Dynamic assessment – Let’s look beyond the checklist

ByLondon Speech and Feeding
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Dynamic assessment – Let’s look beyond the checklist

As a parent, you’re always observing your child, celebrating his or her milestones, and sometimes, wondering if he or she is quite on track. When it comes to speech, language, play, attention, and listening, these early years are a whirlwind of development! It’s natural to seek guidance if you have concerns, and that’s where a truly comprehensive assessment comes in.

But what exactly does ‘comprehensive’ mean, especially when it goes beyond a typical checklist? You can find any number of check lists online these days but whilst they can give you an overall idea of what a child is typically expected to do at any given age, it can also start leading you into a rabbit hole of anxiety of ‘what-iffery’.

At The London Speech and Feeding Practice I believe in something far more insightful than a static evaluation: Dynamic Assessment. Think of it as an in-depth, interactive investigation into your child’s unique communication landscape, exploring not just what he or she can do, but how he or she learns and why he or she might be facing challenges. This is so important.

What makes an assessment ‘dynamic’?

Imagine trying to understand a child’s personality by just looking at a single photograph. It gives you a glimpse, but it hardly tells the whole story. Traditional, formal assessments, while valuable, can sometimes be like that photograph – a snapshot of skills at one specific moment.

Dynamic assessment, on the other hand, is a living, breathing process. It’s called ‘dynamic’ because:

  • It’s interactive and responsive: It adapts to your child’s needs in real-time. It’s not about sticking rigidly to a pre-set schedule of tests. Instead, it’s about observing, gently prompting, and providing support to see how your child responds and learns. This allows me to understand his or her learning potential, not just his or her current performance.
  • It’s holistic and multi-faceted: I look at the whole child. We delve deep into not just speech and language, but also his or her play skills (a crucial window into cognitive and social development), attention and listening abilities, and his or her social engagement. These areas are intricately linked, and a delay in one can often impact others.
  • It integrates multiple perspectives: Your insights as a parent are invaluable! Before we even meet, my comprehensive onboarding questionnaire gathers essential background. During the assessment, your feedback, observations, and comments are woven into the fabric of our session. You are the expert on your child, and your voice is central to forming a complete picture.
Dynamic assessment – Let’s look beyond the checklist

More than just ‘speech’: A deep dive into development

You might initially be concerned about your child’s speech sounds, or perhaps his or her ability to form sentences. These are vital areas, but my approach goes much further. I’m keen to understand:

  • The ‘why’ behind the ‘what’: Is a child struggling with language because of difficulties with understanding instructions (receptive language), or with expressing themselves (expressive language)? Are his or her attention skills impacting his or her ability to follow a conversation? Is his or her play demonstrating imaginative thought, or does he or she prefer more structured, repetitive activities? These nuances are critical.
  • Differential diagnosis: This is where the skill of an experienced clinician truly comes into its own. Through dynamic assessment, I can differentiate between a developmental delay (where a child is following a typical progression but at a slower pace) and a disorder (where his or her development is following an atypical pattern). This distinction is vital because it guides the type of support and intervention that will be most effective. Understanding the cause of the delay or disorder is paramount to creating a targeted, impactful therapy plan.

The art of observation

While I draw upon evidence-based practice as well as a formal, standardised assessment as well as my extensive clinical knowledge, I also rely heavily on the art of observation. From the moment your child walks into the room, I’m establishing rapport, engaging them in play, and creating a safe, fun environment. It’s through this genuine interaction – often without them even realising they’re being ‘assessed’ – that the most authentic insights emerge.

This is where the magic happens:

  • Building rapport: A child who feels comfortable and connected will show you so much more of his or her true abilities and personality. I pride myself on creating an atmosphere where children can relax and simply be themselves.
  • Play as a window: Play isn’t just fun; it’s a child’s natural language. It reveals his or her understanding of the world, his or her problem-solving skills, his or her social engagement, and his or her ability to use symbols and language.
  • Skilled interpretation: My years of experience allow me to see beyond surface-level behaviours and interpret the subtle cues that might indicate underlying strengths or challenges. This goes far beyond what any standardised test alone can capture.

