Principles of motor learning in Childhood Apraxia of Speech (CAS)

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We use powerful motor learning principles to help children with CAS (Childhood Apraxia of Speech) learn how to produce better, clearer speech sounds in words, phrases and sentences.

What are these principles?

Principle 1: MASSED PRACTICE

This is where you see a child for lots of sessions in a shorter period of time, so for instance six weeks of three times weekly for 30 minutes.

This leads to motor performance or automaticity.

Principle 2. DISTRIBUTED PRACTICE

This is what I use, as most of my clients are not able to come and see me that often on a weekly basis. It is hard to travel in London and life is hectic. So I favour one session a week over say a term or two terms and a session is usually 45 minutes long.

This leads to improved Motor Learning and good generalisation.

During either Massed or Distributed Practice, we choose between 4 variables:

Principle 3: Constant vs Variable

Principle 4: Blocked vs Random

To explain:

Constant Practice is where we repeat the practice of a small handful of target words.

We practise the same target sound in the same word position, e.g. at the beginning of a word: ‘bee’, ‘bye’, ‘bow’, ‘baa’ or ‘key’, ‘car’, ‘cow’, ‘Kaye’ etc.

We keep the rate, pitch and intonation constant.

Variable Practice is where we vary the rate, volume, pitch and intonation of the targets

We use a larger number of sounds, and words that are motivating to say for the child.

For example, if a child loves Peppa Pig then I might choose the words: ‘Peppa’, ‘Daddy Pig’, ‘George’, ‘Mummy Pig’ and a couple of other favourite characters. My child might struggle with a number of sound sequences there but we will target them one by one.

We can also select simpler words like ‘cape’ and ‘cake’ or ‘tick’ and ‘tip’.

Blocked Practice is where we practise one target word for say five minutes then we move to another target word for the next five minutes and then we revert back to the first target word again and so on, so blocks of practice.

Random Practice means we practise several target words at the same time.

How do I decide on what to use?

Good question!

I always opt for distributed practice (weekly for up to 45 minutes).

Within that, I tend to find it most successful to start out with constant practice when a child is finding a certain sound sequence really hard and we need to just ‘nail it’. Bearing in mind I only pick sounds that my student can actually make in isolation, so we are not working on articulation! (where we focus on trying to elicit single sounds correctly – or even at all sometimes) Here in CAS work, we are working with sounds the student can make but is having trouble to add together, into a sequence that is needed to make a word sound right.

As soon as I feel we have some traction I will go to variable practice, i.e. I pick words that are either funny or interesting for the child and it can be a slightly larger number.

I tend to use blocked practice in the beginning or when working on vowels. That’s because it is more important we get our vowels right. They carry a word and are very important for overall speech intelligibility. Once we are on a roll, I tend to go more for random practice.

Example

Here in the video clip, we try and work the /e/ vowel in short words likes ‘bell’, ’fell’, ‘dell’, ‘sell’, ‘smell’ and I am using an AAC device to give a child’s voice as auditory feedback as well as using the PROMPT approach to help my student shape his vowels.

So this is:

  1. Distributed (1 x week for 45 minutes)
  2. Constant – we are practising the /e/ vowel in the same position in six different words
  3. Blocked – we did this: several repetitions of each word and after the sixth we moved to another sound, and then later we came back to this.

Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.

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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    One toy, endless targets: How to grow consonant clusters, core words and colours with one flower garden toy

    Sonja McGeachie with the build-a-flower garden toy

    If you’ve been following me for a while you already know my absolute favourite rule for speech therapy: let the toy work for you. You don’t need an entire cabinet full of different flashcards or games to target a massive range of speech goals (though truth be told I do have 4 cabinets! What am I saying…) but often I find that sticking to one highly engaging, open-ended toy reduces a child’s cognitive load, keeps them firmly planted in play, and gives you dozens of natural opportunities for high-repetition practice. It also reduced my cognitive load!

    In today’s post we are looking at a classic: The build-a-flower garden toy. A link is here: https://www.amazon.co.uk/Fivejoy-Flower-Garden-Building.

