St. Ives | Bondi Junction | Leichhardt | Telehealth
Speak & Write offers a comprehensive range of professional Speech Pathology services including:
Children learn to talk at their own rate. They start by babbling and their first words emerge around their 1st birthday. By their 2nd birthday most children have at least 50 words, are using 2-3 word phrases and asking questions, lots of questions! If your child is not meeting these milestones, they may be considered a late talker. Therapy for late talkers involves a lot of play and creating opportunities for your little one to express their needs and likes. We use evidence-based programs such as Hanen’s ‘More Than Words’ and ‘It Takes Two to Talk’ to teach parents language stimulation strategies that they can use at home to support their child’s language development.
Unclear speech is generally obvious to parents and teachers and can be caused by several factors. The table below explains the difference between articulation and phonology and general expectations for different ages.
There are a number of different therapy approaches used to treat speech sound errors including articulation therapy, minimal pairs and multiple oppositions.
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Childhood Apraxia of Speech (CAS) is a motor speech disorder that affects the brain's ability to plan and coordinate the movements needed for speech. A child with CAS knows exactly what they want to say - the difficulty is in the brain reliably telling the lips, tongue and jaw how to move to say it. This can result in speech that sounds inconsistent, hard to understand, or that comes out differently each time, even when your child is trying to say the same word.
CAS is less common than other speech sound difficulties, and it's normal to feel overwhelmed if your child has been diagnosed, or if you suspect they might have it. The good news is that CAS is well understood by speech pathology research, and there are structured, evidence-based programs that make a real difference.
At Speak & Write, CAS is one of our team's key areas of expertise. We see children with CAS at our clinics, and via telehealth for families anywhere in Australia.
Signs your child might have CAS
Every child is different, and only a qualified speech pathologist can confirm a CAS diagnosis. That said, some of the signs parents often notice include:
- Speech that is very hard to understand, even for family members
- Saying the same word differently each time they say it
- More difficulty with longer or more complex words than shorter, simple ones
- Groping or visible effort with the mouth when trying to get a word out
- Vowel sounds that are distorted or inconsistent
- Speech that sounds flat, or where the stress falls on the wrong part of the word
- Difficulty imitating sounds or words on request, even when they can say them at other times
If some of this sounds familiar, the next step is a proper assessment - we'd rather you reach out and find out than spend months wondering.
How we treat CAS at Speak & Write
CAS responds best to therapy that specifically targets motor planning, delivered with the right frequency and consistency - a general "practise your sounds" approach isn't enough. Our speech pathologists have specialist training in motor speech disorders and use evidence-based programs designed specifically for CAS.
We offer CAS therapy:
- In clinic
- Via telehealth, for families anywhere in Australia, including our ReST intensive blocks (more on this below)
Because CAS presents differently in every child, we don't put children into a program off a checklist. We assess first, then match your child to the approach (or combination of approaches) that fits where they're at.
Our Evidence Based CAS treatment programs
Nuffield Dyspraxia Programme
The Nuffield Dyspraxia Programme is a structured program that builds a child's speech step by step - starting with individual sounds, then building up through syllables, words, phrases and sentences. Each stage only progresses once your child has mastered the one before it, giving them a solid foundation to build on rather than practising in a way that's too hard too soon.
It's often a good fit for younger children, or children who are still building their basic sound system, and can be delivered in clinic or via telehealth as part of regular ongoing sessions.
DTTC (Dynamic Temporal Tactile Cueing)
DTTC combines three types of support at once - your child watches the therapist's mouth (visual), hears the sound modelled clearly (auditory), and may receive light touch cues (tactile) to help guide accurate movement. Speech is slowed right down at first so your child can focus on getting the movement right, and this support is gradually faded out as their accuracy improves.
DTTC is often used with younger children or those with more severe CAS, where extra support to get an accurate first attempt makes a real difference. Like Nuffield, it's delivered in clinics or via telehealth as part of regular ongoing sessions.
ReST (Rapid Syllable Transition Treatment)
ReST is one of the most well-researched treatments available for CAS, developed through research at the University of Sydney. Rather than practising familiar words, your child works with playful made-up words that let them focus purely on building new, accurate speech movements, without old habits getting in the way. It targets sound accuracy, word rhythm and stress, and smooth transitions between syllables, all at once.
