The art of selective care: My journey as a semi-retired private therapist

ByLondon Speech and Feeding September 3, 2025November 6, 2025

Welcome!

Hello, and welcome. I’m writing this today to share a bit about my professional journey, a journey that has evolved over many years from a bustling, full-schedule practice to a more intentional, deeply fulfilling semi-retired life. This shift wasn’t born out of a desire to slow down, but rather an understanding of what truly matters: my time, your time, and the quality of the work we do together.

For decades, I poured my energy into a full calendar, helping as many families as I possibly could. It was a wonderful, demanding, and rewarding time. I learned so much, grew immensely as a professional, and had the privilege of witnessing countless moments of breakthrough and success. But over recent months, I began to realise that the most impactful work wasn’t about quantity; it was about quality. It was about giving my whole, undivided attention to a select few, creating an environment where true progress could flourish.

Change

This realisation led to a significant change in my practice. I am now at a point in my career where my time is both valuable and precious. It is no longer a commodity to be filled, but a resource to be invested wisely. This doesn’t just apply to my personal life, but to my professional life as well. I’ve chosen to be more selective about the clients I see, and this selectivity is rooted in a single, powerful question: ‘Who can I truly, profoundly help?’

I believe that successful therapy is a partnership. It requires commitment, trust, and a genuine connection between therapist and client. When I take on a new family, I am not just filling a slot in my schedule; I am making a deep commitment to them. I am dedicating a part of my precious time and decades of expertise to their child’s success. This is why I am now focusing on who I can really work with: families who are equally invested in the process, who understand that progress is a team effort, and who are ready to engage fully in the journey.

My fees reflect this deep investment. You will find that my rates are higher than those of many other therapists, and I want to be transparent about why. It’s a reflection of the extensive experience I bring to the table. I have spent years honing my skills, navigating complex cases, and developing a unique, effective approach to speech, language and feeding challenges. This is not just a job for me. It is my life’s work, and I honour the value of that expertise and the time I dedicate to each family.

I want to ensure that every minute you spend with me is productive, focused, and truly transformative. Therefore, I provide a ‘boutique style’ of care. Think of it as an exclusive, personalised experience where every detail is considered and your needs are at the forefront. You won’t feel like you’re just another appointment on a long list. You will feel that you have my full, undivided attention, as if you were my only client.

This means less time spent on administrative tasks and more time dedicated to preparing for your sessions, reflecting on our progress, and providing you with the most thoughtful, tailored support possible. It means an environment of calm and focused expertise, where we can truly dive deep into the specific challenges and build a clear, effective path forward.

New perspective

For parents reading this, I hope this provides a new perspective. Choosing a therapist for your child is one of the most important decisions you can make. It’s about finding not just a professional, but a partner. I want you to feel that, if we choose to work together, you are entering into a unique partnership where your child’s growth is my singular focus.

In this next chapter of my career, I am prioritising passion over pace, depth over breadth, and meaningful connections over a packed schedule. I am here to work with families who are ready for a truly collaborative and transformative experience. If you are seeking a level of care that goes beyond the standard, an approach that is both highly experienced and deeply personal, I would be honoured to speak with you.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Royal College of Speech & Language Therapists Member

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.

Autism Therapy · Speech and Language Therapy

Discover more about Verbal Dyspraxia
ByLondon Speech and Feeding September 4, 2023August 28, 2023

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).

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.

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Book corner · Speech and Language Therapy

Support your child’s communication using books: OI FROG
ByLondon Speech and Feeding March 17, 2023February 10, 2023

Oi Frog by Kes Gray and Jim Field

Book corner with Oi Frog! by Kes Gray and Jim Field.

Books are an engaging way to support your child’s communication development. Even if your little one dislikes reading in the traditional sense. They will become immersed in this adventure, without realising they are taking in language and developing vital communication skills. This is one of my favourite series for children.

