Speech Sound Disorders

ByLondon Speech and Feeding September 21, 2021January 31, 2023

Kids Speech Therapist London — Speech Sound Disorders

Treatment Approaches – A Typical Session

There are various great ways to treat speech sound disorders and I use all the approaches available selectively; I decide what works with each individual child and I also vary the approach depending on the child’s frame of mind at any given time during my session.

Some of the approaches are more “drill-based” and require a child to be able to pay attention and really participate actively in the therapy, and this is what I am showing you today with this video clip.

My little student here has been working with me for some time and from only saying a handful of words which were not very easy to understand he has come a long way. He does have some features of Verbal Dyspraxia which I shall briefly outline here:

Making sounds in general is a struggle, especially when asked to copy certain sounds, example: ‘can you say: a ee ou oo?”
Repeating sound sequences or words sequences is hard, for example: “say p-t-k in sequence” or “say fish chips fish chips fish chips
When saying the same word again and again, different mistakes can be heard
Intonation difficulties: speech sounds monotonous
Vocabulary is very limited

Some therapy approaches are more play based, for example the Core Word method: here we pick a few words at a time which are very significant to the child and therefore highly motivating to try and say. These could be characters of Pokemon or Minecraft for example, or simple words like “GO!”

When you watch the video you will see that I use a lot of visual prompting, such as showing him where the tongue is moving to or from. I do this with my index finger and this approach is called Tactile Cueing or “Cued Articulation”. Part of the approach is to give a visual prompt and then reduce the prompt as the learner is more able to produce the correct sounds. Once he can produce the sound on its own, we quickly move to the sound within a word.

I do mix and match my approaches and in fact here I am drilling but I also use the Core Word which for him (YELLOW) — it’s his favourite colour and I happen to have quite a few good games where a YELLOW something or other can be asked for….. WHO KNEW!? 🙂

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.

Neurodiversity · Speech and Language Therapy

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

ByLondon Speech and Feeding July 5, 2024July 2, 2024

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

What are these principles?

Principle 1: MASSED PRACTICE

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

This leads to motor performance or automaticity.

Principle 2. DISTRIBUTED PRACTICE

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

This leads to improved Motor Learning and good generalisation.

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

Principle 3: Constant vs Variable

Principle 4: Blocked vs Random

To explain:

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

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

We keep the rate, pitch and intonation constant.

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

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

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

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

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

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

How do I decide on what to use?

Good question!

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

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

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

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

Example

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

So this is:

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

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

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

A young boy is in the foreground and has turned his head away from the woman sitting next to him.

Autism Therapy

Explore 12 questions to determine whether your child may be Autistic

ByLondon Speech and Feeding October 7, 2022February 10, 2023

As professionals, when diagnosing young children with an Autistic Spectrum Condition, it is vital we work as a multi-disciplinary team, so you will likely see many professionals. This may include Educational Psychologist, Dietician, General Practitioner, Occupational Therapist, Paediatrician, Special Educational Needs Coordinator, Speech and Language Therapist and Social worker. Once the evidence is collated, then a diagnosis may be made.

You may be wondering what are some of the early signs of social communication difficulties? Whilst no autistic child is the same and we know Autism is very much a very wide spectrum of abilities and needs there are some autistic spectrum characteristics we do typically see in the early years of childhood. You may wish to think about these areas or presentations to help you prepare for the Speech and Language Therapy appointment.

Twelve questions

Does your child respond to their name?
Are they fixated with watching their hands?
Do they have sensory processing difficulties such as bright lights, food textures, or loud noises?
Are they meeting their milestones or are they delayed?
Do they flap their arms or legs when excited?
Have you noticed any rocking back and forth?
Do they blink excessively or display any facial tics?
Do they play with a particular sort of toy e.g. spinning toys?
Have you noticed that they lack interest in toys?
Have they regressed in their language? Perhaps you’ve noticed they are not using words that they have previously learnt.
Do they use gestures to communicate their needs? How do they communicate their wants and needs?
Do they appear to be in their own world?

