Apraxia or dyspraxia is a difficulty in motor planning, which sometimes can be seen in both gross and fine motor skills, as well as speech. Gross motor refers to difficulties in coordinating the whole body (e.g., bumping into things frequently, often falling over hurting themselves or others through being “clumsy” or unsteady). Fine motor movements refer to smaller, more precise movements (e.g., difficulties doing anything with their hands such as holding a spoon or pen).
In Dyspraxia of Speech, instead of seeing a coordinated smooth way of talking, we see the articulators (tongue, lips, cheeks) and voice coordinating very smoothly. The voice can be very quiet or very loud. Muscle tone can be weaker at times. Speech sounds are very unintelligible, with a flat voice that can sound forced. It may be that the timings of verbalisation appear random and that children can say a certain word once and never again. This is often what we hear from parents.
It is interesting to note that many of our autistic clients are either non-speaking or are reluctant speakers. Sometimes they say a word once and then never again. Others say lots of words but the words are very hard to make out. Did you know that about 40% of autistic people have verbal dyspraxia? (Richard, 1997). Because the problem is one of motor planning, not of automatic motor execution, once a plan has become automatic, it is easier to get back to it and this is why we often see repetitive patterns that can be called ‘stims’ (Marge Blanc, 2004).
How can Speech and Language Therapy help?
Children with verbal dyspraxia can make great progress!
We provide frequent and appropriate speech movement opportunities and with time and the right support, children will move forward and begin to speak more fluently and with greater intelligibility. It is important to know this can take time.
We provide Oral Motor Therapy using a variety of approaches to practise breathing, vocalising on the outbreath, and sequencing our speech movements.
We design carefully tailored programmes focusing on words that have a lot of power (e.g., NO, GO, UP, IN, OUT, LET’S GO, STOP).
We offer shared enjoyment, and laughter. This helps a child find their voice. Other ways of finding our voices include singing or humming, or even yelling/shouting!
The most difficult phase of verbal dyspraxia is initiation, that is to start talking, to start producing a word. Frequent “automatic” repetition supports children with initiation because it removes the element of “thinking to start”. I often ask a child to repeat a word 5-10 times (with rewards at the end. A little game works well). You can see that with repetition the act of initiating is taken out of the equation as you are “on a roll “as it were.
Once a child starts to find their voice, we will be able to hear them talk lot… And if we give them credit and presume that what they are saying has meaning, we will find in time that their words become clearer and more intelligible. If we listen carefully, we can detect real words and phrases.
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.
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.
Now you know a bit about Intensive Interaction, why not book a call to discuss how we can support your Autistic child’s communication using this evidence-based approach.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
When working with Gestalt Language Processors, it is always advisable to use child-led therapy. What does that mean? Child led therapy involves following a child’s interests and allowing her/him to lead the play activity throughout the speech and language therapy session. In other words, instead of having my own ideas of what we might want to play with or what activities I might try and use, I provide a range of toys I know the child likes or has played well with before; then I wait for the child to pick what she/he enjoys doing.
Play can be very repetitive and we can often see our child cycling back to the same one or two toys throughout the session. But this is what she/he needs to do at that time and it means that we have focused attention and engagement. This in turn is very helpful for the therapeutic process, which is to offer great scripts and phrases/words alongside what she/he is playing with.
Monotropic minds
Often the mind of autistic children is more strongly pulled towards a smaller number of interests or hobbies as I like to call them. Dr Dinah Murray, Dr Winn Lawson and Mike Lesser have found in 2005 that autistic people have ‘monotropic’ minds. They explain that autistic children focus their energy on a narrow range of activities as the energy required to switch between several toys is much higher than we would see in the neuro-typical population.
Gestalt Language Processors are often also Gestalt Cognitive Processors. This is when experiences are retained as episodic events and memories. An event is remembered by specific parts of the same event. And, therefore, these specific parts should always be part of that event, when the event is repeated.
Should any of the specifics be changed or are missing, then this can cause great upset to Gestalt Cognitive Processors. So, for example, if the last two times in speech therapy we had the train set out and this was played with happily, then this becomes a specific part of the whole session. If, I then don’t offer the train set the third time a child comes to see me, this could be very upsetting.
This is why I tend to try this out and see what happens. Usually in the 3rd or 4th session: I might not bring out the car run that has hitherto been super successful to see if we are able to transition well to other toys. If yes, then we can have new experiences but if not then I will re-offer the car run/or whatever toy pretty quickly so as not to cause complete dysregulation.
