Transitions - Kindergarten

18th January 2024

It’s an exciting time of the year as children are receiving kindergarten and primary school admissions. Over the next few posts, we’ll be looking at school readiness and how you can support this transition as parents and caregivers. 

Transitions can be difficult for people of all ages. 90% of Hong Kong parents worry about the transition from kindergarten to primary school.

Kindergarteners need to adapt to the many different sessions and tasks they have to do in preschool; students in primary and secondary schools are constantly confronted with changes in social groups and academic expectations; adults encounter changes all the time on the job; and parents need to deal with transitions as their children grow and achieve developmental milestones.

What is the transition like from playgroups or home to formal kindergarten? 

A lot of the parents we work with are surprised to hear that kindergartens now expect children to know how to follow routines by the time they start at three years old. Following instructions can be difficult to many three year-olds, particularly those who have only attended play based playgroups or those who are struggling to integrate.

How can speech and language therapy support kindergarten readiness in your child?

Sessions are set up in an authentic way to help children master the skills needed to successfully attend kindergarten.

Key skills needed for kindergarten readiness 

- Sharing & Turn-taking;

- Verbal & non-verbal participation in circle time;

- Complete general classroom activities independently; 

- Complete table tasks; and so on

How can speech therapy help you as a parent/ caregiver?

Parents can feel a bit out of the loop in kindergarten because they are no longer active participants like they were when their children were in playgroups. In our sessions, we coach parents to practise the key kindergarten routines with their children at home in a digestible and sustainable way. For instance, parents have seen quick and lasting results is in teaching their children to sit at a desk or shared workspace for a short period of time to complete tasks.

How it works:

- We teach parents how to set up a table task pace in the home 

- ⁠We coach parents on language to use with their children to promote specific language goals

- ⁠We rehearse different fun, engaging and timed activities they can perform alongside their child that mimic those in school 

- ⁠We create an individualized plan to promote independence  

- ⁠We increase the duration of time spent at the workspace 

- ⁠We gradually change the activities to mimic more pen/ paper classroom activities 

Interested in learning more about supporting your child’s school readiness? Keep an eye out for this month’s blog posts and contact us at 

Clinic Whatsapp: (852) 9339 5807

A shell & a Table

9th August 2023

A child told me that he found "treasure" at the beach and gave me this shell so I kept it at the windowsill in my room. 

When I came back from vacation, I noticed that another child found a new toy table in my room and placed the shell on the top so that it looks like a trophy. I still haven't identified the creator (the treasure "explorer" is still traveling overseas at the moment so it cannot be him). 

One of the most wonderful parts of my job is that, after years of working, I still find myself amazed by the creativity children possess even if they have speech and language delays. I would have never considered building a "trophy" with an unremarkable shell and a boring ol' toy table. 

Even in this digital age, toys and physical activities still hold great educational value - in fact, studies have shown that toys and pretend play can offer some relief against excessive screen time. Playing toys can also help fine motor skills development. In our clinic, we also use cooperative play to foster social communication skills development

ChatGPT - Initial Thoughts

21st April 2023

Before I begin, I want to stress that I am largely a luddite who play sports, so my understanding of #ChatGPT is hugely limited to the articles I can find, which I have shared below. 

ChatGPT started to affect my work when my secondary school clients started asking me if I know what it is. None of them admitted to using it for homework, but all of them started sweating when I told them about ol' TurnItIn. Online academic plagiarism tools are now capable of detecting AI-generated homework, so I warned my students to not tempt fate. 

From the work they showed me, clearly that they are still learning to use ChatGPT. For example, they do not know how to get ChatGPT to produce an essay that includes citations. Another common problem they have is that "their" work contain zero grammatical errors, a dead giveaway in my line of work. Once I pointed out these issues, most of the students vowed to not use ChatGPT, while one attempted to pay me out of his own pocket to teach him how to use ChatGPT (my asking price was 10 #bitcoin, buddy please). 

