapy. A photo of Sonja McGeachie smiling.

    There will be laughter, encouragement and opportunities to play. But there will also be moments when I ask a child to stop, listen carefully, try a sound again or adjust the way they are producing it.

    To an outside observer, this might sometimes look quite structured. And that raises an important question: does effective speech therapy need to be more than simply playing with a child?

    My answer is yes.

    Play has a valuable place in speech therapy, but when a child is working on a speech sound disorder, we also need clinical expertise, purposeful practice, careful listening and clear goals. Children deserve sessions that are enjoyable and supportive, while also helping them develop the skills they need to communicate more clearly and confidently.

    For me, the key is combining warmth and encouragement with high expectations, appropriate structure and an approach tailored to each individual child.

    Here is why I believe this balance matters.

    1. Speech sound therapy involves learning a new skill

    Learning to produce a speech sound accurately is not simply a matter of telling a child what to do. Speech involves highly coordinated movements, and children who have difficulty producing particular sounds may need considerable support to develop new or more consistent ways of producing them.

    Think about learning to play a musical instrument. Understanding what a note should sound like is not the same as being able to play it accurately. It takes practice, feedback and time to develop the necessary skills.

    Speech sound therapy can be similar. A child may understand that they need to make a /K/ sound, for example, but continue to produce a /T/ sound instead. They may need help to notice the difference, understand where the sound is produced in the mouth and practise the new movement with appropriate support.

    This is where purposeful practice becomes important.

    During a session, I listen closely to how a child produces a sound. I may model the sound, use a visual cue, help the child notice their tongue position or break the task into smaller, more manageable steps.

    Sometimes a child can produce a sound accurately straight away. At other times, we need to slow down, change our approach or practise at an easier level before moving on.

    The aim is not simply to produce lots of sounds. It is to help a child practise in a way that supports accurate, increasingly consistent speech.

    That means I will sometimes ask a child to try again. Not because I expect perfection, but because I want to help them discover what works and build on their successes.

    2. Clear structure can help children know what to expect

    Some children arrive at therapy full of energy. Others may find it difficult to concentrate on a task, manage transitions or persist when something feels challenging.

    Expecting every child to sit still and work in exactly the same way would not be realistic, nor would it be appropriate.

    However, children often benefit from knowing what is happening, what we are working towards and what comes next.

    For example, I might explain:

    ‘First, let’s practise five careful /S/ sounds together. Then we’ll take our turn in the game.’

    This gives the child a clear, achievable goal and a predictable next step. For another child, I might use a visual timetable, shorter practice bursts, movement breaks or a more playful activity to support participation.

    Structure does not mean that every session must look the same. It means that the activities have a purpose and that I am making thoughtful decisions about how best to help the child learn.

    If a child becomes tired, frustrated or overwhelmed, I may need to adapt the task rather than simply insist that they continue. Sometimes a short break or a different approach is exactly what enables the child to return to the activity successfully.

    My responsibility is to recognise what the child needs while keeping sight of the therapeutic goal.

    3. Warmth and high expectations belong together

    I believe one of the most important qualities of a good speech and language therapist is the ability to combine a positive relationship with clear clinical guidance.

    Children need to feel safe enough to try something difficult, make mistakes and have another go. They also need a therapist who can recognise when they are ready for the next step and help them work towards it.

    In my sessions, encouragement might sound like this:

    ‘That was a good try. Let’s see if we can make that sound even clearer together.’

    ‘I know this sound is tricky. Let’s slow it down and find the mouth position that works.’

    ‘You did that one really carefully! Can you remember what you did with your tongue?’

    These are small moments, but they matter. They help children understand that speech sounds can take practice, that mistakes are part of learning and that they can make progress with the right support.

    I celebrate genuine achievements, whether that means producing a difficult sound accurately for the first time, becoming more aware of how a sound feels, or managing to use a new skill more consistently.

    I also want children to understand that they are not expected to get everything right immediately. My job is to guide them, give them appropriate feedback and help them develop their skills step by step.

    High expectations should never mean expecting every child to progress at the same pace. They mean taking each child’s potential seriously and giving them the support they need to move forward.

    4. Play can be powerful when it has a purpose

    I love using games and playful activities in therapy. They can motivate children, create opportunities for interaction and make repeated practice much more enjoyable.

    But the game itself is not the therapy. It is one of the ways I help a child engage with the therapeutic task.

    For example, a simple board game might provide opportunities to practise a target sound in carefully chosen words. A picture activity might help a child listen for the difference between two sounds. A motivating toy might encourage a child to practise a word several times without the session feeling repetitive.

    While the child is playing, I am listening, observing, adjusting the level of difficulty and deciding what support to offer next.

    If a child is not yet able to produce a sound accurately in a particular word, I may return to an easier level of practice. If they are achieving the target consistently, I may begin to introduce more challenging words or activities that help them use the sound in a wider range of situations.

    The activities may look simple, but the clinical reasoning behind them is important.

    Parents should be able to understand what their child is working on, why a particular approach has been chosen and how progress is being monitored.

    For me, effective therapy is about making the session purposeful, responsive and productive.

    5. Progress takes clinical expertise, practice and partnership

    When parents seek specialist speech and language therapy, they understandably want to see progress. They want their child to be understood more easily, to feel more confident communicating and to experience fewer frustrations when speaking.

    My role is to assess the child’s speech carefully, identify the areas that need support and develop an appropriate plan.

    Depending on the child’s needs, this may involve working on individual speech sounds, helping them distinguish between sounds, addressing patterns that affect several sounds, or using a more specialised approach where speech motor planning is a concern.

    There is no single programme that suits every child. The type of intervention, the amount of practice and the pace of progress will depend on the child’s individual profile and response to therapy.

    I monitor how a child is progressing and adjust my approach accordingly. I also explain what we are working towards and, where appropriate, suggest practical ways parents can support learning between sessions.

    Home practice is particularly valuable, and it needs to be realistic and manageable for each family. Even a short period of well-supported practice provide useful opportunities to build on what a child has been learning in therapy.

    Ultimately, I want parents to feel informed and involved, with a clear understanding of their child’s goals and the steps we are taking to work towards them.

    The takeaway: Structure with warmth

    I believe children deserve speech therapy that combines a warm, trusting relationship with skilled clinical intervention.

    I will encourage a child, celebrate their achievements and make sessions enjoyable. I will also listen carefully, give feedback, revisit difficult sounds and help them work towards their goals.

    Sometimes that means asking for another attempt. Sometimes it means changing the activity, taking a break or approaching the task in a completely different way.

    The important thing is understanding when to encourage, when to challenge and when to adapt.

    High expectations are not about making children comply. They are about believing in their capacity to learn while giving them the individual support they need to succeed.

    For me, that is the balance at the heart of effective speech sound therapy: warmth, structure, clinical expertise and a genuine commitment to helping every child make meaningful progress.

    Looking for specialist speech sound therapy?

    If your child has difficulty producing particular speech sounds, is difficult to understand or is becoming frustrated when trying to communicate, an individual assessment can help clarify their needs and identify appropriate next steps.