    This vibrant, stacking toy isn’t just great for fine motor skills. It is an absolute goldmine for speech therapy. While it is incredible for targeting tricky consonant clusters (blends) like /ST/, /SP/, /SPR/, /FL/, /BL/, and /GR/, it is equally powerful for building functional core vocabulary.

    1. Digging deep with /ST/

    Let’s start building our garden.

    Stem & stalk: ‘Look at this long stem!’ or ‘Can you put the stem in?’ or ‘do you want the green or the red stem’?

    • Stuck: If a piece is a little tight to push down, it’s a brilliant opportunity for a natural exclamation: ‘Oh no, it’s stuck! Help me!’
    • Stand: Once it’s secure, you can celebrate: ‘it can stand up now!’
    • 👉 Core word integration: Use this setup stage to practise ANOTHER ONE. As you hold the base pieces, wait for the child to use their words or AAC device to request, ‘I want another one!’ before handing over the next stem.

    2. Sowing seeds with /SP/ and /SPR/

    Every good gardener needs the right equipment and a close eye for detail. We can introduce tools and descriptive language to hit our /SP/ and triple-blend /SPR/ targets.

    • Spade: Grab a toy shovel or pretend to use one. ‘Let’s dig a hole with the spade.’
    • Spot: Point to the holes on the base. ‘Find a good spot for this flower.’
    • Sprout: Talk about the little green pieces: ‘Look at the little sprout!’
    • 👉 Core word integration: Build on spontaneous requesting here. If they are eyeing a specific piece, model a full phrase like: ‘I WANT THE PINK ONE.’

    3. /FL/ and fine motor actions

    Now, we can start adding the colourful petals.

    • Flower: This is your high-frequency word for the entire activity. ‘Put the green/blue/pink flower on top.’
    • Flat & flutter: ‘This piece is flat on the ground,’ or ‘The butterfly flutters by!’
    • 👉 Core word integration: This stage is perfect for teaching directional actions. Every time they stack a petal onto a stem, model the core phrase: ‘PUT IT ON!’

    4. Blending it all together with /BL/

    Building a garden is a fantastic sensory experience because of the vivid colours. We can lean heavily into the /BL/ sound by focusing on colour selection and the action of growth.

    • Blue & bloom: ‘Should we use a blue flower?’ and ‘Watch it bloom!’
    • Blade & blend: Point out the blades of grass and talk about how we blend all the colours together.
    • 👉 Core word integration: Don’t just focus on putting the toy together, taking it apart is half the fun! If a child places a piece they don’t want, or when it’s time to clean up, model: ‘TAKE IT OFF.’

    5. Working the /GR/

    Finally, we look at the environment supporting our garden. The /GR/ blend can be targeted by looking downward at the base of our toy setup.

    • Green: Nearly every stem and base piece in this toy is a vibrant shade of green.
    • Grass & ground: ‘Put the base down on the ground.’ ‘Look at the green grass.’
    • 👉 Core word integration: Combine your /GR/ blend with a powerful core phrase. As you pull a stem upward slowly or stack the petals higher and higher, chant together: ‘MAKE IT GROW! Grow, grow, grow!’

    Maximise your repetitions in play

    The beauty of the flower garden toy is its repetitive nature. Because a child builds multiple flowers, you aren’t just saying a word or a phrase once, you have the potential to repeat it 10, 15, or 20 times in a single sitting without the child losing interest.

    By layering structural speech sounds (like blends) over functional communication phrases (like core words), we give children words they can use across their entire day.

    What toy would you like to see us target next in our series? Let me know in the comments on Instagram, and don’t forget to swipe through the carousel there to save these word lists for your next playtime!

    If you are concerned about your child’s speech, please do not hesitate to get in touch. I would love to help you find some answers.

    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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    For many children, especially those navigating Childhood Apraxia of Speech (CAS), the challenge isn’t just making individual sounds. It’s the ‘speech gymnastics’ required to move smoothly from one sound to the next.

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    • The /T/ sound: A tiny tap of the tongue behind the teeth.

