Why structure, high expectations and warmth matter in speech therapy

ByLondon Speech and Feeding
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If you were to peek through the window of one of my speech therapy sessions, you might notice two things: a room full of engaging games and activities, and a therapist who is carefully guiding a child towards a specific goal.

Why structure, high expectations and warmth matter in speech therapy. A photo of Sonja McGeachie smiling.

There will be laughter, encouragement and opportunities to play. But there will also be moments when I ask a child to stop, listen carefully, try a sound again or adjust the way they are producing it.

To an outside observer, this might sometimes look quite structured. And that raises an important question: does effective speech therapy need to be more than simply playing with a child?

My answer is yes.

Play has a valuable place in speech therapy, but when a child is working on a speech sound disorder, we also need clinical expertise, purposeful practice, careful listening and clear goals. Children deserve sessions that are enjoyable and supportive, while also helping them develop the skills they need to communicate more clearly and confidently.

For me, the key is combining warmth and encouragement with high expectations, appropriate structure and an approach tailored to each individual child.

Here is why I believe this balance matters.

1. Speech sound therapy involves learning a new skill

Learning to produce a speech sound accurately is not simply a matter of telling a child what to do. Speech involves highly coordinated movements, and children who have difficulty producing particular sounds may need considerable support to develop new or more consistent ways of producing them.

Think about learning to play a musical instrument. Understanding what a note should sound like is not the same as being able to play it accurately. It takes practice, feedback and time to develop the necessary skills.

Speech sound therapy can be similar. A child may understand that they need to make a /K/ sound, for example, but continue to produce a /T/ sound instead. They may need help to notice the difference, understand where the sound is produced in the mouth and practise the new movement with appropriate support.

This is where purposeful practice becomes important.

During a session, I listen closely to how a child produces a sound. I may model the sound, use a visual cue, help the child notice their tongue position or break the task into smaller, more manageable steps.

Sometimes a child can produce a sound accurately straight away. At other times, we need to slow down, change our approach or practise at an easier level before moving on.

The aim is not simply to produce lots of sounds. It is to help a child practise in a way that supports accurate, increasingly consistent speech.

That means I will sometimes ask a child to try again. Not because I expect perfection, but because I want to help them discover what works and build on their successes.

2. Clear structure can help children know what to expect

Some children arrive at therapy full of energy. Others may find it difficult to concentrate on a task, manage transitions or persist when something feels challenging.

Expecting every child to sit still and work in exactly the same way would not be realistic, nor would it be appropriate.

However, children often benefit from knowing what is happening, what we are working towards and what comes next.

For example, I might explain:

‘First, let’s practise five careful /S/ sounds together. Then we’ll take our turn in the game.’

This gives the child a clear, achievable goal and a predictable next step. For another child, I might use a visual timetable, shorter practice bursts, movement breaks or a more playful activity to support participation.

Structure does not mean that every session must look the same. It means that the activities have a purpose and that I am making thoughtful decisions about how best to help the child learn.

If a child becomes tired, frustrated or overwhelmed, I may need to adapt the task rather than simply insist that they continue. Sometimes a short break or a different approach is exactly what enables the child to return to the activity successfully.

My responsibility is to recognise what the child needs while keeping sight of the therapeutic goal.

3. Warmth and high expectations belong together

I believe one of the most important qualities of a good speech and language therapist is the ability to combine a positive relationship with clear clinical guidance.

Children need to feel safe enough to try something difficult, make mistakes and have another go. They also need a therapist who can recognise when they are ready for the next step and help them work towards it.

In my sessions, encouragement might sound like this:

‘That was a good try. Let’s see if we can make that sound even clearer together.’

‘I know this sound is tricky. Let’s slow it down and find the mouth position that works.’

‘You did that one really carefully! Can you remember what you did with your tongue?’

These are small moments, but they matter. They help children understand that speech sounds can take practice, that mistakes are part of learning and that they can make progress with the right support.

I celebrate genuine achievements, whether that means producing a difficult sound accurately for the first time, becoming more aware of how a sound feels, or managing to use a new skill more consistently.

I also want children to understand that they are not expected to get everything right immediately. My job is to guide them, give them appropriate feedback and help them develop their skills step by step.

High expectations should never mean expecting every child to progress at the same pace. They mean taking each child’s potential seriously and giving them the support they need to move forward.

4. Play can be powerful when it has a purpose

I love using games and playful activities in therapy. They can motivate children, create opportunities for interaction and make repeated practice much more enjoyable.

But the game itself is not the therapy. It is one of the ways I help a child engage with the therapeutic task.

For example, a simple board game might provide opportunities to practise a target sound in carefully chosen words. A picture activity might help a child listen for the difference between two sounds. A motivating toy might encourage a child to practise a word several times without the session feeling repetitive.

While the child is playing, I am listening, observing, adjusting the level of difficulty and deciding what support to offer next.

