Speech prompts and strategies I use in Speech Sound Therapy

ByLondon Speech and Feeding
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This particular student has a mild motor planning difficulty and six weeks ago he came to me with a very strong lisp. In addition to the lisp he is struggling to produce a number of sounds, SH and L on its own and all the clusters (FL/BL/KL/PL) but also CH together with some vowel difficulties.

The prompts are a mix partially from the DTTC (Dynamic Temporal and Tactile Cueing) model by Dr Edythe Strand as well as phonological models I have learned over the years, and some of them are my own.

Visual/picture prompts and Images

Here I use the ‘Flat Tyre’ Sound, to offer as an image for a new S sound and the ‘Tick Tock’ Sound for a new image of the T sound. Both cards are from the Bjorem Speech Sound Deck, which I love and use almost daily.

Gestural Cues

I like to use all the ‘cued articulation’ hand cues by Jane Passy for consonants and fricatives. Here we use our fingers and hand to illustrate what our tongue does, and we also show whether a sound is voiced or voiceless. When I use one finger it is voiceless (k/f/s/p) and when I use two fingers for the same cue it means that the voice needs to be turned on: (g/v/z/b/n/m). For vowels I like to use Pam Marshalla’s cue system.

Simultaneous production

We say the word together.

Direct imitation

I say the word and my student copies me directly.

Imitation after a delay

I say the word and then after a little wait my student says the word.

Spontaneous production

My student has now learned to say the word by him/herself.

Offering feedback

It sounds like… I just heard… I didn’t hear the first sound there? Can you try again?

Letting the student reflect

By just shaking my head or by looking quizzical so that my student realises something didn’t quite go right.

Postitive reinforcement

‘Yes that was it, do it again, nice one…’

Cognitive reframing

This is a technique where we identify different semantic cues and metaphors or imagery cues, so instead of teaching or focusing on a sound we try out viewing each syllable from a different point of view.

For example: ‘yellow’. I have had great success with this one: we start with just saying ‘yeah yeah yeah’. I might make a little joke and say something like ‘imagine your mum says tidy your bedroom, what do you say or what do you think?’ Answer: ‘yeah yeah yeah’. Then we practice ‘low’ together, I might blow some bubbles high and low and we talk about ‘low’. And then we put ‘Yeah’ and ‘Low’ together and now we have YELLOW!! It might at first still sound a bit odd, like ‘yea-low’ but we soon shape that up and have the real word.

Each student is different and having a great rapport is crucial to our success.

Then a little game break after some 7–10 or so repetitions and always trying to finish on a positive note.

What game breaks do I use:

Very quick ones! Students can post something, place a counter in a game, take out a Jenga block from the tower, pop in a counter for ‘connect 4’, stick a sword into the Pop the Pirate barrel or add a couple of Lego blocks to something they are building.

I hope this is helpful, please contact me for any questions.

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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    We want to try and not direct our child but respond with interest and fun! This creates a lovely stage for interaction and joint play! And this leads in turn to practising conversation and ever more opportunities for great speech and language skills to emerge.

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    LAMP Words for Life: A revolutionary AAC system

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    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

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

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    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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  • ·

    A bite-sized guide to Speech and Language Therapy: feeding and swallowing

    ByLondon Speech and Feeding

    What is a Speech and Language – Feeding Therapist?

    You’ve probably heard of speech therapists helping people who stutter or struggle to pronounce words. But did you know that they also work with children and adults who have problems with eating and swallowing? This specialised area is called Speech and Language Therapy: Feeding and Swallowing, or Dysphagia Therapy.

    Why does a Speech Therapist help with eating and swallowing?

    The mouth, tongue, and throat are all involved in both speech and swallowing. When there’s a problem with any of these parts, it can affect both your ability to talk and to eat. For example:

    • Weak tongue muscles: Can make it hard to chew food and to form sounds.
    • Difficulty coordinating swallowing: Can lead to choking or aspiration (when food or liquid goes into the lungs).
    • Sensory issues: Can make certain textures or tastes feel unpleasant or overwhelming.
    • Communication: If we are not able to express ourselves we are likely to have difficulties during daily mealtimes: how do we ask for ‘more’ of something, how do we say we have had enough or we don’t like a particular food?

    How does a Speech and Language Therapist help?

    Our work involves a combination of assessment and therapy. We carefully observe how your child feeds, eats and swallows, and we look into your child’s mouth to help us see what the cause of the difficulties are: could be a very highly-arched palate, it could be a very flaccid/low tone tongue, it could be poor dentition. Then, we create a personalised treatment plan to address your specific needs.