    At London Speech and Feeding, I provide tailored speech and language therapy with clear goals, careful clinical guidance and an approach that recognises each child as an individual.

    Get in touch to arrange an initial assessment and discuss how I may be able to help your child.

    Sonja McGeachie

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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    Three-syllable words made fun: How I use play to build speech skills

    ByLondon Speech and Feeding

    Why spend time on syllables?

    Sounds have to be organised into syllables, words and phrases. A child needs to coordinate these parts to produce longer words successfully.

    This can be particularly relevant for children who:

    • leave out parts of longer words
    • simplify multisyllabic words
    • have reduced speech intelligibility
    • have phonological difficulties
    • have difficulty remembering or organising the sound sequence in a word
    • have suspected or diagnosed Childhood Apraxia of Speech (CAS)
    • find longer or more complex words particularly difficult.

    For children with speech sound disorders, phonological awareness is important because speech sound development and awareness of the sound structure of words are connected areas of development.

    When creating new habits, new motor plans,new anything repetition is important!

    But the way we get to that repetition can be playful and creative.

    Today I give you a little window into one of my recent speech therapy sessions. I was working on three-syllable words, words such as ladybird, butterfly and other longer words that contain three ‘beats’.

    I used five very simple activities:

    • playdough
    • two different versions of Snap
    • an online activity
    • stickers.

    None of these activities are complicated or expensive. What matters is how the activity is being used and what the child is practising within it.

    Video examples

    Here are five little clips from the session so you can see what I mean.

    Squashing the syllables with playdough

    In my first clip, you can see me using three blobs of playdough with picture cards.

    The child places or squashes one blob onto each part of the word.

    For example:

    LA – DY – BIRD

    Three blobs. Three beats.

    This gives the child something very concrete to see and feel while they are listening to the word.

    We can squash:

    • 🟢 LA
    • 🟢 DY
    • 🟢 BIRD

    And then say the whole word: LADYBIRD.

    Next came Snap.

    I used cards containing the target words and played two different versions of the game.

    This is where something very simple becomes surprisingly useful.

    The child isn’t just practising ‘ladybird, ladybird, ladybird…’

    Instead, they are playing a game.

    They have to look. They have to listen. They have to wait. They take a turn.

    And, importantly, they have a reason to say the word.

    When a card appears, we can practise the three syllables: LA – DY – BIRD

    Then we might say it again naturally: ‘I got ladybird!’

    This gives us repeated opportunities to practise the target word while keeping the activity meaningful.

    Taking the practice online

    The fourth clip shows an online activity.

    Here, the online pictures provide another opportunity to look at a picture, identify the word and break it into its three syllables.

    My child taps each syllable.

    Thun-der-storm

    👏 👏 👏

    The visual presentation can be particularly helpful for children who benefit from seeing exactly what we are talking about.

    And we can move between levels of difficulty.

    First:

    How many beats can you hear?

    Then:

    Can you say the word with me?

    Then:

    Can you say it by yourself?

    That progression is important. We build the steps.

    This time, I used a sticker sheet

    We practise:

    TAKE – IT – OFF

    👏 👏 👏

    Three syllables.

    And then we can reverse the action:

    PUT – IT – ON

    👏 👏 👏

    Three syllables again.

    This is a lovely example of why I like to work on speech within real actions and little phrases, rather than only isolated words.

    The child has an actual reason to communicate.

    They want the sticker. They want to take it off. They want to put it somewhere.

    And suddenly our three-syllable practice is also helping with:

    • verbs
    • little phrases
    • following an action
    • understanding language
    • turn-taking
    • functional communication.

    So although my clinical focus might be syllable structure and speech production, I am still thinking about the whole child and the whole communication experience.

    And eventually we want those words to become part of everyday communication rather than something that only happens during therapy.

    That is the real goal.

    A little bit of research

    A useful recent article by Brosseau-Lapré and Roepke (2024) looked at phonological awareness skills in preschool children with speech sound disorders. Through three case studies, the authors highlighted that children with speech sound disorders can have very different profiles of phonological and pre-literacy skills, and that children with more atypical and omission-type speech errors were more likely to show phonological awareness difficulties.

    It is another reminder that speech development is wonderfully complex, and that sometimes a seemingly simple activity, such as putting three blobs of playdough onto a picture, can have a very specific clinical purpose behind it.

    If you are concerned about your child’s speech, a speech and language therapist can help identify whether the difficulty is primarily related to speech sounds, phonological patterns, syllable structure, motor planning, language development, or a combination of factors.

    Any questions please contact me via my contact form.

    Sonja McGeachie

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

    Reference

    Brosseau-Lapré, Françoise & Roepke, Elizabeth. (2024). Beyond Sounds: Decoding Speech Errors and Phonological Awareness in Preschoolers. Perspectives of the ASHA Special Interest Groups. 9. 922-934. 10.1044/2024_PERSP-24-00001.

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    When AAC modelling doesn’t feel natural yet: Helping parents learn to use their chosen AAC system

    ByLondon Speech and Feeding

    One of the most common pieces of advice parents hear when their child starts using AAC is: ‘Just model the words naturally.’

    And, yes, natural modelling is an important part of AAC support.

    But there is something we don’t always talk about: How on earth is a parent supposed to model a word naturally when they are still trying to work out where the word is themselves?

    Using a robust AAC system such as LAMP Words for Life can feel a little like learning a new language.

    The parent is learning the language at the same time as the child they are hoping to teach it to.

    So, although I absolutely want AAC to become part of everyday life, I often begin with something much more structured.

    And I have found that this can make the transition to natural, everyday modelling much easier for families.

    Learning the system first

    In my first video clip, I am using a very simple farm animal sticker activity with LAMP Words for Life.

    The activity gives us the opportunity to practise some useful, functional words:

    • OFF: taking the sticker off
    • FARM ANIMALS: finding the animal category
    • HORSE
    • SHEEP
    • CHICK
    • ON: putting the sticker onto the book

    At first, I am quite explicit about what I am doing.

    I might draw attention to the relevant button, help the child navigate to it, talk through what we are looking for and practise finding the word several times.

    This is more didactic and structured than the idealised picture some people have of AAC modelling.

    And I am completely comfortable with that at the beginning.

    Why start so explicitly?

    Imagine that you are given a brand-new device containing hundreds or thousands of words.

    Someone tells you: ‘Don’t worry. Just use it naturally.’

    You might manage to find a few obvious words.

    But when you are suddenly standing in the kitchen taking your child’s coat off and want to say ‘OFFS, you may have absolutely no idea where to look.

    That is exactly why I think parents sometimes need permission to learn the system in a supported way.

    The structured activity creates a safe environment where we can stop and think:

    • Where is that word?
    • How do I get there?
    • What does this word do?
    • What happens when I press it?

    We can practise it more than once.

    We can repeat it.

    And gradually, the route to that word becomes familiar.

    AAC systems are not simply devices that children need to learn. Communication partners need to learn them too. All the AAC research highlights partner training as an important part of AAC intervention and notes that intervention initially includes helping the individual and their family or carers develop operational competence with the system.

