How to model AAC with our minimally speaking students?

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modelling AAC

How should we start? Should we use prompts? What kind of prompts? hand-over-hand or just pointing? Should we wait, and, if so, how long? Introducing an alternative communication system (AAC) to our child is for many of us a confusing and sometimes scary prospect, but it needn’t be! Let me reassure you and share some tricks of my practice in this area.

Once we have decided to try for a picture based communication system, I usually start with a paper-based single page with between 48–88 core-words. I choose the number of words depending on where the child is developmentally and also verbally.

If a child does have a small handful of words already, I might start with the 88-cell board below. If, on the other hand, my student is completely non-speaking and still quite little then I might go for the 48-cell below here or I might have even less cells to start with. Again, sometimes I start with an electronic device in my clinic just to trial and introduce the idea and to see if, or how, a student responds. 

Below are some samples: a 49-cell board which I made for a child in a nursery setting

Below a Saltillo WordPower board that can be downloaded from the Saltillo website:

Example of a slightly more advanced board, again from the Saltillo Website

And here below one example of a board I made for a specific activity for a child who loves water and sand play:

It is perfectly possible to be very flexible and create a suitable board for any student, starting with as few as 2–5 cells and working up to over a 100 (very small ones) on a sheet of A4 or A3 paper.

So once we have a good board for our child, what now? How do we start introducing this into our daily life?

We can start by showing/pointing to the word GO within a play activity. For example:

  • a car run,
  • or a marble run,
  • or a spinner activity,
  • a wind-up toy,
  • anything that can be stopped and started easily.

How to start?

I will talk us through each of the steps using the example for the word ‘GO’.

First phase

The first phase is a TEACHING/ LEARNING PHASE. In this phase we do not expect our student to do anything, to copy us or to point to the board. If they do that it is of course a huge bonus and we will celebrate it.

Our job is to simply MODEL/SHOW/GIVE EXAMPLES of how we can use the board, by steadily and regularly pointing to the chosen word or words. We do so across the day and across settings:

  • play
  • meal time
  • getting dressed/undressed
  • bath time
  • going to the car/shops
  • etc

Once we can be sure that our student has been submerged and SOAKED in seeing the coreboard being used, say after some 3–4 weeks of using it consistently…

Second phase

We can begin to move into the second phase which is the PRACTICE PHASE. By now the student has seen the boards and he or she has seen the word GO (as a example) modelled many times.

Now we can start to see if we can tempt our student into trying this out for themselves.

What sort of TEMPTING are we talking about? Take a look at the Prompt Hierarchy below, which shows us what to do to get our student to be independently communicating as soon as possible. 

The PROMPT HIERARCHY: what sort of prompting should we do, should we expect something from our student or how should we view this stage?

  1.  TEMPT AND PAUSE

I have the AAC near to the toy and each time the child starts another round of the activity I say clearly ‘GO’ and I point to the picture as do so. I then pause and wait to see what happens. NOTHING? Then…

  1. USE SIGNS AND BODY LANGUAGE

Next time the child starts another round I might be very animated and do a Makaton sign for GO as I say ‘GO’ and I make a very over point to the picture again. Then I wait. STILL NOTHING? OK then…

  1. OPEN-ENDED QUESTION

Now I might say ‘GO’ and follow with: ‘OOH I WONDER IF THERE IS A PICTURE TO POINT TO…’

‘OH LOOK HERE IS GO!’ I then point to GO.

 STILL NO RESPONSE?

  1. ASK FOR A RESPONSE

I might say ‘GO’ followed by ‘LOOK! LET’S POINT TO GO HERE ON THE PICTURE.’

STILL NO RESPONSE? 

  1.  PHYSICAL TOUCH

Next time I say ‘GO’ I will try and take the student’s hand, help isolate their finger and help him or her to point to the actual picture.

REMEMBER: Prompting serves a very important function in scaffolding learning for students BUT if we are constantly prompting kids, then we are teaching them to only communicate when someone tells them to. We want our student to become as independent in speaking and using words as possible.

So once I have done Physical Prompting I will try and phase back down to number 1 where all I need to do is point to the picture or look at the board with the aim that the student will then point to the picture.

