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.
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.
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.
Mealtimes can be a battleground for parents of picky eaters, especially toddlers with Avoidant/Restrictive Food Intake Disorder (ARFID). I see a great number of toddlers with Autism traits and many of my clients are picky eaters from mild to severe. Take a look at my blog for an outline of what the issues are and how to try and help.
ARFID goes beyond typical ‘picky eating’ and can significantly impact a child’s growth, nutrition, and social-emotional well-being. If your toddler is resistant to trying new foods or has a very limited diet, here are some strategies to navigate the introduction of solids:
1. Understand ARFID:
ARFID is a diagnosable eating disorder characterised by:
Limited food variety: Eating only a small range of foods, often with specific textures or colours.
Fear of new foods: Intense anxiety or aversion to trying unfamiliar foods.
Sensory sensitivities: Heightened sensitivity to taste, smell, texture, or appearance of food.
Lack of interest in eating: May show little interest in food or mealtimes.
2. Seek professional guidance:
Paediatrician and/or gastroenterologist: Rule out any underlying medical conditions.
Registered dietitian: Assess nutritional needs and create a balanced meal plan.
Speech and language therapist (SLT): If oral-motor skills or sensory sensitivities are contributing to feeding difficulties.
Occupational therapist (OT): If sensory processing challenges are affecting mealtime behaviours.
Child psychologist: If anxiety or emotional factors are contributing to ARFID.
3. Strategies for introducing solids:
Start small: Introduce one new food at a time, in small amounts, alongside familiar favourites.
Patience is key: It can take multiple exposures (up to 10–15 times!) for a child to accept a new food. Don’t give up!
Positive reinforcement: Praise and encouragement for any interaction with the new food, even just touching or smelling it.
No pressure: Avoid forcing or pressuring the child to eat. This can create negative associations with food.
Make it fun: Present food in playful ways, use cookie cutters for fun shapes, or involve the child in food preparation.
Sensory exploration: Encourage exploration of food through touch, smell, and sight before tasting.
Role modelling: Show the child that you enjoy eating a variety of foods.
Use fun utensils: your child might like characters from ‘Frozen’ or ‘Dinosaurs’ or ‘Diggers’ there are a host of character-based cutlery and cups/plates to be had. Also, I really rate these two items very highly they are so good so I want to share these with you. Both are available online. But warning: the cup is outrageously expensive as it comes from the United States and is sold by a small scale company. But I feel this is cup very worth trying, I have had good results with this.
Gradual desensitisation: Start with foods that are similar in texture or taste to accepted foods, then gradually introduce more challenging options.
Food chaining: Introduce new foods that are similar in taste, texture, or appearance to accepted foods.
4. Mealtime Environment:
Positive and relaxed: Create a calm and enjoyable mealtime atmosphere.
No distractions: Minimise distractions like TV or toys.
Consistent schedule: Offer meals and snacks at regular times.
Child-sized portions: Offer small, manageable portions to avoid overwhelming the child.
Involve the child: Let the child choose their utensils, plate, or cup.
5. Remember:
Every child is different: What works for one child may not work for another.
Progress takes time: Be patient and celebrate small victories.
Focus on the positive: Praise any positive interaction with food.
Seek support: Connect with other parents or support groups.
Introducing solids to toddlers with ARFID can be challenging, but with patience, persistence, and professional guidance, you can help your child develop a healthier relationship with food.
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.
Tongue-tie, or ankyloglossia, is a condition where the lingual frenulum, the thin piece of tissue that connects the underside of the tongue to the floor of the mouth, is too short or tight. Tongue-tie is quite common in babies and is often not detected after birth. Tongue-tie can lead to a difficult start with breast feeding as it makes it very difficult for the baby to latch effectively.
In my clinical experience as a feeding therapist, I have seen many babies who were not able to latch well due to the frenulum being tight. In many cases an experienced feeding speech therapist/lactation consultant can really make a difference and help a new mum to latch the baby even though the tongue is tethered to the floor of the baby’s mouth. In some cases the frenulum can be divided and once this has been done, in some cases, feeding improves immediately or soon after the division. But this is not always the case. I have seen several babies who have had as many as four tongue-tie divisions and feeding was still difficult.
