Something that keeps surprising me…

ByLondon Speech and Feeding
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After thirty years of helping children with lisps, you’d think very little would still surprise me. And yet…

Girl looking at herself in a mirror and looking at her tongue

Every few weeks, a lovely, and well-informed parent will describe their five, six, or seven year-old’s slushy, sideways /S/ and then ask ‘So, how many sessions do we need to fix this? Perhaps five–six? ‘

And every time, I have to resist the urge to laugh, cry, and reach for the biscuits all at once. Because the honest answer, for an established lateral lisp in a school-aged child, is usually twenty sessions or more. Wait! Hear me out!…

‘Why so many?!’ … once you understand what’s actually going on inside your child’s mouth, the number 20+ does no longer sound outrageous and starts sounding rather reasonable.

First: not all lisps are equal

Most people picture a lisp as the gentle, even endearing /TH/ for /S/ — ‘thnake’ instead of ‘snake’. That’s an inter-dental lisp, where the tongue pokes forward between the teeth. It’s common, it’s developmentally normal in younger children, and this is the important bit, it’s usually visible. It’s still a bit tricky to correct at first but I often can show a child what to do, they can watch themselves in a mirror, and quite often we’re away. But it still takes a lot longer than parents think because just fixing the sound does not mean it will be produced correctly in normal, daily speech and conversation.

Lateral lisp

A lateral lisp on the other hand is an entirely different animal. Instead of the air flowing in a neat central stream down a groove in the middle of the tongue, it spills out over the sides, around the molars. The result is that wet, slushy, quality. It affects not just /S/ and /Z/, but very often /SH/, /CH/ and /J/ too which is a big chunk of English.

Here’s the snag: it’s happening where nobody can see it. There’s no mirror in the world that shows you the sides of your tongue as you are speaking, or chewing for that matter. We’re teaching a child to control a movement they can’t see, can’t easily feel, and have never once performed correctly in their life.

By five, six or even seven years old your child has said the /S/ sound about several hundred times a day, every day, for several years. It’s one of the most frequent sounds in English: it makes our plurals, our possessives, our verb endings. Every ‘cats’, ‘let’s’, ‘she runs’.

So we are now talking about a deeply ingrained motor habit, rehearsed tens of thousands of times, that now feels completely normal and correct to the child producing it. We’re not teaching a new skill onto a blank page; we’re overwriting a very strong habit. Think of a tennis player with a flawed serve who’s played for five years… You don’t fix that in a fortnight, and nobody expects you to.

The good news is: school children, seven-year-old and up, are brilliant at this work. They can self-monitor, they can practise independently, they can hear the difference. It just takes time.

The quiet culprit: where the tongue lives at rest…

Here’s the piece that most parents have never heard, and it explains a lot.

When the mouth is at rest, the tongue should sit up — tip resting lightly behind the top front teeth, body gently suctioned to the roof of the mouth, lips together, breathing through the nose.

Many children with a lateral lisp have a low, forward resting tongue posture. The tongue sits on the floor of the mouth, often with the lips slightly apart. This is frequently associated with a history of mouth breathing, blocked noses and allergies, enlarged tonsils or adenoids, prolonged dummy or thumb-sucking, and sometimes dental or orthodontic differences such as an open bite.

Why does this matter so much? Because a good /S/ requires the tongue’s sides to brace firmly against the upper back teeth to form that central channel. A tongue that spends 23 hours a day flopped on the floor of the mouth simply doesn’t have the habitual strength, position or awareness to do that on demand. We can teach a beautiful /S/ in the clinic — but if the tongue’s default setting is ‘down’, we’re swimming upstream all week.

So, for many children, part of the work is establishing a better resting posture alongside the sound itself. That’s foundational and it’s slow.

So what does twenty-plus sessions actually achieve?