Take away points:

  • Keep the learning phase pressure-free and model without expecting our student to jump in. In other words, let’s model first without expectation. Later we can have a little bit of expectation.
  • After they’ve been exposed to and have been ‘soaked’ in plenty of AAC input, then, YES, we can create an opportunity to help them say or point to the word on their own.
  • We can model BOTH with and without expectation.
  • Only after LOTS of exposure, use the least to most prompting hierarchy and start creating opportunities for a student to become an independent communicator.

Do get in touch if you have any questions or comments or if you would like some practical help.

I am always pleased to hear from you.


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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    The power of babble: Why your baby’s ‘talk’ matters

    That adorable string of ‘ba-ba-ga-ga-ma-ma’ might sound like baby gibberish, but it’s actually a crucial milestone in your little one’s language development. Babbling or babble, as we call it, is far more than just cute baby noises. It’s a sequence of sounds that lays the foundation for future communication.

    Image by freepik

    What is babbling?

    Babbling typically begins around six months of age, though the timing can vary slightly from baby to baby. It involves your baby experimenting with different sounds, stringing together consonants and vowels. You might hear them repeating sounds like:

    • ‘Ba-ba’
    • ‘Da-da’
    • ‘Ma-ma’
    • ‘Ga-ga’

    As they progress, the babbling becomes more complex, with variations in pitch, rhythm, and intonation. It might even sound like they’re having a conversation with you!

    Why is babbling so important?

    1. Laying the groundwork for speech: Babbling is like a vocal workout for your baby. By practising these sounds, they’re strengthening the muscles in their mouth, tongue, and vocal cords that are essential for speech.
    2. Developing phonological skills: Through babbling, babies begin to understand the sound patterns of their native language. They’re learning which sounds go together and how they’re used.
    3. Enhancing social interaction: Babbling is a social activity. Babies often babble back and forth with their caregivers, which helps them learn about the give-and-take of communication.
    4. Cognitive development: The act of babbling requires babies to use their brains in new ways. They’re learning to control their vocalisations, pay attention to the sounds they’re making, and connect those sounds to the responses they receive from others.

    How can you encourage babbling?

    • Talk to your baby: Even though they can’t understand your words yet, talking to your baby exposes them to language and encourages them to respond with their own vocalisations.
    • Imitate their sounds: When your baby babbles, imitate them! This shows them that you’re paying attention and encourages them to keep ‘talking.’
    • Respond to their babbling: Treat your baby’s babbling as if it’s a real conversation. Respond with words, smiles, and gestures.
    • Play sound games: Make different sounds for your baby and encourage them to imitate you. This could include animal sounds, silly noises, or simple words.
    • Read to your baby: Even before they can understand the words, reading to your baby exposes them to the rhythm and sounds of language.
    • Sing songs: Singing is a fun and engaging way to introduce your baby to new sounds and words.
    • Use mirrors: Babies often enjoy watching themselves make sounds in a mirror.
    • Tactile stimulation: Gentle massage around the mouth and face can increase oral awareness and encourage vocalisations.
    • Vary textures: Offer different textured teethers.
    • Read books with sound effects: Choose books with animal sounds or other engaging noises.
    • Blow bubbles: The act of blowing and popping bubbles can encourage vocalisations.
    • Use visual aids: Show pictures of objects and say their names, emphasising the consonant sounds.
    • Use exaggerated facial expressions: When you make sounds, exaggerate your mouth movements to help your baby see how sounds are made.
    • Increase joint attention: Follow the child’s gaze and point to objects that they are looking at and say the name of the object.

    When to seek help

    If you notice that your baby is not babbling by eight months, it’s a good idea to talk to your speech and language therapist. You might also notice a lack of variation in tone when your child is making sounds, is your baby sounding a little ‘flat’ or monotonous? While every child develops at their own pace, a lack of babbling can sometimes indicate a developmental delay or hearing issue.

    Remember, babbling is a gift. So, enjoy those precious moments of ‘baby talk’ and take comfort in knowing that your little one is on the path to becoming a chatterbox!

    Do get in touch via my contact form if you are concerned about your child’s development or if you simply want some reassurance that your baby is developing well. We will be delighted to arrange a screening appointment for you and give you support and reassurance.

    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.

    1
  • Cycles Approach speech therapy: Why syllables come first

    and why it matters more than you might think!

