Principles of motor learning in childhood apraxia of speech: A guide for parents and therapists

ByLondon Speech and Feeding
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Image by Freepik

Childhood Apraxia of Speech (CAS) is a complex neurological disorder that affects a child’s ability to plan and coordinate the movements necessary for speech production. Children with CAS often have difficulty with articulation, prosody, and fluency, making it challenging for them to communicate effectively. While there is no cure for CAS, speech and language therapy can significantly improve a child’s communication skills and overall quality of life. Understanding the principles of motor learning is crucial for both parents and speech therapists to support children with CAS on their speech journey.

What is MOTOR LEARNING?

Motor learning refers to the process of acquiring and refining new skills through practice and experience. This applies to all aspects of movement, including speech production. The brain constantly receives sensory information about the movements being made and adjusts them based on the desired outcome. A breakdown or interruption of this process can make it difficult for children to plan, sequence, and coordinate the intricate movements involved in speech.

What key principles do we use in speech and language therapy for motor learning?

  • Task Specificity: Speech Therapy activities that directly target the specific speech sounds or skills your child is working on. For example, if your child is struggling with /p/, practising isolated /p/ sounds, words with /p/, and phrases with /p/ would be most beneficial.
  • Massed vs. Distributed Practice: We consider the optimal amount and distribution of practice sessions throughout the day. Massed practice involves concentrated practice in a single session, while distributed practice spreads practice sessions throughout the day. The best approach depends on the individual child’s learning style and attention span.
  • Feedback: We provide clear and immediate feedback to help your child understand the accuracy and effectiveness of their attempts. This feedback can be auditory, visual, or touch based.
  • Error Correction: We aim to gently correct errors so that we can help your child refine their movements and avoid developing bad habits. The focus is on providing specific cues and guidance rather than simply pointing out mistakes.
  • Variety and Progression: We gradually introduce new challenges and variations in speech therapy activities to prevent plateaus and maintain motivation.
  • Motivation and Engagement: A big part of our work is to make therapy sessions fun and engaging to keep your child motivated and actively participating. We use games, songs, and activities that your child enjoys while incorporating targeted practice opportunities.

What about home work?

Yes we need your help and here are some examples of how this could look:

  • Task Specificity: During story time, focus on practising target sounds present in the story. Have your child repeat words or phrases containing the sound and encourage them to identify the sound in other words.
  • Massed vs. Distributed Practice: Instead of one long practice session, try shorter, more frequent sessions throughout the day. This can help maintain focus and prevent fatigue. It is recommended to go for 100 repetitions of the target sound per day, every day in between the sessions. We can decide together how you can best do that through either massed or distributed practice. We can decide after the session.
  • Feedback: Use a mirror to provide visual feedback on lip and tongue placement during sound production. Record the child’s speech and play it back to help them self-monitor their accuracy.

I quite like this mirror below but any table top mirror will work as long as it is not too small. Your child should see their whole face easily.

tabletop mirror
  • Error Correction: If the child makes an error, gently model the correct sound or movement without shaming or criticising. Provide specific cues such as ‘lips together’ for /p/ or ‘tongue up’ for /t/.
  • Variety and Progression: We will guide you on exactly what words to practise so this is something you need not worry about.
  • Motivation and Engagement: Use games, songs, and activities that your child enjoys. Play a game of ‘I Spy’ focusing on words with the target sound or create silly sentences with the sound to make practice fun.

Let’s work together!

It is crucial for parents, therapists, and other caregivers to work collaboratively to ensure a consistent and comprehensive approach to supporting your child’s speech development. Speech and Language Therapists can provide guidance and resources on implementing these principles at home, while parents can share observations and progress updates to inform therapy sessions.

Remember, every child with CAS learns at their own pace. By understanding and applying the principles of motor learning, parents and speech therapists can create a supportive and stimulating environment that empowers children with CAS to reach their full communication potential.

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

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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    Halloween without the tears: Supporting children through the Spooky Season

    ByLondon Speech and Feeding

    For many families, Halloween is an exciting time filled with costumes, decorations, and sweets. But for children who are sensory sensitive, whether they’re autistic, have sensory processing differences, or simply find new experiences overwhelming, Halloween can feel like a night of chaos rather than fun.

    The bright lights, unexpected noises, strange textures, and social pressure to ‘join in’ can quickly become too much. The good news? With some thoughtful planning and gentle support, you can make Halloween a positive and manageable experience for your child.

    Understanding sensory overload

    Sensory overload happens when a child’s brain receives more sensory input than it can process. This might mean:

    • Costumes that itch, squeeze, or feel strange on the skin.
    • Loud sounds like doorbells, fireworks, or shrieking decorations.
    • Crowds and unpredictability during trick-or-treating.
    • Strong smells or tastes from face paint or unfamiliar sweets.

    When overloaded, children may cry, cover their ears, hide, run away, or ‘shut down.’ These reactions aren’t ‘bad behaviour’, they’re signs of distress. The goal isn’t to eliminate Halloween fun, but to adjust it to your child’s comfort level.