Therapy for a lateral lisp moves through a strict hierarchy, and you cannot skip a rung:

  • Auditory discrimination: Can they hear the difference? (Often, initially, no.)
  • Eliciting the sound: Sometimes a single session, can be six.
  • Stabilisation: Building consistency in isolation, then syllables, then single words (beginning, middle, end).
  • Blends: Mastering challenging combinations like ‘spoon’, ‘street’, and ‘smile’.
  • Sentences: Moving to phrases, full sentences, and structured conversation.
  • Generalisation: Using it naturally with family, at school, when tired, or when telling a long story.
  • Self-monitoring: Training them to catch and correct themselves without therapist intervention.

Rushing a level guarantees a collapse two levels later. I’ve never once regretted going slowly; I’ve frequently regretted going fast.

The bit that decides everything: home practice

Let me be blunt in a nice way 😊 The child who practises five to ten minutes a day, six days a week, will finish in half the time of the child who practises the night before their session.

An hour with me per week is roughly 1% of your child’s waking life. The other 99% is where habits are made or unmade. What I need at home is:

  • Short and daily beats long and occasional: Five focused minutes, ideally at a consistent time.
  • Practise only at the set level: If we’re on words, don’t leap to sentences. That’s how we go backwards.
  • Give specific feedback: Say ‘that one was lovely and sharps or ‘that one slipped sideways, try again’.
  • Hold back on everyday corrections: Don’t correct them in normal conversation until we’re ready.
  • Record them occasionally: Children love hearing their own tangible progress.

The bottom line

I’m good at this. I’ve been doing it for thirty years and I love it. But I’m a therapist, not a magician, and the parents who get the best outcomes are the ones who view this as a partnership. When we work together—combining expert clinic guidance with steady, gentle practice at home, that ‘twenty-plus’ number isn’t a sentence. It’s simply the guideline to giving your child a clear, confident voice for the rest of their life.

Do get in touch with me. I would love to hear from you and help you and your child.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

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

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    From ‘Nailed it!’ in therapy to ‘Whoops!’ at home: Why generalising speech sounds is tricky

    ByLondon Speech and Feeding

    As a parent, you’ve likely experienced the triumphant feeling when your child, who’s been working so hard on his or her /S/ sound, produces it perfectly in a therapy session. He or she is rocking those ‘sun’ and ‘socks’ words, his or her lisp seemingly a distant memory. You leave feeling elated, confident that all that hard work is finally paying off.

    Then you get home. And within minutes, you hear it: ‘Thooper!’ instead of ‘Super!’ Or maybe the clear /R/ in ‘rabbit’ from therapy reverts to a ‘wabbit’ when his or she is playing with his or her toys. It’s frustrating, confusing, and can feel like you’re back to square one.

    So, what’s going on? Why is it so difficult for children to take those amazing skills learned in a focused therapy session and seamlessly apply them to their everyday conversations? You’re not alone in wondering this. It’s a common challenge in speech therapy and understanding the ‘why’ can help both parents and children navigate this crucial stage.

    The brain’s habits: Old pathways are strong pathways

    Think of your child’s brain as having established ‘pathways’ for how he or she produces certain sounds. If he or she has been lisping his or her /S/ sound for years, that neural pathway is deeply ingrained. It’s like a well-worn path through a field: easy to follow because it’s always been there.

    In therapy, we’re essentially trying to forge a new path. We’re teaching him or her a new, more accurate way to make the sound. This new path is initially faint, like a barely visible trail. It takes conscious effort and repeated practice to strengthen it. Outside of the structured therapy environment, his or her brain often defaults to the old, comfortable, and well-established pathway, even if it’s not the most accurate.

    The demands of daily conversation: A multitasking challenge

    Therapy sessions are designed to be focused and controlled. We isolate sounds, practice them in specific words, and provide immediate feedback. There are minimal distractions, and your child’s full attention is on his or her speech production.

    Now, consider daily conversation:

    • Speed: We speak much faster in natural conversation than we do during structured practice. There is less time to think about individual sounds.
    • Cognitive load: Children are simultaneously thinking about what they want to say, understanding what others are saying, processing social cues, and managing their emotions. Adding the conscious effort of producing a new speech sound correctly on top of all that is a huge cognitive demand.
    • Variety of contexts: In therapy, we might practise ‘sun’ and ‘socks’. In real life, the /S/ sound appears in countless words, in different positions within words, and alongside a vast array of other sounds. Each new word and phonetic context present a fresh challenge.
    • Lack of immediate feedback: In therapy, the speech therapist is right there to provide instant correction and reinforcement. In a playground, during a family dinner, or while playing with friends, that immediate, consistent feedback isn’t present.