Why choose a clinician who offers dynamic assessment?

In essence, a dynamic assessment provides a rich, nuanced, and truly personalised understanding of your child. It’s an investment in:

  • Accuracy: Leading to a more precise diagnosis and understanding of his or her unique profile.
  • Tailored support: Enabling the creation of highly individualised therapy goals that truly meet your child where he or she is and gently guide him or her forward.
  • Empowerment: You’ll leave with not just answers, but also practical strategies and a clear path forward, feeling confident and informed.

If you’re seeking a thorough, empathetic, and truly insightful assessment for your child’s communication development in London, I invite you to get in touch. Let’s work together to unlock your child’s full potential.

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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  • · ·

    Strategies to support children with eating difficulties

    ByLondon Speech and Feeding

    where the cause is NOT a swallowing problem, but we are having a “fussy eater” in the family, seeming for no obvious reason

    When parents have a child who find mealtimes or eating difficult, it can put pressure on the whole family dynamics. Once we have observed a child’s eating and drinking skills and found that they are not swallowing impaired, but are for want of a better word “fussy” or “picky”, we can then start to look at what might be underpinning the food aversions/picky eating/food avoidance. Two of the main questions parents have (of course) are:

    • ‘is my child getting the right nutrition?’
    • ‘how can I have less anxiety-provoking and stressful mealtimes?’

    We all tend to have an image in our minds about the ‘perfect mealtime’, and how mealtimes ‘should’ be. Speech and Language Therapists with a Feeding Specialism are the perfect professionals to help you unpick feeding issues. We are trained to look at swallowing and oral skills and we also know a lot about feeding behaviours and sensory difficulties which could be causing your child’s eating avoidance.

    Here are some strategies that can support children with their eating:

    1. Create and maintain a mealtime culture that suits your home and lifestyle. Then stick to that. We all need some routine in our lives to thrive. Mealtimes are no different. It might be that you eat in the same place for every meal, with the same knives and forks, concentrating on maintaining good posture. Children learn by repetition so the more familiar it is, the easier they will find it. In the physical sense, our bodies also need preparing for food, regardless of whether we are eating with our mouths or we are tube-fed. We want every child to connect all the dots of the process. It starts with their eyes, noses, expectations, memories of past experiences, feelings and then finally their mouths….
    2. Be an excellent role model. Children learn through watching others, so your child will be observing you without you knowing. Ensure that you are positive about the food you are all eating, and talk about how delicious, tasty, juicy, and yummy the foods are. Make the atmosphere around the dinner table light hearted. Even though you are secretly stressed about your child not eating, try and not show this. Instead pick a topic or put on some nice music, or talk about something your child might be interested in, and try and avoid coercing your child to eat. Leave small finger foods on their plates and have a range of foods available on the table so that your child can see that everyone is eating a range of foods and enjoying them.
    3. Use positive reinforcement. Try and think of mealtimes as fun and motivating. Children who are happy will likely be more inclined to try foods and take part in family mealtimes. Reward all interactions around food, so if your child merely touches a new food then praise this behaviour. Or if your child licks a food just once, again make a nice comment and praise your child for touching and licking the food. The takeaway here is to try and keep all messages positive around food.
    4. Keep offering all types of food. What often happens is that parents stop serving foods they know will not be eaten. This makes sense in a way; we don’t want wastage! However, try and keep the doors open and re-offer all types of foods, even the ones that your child has not wanted in the past. Try and give your child one food they will like and one food they have tasted before and liked before, even a little, and then one new food to try. So, your child always has something to fall back on and they can join in with eating. But they can also try (or at least look at and think about trying) other foods that you and perhaps the siblings are eating.

    Take a look at this website, I find it very helpful in showing parents what types of foods and how big a portion to offer

    Have a go and try and implement some of the ideas above, and should you get stuck please get in touch!

