Learn why ‘watchful waiting’ isn’t the answer

ByLondon Speech and Feeding

As a Speech and Language Therapist, I am a big advocate of early intervention. And I’m always encouraging you (as parents and carers) to seek intervention as early as possible. But you might be thinking, “my child just needs more time.” Have you ever wondered why early intervention is important? Read on to learn more.

Speech Therpaist in London
Watchful waiting is not the answer

Early intervention

By intervening at a later age or stage of development, you may be leading your child to develop consequences as a result. One consequence can be challenging behaviour due to their inability to express their wants and needs. They may have difficulty in understanding and following directions. This will not only affect their ability in the classroom but also socially, maintaining friendships. Early intervention can support understanding. This can also help you support your child in breaking down activities so they can fully take part in home and school life. The Early Intervention Foundation (2021) suggest that providing early intervention can develop a young person’s strengths. You can use these activities to support their needs which creates better outcome measures. This allows young people to reach their full potential across a range of settings. It can positively impact on mental health and self-esteem.n

Positive outcomes

Also, we are protecting our young people from harmful situations by giving them a voice. And by giving them a voice, they are:

  • more likely to achieve and
  • less likely to have in negative experiences such as crime and with the justice system.

We know that social and emotional skills (such as developing self-awareness, social skills, and emotional regulation) are crucial to a young person’s development. Research has found that children with a higher level of social and emotional skills are more likely to:

  • achieve in education,
  • graduate from university,
  • have career prospects,
  • have positive work and family relationships,n
  • maintain good mental and physical health.

By having these positive aspects in their lives, they are less likely to engage in antisocial behaviour and related crime. It’s easy to think this feels like a long way off for your family. But by giving them the best possible start, you are promoting a positive future in all aspects of their life.

Contact me today to get started with speech, language and communication intervention.

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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    Discover more about Verbal Dyspraxia

    ByLondon Speech and Feeding

    What is Verbal Dyspraxia?

    Apraxia or dyspraxia is a difficulty in motor planning, which sometimes can be seen in both gross and fine motor skills, as well as speech. Gross motor refers to difficulties in coordinating the whole body (e.g., bumping into things frequently, often falling over hurting themselves or others through being “clumsy” or unsteady). Fine motor movements refer to smaller, more precise movements (e.g., difficulties doing anything with their hands such as holding a spoon or pen).

    Verbal dyspraxia

    In Dyspraxia of Speech, instead of seeing a coordinated smooth way of talking, we see the articulators (tongue, lips, cheeks) and voice coordinating very smoothly. The voice can be very quiet or very loud. Muscle tone can be weaker at times. Speech sounds are very unintelligible, with a flat voice that can sound forced. It may be that the timings of verbalisation appear random and that children can say a certain word once and never again. This is often what we hear from parents.

    It is interesting to note that many of our autistic clients are either non-speaking or are reluctant speakers. Sometimes they say a word once and then never again. Others say lots of words but the words are very hard to make out. Did you know that about 40% of autistic people have verbal dyspraxia? (Richard, 1997). Because the problem is one of motor planning, not of automatic motor execution, once a plan has become automatic, it is easier to get back to it and this is why we often see repetitive patterns that can be called ‘stims’ (Marge Blanc, 2004).

    How can Speech and Language Therapy help?

    Children with verbal dyspraxia can make great progress!

    We provide frequent and appropriate speech movement opportunities and with time and the right support, children will move forward and begin to speak more fluently and with greater intelligibility. It is important to know this can take time.

    We provide Oral Motor Therapy using a variety of approaches to practise breathing, vocalising on the outbreath, and sequencing our speech movements.

    We design carefully tailored programmes focusing on words that have a lot of power (e.g., NO, GO, UP, IN, OUT, LET’S GO, STOP).

    We offer shared enjoyment, and laughter. This helps a child find their voice. Other ways of finding our voices include singing or humming, or even yelling/shouting!

    The most difficult phase of verbal dyspraxia is initiation, that is to start talking, to start producing a word. Frequent “automatic” repetition supports children with initiation because it removes the element of “thinking to start”. I often ask a child to repeat a word 5-10 times (with rewards at the end. A little game works well). You can see that with repetition the act of initiating is taken out of the equation as you are “on a roll “as it were.