    Step 1: Choose costumes wisely

    Costumes are often the biggest trigger. Scratchy fabrics, tight seams, or masks that restrict breathing can be unbearable for some children.

    Try these tips:

    • Go sensory-friendly: Use soft, breathable fabrics and remove tags. Many retailers now sell sensory-safe costumes.
    • Test it early: Let your child wear the outfit around the house before Halloween. If it’s too much, simplify — maybe themed pyjamas or a favourite T-shirt with Halloween accessories.
    • Skip the mask: Face paint can be equally challenging, always test on a small patch of skin first. A comfortable headband or hat might be enough to feel ‘in costume.’

    Remember, participation doesn’t require perfection. Your child can still ‘be’ their favourite character without a full costume.

    Step 2: Plan your Halloween environment

    Before the big day, think about what parts of Halloween your child enjoys — and what might overwhelm them.

    At home:

    • Keep decorations minimal and predictable. Avoid motion-activated sounds or flashing lights.
    • Practise knocking at your own front door or saying ‘trick or treat’ with a trusted adult.
    • Have a ‘quiet space’ ready, a cosy corner or room where your child can retreat if things get too intense.

    If you’re going out:

    • Choose earlier, quieter times for trick-or-treating.
    • Visit a few familiar houses instead of the whole street.
    • Bring ear defenders or noise-cancelling headphones.
    • Have a clear exit plan if your child needs a break.

    Sometimes, watching from the window and handing out sweets can be just as enjoyable! it still offers social participation without sensory overload.

    Step 3: Prepare socially and emotionally

    Halloween involves a lot of unexpected social interaction: strangers at the door, unfamiliar greetings, and different rules.

    Help your child by:

    • Using visuals or stories: Read picture books about Halloween or make a short social story about what will happen.
    • Role-playing: Practise saying ‘Trick or treat!’ or handing out sweets in a fun, low-pressure way.
    • Labelling feelings: Explain that it’s okay to feel nervous or to take a break if something feels ‘too loud’ or ‘too much.’

    Children feel safer when they know what to expect. Predictability reduces anxiety and makes participation more enjoyable.

    Step 4: Rethink the treats

    Not every child enjoys sweets; some dislike sticky textures or strong flavours. Offer non-food alternatives like stickers, glow sticks, or small toys.

    If your child has feeding difficulties or oral sensitivities, it’s okay to opt out of the traditional treats entirely. They can still join in by giving treats or decorating treat bags instead.

    It’s also helpful to prepare your child that others might offer sweets they don’t want. Practising polite ‘no thank you’ responses can make these moments easier. (check out my symbol download for children who struggle to speak)

    Step 5: Celebrate your way

    Halloween doesn’t have to look like anyone else’s version. Maybe your family watches a ‘not-too-scary’ film, carves pumpkins, or does a flashlight treasure hunt indoors. The goal is joyful connection, not conformity.

    A calm, happy experience, even if it looks simple from the outside builds positive associations your child will carry into future celebrations.

    In summary

    Halloween can be full of sensory surprises, but with empathy, planning, and flexibility, it doesn’t have to end in tears.

    The more you adapt to your child’s sensory needs, the more they learn that they are safe, understood, and included not just at Halloween, but in every celebration.

    As with all things in speech and feeding development, progress starts with connection. When children feel regulated and supported, communication and confidence follow.

    HAPPY HALLOWEEN!

    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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  • Speech sound disorders

    ByLondon Speech and Feeding
    Kids Speech Therapist London
    Speech Sound Disorders

    Treatment Approaches – A Typical Session

    There are various great ways to treat speech sound disorders and I use all the approaches available selectively; I decide what works with each individual child and I also vary the approach depending on the child’s frame of mind at any given time during my session.

    Some of the approaches are more “drill-based” and require a child to be able to pay attention and really participate actively in the therapy, and this is what I am showing you today with this video clip.

    My little student here has been working with me for some time and from only saying a handful of words which were not very easy to understand he has come a long way. He does have some features of Verbal Dyspraxia which I shall briefly outline here:

    • Making sounds in general is a struggle, especially when asked to copy certain sounds, example: ‘can you say: a ee ou oo?”
    • Repeating sound sequences or words sequences is hard, for example: “say p-t-k in sequence” or “say fish chips fish chips fish chips
    • When saying the same word again and again, different mistakes can be heard
    • Intonation difficulties: speech sounds monotonous
    • Vocabulary is very limited

    Some therapy approaches are more play based, for example the Core Word method: here we pick a few words at a time which are very significant to the child and therefore highly motivating to try and say. These could be characters of Pokemon or Minecraft for example, or simple words like “GO!”

    When you watch the video you will see that I use a lot of visual prompting, such as showing him where the tongue is moving to or from. I do this with my index finger and this approach is called Tactile Cueing or “Cued Articulation”. Part of the approach is to give a visual prompt and then reduce the prompt as the learner is more able to produce the correct sounds. Once he can produce the sound on its own, we quickly move to the sound within a word.