You are not alone

These questions are by no means exhaustive and there are many more factors to consider. But it is important to trust your instincts as you are the expert on your child and know your child the best. Regardless of whether you see all of the above points or none, do not hesitate to have an assessment if you are concerned as, even if it turns out to be nothing to worry about, there is always at least one or two great pieces of advice I can offer you on the way and you will leave feeling hopeful and empowered. It’s always best to seek early intervention with communication difficulties. This allows strategies and support to be put in place. Never feel alone, always speak out.

Find communication support here from me, Sonja, (Specialist Speech and Language Therapist)

Speech and Language Therapy

Teletherapy: A fun and convenient way to help your child master those sounds!

ByLondon Speech and Feeding April 12, 2024April 12, 2024

It can be hard to get your child to come to the clinic on a weekly basis to work on those tricky sounds. Perhaps the car isn’t working, you have had a lot on, or our student has a bit of a cold but is still able to do a little bit of sound practice?

The good news is that Teletherapy can be a fantastic option to continue your child’s speech journey from the comfort of your own home!

Even when your wifi is not working and your laptop is broken, as you can see on this clip I was able to stretch into running the session on WhatsApp video, but that is less then ideal I will say.

What is Teletherapy?

Teletherapy is speech therapy delivered virtually, through a secure video platform. I use Zoom for example, but I have also used WhatsApp Video Call on occasions where parents’ zoom was not working.

When is Teletherapy perfect?

Here’s why teletherapy can be a great fit for helping your child solidify those learned sounds:

Basic sound patterns have been established in clinic: Your child is now able to say those tricky sounds BUT they are not saying them in daily life yet; they are not ‘generalising’ those new sounds into the normal speech.

You just can’t make it today: No more fighting traffic or fitting appointments into busy schedules. Teletherapy sessions happen at home, on your time. Sometimes even in the attic or the garden shed as in my video clip here ????
Your child is about 7 years old or older and is motivated to work on their sounds: I use fun and interactive online tools and games to keep your child engaged during practice sessions. Due to having done teletherapy over the Covid period I have amassed lots of great games and know-how in this area. Our student needs to be mature enough to be able to sit in front of the laptop camera and participate with a minimum of adult help.
Your child loves gaming and is best motivated through online games: Sometimes children are best motivated when playing online games in between speech sound/language activities; in this case teletherapy is totally perfect.
Focus on Carryover: The familiar environment of your home can actually be an advantage! I can guide my student on practising sounds in everyday situations, like reading a book together or playing with toys, sometimes even talking to their sibling or a.n.other in the room.
Parental Involvement: Teletherapy allows you to be directly involved in the sessions just in same way as when I see your child in my clinic. You can learn strategies and techniques from me to continue practising with your child throughout the day. You can also make a note of the online games I have and then use them in your home sessions.

What to Expect During a Teletherapy Session

Initial Consultation: We start with a brief chat on how the week has gone, what gains have been made with the home exercises and we settle the student into a good learning mode; sometimes I start off with a very quick game just to set the scene.
Working on generalising: When asking my student about how their week has been I will remind them to remember their new sounds and to try and produce them whilst talking to me. This is already the start of therapy.
Practising target sounds: We practice our target sounds in different contexts, using games, visuals, and activities.
The teletherapy session lasts the same amount of time as do 1:1 sessions, unless I see that a child becomes very fidgety and we are not able to hold out much longer, I will cut short the session and focus on increased home practice.
Home Practice: Just like in 1:1 clinic sessions, I will provide you with easy-to-follow tips and activities to continue practising sounds throughout the week.

Getting Started with Teletherapy

Technology Check: Ensure you have a reliable internet connection and a device with a camera and microphone.
What device is best: Ideally the student needs to be on a laptop or PC because that way the student can actively engage with their mouse, moving game pieces, or participating in online activities using their mouse. Tablets are ok but do not allow active participation of the student as described above. However once in a while we can make it work and I do have some games and activities that do not rely on student participation.

Finally, I would say that Teletherapy is a safe, fun and effective way to continue your child’s speech therapy journey. It’s convenient, engaging, and it is perfect on a rainy day when you don’t want to or can’t come out to bring your child to clinic.

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

Speech and Language Therapy

Discover the secrets to applying for an Education and Healthcare Plan

ByLondon Speech and Feeding March 27, 2023February 10, 2023

Navigating the education and healthcare system isn’t easy, which you’re all too familiar with. You want what’s best for your child so that they can thrive. This isn’t about achieving top grades in class or getting into a top set in a subject. It’s allowing independence, being able to make developmentally appropriate choices and giving them a voice, allowing them to be heard.