    Once a child starts to find their voice, we will be able to hear them talk lot… And if we give them credit and presume that what they are saying has meaning, we will find in time that their words become clearer and more intelligible. If we listen carefully, we can detect real words and phrases.

    For more tips and support, 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.

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    How to model AAC with our minimally speaking students?

    ByLondon Speech and Feeding
    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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  • My child is very hard to understand! How can Speech Therapy help?

    ByLondon Speech and Feeding

    Kids Speech Therapist London

    There are many reasons for speech sound delay or disorders and the first step is a thorough assessment.

    What does a Speech Assessment look like?

    With younger children, around 2 – 2.5 years we often start by collecting a good speech sample during play or general chatting. Sometimes we do this with an audiotape so that we are able to listen to your child’s speech sounds repeatedly in order to determine any speech error patterns. A good way to get a speech sample is looking at a favourite book together and trying to get your child to name as many items, animals or characters as possible in the book. For older children, 4.5 years plus we do more formal speech sound assessments where we show your child a series of pictures which focus on varying sounds or sound patterns, for example:

    • Are the end sounds present or left off, does your child say BE_ instead of BED for example?
    • Are the back sounds produced at the front of the mouth, is a digger a DIDDER or a pig a PID?
    • Are sound blends reduced, for instances a snake becomes a NAKE ?
    • Or do many phonemes (single speech sounds) collapse all into one error sound? Like all F , R or L become a B?

    Once we have discovered the error pattern we can then unravel the problem and work on solutions. We make a plan and prioritise which of the patterns we can target first, second and next. There are several approaches that can be used to tackle speech sound errors and most therapist have two or three favourite approaches as their go-to. I will fill you in on my favourite ones in future blogs.

    What does a Speech Therapy session look like?

    These days we have two options: on-line via zoom and face to face in the clinic setting.

    Both are great options!

    For all clients who live far away a zoom session will be the option to go for. But zoom sessions also work really well for the older child as, let’s face it, are there any kids out there who do not like a bit of screen time?

    I find that children around 5 years old really love the on-line games and sessions are fun and very effective. We usually start off with a quick game to warm up and then we go into the speech sound patterns we need to improve and work on. There are 100s of tried and tested on-line games and game decks which can be hugely entertaining and really nice to work with.

    In clinic, we also often start with a short game to settle in and then we target the various sound patterns we are working on within table top games, or arts and crafts activities. We aim to get up to 100 speech sound trials per session, using a variety of motivating games to keep our little ones going and focused.

    Both, face to face and on-line sessions are between 40-45 minutes long – time usually flies by! – and then parents get to practise home exercises to make sure that the new speech sounds are being practised every day.

    Over the coming weeks I shall do blogs on great games and home exercises that I give the parents and I will talk about games we do in the session that are fun and can be copied for home use. Watch this space!

    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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    Tongue training: Why tongue placement matters for clear speech

    ByLondon Speech and Feeding

    As speech and Language therapists (SLTs), we know that where your tongue goes, so goes your sound. This blog post will explore why tongue placement is so vital for speech correction and how we use tools and techniques to help our clients find their ‘sweet spot’ for sound production.

    Let me show you here a little video clip where I am using my dentist’s mouth/teeth model to help my clients navigate their tongue movements.

    The tongue: A tiny muscle with a big job

    The tongue is a small but mighty muscle. It’s incredibly versatile, playing a key role in eating, swallowing, and, of course, speaking. For each speech sound, the tongue, along with the lips and jaw, needs to move to a very specific spot. Think of it like a dance: every part of your mouth has a choreographed movement to produce the correct sound. If the tongue is out of sync, the sound comes out muffled, distorted, or just plain wrong.

    The trouble with our tongue movements is that most of us never think about how the tongue has to move and what it does to: swallow, chew, drink, suck and speak. Most parents when asked to think about their own tongue placement for say the /S/ sound are completely lost as to what their tongue is doing. Yet, of course, they produce a perfect /S/ and perfect speech in general. The same goes for swallowing. When did you last think about what happens in your mouth when you swallow? I bet you have not thought about it. We ‘just do it’, right?

    Why is tongue placement so important?