If a child is not yet able to produce a sound accurately in a particular word, I may return to an easier level of practice. If they are achieving the target consistently, I may begin to introduce more challenging words or activities that help them use the sound in a wider range of situations.

The activities may look simple, but the clinical reasoning behind them is important.

Parents should be able to understand what their child is working on, why a particular approach has been chosen and how progress is being monitored.

For me, effective therapy is about making the session purposeful, responsive and productive.

5. Progress takes clinical expertise, practice and partnership

When parents seek specialist speech and language therapy, they understandably want to see progress. They want their child to be understood more easily, to feel more confident communicating and to experience fewer frustrations when speaking.

My role is to assess the child’s speech carefully, identify the areas that need support and develop an appropriate plan.

Depending on the child’s needs, this may involve working on individual speech sounds, helping them distinguish between sounds, addressing patterns that affect several sounds, or using a more specialised approach where speech motor planning is a concern.

There is no single programme that suits every child. The type of intervention, the amount of practice and the pace of progress will depend on the child’s individual profile and response to therapy.

I monitor how a child is progressing and adjust my approach accordingly. I also explain what we are working towards and, where appropriate, suggest practical ways parents can support learning between sessions.

Home practice is particularly valuable, and it needs to be realistic and manageable for each family. Even a short period of well-supported practice provide useful opportunities to build on what a child has been learning in therapy.

Ultimately, I want parents to feel informed and involved, with a clear understanding of their child’s goals and the steps we are taking to work towards them.

The takeaway: Structure with warmth

I believe children deserve speech therapy that combines a warm, trusting relationship with skilled clinical intervention.

I will encourage a child, celebrate their achievements and make sessions enjoyable. I will also listen carefully, give feedback, revisit difficult sounds and help them work towards their goals.

Sometimes that means asking for another attempt. Sometimes it means changing the activity, taking a break or approaching the task in a completely different way.

The important thing is understanding when to encourage, when to challenge and when to adapt.

High expectations are not about making children comply. They are about believing in their capacity to learn while giving them the individual support they need to succeed.

For me, that is the balance at the heart of effective speech sound therapy: warmth, structure, clinical expertise and a genuine commitment to helping every child make meaningful progress.

Looking for specialist speech sound therapy?

If your child has difficulty producing particular speech sounds, is difficult to understand or is becoming frustrated when trying to communicate, an individual assessment can help clarify their needs and identify appropriate next steps.

At London Speech and Feeding, I provide tailored speech and language therapy with clear goals, careful clinical guidance and an approach that recognises each child as an individual.

Get in touch to arrange an initial assessment and discuss how I may be able to help your child.

Sonja McGeachie

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

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

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

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    Your Speech Therapist might have been advising you to introduce words to your child with the help of a CORE BOARD. What on earth is she talking about and why would we want to do this, I hear you think – and in fact this is what I get asked a lot, as I often do recommend using Core Boards.

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    • Children who are slow to speak and have difficulty expressing themselves verbally, due to genetic conditions as Down Syndrome, Verbal dyspraxia, Autism or any other learning difficulty that means a child is slow to develop speech.

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    Core vocabulary consists of the most common words used by children throughout a day. In 2003 Banajee and Dicarlo et al found that 50 % of pre-schoolers in their project used nine words consistently across their daily play and meal routines. These words are Core words and are typically the ones you can see on a board, like the one above.

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    This is not as cumbersome or limited as it first sounds or appears. Here’s why: As adult you can talk normally and, of course, many words you are using will not be on this board. But some will be, and you will be surprised how many you can find when you start using it. So you could say quite normally: Hey lovely (name of your child) would YOU LIKE some MORE water? The words in capital are on the board which you can point to as you speak normally. Basically, you are showing/saying to your child: “We can speak and these are the pictures we can use to help us; We call this TOTAL COMMUNICATION, as communication is so much more than just words! Great communication can be silent, where we use our facial expression, our smile, our eyes, our hand gestures, body movements and yes, of course, words. But when words fail us, these boards are so helpful.

    This still does not answer your original question of: why would I want to do this, I want my child to talk!? You are a SPEECH Therapist, please help my child TALK, not point to pictures, that is not what I had in mind.

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    When speech is difficult for a child it doesn’t mean that there is nothing to talk about! Of course, we want all our children and all people to speak because it is the easiest and most effective way of communicating, no doubt! However, sometimes this is very hard for some children and whilst we are always working towards speech where possible, we also want to make sure that whilst figuring out how to speak, your child has a MEANS TO COMMUNICATE. Using a board like this might well be a temporary strategy but whilst you are using it and working on their speech you will find a reduction in tantrums and frustration as you child is able to express themselves more effectively.

