Feeding therapy: A guide for parents and caregivers

ByLondon Speech and Feeding
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Image by gpointstudio on Freepik

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?

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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    Chaining: A powerful tool for phonological development

    ByLondon Speech and Feeding

    Understanding chaining

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

    There are two types of chaining: Forward and backward chaining

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

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

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

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

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

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

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

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

    Forward chaining

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

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

    Benefits of chaining

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

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

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

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

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

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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

    The London Speech and Feeding Practice

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

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  • · ·

    Great toys and books for our toddlers (around 1–2 years old)

    ByLondon Speech and Feeding

    As a speech and language therapist, I often get asked by parents what toys and books they should buy for their toddlers. It can feel overwhelming with so many options available! So, I’ve put together a list based on my experience and what I’ve found works well.

    Remember, every child is unique!

    Observe your toddler’s interests and play style. Some toys that are popular might not be engaging for your child.

    Here are a few ideas to get you started:

    Sensory Toys:

    • Stacking cups: These are fantastic for developing hand-eye coordination, fine motor skills, and understanding size relationships. (Various brands available) Note: You can stack many things you have around the house, like bowls or measuring cups, for a similar experience!
    • Shape sorters: Help with shape recognition, hand-eye coordination, and problem-solving. (Melissa & Doug, Vtech)
    • Sensory balls: Balls with different textures (soft, bumpy, squishy) provide tactile stimulation. (Various brands)
    • Push and pull toys: Encourage gross motor development and exploration. (Vtech, Fisher-Price)

    Communication-focused toys:

    • Picture books with flaps: Engage curiosity and encourage language development. (Various brands)
    • Talking toys: Introduce new vocabulary and encourage imitation. (Vtech, Fisher-Price)
    • Simple puzzles: Develop hand-eye coordination, problem-solving, and spatial awareness. (Melissa & Doug, Ravensburger)
    • Musical instruments: Encourage exploration of sounds and develop auditory skills. (Bright Starts, Fisher-Price)

    Now, let’s talk about books:

    • The Very Hungry Caterpillar by Eric Carle: A classic with repetitive text and vibrant illustrations, great for introducing vocabulary and concepts like days of the week.
    • Brown Bear, Brown Bear, What Do You See? by Bill Martin Jr. and Eric Carle: Simple, repetitive text and engaging illustrations make this a favourite for many toddlers.
    • Goodnight Moon by Margaret Wise Brown: A soothing bedtime story with calming illustrations.
    • Pat the Bunny by Dorothy Kunhardt: An interactive book with textures and flaps to engage young children.
    • Corduroy by Don Freeman: A heartwarming story about a teddy bear who loses his button.

    Remember:

    • Observe your child’s interests: Choose toys and books that capture their attention and encourage exploration.
    • Engage with your child: Play with the toys together and read books aloud with enthusiasm.
    • Keep it simple: Start with a few toys and books and gradually introduce new ones.
    • Rotate toys: Keep playtime fresh by rotating toys and books regularly.
    • Most importantly, have fun! Reading and playing with your child should be a joyful experience for both of you.

    Also consider the power of open-ended play

    In today’s world filled with electronic gadgets, it’s easy to overlook the value of open-ended play. Open-ended toys lack specific functions or prescribed outcomes, allowing children to use their imaginations to explore and create. Unlike toys with pre-determined ways to play, open-ended toys encourage:

    • Creative thinking: Children can use them in countless ways, developing their own rules and narratives. A block can become a car, a house, or a spaceship, depending on the child’s imagination.
    • Problem-solving skills: Children learn to figure out how to use the toys, experimenting and adapting as they go. Don’t immediately rush in and fix things for your little one, let them think for themselves and then communication incentive: let them come and find you!
    • Fine motor skills: Many open-ended toys, like blocks, encourage the development of fine motor skills like grasping, stacking, and building.
    • Cognitive development: Children learn about cause and effect, spatial relationships, and problem-solving as they play with open-ended toys.
    • Social-emotional development: Open-ended play can foster social interaction and cooperation as children play together and share ideas.

    Simple toys with big impact

    Some of the best toys for toddlers are often the simplest ones. Here are a few examples:

    • Wooden blocks: Building towers, bridges, and forts encourages creativity and problem-solving.
    • Balls: Throwing, kicking, and rolling balls promote gross motor skills and hand-eye coordination.
    • Fabric: Bits of fabric can be draped, draped, and used for imaginative play.
    • Empty boxes: From cardboard boxes to tissue boxes, these can be transformed into anything a child can imagine: a car, a house, a spaceship!
    • Natural materials: Sticks, leaves, pinecones, and rocks can be used for imaginative play and sensory exploration.