    The role of automaticity: Making it second nature

    The ultimate goal of speech therapy isn’t just correct sound production; it’s automaticity. This means producing the sound correctly without having to consciously think about it. It’s like learning to ride a bike. Initially, every pedal stroke and steering adjustment is deliberate. Eventually, it becomes second nature.

    Generalisation is the process of moving from conscious, controlled production to unconscious, automatic production. This takes time, consistent practice, and exposure to a wide variety of real-life speaking situations.

    How can we help? Bridging the gap

    So, what can parents do to help their children bridge this gap between therapy success and everyday speech?

    1. Be patient and positive: This is a marathon, not a sprint. Celebrate the small victories and avoid getting discouraged by setbacks. Your positive reinforcement is crucial.
    2. Practise little and often: Instead of long, infrequent practice sessions, aim for short, consistent bursts throughout the day. ‘Sprinkle’ in opportunities to practise their target sounds in natural conversations.
    3. Create ‘sound awareness’ moments: Gently draw your child’s attention to his or her target sounds in everyday words. For example, if he or she is working on /R/, you might say, ‘Oh, you said ‘wabbit.’ Can you try to make your /RRR/ sound for ‘rabbit’?’
    4. Model correct production: Continue to model the correct production of their target sounds in your own speech.
    5. Collaborate with your speech therapist: Your therapist is your best resource! Ask them for specific strategies and activities you can do at home to support generalisation. They can also provide guidance on when and how to gently correct your child.

    Tips and tricks

    Below I have listed a few good tips and tricks that can help the transition from therapy room to daily life:

    Empowering your child as the ‘sound detective’:

    • ‘Secret sound listener’: Instead of you doing the correcting, make your child the detective. When you’re having a conversation, say ‘your /S/ sounds are sometimes a bit “slippery”’ (or whatever fun, non-judgmental term you like). Ask your child to quietly listen for your /S/ sounds. You can even purposely make a few ‘slippery’ ones (or correct yourself immediately after) and see if they notice. This shifts the focus from being corrected to actively listening and identifying the sound in a non-threatening way.
    • ‘Sound scorecard’: For a short period (maybe 10–15 minutes during a specific activity, like dinner or a game), provide a small notepad and pencil. Explain that your child is going to listen for his or her /S/ sounds and gently mark a tally every time he or she uses it correctly. The goal isn’t perfection, but awareness. This gives your child agency and a visual representation of progress. You can even make it a game: ‘Let’s see how many /S/ sounds we can catch in five minutes!’
    • /S/ sound song/rhyme creation: Work together to create silly songs or rhymes that are packed with /S/ sounds. The sillier, the better! You can sing them in the car, while doing chores, etc.
    • /S/ sound superpower: Frame the new sound skill as a ‘superpower’. ‘You’re getting so good at using your /S/ superpower! It’s going to help you speak so clearly and confidently.’
    • Highlighting successes: Always go out of your way to acknowledge and praise successful /S/ productions in natural conversation. ‘I really understood you clearly when you said ”s_top”.’ or ‘That /S/ sound was perfect when you told me about the “s_tory”!’

    Important considerations:

    • Keep it low-pressure: The goal is generalisation, not perfection. If your child is feeling pressured, he or she will likely revert to old patterns.
    • Focus on awareness, not just correction: Help your child become aware of his or her own speech rather than relying on you for corrections.
    • Short, frequent bursts: A few minutes of subtle focus multiple times a day is more effective than one long, forced session.
    • Acknowledge feelings: If your child expresses frustration about ‘being corrected’, validate these feelings. ‘I understand it can feel like a lot of listening, but we’re just trying to help you use that super /S/ sound all the time!’