    Why is this important?

    You might ask, ‘If I can still understand them, does it really matter if they say “ter-ain”?’

    The goal of speech therapy isn’t just functional communication; it’s building phonological awareness. When a child adds extra vowels, it can eventually impact their literacy. If they hear ‘ter-ain,’ they are much more likely to eventually spell it as ‘terain’ or ‘traint’.

    By helping them master these clusters through co-articulation now, we are setting them up for success in reading and writing. And we are giving them the confidence to speak with ease.

    Feel free to contact me if your child needs help with clusters or other difficulties either aligned with Childhood Apraxia of Speech or other articulation difficulties.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    References

    • Hall, N. (2011). Vowel Epenthesis. In The Blackwell Companion to Phonology (eds M. Oostendorp, C.J. Ewen, E. Hume and K. Rice). In this work, epenthesis is defined as the insertion of a vowel to break up complex consonant clusters into simpler, more manageable syllables. This is often viewed as a ‘repair strategy’ used by the brain when a transition between sounds is too complex to execute quickly.
    • Aichert, I., & Ziegler, W. (2004) Brain and Language 88(1):148-59. Syllable frequency and syllable structure in apraxia of speech. This research highlights that children with Apraxia often struggle specifically with word-onset clusters, leading to distortions like the schwa.
    • Browman, C. P., & Goldstein, L. (1992) Phonetica 1992;49(3-4):155-80. Articulatory Phonology: An Overview. This paper explains that fluent speech requires ‘gestural overlap,’ where the movements for two different sounds happen simultaneously. This supports the ‘Best Friends’ method of keeping sounds close together.

    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 joyful language toolkit: Strategies for connecting with your child through play

    As parents and therapists, we all want to help our children communicate. But sometimes, the process can feel like ‘work’. If I had a penny for every parent saying ‘I find it so boring!’… Ok hang in… what if I told you the most effective therapy happens when it doesn’t look like therapy at all?

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    Some of my favourite strategies

    Today I want to share a few of my favourite strategies to turn everyday interactions into powerful communication opportunities regardless of why or how big a delay your child is having.

    1. Facial expressions & exaggeration: Use an exaggerated facial expression to show surprise (wide eyes!), excitement (big smile!), or confusion (a crinkled brow!). Your face is a powerful teaching tool. I am always talking like a clown in my sessions. I can announce that I have also a normal speaking voice outside my clinic room! 😊
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    5. Core board & language modelling:
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      • Model the core board repeatedly throughout the activity, showing genuine excitement. This demonstrates the board is a joyful tool, not homework.
      • Pointing to the core board: When you say a core word, point to the corresponding symbol. You are showing your child, ‘My words live here, and your words can too’.
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    8. Following your child’s Interest: Put down your agenda and follow your child’s lead. If they pick up a block, talk about the block. This ensures they are engaged and ready to learn.
    9. Allowing for pauses: This is critical! After you made a comment, allow for a significant pause (count to five in your head) for your child to fill. The silence creates a powerful opportunity for them to initiate communication.
    10. Copying your child’s sounds: If he or she makes a sound (‘buh!’), you make the sound back! Copying your child’s sounds shows him or her ‘I hear you, and your communication is important’.
    11. Lots of repetition: Hearing a word many times in meaningful contexts is how we learn! Repeat key phrases and core words throughout the activity. Repetition is the key to retention.
    12. Getting turns: Explicitly teach and celebrate getting turns in a game. ‘My turn! Your turn!’ This is a foundational social and communication skill.
    13. Using tidy up as a teaching activity: Turn cleanup into a fun game! It’s a goldmine for core words like PUT IN, ALL DONE, HELP, and MORE. For example, ‘Let’s PUT IN the red block! Yay!’
    14. Using exaggerated repeats: When your child tries a sound or word, give it back with exaggerated, tuneful repeats.

    Try out all or even just a few of these strategies, and I can promise you, you’re not just encouraging language; you’re building a joyful, reciprocal relationship based on genuine communication!

    Which strategy are you excited to try first? Let me know in the comments!

