Stage 2 NLA

ByLondon Speech and Feeding
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Image by Freepik

Last time we asked: is our child ready tp move to Stage 2 NLA (Natural Language Acquisition stage 2) and we looked at how we can know. Now we know: he/she is ready, they are mixing and matching those scripts quite liberally! Hurrah!

So for example we hear phrases like:

  • ‘let’s go’+ ‘downstairs’
  • ‘it’s’ + ‘downstairs’
  • ‘I see it’ + ‘downstairs‘
  • ‘I want to’ + ‘shoes downstairs’ (I want to put my shoes on downstairs)

To recap, it’s important to listen out to a variety of contexts because if we only hear the single version of a gestalt —this is so great, hurrah!— but that’s not yet Stage 2.

What we can now do on a daily basis to help and support at this time:

1. We need to offer more ‘mix and match’ phrases to help our child establish this new way of communicating.

Good phrases:

  • It’s … raining / cooking / eating / washing / brushing
  • That’s … great / cool / amazing / wow / so good
  • Let’s … see / look / go / run / chase
  • How’bout … some food / playing / I’ll chase / sleeping / we read a book
  • I see a … bird / large car / fire engine
  • I wanna … have a biscuit / have a book / have a snuggle
  • We’re … going out / going home / going in the car / going upstairs

Here in my video clip of train play I use:

  • Let’s go
  • It’s going up the hill
  • It’s coming down
  • Ooops it falls!
  • It’s stopping
  • Let’s put on another parcel
  • Ready steady go
  • Off we go
  • It’s come off!
  • Let’s fix it
  • I can do it
  • I don’t need help

You can offer these gestalts either with an AAC as you can see me do in the video clip or you can just verbally offer these.

2. Watch out for Pronoun confusion or reversal:

Gestalt kids repeat gestalts, so we don’t want to create ‘pronoun reversal’.

Instead model from a:

  • first person perspective: ‘I’ / ‘Our’ / ‘Us’
  • joint perspective: ‘We’ / ‘Let’s’ or a
  • neutral perspective: ‘It’

You can turn almost any sentence into a good language model once you get used to it. And you can avoid ‘you’ and ‘your’ at the same time!

So instead of saying, ‘Do you want to go to the park?’

You could say:

  • We wanna go to the park?
  • Let’s go out?
  • Shall we go out / to the park?

3. Start providing ‘variation’ in your language modelling:

Instead of just modelling something one way, start thinking about offering a pattern in a couple of other ways, in a couple of different situations, then several ways in several different situations.

Example: once you hear your child saying: ‘it’s raining’ and you know it’s a mitigation, because you don’t often say ‘it’s raining’, or haven’t said it in a while and you know your child says other ‘it’s’ phrases.

Repeat: ‘it’s raining!’

Then: ‘it’s’ + ‘raining hard’ / ‘it’s wet out there’ / ‘It’s’ + ‘raining lot’s’.

Then later think of other combinations for ‘it’s’ + ‘something’:

  • (rice) ‘It’s’ + ‘cooking’
  • (water/tap) ‘It’s’ + ‘running’
  • (radio) ‘It’s’ + ‘singing
  • (dog) ‘It’s’ + ‘peeing’ / ‘it’s’ + ‘running’ / ‘it’s’ + ‘jumping’

In my train video clip:

  • Let’s go
  • It’s going
  • Let’s make it go
  • Ready steady go
  • Oops its gone

4. Use natural intonation that shows you really mean what you’re saying.

You can be animated or try for musical if your child prefers that / doesn’t mind you singing —they might not like it if their hearing is pitch perfect and your singing is off key…—

  • ‘I’m’ + ‘trying to find you!’ (animated, goofy face)
  • ‘I’m’ +’ getting tired!’ (exaggerated stretch and yawn)
  • ‘I’m’ + ‘catching up with you!’ (animated goofy)
  • ‘I’m’ + ‘gonna get you!’ (animated goofy)
  • ‘I’m’ + ‘sad right now’ (exaggerated face and tone of voice)

5. USE SILENCE!

Important, I might not have said this before but we need to hold back sometimes (hard I know) and not constantly offer models. Let our child sit in a bit of silence with us there just observing and waiting for their own offers. This is a very important point. Silence is golden sometimes. Try it out. I am not talking about the silence that comes with a person scrolling on their phone though, we do need to be present and receptive.

You will see this works wonders!

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.

You can also check my friend’s lovely handmade jewelry on her website.

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

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  • · · ·

    The purpose and nature of a speech and language therapy assessment

    ByLondon Speech and Feeding

    If you have ever wondered what happens when you bring your child to a speech and language therapy assessment, then this blog will shed light on the ins and outs of it for you.