    By incorporating these strategies, you can help your child naturally integrate the new /S/ sound into daily speech, fostering independence and confidence without it feeling like constant ‘testing’ or ‘correction’. Generalising new speech sounds is arguably the hardest part of speech therapy, but it’s also the most rewarding. With patience, consistent effort, and a collaborative approach between parents and therapists, children can successfully integrate their new, clearer speech sounds into every aspect of their daily lives.

    Any comments or if you need help and support with your child’s speech please do not hesitate to get in touch with me: simply fill out the contact form here on the website. I endeavour to reply within 48 hours.

    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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  • 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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  • · ·

    AAC Systems and Speech and Language Development

    ByLondon Speech and Feeding

    Introduction

    I see a lot of minimally speaking or non-verbal children in my practice. Some children are autistic and others are severely challenged with motor planning and some are both. Some children are simply delayed in their spoken language for reasons that we don’t quite know yet.

    Regardless of the causes, what is always apparent pretty quickly is that apart from the odd gestures or Makaton signs (mainly ‘more” ‘finished’ and “biscuit) we don’t have a robust alternative for speech in place. Instead, what we often have is a child with lots of frustration and tantrums and some behaviours we really don’t want like: hitting, biting, pushing, grabbing and often throwing… There are others, too many to mention, but we don’t enjoy watching our children in these states. And we are often fearful of what might happen next if we don’t find a way to calm our child.

    Fear not

    In my work, before I get to offer an alternative means of communication, I often have to work with a fair amount of resistance on the parents’ side as parents tend to feel that allowing such a system into their lives will prevent their child from speaking. They fear that their child will so enjoy pressing those buttons that they will become lazy and not talk at all.

    I totally get it!

    Parents often feel overwhelmed by the task of getting their own heads round how to use AAC, either in paper form or a computerised system. This can be a great turn-off for lots of people who feel they are not very “techy” – like myself actually! Indeed, it is true to say that I resisted operating in this field for a long time as I didn’t feel able to navigate electronic devices. But fear not. Truly, most systems are very user-friendly. The support is great. And I have managed to become quite proficient in one or two of these systems, through using it daily. It really is as simple as that.

    Alternative and Augmentative Communication (AAC)

    There is plenty of research on the efficacy of Alternative and Augmentative Communication (AAC). It is now very well understood and proven that, once we introduce our child to a good, attractive way of communicating that they can actually do, in time children who can speak will speak. Speaking is more effective than any AAC system. It is more versatile, more fun, and when human beings have discovered how to speak, most will do so in favour of any other system.

    Many children and adults, for many reasons, were never going to speak an awful lot, or with great difficulty. Or they were not going to like to speak. Or they were going to like to speak some times but not other times… And for all those people an AAC system is invaluable and a wonderful resource.

    Neuro-diversity affirming means that we do not impose one system of communication on our children (speaking with our mouth) only because it is the one we are using and most people we know too.

    Of course, we want the best for our children, and we want them to have the easiest and most straight forward existence on Earth. Of course we do. Speaking with our mouth does help with that. But we must come to understand that not all children and people feel like that and they struggle to use their mouth for talking.

    Personal experience

    I have difficulties understanding this myself, I will be very honest here. And I will say that – shoot me down in flames SLT fraternity – but I am learning to accept that using an AAC system proficiently is a very good alternative for when speech is not coming. I am learning to accept that some people are perfectly able to speak, and might do so but not always and only when conditions are right. I came into the profession as a speech therapist with the idea that I would help anybody that came to me to speak with their mouth. But I have changed my stance on that and now am happy to help anybody that comes to me to communicate most effectively with whatever works for them. I will always try for speech if I can … Just because it’s easiest!

    Acceptance

    Now I will equally celebrate a child pointing to a symbol or making a sign for something. It is a fantastic moment when it happens for the parents and me and the child! And we can always hope for more speech to come as we go. Nothing wrong with our aspirations, is there?

    The basic premise is this: accept any mode of communication as valid, as long as your communication partner understands what it means. Don’t require individuals to repeat themselves in another modality. Do model the response in the modality you are trying to teach. So, a child can point to a symbol and I will respond with speaking (with my mouth) but I will also respond by pointing to a symbol because that way I am signalling that both are ok and that I have understood and am encouraging the person to say some more.