It is important to say that while tongue-tie can sometimes impact speech and feeding, it’s important to note that it’s not always the root cause of these difficulties. In recent years, there has been a surge of interest in tongue-tie division surgeries, with some cases being unnecessary. It’s crucial to understand the complexities of tongue-tie and the role of speech therapy in addressing related challenges.
The impact of tongue-tie on speech and feeding
When tongue-tie is severe, it can interfere with the tongue’s ability to move freely, affecting speech production and swallowing. Some common speech and feeding difficulties associated with tongue-tie include:
Feeding difficulties: Challenges with sucking, chewing, and swallowing.
Drooling: Excessive drooling due to difficulty controlling saliva.
Speech problems: Difficulty producing certain sounds, such as /l/, /r/, /t/, /s/ and /d/.
The importance of comprehensive assessment
Before considering any surgical intervention for tongue-tie, it’s essential to undergo a thorough evaluation by a qualified speech-language therapist (SLT). An SLT can assess the severity of the tongue-tie, its impact on speech and feeding, and determine if surgery is necessary.
Functional assessment: The SLT will assess the tongue’s range of motion, its impact on speech sounds, and the child’s overall oral motor skills.
Feeding evaluation: The SLT will observe the child’s feeding patterns and identify any difficulties related to tongue-tie.
Differential diagnosis: The SLT will rule out other potential causes of speech and feeding difficulties, such as apraxia of speech, dysarthria, or sensory processing disorders.
The role of speech therapy
Even in cases where tongue-tie is present, speech therapy can often be highly effective in addressing speech and feeding difficulties. Here’s how speech therapy can help:
Articulation therapy: Targeting specific speech sounds that may be affected by tongue-tie.
Childhood Apraxia of Speech (CAS): if the diagnosis by the SLT has shown that in fact the child has motor planning difficulties then there are very specific and effective treatment programmes that help with this and can make a real difference over time.
Feeding therapy: Strategies to improve swallowing, chewing, and oral-motor skills.
Sensory integration: Addressing underlying sensory processing issues that may contribute to feeding difficulties.
London Speech and Feeding Case Study: The importance of comprehensive assessment
One of my clients was initially diagnosed with tongue-tie and recommended for surgery at the age of eight years old. His speech had been perceived by parents and teachers as ‘mumbled and unclear’.
However, after a thorough evaluation, I was able to determine that the child’s primary issue was apraxia of speech, a neurological disorder that affects motor planning for speech. Parents decided to wait with surgery and trust my judgment and we proceeded with weekly intensive speech therapy to address motor planning difficulties around tricky sounds and words. I am delighted to say that the child’s speech has improved significantly, demonstrating the importance of comprehensive assessment and individualised treatment. He is no longer seen as a candidate for an operation, which would have been traumatic for him at his age and, as it turned out, entirely unnecessary.
Below is a short video clip of my working on the /l/ sound with this child.
Tongue-tie is a complex issue that requires careful evaluation and individualised treatment. While surgery may certainly be necessary in some cases, it’s essential to consider the potential benefits and risks. Speech therapy can be a highly effective approach for addressing speech and feeding difficulties associated with tongue-tie, even in cases where surgery is still required. By working with a qualified speech-language therapist, parents can ensure that their child receives the best possible care and support.
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.
What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?
Speech and language therapists provide treatment, support and care for children and adults who have difficulties with communication, eating, drinking and swallowing. We help children and adults who have problems speaking and communicating.
How to find the perfect therapist for my child/client:
There are a huge number of speech and language difficulties, or feeding and swallowing problems that we can help with and the first thing to think about is what age group the person is you are seeking help for. Most SLT’s specialise in a range of disorders and treatments and they often treat specific age ranges. This could be, for instance, very young children up to 3 years, or school aged children, adolescents or just adults. Once you have narrowed it down to age and general area of difficulty you can then go and seek your perfect SLT match.
Generally it is my view that SLT’s with a narrow area of specialist interest are most likely to help you better if the problem you or your child/adult is having is significant and/or profound. For example, if your child has a very severe stutter/stammer but is otherwise developing fine and has good skills all round, then I would recommend to look for an SLT who only specialises in stammering/stuttering, or has only a small range of other specialist areas related to stammering , such as speech and language delay.
The reason is that it is a tall order for any professional to stay up to date with latest research, latest clinical developments and training for more than, say, five distinct areas of interest.