    From structured practice to everyday life

    And this is where the useful transfer can happen.

    Take the word OFF.

    In our sticker activity, we may practise:

    ‘OFFS

    ‘OFFS

    ‘OFF’

    We take the sticker off.

    We find the button again.

    We use the word again.

    After several opportunities, the parent has not only seen their child use the word, the parent now knows where the word lives too.

    Then later that day, they are taking their child’s coat off.

    Suddenly:

    ‘OFF!’

    And they know exactly where to find it.

    The same thing might happen with ON.

    Once the parent has practised finding ON several times during play, it becomes much easier to spot opportunities for it during the day:

    ‘Shoes ON.’

    ‘Lights ON.’

    ‘Music ON.’

    ‘Hat ON.’

    ‘Tap ON.’

    This is one of the reasons I like structured AAC activities. They are not necessarily the final goal.

    They can be the rehearsal space that gives parents and children enough confidence to use AAC in real life.

    Natural modelling is still the goal

    This doesn’t mean that I want parents spending their whole day sitting beside their child and directing them towards buttons.

    Quite the opposite.

    The aim is to gradually move towards a much more natural style of AAC use.

    Once parents know their way around the system, they can begin to model words spontaneously as they occur in everyday interactions.

    Research into aided AAC modelling describes adults using AAC alongside speech within meaningful activities, and evidence supports the use of aided input as part of AAC intervention.

    But getting there may take teaching, repetition, practice and coaching.

    And that’s okay.

    It is not about making the child press the button

    There is another important distinction here.

    When I say that I may initially be more explicit or ‘direct’ during an activity, I do not mean that I am trying to make a child perform the correct response.

    I am not interested in turning AAC into a test.

    I am not continually asking:

    ‘Where’s HORSE?’

    ‘Find SHEEP.’

    ‘Show me CHICK.’

    Instead, I am helping the child and parent become familiar with the system.

    I might point, gesture, navigate, model the word and repeat it within a meaningful activity.

    As confidence grows, the support can be reduced so that the child has increasing opportunity to locate and use the language themselves.

    My second video clip shows a child using their own LAMP Words for Life system at home, accessing a category they have chosen which is FOOD.

    This is what I love about AAC.

    The device isn’t just being used in the therapy room.

    It becomes part of the child’s own life.

    And the child is using it around their own interests and choices.

    That is the direction I want families to move towards:

    From ‘I don’t know where anything is!’ to ‘I know where some useful words are.’

    Then ‘I can use those words during our everyday routines.’

    And eventually: ‘This is my communication system, and I can use it to tell you what I think, want, notice, enjoy, reject and choose.’

    Parents don’t have to get it perfect

    This is perhaps the biggest message I would like parents to take away.

    You do not have to become an AAC expert overnight.

    You are learning too.

    It is completely reasonable for a parent to need time to become familiar with the layout, vocabulary and navigation of their child’s system.

    Learn it. Practise it. Model it. Then take it into real life.

    Any questions please contact me via my contact form.

    Sonja McGeachie

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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    Unlocking connection: Why the Hanen ‘More Than Words®’ approach works (BEST online!!)

    ByLondon Speech and Feeding

    As a Speech and Language Therapist, one of the most rewarding parts of my job isn’t just working on speech sounds or vocabulary lists. It’s helping parents truly connect with their autistic children.

    Recently, I had a 1-hour initial online session with the parent of a 7-year-old boy. In just 75 minutes, we achieved a massive breakthrough in perspective, all without parents setting foot into my traditional clinic setting or me visiting them at home.

    I had been sent some video footage of their child along with detailed parent questionnaire and both gave me so much information from which I then worked online with the parent.

    Here is a glimpse into what the Hanen More Than Words® approach is, how I structure my initial sessions, and why doing this work online with parents is often far more powerful than traditional therapy.

    What is the Hanen More Than Words® approach?

    The Hanen More Than Words® programme is an evidence-based framework designed specifically for parents of autistic children or children with social communication difficulties. Rather than treating communication as a clinical ‘lesson’ taught by a therapist, Hanen empowers parents to become their child’s primary communication partner. It focuses on turning everyday interactions, routines, and play into natural opportunities for a child to build connection, express themselves, and initiate communication at their own pace.

    How I structure the first session: Reframing expectations

    When parents first come to speech therapy, they often arrive with understandable anxiety and big, sometimes overwhelming, expectations. My primary goal in session one is to take those expectations, reframe them into realistic, hopeful goals, and establish a clear baseline of where we are right now.

    To do this, I use the Hanen Social Communication Checklist.

    In my session with any parent this tool is always a game-changer. Today, for example, it allowed us to celebrate every single achievement our child has already made, while highlighting the specific micro-skills we want to consolidate next. Instead of focusing on ‘fixing’ speech, our baseline focused on three functional social goals:

    • Responding to comments from others.
    • Initiating his own comments, requests, or questions (in whatever way he can).
    • Taking a single, natural conversational turn, even if that turn takes time to come.

    Why online therapy for Hanen works so well

    People often ask me: ‘Can speech therapy really be effective over Zoom?’

    My answer is an emphatic yes. And for Hanen, online is often superior to a clinic.

    In a clinic, a child is in an unfamiliar environment with a new adult, which can feel demanding or artificial. Online, the child stays in their safe, natural home environment. I get to coach the parent directly in real time, giving them immediate tools they can use every single day. In just one hour online today with one parent, for example, we got a massive amount of foundational work done without causing a single moment of stress for the child.

    Key takeaways: The power of silence, OWL, and agenda-free fun

    If you are looking to support an autistic child’s social communication at home, here are the core principles we put into home practice after our first session:

    1. Embrace the power of O.W.L. (Observe, Wait, Listen)

    We live in a fast-paced world where adults feel compelled to fill every quiet moment with questions (‘What’s that?’, ‘What colour is the car?’). Hanen flips this script.

    • Observe: Step back and see what truly captures your child’s interest.
    • Wait: Be comfortable with silence. Give your child the extra time they need to process their thoughts and formulate a response.
    • Listen: Pay attention to every sound, gesture, or attempt at communication.

    2. Become a buddy, not a teacher

    Try to play alongside your child the way another 5-to-7-year-old peer would. A peer doesn’t quiz, direct, or lecture; they do their own thing nearby, make occasional fun comments, and signal that they simply enjoy being together. Shift your role from communication director to play buddy.

    3. Comment naturally. Don’t ‘state the obvious’

    Once you master silence, narration should feel natural, spontaneous, and genuine.

    • Avoid: Pointing out things they already know just to test them (e.g., ‘That’s a blue car!’).
    • Try: Generic, enthusiastic reactions that invite connection without demanding a answer (e.g., ‘Whoa, look at that!’, ‘Goodness!’, ‘Hey, that’s cool!’).

    4. Have fun with no agenda

    School and daily routines carry a lot of demands for a 7-year-old. Take time every day to simply join your child’s world and have fun with zero clinical agenda. Laughter and genuine connection are the ultimate foundations for all communication.

    Interested in learning how the Hanen programme can support your family? Get in touch today to learn more about our online parent coaching sessions.