    If your child’s speech is difficult to understand, it can feel tempting to focus straight away on individual sounds: those tricky /S/, /K/, or /SH/ sounds that just won’t come out clearly.

    But in therapy, we don’t always start there.

    When a child is very difficult to understand, and I have ruled out that the underlying cause is motor-based, I often opt for the Cycles Phonological Approach. This is helpful for those kids where we can feel like we don’t know where to start! The Cycles Approach helps to generate a broad overall increase in speech clarity by sequentially targeting a variety of speech patterns over the course of 8–10 weeks.

    So rather than working on one sound until it’s ‘fixed,’ we:

    • Work on patterns (not just individual sounds)
    • Target each pattern for a short period of time
    • Then cycle to the next one
    • And come back around again later

    This mirrors how speech development naturally happens: gradually, with increasing accuracy over time.

    Why don’t we start by fixing erroneous sounds straight away?

    To use a metaphor, if a child doesn’t have a strong syllable structure, working on individual sounds is like decorating a house that doesn’t have solid walls yet.

    Many children with speech sound difficulties:

    • Drop syllables (e.g. ‘banana’ → ‘nana’)
    • Simplify longer words
    • Struggle to maintain rhythm and stress patterns

    So, before we refine speech sounds, we need to build the framework of speech.

    Why syllables come first in every cycle

    In the Cycles Approach, we always begin with 2- and 3-syllable words, even if that’s not the main concern.

    Why?

    Because syllable awareness supports:

    • Speech clarity (intelligibility)
    • Word structure and sequencing
    • Prosody (rhythm and stress)
    • Motor planning for longer words

    Without this, even perfectly produced sounds can still be hard to understand in real speech.

    What do ‘2 and 3 beats’ mean?

    When we talk about ‘beats’ we mean syllables you can clap.

    Try it:

    • ‘Table’ → ta-ble (2 beats 👏👏)
    • ‘Banana’ → ba-na-na (3 beats 👏👏👏)

    In therapy, we help children:

    • Hear the beats
    • Feel the rhythm
    • Produce the full word (without dropping parts)

    What this looks like in therapy

    In my sessions, this part of the cycle is active, visual, and repetitive.

    You might see me using:

    • 👏 Clapping or tapping out syllables
    • 🧩 Using visual supports or blocks for each beat
    • 🎲 Play-based repetition of target words
    • 🎯 High-frequency practice (lots of turns!)

    I also keep the focus on success and flow, rather than correction.

    If you’re watching the video clip I’ve shared here, you’ll notice:

    • I’m not over-correcting every sound
    • I’m prioritising getting the whole word out
    • I’m building rhythm, confidence, and consistency

    Why this stage is so powerful

    It can look simple, but it’s doing a lot of heavy lifting.

    Working on syllables helps children:

    • Say longer words more clearly
    • Reduce ‘mumbling’ or collapsing of words
    • Improve overall intelligibility quickly
    • Prepare for more precise sound work later

    Often, parents notice early wins like:

    ✨ ‘They’re easier to understand already’

    ✨ ‘They’re saying longer words!’

    ✨ ‘They’re more confident speaking’

    And that’s before we’ve even fully targeted specific sounds.

    But will my child still learn their sounds?

    Yes. Absolutely.

    The Cycles Approach is structured so that after syllables, we move into:

    • Early developing sounds
    • Then more complex patterns (like fronting or clusters)

    And  importantly, we come back around again.

    Nothing is missed. It’s just sequenced in a way that supports success.

    A different way of thinking about progress

    One of the biggest mindset shifts with the Cycles Approach is this:

    👉 We’re not aiming for perfection straight away

    👉 We’re aiming for gradual system-wide change

    That means:

    • Your child doesn’t need to ‘master’ something before moving on
    • Progress builds across cycles
    • Speech becomes clearer over time, not overnight

    So, to sum up

    Starting with syllables might seem unexpected but it’s one of the most powerful foundations we can give a child whose speech is hard to understand.

    By building rhythm, structure, and confidence first, we make everything that comes next more effective.

    If your child is starting speech therapy and you notice we’re clapping words like ‘banana’ or ‘elephant’, there’s a very good reason for it.

    We’re not going backwards.

    We’re building from the ground up.

    We’re making later sound work more effective and more likely to generalise into everyday talking.

