What is FRONTING?

ByLondon Speech and Feeding
Kids Speech Therapist London

Does your child say “Dough” instead of “Go”? Or “Tea” instead of “Key”? Do you hear a /Sh/ instead of an /S/ does “see” sound more like “she”?

We Speechies call this a Fronting Pattern which means that a sound that should be produced at the back of the throat with the back of the tongue, like K or G , is said at the front of the mouth with the tip of the tongue, like a T or a D or SH. When this happens speech can be really hard to make out because these sounds are literally everywhere in everyday sentences. Just think how many K’s and G’s we hear in a simple sentence?

For example, I heard my little student say earlier today: “I know what game we can play in your garden? It’s the one with cones and rings and cushions! I know where it is I can get it.”

But it sounded like:

“I know what DAME we DAN play in the DARDEN! It’s the one with TONES and rings and TUSHIONS! I know where it is I TAN DED it.”

If that sounds familiar to you, here is a little overview of what we can do about it:

First up it’s always good to start with general speech sounds awareness: does a child hear syllables and intonation? Do they know words that rhyme? Can they follow or copy a simple beat with a drum? Can they listen and hear quiet sounds and loud sounds and can they copy those? Can they follow mouth and tongue movements:, for example : stick out your tongue, lick your lips, click your tongue, blow raspberries?

Then it really helps to talk about BACK and FRONT of things and to draw attention to the back of the mouth and the back of the tongue and the front tip of the tongue and how sounds are made in the mouth. I often use a puppet to show this or a model of a mouth like this one here in the picture.

Next we try and listen to words starting with a BACK sounds like a K or a G , and I read out a list of words with those sounds: COW, CORE, CAT, CONE, KEY etc or ARK, EEK, OAK, ACHE…

Or GOO GUY GUM GONE

After that we try and see if a student can actually produce a single sound like a K or a G just by itself. If they can, that’s a really great start and if they can’t I help them to produce one – over a few sessions we usually get there. We call this Sound production in isolation.

Once a child can produce a sound correctly, on its own, we try and start working on very simple words that are really powerful like “GO”!!!!! in a motivating game or “CAR” for little ones who love a car racing track.

Now that we have established the back sounds and are using it in short words, we can gradually re-train brain pathways and oral- motor/movement pathways to use these new sounds in many words and then short phrases. That can take time!! This is called generalisation and it is not uncommon for it to take up a whole year for fluent speech to be error-free .

Why does it take so long? Being able to produce a correct and clear K or G sound does not mean it will be used easily. Our brain pathways are fixated or habituated to the error sound. It takes time for habits to change. A child might be able to hear the word TIGER with a G in the middle and she knows that it is not a TIDER but when saying it her tongue automatically moves forward rather than lifts up at the back. It’s a bit like a person who has a rounded back: the brain knows to stand upright and how not to slouch, but when we don’t focus on it, ooops we have slouched again because that is what we are comfortable doing and our body moves with our habit.

It takes effort and motivation to change our movement patterns and that includes our tongue and lip patterns! We usually get there through a huge variety of games and practice. Lots and lots of repetition is key as is motivation to change.

Parents and carers are crucial in the success of Speech Therapy!

We need your feedback at home, the regular short and sweet exercises, the constant positive encouragement and great modelling of speech sounds. We often find that parents are tuned into their child’s error sounds and can understand them much better than anyone else. This is great of course in many ways, however, it also means that the child has less motivation to change: if mummy understands me then my world is ok.

I will give you a short outline of what different speech therapy models I use in my practice, be it in clinic face to face or on-line in my future blogs soon.

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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Milestones of Autistic Children: Crawling, Walking, and Talking
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Milestones of Autistic Children: Crawling, Walking, and Talking

ByLondon Speech and Feeding
Image by wayhomestudio on Freepik

For all children every milestone achieved is a testament to the unique and intricate process unfolding within each young mind. For autistic children, this journey may present a distinct pattern, with some reaching developmental milestones like crawling, walking, and talking later than their neurotypical peers. Let’s have a look into the fascinating realm of Autism and explore why some autistic children might crawl, walk, and talk later, shedding light on the underlying factors contributing to this unique way of developing.