    Here are some of the things we might do:

    • Teach swallowing techniques: We can help your child learn strategies to improve or facilitate a safe swallow.
    • Recommend dietary modifications: We may suggest changes to your child’s diet to make it easier to eat and swallow.
    • Provide sensory therapy: If your child has sensory needs we can help your child become more comfortable with different textures, tastes, and smells.
    • Work on oral motor skills: We can help to encourage more effective chewing, or drinking skills, or we can help your child to close his/her mouth more during chewing or drinking from a straw.
    • Collaborate with other professionals: We often work closely with doctors, nurses, occupational therapists, and dietitians to provide comprehensive care.

    What kinds of problems do Speech and Language Therapists help with?

    We see a wide range of feeding and swallowing difficulties, including:

    • Delayed feeding: Children who are slow to develop feeding skills or who have difficulty transitioning to solid foods.
    • Tongue-ties: Babies can have significant difficulties with feeding when the tongue is very tightly tethered to the floor of the mouth.
    • Refusal to eat: Children who refuse to eat certain foods or textures.
    • Aspiration: When food or liquid goes into the lungs, which can lead to pneumonia and other serious complications.
    • Chewing difficulties: Problems with chewing food, such as difficulty breaking down food or keeping food in the mouth.
    • Swallowing difficulties: Problems with swallowing, such as feeling like food is stuck or choking.
    • Neurological conditions: Conditions like cerebral palsy, down syndrome or other genetic syndromes can affect feeding and swallowing.
    • Developmental delays: Children with developmental delays may have difficulties with feeding and swallowing.

    Is there hope?

    If your child is struggling with feeding or swallowing, know that there is help available. Speech and Language Therapy can make a significant difference in your and your child’s quality of life. We’re here to support you every step of the way.

    Remember, you don’t have to suffer in silence. If you’re concerned about your child feeding or swallowing, please reach out. You can find a Speech and Language Therapist with a Feeding/dysphagia qualification near you via www.asltip.co.uk or contact me.

    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.

    1
  • ·

    Transforming Mealtimes

    ByLondon Speech and Feeding
    Speech Therpaist in London

    Transforming Mealtimes

    Below are two reviews I got from grateful clients over the past 4-6 weeks; this blog is more about how Feeding Therapy can help you than blowing my own trumpet…. though that said, it is always so nice and gratifying to hear when parents are happy and hopeful about their little one’s feeding journey. Feeding Therapy is a substantial part of my work as a Children’s Speech and Language Therapist. One of my specialist subjects is Autism and we find that many children on the Autism Spectrum are very specific about eating, and will often refuse a range of typical family foods in favour of a narrow range of foods/snacks.

    Mostly, feeding difficulties are a combination and complex cocktail of factors that have contributed to the current status quo: sure, there may have been some physical problems to start off with, such as reflux causing the baby discomfort, constipation, a very tight tongue tie or a swallowing problem caused by neurological difficulties and of course sensory processing difficulties are also very physical experiences. We always begin with a very thorough case history taking and information gathering, followed by an oral assessment and observation of the actual swallow to establish what might have been – or still might be – the cause for the feeding difficulties.

    In most of the cases I see in my practice, the original obvious cause is no longer present, especially with older children. So, if the swallowing is fine, the reflux is no longer present, the tongue was divided (twice!) why are they still not eating much, refusing to try new foods, only accept certain textures etc.

    The answer is extremely complex and multi-faceted and this little blog is not covering any factors in detail (we would be here all night) -I mentioned sensory processing difficulties earlier on. These are mostly still present but often not acknowledged or recognised by parents. And it is certainly the case that one of the contributors is parental anxiety; this tends to run very high and has been for many months, sometimes years. This in turn often leads to very tense and unpleasant, endlessly long meal times and many times children are force-fed several times a day in order to “get something down there” as otherwise they would probably starve themselves.

    Additionally, parents end up only offering a very narrow range of foods because that is all their child will eat. This ends up in a vicious cycle of children being fed porridge-style food for all meal times and of course they won’t progress to more mature foods if these mature foods are never on offer.

    In order to help address and disentangle some of the issues I often introduce the “Division of Responsibility in Feeding” as researched and recommended by Ellyn Satter (The Satter Feeding Dynamics Model)

    Here are the main points of her approach:

    Children have a natural ability with eating, they eat as much as they need and they grow in the way that is right for them and they learn to eat what their parents eat. (E Satter). The parent is responsible for WHAT the child eats, WHERE and WHEN the child eats. The child is responsible for HOW MUCH they eat or WHETHER to eat. Satter proposes that parents should guide their child’s transition from nipple feeding through semi-solids, then thick and lumpy foods to finger foods and then on to normal family meals.

    Please note: this model is only appropriate for children where the original physical cause is no longer present!

    Of course it’s not easy! It requires a huge shift in thinking about feeding and it requires to trust our children to know what is best for them. This is very big for most parents, as it is not how we were brought up and it is not commonly known that babies and children know what is good for them!

    However, it is certainly true that parents who follow this particular approach and make small, steady changes in the way the offer foods, and in the way they create family meal times differently, children make very nice, pleasing progress and over some months we often see remarkable positive changes.

