Chaining: A powerful tool for phonological development

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Understanding chaining

Chaining is a therapeutic technique I like to use in my speech therapy work with children who have Childhood Apraxia of Speech (CAS) or phonological speech sound difficulties. It helps to break down a complex target behaviour into smaller, more manageable steps. By systematically teaching and reinforcing each step, I can help my students achieve their communication goals.

There are two types of chaining: Forward and backward chaining

Today I am going to show and talk about backward chaining. This technique involves starting with the last step and working backward to the first. This approach can be particularly effective for children with persistent speech sound difficulties where combining consonants into clusters, such as /BL/ or /FR/ or /SHR/ is very difficult.

Backward chaining allows my student to experience immediate success and build his confidence.

In my video I show you how I applied backward chaining to the words ‘Shriek’, ‘Shrub’, ‘Shrimp’ etc

My student struggles with both the /SH/ and the /R/ sounds and we have been working on both sounds for some weeks now. He has mild Childhood Apraxia of Speech and he has difficulties with coordinating his tongue movements, breathing and using his jaw effectively to make words. His sound repertoire has grown a lot since we started working together last year. Today in this session I show you how we pulled both the sound /SH/ together with /REEK/ to make ‘SHRIEK’. I love using the pictures and therapy materials from Adventures in Speech Pathology.

This is also part of the Complexity approach which I will explain in a separate blog post.

  • Step 1 (not shown in the video): I explain what the word means; I find that when my student understands what a word means he is much better at saying it. It increases his confidence and motivation to say a word that he knows the meaning of. Often this student does not tell me that he does not know what a word means, so I always remind myself to check that out first.
  • Step 2 (not shown in the video): We do a little rhyming game and think about what any one word rhymes with: ‘Shriek’ – ‘meek’, ‘weak’, ‘seek’.
  • Step 3: I show my student that there are two parts to this word /reek/ and the sound /SH/.
  • Step 3: We practise the easier part: /reek/ /reek/ /reek/.
  • Step 4: We add the /SH/ sound and pull it together to make our target word ‘Shriek’.

/REEK/ /REEK/ /REEK/ + /SH/ = ‘SHRIEK’
/RUB/ /RUB/ /RUB/ + /SH/ = ‘SHRUB’
/RUG/ /RUG/ /RUG/ + /SH/ = ‘SHRUG’

By breaking down the word into smaller, manageable steps, my student can focus on each syllable individually, get that right and then gradually build up to the full word. This approach can help to reduce frustration and increase motivation.

Forward chaining

Forward chaining is the same process but in reverse: we start with the front sound or syllable and work forward towards the next/last part of the word:

/SH/ + /REEK/ = ‘SHRIEK’
/SH/ + /RUB/ = ‘SHRUB’
/SH/ + /RUG/ = ‘SHRUG’

Benefits of chaining

  • Increased motivation: By starting with the last step, my student experiences success, which boosts his motivation to continue trying to say the word and trying other words.
  • Reduced frustration: Breaking down the target behaviour into smaller steps can make the task less overwhelming, reducing frustration and anxiety.
  • Improved confidence: As the little learner masters each of the step, his confidence and self-esteem increases. Again, this leads to increased motivation.
  • Faster learning: By focusing on the final step first, and practising lots of chaining (forward and backward), a student can quickly learn to generalise to other words.

Backward chaining (and forward chaining) is a really great tool for teaching complex speech sounds and words to children with phonological disorders.

Watch out for my next blog which is all about the complexity approach in Phonology.

Do get in touch if your child has a speech sound disorder, I would love to help.

Any questions or need help with supporting your little one’s language please contact me via my contact form, or you could also check out www.hanen.org for advice and lots of inspiration.

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.

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    When speech difficulties overlap: Helping children with phonological delay and childhood apraxia of speech

    One of the questions parents often ask is:

    ‘What kind of speech difficulty does my child have?’

    It’s a very understandable question. We often hear different terms such as phonological delay, articulation difficulties, or Childhood Apraxia of Speech (CAS), and it can be confusing.

    The reality is that many children don’t fit neatly into one single category.

    In fact, quite often I see children whose speech profile includes a mixture of difficulties. They might have some phonological patterns (where they substitute one sound for another) alongside challenges with motor speech planning, where coordinating the movements needed for speech is harder.