    At its heart, a speech and language therapy assessment is a systematic and thorough evaluation of your child’s communication or eating/swallowing abilities. It’s more than just asking a few questions. It is a carefully constructed process designed to identify strengths, pinpoint challenges, and ultimately pave the way for effective intervention.

    Establishing a detailed profile – a few bullet points:

    • Identification of communication and swallowing difficulties: I aim to determine if a communication or swallowing disorder exists. I will establish if the difficulty is a delay or a more complex disorder.
    • Diagnosis of the specific disorder/autism: The assessment delves deeper to pinpoint the specific type and nature of the difficulty. For instance, is your child’s language delay due to a specific learning disability, a developmental delay, or another underlying condition?
    • Knowing the aetiology or what is causing a difficulty is crucial for targeted intervention. And whilst we are on the topic let’s talk about an autism assessment: I am trained and experienced in assessing and diagnosing autism. However, when it comes to the diagnosis of autism I provide a preliminary ‘working hypothesis’ rather than giving a definite final diagnosis. The reason for this is that it is considered the ‘gold standard’ and ‘best practice’ to diagnose autism in a multi-disciplinary setting and context. Since I work on my own, I always refer to highly recommended multi-disciplinary clinics for the ultimate diagnostic assessment.
    • Determination of severity: Understanding the severity of the difficulty is essential for prioritising intervention and measuring progress. Is your child’s difficulty mild, moderate, or severe? This helps me choose a particular approach and then tailor it to suit each individual child.
    • Identification of underlying strengths and weaknesses: An assessment doesn’t just focus on what’s wrong. It also highlights your child’s strengths and areas of relative ease. This information is invaluable for building upon existing skills during therapy. Understanding weaknesses provides specific targets for intervention.
    • Guiding intervention planning: The assessment provides the crucial information I need to develop an individualised intervention plan. The findings directly inform the selection of therapy goals, strategies, and techniques. Without a thorough assessment, therapy would be a shot in the dark.

    A multi-faceted approach

    A speech and language therapy assessment is not a ‘one-size-fits-all’ procedure. The specific tools and techniques used will vary depending on a child’s age, the nature of the suspected difficulty, and other relevant factors. However, most comprehensive assessments incorporate several key components:

    • Case history: This involves gathering information about your child’s developmental, medical, social, and educational background. We will go through all the relevant milestones and throughout the process I will make notes which will help bring all the puzzle pieces together.
    • Observation: I will observe how parent and child play together and we also look at how the child plays by themselves. Additionally of interest is how a child plays with me, the therapist. Through discussion I will also endeavour to find out how your child plays with other children, be it at the nursery or within the family.
    • Standardised assessments: These are commercially available tests with specific administration and scoring procedures. They provide norm-referenced data, allowing to compare the individual child’s performance to that of his or her peers. Examples include articulation tests, language comprehension and production tests, and fluency assessments. I tend not to use these assessments a lot.
    • Instead, I use non-standardised assessments: These are more flexible and allow to probe specific areas of concern in more detail. This might include language samples (analysing spontaneous speech), dynamic assessment (testing and teaching to identify learning potential), and informal observation of play or interaction.
    • Immediate feedback and report writing: During and thenfollowing the assessment, I will bring all the gathered information together and I will discuss with the parents what my findings are and what my recommendations in the short term are. Parents always go home with a good handful of useful strategies that they can implement at home right away. In addition, I provide a comprehensive report outlining the findings, diagnosis (if applicable), severity, strengths and weaknesses, and recommendations for intervention.

    In conclusion, a speech and language therapy assessment is a dynamic and essential process. It is a journey of discovery, aiming to understand a child and the child’s family and his or her unique communication or feeding profile. The assessment is usually the start of our wonderful learning journey together.

    Below is a short video clip of an assessment where you see me in action explaining a particular therapy approach to a set of parents. It perhaps shows a tiny bit of how relaxed we are in our sessions and that assessment is not at all daunting, but a hugely informative event overall which will leave you feeling empowered and hopeful.

    What happens after an assessment?

    Please feel free to get in touch with me via my contact form if you wish to have an assessment for your child’s communication difficulties or feeding difficulties.

    An assessment is always a stand-alone event and does not mean you need to automatically book follow up sessions at all. It will give a lot of information and based on this you can decide if you would like more therapy or follow up for you and your child. Many times ongoing therapy is not needed! I only recommend a course of therapy if it is really needed and where it would be immediately beneficial for your child.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

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

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

    1
  • ·

    There is more than one way to model communication: Using speech prompts, signs, and AAC together in therapy

    ByLondon Speech and Feeding

    One of the most important things I have learned as a paediatric speech and language therapist is this:

    Children do not all learn communication in the same way.