    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.

    0
  • · ·

    Childhood Apraxia of Speech: Signs and first steps (2–5 years)

    ByLondon Speech and Feeding

    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)

    Sonja showing power words on a board

    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.

    If you’d like to read more about verbal dyspraxia, you may also find this helpful: Supporting children and families living with verbal dyspraxia.

    Why is CAS such a big topic right now?

    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

    Book your consultation here.

    Final gentle reminder

    You are not overreacting. Trust your instincts.

    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.

    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

  • Quick Overview Of How To Implement Those Early Hanen Speech And Language Strategies

    ByLondon Speech and Feeding
    Quick Overview Of How To Implement Those Early Hanen Speech And Language Strategies

    First up try and get down at eye level or Face-to-Face with your child

    Try to sit so that your child can see you easily, i. e. your child does not have to look up to make eye contact with you. We call that Face to Face: try and sit opposite your child. This makes it easier for you to see facial expressions and therefore pick up nonverbal /pre-verbal communication. Now you can connect and share the moment with your child.

    OWL (Observe, Wait and Listen)

    Never skip this step as it prepares us for what happens next !

    Observe

    First, try and simply watch your child quietly and listen and observe what he/she says or does; you need to know what your little one is interested in. For example with this toy (pictured below) we could observe that your child loves the actual spinning of the marble, perhaps more than that noisy click-clacking down the run. Or perhaps he loves collecting the marble at the end and feeling it in his hand.

    You could start off with showing once how the marble goes down and say:“ look it goes round and round !” Then hold back and observe, without speaking, so that your child has time to explore the toy.

    Wait

    Just sit and avoid telling or showing your child what he or she could do with the toy. This gives your child an opportunity to explore and experiment.

    Listen

    Listen to what your child says, or look at your child’s non-verbal communication without interrupting. Your child will now feel and know that you are really present and that what they have to say is important. It’s best to avoid questions like, “What are you doing or “What’s this?” as that might be a lot of pressure when they don’t know what to say about that yet.

    Respond immediately by showing interest

    Once you have all the information from OWLing you can respond in the right way, for example: if she catches the marble at the end of the run and looks up with a smile or a sound you could respond with: you’ve got it! One marble in your hand! Nice playing!

    Now how to join in the play:

    First you can copy what your child is doing

    If your child puts the first marble at the top of the run you can take a turn and do exactly the same once his marble is done. Ideally you might have another marble run, perhaps a similar one, it does not have to be exactly the same! Once your child has put the first marble in you can do the exact same with your own marble on your run. Your child is likely to look at what you are doing and you might well see a smile on their face or perhaps she might say: look at mine!

    Next you can build on that

    You can respond with simple comments like: “Wow! Yes I am looking at yours now! It’s spinning on the red one lots! I love the noise!” Now wait once more to see what your child says or does.

    To summarise

    We are signalling to our child that we are really interested in what they are doing and saying so we can “collect” our child, i.e. bring him/her back into a joint interaction.

    Important

    We want to try and not direct our child but respond with interest and fun! This creates a lovely stage for interaction and joint play! And this leads in turn to practising conversation and ever more opportunities for great speech and language skills to emerge.

    Great activities we use in Speech and Language Therapy:

    • Any cause and effect toys like this Marble Run
    • Creative activities, such as mark making with crayons
    • Train tracks (building and running the trains)

    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.

  • · ·

    The power of containment: A therapeutic approach for autistic children

    ByLondon Speech and Feeding
    Photo by lemonlenz

    The practice of wrapping or swaddling children, often referred to as ‘containment,’ has been used for centuries to soothe and comfort infants. I use this therapeutic approach with autistic children at the London Speech and Feeding Practice. While it might seem counterintuitive, the act of being tightly wrapped can provide significant benefits for children who struggle with sensory processing, emotional regulation, and communication.