Increase fun and interaction

These books are made for fun and excitement! It may seem silly putting on different voices for different characters, but this is one way in which you can engage your child. Why not try to use different intonation patterns (e.g., you may use a deep voice for the dog, and a higher pitch for the cat)? Make your story interactive: you could ‘rawww’ like a lion and see who can make the loudest noise. Make noises to encourage interaction (e.g., when scratching his chin, make a squeaky sound!). You could also relate the experience back to your child (e.g., ‘can you scratch your chin?’).

Time to talk

Talk about what you can see on the front cover (e.g., There’s a frog on a log, how funny!) You could also ask your child to choose the rhyming words on a page in the book. Can your child tell you what rhymes with certain words (e.g., can you guess what a parrot sits on?)? Make use of every page. You could comment on your favourite frog and see if your child can talk about their favourite. You can support them by giving them an example (“my favourite frog is the one swimming backwards because he looks funny”). Then you could use this scaffold to support their answer. Your favourite is [________________] because [_________________]

If your child is reluctant to use language, the use of commenting can take the pressure of them (“look at all those frogs” or “he’s climbing up the stool”) is a powerful way in which you (as parents) can take the pressure off your child. A top tip I like to give is to make sure you pause regularly, which creates opportunities for your child to use language.

This book uses a subject-verb-object sentence structure (e.g., ‘hares sit on chairs’) which allows your child to hear a good model of a sentence. You could also talk about things in the book that belong in a certain category (e.g., animals, food) or begin with a specific sound. See if your child will name any more.

Reap the reward of repetitive language

Oi Frog uses repetitive rhyming language and puts emphasis on these words. This is important because the more your child hears a word, the more likely they are to remember, understand and use it in the correct context.

Emotions matter

Talk about how the animals feel and why they may feel this emotion (e.g., the cat’s feeling annoyed because…, Lions sit on irons, how does the lion feel?). Reasons can be difficult for children with communication difficulties. Support them by giving an example or by giving them an option (e.g., “does the lion feel happy or sad? I think the lion feels sad because he’s burnt his bottom on the iron! It’s too hot!”)

OI Books

Why not read similar stories? I highly recommend OI CAT, OI DOG and OI DUCK-BILLED PLATYPUS.

Need support for your child’s communication? Contact me here.

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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Speech and Language Therapy

Submucous cleft palate: What is it and how does it impact on speech?
ByLondon Speech and Feeding August 26, 2025November 17, 2025
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.

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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Speech and Language Therapy · Top tips

Principles of motor learning in childhood apraxia of speech: A guide for parents and therapists
ByLondon Speech and Feeding March 22, 2024March 22, 2024
Image by Freepik

Childhood Apraxia of Speech (CAS) is a complex neurological disorder that affects a child’s ability to plan and coordinate the movements necessary for speech production. Children with CAS often have difficulty with articulation, prosody, and fluency, making it challenging for them to communicate effectively. While there is no cure for CAS, speech and language therapy can significantly improve a child’s communication skills and overall quality of life. Understanding the principles of motor learning is crucial for both parents and speech therapists to support children with CAS on their speech journey.

What is MOTOR LEARNING?

Motor learning refers to the process of acquiring and refining new skills through practice and experience. This applies to all aspects of movement, including speech production. The brain constantly receives sensory information about the movements being made and adjusts them based on the desired outcome. A breakdown or interruption of this process can make it difficult for children to plan, sequence, and coordinate the intricate movements involved in speech.