    Accurate tongue placement is the foundation of clear articulation. When a child struggles with a particular sound, it’s often because his or her tongue isn’t quite reaching the right spot or moving in the correct way. For example, the /S/ sound requires the tongue to be slightly raised and positioned behind the top teeth, creating a narrow channel for air to flow through. If the tongue is too far forward, you might get a /TH/ sound instead. If it’s too far back, the /S/ can sound muffled.

    Visual aids: Our secret weapon

    We SLTs love our visual aids! They’re incredibly helpful for showing clients exactly where their tongue needs to be. Here are some of our favourite tools:

    • Mirrors: Mirrors provide instant feedback. Clients can see their tongue’s position and make adjustments in real-time. We often use hand mirrors or even the mirror on a compact for quick checks.
    • Tongue depressors: These simple tools can gently guide the tongue to the correct position. We might use them to show where the tongue tip should rest for the /L/ sound or how the sides of the tongue should touch the molars for the /K/ and /G/ sounds.
    • Diagrams and models: Pictures and models of the mouth can help clients visualise the tongue’s movements. We might use a cross-section diagram of the mouth to show how the tongue forms different sounds.

    Beyond the tongue: The jaw’s role

    While the tongue takes centre stage, the jaw plays a supporting role. It provides a stable base for the tongue and helps control the opening and closing of the mouth. Sometimes, jaw stability is an issue, and we might use techniques to help clients find a comfortable and stable jaw position.

    Making it fun and engaging

    Learning correct tongue placement can be challenging, but we make it fun! We use games, stories, and playful activities to keep clients motivated. For younger children, we might use silly voices or pretend to be animals. For older children, we might incorporate their interests, like using a car analogy for tongue movements.

    The takeaway

    Correct tongue placement is essential for clear speech. By using visual aids, interactive techniques, and a bit of creativity, we can help our clients master their speech sounds and communicate with confidence.

    If you have any concerns about your child’s speech, don’t hesitate to reach out to a qualified speech and language therapist, we are here to help! 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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    Discover seven activities to support young children with word-finding difficulties

    ByLondon Speech and Feeding
    Speech Therpaist in London
    Discover seven activities to support young children with word-finding difficulties

    You watch your child struggle to find the right words in conversation. You’ve noticed that they describe what they mean (e.g., it lives in the trees outside, has wings to fly and squawks) but cannot think of the correct word to use (i.e., bird). You see the frustration on their face as they search for that never-ending missing word. You know that as your young person becomes older, they are likely to face an increasing frustration. You recognise the importance of putting strategies into place for their word-finding difficulties. It’s vital that this diagnosis has come from a Speech and Language Therapist, as different activities will target different needs.

    Ensure activities are interesting and fun. Be creative and use the activities your young person relates to. Use words that interest them. Remember, the words we use matter.

    1. Read, read, and read some more!

    • Read books that rhyme, or those that talk about opposites
    • Read about the semantic classes in the book such as occupations, the equipment they might use, or names of related words
    • Talk about books that involve animals and their young, and the names of the animal genders (i.e., Horses have foals; horse; mare, stallion, filly, colt)
    • Use books that have repetition of the same word or ones that have a silly rhyme

    2. Play word-games

    You could play games which transform one part of speech to another

    • Today I am riding, yesterday I … (rode)
    • Today I am driving, yesterday I … (drove)

    You could name the odd word out from a list of items

    • e.g., cat, dog, sheep, red

    Why not read out a list of words and your child must guess which two go together

    • e.g., television, sofa, apple, banana

    Play a game of complete the sentence

    • e.g., “A house is a place to live. An office is a place to …”

    Play a word game involving synonyms or antonyms

    • e.g., Can you think of another word for “small”? Can you think of another word for “sleepy”?
    • e.g., “The opposite of hot is …” or use a question-and-answer format e.g., “What is the opposite of hot?”

    Play a word game involving similarities and/or differences

    • e.g., “what is the same as a car and a bus?”
    • e.g., “what is the difference between a car and a bus?”

    3. Use story telling

    Sing rhymes or songs, and allow children to complete the sentence

    • e.g., ‘Little Jack Horner sat in a …’ (corner)

    4.Tell jokes

    Why not tell knock-knock jokes, or riddles? These need accurate word-retrieval otherwise they wouldn’t be funny.