1. Individual Pacing:

Child development is not a one-size-fits-all journey. Each child, whether neurotypical or autistic, has a unique timeline for achieving milestones. Autistic children, like any other children, follow their own pacing. This individual rhythm might lead them to focus on one set of skills before they progress to others. Like some neurotypical children might focus on talking earlier than walking, autistic children might prioritise other areas before crawling or talking.

2. Neurodevelopmental Complexity:

The human brain is a remarkable entity, with a bewildering array of interconnected processes that lead to us achieving our developmental milestones. Autistic children often have variations in “neural wiring”, which can impact the balance between gross motor skills (crawling, walking) and fine motor skills. Speech and language acquisition falls under fine motor skills and may be momentarily disrupted due to the divergent neurological pathways at play in autism.

2. Sensory Processing Differences:

One of the hallmarks of autism is altered sensory processing. Autistic children often experience sensory stimuli differently than their neurotypical peers. This heightened or diminished sensitivity can influence a child’s desire or ability to engage in activities like crawling and walking. The sensation of movement while crawling or walking, for instance, might be overwhelming for some autistic children, causing them to either avoid or delay these activities.

3. Visual-Spatial Abilities:

Autistic children and adults frequently display excellent visual-spatial abilities. This strength might lead some children to focus more on activities that engage these skills, potentially delaying their engagement with activities like walking or talking. As they navigate their environment and process information visually, they might naturally invest more time in activities that stimulate this particular cognitive ability and strength.

4. Communication Challenges:

For many autistic children, speaking can be a really complex and difficult endeavour. Communication delays are a common feature of autism. This can affect both receptive and expressive language development. While some children might be physically capable of crawling or walking, they may not yet have the tools to communicate their desires and intentions. This leads to a temporary focus on non-speaking forms of expression. This does not mean that they do not communicate at all. But autistic individuals often start out using jargoning or echolalia as a form of communication as well as behaviours and physical forms of communication.

5. Executive Functioning and Motor Skills:

Executive functioning, or abilities for planning, organising, and carrying out tasks, can vary in autistic children. These skills are crucial for activities like crawling, walking, and talking, which need coordination and planning. About 40% of autistic persons have a motor planning difficulty.

6. Intense Interests and Routines:

Autistic children often develop intense interests in specific subjects, sometimes to the exclusion of other activities. These interests might become their primary mode of engagement. They might side-line milestones like crawling, walking, or talking. The mostly rigid adherence to routines and preferences might cause them to allocate more time to their preferred activities. This delays their engagement with other developmental tasks.

How can Speech and Language Therapy help:

Support and Intervention:

Early intervention and regular Speech and Language Therapy play a pivotal role in the developmental journey of autistic children. Therapies tailored to individual needs can aid in bridging the gaps between milestones. Occupational therapy, for example, can help address sensory sensitivities and motor skill challenges that might impact crawling and walking. Speech therapy can help communication development, gradually bridging the gap between non-verbal expressions and spoken language.

For example, we now know that echolalia or jargoning of longer phrases with intonation, repeating scripts from favourite tv shows or songs have many meanings and communicative functions. For example, a child who utters long strings of echolalic utterances, often difficult to understand, might want to do any one of the following:

  • Comment
  • greet
  • ask a question
  • make a request
  • express surprise
  • negate something.

We now understand that the way to support a child with echolalia is to acknowledge all utterances and try and find out what the meaning is behind these scripts. This is very supportive. Over time it will lead a child to move on to understanding and saying more clear and self-generated language. For more information about this Natural Language Acquisition here are some other great websites for you to look at:

Conclusion

In conclusion, the journey of an autistic child’s development is a testament to the uniqueness and complexity of the human mind. The delays or differences in achieving milestones like crawling, walking, and talking can be attributed to a range of factors, including

  • neurodevelopmental intricacies,
  • sensory processing variations,
  • and communication challenges.

It’s crucial to recognise that these delays are not indicative of a lack of potential, but rather a manifestation of the intricate interplay between an autistic child’s strengths and challenges. By embracing these differences and providing tailored support, we can help each autistic child unfold their potential at their own pace.

Do get in touch if you would like to book an appointment where we can explore how to help your child develop and thrive

Do get in touch if you would like to book an appointment where we can explore how to help your child develop and thrive

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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How can we help practise speech targets with our children during the day, without it being an “extra tedious ask”?