You may be at the start of your journey or going through the process of applying for an Education and Healthcare Plan (EHCP). You feel lost and have minimal confidence in the system, and every question you ask feels like it’s challenging every belief you have. But you know you must carry on. You worry that your child’s EHCP will be rejected and that this will prevent them from achieving their potential. You’re aware of the importance to put forward your child’s case and advocate for them. What the panel don’t see is that you have your child’s best interests in mind every single minute of every single day. Fighting for their needs is tough on your family.

Let me guide you through some of the most frequently asked questions, allowing you to feel more confident in the process and how together we can make a difference to your child’s future.

1. What is an EHCP?

An EHCP is a legal binding document which provides support for children up until the age of 25. These are for children who require more support than the provision given through Special Educational Needs.

2. Why is an EHCP used?

An EHCP is used to help you get the correct support for your child, so they can achieve their potential, and improve the quality of their learning. It also allows support for the family.

3. What is the role of a Speech and Language Therapist in the process of applying for an EHCP?

The role of a Speech and Language Therapist is to assess your child’s speech, language, and communication. It forms part of the plan to see what extra support is needed to access their education and reach their full potential. A report will be formulated and identify any limitations in your child’s communication profile and how these impact on their education.

4. What areas does an EHCP cover?

The EHCP document is very detailed to demonstrate what support your child needs and is likely to need. There are 11 sections (A-K). It covers the following:

A – An overview of the child to include your child’s interests and wishes.
B – A detailed explanation of your child’s needs which includes their cognition and learning ability, communication and interaction skills, social, emotional, and mental health and sensory and physical disabilities.
C – The healthcare needs of your child which may include physical or mental health difficulties, difficulties with eating, anxiety, and epilepsy.
D – The social care needs of your child such as being able to take part in activities outside of school.
E – This section collates all the information and discusses the outcomes which are based on the assessment (which includes educational aims such as success in education or participation).
F – Section F details the provision required to meet their needs.
G – Section G is where you’ll need information about their learning difficulty or disability which may include information about equipment or medication (e.g., software or a specialist wheelchair).
H – You’ll provide details on social care for your child (such as activities attended outside of school or any short breaks). This is also the section to write about the support you get at home as a family.
I – Section I should give details on the education setting your child attends.
J – This section contains information about finances you will receive to get the support your child needs.
K – The final section contains all the supporting documentation (such as assessments, reports, and advice).

Together we can achieve support

Whilst this may seem daunting, it is necessary to gain the support your child requires. I will guide you through the process, step by step, so you feel confident in the application that you submit on your child’s behalf. This document supports your child’s future.

Let’s break down the barriers and allow your child to learn and flourish. It’s their time to be independent.

Support is only a click away. I’m here to help.

Autism Therapy · Speech and Language Therapy

Discover how Attention Autism can support your Autistic child’s communication

ByLondon Speech and Feeding May 5, 2023May 31, 2023

“I’ve got something in my bag, in my bag, in my bag,

I’ve got something in my bag,

what it is”

You might be wondering why your Speech and Language Therapist is singing this song and then presenting items from a zipped-up bag. Let me take you through stage one of this evidence-based approach.

There are many aims of ‘bucket or bag time’. During stage one, you are simply engaging your child’s attention (whilst also exposing them to language). It’s important to remember that you are not forcing your child to say or do anything. The idea is that the items in the bag or bucket ‘offers an irresistible invitation to learn’ (Gina Davies, 2020).

You don’t need ‘special’ expensive toys. Use what you have at home. It might be that you have some bubbles, a wind-up toy. You might have some foil that you can roll up into a ball, or a balloon. Keep these items for ‘bucket time’. This means that your child is likely to be excited and motivated for the activity. The only stipulation is that these items must be highly motivating and must be the most exciting thing in the room. You’ll want to cover up any distractions.