What key principles do we use in speech and language therapy for motor learning?
- Task Specificity: Speech Therapy activities that directly target the specific speech sounds or skills your child is working on. For example, if your child is struggling with /p/, practising isolated /p/ sounds, words with /p/, and phrases with /p/ would be most beneficial.
- Massed vs. Distributed Practice: We consider the optimal amount and distribution of practice sessions throughout the day. Massed practice involves concentrated practice in a single session, while distributed practice spreads practice sessions throughout the day. The best approach depends on the individual child’s learning style and attention span.
- Feedback: We provide clear and immediate feedback to help your child understand the accuracy and effectiveness of their attempts. This feedback can be auditory, visual, or touch based.
- Error Correction: We aim to gently correct errors so that we can help your child refine their movements and avoid developing bad habits. The focus is on providing specific cues and guidance rather than simply pointing out mistakes.
- Variety and Progression: We gradually introduce new challenges and variations in speech therapy activities to prevent plateaus and maintain motivation.
- Motivation and Engagement: A big part of our work is to make therapy sessions fun and engaging to keep your child motivated and actively participating. We use games, songs, and activities that your child enjoys while incorporating targeted practice opportunities.
What about home work?

Yes we need your help and here are some examples of how this could look:
- Task Specificity: During story time, focus on practising target sounds present in the story. Have your child repeat words or phrases containing the sound and encourage them to identify the sound in other words.
- Massed vs. Distributed Practice: Instead of one long practice session, try shorter, more frequent sessions throughout the day. This can help maintain focus and prevent fatigue. It is recommended to go for 100 repetitions of the target sound per day, every day in between the sessions. We can decide together how you can best do that through either massed or distributed practice. We can decide after the session.
- Feedback: Use a mirror to provide visual feedback on lip and tongue placement during sound production. Record the child’s speech and play it back to help them self-monitor their accuracy.
I quite like this mirror below but any table top mirror will work as long as it is not too small. Your child should see their whole face easily.
- Error Correction: If the child makes an error, gently model the correct sound or movement without shaming or criticising. Provide specific cues such as ‘lips together’ for /p/ or ‘tongue up’ for /t/.
- Variety and Progression: We will guide you on exactly what words to practise so this is something you need not worry about.
- Motivation and Engagement: Use games, songs, and activities that your child enjoys. Play a game of ‘I Spy’ focusing on words with the target sound or create silly sentences with the sound to make practice fun.
Let’s work together!

It is crucial for parents, therapists, and other caregivers to work collaboratively to ensure a consistent and comprehensive approach to supporting your child’s speech development. Speech and Language Therapists can provide guidance and resources on implementing these principles at home, while parents can share observations and progress updates to inform therapy sessions.

Remember, every child with CAS learns at their own pace. By understanding and applying the principles of motor learning, parents and speech therapists can create a supportive and stimulating environment that empowers children with CAS to reach their full communication potential.

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.

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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Autism Therapy · Speech and Language Therapy

Empowering non-speaking children: the power of AAC Core Boards
ByLondon Speech and Feeding September 25, 2023September 25, 2023

Communication is the essence of human interaction, allowing us to express thoughts, feelings, wants and needs. For non-speaking children and their families finding an avenue to communicate effectively can be a really challenging journey.

Augmentative and Alternative Communication (AAC) offers a solution: with AAC Core Boards as a powerful ally and tool to empower and express more than requests: ideas, comments, surprise and delight, as well as saying no to something! Very important!

“AAC is a set of tools and strategies that an individual uses to solve every day communicative challenges. Communication can take many forms such as: speech, a shared glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, and speech-generating devices” (RCSLT, 2023) to name just some.

AAC Core Boards are a powerful tool to empower non-speakers to express ideas. In this blog, we’ll explore the significance of AAC Core Boards and how they can unlock the world of communication for non-speaking children.

Let’s discover and understand AAC Core Boards

Firstly, let’s look at what a Core Board looks like…

Credit: Saltillo Word Power

Why not have a go and download your own copy (and other boards) for free on the Saltillo Word Power website.

AAC Core Boards are a specific type of AAC system that employs a grid-style board. This grid contains a set of core vocabulary words or symbols, which serve as a foundation for all communicative functions (e.g., initiating, greeting, requesting, negating, commenting, asking a question, and expressing surprise).