    When this happens, therapy needs to be flexible, responsive, and tailored to the child sitting in front of us.

    Example

    Recently I filmed a short clip from one of my therapy sessions which shows exactly how this works in practice.

    The child I was working with has difficulties with several speech sounds. Part of the challenge relates to a phonological pattern called fronting.

    Fronting is when sounds that should be made further back in the mouth (like /K/ or /G/) are produced further forward instead.

    At the same time, this child also shows signs of motor speech planning difficulty, which means the brain has to work harder to organise and sequence the movements of the tongue, lips and jaw for speech.

    This type of profile can sometimes overlap with characteristics seen in Childhood Apraxia of Speech (CAS).

    When difficulties overlap like this, therapy cannot rely on a single approach. Instead, it needs to draw on multiple evidence-based strategies.

    That is exactly what you see happening in the clip. We started out generalising the /K/ sound which until recently had been replaced by a /T/ sound. Whilst looking at a sound loaded picture of /K/ sounds we somehow got talking about a ‘dent’ (I don’t recall how we got there!) but the ‘dent’ was a ‘det’ and I decided to tackle this there and then because there are other great words that end in ‘nt’ like : ‘count’ ‘giant’ ‘point’ or ‘paint’.

    Using visual cues to support motor planning

    Speech is incredibly complex. For children with motor speech difficulties, the challenge is not only knowing what sound they want to say, but also how to move their mouth to produce it.

    This is where visual cues can be incredibly helpful.

    In the clip, you can see me using a whiteboard with pictures and simple visual prompts. These help to:

    • Focus attention on the target sound
    • Understand where the sound occurs in the word
    • Remember the sequence of sounds needed

    Visual supports can act almost like a map for the mouth, guiding children as they practise new speech movements.

    For children with motor planning difficulties, this type of cueing can make a huge difference.

    Why repetition of a single word (massed practice) is so important

    Another key feature you will notice in the clip is lots of repetition.

    This is very deliberate.

    When we are supporting children with motor speech challenges, the brain needs repeated opportunities to practise the correct movement patterns. Just like learning a musical instrument or a new sport, repetition helps the brain build stronger and more efficient pathways.

    In therapy we call this massed practice.

    Rather than saying a word only once or twice, we practise it many times in a structured way, helping the child stabilise the new speech pattern.

    But repetition alone is not enough. The child also needs to understand why the sound matters.

    Showing children that sounds change meaning

    This is where another powerful therapy approach comes in: minimal pairs.

    Minimal pairs are word pairs that differ by only one sound. For example:

    • debt
    • dent

    In the clip, I use these two words to help the child realise that the /N/ sound makes a meaningful difference.

    Without the /N/, the word becomes something else entirely.

    This approach helps children recognise that speech sounds are not random: they carry meaning. If a sound is missing or substituted, the message may change.

    Helping children notice these differences can be a very motivating moment in therapy. Suddenly the sound is no longer just an abstract exercise; it becomes part of real communication.

    Blending approaches for the best outcomes

    In this short therapy moment, I am combining:

    • Visual cueing

    • Motor speech practice

    • High repetition (massed practice)

    • Minimal pair contrasts

    • Listening and awareness of sound differences

    Each element supports a different part of the speech system.

    Some strategies help with motor planning, others support phonological awareness, and others build accuracy and consistency.

    Together they create a therapy session that is both structured and responsive.

    Every child’s speech journey is unique

    One of the most important things I want to convey is that speech development is not always straightforward.

    Two children may both struggle with speech sounds, yet the underlying reasons may be very different.

    This is why careful assessment is essential, and why therapy needs to stay flexible as we learn more about how a child’s speech system works.

    Sometimes a child needs more motor-based work.

    Sometimes the focus shifts towards phonological contrasts.

    Often, as in this example, the most effective therapy uses both.

    Small steps lead to big progress

    Every session helps us understand a little more about how a child’s speech system works and what support will help them move forward.

    And when the pieces start to come together, when a child realises that one tiny sound can change a whole word, that is when the real progress begins.

    If you are concerned about your child’s speech sounds, clarity of speech, or possible motor speech difficulties, early support can make a significant difference. A detailed assessment can help identify the nature of the difficulty and guide a therapy approach tailored to your child’s individual needs.