We offer ReST both as part of regular ongoing therapy, and as an intensive telehealth block for families who want a focused, concentrated push - see below for details.
Your child's journey with us
CAS therapy is rarely a single program - it's a relationship with a therapist who gets to know your child's speech well. Here's what that typically looks like:
1. Get in touch. Reach out to our team directly, or ask your current speech pathologist or GP to refer you.
2. Assessment. One of our speech pathologists will complete a full speech assessment to understand your child's specific difficulties and confirm (or investigate) a CAS diagnosis. Often we are unable to diagnose in a single assessment and need time to get to know your child and complete a differential diagnosis.
3. A tailored plan. Based on your child's assessment, age and needs, we'll recommend the right approach - this might be Nuffield, DTTC, ReST as part of regular therapy, an intensive ReST block, or a combination over time as your child progresses.
4. Ongoing therapy. Sessions run in clinic, or via telehealth, whichever suits your family. From the evidence base we know that CAS therapy requires at least 2 sessions per week, with best practice sitting at 3-4 sessions a week.
5. Review and adjust. CAS therapy isn't set-and-forget - we regularly review progress and adjust the approach as your child's speech develops.
Ready to find out more?
If you're noticing signs of CAS in your child, or you already have a diagnosis and are looking for a team with genuine expertise in this area, we'd love to hear from you. Reach out to our team, or ask your current speech pathologist to complete a referral on your behalf.
Childhood Apraxia of Speech (CAS) is a rare motor speech disorder that affects the brain’s ability to plan and program the movements required for speech. While a child with CAS knows what they want to say, when they speak, their brain has difficulty making plans to tell the speech muscles to move the lips, jaw and tongue in specific ways, resulting in poor coordination, inaccurate speech sounds and uneven stress and intonation. CAS is a complex disorder and symptoms can often persist beyond childhood. Treatment programs that target the motor control aspects of the disorder are available. These include the Nuffield Dyspraxia Programme, ReST (Rapid Syllable Transition Treatment) and DTTC (Dynamic Temporal Tactile Cueing).
Language forms the foundation of how we learn and therefore it is important to provide appropriate support as early as possible. Understanding language is also known as comprehension or receptive language and includes:
The type of therapy is determined by the area(s) of difficulty.
Language forms the foundation of how we learn and therefore it is important to provide appropriate support as early as possible. Using language through speaking and writing is also known as expressive language and includes:
The type of therapy is determined by the area(s) of difficulty.
Phonological and phonemic awareness are the early literacy skills that form the foundations of learning to read, write and spell. Put simply, children need to understand that the words we speak are made up of sounds that can be broken up and moved around.
Therapy to support children to develop their phonological and phonemic awareness skills involve using nursery rhymes, songs and activities based on having fun with and playing around with letter sounds.
Once these skills have been mastered children can then apply them to writing by learning about how letters and groups of letters represent the sounds in words through phonics instruction. They can then use this knowledge to read and write printed words.
Children who have speech sound errors are at higher risk of having difficulties learning these early literacy skills so it’s important to keep this in mind.
We live in a literate society and everyone needs to learn how to read and write through instruction, but some children don’t develop these skills as easily as others. Reading & spelling is incredibly important for more than just getting through school but for engaging with friends over text, entering the workforce and becoming independent.
Literacy difficulties may look like a reluctance to attempt to read and write or having to put in lots of effort and guessing words based on the first letter or relying on pictures. Reading disorders can occur in isolation or may be due to underlying language and/or learning difficulties.
Some children have difficulties reading but are able to spell while others are the opposite and some find both tasks hard. While related, reading & spelling are distinct skills that use different parts of the brain. While reading is a decoding activity (break it down and put it together) spelling is an encoding activity (retain, identify the sounds & recall the letters that match). It’s a big job, did you know that there are 9 ways to spell the sound “ay” - baby, rain, day, name, great, eight, straight, vein & they!
At Speak & Write, all our therapists are trained in the Spalding Method which is an evidence-based multisensory approach to literacy development. It incorporates letter-to-sound association practice, spelling, reading comprehension strategies and letter formation.