    Next steps:

    If you’re concerned about your child’s speech clarity or wondering whether they might benefit from a structured approach like this, feel free to get in touch. I offer individualised assessments and therapy plans tailored to each child’s speech profile whether that’s early sound development, phonology, or motor speech difficulties.

    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.

    Parent FAQ section

    Why is my child practising words like ‘banana’ instead of sounds like /K/ or /S/?

    Because your child first needs to be able to hold and produce the full shape of a word. If they’re dropping syllables (e.g. ‘banana’ → ‘nana’), working on individual sounds won’t carry over into real speech. We build the structure first, then refine the sounds.

    What if my child can already say some long words?

    That’s great. But we’re looking for consistency and clarity across many words, not just a few familiar ones. This stage helps stabilise that skill so it becomes reliable in everyday talking.

    How long will we stay on syllables?

    Usually, this is a short but important phase within each cycle. We revisit it regularly, but we also move on to other patterns (like specific sounds or sound processes) within the same therapy block.

    Will this delay my child learning their sounds?

    No. In fact, it often speeds things up overall. Once the syllable structure is in place, children are much more able to use correct sounds in longer words and sentences.

    What can I do at home?

    Keep it simple and playful:

    • Clap out words together (e.g. ‘el-e-phant’)
    • Emphasise full words naturally in conversation
    • Repeat back what your child says with the full structure (without pressure)

    Consistency and exposure matter more than correction.

    My child gets frustrated. Will this help?

    Yes. Many children become frustrated when they’re not understood. Improving syllable structure often leads to quick wins in clarity, which can boost confidence and reduce that frustration.

    Building clearer speech: Why we practise syllables first

    What are syllables?

    Syllables are the ‘beats’ in words.

    • ‘Table’ = 2 beats (ta-ble)
    • ‘Banana’ = 3 beats (ba-na-na)

    Why is my child working on this?

    If your child:

    • Drops parts of words (‘banana’ → ‘nana’)
    • Mumbles longer words
    • Is hard to understand

    …then we need to build the structure of words first.

    This helps your child:

    ✔ Say longer words clearly

    ✔ Be easier to understand

    ✔ Feel more confident speaking

    What does this look like in therapy?

    We practise:

    • Clapping or tapping out beats 👏
    • Saying full words with rhythm
    • Repeating target words through play
    • Using visuals or actions to support learning

    How you can help at home

    Keep it light and playful, little and often!

    Try this:

    • Clap words together أثناء play (e.g. toys, food, animals)
    • Model full words naturally (‘Yes, ba-na-na!’)
    • Repeat and expand what your child says

    Example:

    Child: ‘nana’

    You: ‘Yes! Ba-na-na‘

    Important to know

    • This is a key first step in speech therapy
    • We will move on to sounds—but this helps them stick
    • Small changes here can make a big difference in clarity
    3
  • One book, dozens of therapy opportunities: What speech therapy really looks like

    As speech and language therapists, some of the most effective moments in therapy don’t come from flashcards, worksheets, or even drilling sounds (though to be fair I do drill quite a lot too! needs must…😊).

    By and large they happen in natural interaction — during shared attention, laughter, storytelling, and connection.

    This short video clip captures that.

    In under two minutes, while simply reading a book together with a three-year-old child, we naturally work on:

    • Speech sounds
    • Vowel production
    • Early phonological patterns
    • Motor planning
    • Signing and total communication
    • Visual cueing
    • Repetition and practice
    • Confidence building
    • And engagement through play

    To many people, it may just look like ‘reading a book’.

    But underneath that moment are years of specialist training, clinical decision-making, preparation, and therapeutic skill.

    Therapy hidden inside play

    One of the most important parts of paediatric speech therapy is knowing how to embed targets into meaningful interaction.

    Books are one of my favourite therapy tools! Why: because as speech therapists we need to prepare for our child and our sessions. And having a book gives me the structure to know beforehand what kind of sounds or words might be coming up. Then I can be prepared for providing extra support for them. As you can see in this clip, I had the sound cards just there because I had anticipated what might be coming up!

    A single story can provide opportunities for:

    • Speech sound practice
    • Vocabulary development
    • Sentence building
    • Turn-taking
    • Symbolic understanding
    • Attention and listening
    • Gesture and signing
    • Motor speech cueing
    • And social communication

    In this clip, I follow my little one’s interests while carefully weaving in her individual therapy targets.