    Feel free to contact me on www.londonspeechandfeeding.co.uk

    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

    McNeill, B. C., Gillon, G. T., & Dodd, B. (2009). Effectiveness of an integrated phonological awareness approach for children with childhood apraxia of speech (CAS). Child Language Teaching and Therapy, 25(3), 341-366.

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    How to use Attention Autism to develop language and communication

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    Knowing what stage your child is working at is vital. Every stage has different aims to develop and enhance functional communication. So being familiar with your child’s goals ensures you can continue to practise at home. If you’re unsure of their goals, please ask your Speech and Language Therapist.

    With all speech, language and communication goals, the aim is always to generalise skills from therapy settings to home and nursery or school life. This generalisation period will take time. Please try to stick with the plan. You will experience the benefits for your child, and it’ll make family life a little easier.

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    On the left is a bag with Now written above it and Bag below. On the right are three children playing with Net written above and Play written below.

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    Stage two of the Attention Autism approach is called “the attention builder”. The clue is in the name, your child’s goal is to keep focused on the activity for a longer period. The duration will be different for every child, but it’s useful to time their attention, so you can report progress back to your therapist.

    Parents are often worried about doing something wrong. If it all goes a bit pear-shaped or not as you expected, don’t panic! This is the time to ask yourself, did my child have fun? Did they engage in the activity? It’s very helpful to reflect on the experience. What could you do that would make the activity easier for your child to access? (For example, did you set up the activity before your child entered the room? This would allow for a smoother session, so that waiting time was minimal.)

    Three ideas for stage two activities

    There are so many ideas out there, which at times can feel overwhelming. I’m always looking for the easiest options to present to you to reduce overwhelm and allow it to feel manageable.

    Remember this is about having fun. Your child’s communication will benefit from you relaxing and having this structured approach.

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    Fill a small glass, cup or container with flour and flip the cup over to build flour castles. It’s great to engage your child especially with the “Splat” at the end.

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    First dip the marbles into the paint, then drop into the container and roll it around to make a pattern. You could always make a pattern on some paper.

    I love to use everyday objects in therapy, so when I came across this next idea, it was added to the list. It’s simple, effective, not to mention clean!

    3. Skittles

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    Have fun!

    If you need speech, language or communication support or advice, I am always here to help.


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

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

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    Speech Therpaist in London

    The effect of expressive language on spelling and reading

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

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

    When should I seek advice or support?

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

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



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

  • ·

    Why Imitation is so Important

    Target Activities and Games For Kids

    Why imitation is so important and how can speech and language therapy help children who struggle to imitate?

    Imitation or copying starts in early infancy. When we observe a young baby and his parent or familiar adult we can see clearly and frequently that the baby will be intently looking at adult’s face and try to copy their facial expressions, smiles and all those funny baby sounds we often make with young babies.

    These sounds are called “motherese” and are the beginnings of a little conversation between the parent and the baby. The “conversation can go back and forth for a long time and include sounds, as well as facial expressions.

    A little later on, once the baby can crawl and sit up unaided the copying then goes on to include toys and objects. Mum or Dad will show their toddler how to use a drum or how to put a little train on the wooden tracks and the toddler will try and copy this. They may not succeed and be a little clumsy perhaps but the act of copying anything and everything their favourite adult does is typically seen throughout the day.

    We all know and have laughed at mums or dads saying; ssshhh don’t say that in front of the baby he/she will copy you, watch your mouth! (as dad is swearing at the broken radiator….)

    This imitation goes on for years and includes eventually of course little words, more words, putting words together and then creating sentences, all the while our toddler is listening to how their adults speak, not only what they say but how they say it. This is how dialects and accents can be transmitted easily from parent /family to child.

    Copying in Children with Autism

    We know that children with autism often struggle to imitate. We see children on the spectrum typically having great difficulty to copy adults or children; this can be seen in very reduced play with their peers in nursery for example.

    Children with autism tend to have reduced joint attention and engagement with others and need to develop the ability and awareness to copy others in order to then engage more jointly with others.

    Speech and Language Therapy can help with Parent Child Interaction work and Coaching, here is how:

    During my coaching work with parents I teach step by step how to help a child who struggles to imitate:

    We look at all the researched skills and actions that adults can take to help their little one to copy, starting with close observation of their child’s interests, then following and including their child’s play and copying/imitating their child in how they play. I teach steps in a graduated way so that it is easy to see the progress and joyful to have the results at the end.