    Some children learn best through listening.
    Some need visual support.
    Some need movement and gesture.
    Some benefit from symbols or technology.
    And many children need multiple supports together before communication truly starts to develop.

    That is why flexible, responsive therapy matters so much.

    In this short therapy clip, I model just two simple words:
    ‘Go’ and ‘Up’.

    But underneath those tiny moments is a combination of therapeutic strategies:

    • speech sound prompting
    • visual cueing
    • Makaton signing
    • AAC (Augmentative and Alternative Communication) modelling
    • repetition
    • motor planning support
    • language modelling
    • total communication principles.

    Communication is bigger than speech alone

    One of the biggest misconceptions about speech therapy is the idea that communication only ‘counts’ if a child says the word verbally.

    In reality, communication comes in many forms:

    • speech
    • gesture
    • facial expression
    • signing
    • pointing
    • symbols
    • body language
    • AAC.

    This is particularly true for children with:

    • developmental language disorder (DLD)
    • autism
    • motor speech difficulties
    • childhood apraxia of speech (CAS)
    • phonological difficulties
    • global developmental delay
    • complex communication needs.

    These children often need communication to be presented through multiple pathways at once.

    That is where total communication approaches become so powerful.

    This is important to know: this does not confuse children. In fact, for many children, it does the opposite. It creates clarity.

    Careful sound prompting helps bridge that gap.

    Research and clinical experience consistently show that signs often support spoken language development rather than hinder it.

    Research suggests that learning signs alongside spoken language does not hinder speech development and may support overall language acquisition, communication confidence, and vocabulary growth in many children.

    For many children, signs actually help speech emerge because they:

    • reduce communication pressure
    • build confidence
    • strengthen understanding of words.

    A child who can successfully communicate is far more likely to keep attempting interaction.

    The power of AAC and LAMP Words for Life

    In the clip, I also model language using an electronic AAC system: LAMP Words for Life.

    AAC stands for Augmentative and Alternative Communication.

    AAC includes any tool that supports communication beyond speech alone, including:

    • picture systems
    • symbol boards
    • communication books
    • speech-generating devices.

    LAMP Words for Life is one of my favourite AAC systems because it focuses on consistent motor patterns and meaningful language development. Because communication is not about achieving perfection. It is about connection.

    And when children are given multiple ways to express themselves, they often become more confident, more engaged, and more willing to interact with the world around them.

    That is the true power of total communication therapy.

    Contact me via my contact form if you would like me to work with your child.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Reference

    Pontecorvo, Elana & Higgins, Michael & Mora, Joshua & Lieberman, Amy & Pyers, Jennie & Caselli, Naomi. (2023). Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language. Journal of Speech, Language, and Hearing Research. 66. 1291-1308. DOI 10.1044/2022_JSLHR-22-00505.

    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.

    3

  • The tricky /R/: Mastering tongue placement for clear speech

    ByLondon Speech and Feeding

    The /R/ sound is notoriously challenging for many children (and even some adults!). It’s one of the most complex sounds in the English language, with various pronunciations depending on its position in a word. If your child is struggling with their /R/s, you’re not alone. As Speech and Language Therapists (SLTs), we frequently work on this sound, and a key component of our therapy is focusing on proper tongue placement.

    Why is the /R/ so difficult?

    The /R/ sound requires precise coordination of the tongue, jaw, and lips. Unlike sounds like /P/ or /B/ that involve simple lip movements, the /R/ involves intricate tongue movements and tension. There are also different ways to produce the /R/ sound, which adds to the complexity:

    • Retroflex /R/: The tongue tip curls up and back towards the roof of the mouth.
    • Bunched /R/: The body of the tongue bunches up towards the roof of the mouth, while the tongue tip remains down.

    The importance of tongue placement

    Regardless of which /R/ variation is being targeted, accurate tongue placement is crucial. Even a slight deviation can result in a distorted or inaccurate sound. That’s why SLTs dedicate significant time to teaching and practising tongue positioning.