    It looks relaxed and spontaneous — and it is — but it is also highly intentional.

    Catching opportunities in the moment

    One lovely example in the clip is when she says ‘yes’.

    She is now starting to say the final /S/ sound, so I immediately model and draw attention to it using the ‘snake sound’ visual cue, giving her positive feedback that she can now also try using this sound at the start of words.

    My gently shaping the word ‘yeSSSS.’ gives her:

    • Auditory feedback
    • Visual support
    • And an achievable opportunity to try again

    A few seconds later, we naturally practise it again.

    That’s responsive therapy.

    Speech therapists are constantly listening, analysing, adapting, and deciding:

    • When should I model?
    • When should I pause?
    • When should I repeat?
    • When should I let it go?
    • How can I keep confidence high while still targeting speech?

    These decisions happen in seconds.

    Working on speech without ‘stopping the play’

    Another moment in the clip focuses on the word ‘out’, where the vowel sound is one of her speech targets.

    Then we move into practising the word ‘open’, a word she has previously found difficult.

    Within this one word, we can support:

    • Sequencing
    • Motor planning
    • Lip shape
    • Vowel production
    • And speech sound accuracy

    We also briefly practise the /K/ sound — a sound produced at the back of the mouth which can be particularly tricky to produce.

    Instead of explaining it verbally (which is often too abstract for young children), I use:

    • Visual demonstration
    • Exaggerated mouth movements
    • Gesture/sign support
    • And playful modelling

    Children learn through seeing, hearing, doing, and experiencing.

    That is why Speech Therapists use multiple layers of cueing simultaneously.

    Why I use signs alongside speech

    Throughout the clip, I also use signs such as ‘book’ and ‘pig’.

    Using signs does not stop children talking.

    In fact, for many children, signs:

    • Reduce frustration
    • Support understanding
    • Increase participation
    • Reinforce vocabulary
    • And help bridge the gap while speech is developing

    Communication always comes first.

    Speech is only one part of communication.

    When children feel successful communicating, they are far more likely to keep trying.

    The skill behind ‘natural’ therapy

    One thing I often hear from parents is:

    ‘You make it look so easy.’

    That is actually one of the biggest compliments a therapist can receive. (Though we also often feel we need to justify our very existence with these thoughts because we don’t just play/just read but we know it can look like that!) 😊 this is the reason for this blog…

    High-quality paediatric therapy should feel warm, playful, responsive, and natural.

    But underneath that natural interaction is:

    • Clinical knowledge
    • Phonological analysis
    • Motor speech understanding
    • Language development expertise
    • Sensory awareness
    • Relationship-building
    • And careful session planning

    Before this session even began, I already knew:

    • Which speech patterns to target
    • Which words would likely appear in the book
    • What visual cues might help
    • Which signs to model
    • And how to adapt depending on the child’s responses

    That preparation allows therapy to stay child-led without losing therapeutic focus.

    Following the child while leading the therapy

    The best therapy is rarely rigid.

    Children do not learn communication through pressure or endless correction. They learn through interaction.

    That is exactly what this short clip demonstrates.

    One book.
    One conversation.
    Hundreds of tiny therapeutic decisions.

    And all within a joyful moment shared together.

    Because good speech therapy should never feel like hard work for a child.

    It should feel like connection, confidence, success — and fun.

    If you’re concerned about your child’s speech and language or wondering whether they might benefit from speech therapy, feel free to get in touch.

    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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  • · ·

    Understanding phonological processes in 3–7-year-olds: What’s typical and when to seek help

    As a speech and language therapist, one of the most common questions I hear from parents is:

    ‘They can talk, but their speech still sounds immature. Is this normal?’

    Many children between the ages of three and seven use speech patterns that make their words sound different from adult speech. These patterns are known as phonological processes, and for younger children, they are a normal part of speech development.

    However, when these processes persist beyond the expected age, they can start to affect clarity, confidence and learning, especially once children enter school.

    This blog will help you understand:

    • what phonological processes are
    • which patterns are typical at different ages
    • and when it might be time to seek speech therapy support

    What are phonological processes?

    Phonological processes are patterns of sound simplification that children use while their speech system is developing.