However, a more generalist Speech therapist who has lots of experience in many different areas could be a very good option for your child or adult who has more general speech and language delay in a number of areas, perhaps a global delay or a syndrome which means that their learning is delayed in general. It also means that your child might benefit from a Generalist SLT because they have many more tools in their SLT bag and your child might need a variety of approaches for several areas.
A good place to start is www.asltip.com which is the Association for Independent Speech and Language Therapists in the UK. Any SLT registered with ASLTIP will also be registered with the HCPC (Health Care Professionals Council), as well as RCSLT (Royal College of Speech and Language Therapists). These two important UK professional regulatory bodies ensure all its members are fully qualified, and are fully up to date with latest developments within their areas of work.
Here you can enter your post code and look for a therapist near you and you can look for specific problems such as stammering for example and narrow down your search. Most therapists have a website which you can then access too. I would recommend you speak to a few therapists on your list and then go with the person you had the best rapport with. You and the therapist will be spending a lot of time together and you will need to feel that you trust them and that you can relax into the process.
How I can help you:
I have 3 main areas of specialism:
Parent Child Interaction Coaching
This is an amazing way to help children with the following difficulties:
Social Communication Difficulties, Autistic Spectrum Disordersand
Speech and Language Delay – for children under the age of 4 years old, this is my preferred way of working because it is so very effective and proven to work. If your child is not developing words or not interacting, has reduced attention and listening and you feel is not progressing or, in fact even regressing, then this way of working is the best. For anyone wanting to read a bit more about the efficacy of this method, below are some research articles. You may also like to check out www.hanen.org which is the mainstay of my work and method when it comes to Parent-Interaction Coaching. You can also look at my latest blog, entitled: Tele-therapy, does it work?
In brief, what’s so great about Parent Coaching is that it empowers you the parent to help your child in daily life! This is where speech, language and social communication develop typically, in a naturalistic way and environment. Simple steps and strategies are discussed and demonstrated every week and you are encouraged to use these strategies with your child in daily routines: getting dressed, having breakfast, on the school run, whilst out in the park or shopping or simply playing at home or having dinner or bath time. Whatever your family routine happens to be, every strategy I teach you will help create a responsive communication environment; generally, if your child is able to develop speech then they will do so in direct response to your changed interaction style.
Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation
I love working with children of all ages on developing their speech sounds. Whether your child has a lisp, or a couple of tricky sounds they simply cannot produce quite right, or perhaps your child is really unintelligible because he/she is having lots of different sound errors, making it really hard to understand them. I typically work on getting “most bang for your buck” , meaning I address the sounds that cause the most problems and, therefore, when they are fixed your child/person’s speech becomes that much clearer fairly quickly.
Feeding and Swallowing Difficulties
Having worked for over 20 years in NHS Child Development Clinics and Special Needs Schools I trained and worked with feeding and swallowing difficulties early on in my SLT career. I later trained as a Lactation Consultant and so I am well placed helping and support all types of Infant feeding, both breast or bottle, as well as toddler weaning. I aim to ensure that your little one swallows the right kind of foods and drinks for their abilities. I am experienced in managing and supporting children with physical needs and mobility problems, Cerebral Palsy, Down Syndrome or any other type of syndrome or presentation.
What does a speech therapy session look like?
All sessions differ slightly depending on the age of the child and the nature of the difficulties.
However, mostly our sessions look like FUN! After arrival and washing hands we tend to start off with the tricky work straight away whilst our child still has energy and the will to engage. So, for speech work we will focus on the target sounds first: this could be sitting at a table doing work sheets together, playing games using the target sound and really any type of activity that gives us around 70-100 repeats of the target pattern. For example, a child who is working towards saying a ‘K’ at the end of the word I will try and get around 100 productions of words like: pack/sack/lick/ pick/bike/lake and so on.
Then we often play a fun game where I might try for a ‘rhyming’ activity or other sound awareness type activities, for perhaps 10 minutes and within that time I aim to trial the next sound pattern we need to improve on; I will test which sound your child can do with help from me. During he last 10 minutes we might look at a book, again listening to and producing whatever sound we are working on. If I did not get 100 sounds earlier on in the session I will try and practice them now as part of the story. In total I aim to have about 40-45 minutes of activities, all aimed at the target sound we are working on.
What does a Coaching session look like?