    Here is some research;

    Binger, C., Berens, J., Kent-Walsh, J., & Taylor, S. (2008) The effects of aided AAC interventions on AAC use, speech and symbolic gestures. Seminars in Speech and Language, 29, 101-111.

    Sennott, S.C., Light, J., & McNaughton, D. (2016). AAC modelling intervention research review. Research and Practice for Persons with Severe Disabilities, 41, 101–15.

    Dada, S., & Alant, E. (2009). The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech. American Journal of Speech-Language Pathology, 18, 50–64.

    Contact me if you would like your child to have neurodiversity affirming speech and language therapy.

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

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  • ·

    Understanding Angelman Syndrome: A guide for parents

    ByLondon Speech and Feeding

    Angelman Syndrome (AS) is a complex neurological disorder that affects development. It’s caused by a missing or functionally incorrect gene (UBE3A) on chromosome 15. While AS is rare, understanding its characteristics is crucial for parents and caregivers.

    What are the key characteristics of Angelman Syndrome?

    Children with AS typically exhibit a range of unique characteristics, which can include:

    • Developmental delay: Significant delays in reaching developmental milestones, such as sitting, crawling, and walking.
    • Speech impairment: Limited or absent speech. Individuals with AS may use few or no words.
    • Movement and balance issues: Difficulties with coordination, balance, and movement, sometimes causing a jerky or unsteady gait.
    • Happy demeanour: Frequent smiling, laughter, and a generally happy, excitable personality.
    • Intellectual disability: Varying degrees of intellectual disability.
    • Seizures: Seizures are common and often begin in early childhood.
    • Sleep difficulties: Disrupted sleep patterns and difficulty falling asleep.

    The role of Speech and Language Therapy

    Speech development and social communication is significantly affected in Angelman Syndrome, and therefore, Speech and Language Therapy plays a vital role in helping individuals with AS to communicate. As Speech and Language Therapists (SLT) we can work with the child and family support any of the following:

    • Assess communication skills: We evaluate the child’s current communication abilities, including any vocalisations, gestures, or signs they may use. With younger children we do this through play and playful social games as well as observation of a child playing and interacting with their siblings or caregivers.
    • Develop alternative communication strategies: Since spoken language may be limited, SLTs can help the child learn other ways to communicate, such as nonverbal communication, e.g
      • Gestures: use of pointing, waving and miming certain activities.
      • More formal sign language: Teaching basic signs to express needs and wants.
      • Core boards: Using pictures and symbols to represent everyday common words, actions, and feelings.
      • Augmentative and Alternative Communication (AAC) devices: Providing electronic devices that can produce speech.
    • Encourage vocalisations: When words don’t readily develop, SLTs can encourage the child to make vocalisations and sounds, as these can be a form of communication.
    • Support language development: SLTs can work on understanding of language, even if expressive language is limited.
    • Educate and support families: SLTs provide families with strategies and techniques to support their child’s communication at home.

    The importance of a multidisciplinary approach

    Caring for a child with Angelman Syndrome requires a team effort. A multidisciplinary approach, involving various healthcare professionals, is essential to address the diverse needs of the individual. This team may include:

    • Paediatrician: Provides overall medical care and monitors the child’s health.
    • Physiotherapist: Helps with movement, balance, and coordination.
    • Occupational therapist: Works on daily living skills, such as feeding, dressing, and self-care.
    • Speech and Language Therapist: Addresses communication and language needs.

    By working together, we can provide comprehensive care, address the unique challenges of Angelman Syndrome, and help the child reach their full potential.

    Conclusion

    Angelman Syndrome presents unique challenges and opportunities. With early diagnosis, appropriate interventions, and a strong multidisciplinary team, children with AS can make good progress and live fulfilling, joyful lives. As Speech Therapists we delight in supporting parents in their role in advocating for their child.

    Do get in touch via my contact form if you are concerned about your child’s development.

