Nothing strikes more fear in the heart of an SLP than those two little words... lateral lisp. To most parents it seems like an easy fix. It's just a sound or two that their child has trouble with... a few speech therapy sessions and boom, it should be fixed, right? Nope! Not that simple.
Now if you're NOT a speech language pathologist, let me first define some terms. Primarily speaking, there are frontal lisps and there are lateral lisps.
A frontal lisp occurs when the tongue either protrudes between, or touches, the front teeth and the sound produced is more like a /th/ sound than a /s/ or /z/. Many children go through a perfectly normal phase of producing a frontal lisp. Most will outgrow this and will be able to produce a correct /s/ sound by around kindergarten. Children who continue with a lisp past this age typically require speech therapy to correct it.
A lateral lisp occurs when the air escapes over the sides of the tongue and into the cheeks.... this can occur on several sounds, /s/, /z/, /sh/, /ch/ /zh/, and /dj/. Parents of children with lateral lisps often describe their child's speech as sounding "mushy" or "slushy". These types of lisps are NOT developmental. Children with lateral lisps do not typically outgrow it and will require speech therapy to correct.
Now speaking to my SLP colleagues.... if you have a child with a lateral lisp I'm assuming you've done a thorough oral motor/mechanism exam to determine if the child has any structural or functional issues. If not... do it! There are often myofunctional issues with these kids and those should be addressed (that's a post for another day).
Let's talk about speech therapy for a lateral lisp....
The first thing we have to do is elicit the correct production of the target sound, whether /s/, /sh/, or /ch/ (I always start by targeting voiceless phonemes). Essentially, these kids have to learn to anchor the lateral borders of their tongue to the interior margins of their molars to prevent air from escaping laterally. There are plenty of techniques out there to help cue correct tongue placement, such as the butterfly technique, using straws, and fantastic resources from Pam Marshalla. But, I prefer what I call a phonetic approximation approach.
I start by eliciting /s/ from the /t/ sound. It looks something like this...
BUT THAT'S NOT THE SECRET!
If your little clients are anything like mine they quickly figure out that I'm trying to get them to say /s/! Ugh... which means they automatically go right back to that lateral airflow when they move to the word level. Oh, the frustration!
So, here's my "secret" (drum roll please)...
Tell the child you're NOT actually going to work on the /s/ sound! That's right.... you're done with /s/ and aren't even going to talk about it anymore! You are going to create a completely new sound... the "flat tire" sound! As we hold out that /t/ sound in step 2, it actually sounds like a tire losing air. It's the idea behind my new deck of speech sound cues from Bjorem Speech Publications created specifically for children who lateralize.
The reason these new picture cues work so well is because you have a visual representation of their "new sound". Often when kids start adding a newly learned non-lateralized sound into different positions of words they begin to realize we're really working on /s/ and go right back to lateralizing again. But these cards help me remind them... NO /s/ sounds! We're only using the "flat tire" sound now. Then we start "removing" the /s/ sound from words and replacing it with that "flat tire" sound.
This mental shift has been the key to my clients creating a new motor plan for correct production of /s/. I'm telling you, it's literally that simple.
Need more information about this technique? There is much more detailed information included on the insert inside the Bjorem Speech Publications deck for Lateralization. Plus this deck also includes "new sound" cues and target words for each sound that kids lateralize.... including /z/, /sh/, /ch/, and /dj/!
And don't forget to follow me on Instagram to see LOTS of real life therapy videos showing how I use this technique!
***A quick word about carryover... Don't forget to use those principles of motor learning to promote generalization of these skills. Working through a hierarchy of constant to variable positions in words/phrases, blocked to randomized practice, and simple to complex tasks will ensure your kids with articulation deficits won't be in years of speech therapy without significant progress.***
Toys and games... they're how we speech language pathologists keep our kids motivated and engaged during therapy, which helps us get the maximum amount of target productions and keep those kids engaged. My practice specializes in speech sound disorders... which means that my clients can range from 10-year-olds who are working on single sound articulation errors to 3-year-olds with Childhood Apraxia of Speech. Here are some our favorite toys and games that have proven to hold kids' interest, especially for those younger ones who are minimally verbal.
Barrel of Monkeys...
For just a few dollars this little compact game is always a hit. It's quick, easily adaptable, and especially great for kids working on getting that lip closure for the /m/ sound. We dump those little guys out on the floor or table and practice our target syllable shapes as we pick them up.... "more!"... "monkey, monkey. monkey!"... "my turn!". But, this is also a great little game to reinforce counting ("let's count all the monkeys"), using adjectives ("three monkeys", "orange monkeys", "little monkeys", "silly monkeys"), and answering "wh-" questions ("what do you have?", "how many monkeys?").
Pop Up Pirate...
Another quick game that my kids just love... their little faces are priceless as the suspense builds each time they poke those swords into the barrel until that pirate pops right out. I love to use Pop Up Pirate for working on /p/ and /b/ sounds increasing in complexity... "up!", "boo!", "pop!", "pop up!", "put it in"... a great way to get the maximum amount of productions in a small amount of time. And of course, a great way to continue to enforce turn taking, descriptive language ("I have a red sword", " I have 4 green swords"), and following directions ("put a blue sword in").
Honey Bee Tree...
I bet you can guess what target sounds and syllable shapes this game is great for!... my favorites are /b/, /m/, and pairing those bilabial sounds with varying vowels, etc. ("bee", "my bee", "go bee!"). And of course, those opportunities for language are abundant... we count the leaves as we put them in the tree with each production of our target words and reinforce basic concepts ("put the leaf in", "leaves go on top", "put the bees inside", "pull the leaf out", "the bee fell down").
Mesh Squishy Ball...
I saved the best for last. This little $3 piece of gold has been a game changer for those kids who are just not interested in participating in speech therapy. We've all worked with those little ones who just want to bury their heads in mommy's lap and have no interest in interacting with us. Until I pull this little beauty out! The shyest of kids can't resist coming over and squeezing those "bubbles" back into the ball. We also get lots of opportunities for practicing target consonants ("pop", "bubble", "ball", "go in") and requesting ("more!", "again?", "do again!").
There you have it... just some of my favorite games and toys for keeping those minimally verbal kids engaged and on task so we can get the most out of speech therapy. What are some of your favorites?
Here's the 3rd installment for Better Hearing and Speech Month!
Speech-language pathologists can diagnose and treat a variety of speech and language disorders among children and adults (e.g., stuttering, voice disorders, articulation, language delays, etc.). My practice happens to specialize in the diagnosis and treatment of pediatric speech sound disorders, including articulation, phonological disorders, childhood apraxia of speech, and other motor speech deficits. But, there are 3 lesser known areas in addition to speech and language that many SLPs assess and treat...
1. Feeding and Swallowing... yup! We assess and treat all phases of swallowing. In fact, when I was working in the acute rehab setting, patients with dysphagia (swallowing disorders) were about 80% of my caseload. There are also SLPs who specialize in the treatment of atypical eating among infants and children (e.g., food selectivity/refusal, negative physiologic response, etc.).
2. Cognition... SLPs frequently address attention, memory, problem-solving, and executive functioning in many different settings, such as hospitals, skilled nursing care facilities, private practices, schools, and even in patients' homes,
3. Literacy... reading, writing, and spelling are a vital part of language, and are areas in which many SLPs choose to specialize. We often think of "language" in terms of primarily spoken language, but written language is a logical and crucial extension of language development.
Click here for more information about the SLP's Scope of Practice.
Happy Better Hearing and Speech Month! #BHSM17