    Speech therapy techniques: Focusing on the tongue

    Here’s a glimpse into how I address /R/ sound difficulties, with a focus on tongue placement:

    • Visual aids:
      • Mirrors: I use a mirror to help children see their tongue movements and make adjustments.
      • Tongue diagrams and models: These visual tools provide a clear representation of where the tongue should be positioned.
    • Tactile cues:
      • Tongue depressors: These can be used to gently guide the tongue into the correct position.
      • Food-grade tools: Sometimes, I use flavoured tongue depressors or other tools to provide tactile feedback and increase awareness of tongue placement.
    • Auditory discrimination:
      • I help children distinguish between correct and incorrect /R/ sounds.
      • I use auditory cues and verbal feedback to reinforce proper pronunciation.
    • Exercises and drills:
      • Tongue strengthening exercises: Strengthening the tongue muscles can improve control and coordination.
      • Tongue placement drills: We practise positioning the tongue in the desired location and holding it there.
      • Sound approximation techniques: Sometimes we use other sounds to help approximate the /R/ sound. For example, I use the /L/ sound, to help achieve the correct tongue placement. Once my child has found the /L/ sound it is then a matter of pulling back just slightly to get a good /R/.
    • Contextual practice:
      • Once the child can produce the /R/ sound in isolation, we gradually introduce it into syllables, words, phrases, and sentences.
      • We also practise the /R/ sound in different contexts, such as at the beginning, middle, and end of words.

    Tips for Parents:

    • Be patient and supportive: Learning the /R/ sound takes time and practice.
    • Practise regularly: Short, frequent practice sessions are more effective than long, infrequent ones.
    • Make it fun! Use games, stories, and other engaging activities to keep your child motivated.
    • Work with an SLT: A qualified SLT can provide personalised guidance and support.

    In conclusion:

    The /R/ sound can be challenging, but with targeted speech therapy and a focus on tongue placement, most children can achieve clear and accurate pronunciation.

    I hope this blog post is helpful!

    Get in touch with me via my contact form if you need support

    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
  • ·

    Discover more about Verbal Dyspraxia

    ByLondon Speech and Feeding

    What is Verbal Dyspraxia?

    Apraxia or dyspraxia is a difficulty in motor planning, which sometimes can be seen in both gross and fine motor skills, as well as speech. Gross motor refers to difficulties in coordinating the whole body (e.g., bumping into things frequently, often falling over hurting themselves or others through being “clumsy” or unsteady). Fine motor movements refer to smaller, more precise movements (e.g., difficulties doing anything with their hands such as holding a spoon or pen).

    Verbal dyspraxia

    In Dyspraxia of Speech, instead of seeing a coordinated smooth way of talking, we see the articulators (tongue, lips, cheeks) and voice coordinating very smoothly. The voice can be very quiet or very loud. Muscle tone can be weaker at times. Speech sounds are very unintelligible, with a flat voice that can sound forced. It may be that the timings of verbalisation appear random and that children can say a certain word once and never again. This is often what we hear from parents.

    It is interesting to note that many of our autistic clients are either non-speaking or are reluctant speakers. Sometimes they say a word once and then never again. Others say lots of words but the words are very hard to make out. Did you know that about 40% of autistic people have verbal dyspraxia? (Richard, 1997). Because the problem is one of motor planning, not of automatic motor execution, once a plan has become automatic, it is easier to get back to it and this is why we often see repetitive patterns that can be called ‘stims’ (Marge Blanc, 2004).

    How can Speech and Language Therapy help?

    Children with verbal dyspraxia can make great progress!

    We provide frequent and appropriate speech movement opportunities and with time and the right support, children will move forward and begin to speak more fluently and with greater intelligibility. It is important to know this can take time.

    We provide Oral Motor Therapy using a variety of approaches to practise breathing, vocalising on the outbreath, and sequencing our speech movements.

    We design carefully tailored programmes focusing on words that have a lot of power (e.g., NO, GO, UP, IN, OUT, LET’S GO, STOP).

    We offer shared enjoyment, and laughter. This helps a child find their voice. Other ways of finding our voices include singing or humming, or even yelling/shouting!

    The most difficult phase of verbal dyspraxia is initiation, that is to start talking, to start producing a word. Frequent “automatic” repetition supports children with initiation because it removes the element of “thinking to start”. I often ask a child to repeat a word 5-10 times (with rewards at the end. A little game works well). You can see that with repetition the act of initiating is taken out of the equation as you are “on a roll “as it were.

    Once a child starts to find their voice, we will be able to hear them talk lot… And if we give them credit and presume that what they are saying has meaning, we will find in time that their words become clearer and more intelligible. If we listen carefully, we can detect real words and phrases.

    For more tips and support, please get in touch!

    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.