    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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  • · · ·

    Beyond the teddy bear picnic: Why language development doesn’t always need imaginative play

    ByLondon Speech and Feeding

    As Speech and Language Therapists (SLTs), we are taught from day one that developmental milestones follow a predictable, linear path: first comes functional play, then symbolic and imaginative play (like pretending to feed a teddy bear or talking on a toy phone), and then comes conversational speech.

    But when working with language delayed children, I have seen something that completely contradicts those textbook charts.

    Many of my students have absolutely no interest in doll play, tea parties, or imaginary scenarios. Yet, as they mature, they still manage to develop robust, meaningful, and conversational language.

    How is this possible? And what does it mean for how we approach therapy?

    Redefining the ‘rules’ of play and language

    The idea that imaginative play is a strict prerequisite for language was built entirely on neurotypical developmental data. But neurodivergent brains don’t follow neurotypical roadmaps. That is not a deficit; it’s simply a different processing style.

    When Gestalt Language Processors bypass traditional imaginative play, they aren’t ‘missing’ a step. They are often using entirely different cognitive vehicles to build their language skills.

    The power of monotropic deep interests

    Video clip 2 lining up dinosaurs

    Many autistic individuals have a monotropic cognitive style, meaning they process the world through deep, single-focused passions (think trains, space, dinosaurs or ocean creatures).

    While a neurotypical child might practise social roles by pretending a doll is going to school, a neuro-diverse child practises language by categorising, analysing, and sharing facts about their deep interest. Their language is anchored in the concrete, fascinating reality of their passion, rather than fictional symbolic play.

    Gestalt Language Processing (GLP)

    A significant number of neuro-diverse children learn language in large ‘chunks’ or ‘gestalts’ (such as movie scripts, songs, or favourite phrases) rather than building sentences word-by-word.

    When a child scripts or uses echolalia, they are storing and mapping vast amounts of conversational data. They don’t need to pretend-feed a teddy bear to practise dialogue; they are actively processing the rhythm, intonation, and structural rules of speech through the media and phrases they love. As they grow, they learn to break these scripts apart to form original sentences.

    Structural play is learning play

    Just because a child is lining up dinosaurs or cars, stacking blocks, or spinning wheels instead of making them ‘talk’ doesn’t mean they aren’t learning. This functional and structural play builds crucial foundational skills like pattern recognition, cause-and-effect, and spatial awareness, all of which directly support cognitive and language development.

    Shifting Our Goals

    Meeting our children on their home turf: if that’s dinosaurs, let’s be creative with dinosaurs!

    If imaginative play isn’t the engine driving language, forcing it in the therapy room can quickly turn into an exercise in compliance rather than connection. Instead of trying to pull a child out of their world and into a neurotypical play model, we can meet them exactly where they are!

    Here are three affirming ways to turn deep interests into conversations:

    • Swap questions for comments (declarative language): Instead of interrogating a child about their play (‘What colour is that train? Where is it going?’) make pressure-free observations (‘Wow, that train is moving fast. Look at those wheels spin.’). This lowers conversational anxiety and models natural communication.
    • Bridge and expand: Use their favourite topic to introduce new ideas and concepts. If we love dinosaurs let’s see if dinos can climb up a ladder, slide down a half pipe into some water, then need drying before making footprints across a piece of paper…
    • Validate any scripts or echolalia and find out the EMOTION underlying it: If your child uses a quote from a favourite cartoon clip, let’s try and figure out in what context this phrase was said in the movie; what is the emotion in the movie when the character says this line? Is it upset? Is it joyful? Is it big surprise or a shock? Don’t dismiss it as meaningless. Acknowledge the emotion behind the script ‘You feel worried right now.’ This way we are showing our child that their unique way of communicating is heard and valued.

    So, to sum up:

    Imaginative play is just one way to learn language, not the only way.

    Let’s stop viewing a lack of pretend play as a barrier to communication, and free ourselves to see our children’s true strengths. By embracing their deep passions, we don’t just help them find their voice. We build a real connection that makes communication possible.

    Are you looking for neurodiversity-affirming speech and language support? Contact my clinic today to learn more about how I tailor my therapy to your child’s unique strengths.