    The results are clear to see over time: our children on the spectrum learn to imitate actions, with objects and gestures, then sounds and words. Alongside this increased imitation skill the child can then develop more joint attention and engagement.

    I would always recommend Parent Child Interaction Training as a first port of call as we learn so many great techniques which are well researched by the Hanen Programme, www.hanen.org. Do drop me a line if you would like to find out more.


    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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    Transforming Mealtimes

    Speech Therpaist in London

    Transforming Mealtimes

    Below are two reviews I got from grateful clients over the past 4-6 weeks; this blog is more about how Feeding Therapy can help you than blowing my own trumpet…. though that said, it is always so nice and gratifying to hear when parents are happy and hopeful about their little one’s feeding journey. Feeding Therapy is a substantial part of my work as a Children’s Speech and Language Therapist. One of my specialist subjects is Autism and we find that many children on the Autism Spectrum are very specific about eating, and will often refuse a range of typical family foods in favour of a narrow range of foods/snacks.

    Mostly, feeding difficulties are a combination and complex cocktail of factors that have contributed to the current status quo: sure, there may have been some physical problems to start off with, such as reflux causing the baby discomfort, constipation, a very tight tongue tie or a swallowing problem caused by neurological difficulties and of course sensory processing difficulties are also very physical experiences. We always begin with a very thorough case history taking and information gathering, followed by an oral assessment and observation of the actual swallow to establish what might have been – or still might be – the cause for the feeding difficulties.

    In most of the cases I see in my practice, the original obvious cause is no longer present, especially with older children. So, if the swallowing is fine, the reflux is no longer present, the tongue was divided (twice!) why are they still not eating much, refusing to try new foods, only accept certain textures etc.

    The answer is extremely complex and multi-faceted and this little blog is not covering any factors in detail (we would be here all night) -I mentioned sensory processing difficulties earlier on. These are mostly still present but often not acknowledged or recognised by parents. And it is certainly the case that one of the contributors is parental anxiety; this tends to run very high and has been for many months, sometimes years. This in turn often leads to very tense and unpleasant, endlessly long meal times and many times children are force-fed several times a day in order to “get something down there” as otherwise they would probably starve themselves.

    Additionally, parents end up only offering a very narrow range of foods because that is all their child will eat. This ends up in a vicious cycle of children being fed porridge-style food for all meal times and of course they won’t progress to more mature foods if these mature foods are never on offer.

    In order to help address and disentangle some of the issues I often introduce the “Division of Responsibility in Feeding” as researched and recommended by Ellyn Satter (The Satter Feeding Dynamics Model)

    Here are the main points of her approach:

    Children have a natural ability with eating, they eat as much as they need and they grow in the way that is right for them and they learn to eat what their parents eat. (E Satter). The parent is responsible for WHAT the child eats, WHERE and WHEN the child eats. The child is responsible for HOW MUCH they eat or WHETHER to eat. Satter proposes that parents should guide their child’s transition from nipple feeding through semi-solids, then thick and lumpy foods to finger foods and then on to normal family meals.

    Please note: this model is only appropriate for children where the original physical cause is no longer present!

    Of course it’s not easy! It requires a huge shift in thinking about feeding and it requires to trust our children to know what is best for them. This is very big for most parents, as it is not how we were brought up and it is not commonly known that babies and children know what is good for them!

    However, it is certainly true that parents who follow this particular approach and make small, steady changes in the way the offer foods, and in the way they create family meal times differently, children make very nice, pleasing progress and over some months we often see remarkable positive changes.

    I like to work in a team and especially for this type of problem it is essential to have a multi-disciplinary approach. A knowledgeable dietician is an enormous plus in any feeding team as is of course a

    Paediatrician and/ or a Gastroenterologist and the most important people in the team are the parents!

    Feeding Therapy is all about collaboration and a ‘team around the child” approach. When we have this in place and there is trust amongst the team members then we make fantastic progress.

    Do get in touch with me if you would like some help with your tricky feeder.