How can we help practise speech targets with our children during the day, without it being an “extra tedious ask”?

ByLondon Speech and Feeding
Image by Freepik

Say, your child replaces the ‘f’ sound with a ‘p’ so they say PAN when they mean FAN or POUR when they mean FOUR. Now after one or two therapy sessions we have managed to get your child to “bite your lip and blow” and we are seeing a little ‘f’ sound right there! Result! But now we need to practise this so it becomes a habit, so that we can start building up some little words like FAN and FUR and FAR or FOUR….

Now, for older children, let’s say over 6 years old, we might just get away with saying: ‘darling come and sit down now and do your speech practice quickly before you go and play.’ But for the little ones, under 5 years old, it is often necessary to “package” the practice within daily activities.

Daily activities

So, our goal might be: produce an ‘f’ about 50 times a day. You might think: ‘oh gosh, I won’t be able to do that, it’s too much’, but wait! It can actually be done as part of your daily activities.

Here are some little examples and you will be able to think of some more for sure.

Morning

Before brushing teeth look into the mirror together and say ‘let’s practise our “bunny sound” quickly: bite your lip and blow: FFF FFF FFF FFF FFF FFF FFFF’. Look in the mirror, get as many done here as possible, 10-15, RESULT! Now brush teeth and done.

Mid-morning snack

A … muffin? Pop a little birthday candle on it and say: ‘let’s practice our Bunny Sound here quickly: bite your lip and blow and try and blow out this candle.’ FFF FFF FFF FFF FFF (you might have to re-light it a few times). Do 10-15, now eat the cake, done!

Play

Pretend to fly an aeroplane and say: “’oh look, I can make the ‘bunny sound’ and make a noise at the same time VVV VVV VVV VVV VVV. That’s cool, let’s try. Ten times?’

Lunch

‘Oh, that soup is a bit hot, let’s blow it, let’s do it with our “bunny sound”: FFF FFF FFF.’ Do ten and by now you have done most if not all of your repeats.

Book time

Select a book with a lot of ‘f’ sounds it in or a book with bunnies (your Speech Therapist will make suggestions). Read the book together with your child and each time there is a bunny or a fish practise the FFF FFF FFF FFF.

By now you will probably have exceeded your target of 50 times FFFs a day!!

Story telling

Now for something different like “Story Telling”: your child’s goal might be: “to talk about what’s first, then, next and finally”.

Examples:

Tooth brushing

Ask your child to think about what is first, what’s next and then last before you start brushing teeth.

Meal times

Talk about what did we eat the other day at Nando’s? ‘First, I had xxx then I had xxx. What about you?’ Or as you are about to lay the table: ‘what do we need to do first, then and then?’

Dressing

Pretend to be an alien who does not know what to do first, get it all wrong and have a laugh… ‘oh I think those underpants must go on my head?!’ Etc

Play time

Use figurines with farms or Lego houses or Playmobil and help your child make up simple little stories using first, then next and last.

Books

Share a book with a clear start, middle and finish and talk about the characters, who does what, who is first, then and then and finally.

At the end of each session with your child we will talk about what the targets for the week will be and together we can think about how you can incorporate your practice easily into your daily life, no matter how busy you are!

Be sure to bring this up next time you have your session, so that we can figure out together what will work for you and your daily schedules.

Together we can make it happen!

Sonja

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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Support your autistic child’s communication by learning the stages of Gestalt Language Processing
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Support your autistic child’s communication by learning the stages of Gestalt Language Processing

ByLondon Speech and Feeding

If your child is using echolalia and/or has a diagnosis of autism, then your child’s way of processing language is most likely different to the classic way children typically learn language. We call this process Natural Language Acquisition or Gestalt Language Processing.

Speech Therpaist in London
Step by Step guide to Gestalt Learning

Let’s explore the following stages of Gestalt Processing:

Stage 1: communicative use of whole language gestalts

(e.g., “let’s get out of here”)

Children and young people in this stage use echolalia. They need to hear more gestalts or scripts. So, your job is to model, model, model and to use functional language that your child can repeat back.