    Sonja McGeachie

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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  • ·

    Something that keeps surprising me…

    ByLondon Speech and Feeding

    After thirty years of helping children with lisps, you’d think very little would still surprise me. And yet…

    Girl looking at herself in a mirror and looking at her tongue

    Every few weeks, a lovely, and well-informed parent will describe their five, six, or seven year-old’s slushy, sideways /S/ and then ask ‘So, how many sessions do we need to fix this? Perhaps five–six? ‘

    And every time, I have to resist the urge to laugh, cry, and reach for the biscuits all at once. Because the honest answer, for an established lateral lisp in a school-aged child, is usually twenty sessions or more. Wait! Hear me out!…

    ‘Why so many?!’ … once you understand what’s actually going on inside your child’s mouth, the number 20+ does no longer sound outrageous and starts sounding rather reasonable.

    First: not all lisps are equal

    Most people picture a lisp as the gentle, even endearing /TH/ for /S/ — ‘thnake’ instead of ‘snake’. That’s an inter-dental lisp, where the tongue pokes forward between the teeth. It’s common, it’s developmentally normal in younger children, and this is the important bit, it’s usually visible. It’s still a bit tricky to correct at first but I often can show a child what to do, they can watch themselves in a mirror, and quite often we’re away. But it still takes a lot longer than parents think because just fixing the sound does not mean it will be produced correctly in normal, daily speech and conversation.

    Lateral lisp

    A lateral lisp on the other hand is an entirely different animal. Instead of the air flowing in a neat central stream down a groove in the middle of the tongue, it spills out over the sides, around the molars. The result is that wet, slushy, quality. It affects not just /S/ and /Z/, but very often /SH/, /CH/ and /J/ too which is a big chunk of English.

    Here’s the snag: it’s happening where nobody can see it. There’s no mirror in the world that shows you the sides of your tongue as you are speaking, or chewing for that matter. We’re teaching a child to control a movement they can’t see, can’t easily feel, and have never once performed correctly in their life.

    By five, six or even seven years old your child has said the /S/ sound about several hundred times a day, every day, for several years. It’s one of the most frequent sounds in English: it makes our plurals, our possessives, our verb endings. Every ‘cats’, ‘let’s’, ‘she runs’.

    So we are now talking about a deeply ingrained motor habit, rehearsed tens of thousands of times, that now feels completely normal and correct to the child producing it. We’re not teaching a new skill onto a blank page; we’re overwriting a very strong habit. Think of a tennis player with a flawed serve who’s played for five years… You don’t fix that in a fortnight, and nobody expects you to.

    The good news is: school children, seven-year-old and up, are brilliant at this work. They can self-monitor, they can practise independently, they can hear the difference. It just takes time.

    The quiet culprit: where the tongue lives at rest…

    Here’s the piece that most parents have never heard, and it explains a lot.

    When the mouth is at rest, the tongue should sit up — tip resting lightly behind the top front teeth, body gently suctioned to the roof of the mouth, lips together, breathing through the nose.

    Many children with a lateral lisp have a low, forward resting tongue posture. The tongue sits on the floor of the mouth, often with the lips slightly apart. This is frequently associated with a history of mouth breathing, blocked noses and allergies, enlarged tonsils or adenoids, prolonged dummy or thumb-sucking, and sometimes dental or orthodontic differences such as an open bite.

    Why does this matter so much? Because a good /S/ requires the tongue’s sides to brace firmly against the upper back teeth to form that central channel. A tongue that spends 23 hours a day flopped on the floor of the mouth simply doesn’t have the habitual strength, position or awareness to do that on demand. We can teach a beautiful /S/ in the clinic — but if the tongue’s default setting is ‘down’, we’re swimming upstream all week.

    So, for many children, part of the work is establishing a better resting posture alongside the sound itself. That’s foundational and it’s slow.

    So what does twenty-plus sessions actually achieve?

    Therapy for a lateral lisp moves through a strict hierarchy, and you cannot skip a rung:

    • Auditory discrimination: Can they hear the difference? (Often, initially, no.)
    • Eliciting the sound: Sometimes a single session, can be six.
    • Stabilisation: Building consistency in isolation, then syllables, then single words (beginning, middle, end).
    • Blends: Mastering challenging combinations like ‘spoon’, ‘street’, and ‘smile’.
    • Sentences: Moving to phrases, full sentences, and structured conversation.
    • Generalisation: Using it naturally with family, at school, when tired, or when telling a long story.
    • Self-monitoring: Training them to catch and correct themselves without therapist intervention.

    Rushing a level guarantees a collapse two levels later. I’ve never once regretted going slowly; I’ve frequently regretted going fast.

    The bit that decides everything: home practice

    Let me be blunt in a nice way 😊 The child who practises five to ten minutes a day, six days a week, will finish in half the time of the child who practises the night before their session.

    An hour with me per week is roughly 1% of your child’s waking life. The other 99% is where habits are made or unmade. What I need at home is:

    • Short and daily beats long and occasional: Five focused minutes, ideally at a consistent time.
    • Practise only at the set level: If we’re on words, don’t leap to sentences. That’s how we go backwards.
    • Give specific feedback: Say ‘that one was lovely and sharps or ‘that one slipped sideways, try again’.
    • Hold back on everyday corrections: Don’t correct them in normal conversation until we’re ready.
    • Record them occasionally: Children love hearing their own tangible progress.

    The bottom line

    I’m good at this. I’ve been doing it for thirty years and I love it. But I’m a therapist, not a magician, and the parents who get the best outcomes are the ones who view this as a partnership. When we work together—combining expert clinic guidance with steady, gentle practice at home, that ‘twenty-plus’ number isn’t a sentence. It’s simply the guideline to giving your child a clear, confident voice for the rest of their life.

    Do get in touch with me. I would love to hear from you and help you and your child.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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  • · · ·

    Why open cup drinking and good sitting matter for your toddler

    ByLondon Speech and Feeding

    When your baby reaches around 12 months, there is a lot going on developmentally. They are learning to walk, communicate, feed themselves and become increasingly independent. One small but important milestone that can sometimes get overlooked is learning to drink from an open cup.

    Many toddlers continue to have milk from a bottle well beyond their first birthday, and parents are often understandably reluctant to take it away. The bottle may be familiar, comforting and convenient, particularly at bedtime.

    But moving towards an open cup is not simply about changing the way your child drinks. It is part of their development of oral-motor skills, feeding independence and mealtime development.

    And there is another piece of the puzzle that is often overlooked: how your toddler is sitting while they eat and drink.

    The way the body is supported can make a real difference to what the mouth is able to do.

    Why introduce an open cup from around 12 months?

    Babies can begin learning to drink from an open cup much earlier than many parents realise. By around 12 months, most children should be given regular opportunities to practise drinking from an open cup alongside other suitable drinking vessels.

    An open cup encourages your toddler to learn a different pattern of drinking from the sucking pattern they have used with a bottle.