    If I can help you with any of the above, if you want to practise these a bit more, I would love to help you!

    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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    Bilingualism – should I speak only English with my speech delayed child?

    Introduction

    Bilingualism is a beautiful aspect of our diverse world. Growing up in a bi- or multi-lingual household is a wonderful gift, allowing children to communicate with a broader range of people and access many cultures.

    My own two children grew up in a bilingual German-English speaking household. They have both been so enriched by this experience, not only language- and learning-wise but of course also culturally: their world has always been so open and colourful. Growing up in inner London and having their German family and mum’s friends as well, this has been a wonderful experience. Both my boys speak German well (not quite like native speakers but like very good second language speakers) and both have very easily learned 3rd and 4th languages additionally when in secondary school.

    Whilst bilingualism has untold benefits, it’s not uncommon for bilingual children to take slightly longer to reach certain speech milestones. This should not be automatically mistaken for speech disorders but rather seen as a natural part of bilingual language development.

    Bilingualism and speech delays

    Sometimes, of course, we do see speech delays or disorders where a child’s speech development lags significantly behind their peers. We often see a delay in both languages equally, making it extra hard for to communicate effectively. BUT PLEASE KNOW the family speaking in multi-lingual languages never caused the delay/disorder!

    If there is a delay or a disorder any number of other reasons could have caused it, such as:

    • hearing impairments,
    • reduced phonological awareness,
    • sensory processing issues,
    • reduced attention and reduced joint attention,
    • neuro-developmental delays or difficulties,
    • general or specific learning difficulties
    • or sometimes other genetic factors.

    So, to say that the difficulty is due to a child being exposed to several languages is a red herring. (no offence to herrings!)

    Speech therapy

    Speech therapy can be powerful to help bilingual /multilingual children with speech delays unlock their full linguistic potential. By providing individualised assessments, targeted interventions, and involving families, speech therapy can bridge the gap between speech delays and bilingualism. It’s essential for the therapist and parents to work together to support the children in their unique linguistic journeys, helping them communicate effectively and thrive in both of their languages.

    Happy Islamic family sitting on the floor
    Image by Freepik

    Speak your home language at home

    Many parents report that they worry about speaking their home language at home and instead they have been focusing on just speaking English at home. They now rarely use their home language with their child. They fear that speaking a language other than English with their child will cause further delay and hinder their progress. All parents want the best for their child and often parents fear that their child won’t fit in or will be seen as ‘different’. So we can understand why parents feel that the English language is the only one worth having.

    But the opposite is the case: it is crucial to speak in both languages freely, both at home and outside the home! Both languages will benefit your child, no matter what the delay or difficulty is. Acquiring a ‘mother tongue’ or native language is absolutely vital for children to have a good, solid linguistic grounding on which to build other languages. Bilingual children may mix languages during speaking and parents may equally mix their languages. This does not hinder language development and is a natural part of linguistic development.

    Speak freely and naturally

    What is far more important than the question: ‘which language should I say this in?’ Instead think: ‘let me speak freely and naturally, let me respond naturally, in good intonation and let communication flow freely to the child.’

    Speech therapy can be a crucial resource for bilingual or multilingual children and their families.

    We work on targeted interventions to address speech and language difficulties, helping your child develop essential communication skills. For home practice between therapy sessions, we can recommend tailored treatment plans to help you help your child in daily life. Our input could be focusing on articulation, phonological awareness, attention and listening, vocabulary development and grammar.

    Family support is crucial in speech therapy. We like to work closely with parents to provide guidance and strategies for fostering language development in both languages at home.

    If you have any worries about your child being delayed in a bilingual or multilingual household do get in touch and we will be happy to support you in your journey.


    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 activities for Gestalt Language Processors to aid communication

    Speech Therpaist in London

    When you have a child who uses Gestalts it is often difficult to think and adapt clinic activities into those to use at home. More importantly, you find that individualising your activities for your child who uses Gestalt are time-consuming. But you value its importance for their communication development.