During a Parent Coaching Session we meet online for about an hour and we discuss how the week has been for you trying out the strategies. Typically parents start off recalling what went well, what progress was made and what had been more tricky. We work through it all, and then follow on to the next strategies: I will show you examples and demonstrations of each strategy and I will get you to think about how you can use this with your child and in what situation you might use it. I will explain what we are doing and what the purpose is. You might want to write down what you are going to work on for the week. Over the course of about sessions we can cover all the major strategies that are proven to help kickstart spoken language and/or help your child to connect more with you. Through that connection spoken words most often develop.
Research Papers on the Efficacy of Parent Child Interaction Coaching
The It Takes Two to Talk Program has been shown to be effective in changing how parents interact with their children, and that children’s communication and language skills improve as a result.
Baumwell, L.B., Tamis-LeMonda, C.S. & Bornstein, M.H. (1997). Maternal verbal sensitivity and child language comprehension. Infant Behavior and Development, 20(2), 247-258.
Beckwith, L. & Cohen, S.E. (1989). Maternal responsiveness with preterm infants and later competency. In M.H. Bornstein (Ed.). Maternal responsiveness: Characteristics and consequences: New directions for child development (pp. 75-87). San Francisco: Jossey Bass.
Bronfenbrenner, U. (1974). Is early intervention effective? (Publication No. (CDH) 74-25). Washington, DC: Department of Health, Education, and Welfare, Office of Child Development.
Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders, 53, 156-167.
Sonja has been a real help for my 5 year old daughter. Due to her support, my daughter is now able to clearly and correctly enunciate ‘th’ ‘f’ and ’s’. She was also helpful in making positional changes to her seating to help her concentrate better and kept her engaged throughout all the lessons which is a feat in itself on zoom!
Helen, Mother of Catherine Age 5.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
As a Speech and Language Therapist with a specialism in paediatric feeding, I’m constantly looking for ways to support families in developing their little ones’ oral motor skills and fostering a positive relationship with food. While Baby-Led Weaning (BLW) has revolutionised how many families introduce solids, (see my previous blog in July 25) a concept that often sparks discussion and curiosity is the use of ‘hard munchables.’
The term ‘hard munchables’ refers to specific types of firm non-digestible food items that are offered to babies for oral exploration and skill development, not for nutrition. These are typically foods that babies cannot bite off or swallow in large pieces due to their texture, but which provide resistance for chewing practice.
The phrase was coined by Marsha Dunn Klein, M.Ed., OTR/L, Occupational Therapist and feeding therapist. Well known for her work in paediatric feeding she introduced and advocated for the concept of hard munchables as part of a therapeutic feeding approach, particularly for infants learning to manage textures and develop crucial oral motor skills.
Common examples of hard munchables include:
Large, raw carrot sticks: Too hard to bite through, but great for gnawing.
Celery sticks: Like carrots, offering firm resistance.
Large, raw apple slices (peeled chunks): A firm, slightly sweet option.
A firm, uncut pear core: With the seeds removed.
Dried mango cheeks (hard, unsweetened varieties): These offer a fibrous texture.
A large, fully cooked but firm piece of meat (like a steak bone with some meat attached): The meat provides flavour and a bit of shreddable texture, while the bone is for gnawing.
Hard crusts of bread or breadsticks (very firm, without soft inner crumb): These can soften slightly with saliva but offer significant resistance.
Image by Freepik
It’s crucial to emphasise that hard munchables are not for consumption or nutrition. They are tools for oral motor development and should always be offered under strict, active supervision.
How do hard munchables fit into weaning?
While weaning (traditional or Baby-Led Weaning) introduces solid foods that a baby can eventually bite and swallow, hard munchables are complementary to the weaning phase. They enhance that phase by helping a child to develop hand dexterity, hand to mouth movement, and oral development.
It’s important to differentiate: Weaning provides the digestible food for eating, while hard munchables provide the tool for skill practice. They are not substitutes for each other but can be used together under careful guidance.
Pros and cons from a speech therapy perspective
As an SLT, I see both the potential benefits and the necessary precautions when incorporating hard munchables.
Pros:
Enhanced oral motor development: Hard munchables provide excellent resistance training for the jaw, helping to develop the strength, endurance, and coordination needed for efficient chewing. This is foundational for moving beyond purées and very soft textures.
