The "secret" to correcting lateral lisps...

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 "garbled". 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 so many wonderful techniques to cue correct tongue placement, such as the butterfly technique, using straws, and fantastic resources from Pam Marshalla. 

​For /s/, I probably don't do anything much different from the above techniques, but I call it the "long /t/ sound".  It looks like this...

1. Have the child produce quick-fire repetitions of the /t/ sound ("t-t-t-t-t-t-t-t-t-t-t-t"), which anchors those lateral borders of the tongue against their teeth.  
2. Once step 1 is consistent, I ask the child to simply "hold out" the /t/ sound which causes them to inadvertently produce the /s/ sound ("t-t-t-t-t-t-tsssss").
3. Then I go directly to words ending in /t/ and have them produce the "long /t/ sound" at the end of the word... so /cat/ becomes /cats/,  /bat/ becomes /bats/, and /hat/ becomes /hats/.... then we add /s/ to initial word position and go from there.

BUT THAT'S NOT THE SECRET!

If your 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 we move to the word level. Oh, the frustration!

So, here's my "secret" (drum roll please)...

Tell the child you're NOT 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! ​This mental shift has been key to my clients creating a new motor plan for correct production of /s/. The child gets to name this "new sound" and even create its very own symbol.

Once they have mastered this "new sound" in isolation (using any of those techniques above) we move to adding it to words with /t/ in final position (cat, bat, hat) and I have them draw their symbol for this "new sound" at the end of the word. Sometimes, at this point they begin to realize we're really working on /s/ and begin to lateralize again... I remind them, NO /s/ sounds! Only use the "new sound". Then we start "removing" the /s/ sound from words and "replacing" it with the new sound. Now once the lateralization has been eliminated for a good period of time, of course we inform them that this new way is actually how we should be saying /s/, which comes automatically most of the time.

***A 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.***

Well, there it is... my big secret for correcting a lateral lisp. Nothing fancy, but it works!