    You feel so busy, you are taking them to other appointments, or trying to get through your daily activities, all whilst still ensuring your child’s emotional needs are met. You know life should not get in the way of your child’s therapy activities at home, but it does. We know your spare time is precious and limited, so let us achieve your child’s or young person’s goals in the allotted time you have which meets their way of learning (using Gestalts).

    We wanted to support you by exploring items which you may have at home, and we will give you some key phrases which you can start to model with your child. Whereas our last blog introduced the idea of gestalt language processors, we are now developing ideas to give you the tools to implement activities at home. We recognise how overwhelming it may feel, and this is one of the reasons to make activities as straight forward as possible. Therapy does not need to be complicated; it just needs to be carried out on a regular basis.

    Explore the samples I’ve created to give you an idea of how this might look but please consult with a Speech and Language Therapist who knows about Gestalt Language Processing so that you can work together to develop great home activities for your child.

    Want to learn more about gestalt language processing?

    Please contact me for help.


    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 art of selective care: My journey as a semi-retired private therapist

    Welcome!

    Hello, and welcome. I’m writing this today to share a bit about my professional journey, a journey that has evolved over many years from a bustling, full-schedule practice to a more intentional, deeply fulfilling semi-retired life. This shift wasn’t born out of a desire to slow down, but rather an understanding of what truly matters: my time, your time, and the quality of the work we do together.

    For decades, I poured my energy into a full calendar, helping as many families as I possibly could. It was a wonderful, demanding, and rewarding time. I learned so much, grew immensely as a professional, and had the privilege of witnessing countless moments of breakthrough and success. But over recent months, I began to realise that the most impactful work wasn’t about quantity; it was about quality. It was about giving my whole, undivided attention to a select few, creating an environment where true progress could flourish.

    Change

    This realisation led to a significant change in my practice. I am now at a point in my career where my time is both valuable and precious. It is no longer a commodity to be filled, but a resource to be invested wisely. This doesn’t just apply to my personal life, but to my professional life as well. I’ve chosen to be more selective about the clients I see, and this selectivity is rooted in a single, powerful question: ‘Who can I truly, profoundly help?’

    I believe that successful therapy is a partnership. It requires commitment, trust, and a genuine connection between therapist and client. When I take on a new family, I am not just filling a slot in my schedule; I am making a deep commitment to them. I am dedicating a part of my precious time and decades of expertise to their child’s success. This is why I am now focusing on who I can really work with: families who are equally invested in the process, who understand that progress is a team effort, and who are ready to engage fully in the journey.

    My fees reflect this deep investment. You will find that my rates are higher than those of many other therapists, and I want to be transparent about why. It’s a reflection of the extensive experience I bring to the table. I have spent years honing my skills, navigating complex cases, and developing a unique, effective approach to speech, language and feeding challenges. This is not just a job for me. It is my life’s work, and I honour the value of that expertise and the time I dedicate to each family.

    I want to ensure that every minute you spend with me is productive, focused, and truly transformative. Therefore, I provide a ‘boutique style’ of care. Think of it as an exclusive, personalised experience where every detail is considered and your needs are at the forefront. You won’t feel like you’re just another appointment on a long list. You will feel that you have my full, undivided attention, as if you were my only client.

    This means less time spent on administrative tasks and more time dedicated to preparing for your sessions, reflecting on our progress, and providing you with the most thoughtful, tailored support possible. It means an environment of calm and focused expertise, where we can truly dive deep into the specific challenges and build a clear, effective path forward.

    New perspective

    For parents reading this, I hope this provides a new perspective. Choosing a therapist for your child is one of the most important decisions you can make. It’s about finding not just a professional, but a partner. I want you to feel that, if we choose to work together, you are entering into a unique partnership where your child’s growth is my singular focus.

    In this next chapter of my career, I am prioritising passion over pace, depth over breadth, and meaningful connections over a packed schedule. I am here to work with families who are ready for a truly collaborative and transformative experience. If you are seeking a level of care that goes beyond the standard, an approach that is both highly experienced and deeply personal, I would be honoured to speak with you.

    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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