So, you have your items and your opaque zipped bag, next you’ll want to put the items into the bag ensuring the zip is closed. The zip is important as it increases suspense and excitement as your child cannot see inside. You can also comment when unzipping ‘open bag’ using the signs ‘open’ + ‘bag’ to support your child’s understanding. Your Speech and Language Therapist can help with any Makaton signs that are unknown. The idea of this activity is that the item isn’t touched by your child. This can seem a little odd or feel “mean” but there is a reason for this: we want our child to look at us as well as the object or toy. As soon as we allow our child to touch and play with that toy their attention will go to the toy alone and we won’t get JOINT attention or engagement. This is the reason why we SHOW interesting things for a brief moment and then put these items back into the bag or bucket and out comes the next item. If your child wants to grab the toy and gets upset, then they may not be quite ready for this approach.

Next, we sing the song (as above) and unzip the bag taking out one of the items. The use of pausing is important. Pause after the song: does your child try to use gesture or sound? You can also use this opportunity to model short phrases, ideally one or two words such “it’s a spinner! Wow… so many colours”. After a couple of turns, repeat the process and pull out a different item. We tend not to sing the song each time for the next item. Just sing it at the beginning and then get on with producing the amazing, wonderful things in your bag. No hard and fast rules though, apart from “don’t let the child touch the toys”.

The biggest factor here is that you and your child enjoy the activity together. Have lots of fun!!

Keep up to date with our latest blogs to explore more stages of Attention Autism.

If you need speech, language or communication support or advice, I am always here to help.

A child playing with a spade in the soil

Speech and Language Therapy · Top tips

Some ideas to encourage communication

ByLondon Speech and Feeding July 21, 2023June 21, 2023

Coming up with ideas for supporting your child’s speech, language and communication can be difficult especially during the holidays. All these activities are easy to implement and can be adapted to your child’s age and stage of development.

Some activities to support your family through the summer:

1. Create a story book / photo book of what you’ve been up to over the holidays

Collect photos of everyday activities and stick them into a file. You can print them out or you could just look at them on your phone or tablet. Create good little sentences or words / phrases for each picture: yummy ice cream / eating pizza / digging the sand / a sandcastle with mum.

This enables your child to develop

their attention and listening
sequencing of events
expressive language (talking)
and conversational skills.

2. Explore the outside world (e.g., water the flowers, dig in the soil)

Depending on your child’s language level keep it very simple: single words or short phrases. Or you could practise concepts such as ‘pronouns’: he is eating an ice cream / we are splashing in the pool / she is riding a bike.

3. Splashing in a paddling pool

This is a great activity to build attention. You can call “splash, splash, splash”, “ready steady go splish splash splosh”, ”pour pour pour”, “stir stir you’re stirring”.

Offer different sized containers. This is often so powerful and keeps your child occupied for a nice long time. No need to buy anything special: just bring out your kitchen utensils and some Tupperware containers.

4. Blow bubbles

Bubbles are a fantastic way to engage children. You can play ‘stop and go’ games, take turns and practise key concepts such as ‘under – blow bubbles under my hand’. Your child can practise their expressive language, creating sentences such as ‘blowing bubbles in the pool’.

5. Draw with chalk on pavement slabs to encourage speech sound production or just general nice communication

Use chalk outside to draw a ladder. Your child can practise their speech sound production without even realising it! You can go first to model the sound if needed. Drawing anything onto the pathway with coloured chalk can be really fun.

Afterwards you can wash the pathway and again there is lots of vocabulary you could use there to help your little one practise speech sounds. For example, if your child is practising the word “YELLOW” (as many of my children do) you can draw lots of little yellow things and then name them together:

yellow banana
yellow flower
yellow submarine
yellow balloon

You get the idea!

6. Walk in nature. Comment on what you see, smell, hear and feel

Make the most of where you live. Go for a walk. You can sing songs along your walk or comment about what you see, smell, hear and feel. For example: I hear the birds, they are singing; I smell the sea and can hear the waves crashing against the rocks. Make sure your comments are appropriate for the age and stage of your child.

7. Sing songs

This is a lovely way to get your child hearing language, rhyme and rhythm. You can take turns, and fill in the missing words such as “heads, shoulders, knees and ______”.

8. Word games (such as ISpy)

The beauty of this game is that it can be played anywhere and everywhere! The importance is that these word games develop phonological awareness (the ability to hear and manipulate sounds in words).

Contact me for speech, language and communication support.