    With an open cup, your child needs to:

    • lean towards the cup and control its position
    • grade how much liquid enters the mouth
    • use their lips to help control the liquid
    • coordinate breathing and swallowing
    • develop increasingly mature tongue and jaw movements
    • learn to take a drink without relying on a teat or nipple.

    These are useful skills for developing efficient eating and drinking.

    This doesn’t mean that a toddler who still has a bottle at 14 or 18 months has somehow ‘missed their chance’. Children develop at different rates, and there is always an opportunity to work towards new skills.

    However, if a bottle remains the main or only way a child drinks for a long time, there can be fewer opportunities to practise these more mature drinking skills.

    What are the pitfalls of staying with a bottle for too long?

    The occasional bottle is not the issue. The concern is when a toddler continues to rely heavily on a bottle and therefore has little reason or opportunity to develop other drinking skills.

    A bottle encourages a sucking pattern which is appropriate for infancy. As children mature, we want to see increasing use of their lips, tongue, jaw and facial muscles in more sophisticated ways.

    Long-term bottle use can also make the transition to an open cup more difficult simply because the child has become very accustomed to the bottle.

    There can also be practical considerations around dental health, particularly when milk is offered frequently throughout the day or overnight.

    For many toddlers, the bottle has also become associated with comfort, sleep or emotional regulation. This can make giving it up feel like a very big change for the whole family.

    So rather than thinking, ‘The bottle has to disappear tomorrow’, think:

    ‘How can I gradually increase opportunities for open-cup drinking?’

    Offer the open cup regularly at meals. Let your toddler experiment. Expect spills. Keep the amount of liquid small initially and provide plenty of encouragement.

    Learning to drink is a skill. And skills need practice.

    But what has sitting got to do with drinking?

    Quite a lot!

    When we think about feeding, we naturally tend to focus on the mouth. We watch what the tongue is doing, whether a child chews, whether they cough or gag and what foods they accept.

    But feeding is a whole-body activity.

    Your child needs a stable body position before they can use their mouth efficiently.

    Think about trying to drink from a cup while sitting on a wobbly stool with your feet dangling in the air. You would probably find it much easier if your body was well supported.

    The same principle applies to toddlers.

    Tripp Trapp® Chair

    A well-designed highchair such as a Tripp Trapp chair can provide a stable base when it is correctly adjusted for the individual child. Ideally, your toddler should have:

    • hips well supported
    • knees comfortably bent
    • feet resting firmly on a footplate
    • a stable pelvis and trunk
    • the table or tray at an appropriate height

    This gives your child a solid foundation from which to move.

    And that matters because stability in the body supports movement and control in the mouth.

    Feet supported = better feeding?

    I sometimes hear parents say, ‘He doesn’t need the footrest don’t worry about it (as I crouch down with my Allenn key to adjust the Tripp Trapp chair) but I always explain it is very important to have his feet supported. Dangling legs can make it much harder to maintain a stable sitting position.

    When the feet are supported, your toddler can push gently through their feet and stabilise their pelvis and trunk. This can help them maintain a more organised position while eating and drinking.

    They can then devote more attention to the job in front of them:

    looking, reaching, grasping, chewing, swallowing and drinking.

    This is particularly important for toddlers who are developing their chewing skills or who find mealtimes physically demanding.

    A stable body supports a busy mouth

    Eating involves an extraordinary amount of coordination.

    Your toddler is managing food in their hands, bringing it to their mouth, biting, chewing, moving food around with their tongue, forming a bolus and swallowing,  often while simultaneously looking around, communicating and interacting with you.

    Drinking from an open cup adds another layer of coordination.

    Good postural support doesn’t teach a child to drink from a cup, but it can give them a much better physical foundation from which to practise the skill.

    This is why, when I assess a toddler’s feeding, I don’t just look inside the mouth.

    I also look at how the child is positioned.

    Making open-cup drinking part of everyday life

    You don’t need a complicated programme.

    At meals, offer a small amount of water in an open cup. You can help your toddler hold the cup initially, tipping it gently towards their lips and allowing them to control the drinking as much as possible.

    Some mess is completely normal!

    You might also use a small, lightweight open cup that is easy for little hands to manage.

    And remember that the goal is not to make every drink perfect. The goal is to give your child regular, positive opportunities to practise.

    If your toddler is struggling with drinking, frequently coughing or choking, refusing cups, relying heavily on a bottle, or experiencing difficulties with chewing and eating, it is worth seeking professional advice from a Speech and Language Therapist with expertise in paediatric feeding.

    The bigger picture

    Open-cup drinking and good sitting are not two unrelated developmental skills.

    They are part of the same picture.

    A stable body provides a foundation for skilled movement. Skilled movement supports feeding. And feeding skills develop through practice and opportunity.

    So as your toddler approaches and moves beyond their first birthday, think beyond simply asking, ‘How much milk are they drinking?’

    Think about how they are drinking, how they are sitting, and what opportunities they have to develop the skills they will need as they grow.

    And if you have a little one sitting beautifully at the table in a well-supported Tripp Trapp chair, remember: you’re not just creating a comfortable seat.

    You’re creating a stable foundation for eating, drinking, learning and growing.

    Do get in touch with me. I would love to hear from you and help your little one develop good sitting and drinking habits.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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  • ·

    Why tongue lateralisation matters: The hidden feeding skill that every toddler needs

    ByLondon Speech and Feeding

    When parents think about feeding milestones, they often focus on what their child is eating. Are they accepting lumps? Will they eat vegetables? Are they managing finger foods?

    However, one of the most important skills happening behind the scenes is something many parents have never heard of: tongue lateralisation.

    Tongue lateralisation simply means the tongue’s ability to move from side to side inside the mouth. Although this sounds like a small movement, it is one of the key building blocks for safe chewing, efficient eating and later speech development.

    As a Speech and Language Therapist specialising in infant feeding, I frequently assess children who have delayed or absent tongue lateralisation. The encouraging news is that this skill can often be developed. But like many areas of development, there is an optimal window during which children learn it most naturally.

    What does the tongue actually do during eating?

    Eating is an incredibly complex process involving the lips, jaw, cheeks, tongue and swallowing muscles all working together.

    For mature chewing, the tongue needs to:

    • move food from the centre of the mouth onto the back gums and molars
    • keep the food positioned while the jaw chews
    • collect scattered pieces of food from around the mouth
    • reform the chewed food into a single cohesive bolus
    • move that bolus safely to the middle of the tongue before swallowing.

    Without good tongue lateralisation, food often stays in the middle or front of the mouth where it cannot be chewed effectively.

    Children may compensate by:

    • swallowing pieces whole
    • mashing food with the front teeth only
    • relying on sucking instead of chewing
    • holding food in their cheeks
    • gagging frequently
    • refusing more challenging textures altogether.

    These children are often described as ‘fussy eaters’, when in reality they may simply lack the oral motor skills needed to manage more advanced textures comfortably.

    When should tongue lateralisation develop?

    Tongue lateralisation begins to emerge during the second half of the first year of life as babies start exploring textured foods.

    Between approximately 6 and 12 months, babies naturally begin learning to move food sideways towards their gums for early chewing. As molars develop during the second year, these movements become more refined and efficient.