    Lovely Reviews

    I visited London Speech and Feeding a couple of days ago with my 8-month-old granddaughter and her mother. Sonja made us feel comfortable and at ease from our first introductions. She was able to pinpoint my granddaughter’s mum’s anxiety around weaning very quickly. She not only gave her the tools to do this successfully, but also really encouraged my granddaughter’s mum and instilled confidence that she had everything she needed to make this sometimes-difficult transition without further anxiety.

    Sonja was very thorough in her initial assessment of my granddaughter’s physical milestones and her developing speech. My granddaughter felt very comfortable with Sonja and happily played along with her. Then came the big moment – trying out various foods! We were amazed to see just how easily my granddaughter, with Sonja’s expert encouragement, took to sampling the wonderful array of different delicious morsels Sonja had prepared for the session. My granddaughter even drank from a cup for the first time! Wonderful!

    Sonja then emailed a summary of the session and an extensive array of resources with suggestions for my granddaughter’s mum which she has now put into action. My granddaughter’s mum couldn’t thank Sonja enough for her caring attitude, extensive knowledge, and warm professionalism. I have no hesitation in recommending Sonja, she’s a fantastic Feeding Therapist!

    –

    Sonja (and her lovely colleague, Sandra) were stupendous. I had brought my one-year-old son to see them as I was concerned that he wasn’t eating enough. They looked at his history and we ate together to make sure they had all the information they needed to give an accurate diagnosis. Whilst our outcome was that Henry was in fact doing brilliantly (and I just needed to chill out a bit!), I would imagine if there was something more serious going on, Sonja would make you feel just as supported and empowered as she did with us. Excellent follow-ups too. Money well spent for a bit of reassurance for a stressed out mama. Thank you, Sonja!


    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.

  • ·

    Target activities and games

    Target Activities and Games For Kids
    Target Activities and Games For Kids

    Target Activities and Games

    AMAZINGLY EASY Activities that we can do at home and in the clinic to help our children practise those targets!

    I bet you have wondered what amazing things are done by a therapist in the clinic that you could not possibly do at home…? Well, if so I am here to tell you that you will be absolutely fine with just a few select toys and games and you will be able to get those targets done in a jiffy!

    What we clinicians do very well and what you probably can’t do yourself is formulate and design the targets that are important for your child to practice. Once we have assessed or reviewed your child’s progress and needs we can then design the perfect next step of targets for you.

    So for example, we have decided your little one needs to be practicing their ‘r’ sounds at the beginning of short words. We decided that based on our clinical expertise and our assessment and we have already worked with your child and managed to get this tricky ‘r’ sound just about right on its own. Now we are ready for short word practice.

    It has been researched that in order for the brain pathways to re-shape or reform we need to get about 100 words in per day of our target sound. That sounds like quite a lot, right? But actually….. it’s not that bad. After all you only need to say 5-7 words about 20 times and hey presto that’s about 80-100 words.

    So here are some simple games I use in my clinic all the time and these games are easily available online or in your local toy shops and this is how to do them:

    Pop the Pirate

    Pop the Pirate, sooo good and popular:

    Lay out your target words which you will have been given by your speech therapist and put a few swords on each word.

    Each time your child picks up a sword they will need to say the target word 5 x, like:

    rip rip rip rip rip or run run run run run just like that in a row, bish bash bosh.

    Then they can stick the sword into the barrel. Onto the next sword which they can pick and then again

    race race race race race and stick in another sword

    So with this little lot I put out 5 target words and 3 swords on each.

    You will therefore get…… 15 words per picture, and that makes….75 words , there that is nearly all you need to do.

    If you then do another little game like this one:

    Magnetic board game

    This is a Magnetic Board game, and they are suddenly EVERYWHERE. But you could also just take a baking sheet and some fridge magnet you might have kicking about.

    Same principle as before, but now since this is your SECOND game of the day and you have already got 75 targets under your belt you only need to do one more round of 5 target words each:

    Each time your child picks up a magnet piece they will say the target word 5 more times:

    Ray ray ray ray ray and DONE you will now at the end of this short round have 105!! target words done with just two little fun games.

    How good is this? Your child won’t hardly notice that they are in fact doing their speech therapy homework.

    You’re welcome 🙂

    Get in touch if you would like me to help finding good targets for your child to work on. They can be speech and/or language targets with this game method.


    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.