    Instead of learning each sound one by one, children initially organise sounds into patterns that make speech easier to produce. This is a normal and efficient strategy for a developing brain.

    For example:

    • saying ‘tar’ instead of ‘car’
    • saying ‘poon’ instead of ‘spoon’
    • saying ‘bud’ instead of ‘bus’

    These are not ‘bad habits’. They are part of how speech develops.

    The key question is how long these patterns last.

    Common phonological processes (and when they usually disappear)

    Below are some of the most common processes parents notice in 3–7-year-olds.

    1. Final consonant deletion

    Leaving off the last sound in a word

    • ‘ca’ for cat, ‘da’ for dog
    • Typically resolved by 3–3½ years

    2. Fronting

    Replacing back sounds (k, g) with front sounds (t, d)

    • ‘tar’ for car, ‘do’ for go
    • Typically resolved by 3½–4 years

    3. Cluster reduction

    Omitting one sound in a consonant cluster

    • ‘poon’ for spoon, ‘top’ for stop
    • Typically resolves by 4–5 years (some clusters slightly later)

    4. Gliding

    Replacing /R/ or /L/ with /W/ or /Y/

    • ‘wabbit’ for rabbit, ‘yion’ for lion
    • Can be typical up to 5–6 years

    5. Weak syllable deletion

    Leaving out unstressed syllables

    • ‘nana’ for banana
    • Usually resolved by 4 years

    If these patterns continue past the expected age, speech can remain difficult to understand particularly for unfamiliar listeners such as teachers, peers, and also Auntie Karen or grandparents who visit once in a while.

    Why phonological processes matter in school-age children

    By the time children reach reception and Year 1, speech clarity becomes increasingly important.

    Persistent phonological difficulties can affect:

    • being understood by teachers and peers
    • phonics and early reading
    • spelling
    • confidence in speaking
    • willingness to participate in class

    Some children become aware that they ‘sound different’ and may speak less, avoid longer words, or become frustrated when misunderstood.

    What’s the difference between a delay and a disorder?

    This is an important distinction.

    • A phonological delay means a child is following the normal pattern of development, just more slowly.
    • A phonological disorder means the child is using atypical patterns, or continuing age-expected patterns well beyond when they should have resolved.

    A speech and language assessment helps identify:

    • which processes are present
    • how many are affecting speech
    • how consistent the errors are
    • and whether intervention is needed

    Signs it may be time to seek speech therapy

    You may want to seek professional advice if your child:

    • is 3½ years or older and still hard to understand
    • is understood well by family but not by others
    • becomes frustrated or avoids talking
    • has difficulty with phonics or spelling
    • uses several phonological processes at once
    • has not made progress despite time and encouragement

    Early support does not mean something is ‘wrong’. It simply helps speech development move forward more efficiently.Research consistently shows that unresolved phonological processes beyond the expected age can impact intelligibility, literacy and confidence (Dodd, 2014; Bowen, 2015).

    How speech therapy helps phonological development

    Phonological therapy is not about drilling individual sounds endlessly.

    Instead, therapy focuses on:

    • helping children recognise sound patterns
    • building awareness of contrasts (e.g. ‘tar’ vs ‘car’)
    • practising speech in meaningful, playful ways
    • supporting generalisation so progress carries into everyday speech

    For school-aged children, therapy is usually structured, motivating and highly targeted and progress can be very encouraging.

    A final reassurance

    Many children with phonological difficulties go on to develop clear, confident speech with the right support.

    If you’re unsure whether your child’s speech is ‘just a phase’ or something that needs attention, a professional assessment can give clarity and peace of mind.

    If you’d like support or advice, please contact me and I can help guide the next steps.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Research references


    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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  • · · ·

    The purpose and nature of a speech and language therapy assessment

    If you have ever wondered what happens when you bring your child to a speech and language therapy assessment, then this blog will shed light on the ins and outs of it for you.

    At its heart, a speech and language therapy assessment is a systematic and thorough evaluation of your child’s communication or eating/swallowing abilities. It’s more than just asking a few questions. It is a carefully constructed process designed to identify strengths, pinpoint challenges, and ultimately pave the way for effective intervention.