From a speech and language standpoint, I initially wondered, why is the word "Chat" included in the name of this beast? After doing my research, I learnt that it is a "language model" that can only generate correct answers when the user provides accurate prompts. Thus, I think ChatGPT makes human language learning more important than ever - the more specific, accurate, and detailed you can write the prompts, the better the product you get from ChatGPT. You need to have a strong vocabulary to instruct it, and you have to be able to craft a message that expresses your needs. And then, you need to have the reading skills to understand the answer provided by ChatGPT, and check whether it works for you. If it does not, you have to re-enter the prompt or edit the answer in your own words. 

As I learn more about ChatGPT I will share my thoughts here - for now, my Toronto Maple Leafs just tied the playoff series, WE ARE BACK! 

#LeafsNation #generativeai #slp #speechtherapy #plagiarism #communicationskills 

I'm thinking of you:   


25th October 2022

Toronto Maple Leafs legend Borje Salming in recently made public of his amyotrophic lateral sclerosis (ALS), a condition where studies have linked to repeated head injuries. Salming now has to rely on augmentative and alternative communication (AAC) system, in the form of an iPad, to communicate. 

When I was a student in Halifax, AACs were cost-prohibitive, generally not easy to carry around, and required a lot of time to modify them physically and functionally to fit the needs of patients. With iPad, anyone who can still type can use it as an affordable, accessible, and effective AAC option. For example, non-verbal children now can use use iPads at home and in schools to communicate their needs. Also, AAC apps often have multiple language options, making it even more practical these days. 

Some apps may require more technical modifications to use, meaning that parents will have to work with a speech therapist to programme these apps properly, while some are more ready-to-use with less personalization required. 

In this video, Salming used his modified iPad to speak to his fans, "I'm thinking of you" - we are also thinking of you and your family, and we will never forget you #LeafsForever 

#ALS #AAC #AACAwarenessMonth #SpeechTherapy #Bilingual #Multilingual

Flexible ThinkinG

29th March 2022

With the increased pandemic measures in March, students here faced many new changes. One of the students we work with told us that "Zoom is now my new best friend" - he had not seen his friends since school closure in January.  He was also concerned by summer holidays being pushed early to March. 

This student is working on his social communication development, and one of the main training goals is to improve his flexible thinking skills. While he is very intelligent, sometimes his thinking can be held back by his rigidity.  In general, he does not like to change even if he sees repeated issues with the same approach.  This can be quite limiting for his learning and daily social functioning. 

To expand his thinking flexibility, we asked him to use a new way to look at the current situation, and come up with alternatives. What can you do now on "vacation"? Instead of the usual summer break, what can you do in July and August? He came up with many new ideas - he can make a video clip online with classmates, spend more time on online games to chat with friends, hike with his older brother, and so on. 

#SocialThinking #Bullying #Resilience #Pragmatics

Size of Problem


16th March 2022

Naomi Osaka was in tears in defeat at Indian Wells Open when a spectator heckled her with "Naomi you suck." While professional athletes have to put up with bullying, average school children also have to deal with this regularly - over 30% primary students reported being bullied in school, compared to 20% for students in secondary.  Some studies have found that cyberbullying is just as prevalent as in-school bullying.

We have to continue to do better at this as a society, but pragmatically we have to work with the children to strengthen their resilience. Through social communication training, we often teach primary and secondary students to learn to assess the size of problems.  When a student faces a social problem, for example being called a "noob", we ask the student to assess whether it is a small, or medium, or large problem. Next, the student can then determine the size of the reaction, which should be proportional to the size of the problem. 