    Understanding sensory processing and autism

    Autistic persons often experience challenges with sensory processing, which is their brain’s ability to interpret and respond to sensory information. This can lead to sensory overload or under-responsivity. Containment can be a valuable tool in helping children regulate their sensory input.

    Photo by lemonlenz

    To summarise, here are some of the benefits of containment:

    • Sensory Regulation:
      • Provides deep pressure input: The tight, enveloping sensation of being wrapped can provide deep pressure input, which is calming and organising for many children.
      • Reduces sensory overload: By creating a controlled sensory environment, containment can help to reduce overstimulation and promote a sense of safety.
    • Emotional Regulation:
      • Containment creates a sense of security: Being wrapped tightly can mimic the feeling of being in the womb, providing a sense of security and comfort.
      • Facilitates calming: The deep pressure input can help to calm the nervous system and reduce anxiety.
    • Improved Body Awareness:
      • Enhances proprioception: Containment can improve the child’s awareness of their body in space, which is essential for motor development and sensory integration. I often provide extra pressure on a child’s arms and legs sticking out of the yoga mat; this helps my child understand where their limbs are in space: I can feel my legs and I can feel my arms and I can feel where they are right now, i.e. they are under Sonja’s hand, I can feel them.
    • Facilitates Communication – and this is obviously where I come in as a Speech and Language Therapist:
      • Swaddling creates a safe space: When a child feels calm and secure, they are more likely to engage in communication.
      • Enhances joint attention: The shared experience of being wrapped can foster joint attention, which is essential for language development. You can see this one in my highlights where I swaddle my student in the yoga mat (picture above). She absolutely loves it, and what is more she is calm and steady when usually this child likes to be on the move constantly. Here we have a wonderful moment of joint engagement. She looks at me, she can listen to what I say or sing, and she can tell me in her own way to carry on rolling her or to carry on singing or providing calming pressure to her legs and arms or to stop.

    A few pointers for when you try this at home: How to practise containment safely and effectively

    • Create a safe environment: Ensure the wrapping material is soft, breathable, and free from any hazards.
    • Observe your child’s cues: Pay attention to your child’s body language and verbal cues to determine their comfort level.
    • Respect your child’s boundaries: If your child shows signs of distress, stop the containment immediately – this might seem obvious but sometimes we adults get so carried away with some ‘great idea’ that we have seen work elsewhere. And so we can be a little too ‘determined’ sometimes to ‘make it happen’… perhaps this rings a bell with some of my readers.
    • MAKE IT FUN: Start carefully and take it step by step. See if the student is having a nice time. It is all about trust and therefore it might not work the very first time you do it.

    It’s important to remember that containment is not a one-size-fits-all approach. Some children may respond better to other sensory-based interventions. However, for many autistic children containment can be a valuable tool in their journey towards improved communication and emotional regulation.

    For more information follow me on Instagram, Facebook or LinkedIn.

    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.

    1
  • · ·

    Using AAC during play with your child

    ByLondon Speech and Feeding

    Playtime! It’s a magic time for exploration, learning, and connection.

    If your child is struggling to use words with his/her mouth, we can always use a robust Augmentative and Alternative Communication (AAC) device to help find their words. We know that using such a device does never stop or delay children to speak with their mouths. On the contrary it helps, enormously!

    Can playtime still be a blast? Absolutely! In fact, incorporating AAC into play can be a powerful way to boost communication skills, build confidence, and create a truly inclusive play experience. Here’s how to make it happen, with a focus on core words and core scripts for our GLP’s (the building blocks of communication used by everyone). In this video I am using the core word ‘IN’ and ‘MORE’.

    The Magic of Core Words

    Core words are the most frequently used words in everyday communication. They might be verbs like ‘want’, ‘more’, ‘go’, or ‘stop’, or adjectives like ‘happy’, ‘sad’, and ‘hot’. These words are the foundation for building sentences and expressing needs and desires. They’re perfect for children using AAC because they’re simple to understand and use.