A few pointers below which help with child-led play:
Introduce a few new toys and see what happens
Parents are encouraged to bring some familiar toys their child likes to the session. We can then introduce a couple of different toys to see how we go. Try offering a new toy alongside the familiar one; try offering new toys without the familiar one present, but be prepared to re-offer the “old” toy should our child get upset.
Rotate toys and don’t offer out too many toys
I find that children can get overwhelmed and overstimulated by too many items out all at once. I always talk to parents about toy rotation at home and I encourage storage and ‘tidy up’ of toys so that we can increase attention focus, and also maintain freshness and new interest in older toys.
Some children are not yet ready to play with toys
Here I suggest people games: these are games where the adult becomes part of a more motor-based activity. Some call it ‘rough and tumble play’ but it can be nursery rhymes such as sleeping bunnies/row row the boat or peek-a-boo for the younger ones.
Copy/Imitation is so important – try getting two identical or similar play items
When we are copying our child, it is often not desirable to ‘take turns’ with their toys/blogs/cars etc as our child may not be ready to let us take a turn. Instead, if we have the exact same toy that our child is having then we can play alongside our child and copy them perfectly without interrupting their play.
References:
Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism, 9(2), 139-156.
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.
Feeding therapy is a specialised form of therapy and support that helps children develop healthy eating habits and overcome challenges related to food. It’s often used for children with picky eating, feeding disorders, or sensory processing issues.
What is feeding therapy?
Feeding therapy involves a series of techniques designed to improve a child’s eating skills and attitudes towards food. In the UK it’s typically provided by speech and language therapists and dietitians. These professionals work closely with parents and caregivers to create a personalised treatment plan tailored to each child’s unique needs.
How does feeding therapy work?
Feeding therapy sessions are typically 30–60 minutes long and involve a variety of techniques, including:
Family counselling: Providing support and guidance to parents and caregivers. This can help address any practical, behavioural and emotional issues that may be impacting the child’s eating.
Play-based activities: Engaging children in fun activities while introducing new foods or textures. This can help alleviate anxiety and make mealtimes more enjoyable.
Sensory exploration: Helping children become more comfortable with different tastes, smells, and textures. This can be achieved through activities like touching, smelling, and tasting various foods.
Oral motor exercises: Improving chewing, swallowing, and lip coordination. These exercises can help children develop the necessary skills for eating independently.
Behavioural techniques: Using positive reinforcement to encourage healthy eating habits. This can involve rewarding children for trying new foods or eating a variety of meals.
When is feeding therapy needed?
Feeding therapy may be beneficial for children who:
Are picky eaters: Refuse to eat a variety of foods or have strong preferences.
Have feeding disorders: Experience difficulties with eating, such as swallowing or chewing.
Have sensory processing issues: Are sensitive to certain textures, smells, or tastes.
Have medical conditions: Such as autism, cerebral palsy, or gastrointestinal disorders.
Feeding therapy strategies you can try at home
While professional feeding therapy can be invaluable, there are several techniques you can try at home to support your child’s eating development:
Create a positive mealtime environment: Make mealtimes enjoyable and stress-free by avoiding distractions, limiting screen time, and creating a calm atmosphere.
Create regular mealtimes and mealtime routines: Introduce set ways of announcing meal times, including songs or short nursery rhymes, try and involve your child with table setting, even just carrying their spoon to the table and putting the beaker next to the plate and ensure that meal time finishes after about 30 minutes, again with a set routine so that the child always knows: this is how we do it in our home, now I am finished and meal time is over.
Introduce new foods gradually: Start with small amounts and gradually increase exposure. This can help reduce anxiety and make new foods less overwhelming.
Model healthy eating: Show your child how to enjoy a variety of foods by eating a balanced diet yourself.
Avoid forcing food: Allow your child to choose and explore foods at their own pace. Forcing them to eat can create negative associations with food.
Seek professional help
If you’re concerned about your child’s eating habits, consult with a feeding therapist. We can provide guidance and support.
Remember, feeding therapy is a collaborative process between parents, caregivers, and professionals. With patience, understanding, and the right strategies, you can help your child develop healthy eating habits and enjoy meals.
Would you like to know more about specific techniques or have any other questions about feeding therapy?
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.
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:
50% of children with language delays also have challenges with literacy (Burns et al, 1999).
73% of poor readers in year three had a history of difficulties with phonemic awareness (the ability to hear, identify and manipulate sounds) or spoken language in pre-school (Catts et al, 1999).
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.