    This period represents an important developmental window because babies are biologically programmed to experiment with increasingly varied textures. Repeated opportunities to chew different foods strengthen the tongue, jaw and cheek muscles while building the complex movement patterns needed for mature eating.

    If a child remains on smooth purées or very soft foods for too long, they may miss hundreds of opportunities to practise these essential movements.

    Why does this developmental window matter?

    Like learning to crawl, walk or ride a bicycle, oral motor skills develop through repeated practice.

    Children who do not experience enough chewing opportunities during infancy can sometimes continue to rely on immature sucking and munching patterns well into toddlerhood.

    This does not mean the opportunity is completely lost after infancy. Many toddlers can still learn tongue lateralisation successfully with the right support. However, the longer an immature pattern is used, the more established it becomes, making change more challenging.

    That is why early assessment is so valuable.

    Signs your toddler may have poor tongue lateralisation

    You may notice your child:

    • chews mainly with the front teeth
    • bites but does not chew efficiently
    • keeps food in the centre of the mouth
    • pockets food in the cheeks
    • frequently spits out textured foods
    • gags on lumps
    • prefers soft foods
    • swallows before food has been adequately chewed
    • takes a very long time to finish meals.

    Not every child showing these signs has an oral motor difficulty, but they do warrant further assessment.

    How can we encourage tongue lateralisation?

    The good news is that the tongue learns through experience.

    One of the best ways to encourage side-to-side movement is by offering long, resistive foods that naturally encourage the tongue to move food towards the side gums for chewing. We also call them sometimes HARD MUNCHABLES – they look like on the following image.

    Hard munchablers

    Examples include:

    • mango pits with most of the flesh removed
    • pineapple core strips
    • thick steak strips
    • cooked pork strips
    • peeled celery sticks
    • thick cucumber spears
    • roasted pepper strips
    • corn on the cob cut into manageable rounds
    • dehydrated apple rings
    • large clean cooked rib bones with a little meat remaining for supervised chewing practice.

    These foods are not intended for children to consume large pieces quickly. Instead, they provide resistance that encourages the jaw, cheeks and tongue to work together while giving valuable sensory feedback.

    A simple technique that can help

    Some toddlers struggle because they never naturally move food to the side of their mouths.

    In these cases, placing a long strip of food gently onto the side gums can sometimes trigger the chewing pattern automatically. This gives the tongue an opportunity to experience where chewing should occur.

    This should always be done calmly, with the child sitting upright and under close adult supervision.

    Every child develops differently

    Some children are more likely to experience delayed tongue lateralisation than others.

    This may include children who:

    • remained on purées for an extended period
    • have developmental delays
    • have low muscle tone
    • were born prematurely
    • have significant sensory processing differences
    • have experienced prolonged tube feeding or medical conditions affecting feeding.

    A feeding assessment can identify whether tongue movement, jaw stability, sensory processing or another factor is contributing to the difficulty.

    Early intervention makes a difference

    One of the biggest misconceptions I hear is:

    ‘They’ll grow out of it.’

    Some children do. Others don’t.

    Without intervention, inefficient chewing patterns can persist for years, affecting food variety, mealtime confidence and nutritional intake. In some cases, immature oral motor patterns may also contribute to unclear speech production later on, although feeding and speech skills do not always develop at the same rate.

    The earlier we identify a problem, the easier it usually is to help children develop more mature, efficient chewing patterns.

    Final thoughts

    Tongue lateralisation may not be a term many parents recognise, but it is one of the foundations of successful feeding.

    By offering opportunities to chew a variety of safe textures during infancy, parents help build the complex tongue movements needed for efficient eating throughout childhood.

    If your toddler still struggles with chewing, gags on textured foods, or seems unable to move food around their mouth, don’t simply wait and hope they will outgrow it. A comprehensive feeding assessment can identify exactly where the difficulty lies and provide practical strategies tailored to your child’s needs.

    Sometimes a few small changes at the right time can make a lifetime of difference. Do get in touch with me. I would love to hear from you and help your little one develop good chewing skills and eating habits.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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  • · · ·

    Beyond the teddy bear picnic: Why language development doesn’t always need imaginative play

    ByLondon Speech and Feeding

    As Speech and Language Therapists (SLTs), we are taught from day one that developmental milestones follow a predictable, linear path: first comes functional play, then symbolic and imaginative play (like pretending to feed a teddy bear or talking on a toy phone), and then comes conversational speech.

    But when working with language delayed children, I have seen something that completely contradicts those textbook charts.

    Many of my students have absolutely no interest in doll play, tea parties, or imaginary scenarios. Yet, as they mature, they still manage to develop robust, meaningful, and conversational language.

    How is this possible? And what does it mean for how we approach therapy?

    Redefining the ‘rules’ of play and language

    The idea that imaginative play is a strict prerequisite for language was built entirely on neurotypical developmental data. But neurodivergent brains don’t follow neurotypical roadmaps. That is not a deficit; it’s simply a different processing style.

    When Gestalt Language Processors bypass traditional imaginative play, they aren’t ‘missing’ a step. They are often using entirely different cognitive vehicles to build their language skills.

    The power of monotropic deep interests

    Video clip 2 lining up dinosaurs

    Many autistic individuals have a monotropic cognitive style, meaning they process the world through deep, single-focused passions (think trains, space, dinosaurs or ocean creatures).

    While a neurotypical child might practise social roles by pretending a doll is going to school, a neuro-diverse child practises language by categorising, analysing, and sharing facts about their deep interest. Their language is anchored in the concrete, fascinating reality of their passion, rather than fictional symbolic play.

    Gestalt Language Processing (GLP)

    A significant number of neuro-diverse children learn language in large ‘chunks’ or ‘gestalts’ (such as movie scripts, songs, or favourite phrases) rather than building sentences word-by-word.

    When a child scripts or uses echolalia, they are storing and mapping vast amounts of conversational data. They don’t need to pretend-feed a teddy bear to practise dialogue; they are actively processing the rhythm, intonation, and structural rules of speech through the media and phrases they love. As they grow, they learn to break these scripts apart to form original sentences.

    Structural play is learning play

    Just because a child is lining up dinosaurs or cars, stacking blocks, or spinning wheels instead of making them ‘talk’ doesn’t mean they aren’t learning. This functional and structural play builds crucial foundational skills like pattern recognition, cause-and-effect, and spatial awareness, all of which directly support cognitive and language development.

    Shifting Our Goals

    Meeting our children on their home turf: if that’s dinosaurs, let’s be creative with dinosaurs!

    If imaginative play isn’t the engine driving language, forcing it in the therapy room can quickly turn into an exercise in compliance rather than connection. Instead of trying to pull a child out of their world and into a neurotypical play model, we can meet them exactly where they are!