遭到觀眾席上的一名球迷直接開罵「妳好爛」, 大坂直美淚灑印地安泉。雖然職業運動員需要學習忍受欺凌,但普通的學童也經常需要處理這種情況: 超過 30% 的小學生報稱在學校受到欺凌,而中學生這一比例為 20%。更有研究發現網絡欺凌與校園欺凌一樣普遍。

作為一個社會,我們必須繼續在這方面做得更好。與此同時,我們必須增強孩子們的韌力(resillience)。 通過社交溝通訓練,我們經常教中小學生如何評估問題的大小。當學生面臨社交問題時,例如被稱為“noob”,我們會教學生評估它是小問題、中問題還是大問題。然後學生可以確定反應的大小,應該與問題的大小成正比。

#SocialThinking #Bullying #Resilience #Pragmatics

Shared Reading


24th February 2022 

Shared Reading Techniques

We often say that shared reading foster language development, well how can we make this happen at home?  For home programme, we often assign the following: 

- Ask inferential questions (e.g. "What will happen next..."How does he/she feel...Why is this happening...")

- Use hypothetical statements (e.g. “Maybe its the …) to guide the reading along, the research shows this method is better than asking instructive statement (e.g. “this is the..”)

- Emphasize a keyword, explain it, relate it and repeat it (e.g. ‘This is GIGANTIC. Gigantic means really really big. Last time we saw an elephant in the zoo, it was gigantic.” 


- 可以問孩子一些推測性問題(如:估下之後發生什麼事?估下佢嘅感受?)

- 亦可以問一些假設性問題(如:可能…… )或是提供指示性問題(如:你要……呢個……..)更佳

- 強調、解釋、聯繫和重覆一個詞彙(如:這個很龐大,龐大意思是非常非常大。上次我們去動物園看到一頭體型龐大的大象。)

Resillience 坚持

1st February 2022 

I had the pleasure of meeting Mr. H., my first Mandarin-speaking aphasia patient from China in the fall of 2019.  Shortly after he physically recovered from his stroke, his wife found me in Hong Kong and took him to see me. At the time, he presented with severe global receptive and expressive aphasia - he could not complete basic instructions, and did not exhibit reliable speech.

When the pandemic started in 2020, Mr. H. insisted that we conduct our sessions online as travel was not feasible at that point.  Given his level of functioning and my rudimentary Mandarin skills at the time, I was apprehensive.  But they were very persistent, and we began our twice a week aphasia therapy in February 2020.  The progress has been steady, and it really comes down to Mr. H.'s will, commitment and daily hard work: in addition to our sessions, he would practise speech tasks with his wife and child, and work on reading and writing on his own down time daily.  

Mr. H. has been an inspiration - since he can speak in sentences around April 2020, almost every time I see him he talks about his new motto: 坚持努力 - being resillient and diligent.  Both in research and my own experience, the internal drive is a significant contributor to stroke recovery. 

Mr. H. sent me this poem he wrote in April 2021 when he finally learnt to use pinyin to write (I asked him to do this in 2020 but he refused).  He was not happy about the poem because he could no longer used complicated vocabulary, and that he had to rely on pinyin (as he still struggles with writing characters).  While the words maybe simple, I found his message incredibly touching and profound. That is why I most meekly attempted to translate into English, so I could share Mr. H.'s spirits with my non-Chinese literate community.  

I want to thank Mr. H. for his persistence, trust in me, and friendship, and I am deeply honoured and humbled to be a part of his journey in recovering from, and living with aphasia.


为什么 前进的很慢 Why am I moving forward so slowly 

为什么 学到了交换 Why have I learnt how to interact

为什么 自己怨自己 Why am I beating myself up

为什么 失去的答案 Why have I lost answers 

我问我自己  这是为什么 I ask myself  This is why 

不是因为,给我做的手术 Not because, of surgery 

不是因为,单独把我救活 Not because, just saving my life 

呼吸    呼吸   呼吸  Breathe Breathe Breathe 


我的 重新 站起来 I can stand up again 

我的 重新 活下来 I am alive again 

我的 改变 曾经的我自己 I have changed    the me that I used to be 

我的 改变 现在的我自己 I have changed    the me that I am 

我的 改变 未来的我自己 I have changed    the me that I will be 




改变 原来的曾经的自己 Change     the me that I used to be  

为什么改变? Why have I changed?

我明白 我失去了太多 I understand     I've lost too much

改变 现在的现在的自己 Change     the me that I am

为什么改变?Why have I changed? 

