Correcting A Lisp

ByLondon Speech and Feeding March 29, 2022January 31, 2023

This is a surprisingly common speech error and it can be corrected really well in my experience. I have helped lots of children of all ages learn how to control their tongue movements and produce clear, sharp /s/ sounds and good /sh/ sounds.

There are some factors which need to be considered before we can dive into therapy proper and these are they, in a nutshell:

Student is not currently displaying negative oral habits such as thumb sucking or excessive sucking on clothing. This is because thumb sucking exerts pressure on the teeth and therefore can, over time, push teeth out of their natural order/position.
Student does not have a restricted lingual frenulum or tongue tie which can cause at times restricted movements of the tongue (pending on how tight the frenulum is attaching the tongue to the base of the oral cavity); equally a labial frenulum or lip-tie can restrict lip movement and therefore physically restrict good speech sound production.
Student does not have enlarged tonsils as they can sometimes push a tongue forward and also cause open mouth posture and open mouth breathing.
Student’s motivation to change their speech pattern is high. (this is an important factor though with younger students I can get round this with a lot of fun games and good parental involvement!)

When I do an Oral Assessment of my student these are the first factors I want to look at and consider. Often I will refer to other agencies such as Orthodontists, dentists or ENT specialists to advise and help with some of these factors before we can get going. However, there are strategies that we can work on almost straight away.

Most of my Lisp Students present with an open mouth posture: that is where the student has their mouth always slightly open for breathing. Over time the tongue starts to fall forward and rests on the front teeth or the bottom lip instead of finding a comfortable resting place either at the alveolar ridge (the bumpy spot behind the upper front teeth) or, alternatively, resting at the bottom of the mouth behind the lower front teeth.

Another common problem is that the tongue is not moving independently from the jaw and so is reluctant to pull back or lift up inside the mouth as the tongue is guided in movement by the jaw.

Combine those two factors and your tongue is not pulling back, or lifting up or doing very much at all without the jaw moving as well. This makes for unclear speech sounds, especially all the sounds we make at the front with our tongue or with our lips: B/P/L//N/ and of course /S/ and /SH/ are particularly hard to make. We often also struggle with the /Y/ sound so /LELLOW/ instead of /yellow/.

But no fear, these problems can be treated over time for sure! We often start with lip, tongue, and jaw exercises that help to move the tongue independently from the Jaw, our student learns that the tongue is a muscle and can be trained to do amazing acrobatic things in the mouth! WOW! It can actually pull back, lift up, and come down again all on its own!

We work on breathing, holding our breath for a bit then pushing it out and then holding it again.

And when it comes to the actual /s/ sound I often try and go a NEW route bypassing the Snake-Sound route if that is what had previously been tried and failed so that we can create completely new sound patterns in our brain and think about our sounds in a completely new way.

We then work on producing the sound /s/ on its own for a bit, at the end of words, then on either side of complimentary sounds, for instance : ‘EASY” – the sound patterns here are EEE-S –EE : the EEE sound is complimentary to the /S/ sound as the tongue is at the right hight for the /S/ already once you have it in place for /EEE/ -……see?! EASY!

And gradually we work towards saying the /S/ sound clearly at the front of short words, then phrases and then sentences.

The process takes some time and it depends on how ready the student is. This varies of course hugely so I can never promise the exact number of sessions we will take to get that Lisp fixed. A lot depends on home practice in between sessions, and this is of course crucial to all therapy! Every day 15-20 mins practice is a good average time to aim for and when this is done it shortens the therapy block drastically.

I always give plenty of home work so there is never a chance of it getting boring or there being “nothing to do”!

Do contact me. I really enjoy working with this type of student and get a great kick out of FIXING THAT LISP!

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

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

Developing Joint Attention

ByLondon Speech and Feeding January 5, 2024January 5, 2024

Joint attention skills — what are they and how can we facilitate those?

