Principles of Motor Learning in Childhood Apraxia of Speech (CAS)

Speech and language therapists provide treatment, support and care for children and adults who have difficulties with communication, eating, drinking and swallowing. We help children and adults who have problems speaking and communicating.

How to find the perfect therapist for my child/client:

There are a huge number of speech and language difficulties, or feeding and swallowing problems that we can help with and the first thing to think about is what age group the person is you are seeking help for. Most SLT’s specialise in a range of disorders and treatments and they often treat specific age ranges. This could be, for instance, very young children up to 3 years, or school aged children, adolescents or just adults. Once you have narrowed it down to age and general area of difficulty you can then go and seek your perfect SLT match.

Generally it is my view that SLT’s with a narrow area of specialist interest are most likely to help you better if the problem you or your child/adult is having is significant and/or profound. For example, if your child has a very severe stutter/stammer but is otherwise developing fine and has good skills all round, then I would recommend to look for an SLT who only specialises in stammering/stuttering, or has only a small range of other specialist areas related to stammering , such as speech and language delay.

The reason is that it is a tall order for any professional to stay up to date with latest research, latest clinical developments and training for more than, say, five distinct areas of interest.

However, a more generalist Speech therapist who has lots of experience in many different areas could be a very good option for your child or adult who has more general speech and language delay in a number of areas, perhaps a global delay or a syndrome which means that their learning is delayed in general. It also means that your child might benefit from a Generalist SLT because they have many more tools in their SLT bag and your child might need a variety of approaches for several areas.

A good place to start is www.asltip.com which is the Association for Independent Speech and Language Therapists in the UK. Any SLT registered with ASLTIP will also be registered with the HCPC (Health Care Professionals Council), as well as RCSLT (Royal College of Speech and Language Therapists). These two important UK professional regulatory bodies ensure all its members are fully qualified, and are fully up to date with latest developments within their areas of work.

Here you can enter your post code and look for a therapist near you and you can look for specific problems such as stammering for example and narrow down your search. Most therapists have a website which you can then access too. I would recommend you speak to a few therapists on your list and then go with the person you had the best rapport with. You and the therapist will be spending a lot of time together and you will need to feel that you trust them and that you can relax into the process.

How I can help you:

I have 3 main areas of specialism:

Parent Child Interaction Coaching

This is an amazing way to help children with the following difficulties:

• Social Communication Difficulties, Autistic Spectrum Disorders and
• Speech and Language Delay – for children under the age of 4 years old, this is my preferred way of working because it is so very effective and proven to work. If your child is not developing words or not interacting, has reduced attention and listening and you feel is not progressing or, in fact even regressing, then this way of working is the best. For anyone wanting to read a bit more about the efficacy of this method, below are some research articles. You may also like to check out www.hanen.org which is the mainstay of my work and method when it comes to Parent-Interaction Coaching. You can also look at my latest blog, entitled: Tele-therapy, does it work?

In brief, what’s so great about Parent Coaching is that it empowers you the parent to help your child in daily life! This is where speech, language and social communication develop typically, in a naturalistic way and environment. Simple steps and strategies are discussed and demonstrated every week and you are encouraged to use these strategies with your child in daily routines: getting dressed, having breakfast, on the school run, whilst out in the park or shopping or simply playing at home or having dinner or bath time. Whatever your family routine happens to be, every strategy I teach you will help create a responsive communication environment; generally, if your child is able to develop speech then they will do so in direct response to your changed interaction style.

Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

I love working with children of all ages on developing their speech sounds. Whether your child has a lisp, or a couple of tricky sounds they simply cannot produce quite right, or perhaps your child is really unintelligible because he/she is having lots of different sound errors, making it really hard to understand them. I typically work on getting “most bang for your buck” , meaning I address the sounds that cause the most problems and, therefore, when they are fixed your child/person’s speech becomes that much clearer fairly quickly.

Feeding and Swallowing Difficulties

Having worked for over 20 years in NHS Child Development Clinics and Special Needs Schools I trained and worked with feeding and swallowing difficulties early on in my SLT career. I later trained as a Lactation Consultant and so I am well placed helping and support all types of Infant feeding, both breast or bottle, as well as toddler weaning. I aim to ensure that your little one swallows the right kind of foods and drinks for their abilities. I am experienced in managing and supporting children with physical needs and mobility problems, Cerebral Palsy, Down Syndrome or any other type of syndrome or presentation.

What does a speech therapy session look like?

All sessions differ slightly depending on the age of the child and the nature of the difficulties.

However, mostly our sessions look like FUN! After arrival and washing hands we tend to start off with the tricky work straight away whilst our child still has energy and the will to engage. So, for speech work we will focus on the target sounds first: this could be sitting at a table doing work sheets together, playing games using the target sound and really any type of activity that gives us around 70-100 repeats of the target pattern. For example, a child who is working towards saying a ‘K’ at the end of the word I will try and get around 100 productions of words like: pack/sack/lick/ pick/bike/lake and so on.

Then we often play a fun game where I might try for a ‘rhyming’ activity or other sound awareness type activities, for perhaps 10 minutes and within that time I aim to trial the next sound pattern we need to improve on; I will test which sound your child can do with help from me. During he last 10 minutes we might look at a book, again listening to and producing whatever sound we are working on. If I did not get 100 sounds earlier on in the session I will try and practice them now as part of the story. In total I aim to have about 40-45 minutes of activities, all aimed at the target sound we are working on.

What does a Coaching session look like?

During a Parent Coaching Session we meet online for about an hour and we discuss how the week has been for you trying out the strategies. Typically parents start off recalling what went well, what progress was made and what had been more tricky. We work through it all, and then follow on to the next strategies: I will show you examples and demonstrations of each strategy and I will get you to think about how you can use this with your child and in what situation you might use it. I will explain what we are doing and what the purpose is. You might want to write down what you are going to work on for the week. Over the course of about sessions we can cover all the major strategies that are proven to help kickstart spoken language and/or help your child to connect more with you. Through that connection spoken words most often develop.

Research Papers on the Efficacy of Parent Child Interaction Coaching

• The It Takes Two to Talk Program has been shown to be effective in changing how parents interact with their children, and that children’s communication and language skills improve as a result.
• Baumwell, L.B., Tamis-LeMonda, C.S. & Bornstein, M.H. (1997). Maternal verbal sensitivity and child language comprehension. Infant Behavior and Development, 20(2), 247-258.
• Beckwith, L. & Cohen, S.E. (1989). Maternal responsiveness with preterm infants and later competency. In M.H. Bornstein (Ed.). Maternal responsiveness: Characteristics and consequences: New directions for child development (pp. 75-87). San Francisco: Jossey Bass.
• Bronfenbrenner, U. (1974). Is early intervention effective? (Publication No. (CDH) 74-25). Washington, DC: Department of Health, Education, and Welfare, Office of Child Development.
• Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders, 53, 156-167.

Sonja has been a real help for my 5 year old daughter. Due to her support, my daughter is now able to clearly and correctly enunciate ‘th’ ‘f’ and ’s’. She was also helpful in making positional changes to her seating to help her concentrate better and kept her engaged throughout all the lessons which is a feat in itself on zoom!

Helen, Mother of Catherine Age 5.

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.