我明白 现在的我自己学不到 原来的我自己了 学的很多东西 

I understand    the me that I am cannot learn the me that I used to be     when I had learnt so much 

改变 未来的未来的我自己 Change    the me that I will be

为什么改变?Why have I changed? 

我明白 未来的我自己 学到未来的未知 I understand     the me right now cannot learn the original me     when I learnt so much

呼吸  呼吸  呼吸 Breathe Breathe Breathe

不知道 曾经的我 Do not know    the me that I used to be  

不知道 现在的我 Do not know    the me that I am

不知道 未来的我 Do not know    the me that I will be

就像曾经我自己   呼吸  呼吸 呼吸

Just like the me that I used to be     breathe breathe breathe

一下就飞到 的天上 Flying skyward straightway

会看见 海 Can see the ocean

会看到 路 Can see the roads

会看见 桥 Can see the bridges 

会看到 草 Can see the grass 

未来的我 会看未来的自己

The me that I will be    will recognise the the me that I will be 

没有放弃自己开的公司 Will not give up my company

没有放弃那些产品 Will not give up my products

没有放弃失去的曾经的朋友 Will not give up the lost friends I used to have  

流泪了  又  流泪了 Tears    Again     Tears

我会面对 I will brave

“曾经的一起” "Together  once"

“现在的一起“  "Together now"

“未来的一起” "Together in the future" 

我又流泪了 I'm crying again

呼吸    呼吸     呼吸 Breathe breathe breathe


Bilingual Development

18th January 2022 by Clara CHENG


1. 建議幼兒先建立好母語基礎和良好溝通能力。

2. 父母應儘量運用自己較流利語言跟孩子溝通,讓孩子能模仿良好的發音、詞彙和句子結構。

3. 語碼轉換(例子:「依個 apple」)是語言學習的正常過程,往往這是兒童自行運用的一種策略,以幫助理解和學習第二語言

4. 鼓勵運用日常溝通機會學習多種語言,避免只運用坊間詞彙卡。

How to support our children’s learning? 

1. Regardless of how many lanugages your child learns, it is important to establish a primary/strongest language as a foundation of all language learning. 

2. Parents should use their mother tongue or "dominant" language when speaking to their children.  This allows the children to imitate accurate articulation, vocabulary and sentence structures. 

3. Understand that code-mixing (e.g. 「依個 apple」) is a normal process in langauge acquistion, and this is sometimes a strategy naturally adopted by children to assist understanding and learning of a second language.

4. Create communication opportunities in different settings, rather than focusing on repetitive and unnautral tasks like practising flash cards all the time at home. 

Source: 香港大學 Hong Kong University, Dual Language Development & Disorders 

Neuropsychological Assessment

30th December 2021

Hope everyone is doing well and apologies for our slow posting! It's been a manic couple of months, but now I finally have some time to blog.

As we wrap up another most interesting and fruitful 2021 despite the pandemic, I want to take the time to congratulate my friend Sandra Laujin for her incredible achievement - publishing her first textbook on neuropsychological assessment using NEPSY-II! While many of us harbour dreams of one day becoming  published authors, only the brave and industrious can actually pull it off.  And only Sandra can do it in French and English!  I'm also especially honoured to be acknowledged for my most minor contributions - it was really Lisa Moore's elite copy editing that was instrumental in assisting Sandra through the translation process.  

I had the pleasure of meeting Sandra in 2018, it has been a real pleasure working together and I look forward to our continual collaboration! 

On that note, from our clinic, wishing everyone a happy new year and an even better 2022!

Sandra's book is available on Amazon

the Boy with a mullet

20th August 2021

He was very tall for his age, walking around, looking, observing, deep in thought. Spotting a velvety brown mullet that made him look like a toddler version of Ryan Smyth, this little boy was wearing my Toronto Maple Leafs home jersey in a community centre that my placement serviced in the Halifax Regional Municipality (HRM) area. I could still see him standing there looking at me intently in the midst of chaos among a few other preschool children running around in the playroom.

For the entire hour I was there, he did not utter a word or make a sound.  