Stage 2: mitigated into chunks and re-combining these chunks

(e.g., “let’s get” + “some more”) and (e.g., “let’s get” + “out of here”)

This is when you take parts of gestalts or phrases and then combine it with other parts.

Stage 3: further mitigation (single words recombining words, formulating two-word phrases)

(e.g., “get…more”)

They are going beyond their gestalts. Furthermore, they may begin to label different objects.

Stage 4: formulating first sentences

(e.g., “let’s get more toys”)

You may see more grammatical errors during this phase as they are creating unique sentences. Please don’t worry about this, it means they are playing and experimenting with language. As communication partners, you could model the correct form of the sentence.

Stages 5 & 6: formulating more complex sentences

(e.g., “how long do you want to play inside for?”)

You can see that language learning is a process, that is trialled and tested, used in different contexts for children to be able to learn and use language appropriately.

My next blog will give you activities ideas and how you might use them specifically with a Gestalt Language Processor.

Remember early intervention is vital. So, if you have any concerns, please seek the advice of a Speech and Language Therapist.

Contact me, Specialist Speech and Language Therapist Sonja 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.

Speech Sound Disorders

Speech Sound Disorders

ByLondon Speech and Feeding
Kids Speech Therapist London
Speech Sound Disorders

Treatment Approaches – A Typical Session

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

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

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

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

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

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

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

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

A day in my life as an Independent Speech and Language Therapist

A day in my life as an Independent Speech and Language Therapist

ByLondon Speech and Feeding

During the pandemic I wrote a blog on what my working day looked like. Now a good year has passed since coming back to some sort of normality and I thought I would update this ‘day in the life of an SLT’ as my working life has changed of course to reflect the ‘new normal’.

I have become truly busy, perhaps busier than I have ever been to be honest. It’s probably mostly due to the fact that I do most of the aspects of my work myself — though I want to mention two invaluable people here without whom I could not function as well as I do: the excellent Nathalie Mahieu () helps me with my SEO, Insta posts and blog uploading and the wonderful Sue Bainbridge () makes sure that my accounts don’t get into trouble with His Majesty’s tax office.

Attached to our role as Speech and Language Therapists is an arguably enormous amount of administration/paperwork and preparation required for each and every client. This needs to be factored in when deciding how many families I can realistically see each working day. For me it works out as typically 3–5 clients a day, Monday to Friday.

So how does my day typically look? Each day varies a lot depending on what type of client I have, but on average it looks a bit like this:

First thing in the morning — after having a coffee and a quick check-in with my besties on WhatsApp — I do my Buddhist chanting for about an hour. My Buddhist prayers are the base of all I do and get me connected to my higher purpose and how to create value with each activity and each person I see that day. It sets me up for the day, I keep in mind who is going to come and see me and how I can best help them.

Next up, I do the daily ‘spring-clean’ of my therapy room (on all fours! no joke ???? those kids see every speck!), vacuum the floors, wipe down the toys with flash-wipes and tidy up all my boxes, making sure that the battery toys are working, and everything else is in place. On to the guest toilet, the hallway needs to be rid of all the men’s shoes and trainers and coats… It’s endless what needs tidying when you are living with three men… This takes about 45 minutes.

An articulation activity – packaging practice into a little game

Then I prep for all my clients that day. I have now got so much quicker about selecting therapy materials. For one thing I have purchased so many toys and materials over the past five years that I can literally now open a shop and need to consider building an extension! ???? The upside is that it is now very easy for me to select a good handful of toys or games for any one child, even at a minute’s notice. Though, on average, I spend about 30 minutes per child preparing activities.

Hurrah, it’s 11 am and my first client of the day arrives and the fun begins.

When they leave around an hour later, the cleaning and wiping down starts again, this time less extensively. I write up my notes and send homework whilst enjoying a cuppa.

The next client comes at 12.30 pm and once they have left, floor cleaned, toys wiped, notes written it is time for a quick lunch. No more than half an hour usually.

Afternoon clients tend to be one more little one (nursery age) at 2.15 pm and thereafter I see mostly older school children for a variety of reasons (mainly speech production but also some language-based activities). I tend to say farewell to my last client of the day around 6 pm. I spend another hour, sometimes more, on writing up notes, answering new enquiries, blogging and phone calls to keep my service fresh, inspirational and exciting.