    Remember, the key to open-ended play is to let children explore and discover

    Step back and observe, allowing your child to use his or her imaginations without too much direction. You might be surprised at the creative ways he or she uses simple toys!

    Happy play times with your little one!

    Contact me via my contact form.

    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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  • Help! My child has a lisp. What can we do about it?

    ByLondon Speech and Feeding

    What is a LISP?

    There are different types of LISPS. Let me explain:

    A lisp is the difficulty making a clear ‘S’ and ‘Z’. Other sounds can also be affected by the tongue protruding too far forward and touching the upper teeth or the upper lip even. ‘T’ and ‘D’ can be produced with ‘too much tongue at the front’ and this can also have an impact on ‘CH’ and often also ‘SH’.

    1. Interdental lisp

    Protruding the tongue between the front teeth while attempting ‘S’ or ‘Z’ is referred to as interdental lisp; it can make the speech sound ‘muffled’ or ‘hissy’. Often, we associate a lisp with the person sounding a bit immature. The good news is that this type of lisp is the easiest to correct and, in my practice. I have a 100% success rate with this type of lisp.

    1. Lateral lisp

    In a lateral lisp the person produces the ‘S’ and ‘Z’ sounds with the air escaping over the sides of the tongue. This renders the ‘S’ as sounding ‘slushy’ or ‘wet’. This type of lisp is a bit harder to correct than the interdental lisp. In my experience this can be fixed but it might need a bit longer, more intensive therapy than the interdental lisp.

    1. Palatal lisp

    With a palatal lisp the ‘S’ sound is attempted with the tongue touching the palate, much further back than it should be. The ‘S’ sounds ‘windy’ and ‘hissy’. This is a quite rare lisp production but it is also not difficult to correct.

    These types of speech difficulties come under the category of ‘speech delay of unknown origin’ and may persist into adolescence and adulthood as ‘residual errors‘.

    Some thoughts on Treatment in general:

    Lisps can be treated successfully by a Speech and Language Therapist. However, for the treatment to work well, a student needs to be able to cooperate and want to improve his or her speech. Lisp remediation entails a fair amount of repetitive work and very young children or unmotivated older children don’t make the best candidates for treatment for this reason. Often students present with other speech, language or social communication difficulties and here the lisp might not be the priority for treating. For example, it might be that due to a student’s Attention Deficit Disorder they are simply not able to focus on speech practice in their daily life.

    When should treatment of lisp begin?

    Waiting well past 4½ years is not advisable as the longer we wait and do nothing the stronger engrained the erroneous tongue/speech habit will become. The ‘right’ age for therapy for one child may be different from the ‘right’ age for another child even within the same family. So do make an appointment with a speech and language therapist to assess and see whether your child might be ready to start therapy.

    Do lots of children lisp—is it normal?

    Until the age of about 4–4.5 years old it can be a perfectly normal developmental phase for some children to have the interdental lisp. But when we see and hear a lateral or palatal lisp we ought to act and see a speech and language therapist for sure.

    After the age of 4.5 or 5 years old most speech therapists would agree on at least having a look to see if treatment could be started. The longer we wait the harder it is to retrain the brain pathways to adopt new speech habits.

    What happens during the first Speech and Language Consultation?

    The first consultation takes about an hour and involves screening relevant areas of communicative function. We take a detailed history, examine the anatomy of the child’s mouth and tongue movements. We check for tongue tie, teeth formation, palate structure and function, as well as swallowing patterns.

    Then we begin straight away to try and see if any of the alveolar sounds (T/D/L/N) can be produced correctly with the right tongue placement as that would be the starting point from where to shape a good, clear ‘S’ sound.

    The first consultation usually ends with home practice being given, explained to parents and another appointment being made for follow up.

    Therapy – what does a session look like?

    Each therapy session consists of:

    1. Listening to sounds, discriminating sounds, identifying sounds, listening to rhyming sounds, sound awareness. We call this Auditory discrimination of single sounds: can the student hear the difference between two words that are the same apart from the first sound: ‘sing’ and ‘thing’ or ‘sigh’ and ‘thigh’?
    2. Sound production: using a variety of different prompts and cues we will teach how to physically make the new sound. Often, we work on making a NEW sound, instead of correcting the OLD one. We work on imitation of single sounds then gradually we try and make new sounds in short words, then longer words and then phrases and sentences.
    3. Games! We play games and try and have fun in between listening and producing our new sounds to help students stay motivated and even enjoy the therapy session and process.