    I do mix and match my approaches and in fact here I am drilling but I also use the Core Word which for him (YELLOW) — it’s his favourite colour and I happen to have quite a few good games where a YELLOW something or other can be asked for….. WHO KNEW!? 🙂

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

  • · ·

    The Hanen Program® – The beauty of the ‘4 S’

    ByLondon Speech and Feeding
    Image by freepik

    One of my favourite pieces of advice I give to parents is the ‘4 S’, a strategy coined by the Hanen Program® which I teach, particularly the ‘More than Words’ programme which is designed for and aimed at parents of children with Social Communication Difficulties or Autism. It is honestly one of those golden nuggets that I use myself in my practice and I highly recommend it to all my parents. There is something about terms like the ‘4 S’ that is easy to recall and therefore use.

    Introduction

    The ‘4 S’ is a strategy that helps to clarify the words we use with our children so that they can notice us, hear us and understand what we are saying.

    Research shows that we use on average 120-200 words per minute during everyday conversation. That’s a lot! And our children who are still learning to communicate are often bombarded with endless speech coming at them all day long. If we take into account that many of our students are Gestalt Language Processors, we can see that picking out relevant chunks of what we are saying is not at all easy, and this contributes to our children’s delays.

    So let’s look at the ‘4 S’

    1. The first one is SAY LESS

    This means we should use shorter, simpler sentences with good grammar, for example, something like: ‘let’s get ready, time to put our shoes on’ instead of what we might be saying: ‘come on then darling, let’s put your shoes on we need to get going it’s dark outside’ or similar.

    Good grammar helps to give clues about what words mean and how they are used in sentences. So, instead of ‘shoes on’ say ‘let’s put our shoes on’.

    2. The second one is STRESS

    I hear you think ‘I am stressed!‘. – NO! here it means ‘highlight’. We use our voice to highlight the important words in our sentence or phrase. For example, when you say ‘this banana is so yummy’ you can stress the word ‘yummy’ by saying it a bit louder and you can make a gesture, like rubbing your tummy as you say it.

    3. The third one is GO SLOW

    This means to speak a bit slower than you normally would and add pauses. By slowing down the pace of our speaking we give our child time to think and understand what we are saying. When we allow for pauses after we have spoken, we are inviting our child to say something in response.

    4. The last one is SHOW

    Always remember to show actions, gestures, objects, and point to pictures while speaking to help support your child’s understanding. We can show our child what words mean by pointing to things or holding up objects whilst describing or talking about them.

    At this point I would also like to recommend the use of Core Boards, and particularly Electronic AAC devices, such as LAMP Words for Life or PODD. I have written about this in other blogs but can always be persuaded to say a bit more on the matter… 😊 It is such a big help to have an AAC talker available for both the child and the adult so we can find words and pictures to help support the words we are saying.

    For example, today when reading a book like The Hungry Caterpillar (so good!) I used my LAMP AAC talker to make comments as we were looking at the pages together with my student. Example: ‘Look! He is eating more cake he is very hungry’ using my AAC talker I was able to supplement my speech and at the same time I was inviting my minimally speaking child to press a button or two and reply with ‘cake!’ which they would not have said with their mouth otherwise.

    5. It does say ‘4 S’ but really it should be ‘5’ except the fifth is not an ‘S’

    The fifth is REPEAT.

    Repeat words and phrases often throughout the day. When learning a language we all need to hear words and phrases several times and in different situations before we can understand, remember, and then eventually use them. Our children are ‘new language learners’ and so we can apply the same principles that we would when learning a new foreign language ourselves.

    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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  • 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.

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  • · ·

    Explore how to improve communication skills for a Gestalt Language Processor

    ByLondon Speech and Feeding

    Let’s break it down into steps to make these complicated words easier to understand. Once you have a deeper understanding, you will then be able to support your child or young person develop their communication skills in the best way as a Gestalt Language Processor. Remember not every child will be a Gestalt Language Processor; if your child uses echolalia and/or has a diagnosis of autism then your child’s way of processing language is most likely different to the classic way children typically learn language.

    Let’s start with understanding what each of these words “Gestalt Language Processors” mean.

    Gestalt: “the way a thing has been placed or put together”

    Language: “a system of human communication”

    Processors: “responds to and processes basic instruction”

    So, let’s put those meanings together. “Gestalt Language Processors are children who process early language in strings of sounds or chunks.” They tend not to process single words.

    It is important to understand this way of processing communication because between 75-90% of children with Autistic Spectrum Conditions process language in this way (Blanc, 2012). We know that it’s important for young people to have their voice heard and to be able to express themselves. So, it’s vital that they move from echolalia to self-generated communication to be able to do this. This means that our children’s communication partners play a vital role in supporting their child’s language. We can support our children by modelling phrases until the child has learnt the process themselves.

    Speech Therpaist in London

    Let’s explore an example together

    X (who is a gestalt language processor) and his family love to feed the ducks in their spare time; this is an activity that takes place regularly. Let’s look at how you, as the adults, could support X in his communication. Look at the phrases that are used. They are meaningful to the activity with repetition used throughout.

    Top tip: You could think of an activity you and your child or young person take part in on a regular basis and brainstorm some key phrases that you could use.

    Need a boost in confidence to support your child’s gestalt language processing?

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

    ByLondon Speech and Feeding

    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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