    I like to work in a team and especially for this type of problem it is essential to have a multi-disciplinary approach. A knowledgeable dietician is an enormous plus in any feeding team as is of course a

    Paediatrician and/ or a Gastroenterologist and the most important people in the team are the parents!

    Feeding Therapy is all about collaboration and a ‘team around the child” approach. When we have this in place and there is trust amongst the team members then we make fantastic progress.

    Do get in touch with me if you would like some help with your tricky feeder.

    Lovely Reviews

    I visited London Speech and Feeding a couple of days ago with my 8-month-old granddaughter and her mother. Sonja made us feel comfortable and at ease from our first introductions. She was able to pinpoint my granddaughter’s mum’s anxiety around weaning very quickly. She not only gave her the tools to do this successfully, but also really encouraged my granddaughter’s mum and instilled confidence that she had everything she needed to make this sometimes-difficult transition without further anxiety.

    Sonja was very thorough in her initial assessment of my granddaughter’s physical milestones and her developing speech. My granddaughter felt very comfortable with Sonja and happily played along with her. Then came the big moment – trying out various foods! We were amazed to see just how easily my granddaughter, with Sonja’s expert encouragement, took to sampling the wonderful array of different delicious morsels Sonja had prepared for the session. My granddaughter even drank from a cup for the first time! Wonderful!

    Sonja then emailed a summary of the session and an extensive array of resources with suggestions for my granddaughter’s mum which she has now put into action. My granddaughter’s mum couldn’t thank Sonja enough for her caring attitude, extensive knowledge, and warm professionalism. I have no hesitation in recommending Sonja, she’s a fantastic Feeding Therapist!

    –

    Sonja (and her lovely colleague, Sandra) were stupendous. I had brought my one-year-old son to see them as I was concerned that he wasn’t eating enough. They looked at his history and we ate together to make sure they had all the information they needed to give an accurate diagnosis. Whilst our outcome was that Henry was in fact doing brilliantly (and I just needed to chill out a bit!), I would imagine if there was something more serious going on, Sonja would make you feel just as supported and empowered as she did with us. Excellent follow-ups too. Money well spent for a bit of reassurance for a stressed out mama. Thank you, Sonja!

    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.

  • A Day In The Life Of An Independent Speech And Language Therapist

    ByLondon Speech and Feeding
    A Day In The Life Of An Independent Speech And Language Therapist

    A Day In The Life Of An Independent Speech And Language Therapist

    I often get asked how many clients/children I see per working day or what my working day/life looks like. I always reply that every day is different, which is true, but there is a sort of average working day which looks a bit like this:

    I usually start preparing for my first client of the day at around 9.30 am: I clean the room, wipe down all the toys and materials (that’s if they are coming to my clinic room) and then it takes me about 30 minutes to select and sometimes make suitable materials, games and activities for the child’s therapy programme. Client arrives at 10.30 am and the fun begins. They leave around 11.30am, and the cleaning and wiping down starts again – yes it’s the pandemic but to be fair I would do this anyway. I quickly write up my notes and send home work to the client via email. Now it’s 12 noon and I start preparing for the next client at 12.30 pm. This might be online parent-child interaction coaching and so I need different materials and activities that are suitable for teletherapy. We finish around 1.30 pm and I will write up my notes before having some lunch.

    Lunch tends to not be around 30 minutes. Around 2.00 pm I start prepping again for the next client: selecting activities, going over their last session, making sure I have everything I need to start at 2.45pm – we finish at 3.45pm, I write up my notes and then have a cuppa. The next client might be more on-line coaching or a child coming to see me: room cleaned and tidy, materials and activities prepared: client arrives at 4.30 pm and we finish at 5.30 pm. I clean the toys again, write up my notes and it is 6.00 pm ready for dinner. So that was four clients between 9 am and 6pm allowing for preparation, aftercare, cleaning and coffee and lunch.

    Other days I might see three clients and do more admin like ordering toys or books or teletherapy activities, or making materials (we therapist make tons of materials, we’d put Blue Peter to shame!) Sometimes I do two home visits, one in the morning and one in the afternoon – the travelling/parking in London is so time consuming that it really reduces the number of clients I can see which is why I don’t do many of those.

    I hand pick my clients to make sure that we are a good fit, and my service is bespoke: no one client gets the same treatment as another; each client is unique, usually very well-known and always highly valued. That takes time and means that in reality each client gets about 2 hours of my time, that is the actual session plus all the preparation and aftercare.

    I love this way of working and would not ever want to return to seeing tons of clients each day, not knowing any of them really well, due to high caseload numbers, staff shortages and an overload of administration.

    My way of working affords all my lovely clients the help they need to be able to feel empowered and to then support their children to make progress; when working with children they make the best progress they can make, fulfilling their potential. My lovely reviews and testimonials tell me that my clients appreciate the extra attention.

    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.