    How long does it take to ‘fix up’ a lisp?

    It tends to take about one term with weekly sessions to help a student make good ‘S’ sounds in phrases and sentences. If the student can do the home practice every day in between the weekly sessions, then in most cases I am able to pronounce the lisp as ‘fixed’ after about one term.

    After that the student needs to practise, practise, practise, at home and in daily life to keep reminding themselves of their new skills and their new sound production.

    It is a matter of reminding and wanting to get it right. Occasionally a student returns to me for another term of simply practising their skills together with me as they are finding it hard for any number of reasons to practise at home. But generally, 8/10 students will be fine after some 12–13 sessions and their speech will be perceived as perfectly typical by family and friends.

    If your child has a lisp or any other speech error, please do not hesitate to contact me.

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

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  • · · ·

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

    ByLondon Speech and Feeding

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

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

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

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

    Redefining the ‘rules’ of play and language

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

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

    The power of monotropic deep interests

    Video clip 2 lining up dinosaurs

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

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

    Gestalt Language Processing (GLP)

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

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

    Structural play is learning play

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

    Shifting Our Goals

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

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

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

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

    So, to sum up:

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

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

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

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

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

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

    3

  • Learn the benefits of Cycles Phonology Approach in Speech Therapy

    ByLondon Speech and Feeding
    A grey, green and orange circle overlaid with Cycles Phonological Approach
    Cycles Phonogogical approach

    When your child attends Speech and Language Therapy, it can look like your child’s therapist is playing. Therapy needs to be fun, which means carrying out therapy through the medium of play. But remember every approach used has evidence behind it. We need to know that therapy will be successful, so an evidence-based approach is essential.

    One of the approaches used for Speech Therapy (i.e., working on speech sound production) is the Cycles Phonology Approach. This approach focuses on the patterns and processes rather than each individual sound. For example, it may be working on final consonant deletion, so the omission of the final sound in words. As Speech and Language Therapists we understand that children can get frustrated and fatigued working on the same sound every day. This approach attempts to solve that. Hodson suggests, the approach is also useful for children with more speech sound errors, as therapists see progress in areas not targeted.

    How does the Cycles Phonology Approach work?

    Your Speech and Language Therapist will assess your child’s speech development and will then analyse the results. They will also look for which sounds they can produce with support (this is called stimulability). They will analyse patterns in the results and will formulate a plan.

    The Cycles Phonology Approach intervention allows your child to work in blocks. This might mean they work for half a week for 30 minutes on (e.g., clusters). Then the next half they’ll work for 30 minutes on a different process (e.g., omission of sounds at the end of words).

    Research has found that the following error patterns respond well to this approach:

    • Syllables (identifying the different parts in a word e.g., “ae-ro-plane”)
    • Final Consonant deletion (omission of the final sound e.g., “ca” instead of “cat”)
    • Initial consonant deletion (omission of the first sound e.g., “at” instead of “cat”)
    • Fronting (instead of making a sound at the back of the mouth, it’s made at the front e.g., “tat” instead of “cat”)
    • Backing (instead of making a sound at the front of the mouth, it’s made at the back e.g., “gun” instead of “bun”)
    • S blends (e.g., “sl, sm, sn, sk, sw”)
    • Gliding of liquids (e.g., “lellow instead of yellow”, “wabbit instead of rabbit”)

    What does a Speech and Language Therapy session look like when using the Phonology Cycles Approach?

    The format of the session remains the same for whichever speech sound pattern your child is working on. Your child’s Speech and Language Therapist will review the previous session. Then they will use an activity to work on your child hearing the sound several times (this is called ‘auditory bombardment’). Then your child will practise saying the sound. Next, the Speech and Language Therapist will check if your child can say any of the sounds which they haven’t been able to produce before, with support. This is called a stimulability check. After this, your child will take part in an activity which builds their awareness of sounds in words (such as a rhyming or syllable activity). The session will finish with another auditory bombardment task (i.e., hearing their tricky sound repeatedly).

    I will give you advice for practising at home, as it’s vital that your child learns in the correct way. We aim for 100 turns in therapy sessions, so it’s vital your child is motivated.

    Contact me to improve your child’s speech sounds and improve their confidence when talking.