Whilst learning to read is a key skill, it’s important to remember that a solid foundation is needed for success. We need to ensure that no steps are missed, otherwise there will be gaps in knowledge.
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.
If your child says ‘dar’ instead of ‘star’, you might be wondering if they will simply outgrow it or if they require specialised support. While ‘cluster reduction’—dropping one of the sounds in a blend—is a normal part of learning to talk, we typically expect these sounds to lock into place by age four years. If these errors persist as a child approaches school age, it often signals a speech sound delay that may now no longer pass without help. As a Speech and Language Therapist, I specialise in helping children bridge this gap using evidence-based techniques like backward chaining.
This isn’t about constant correction; it’s about providing the right clinical scaffolding to move a child from ‘frustrated’ to ‘fluent’ before they hit those critical early school years.
Dropping sounds from words is a common feature of speech sound difficulties, and while it can look small on the surface, it can have a big impact on how clearly a child is understood. In this short video clip, I’m working with a child on an /ST/ sound cluster, demonstrating how I use an evidence-based speech therapy technique called backward chaining to help children build clearer speech with confidence.
What’s actually happening when a child drops the ‘S’?
Clusters like /ST/, /SP/, and /SK/ are tricky. They require:
precise timing
careful airflow
and the ability to blend sounds smoothly
For many children, especially those with speech sound difficulties, this is a big ask.
So instead of hearing:
‘star’
we might hear:
‘tar’ or ‘dar’
This isn’t laziness or refusal. It’s the child simplifying the word to make it manageable.
Why I don’t start by saying ‘say star’
Telling a child to ‘just add the S’ rarely works.
Instead, I meet them where they are already successful.
In this clip, the child can already say ‘dar’ clearly. That’s our starting point.
Backward chaining: building speech from success
Backward chaining means we:
Start with the part of the word the child can already say
Gradually add the missing sound
Keep the child feeling successful at every step
So rather than jumping straight to ‘star’, we:
secure the ending
gently introduce the /S/
and blend it in a way that feels achievable
This approach reduces frustration, builds confidence, and helps the sound stick not just in the therapy room, but out in the real world.
Why this matters beyond one word
This isn’t just about saying ‘star’.
It’s about:
teaching the mouth a new movement pattern
giving the brain time to organise the sound sequence
and helping the child feel capable, not corrected
When therapy feels safe and successful, children are far more likely to generalise their new sounds into everyday speech.
Speech therapy works best when children feel supported not tested.
If your child struggles with speech clarity
If your child:
drops sounds from words
avoids longer or trickier words
or becomes frustrated when they’re not understood
This is the kind of work I do every day building speech step by step, in a way that respects each child’s pace and strengths.
Support can be gentle, effective, and empowering.
If you’d like to learn more about how speech therapy can support your child, you’re always welcome to get in touch.
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of 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.
If you’ve found yourself wondering ‘Why can my child say a word one day, but not at all the next?’ it might be that your child has a motor speech difficulty. This means the challenge isn’t that your child doesn’t know what they want to say; it’s that their brain finds it harder to plan and coordinate the movements needed for clear speech. This speech difficulty is called Childhood Apraxia of Speech (CAS)
In this post, I’ll explain what CAS can look like in 2–5 year olds, what an assessment usually involves, and what you can start doing at home to support your child without turning life into ‘speech homework all day long’.
What is childhood apraxia of speech (CAS)?
Children with CAS often have lots to communicate about (and strong ideas!) but their speech may come out as:
Unclear
inconsistent
hard to ‘copy’ on demand
frustrating for them and for you
CAS is not caused by laziness and it is not a parenting issue. It is also not something children simply ‘grow out of’ without support. But with the right therapy approach, children can absolutely build clearer speech over time.
Many families come to me after months (or years) of being told:
‘She’ll talk when she is ready’
‘He’s just shy’
‘It’s probably a speech delay’
‘It’s normal for toddlers’
And sometimes it is a general delay. But sometimes it’s something more specific, like CAS.
There’s also been a huge rise in parents seeking information online, and CAS is often mentioned alongside speech sound difficulties such as:
phonological delay (pattern-based speech errors)
articulation difficulties (one sound that won’t come out clearly)
inconsistent speech disorder
These can look similar at first glance, which is why a specialist assessment matters.
Signs of childhood apraxia of speech in 2–5 year olds
Children develop speech at different rates, and not every unclear speaker has CAS. But here are some common features that may raise a flag, especially when you notice several together.
1) Inconsistent speech errors
Your child might say the same word in different ways:
‘banana’ → nana / baba / mana
‘daddy’ → gaga / daddy / dadi
This inconsistency is one of the biggest clues.