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    How parent coaching turns story time into a communication success

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    We often hear from parents who are trying their best to connect with their child, especially when reading books, but are met with frustration. They’ll say, ‘I read the book exactly as it’s written, but my child can’t focus for very long and just runs off!’ or ‘my child just flicks through the pages then turns it upside down and runs off with it’ or similar.

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    4. Acknowledging and interpreting echolalia

    In the video, you may hear the little boy repeat a phrase from the book or from what his dad just said. This is called echolalia, and for a long time, it was often dismissed or discouraged.

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    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

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

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

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  • One activity, endless opportunities for speech and language therapy targets

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    Using language activities to refine speech sound targets

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    • How can I expand this sentence?
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    Again, this may look simple from the outside.

    But underneath it is highly intentional clinical work.

    Listening for speech sound errors at the same time

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    In this short interaction, I respond to speech sound errors as they arise.

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    And sometimes I intentionally let the error go in order to protect confidence and maintain communication flow.

    That balance is incredibly important.

    Children need support. But they also need to feel successful communicating.

    The child simply experiences this as warm, responsive interaction.

    But underneath it is detailed clinical reasoning.

    This is why effective therapy is never about simply owning resources or downloading activities online.

    The real skill lies in:

    • how the therapist uses the activity
    • how they adapt moment by moment
    • how they analyse communication in real time
    • how they shape interaction to maximise learning opportunities.

    One activity. Endless opportunities.

    A single book, picture scene, or playful interaction can provide opportunities to support:

    • speech sounds
    • language development
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    • attention
    • confidence
    • social communication
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    The magic is not in the activity itself.

    The magic is in how a therapist uses it.

    Because excellent speech therapy is never ‘just playing’.

    It is careful, responsive, evidence-based intervention woven seamlessly into joyful interaction.

    Contact me avia 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

    Bryan A (1997) Colourful semantics. In: Chiat S, Law J, and Marshall J (eds) Language disorders in children and adults: psycholinguistic approaches to therapy. London: Whurr, 143–61.

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

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

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  • · ·

    The picky eater’s plate: Introducing solids to toddlers with ARFID

    ByLondon Speech and Feeding
    Designed by Freepik

    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.
    NumNum Baby Spoons Set
    TalkTools Recessed Lid Cup with Handles
    • 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.

    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

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

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

    What exactly is a submucous cleft palate?

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

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

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

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

    My experience as a speech therapist in private practice:

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

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

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

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

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

    Surgery

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

    Speech therapy

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

    Next steps?

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

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

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

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

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

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    Why Imitation is so Important

    ByLondon Speech and Feeding
    Target Activities and Games For Kids

    Why imitation is so important and how can speech and language therapy help children who struggle to imitate?

    Imitation or copying starts in early infancy. When we observe a young baby and his parent or familiar adult we can see clearly and frequently that the baby will be intently looking at adult’s face and try to copy their facial expressions, smiles and all those funny baby sounds we often make with young babies.

    These sounds are called “motherese” and are the beginnings of a little conversation between the parent and the baby. The “conversation can go back and forth for a long time and include sounds, as well as facial expressions.

    A little later on, once the baby can crawl and sit up unaided the copying then goes on to include toys and objects. Mum or Dad will show their toddler how to use a drum or how to put a little train on the wooden tracks and the toddler will try and copy this. They may not succeed and be a little clumsy perhaps but the act of copying anything and everything their favourite adult does is typically seen throughout the day.

    We all know and have laughed at mums or dads saying; ssshhh don’t say that in front of the baby he/she will copy you, watch your mouth! (as dad is swearing at the broken radiator….)

    This imitation goes on for years and includes eventually of course little words, more words, putting words together and then creating sentences, all the while our toddler is listening to how their adults speak, not only what they say but how they say it. This is how dialects and accents can be transmitted easily from parent /family to child.

    Copying in Children with Autism

    We know that children with autism often struggle to imitate. We see children on the spectrum typically having great difficulty to copy adults or children; this can be seen in very reduced play with their peers in nursery for example.

    Children with autism tend to have reduced joint attention and engagement with others and need to develop the ability and awareness to copy others in order to then engage more jointly with others.

    Speech and Language Therapy can help with Parent Child Interaction work and Coaching, here is how:

    During my coaching work with parents I teach step by step how to help a child who struggles to imitate:

    We look at all the researched skills and actions that adults can take to help their little one to copy, starting with close observation of their child’s interests, then following and including their child’s play and copying/imitating their child in how they play. I teach steps in a graduated way so that it is easy to see the progress and joyful to have the results at the end.

    The results are clear to see over time: our children on the spectrum learn to imitate actions, with objects and gestures, then sounds and words. Alongside this increased imitation skill the child can then develop more joint attention and engagement.

    I would always recommend Parent Child Interaction Training as a first port of call as we learn so many great techniques which are well researched by the Hanen Programme, www.hanen.org. Do drop me a line if you would like to find out more.

    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.