    Here are three affirming ways to turn deep interests into conversations:

    • Swap questions for comments (declarative language): Instead of interrogating a child about their play (‘What colour is that train? Where is it going?’) make pressure-free observations (‘Wow, that train is moving fast. Look at those wheels spin.’). This lowers conversational anxiety and models natural communication.
    • Bridge and expand: Use their favourite topic to introduce new ideas and concepts. If we love dinosaurs let’s see if dinos can climb up a ladder, slide down a half pipe into some water, then need drying before making footprints across a piece of paper…
    • Validate any scripts or echolalia and find out the EMOTION underlying it: If your child uses a quote from a favourite cartoon clip, let’s try and figure out in what context this phrase was said in the movie; what is the emotion in the movie when the character says this line? Is it upset? Is it joyful? Is it big surprise or a shock? Don’t dismiss it as meaningless. Acknowledge the emotion behind the script ‘You feel worried right now.’ This way we are showing our child that their unique way of communicating is heard and valued.

    So, to sum up:

    Imaginative play is just one way to learn language, not the only way.

    Let’s stop viewing a lack of pretend play as a barrier to communication, and free ourselves to see our children’s true strengths. By embracing their deep passions, we don’t just help them find their voice. We build a real connection that makes communication possible.

    Are you looking for neurodiversity-affirming speech and language support? Contact my clinic today to learn more about how I tailor my therapy to your child’s unique strengths.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

    3
  • · ·

    One toy, endless targets: How to grow consonant clusters, core words and colours with one flower garden toy

    ByLondon Speech and Feeding
    Sonja McGeachie with the build-a-flower garden toy

    If you’ve been following me for a while you already know my absolute favourite rule for speech therapy: let the toy work for you. You don’t need an entire cabinet full of different flashcards or games to target a massive range of speech goals (though truth be told I do have 4 cabinets! What am I saying…) but often I find that sticking to one highly engaging, open-ended toy reduces a child’s cognitive load, keeps them firmly planted in play, and gives you dozens of natural opportunities for high-repetition practice. It also reduced my cognitive load!

    In today’s post we are looking at a classic: The build-a-flower garden toy. A link is here: https://www.amazon.co.uk/Fivejoy-Flower-Garden-Building.

    This vibrant, stacking toy isn’t just great for fine motor skills. It is an absolute goldmine for speech therapy. While it is incredible for targeting tricky consonant clusters (blends) like /ST/, /SP/, /SPR/, /FL/, /BL/, and /GR/, it is equally powerful for building functional core vocabulary.

    1. Digging deep with /ST/

    Let’s start building our garden.

    Stem & stalk: ‘Look at this long stem!’ or ‘Can you put the stem in?’ or ‘do you want the green or the red stem’?

    • Stuck: If a piece is a little tight to push down, it’s a brilliant opportunity for a natural exclamation: ‘Oh no, it’s stuck! Help me!’
    • Stand: Once it’s secure, you can celebrate: ‘it can stand up now!’
    • 👉 Core word integration: Use this setup stage to practise ANOTHER ONE. As you hold the base pieces, wait for the child to use their words or AAC device to request, ‘I want another one!’ before handing over the next stem.

    2. Sowing seeds with /SP/ and /SPR/

    Every good gardener needs the right equipment and a close eye for detail. We can introduce tools and descriptive language to hit our /SP/ and triple-blend /SPR/ targets.

    • Spade: Grab a toy shovel or pretend to use one. ‘Let’s dig a hole with the spade.’
    • Spot: Point to the holes on the base. ‘Find a good spot for this flower.’
    • Sprout: Talk about the little green pieces: ‘Look at the little sprout!’
    • 👉 Core word integration: Build on spontaneous requesting here. If they are eyeing a specific piece, model a full phrase like: ‘I WANT THE PINK ONE.’

    3. /FL/ and fine motor actions

    Now, we can start adding the colourful petals.

    • Flower: This is your high-frequency word for the entire activity. ‘Put the green/blue/pink flower on top.’
    • Flat & flutter: ‘This piece is flat on the ground,’ or ‘The butterfly flutters by!’
    • 👉 Core word integration: This stage is perfect for teaching directional actions. Every time they stack a petal onto a stem, model the core phrase: ‘PUT IT ON!’

    4. Blending it all together with /BL/

    Building a garden is a fantastic sensory experience because of the vivid colours. We can lean heavily into the /BL/ sound by focusing on colour selection and the action of growth.

    • Blue & bloom: ‘Should we use a blue flower?’ and ‘Watch it bloom!’
    • Blade & blend: Point out the blades of grass and talk about how we blend all the colours together.
    • 👉 Core word integration: Don’t just focus on putting the toy together, taking it apart is half the fun! If a child places a piece they don’t want, or when it’s time to clean up, model: ‘TAKE IT OFF.’

    5. Working the /GR/

    Finally, we look at the environment supporting our garden. The /GR/ blend can be targeted by looking downward at the base of our toy setup.

    • Green: Nearly every stem and base piece in this toy is a vibrant shade of green.
    • Grass & ground: ‘Put the base down on the ground.’ ‘Look at the green grass.’
    • 👉 Core word integration: Combine your /GR/ blend with a powerful core phrase. As you pull a stem upward slowly or stack the petals higher and higher, chant together: ‘MAKE IT GROW! Grow, grow, grow!’

    Maximise your repetitions in play

    The beauty of the flower garden toy is its repetitive nature. Because a child builds multiple flowers, you aren’t just saying a word or a phrase once, you have the potential to repeat it 10, 15, or 20 times in a single sitting without the child losing interest.

    By layering structural speech sounds (like blends) over functional communication phrases (like core words), we give children words they can use across their entire day.

    What toy would you like to see us target next in our series? Let me know in the comments on Instagram, and don’t forget to swipe through the carousel there to save these word lists for your next playtime!

    If you are concerned about your child’s speech, please do not hesitate to get in touch. I would love to help you find some answers.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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  • A day in my speech clinic: Mastering the /SP/ cluster

    ByLondon Speech and Feeding

    I very often work on /S/ Blends (/SP/ /ST/ /SM/ /SK/ /SN/ and /SL/). When we work on these sound blends (like SPider, STop, or SMile), we are using a clever speech therapy ruse! Because these blends are complex, teaching a child how to master them naturally helps them clear up simpler single sounds (like just /S/ or just /P/) at the same time. Plus, because S-blend words are so common in everyday language think spoon, spy, spot, and spin, practising them gives your child an immediate confidence boost when they are understood much more easily.

    Good news: high-repetition motor practice doesn’t have to be a chore. In fact, the more sensory input we can provide, the faster those new neural pathways are built. Recently, I recorded a series of seven short clips to demonstrate how we can weave intense speech practice into the fabric of play.

    Here is a look at a typical day in the clinic focusing on /SP/ blends.

    1. The sensory sandbox:

    We started our session at the sensory table. Sensory bins can often work well because they provide tactile feedback that grounds the child’s focus (of course they are usually messy, so one needs to have the physical space and energy for it to be fair!).

    • The Activity: I pointed to our ‘I Spy’ board before we dove into the sand. Using a toy spade we dug for hidden objects and named them each time we found one.
    • Every time we scooped, we practised Spade. Every discovery was a spider, a spoon or a spotty animal. By pairing the physical effort of digging with the speech sound, we help the brain synchronise motor planning and vocal execution.