And then dinner and the rest of the day rushes by. I tend to finish my day with some more Buddhist chanting, not a lot, perhaps 10–20 minutes to reflect on what has gone well and what could have been better — re-determine to improve or make better as needed.

Tele therapy activity using online materials plus a coreboard

In terms of where I provide a service, I still do a good mix of online clients (tele-therapy) and in-person clients in my clinic, which I love. Occasionally, I visit children in their nursery or at home but this service is now only available for long-standing clients.

Each client is hand-picked to make sure that we are a good fit: no one client gets the same treatment as another; each client is unique, we get to know one another well over the time we work together and they are always highly valued. That takes time and, in reality, each client gets about two hours of my time. That is the actual session plus all the preparation and aftercare, i.e., bespoke hand holding, tweaks, problem solving and reassurance in between sessions.

I absolutely love this way of working and would not ever want to do anything else. Nearly three decades of working both in the NHS and in private practice, countless courses (continual professional development) have enabled me to flourish as a therapist and I know that I offer something special and very valuable to my clients.

My unique way of working affords all my lovely clients the help they need to support their children to make progress; and it gives me the right balance of job satisfaction and work life balance for now. My lovely reviews and testimonials tell me that my clients appreciate my service and this at the end of the day is the most important.

If you are interested in exploring Buddhism/buddhist chanting then check out this link (https://sgi-uk.org/), and feel free to contact me about that specifically, regardless of whether you want speech therapy. I am always happy to chat about Buddhism, it has been so enriching for the last 43 years of my life.

If you need help with your child, please do not hesitate to contact me.

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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Explore four truths or myths about speech, language, and communication
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Explore four truths or myths about speech, language, and communication

ByLondon Speech and Feeding

There are many truths and myths out there that I’d like to explain to prevent misunderstanding. This will enable you to support your child by seeking the correct information.

Why not have a look at the following statements and decide if you think they are true or false?

  1. Flashcards will fix my child’s speech, language, and communication needs.
  2. Singing to my child will not help their language development.
  3. My child communicates in a variety of ways not just through speech.
  4. Learning another language is good for my child.
Speech Therpaist in London

Now let’s explore these statements in more detail.

1. Flashcards will fix my child’s speech, language and communication needs – False

To develop your child’s communication skills, you’ll want your child to generalise their skills across multiple areas. I would highly recommend staying away from flashcards if they are only teaching ‘rote learning’. Children need to explore the world through play. However if you’re looking at cards, talking about them and having meaningful conversations, and your child is enjoying it, then there potentially is a use for flashcards. But at London Speech and Feeding, we love innovative activities that your child is fully immersed in.

2. Singing to my child will not help their language development – False

Singing introduces your child to rhyme, and repetition amongst many other benefits. It allows them to attend and listen to you as their caregiver and develop the vital stages of early communication. Singing slows down language so your child becomes more aware of the relationship between letters and sounds. You’re also supporting your child’s oral fluency as well as their memory. Furthermore, you’ll often be face to face with your child singing which allows them to see your facial expressions, lip patterns and eye contact (to name a few).

3. My child communicates in a variety of ways not just through speech – True

Communication is much more than just talking. So, it’s true that communication happens in a variety of ways. Think about it. If you didn’t talk and you wanted to convey a message of frustration, you may show different facial expressions, body language; you may point at something which has caused your frustration. We can communicate through a variety of means (some of which include symbols, gestures, hand signals, and pictures). Can you think of any other ways in which you communicate to others?

4. Learning another language is good for my child – True

Current evidence suggests that speaking another language to your child is a positive. It allows your child to interact with different members of the family or with their friends. ASHA suggests that children who speak two languages fluently often learn new vocabulary easier and find categorisation simpler. Bilingual children have been shown to understand the needs of their communication partner. In addition, increased vocabulary may support better understanding. There are no negative factors about learning more than one language. We would recommend that, whatever language(s) your child is learning, they have a good model of that language, so they learn best practice.

Always seek the advice from a qualified Speech and Language Therapist if you’re unsure of how your child’s speech, language and communication is developing, as there are lots of information online that aren’t always accurate.

I’m always happy to support your family to increase your knowledge and understanding.

You can find support by contacting Specialist Speech and Language Therapist Sonja 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.