Most of us want to make friends, connect with others and bond with a friend or be part of a community. To do so we need to develop an important social skill which is: initiating, responding to, and maintaining ‘shared/joint attention’ with another. When we can do this, we are able to focus on the same thing with another person or a group of people: music, hobbies, sport, art, books, toys, games or memories: remember when we did x y z…

Many children who struggle with speech and language development are not able to share or hold attention with another person very easily. My latest blog is all about what we can do to help our children develop Joint Attention.

So to re-cap, joint or shared attention happens when one person gets the other’s attention by either words, or gestures like pointing to something and saying ‘OMG look over there!’ – both people look at that same thing.

What does it take to have or develop this skill?

We need to first of all find something of interest that captivates our own attention. This part is usually not difficult for most people or children.

Then, crucially, we need to direct our focus away from what we find interesting, for long enough to get another person’s attention onto the same topic. This could be just seconds or it could be longer if we are very determined and good at embracing others into our experience. But if we are not then it must not take longer than seconds!

Let me give an example: if someone is in the room with me whilst I see something strange out the window, I would take that second to draw their attention to it. However, I might not be bothered to run upstairs and find someone only to show them something odd outside in the road. If I am very bored, I might do! But as I am rarely bored it is unlikely. So, unless someone else is right here with me, they are not going to be part of that particular experience, I would not share it.

Back to our child: if we make it difficult for a child who is not naturally inclined to share an interest then it is not going to happen. We must be ready, and right there for our child to have that fleeting second to look at us before returning to their hobby/interest.

This skill ‘to share a moment’ tends to develop around 12 months of age and starts with a child pointing to things. Prior to that, our child might give us something or come to show us a thing. Joint attention underpins language skills and is strong predictors of later language development (Law et al, 2017).

What are the signs that my child is struggling with Joint Attention?

Tunes out or does not respond when I call their name
Cannot follow my suggestions for games or toys/play activities
Does not point to anything of interest, like a truck passing by, or an aeroplane in the sky
Ignores or does not respond to what I say, does not follow instructions, only when he/she wants to

What can I do to help with this?

Here are some ideas you can follow in no particular order – see which one sticks:

Get down to your child’s eye/face level, we call it ‘face to face’. It does not require your child to make eye contact with you but they might just do so more easily if you are ‘just there’ and don’t have to crook their neck to look up at you. When reading a book with your child, instead of sitting behind try sitting opposite him/her.
Mirror play – making funny faces together in a mirror can be fun.
COPY your child: top tip!! Imitate your child’s vocalisations and actions. Even if these are repetitive, just enjoy the ride.
Follow your child and let your child take the lead in the play activity. What does that look like? The adult has no agenda, does not want to teach, to ask questions (see point number 9) does not want to direct or show the child how to ‘do it better/differently’ – instead accept that the child is the boss when it comes to their play and take their lead in how a toy should be played with.
Hold up objects to your face or at eye level so that your child can see your face and the item at the same time.
Be the ‘funniest thing’ in the room; be hugely entertaining, watchable and offer the ‘irresistible invitation’ to look at you or play with you.
Offer PEOPLE TOYS (any toy where another person is needed to have fun) so: wind-up toys, bubbles, anything that needs opening or holding or doing which is tricky for the child to do alone. I always try and hide the buttons that make something ‘go’ so that my child needs to come back to me for ‘more/again’.
Do PEOPLE GAMES – as above really but games that do not need a toy, that need another person to have fun: being swung round, row row the boat, being pushed on a swing etc.
REDUCE ASKING QUESTIONS – this is my favourite top tip!!! Instead of asking lots of questions try and make simple statements/comments on what is happening so there is absolutely no pressure on your child to ‘perform’. Equally, silence is actually golden sometimes! An odd bit of advice from a speech therapist? Try sitting with your child, next to them or opposite and just don’t talk but simply BE… yes easier said than done, I do know this. Turn off your phone (OMG did I just say that!?) yes, please turn it off and just be with your child for a little while, just like a comfy buddy who is just enjoying their company with no agenda. You might be very surprised how your child suddenly seeks you out!