    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
  • · · ·

    Autism – Benefits of Early Assessment and Intervention

    ByLondon Speech and Feeding
    I think my child might be autistic – how can we help?
    Image by macrovector on Freepik

    Consulting a Specialist Speech and Language Therapist can help you in several ways: assessment, informal and formal observation, discussion and advice, onward referrals, direct intervention, parent coaching, educational support and much more, all geared towards supporting you the parents, and helping your child to flourish and thrive.

    First up, we can help you with assessment and advice: with a wealth of expertise in observing childrens’ play and communication, as well as knowledge of the latest research we can see a child’s strengths and areas of struggle very quickly indeed.

    Within a short space of time, we can identify the areas we need to focus on and start guiding you towards helping your child to connect, respond, react and feel better.

    Early detection is key

    If autism is detected in infancy, then therapy can take full advantage of the brain’s plasticity. It is hard to diagnose Autism before 18 months but there are early signs we know to look out for. Let’s have a brief look at the sorts of things we look at.

    The earliest signs of Autism involve more of an absence of typical behaviours and not the presence of atypical ones.

    • Often the earliest signs are that a baby is very quiet and undemanding. Some babies don’t respond to being cuddled or spoken to. Baby is being described as a ‘good baby, so quiet, no trouble at all’.
    • Baby is very object focused: he/she may look for long periods of time at a red spot/twinkly item further away, at the corner of the room for example.
    • Baby does not make eye contact: we can often see that a baby looks at your glasses for example instead of ‘connecting’ with your eyes.
    • At around 4 months we should see a baby copying adults’ facial expressions and some body movements, gestures and then increasingly cooing sounds we make; babies who were later diagnosed with autism were not seen to be doing this.
    • Baby does not respond with smiles by about 6 months.
    • By about 9 months, baby does not share sounds in a back-and-forth fashion.
    • By about 12 months baby does not respond/turn their heads when their name is called.
    • By around 16 months we have no spoken words; perhaps we hear sounds that sound like ‘speech’ but we cannot make out what the sounds are.
    • By about 24 months we see no meaningful two-word combinations that are self-generated by the toddler. We might see some copying of single words.

    24 months plus:

    • Our child is not interested in other children or people and seems unaware of others in the same room/play area.
    • Our child prefers to play alone, and dislikes being touched, held or cuddled.
    • He/she does not share an interest or draw attention to their own achievements e.g., ‘daddy look I got a dog’.
    • We can see our child not being aware that others are talking to them.
    • We see very little creative pretend play.
    • In the nursery our child might be rough with other children, pushing, pinching or scratching, biting sometimes; or our child might simply not interact with others and be unable to sit in a circle when asked to.

    What sort of speech and language difficulties might we see?

    Our child might do any of the following:

    • have no speech at all, but uses body movements to request things, takes adults by the hand
    • repeat the same word or phrase over and over; sometimes straight away after we have said it or sometimes hours later
    • repeat phrases and songs from adverts or videos, nursery rhymes or what dad says every day when he gets back from work etc.
    • copy our way of intonation
    • not understand questions – and respond by repeating the question just asked:
      • adult: Do you want apple? child: do you want apple?
    • not understand directions or only high frequency directions in daily life
    • avoid eye contact or sometimes ‘stares’
    • lack of pointing or other gestures

    Common behaviours:

    • Hand flapping
    • Rocking back-and-forth
    • Finger flicking or wriggling/moving
    • Lining up items/toys
    • Wheel spinning, spinning around self
    • Flicking lights on and off, or other switches
    • Running back-and-forth in the room, needing to touch each wall/door
    • Loud screaming when excited
    • Bashing ears when frustrated or excited
    • Atypical postures or walking, tip toeing, can be falling over easily, uncoordinated
    • Can be hyper sensitive to noises, smells, textures, foods, clothing, hair cutting, washing etc.
    • Being rigid and inflexible, needing to stick to routines, unable to transition into new environments
    • Food sensitivity, food avoidance, food phobias

    I mentioned this to be a ‘brief’ look at the areas and it is: each topic is looked at very deeply and each area is multi-facetted therefore a diagnosis is rarely arrived at very quickly. We want to make sure we have covered all aspects and have got to know your child very well before coming to conclusions.

    Early detection is key, because we want to start helping your child to make progress as quickly as is possible. If you feel /know that your child is delayed in their speech and language development and you would like a professional opinion then please do contact me, I look forward to supporting you. It is important to know at this point, that if your child only has one or two of the above aspects it may mean that your child is simply delayed for reasons other than Autism and if that is the case, we will be able to help you iron out a few areas of need so that your child can go on thriving.

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

    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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