Promotes lateralisation of the tongue: The act of moving the hard item from side to side in the mouth encourages the tongue to move independently of the jaw, a crucial skill for managing food and for speech sound production.
Preparation for more complex textures: By strengthening the oral musculature and refining chewing patterns, hard munchables can help babies transition more smoothly to lumpy and mixed textures.
Sensory exploration: They offer rich sensory input (tactile, proprioceptive) that can be beneficial for oral mapping and awareness, especially for babies who might be orally sensitive.
Cons:
Choking risk: While the intention is for the baby not to bite off pieces, there is always a risk. Small pieces can break off, or a baby might accidentally bite off a larger chunk than he or she can manage. Active, vigilant supervision is non-negotiable.
Not a replacement for digestible solids: It’s vital to remember that hard munchables are for practice, not nutrition. They should complement, not replace, the introduction of varied, digestible solid foods.
Not suitable for all babies: Babies with certain developmental delays, oral motor deficits, or medical conditions might not be appropriate candidates for hard munchables without highly specialised guidance. For instance, babies with an exaggerated gag reflex might find them overwhelming.
Key Considerations for Parents
Here are my top recommendations:
Consult with a professional: Always discuss this with your Paediatric Feeding SLT first before you introduce hard munchables. We can assess your baby’s individual readiness and guide you on safe practices.
Strict supervision: Never leave your baby unsupervised with a hard munchable, even for a second. Your full attention is required.
Appropriate size: Ensure the item is large enough that the baby cannot fit the whole thing in their mouth. It should extend well beyond their fist.
No biting off: The goal is gnawing and scraping, not biting off pieces. If your baby is consistently breaking off chunks, stop using them.
Focus on skill, not consumption: Reiterate to yourself that this is for practice, not for eating.
In conclusion, hard munchables, when used appropriately and under guidance, can be a very valuable tool to support oral motor development during the weaning journey. However, always be safe and consult with a specialist to ensure your little one develops his or her feeding skills effectively and joyfully.
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of 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.
As an AAC speech and language therapist who uses the Saltillo 88 Core board every day, I can tell you it’s more than just a communication tool. It’s a doorway to independence, connection, and expressing my students’ unique voice.
What is the Saltillo 88 and why do I use this one?
In this blog post, I want to share practical, real-world examples of how I integrate the Saltillo 88 into various daily activities, empowering my students and parents to learn to communicate.
There are literally hundreds of core boards out there and I have tried many different ones over the years. Which one should I use with this particular client? Should I make up my own? (I have made up tons!) or should I use a ready-made one like the one below which is what this blog is about.
For me the best ones are boards with a good number of core words (at least 60) so that the board is versatile and can be used across a range of activities. The board needs to have a range of pronouns, verbs, descriptors, prepositions and question words to be useful and to stimulate not just requesting but commenting and asking questions. Another consideration is: can the board easily be transferred to a more robust AAC system. Once my student is used to the symbols and where they are could we move to an electronic talker/device. And if this answer is ’yes’ then we have a great board to get started with.
It has 88 words and I find it really does suit most activities. The same board and design is also then found on the TOUCHCHAT AAC device which can be a seamless transition for our learner.
Let me dive into how core words/board or AAC can be used daily:
1. Getting dressed
Whilst choosing clothes for your little one and getting them ready for the day you can use the following words: want, like, get, finish. Always pack the words into little phrases you can speak naturally when using a board. I have tried to show you phrases that you could use below.
The words in bold are the core words on the board and the other words are just words you say whilst pointing to the core word.
Goal: Express choices, needs, and preferences about clothing.
Ideas:
‘I want this one [specific item of clothing: ‘shirt’, ‘pants’]’
‘I like that one [colour/type of clothing]’
‘Help me [put/get it on/take off]’
‘let’s get your socks now’
‘finished let’s go’ (when dressed)
2. Having a shower/bath
Goal: Bath time tends to happen daily and so it lends itself to using the same useful phrases and words to chat about temperature preferences, to ask for toys or for washing routines.
Ideas:
‘let’s go have a bath/shower’
‘let’s turn on the tap/water’
‘now turn it off’
‘let’s get/have more toys/water/bubbles/tickles’
‘all gone, what’s next?’
‘how about washing your hands/feet’
‘let’s do that again’
‘need some help?’