    0
  • · · · ·

    Holiday disruptions & New Year routines: How to support your child’s feeding, communication and regulation over the festive season

    ByLondon Speech and Feeding
    Holiday disruptions & New Year routines

    The festive season is a wonderful time for many families, but for children with feeding challenges, sensory differences, or autism traits, December can feel overwhelming. Changes in routine, busier environments, travel, new foods, disrupted sleep, and well-meaning relatives giving ‘advice’ can all affect a child’s feeding, communication and overall regulation.

    As a speech and language therapist specialising in Early Years, I see the same pattern each year: children often make progress during the term, only to struggle in late December when everything becomes unpredictable. The good news? With a bit of preparation, children can not only cope better, but they can actually make significant developmental gains during the holidays.

    This blog will help you feel confident, supported and prepared for the transition from ‘festive mode’ to a smoother, regulated start in January.

    1. Why routines matter so much. Especially now

    Young children thrive on predictability. For neurodivergent children or those with sensory, feeding or communication needs, routine isn’t just helpful: it’s the backbone of emotional regulation.

    In December, typical patterns change:

    • Mealtimes shift or become irregular
    • Bedtime slides
    • New foods appear
    • Loud social gatherings overwhelm
    • Travel disrupts naps and comfort routines
    • Therapies pause
    • Childcare closes

    Any one of these can lead to feeding refusals, more meltdowns, increased stimming, reduced communication attempts or regression in speech sounds.

    It’s simply the nervous system responding to too much change.

    2. Protecting feeding progress during holiday mealtimes

    My last blog and insta post have a nice social story on festive meals. They are often the trickiest part of the season for families I support. Children with sensory-based feeding challenges, or ARFID traits may find holiday foods completely unfamiliar and challenging.

    What helps:

    • Offer one ‘safe food’ at every meal
    • Keep portion sizes tiny
    • Use the ‘buffet rule’
    • Rehearse tricky moments

    3. Supporting communication when routines are disrupted

    Holiday time actually offers more opportunities for communication, just in different ways.

    Strategies:

    • Slow down and follow your child’s lead
    • Use everyday routines as language opportunities
    • Keep AAC going even if casually

    4. Understanding holiday ‘regressions’ and know they’re temporary

    This is almost always due to nervous system overload. Children don’t truly ‘lose’ skills; they temporarily prioritise regulation over learning.

    5. A gentle January reset: How to start the New Year smoothly

    • Re-establish predictability early
    • Return to preferred foods
    • Book early support if needed
    • Focus on regulation first

    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.

    Reference:

    Bronson, M. (2000). Self-regulation in early childhood. Guilford Press.

    2

  • Explore the relationship between poor speech, language and communication and literacy skills

    ByLondon Speech and Feeding

    Communication skills are critical in all areas of communication throughout childhood and into adulthood. They are needed for understanding, narrating, making predictions and to develop social skills, for example in understanding everyday language or talking in the classroom or socialising with peers. Children with communication needs can experience low self-esteem, potential behavioural difficulties, lower school attendance and attainment.

    Communication skills have a strong impact on literacy. Let’s look at some of the facts:

    • 50% of children with language delays also have challenges with literacy (Burns et al, 1999).
    • 73% of poor readers in year three had a history of difficulties with phonemic awareness (the ability to hear, identify and manipulate sounds) or spoken language in pre-school (Catts et al, 1999).
    Speech Therpaist in London

    The effect of expressive language on spelling and reading

    The ability to read is very much dependent on competent language skills. Furthermore, a limited vocabulary will also have an impact on literacy skills. The more we know about a word, the easier it is to retrieve, recall, understand and use. So, if a young person has a poorer vocabulary, it’s likely that they will not have the same decoding skills as a peer with a richer set of vocabulary. By decoding we mean the ability to apply knowledge of letter-sound relationships including pronunciation of words. Decoding is a vital skill used in literacy.

    Whilst learning to read is a key skill, it’s important to remember that a solid foundation is needed for success. We need to ensure that no steps are missed, otherwise there will be gaps in knowledge.

    As your child moves further through the education system, they will be “reading to learn”. This is where young people with poorer language skills may show literacy difficulties (for example, reading comprehensions become more challenging, and their expressive language skills impact on their written abilities).

    When should I seek advice or support?

    Always seek the advice from a qualified professional such as a Speech and Language Therapist. You need appropriate advice for the age and stage of your child’s development and early intervention is of course key to success. It is never too late to ask for advice. The earlier you seek support, the better the outcome for your child in all areas (language, literacy, and emotional well-being).

    Have you still got unanswered questions? Contact me here and we can have a look at your child’s phonemic awareness, auditory processing skills, verbal understanding and assess his/her ability and likelihood of reading and literacy struggles. If we find that your child has dyslexia I can refer on to a specialist colleague who can help you further.


    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.