2) Difficulty copying words on request
Some children speak more easily in natural play, but when asked ‘Say ___’, they freeze or the word becomes much harder.
3) Limited sound repertoire
They may use only a small set of consonants (like /M/, /N/, /B/, /D/) and avoid others.
4) Vowel distortions
Many children with typical delays mainly struggle with consonants. But in CAS, vowels can also sound ‘off’ or change between attempts.
5) Speech that sounds effortful
You might notice your child:
pauses between sounds
tries multiple times
looks like they’re ‘searching’ for the right mouth movement
6) Longer words are much harder
‘Car’ might be easier than ‘carry’, and ‘carry’ easier than ‘caterpillar’.
7) Prosody differences (rhythm and stress)
Some children with CAS sound a little unusual in their speech rhythm, stress, or intonation.
8) Frustration or reduced confidence
When a child is frequently misunderstood, they may:
talk less
use gestures more
become upset when asked to repeat themselves
Important note: none of these signs alone prove CAS but they are a strong reason to seek a speech assessment rather than waiting.
CAS vs phonological delay vs articulation difficulty (quick guide)
These are some of the most common questions I hear.
If it’s mainly an articulation difficulty…
A child may consistently say one sound incorrectly (for example, ‘thun’ for ‘sun’- lisp- but everything else is developing well.
If it’s mainly a phonological delay…
You might notice clear patterns, like:
leaving off the ends of words (‘ca’ for ‘cat’)
swapping back sounds for front sounds (‘tar’ for ‘car’)
Patterns are often consistent and respond well to phonology-based therapy.
If it might be CAS…
Speech often feels less predictable, harder to imitate, and more impacted by word length and complexity.
If you’re unsure, that’s completely normal, and exactly why assessment matters.
What happens in a CAS assessment?
A high-quality speech assessment for possible CAS usually includes:
1) Parent discussion and developmental history
We talk about:
pregnancy and birth history (where relevant)
feeding history
early sounds and babbling
first words and how speech has progressed
family history of speech/language needs
2) A speech sound assessment
Your child might be shown pictures or play-based prompts so we can hear:
what sounds they can say
what they simplify
whether errors are consistent or inconsistent
3) An oral-motor and movement check
This isn’t about ‘strength’. It’s about coordination and planning. We look at how your child manages speech movements and transitions.
4) Stimulability testing
This means: how easily can your child learn a new sound or word with support?
For CAS, we often explore how they respond to:
slowed-down speech
visual cues
rhythm/tapping
short, simple syllable shapes
5) Functional communication and confidence
We look at how speech impacts daily life:
being understood at nursery
joining in with peers
asking for help
managing emotions when misunderstood
At the end, you should leave with:
a clear explanation of what we think is going on
a therapy plan
practical home strategies
realistic next steps
What parents can do at home
Here are CAS-friendly strategies you can start right away.
1) Choose ‘power words’
Pick 1–2 words that matter most in your child’s daily life, such as:
more
help
mummy
again
stop
open
These words are motivating and functional.
2) Keep it short and successful
For many children with CAS, the goal is quality over quantity.
Try five minutes a day rather than 30 minutes of struggle.
3) Support speech with rhythm
Some children benefit from:
tapping a beat on the table
clapping syllables
using a gentle ‘marching’ rhythm
This can help the brain organise the sequence of movements.
4) Celebrate approximations
If your child says ‘moh’ for ‘more’, that’s communication!
We want them to feel:
safe
understood
proud to try again
Confidence is a key part of progress.
A short parent story (anonymised)
One mum said to me:
‘We kept being told to wait. But I could see my child understood everything; they just couldn’t get the words out. Once we had an assessment and a plan, it felt like we finally knew what to do. The biggest change was his confidence. He started trying more.’
When should you seek support?
You don’t need to wait until school.
It’s worth getting an assessment if your child is:
hard to understand compared with peers
becoming frustrated or withdrawing from talking
inconsistent with words they used to say
struggling to imitate speech sounds
showing signs that match CAS
Early support can reduce stress for the whole family and help your child feel successful in communication.
Here’s how I can help:
✅ A detailed speech assessment (including whether CAS is likely)
✅ A clear therapy plan with realistic goals
✅ Practical home strategies you can use immediately
✅ Support for nurseries and schools (where needed)
✅ In-person sessions in North-West London and online options
Your child is communicating the best way they can, and with the right support, speech can become easier, clearer, and more confident.
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of 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.