    Establishing a detailed profile – a few bullet points:

    • Identification of communication and swallowing difficulties: I aim to determine if a communication or swallowing disorder exists. I will establish if the difficulty is a delay or a more complex disorder.
    • Diagnosis of the specific disorder/autism: The assessment delves deeper to pinpoint the specific type and nature of the difficulty. For instance, is your child’s language delay due to a specific learning disability, a developmental delay, or another underlying condition?
    • Knowing the aetiology or what is causing a difficulty is crucial for targeted intervention. And whilst we are on the topic let’s talk about an autism assessment: I am trained and experienced in assessing and diagnosing autism. However, when it comes to the diagnosis of autism I provide a preliminary ‘working hypothesis’ rather than giving a definite final diagnosis. The reason for this is that it is considered the ‘gold standard’ and ‘best practice’ to diagnose autism in a multi-disciplinary setting and context. Since I work on my own, I always refer to highly recommended multi-disciplinary clinics for the ultimate diagnostic assessment.
    • Determination of severity: Understanding the severity of the difficulty is essential for prioritising intervention and measuring progress. Is your child’s difficulty mild, moderate, or severe? This helps me choose a particular approach and then tailor it to suit each individual child.
    • Identification of underlying strengths and weaknesses: An assessment doesn’t just focus on what’s wrong. It also highlights your child’s strengths and areas of relative ease. This information is invaluable for building upon existing skills during therapy. Understanding weaknesses provides specific targets for intervention.
    • Guiding intervention planning: The assessment provides the crucial information I need to develop an individualised intervention plan. The findings directly inform the selection of therapy goals, strategies, and techniques. Without a thorough assessment, therapy would be a shot in the dark.

    A multi-faceted approach

    A speech and language therapy assessment is not a ‘one-size-fits-all’ procedure. The specific tools and techniques used will vary depending on a child’s age, the nature of the suspected difficulty, and other relevant factors. However, most comprehensive assessments incorporate several key components:

    • Case history: This involves gathering information about your child’s developmental, medical, social, and educational background. We will go through all the relevant milestones and throughout the process I will make notes which will help bring all the puzzle pieces together.
    • Observation: I will observe how parent and child play together and we also look at how the child plays by themselves. Additionally of interest is how a child plays with me, the therapist. Through discussion I will also endeavour to find out how your child plays with other children, be it at the nursery or within the family.
    • Standardised assessments: These are commercially available tests with specific administration and scoring procedures. They provide norm-referenced data, allowing to compare the individual child’s performance to that of his or her peers. Examples include articulation tests, language comprehension and production tests, and fluency assessments. I tend not to use these assessments a lot.
    • Instead, I use non-standardised assessments: These are more flexible and allow to probe specific areas of concern in more detail. This might include language samples (analysing spontaneous speech), dynamic assessment (testing and teaching to identify learning potential), and informal observation of play or interaction.
    • Immediate feedback and report writing: During and thenfollowing the assessment, I will bring all the gathered information together and I will discuss with the parents what my findings are and what my recommendations in the short term are. Parents always go home with a good handful of useful strategies that they can implement at home right away. In addition, I provide a comprehensive report outlining the findings, diagnosis (if applicable), severity, strengths and weaknesses, and recommendations for intervention.

    In conclusion, a speech and language therapy assessment is a dynamic and essential process. It is a journey of discovery, aiming to understand a child and the child’s family and his or her unique communication or feeding profile. The assessment is usually the start of our wonderful learning journey together.

    Below is a short video clip of an assessment where you see me in action explaining a particular therapy approach to a set of parents. It perhaps shows a tiny bit of how relaxed we are in our sessions and that assessment is not at all daunting, but a hugely informative event overall which will leave you feeling empowered and hopeful.

    What happens after an assessment?

    Please feel free to get in touch with me via my contact form if you wish to have an assessment for your child’s communication difficulties or feeding difficulties.

    An assessment is always a stand-alone event and does not mean you need to automatically book follow up sessions at all. It will give a lot of information and based on this you can decide if you would like more therapy or follow up for you and your child. Many times ongoing therapy is not needed! I only recommend a course of therapy if it is really needed and where it would be immediately beneficial for your child.

    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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  • A day in my life as an Independent Speech and Language Therapist

    During the pandemic I wrote a blog on what my working day looked like. Now a good year has passed since coming back to some sort of normality and I thought I would update this ‘day in the life of an SLT’ as my working life has changed of course to reflect the ‘new normal’.