Writing is an extension of our expressive language skills or how we use language. For many children, they may have great ideas they can share verbally but have difficulty transferring them to text. Perhaps they only write short sentences that lack description, are missing words or their ideas don’t quite make sense.
Writing involves understanding different text types and how they are constructed - a narrative is very different to a discussion which looks nothing like a procedure!
We used strategies such as mind maps and diagrams to help students collect, organise and order their ideas. We also introduce scaffolds and templates to help them plan their writing and give them the skills and confidence to get started, which can often be the hardest part.
Executive functions are the mental processes that we use in planning, memory, attention and problem-solving. They help us self-regulate so we can effectively plan, prioritise and sustain effort towards a goal. They allow us to move from just wanting to do something to actually getting it done!
Speak & Write start by conducting a full language assessment aimed at pinpointing the problem or ‘missing link’ so that the student and parents have a better understanding of how this may be impacting the student’s academic success.
Therapy plans are then developed with the student’s and parents’ goals in mind, which involve teaching the students techniques and strategies to overcome or manage their difficulties.
We teach our students the skills to:
Working with adolescents is a particular passion of the team at Speak & Write. The transformation we see in teenagers’ self-esteem, once they learn the above, inspires us all.
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Forming meaningful friendships and connections with peers is a priority for children and their parents. While the skills necessary to make friends and navigate social situations effectively can come naturally to some, others may benefit from additional support and guidance to develop these skills and understand their purpose. We seek to encourage social engagement without promoting masking.Some important skills that support social engagement include:
Stuttering is a type of dysfluency that interrupts the smooth flow of speech. Stuttering most often starts around 3-4 years old and can appear suddenly or gradually and be mild to severe. Stuttering can be very unpredictable and vary depending on the child, the setting they are in or who they are talking to. While some children’s stutter may disappear without treatment it is impossible to know who will experience this and the current recommendations are to seek early intervention.
Stuttering can take several forms including:
While we don’t know for sure what causes stuttering, we do know how to treat it!
Speak & Write implement the following evidence-based programs and will determine the best program to help your child:
Lidcombe Program:
The Lidcombe Program is a behavioural treatment for young children who stutter, developed in Australia in the 1980s. It involves training parents to provide feedback on their child's speech and helping the child monitor and modify their own speech. The program emphasises positive feedback for fluent speech and has been shown to be effective in reducing stuttering in about 75% of children who complete it. It is a promising option for parents of children under the age of 6 years.
Please see the Lidcombe Program Outline for further information.
Oakville Program:
The Oakville Fluency Program is a behavioural program which aims to reduce stuttering to very little- no stuttering. The program is most appropriate for children over 6-years of age. The program is a combination of two successful stuttering treatments.
- Syllable-timed speech (saying each syllable to a rhythmic beat)
- Verbal contingencies (specific feedback) within the Lidcombe Program
Parents' input and training is essential to the success of the program.
Please see the Oakville Fluency Program Outline for further information.
Camperdown Program:
The Camperdown Program is a speech restructuring program used to treat stuttering in adolescents and adults. The aim of the program is to provide the client with a way to communicate with as little-no stuttering as possible.
Please see the Camperdown Program Outline for further information.
As a parent, some easy ways to start supporting your child if they have a stutter is to not interrupt them or ask them to start over, give them time to finish their thought or sentence and avoid making comments like “take your time” or “slow down”, even if well intended.
Please see the Stuttering Dos & Don’ts handout for further information.
We often don’t give much thought to our voice or the voice of others unless something sounds a little funky. The voice might sound breathy, rough or strained or you may have noticed a change in strength or pitch.A speech pathologist’s role when treating a voice disorder is to promote and support healthy everyday voice use. The cause of the voice concerns will determine the therapy approach taken. Education and awareness form the basis of indirect therapy. Vocal hygiene includes encouraging a range of behaviours to look after the voice as well as stopping habits that can do permanent damage.
Making lifestyle changes (like not spending all day screaming at their siblings) or managing medical conditions such as allergies or reflux can have a significant impact on the voice. Direct therapy looks like functional exercises and treatments that work on improving the quality and function of the muscles used when producing voice. When it comes to the voice, we don’t want to mess around so consultation with an ENT (ear nose & throat specialist) is alway recommended before starting any therapy to check on any structural issues and ensure the necessary care is taken.