    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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  • Submucous cleft palate: What is it and how does it impact on speech?

    ByLondon Speech and Feeding
    Submucous cleft palate: What is it and how does it impact on speech?

    What exactly is a submucous cleft palate?

    A submucous cleft palate (SMCP) is much less obvious than its counterparts, cleft of lip and/or palate, and can profoundly impact a child’s speech development. It leads to often extreme hyper nasal speech and difficulty with producing many sounds (/K/ /G/ /T/ /D/ /P/ /B/ /S/ /Z/ /F/ /V/).

    In short, the muscles and bone of the soft palate, and sometimes the hard palate, do not fuse completely during foetal development and the mucous membrane that lines the roof of the mouth remains intact, effectively camouflaging the underlying muscular and bony deficit.

    So, while the surface of the palate appears normal, the essential muscle and functions responsible for sealing off the nasal cavity from the oral cavity during speech are compromised. This cleft (or lack of muscle) can be seen as a bluish midline discoloration of the soft palate, often a bifid (split) uvula, and at times a notch in the posterior border of the hard palate can be felt upon palpation. However, these signs aren’t always present or easily discernible, contributing to the difficulty arriving at a diagnosis.

    Diagnosing a submucous cleft palate is often akin to searching for a needle in a haystack, especially for the untrained eye. Unlike overt clefts that are visually apparent at birth, an SMCP can go undiagnosed for years, sometimes well into childhood or even adolescence. Paediatricians and even ENT surgeons have been known to miss it during routine checks due to the intact mucosal lining. Parents might notice their child’s speech sounds ‘different’ or ‘nasal’ but struggle to pinpoint the cause. Children might undergo extensive speech therapy without a proper diagnosis, as the underlying structural issue continues to hinder progress.

    My experience as a speech therapist in private practice:

    Over my years of practice, I have encountered several children presenting with persistent hyper-nasal speech and significant difficulties producing plosive and fricative sounds.

    It has been incredibly rewarding, though at times challenging, to successfully diagnose SMCP in a number of these children. My approach often involves:

    • a meticulous oral motor examination,
    • careful listening for the specific qualities of hypernasality,
    • and a deep understanding of the physiological requirements for clear speech sound production.

    When I suspect an SMCP, I refer these children to Great Ormond Street Hospital where a fantastic multidisciplinary team, typically including ENT surgeons and a specialist speech-language therapist can conduct more definitive assessments. These assessments often involve instrumental analyses such as videofluoroscopy or nasoendoscopy, which provide objective measures of velopharyngeal function and visual confirmation of the anatomical deficit.

    The path to resolution: surgery, therapy, and successful outcomes

    Surgery

    The journey for these children, once diagnosed, often involves surgical intervention. It’s not uncommon for children with SMCP to undergo multiple operations to achieve optimal velopharyngeal closure. These procedures aim to reconstruct or augment the velopharyngeal mechanism, enabling it to effectively separate the oral and nasal cavities during speech. The specific surgical approach depends on the individual child’s anatomy and the severity of the velopharyngeal insufficiency. It’s a testament to the skill of these specialised surgeons that such intricate repairs can be performed with remarkable success.

    Speech therapy

    Following surgery these children embark on the crucial phase of speech therapy. While surgery addresses the structural problem, speech therapy helps a child learn to utilise their newly improved anatomy. It involves intensive work on developing oral airflow, establishing correct articulatory placement, and reducing learned compensatory strategies that have developed due to the original structural deficit. It is immensely gratifying to witness the transformation. Children who once struggled to produce basic sounds, whose speech was difficult to understand, gradually develop clear speech.

    Next steps?

    If you’re a parent concerned about your child’s speech and feeding, you’re not alone. The journey can feel confusing, but professional guidance can make all the difference. Never hesitate to have a second opinion when you have that niggling feeling that there is something that has not yet been explored. At London Speech and Feeding I specialise in being thorough and thinking outside the box.

    I am here to provide the support you need. Reach out to schedule a consultation and take the first step towards helping your child communicate and thrive.

    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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