    I have become truly busy, perhaps busier than I have ever been to be honest. It’s probably mostly due to the fact that I do most of the aspects of my work myself — though I want to mention two invaluable people here without whom I could not function as well as I do: the excellent Nathalie Mahieu () helps me with my SEO, Insta posts and blog uploading and the wonderful Sue Bainbridge () makes sure that my accounts don’t get into trouble with His Majesty’s tax office.

    Attached to our role as Speech and Language Therapists is an arguably enormous amount of administration/paperwork and preparation required for each and every client. This needs to be factored in when deciding how many families I can realistically see each working day. For me it works out as typically 3–5 clients a day, Monday to Friday.

    So how does my day typically look? Each day varies a lot depending on what type of client I have, but on average it looks a bit like this:

    First thing in the morning — after having a coffee and a quick check-in with my besties on WhatsApp — I do my Buddhist chanting for about an hour. My Buddhist prayers are the base of all I do and get me connected to my higher purpose and how to create value with each activity and each person I see that day. It sets me up for the day, I keep in mind who is going to come and see me and how I can best help them.

    Next up, I do the daily ‘spring-clean’ of my therapy room (on all fours! no joke ???? those kids see every speck!), vacuum the floors, wipe down the toys with flash-wipes and tidy up all my boxes, making sure that the battery toys are working, and everything else is in place. On to the guest toilet, the hallway needs to be rid of all the men’s shoes and trainers and coats… It’s endless what needs tidying when you are living with three men… This takes about 45 minutes.

    An articulation activity – packaging practice into a little game

    Then I prep for all my clients that day. I have now got so much quicker about selecting therapy materials. For one thing I have purchased so many toys and materials over the past five years that I can literally now open a shop and need to consider building an extension! ???? The upside is that it is now very easy for me to select a good handful of toys or games for any one child, even at a minute’s notice. Though, on average, I spend about 30 minutes per child preparing activities.

    Hurrah, it’s 11 am and my first client of the day arrives and the fun begins.

    When they leave around an hour later, the cleaning and wiping down starts again, this time less extensively. I write up my notes and send homework whilst enjoying a cuppa.

    The next client comes at 12.30 pm and once they have left, floor cleaned, toys wiped, notes written it is time for a quick lunch. No more than half an hour usually.

    Afternoon clients tend to be one more little one (nursery age) at 2.15 pm and thereafter I see mostly older school children for a variety of reasons (mainly speech production but also some language-based activities). I tend to say farewell to my last client of the day around 6 pm. I spend another hour, sometimes more, on writing up notes, answering new enquiries, blogging and phone calls to keep my service fresh, inspirational and exciting.

    And then dinner and the rest of the day rushes by. I tend to finish my day with some more Buddhist chanting, not a lot, perhaps 10–20 minutes to reflect on what has gone well and what could have been better — re-determine to improve or make better as needed.

    Tele therapy activity using online materials plus a coreboard

    In terms of where I provide a service, I still do a good mix of online clients (tele-therapy) and in-person clients in my clinic, which I love. Occasionally, I visit children in their nursery or at home but this service is now only available for long-standing clients.

    Each client is hand-picked to make sure that we are a good fit: no one client gets the same treatment as another; each client is unique, we get to know one another well over the time we work together and they are always highly valued. That takes time and, in reality, each client gets about two hours of my time. That is the actual session plus all the preparation and aftercare, i.e., bespoke hand holding, tweaks, problem solving and reassurance in between sessions.

    I absolutely love this way of working and would not ever want to do anything else. Nearly three decades of working both in the NHS and in private practice, countless courses (continual professional development) have enabled me to flourish as a therapist and I know that I offer something special and very valuable to my clients.

    My unique way of working affords all my lovely clients the help they need to support their children to make progress; and it gives me the right balance of job satisfaction and work life balance for now. My lovely reviews and testimonials tell me that my clients appreciate my service and this at the end of the day is the most important.

    If you are interested in exploring Buddhism/buddhist chanting then check out this link (https://sgi-uk.org/), and feel free to contact me about that specifically, regardless of whether you want speech therapy. I am always happy to chat about Buddhism, it has been so enriching for the last 43 years of my life.

    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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