I will write about more ideas on this in my next blog so look out for more play ideas to encourage Joint Attention.

Most important, try and have fun with your child. Think about what is fun for her or him. And make it EASY for your child, remember unless you are ‘right there’ it might not happen so easily.

Happy New Year!

If you need help with your child, please do not hesitate to contact me.

Neurodiversity · Speech and Language Therapy · Top tips

Speech Sounds Practice at home

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

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

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

Why Visual Cues matter?

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

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

Finger fun: making sounds with our hands

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

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

Bringing sounds to life with pictures

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

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

Unlocking sounds with semantic prompts

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

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

Practice makes progress, but fun makes it funnier!

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

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

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

Please contact me if your child has speech sound difficulties.

Sonja McGeachie

Early Intervention Speech and Language Therapist

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

The London Speech and Feeding Practice

Autism Therapy · Speech and Language Therapy

Explore activities for Gestalt Language Processors to aid communication

ByLondon Speech and Feeding September 16, 2022January 3, 2024

When you have a child who uses Gestalts it is often difficult to think and adapt clinic activities into those to use at home. More importantly, you find that individualising your activities for your child who uses Gestalt are time-consuming. But you value its importance for their communication development.

You feel so busy, you are taking them to other appointments, or trying to get through your daily activities, all whilst still ensuring your child’s emotional needs are met. You know life should not get in the way of your child’s therapy activities at home, but it does. We know your spare time is precious and limited, so let us achieve your child’s or young person’s goals in the allotted time you have which meets their way of learning (using Gestalts).

We wanted to support you by exploring items which you may have at home, and we will give you some key phrases which you can start to model with your child. Whereas our last blog introduced the idea of gestalt language processors, we are now developing ideas to give you the tools to implement activities at home. We recognise how overwhelming it may feel, and this is one of the reasons to make activities as straight forward as possible. Therapy does not need to be complicated; it just needs to be carried out on a regular basis.

Explore the samples I’ve created to give you an idea of how this might look but please consult with a Speech and Language Therapist who knows about Gestalt Language Processing so that you can work together to develop great home activities for your child.

Want to learn more about gestalt language processing?

Please contact me for help.

Speech and Language Therapy · Top tips

Four reasons to continue Speech and Language Therapy during the summer

ByLondon Speech and Feeding July 10, 2023July 12, 2023

The summer holidays can be tricky for parents as there is so much to do: organising childcare, the actual holiday, and trying to have some all-important ‘me time’. Speech therapy for your little one might be the last thing on your mind. But …. If we can prioritise only a small amount of time every day then we are maximising time and finances spent thus far and can continue your child’s Speech and Language Therapy sessions throughout the summer, no problem. Have a look at this blog. We’ll take you through good reasons why you shouldn’t ignore Speech and Language Therapy sessions this summer.

1. Building communication skills takes time

You’ve worked so hard throughout the year to support your child’s speech, language and communication. Now is the time to continue, not to stop! You will watch your child’s communication and confidence grow and flourish over the next couple of months. All the different experiences your child will have on holiday or just even pootling about in your local park with you, or granny/nanny will help expand their capacity for learning and using language and words to communicate with you. If you have time during the summer, you can embed the skills your child has learnt into everyday life which is vital . If in doubt ask how you can use the strategies you have learned in any new environment. Together we can workshop all eventualities and make them fun and doable. There is no end of fun and opportunities with a bucket, spade and a bit of sand!

2. Getting to know your child’s Speech and Language Therapist is vital

Here’s a plug for regular therapy sessions: building a rapport with your child’s Speech and Language Therapist is key. If our sessions together are consistent and regular, then it will be so easy for us to develop a good rapport with your little one. Trust is key. So if sessions are infrequent and irregular it is hard for your child to build up trust with their therapist and it is hard for the therapist also to get you know your child and tailor the sessions so that they really work very well. We need to know what your child loves and what activities or toys work well; so, if sessions are missed and irregular then the process just takes longer.