These boards incorporate high-frequency (most used) and versatile words. They enable us to construct sentences, express emotions, and take part in conversations, fostering a sense of independence and autonomy. By enabling communication, we also remove some of the frustration (from not being able to communicate) which contributes/or often leads to behavioural difficulties.

Building literacy skills

AAC Core Boards are not only tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-verbal children engage with words and symbols. It reinforces their understanding of language structure and grammar.

As they consistently play with and then use their boards, they naturally absorb language patterns, laying the foundation for improved literacy skills. This immersive learning experience paves the way for future language acquisition and communication growth.

Customisation for individual needs

Every child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind, allowing for customisation to suit individual preferences and abilities. The boards can be adapted to include specific vocabulary relevant to a child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of your child’s personality and needs, making communication more motivating, engaging and effective.

Collaboration between AAC Core Boards and Speech Therapy

AAC Core Boards are an excellent tool but we need to know one important aspect: they only work well when used regularly by the child’s family and key people in the first place.

The board needs to be used and modelled by adults consistently and regularly across environments. This is so our children know what to expect, take an interest and begin to use the boards themselves. Modelling the use of AAC Core boards is vital. Think how long it typically takes for a child to learn their first word. Around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.

Collaborating with your child’s Speech and Language Therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best put them in place, so that your child can reach their communicative potential.

For non-speaking children, AAC Core Boards are more than just tools. They are bridges to a world of communication, connection, and empowerment. These boards harness the power of visual communication, foster language development, social interaction, and personal expression. They can be tailored to individual needs with the support of skilled professionals. AAC Core Boards offer a beacon of hope, helping to break through communication barriers and thrive in a world that is waiting to hear your child’s voice.

For answers to your questions and to explore the most effective support for your child, feel free to contact us.

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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Speech and Language Therapy

Why imitation is a powerful strategy to support social communication
ByLondon Speech and Feeding April 6, 2023April 11, 2023
Before reading this blog, it’s important to understand what we mean by ‘social communication’ and ‘imitation’. Social communication is more complex than it first appears. It refers to many aspects of communication such as body language, voice, conversational skills, social ‘rules’ (such as being polite and using manners), interpersonal skills (such as developing friendships), and emotional literacy (such as appropriacy and developing self-awareness). Imitation refers to the simple act of copying.

You may have noticed that your child has difficulties in some of the areas mentioned above. They might be less responsive to you and appear to be quite happy in their own world. Whilst we do not want to change their unique characteristics, we do need to prepare them for future experiences, and what is socially acceptable.

How will copying my child develop their social communication?
1. If your child is already engaged with a certain activity, they are already interested and motivated. You’re not competing for their attention.
2. Both yours and your child’s attention is on the same activity which makes imitating for you (as the parent) easier.
3. Studies have demonstrated that when a parent imitates a child, they are more likely to look at the adult.
4. Imitation not only supports eye contact but supports facial expressions (such as smiling), may increase vocalisations, and encourages your child to sit closer to you.
5. Children learn through trial and error. They may start to try to perform new actions to gain their parents attention. Let your child lead the play!!
How do I start imitating my child?
1. Start with observing them. Take the time just to watch. You don’t need to make notes. Sit back and observe their actions, movements, and sounds they make.
2. Wait for your child’s reaction when they realise you are copying their actions. Remember they may not notice, you don’t need to remind them, simply copy them again.
3. Having the same set up as your child allows them to feel in control. So, you may have two sets of the same activity rather than copying using their set of toys.
This may sound daunting, but it doesn’t have to be. Start with a ten-minute time frame where you choose to copy your child. This is where you can practise your imitation strategy. Ten minutes a day is far more effective than an hour every two weeks. You may feel self-conscious but trust the process. Build your confidence, whilst exposing your child’s to increased language and communication, enabling them to develop vital social communication skills.

Look at the video above to watch the strategy in action!

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

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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