    2. Bingo dabbers rock!

    Next, we moved to making ink marks on paper.

    • The Activity: I demonstrated making spots with coloured bingo dabbers.
    • We treated each ink spot as a visual anchor. Stamp –Spot Stamp –Spot. This creates a rhythmic pacing that prevents the child from rushing. It’s a wonderful way to get 50+ repetitions in under five minutes without the child even realising they are ‘working’.

    3. Drawing spiders

    Building on the previous activity, we took those spots and turned them into something more complex.

    • The Activity: I drew spiders out of the spots we had just made.
    • Drawing the legs provided a perfect opportunity for ‘stretch’ sounds. As we drew a long leg, we practise a long, hissy ‘Sssssssss’, snapping into the /P/ as the pen hits the spot.

    4. Wind-up spinners

    High-energy toys are excellent for eliciting ‘power’ sounds.

    • The Activity: I brought out two mechanical wind-up spinners.
    • Method: The child says Spin or Spinner to get me to wind them up. The anticipation of the toy moving acts as a natural reinforcer.

    5. The Incy Wincy spider game

    • The Activity: I spun a game spinner to determine how many steps our toy spiders would take up the spout.
    • This activity is a triple threat. We practised ‘Spin’, ‘Spider’, and ‘Spout’ all in one go. The visual of the spider moving up the spout also helps with the concept of UP and DOWN of course.

    6. Searching for Spot

    Books are a great tool for generalisation, taking a sound from a single word and moving it into phrases and sentences.

    • The Activity: We went through a ‘Spot the Dog’ book.
    • Instead of just reading, we used the ‘I Spy’ strategy. ‘I spy Spot! He has a big spot on his back!’ This encourages the child to use the target word in a functional, communicative way rather than just repeating it after me.

    7. Finally, sponging off some sand

    We ended the session with some ‘heavy work’ and cleaning.

    • The Activity: We took a soft toy that had gotten a bit ‘dusty’ in the sandbox and used a sponge to clean it down.
    • The action of squeezing the sponge provides proprioceptive input (pressure), which can be very calming and help a child focus on their articulatory placement for those final repetitions of the day.
    A day in my speech clinic: Mastering the /SP/ cluster

    Speech therapy works on motor learning. Just like learning to ride a bike or play the piano, the brain needs thousands of correct repetitions to make a movement automatic. By using /SP/ words in these seven distinct, sensory-rich ways, we:

    1. Reduce frustration: The focus is on the play, not the correction.
    2. Increase engagement: A child who is having fun will stay in the learning zone longer.
    3. Provide context: The child learns that saying /SP/ correctly helps them get the spade, spin the spinner, and find the spider.

    Next time I will show you some more activities for /ST/ and /SM/ words. If you have any super ideas for /S/ cluster words please leave me your suggestions in the comments on instagram, I would appreciate it thank you! 😊

    If you are concerned about your child’s speech, please do not hesitate to get in touch. I would love to help you find some answers.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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  • · ·

    Why pretend play is the perfect therapy vehicle for children with dyspraxia

    ByLondon Speech and Feeding

    Picture this. A small dinosaur is stomping across a wooden floor. A tiny teacup is being filled with imaginary juice. Someone, probably you, has just been told very firmly that you are the baby and you must go to sleep now.

    To the outside world, this is just play. Joyful, chaotic, completely ordinary toddler play.

    But for a child with Childhood Apraxia of Speech (CAS), also known as verbal dyspraxia, what is happening inside a well-designed pretend play session is anything but ordinary. It is, in fact, some of the most powerful motor speech therapy we have.

    Let me explain why.

    First, a quick reminder: what is dyspraxia?

    Childhood Apraxia of Speech is a motor speech disorder. The difficulty does not lie in the muscles of the mouth, those are perfectly capable. The difficulty lies in the brain’s ability to plan and sequence the precise movements needed to produce speech sounds consistently and accurately.

    A child with CAS knows what they want to say. The message is there. But somewhere between the intention and the execution, the plan breaks down. Words come out differently each time, or not at all. It is effortful, unpredictable, and for many children, deeply frustrating.

    What this means for therapy is important: CAS requires motor learning, not just language stimulation. And motor learning has very specific conditions under which it thrives.

    Repetition is the medicine and pretend play delivers it without the child noticing

    One of the most well-established principles of motor learning is that new movement patterns need to be practised many, many times before they become reliable. Think of learning to ride a bike, or to touch-type. Repetition is how the motor system builds consistency.

    For speech, this means a child needs many opportunities to attempt a target word or phrase within a single session. In a formal drilling exercise, this quickly becomes tedious and dysregulating, especially for young children. After five attempts at ‘go’, most three-year-olds have mentally left the building.

    But inside a pretend play scenario? The word ‘go’ appears naturally and meaningfully dozens of times. The car goes. The train goes. Ready, steady, go. Go to sleep. Go there doggie. Every repetition is embedded in a moment that makes sense to the child, which means they are motivated to keep going, and the practice is accumulating without any sense of effort or demand.

    A relaxed brain learns better

    There is a reason I tend not to sit a dyspraxic child at a table with flashcards and ask them to repeat after me. It is not because I lack structure. Every session I run has clear targets and intentional design. It is because we know that anxiety and pressure actively interfere with motor learning.

    When a child feels observed, corrected, or under pressure to perform, the cognitive load increases and the very motor planning system we are trying to support becomes less accessible. The errors increase. The frustration escalates. The session unravels.

    Pretend play, by contrast, creates a state of engaged, relaxed absorption. The child is leading. They are safe. They are having fun. In this state, the brain is far more receptive to new motor patterns being laid down. I am not asking the child to perform speech. I am simply being present, following their lead, and slipping in carefully chosen models at exactly the right moments.

    Child-led play gives us the child’s own words to target

    Another reason pretend play works so beautifully for children with dyspraxia is that it tells us exactly which words matter most to this particular child, right now, today. When a child reaches for the toy telephone and hands it to me with enormous expectation, I know that ‘hello’ is a word worth targeting in this moment. When they are clearly trying to tell me that the baby needs feeding, ‘more’ and ‘eat’ have instant, genuine relevance.

    Targeting words a child is already motivated to say means the communication attempt is coming from them. And a self-initiated attempt, even an approximation, is neurologically far more valuable than a prompted imitation.

    What this looks like in practice

    In the short video clip below you can see this dynamic in action. Notice how the session looks relaxed and playful on the surface. The child is absorbed in the pretend play scenario we have created together.

    Notice, though, what is happening underneath:

    • the consistent, gentle modelling of target words
    • the use of Makaton signs alongside speech to provide an additional sensory pathway
    • the visual mouth cues that give the child a roadmap for how a sound is shaped
    • and running through all of it, the repetition. The same words, again and again, wrapped in play.

    This is not therapy disguised as play. It is therapy that is play, because for a child with dyspraxia, those two things are not in opposition. They are, in fact, perfectly aligned.

    If you are concerned about your child’s speech and wondering whether verbal dyspraxia might be a factor, please do not hesitate to get in touch. I would love to help you find some answers.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

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

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