    Let’s Play! Here’s How

    1. Choose Your AAC System

    Many options exist! It could be a low-tech picture board with core words, such as the one you see pasted on my cabinet door in the background, or it can be a dedicated AAC app on your tablet. Here I am using the GRID app but I also love using others, such as LAMP Words for Life.

    2. Make it Fun and Functional

    No pressure! Integrate your AAC system seamlessly into your play routine. Here are some ideas:

    • Car/trains: Use core words to describe what the cars are doing: (‘down’, ‘go’, ‘stop’, ‘again’ ‘fast’ ‘slow’).
    • Dress-up: Use core words to choose clothes (‘want’, ‘hat’, ‘shoes’).
    • Tea Party: Use core words to ask for and share (‘more’, ‘juice’, ‘give’).
    • Building Blocks: Use core words to describe what you’re building (‘tall’, ‘big’, ‘house’).
    • Dolls/Stuffed Animals: Use core words to act out scenarios (‘sleep’, ‘eat’, ‘cry’).
    • Arts and Crafts: Use core words to describe colours (‘red’, ‘blue’), actions (‘draw’, ‘paint’), and feelings (‘happy’, ‘sad’).

    If your child is a Gestalt Language Processor you will want to model meaningful, fun scripts instead of single words! As above, but use phrases:

    • Car/trains: Use scripts to describe what the cars are doing: (‘it’s going down’, ‘let’s go’, ‘make it stop’, ‘want it again’, ‘that was fast’, ‘it’s so slow’).
    • Dress-up: Use scripts to choose clothes (‘I’m gonna wear this’ ‘that’s a lovely hat’, ‘let’s choose shoes’).
    • Tea Party: Use scripts to ask for and share (‘I want more’, ‘more juice’, ‘give me this’).
    • Building Blocks: Use scripts to describe what you’re building (‘a tall one’, ‘that’s so big’, ‘it’s a house’).
    • Dolls/Stuffed Animals: Use scripts to act out scenarios (‘it’s time to sleep’, ‘let’s eat’, ‘he’s crying’).
    • Arts and Crafts: Use scripts to describe colours (‘a red crayon’), actions (‘let’s draw’, ‘I’m gonna paint’), and feelings (‘I’m happy’, ‘that’s so sad’).

    3. Model, Model, Model

    This is key! As you play, constantly model using your child’s AAC system.

    • Point to the picture or word or script you’re using.
    • Speak clearly and slowly while pointing.
    • When using core words for either Analytical or Gestalt Language Processors, try using good phrases. For example, instead of just saying ‘juice’, say, ‘you want more juice?’

    4. Make it a Team Effort

    Get everyone involved! Encourage siblings, grandparents, and caregivers to use the AAC system with your child during playtime. The more consistent the approach, the faster your child will learn and feel confident using their voice.

    5. Celebrate Progress, Big and Small!

    Every step counts! Acknowledge and celebrate your child’s efforts, whether it’s reaching for their AAC system or successfully using a core word. This positive reinforcement will keep them motivated.

    Remember

    • Playtime should be fun, not stressful. Don’t force your child to use their AAC system. Let them lead the way and follow their interests.
    • Every child develops at their own pace. Celebrate your child’s unique communication journey.
    • Seek professional help when needed. Your SLT can provide tailored strategies and resources to support your child’s development.

    By incorporating AAC and core words into playtime, you’re not just fostering communication; you’re creating a space for your child to thrive, explore, and build strong connections.

    So, grab those toys, power up your AAC system, and get ready for a playtime adventure filled with fun, connection and, therefore, communication!

    Don’t hesitate to contact me!

    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.

    1

  • Tongue-Tie: A complex issue requiring careful assessment

    ByLondon Speech and Feeding

    Tongue-tie, or ankyloglossia, is a condition where the lingual frenulum, the thin piece of tissue that connects the underside of the tongue to the floor of the mouth, is too short or tight. Tongue-tie is quite common in babies and is often not detected after birth. Tongue-tie can lead to a difficult start with breast feeding as it makes it very difficult for the baby to latch effectively.