My supervisor held an autism service position where she would drive around the HRM to assist children with autism in the areas of speech and language development.  Every week, we would find time to visit different families, kindergartens, schools, and government-assisted locations to support these children.

As a young clinician, this boy was very unique to me because he was very calm as if he understood what was happening, but he was essentially non-verbal.  The other children with autism I worked with during that time were more rambunctious and exhibited more stereotypical and repetitive behaviours.  He looked so "mature" for his age, but it seemed to be a confounding product of his flat affect.  When his father told him it was time to go and he had to put on his coat (it was another typical wet and stormy winter afternoon in the Maritimes), he just stood there motionless.  He was not being defiant, but his father had to put on his coat for him.  

Meeting him made me rethink a lot about how I should approach this caseload - helping children with autism to communicate is primarily about incentivizing them to speak. If therapy can show them that talking can get them what they want, then some of them will eventually learn to start using some words.  He also taught me that every child with autism really is different. That is why therapy needs to be tailored to each child's needs.  

 *Details about any people in all posts on this blog are slightly altered or withheld to protect confidentiality. No identifying information will be provided. 

10 for 10

13th August 2021

I cannot think of a better post to start - I left Halifax (Canada) for Hong Kong in 2011 after my masters,  passed my SAC (Speech and Audiology Canada) licensing exam, and started working for my first and only employer in Hong Kong in May that year. The plan was to stay and save some money, and move back to Toronto in one year's time.  Of course life never works out the way you think it will - I ended up starting my practice in December 2012, and ten years of practice as an SLP later I am still in Hong Kong. 

I’ve always enjoyed writing but haven’t had a chance to cut my teeth since I started practising. To me this is all one full circle.  I was planning for a writing career before I became an SLP.  However, I still managed to get a few articles published at my undergrad's school paper and South China Morning Post, and one book review by my alma mater's vaulted literary journal, The Shenandoah (Note that my book review has since been cited at least twice in the literature). And what better way to start my blogging career with a post to recapture this journey and thank the people who help me get to where I am. 

When I was at Washington and Lee University deliberating on what I should do with my life, a number of professors and staff gifted me with so much wisdom in picking this career: my Philosophy professors Dr. Harrison Pemberton (God rests his soul) and Dr. Lad Sessions; English professors Dr. Marc Conner (who is now the president of Skidmore College), Dr Holly Pickett, and Professor R.T. Smith; and Dr. Kirk Luder. When I told them about my plan to pursue a career in speech-language pathology, they were all very supportive and extremely encouraging.  I genuinely believe that they are a big reason why my clinic has persevered over the years.  Subconsciously, their collective optimism and counsel formed the basis of my confidence - if these highly successful and intelligent academics were to have that kind of faith in me, I should be alright.  And for that, I am and will forever be grateful to my many mentors, teachers, and friends that I met at W&L. 

Fastforward to 2008 when I arrived at Dalhousie University, I had to put aside my writing dreams and focused on surviving the masters programme.  Halifax will always be my home away from home - there is just something magical about Atlantic Canada, and I will forever be indebted to the many wonderful professors, clinicians and maritimers I met in the region who made my three years there some of the happiest times of my life.  Especially to my clinical supervisors Sarah Boyne, Janice Whebby and Rachael Tabor, and all of staff at the Nova Scotia Hearing and Speech Centre (Susan, Nicole, Angela Ryan, Lisa Spinney, and Karen Veinot) - I learnt everything I needed to know to start my career from these excellent clinicians at the Dartmouth centre, and not only that they collected their personal favourite recipes and gave them to me as a graduation gift before I left Halifax.  Ladies, I hope we can all meet again soon!

For this year, my class of 20011 from Dalhousie were planning a reunion that was obviously all for naught thanks to the pandemic.  But I do want to take this opportunity to celebrate our 10th year "reunion" - another big reason why I had such a great time in Halifax was because of my wonderful classmates.  I hope you are all doing well wherever you are, and hopefully we can all celebrate in 2022!