    5. Make up words in rhymes

    Use rhymes and make up words

    • e.g., “Humpty Dumpty had a great… grandmother”

    6. Play word category games

    These games might include ones (e.g., “see how many boys’ names you can think of in one minute”. Time yourself while you do it. Categories may include tools, games, girls’ names, drinks, films, toys, animals, makes of cars, clothes, sports, items that you find in school, colours, names of places beginning with ‘B’). You could also play this in reverse, so name items in the category and your conversation partner guesses the category.

    7. Play “what comes next?”

    • e.g., ABCDE…
    • e.g., First, second, third…
    • e.g., Monday, Tuesday, Wednesday…

    Knowing that you’re helping your child with their word finding is a weight off your mind. It helps you to relax knowing that you’re supporting their word-finding difficulties. Watch your child develop strategies as their word knowledge grows.

    Credit: Caroline Bowen

    All information in this blog originates from:

    Bowen, C. (1998). Information for Families: Helping Children Who have Word Retrieval Difficulties. Retrieved from http://www.speech-language-therapy.com/index.php?option=com_content&view=article&id=100 on [15.11.2022]

    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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    13 tips to support children and young people with food aversions

    ByLondon Speech and Feeding

    When you have a picky eater it’s easy to feel on edge and that others are judging your parenting skills. It is astonishing how suddenly the world and its brother/sister are all experts on how to feed your child, even the lady in the corner shop is not shy to offer unsolicited tips and advice on your child’s nutrition intake. They will say “try this or that“, “how about these new crackers (only £1.99 special offer)” but…

    The fact is often that you are very concerned about what your child is eating. And you desperately want to give them a healthy, nutritious packed lunch but you know that it will get left, unopened, and unfinished. So, instead, you stick to the same sad soft cheese sandwich on white bread as it is at least something you know they’ll eat.

    Sensory needs can impact on eating with both individuals with and without other conditions. We need to consider all these elements:

    • taste (sweet vs. sour)
    • consistency (crunchy vs. soft)
    • temperature (hot vs. cold)
    • colour (beige vs. colourful)
    • and smell (pungent vs. mild)

    Let’s take a blueberry as an example: it can be sweet or sharp; it can be firm or mushy; it can even differ in colour. Now let’s look at a piece of cereal: it’s crunchy all the time; it looks the same. It’s very predictable, and therefore less anxiety provoking.

    Speech Therpaist in London

    Find our top tips here:

    1. Check with a medical professional that there is nothing physically wrong (e.g. gastrointestinal, or anatomical structural difficulties).
    2. For swallowing difficulties, whether confirmed or suspected, please book an assessment with a certified swallowing/feeding Speech and Language Therapist or please contact me.
    3. Does your child have confirmed or suspected allergies? If so, please contact a dietician who has experience with allergies and can advise, for example: Dr Rosan Meyer.
    4. Talk to other family members about food and their experiences of food. Perhaps there is a family tendency to be picky with eating/food avoidant. This may be important information that you can share with your clinician during the case history taking.
    5. Be patient, though this is easier said than done/felt! Know that many children need repeated exposure to food(s) before liking them, up to 14 spoons! So, take it at your child’s pace and it’s vital we don’t force them to try new foods or use bribes.
    6. You can provide opportunities to engage with food, perhaps you could cook with your child, and allow them to choose what they want to cook. For younger children try Messy Food Play – there are tons of suggestions on Pinterest for ideas on how to incorporate foods into play activities or ask your feeding-Speech and Language Therapist.
    7. You may want to talk about pictures in books that introduce new foods (e.g. The Very Hungry Caterpillar for younger children or magazines if older).
    8. You can play with toy food in a toy kitchen for little ones, or comment on supermarket adverts for young people who are older.
    9. Offer opportunities to taste new foods. You could use a toothpick for bite-sized pieces.
    10. Be sure you eat together with your child as often as you can, modelling positive eating behaviour is most important and can be really effective over time.
    11. You could ask your child to sort foods by colour or stack them on a plate.
    12. We know that Autistic Spectrum Conditions often come with hypersensitivity to textures, so consider what your child prefers (e.g. they may not like slices of tomato but prefer the runnier texture of a tomato sauce).
    13. Reward and give praise following your child’s flexibility with foods and their attempts to try and not whether they like/dislike the food, for example “well done for touching the avocado!” Or “great you licked your fingers with the humous on, that’s excellent”.

    We are always here to support you in whatever way we can. Contact me for support.

    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.