3. Goals are set and measured

Sometimes a break is needed and that’s fine. We measure goals within a certain time frame and whilst a few weeks holiday are great for everyone, we don’t want to lose any progress your child has made. If a child does not attend sessions, progress will often diminish as consistency in therapy is key!

4. You’ll be able to embed skills over the summer at home

Did you know you can access Speech and Language Therapy wherever you are with our remote service? Teletherapy allows flexibility which means your child’s sessions can be wherever you are. Whilst this isn’t for everyone, it does allow regular sessions to continue. If that does not work for you then let’s talk about how we can help you transfer all the therapy goals into your holiday. You will be surprised how easy it is: lots of goals can be worked into snack times for example or bath times. You will have those wherever you are so this won’t take away your holiday fun, promise!

Find out more about teletherapy.

Speech and Language Therapy · Top tips

Explore speech delays and disorders and how you can support your child’s communication

ByLondon Speech and Feeding January 16, 2023February 10, 2023

Speech delay vs speech disorder — Speech Delay vs Speech Disorder

You often wonder if your child’s speech difficulties will resolve. This very much depends on whether they have a speech disorder or delay. You often wonder if there’s something you’ve done to cause your child’s speech difficulties. Rest assured this is not the case. Let’s explore some of the factors to put your mind at ease.

We know that males are more likely to have a speech, language, or communication difficulty than females. Additionally, if your child has an older sibling, they may not have the opportunities to speak. Their sibling may speak for them, especially if their speech difficulty causes them to be anxious or self-conscious. It’s important to note that bilingualism does not cause a speech delay or difficulty. Your child’s Speech and Language Therapist will ask about your child’s milestones. Research suggests that if your child did not babble then they may be at a higher risk of having communications difficulties.

When it comes to a speech delay or disorder, it’s vital to rule out any other co-occurring difficulties such as hearing loss. Your child’s Speech and Language Therapist will need to factor in the health of your child. They will ask if your child has had lots of colds or ear infections. This may have affected their hearing, so it’s also recommended that your child has a hearing test. Your Speech and Language Therapist will tell you how you can book an appointment.

It’s natural that children learn at different rates. The same is true for speech sounds. Some children are slower to pick up speech sounds, and this might be called a ‘speech delay’. A delay is when a child is behind with the development in a particular area or areas but is generally progressing along typical milestones. They will be progressing at a slower rate than expected. For example, a four-year-old understands two key word instructions and utterances are at a single word level, with some short phrases. But, some may show unusual speech sound error patterns, and this is typically where you may hear it called a ‘speech disorder’. A disorder is where the development we see is patchy and not following what is typically expected for your child’s chronological age. For example, a child understands three key word sentences, but speech is unintelligible and the utterances sound like jargon.

You recognise how important speech is in daily living and want to build your child’s confidence so they can maximise social and educational opportunities. Follow our top tips to support your child’s communication.

Top tips for supporting your child with their speech sounds:

Allow your child to communicate in another way to convey their message if they get stuck (e.g., you could ask ‘show me’, ‘draw it for me’).
Model the correct sound (e.g., child: It’s a thnake, adult: it’s a snake, a slithery snake).
You can emphasise their tricky sound.
Avoid telling your child to ‘say [insert sound here]’.
Your child may speak quickly, especially if they are excited to tell you a story. If you slow down your rate of speech, they will too. This may make it easier for you to understand the message of their story.
Allow your child to speak about how their communication difficulty makes them feel (if they are aware and want to speak about it).

If you are unsure of where to start, contact me to ease your confusion, and allow your child to communicate effectively.

Autism Therapy · Speech and Language Therapy

Explore how Intensive Interaction develops Autistic children’s communication

ByLondon Speech and Feeding July 31, 2023June 21, 2023

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

So, what is Intensive Interaction?

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

There are many aspects that this approach supports:

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

Who benefits from Intensive Interaction?

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

How is Intensive Interaction implemented?

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

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

Waiting

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

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

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

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

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

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