    In my clinical experience as a feeding therapist, I have seen many babies who were not able to latch well due to the frenulum being tight. In many cases an experienced feeding speech therapist/lactation consultant can really make a difference and help a new mum to latch the baby even though the tongue is tethered to the floor of the baby’s mouth. In some cases the frenulum can be divided and once this has been done, in some cases, feeding improves immediately or soon after the division. But this is not always the case. I have seen several babies who have had as many as four tongue-tie divisions and feeding was still difficult.

    It is important to say that while tongue-tie can sometimes impact speech and feeding, it’s important to note that it’s not always the root cause of these difficulties. In recent years, there has been a surge of interest in tongue-tie division surgeries, with some cases being unnecessary. It’s crucial to understand the complexities of tongue-tie and the role of speech therapy in addressing related challenges.

    The impact of tongue-tie on speech and feeding

    When tongue-tie is severe, it can interfere with the tongue’s ability to move freely, affecting speech production and swallowing. Some common speech and feeding difficulties associated with tongue-tie include:

    • Feeding difficulties: Challenges with sucking, chewing, and swallowing.
    • Drooling: Excessive drooling due to difficulty controlling saliva.
    • Speech problems: Difficulty producing certain sounds, such as /l/, /r/, /t/, /s/ and /d/.

    The importance of comprehensive assessment

    Before considering any surgical intervention for tongue-tie, it’s essential to undergo a thorough evaluation by a qualified speech-language therapist (SLT). An SLT can assess the severity of the tongue-tie, its impact on speech and feeding, and determine if surgery is necessary.

    • Functional assessment: The SLT will assess the tongue’s range of motion, its impact on speech sounds, and the child’s overall oral motor skills.
    • Feeding evaluation: The SLT will observe the child’s feeding patterns and identify any difficulties related to tongue-tie.
    • Differential diagnosis: The SLT will rule out other potential causes of speech and feeding difficulties, such as apraxia of speech, dysarthria, or sensory processing disorders.

    The role of speech therapy

    Even in cases where tongue-tie is present, speech therapy can often be highly effective in addressing speech and feeding difficulties. Here’s how speech therapy can help:

    • Articulation therapy: Targeting specific speech sounds that may be affected by tongue-tie.
    • Childhood Apraxia of Speech (CAS): if the diagnosis by the SLT has shown that in fact the child has motor planning difficulties then there are very specific and effective treatment programmes that help with this and can make a real difference over time.
    • Feeding therapy: Strategies to improve swallowing, chewing, and oral-motor skills.
    • Sensory integration: Addressing underlying sensory processing issues that may contribute to feeding difficulties.

    London Speech and Feeding Case Study: The importance of comprehensive assessment

    One of my clients was initially diagnosed with tongue-tie and recommended for surgery at the age of eight years old. His speech had been perceived by parents and teachers as ‘mumbled and unclear’.

    However, after a thorough evaluation, I was able to determine that the child’s primary issue was apraxia of speech, a neurological disorder that affects motor planning for speech. Parents decided to wait with surgery and trust my judgment and we proceeded with weekly intensive speech therapy to address motor planning difficulties around tricky sounds and words. I am delighted to say that the child’s speech has improved significantly, demonstrating the importance of comprehensive assessment and individualised treatment. He is no longer seen as a candidate for an operation, which would have been traumatic for him at his age and, as it turned out, entirely unnecessary.

    Below is a short video clip of my working on the /l/ sound with this child.

    Using the Gingo Puppet from GingoTalk

    Conclusion

    Tongue-tie is a complex issue that requires careful evaluation and individualised treatment. While surgery may certainly be necessary in some cases, it’s essential to consider the potential benefits and risks. Speech therapy can be a highly effective approach for addressing speech and feeding difficulties associated with tongue-tie, even in cases where surgery is still required. By working with a qualified speech-language therapist, parents can ensure that their child receives the best possible care and support.

    Please feel free to contact me.

    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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