‘Stop it now, let’s do something different’
3. Mealtimes
Goal: Mealtimes can be (or should be) enjoyable and motivating to ask for specific things we like, and commenting about our eating experiences.
Ideas:
‘I want/give me [food item: ‘apple’, ‘bread’]/[drink item: ‘water’, ‘juice’]’
‘More foods/drinks/snacks’
‘All done’
‘that’s messy we like that (not)’
‘Like’/‘Don’t like’
‘Big’/‘Little’
‘this is so nice!’
4. Playing
Goal: This is where it’s at for children of course and we can use our core words to chat and engage with our little learners.
Ideas:
‘I want play’
‘Go’/‘Stop’
‘More/again’
‘not it’s my My turn’/’it’s Your turn’
‘that’s a Big one!’/‘let’s do Little bubbles’ (describing toys)
‘let me Open it for you’ (for boxes, doors in play)
‘I See it’ (to draw attention)
‘Help me’ (with a tricky toy)
5. Opening boxes/doors/etc
Goal: Most kids love opening boxes, doors and cabinets to see what there is to play with. Help your child to ask for what they want.
Ideas:
‘let’s Open that box/bag/zip/door’
‘get me a (toy) out of here’
‘Let’s Take it out and see what it is?’
‘finished’ (when finished with the task)
‘I want [what’s inside]’
‘What’s next? Let’s see’
Tips for using AAC effectively
Consistency is key: Emphasise using it regularly, even for small things.
Modelling: this is crucial, the adults need to use the board for all situations first and foremost before we can expect our child to be interested.
Patience: Communication takes time and practice.
Celebrate successes: Acknowledge every communicative attempt.
Make it accessible: Keep the board within easy reach at all times.
Conclusion
If you’re considering the Saltillo 88, or TouchChat, or are already using it, I hope these examples inspire you. It’s a journey of discovery, and every word communicated is a step towards a more connected and independent life. What are your favourite ways to use the Saltillo 88 or which core board do you love using? I would love to hear your comments and stories.
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of 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.
If your child’s speech is difficult to understand, it can feel tempting to focus straight away on individual sounds: those tricky /S/, /K/, or /SH/ sounds that just won’t come out clearly.
But in therapy, we don’t always start there.
When a child is very difficult to understand, and I have ruled out that the underlying cause is motor-based, I often opt for the Cycles Phonological Approach. This is helpful for those kids where we can feel like we don’t know where to start! The Cycles Approach helps to generate a broad overall increase in speech clarity by sequentially targeting a variety of speech patterns over the course of 8–10 weeks.
So rather than working on one sound until it’s ‘fixed,’ we:
Work on patterns (not just individual sounds)
Target each pattern for a short period of time
Then cycle to the next one
And come back around again later
This mirrors how speech development naturally happens: gradually, with increasing accuracy over time.
Why don’t we start by fixing erroneous sounds straight away?
To use a metaphor, if a child doesn’t have a strong syllable structure, working on individual sounds is like decorating a house that doesn’t have solid walls yet.
Many children with speech sound difficulties:
Drop syllables (e.g. ‘banana’ → ‘nana’)
Simplify longer words
Struggle to maintain rhythm and stress patterns
So, before we refine speech sounds, we need to build the framework of speech.
Why syllables come first in every cycle
In the Cycles Approach, we always begin with 2- and 3-syllable words, even if that’s not the main concern.
Why?
Because syllable awareness supports:
Speech clarity (intelligibility)
Word structure and sequencing
Prosody (rhythm and stress)
Motor planning for longer words
Without this, even perfectly produced sounds can still be hard to understand in real speech.
What do ‘2 and 3 beats’ mean?
When we talk about ‘beats’ we mean syllables you can clap.
Try it:
‘Table’ → ta-ble (2 beats 👏👏)
‘Banana’ → ba-na-na (3 beats 👏👏👏)
In therapy, we help children:
Hear the beats
Feel the rhythm
Produce the full word (without dropping parts)
What this looks like in therapy
In my sessions, this part of the cycle is active, visual, and repetitive.
You might see me using:
👏 Clapping or tapping out syllables
🧩 Using visual supports or blocks for each beat
🎲 Play-based repetition of target words
🎯 High-frequency practice (lots of turns!)
I also keep the focus on success and flow, rather than correction.
If you’re watching the video clip I’ve shared here, you’ll notice:
I’m not over-correcting every sound
I’m prioritising getting the whole word out
I’m building rhythm, confidence, and consistency
Why this stage is so powerful
It can look simple, but it’s doing a lot of heavy lifting.
Working on syllables helps children:
Say longer words more clearly
Reduce ‘mumbling’ or collapsing of words
Improve overall intelligibility quickly
Prepare for more precise sound work later
Often, parents notice early wins like:
✨ ‘They’re easier to understand already’
✨ ‘They’re saying longer words!’
✨ ‘They’re more confident speaking’
And that’s before we’ve even fully targeted specific sounds.
But will my child still learn their sounds?
Yes. Absolutely.
The Cycles Approach is structured so that after syllables, we move into:
Early developing sounds
Then more complex patterns (like fronting or clusters)
And importantly, we come back around again.
Nothing is missed. It’s just sequenced in a way that supports success.
A different way of thinking about progress
One of the biggest mindset shifts with the Cycles Approach is this:
👉 We’re not aiming for perfection straight away
👉 We’re aiming for gradual system-wide change
That means:
Your child doesn’t need to ‘master’ something before moving on
Progress builds across cycles
Speech becomes clearer over time, not overnight
So, to sum up
Starting with syllables might seem unexpected but it’s one of the most powerful foundations we can give a child whose speech is hard to understand.
By building rhythm, structure, and confidence first, we make everything that comes next more effective.
If your child is starting speech therapy and you notice we’re clapping words like ‘banana’ or ‘elephant’, there’s a very good reason for it.
We’re not going backwards.
We’re building from the ground up.
We’re making later sound work more effective and more likely to generalise into everyday talking.
Next steps:
If you’re concerned about your child’s speech clarity or wondering whether they might benefit from a structured approach like this, feel free to get in touch. I offer individualised assessments and therapy plans tailored to each child’s speech profile whether that’s early sound development, phonology, or motor speech difficulties.
Sonja McGeachie
Highly Specialist Speech and Language Therapist
Owner of 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.
Parent FAQ section
Why is my child practising words like ‘banana’ instead of sounds like /K/ or /S/?
Because your child first needs to be able to hold and produce the full shape of a word. If they’re dropping syllables (e.g. ‘banana’ → ‘nana’), working on individual sounds won’t carry over into real speech. We build the structure first, then refine the sounds.
What if my child can already say some long words?
That’s great. But we’re looking for consistency and clarity across many words, not just a few familiar ones. This stage helps stabilise that skill so it becomes reliable in everyday talking.
How long will we stay on syllables?
Usually, this is a short but important phase within each cycle. We revisit it regularly, but we also move on to other patterns (like specific sounds or sound processes) within the same therapy block.
Will this delay my child learning their sounds?
No. In fact, it often speeds things up overall. Once the syllable structure is in place, children are much more able to use correct sounds in longer words and sentences.
What can I do at home?
Keep it simple and playful:
Clap out words together (e.g. ‘el-e-phant’)
Emphasise full words naturally in conversation
Repeat back what your child says with the full structure (without pressure)
Consistency and exposure matter more than correction.
My child gets frustrated. Will this help?
Yes. Many children become frustrated when they’re not understood. Improving syllable structure often leads to quick wins in clarity, which can boost confidence and reduce that frustration.
Building clearer speech: Why we practise syllables first
What are syllables?
Syllables are the ‘beats’ in words.
‘Table’ = 2 beats (ta-ble)
‘Banana’ = 3 beats (ba-na-na)
Why is my child working on this?
If your child:
Drops parts of words (‘banana’ → ‘nana’)
Mumbles longer words
Is hard to understand
…then we need to build the structure of words first.
This helps your child:
✔ Say longer words clearly
✔ Be easier to understand
✔ Feel more confident speaking
What does this look like in therapy?
We practise:
Clapping or tapping out beats 👏
Saying full words with rhythm
Repeating target words through play
Using visuals or actions to support learning
How you can help at home
Keep it light and playful, little and often!
Try this:
Clap words together أثناء play (e.g. toys, food, animals)
Model full words naturally (‘Yes, ba-na-na!’)
Repeat and expand what your child says
Example:
Child: ‘nana’
You: ‘Yes! Ba-na-na‘
Important to know
This is a key first step in speech therapy
We will move on to sounds—but this helps them stick
Small changes here can make a big difference in clarity
