Q: My student has very uncoordinated oral movements and severely unintelligible speech. He is unable to elevate his tongue-tip, and therefore does not produce any alveolars. His S and Z are very frontal––like Th––and he reduces S-blends. How do I teach alveolars, and do I concentrate on S-blends or correct production of S and Z?

Your client requires a whole semester class on how the body works, and how that plays into speech movement development. Questions like yours are the hardest ones for me to answer in this format because, on the surface, it sounds like he just has trouble with phonemes, but I know that he has much bigger problems. That is why I have been putting off writing back to you. I almost don’t know where to start. So let me say a few things, and you can get back to me for further clarification on any part of it —

I saw a client very similar to yours a few weeks ago in Texas, so this is fresh on my mind ––

1) He is highly unintelligible, and he has uncoordinated OM movements, probably because he is unstable. His mouth is unstable, and probably his whole body is unstable. He probably has slightly low tone, and therefore is fixing somewhere along the spine, in the jaw, in his face, somewhere, to stay upright The combination of low tone and high tone mixed together causes his oral mechanism to be inconsistent in the way it moves. This wreaks havoc on jaw positioning, and lip and tongue positioning as a result. He needs to develop a stable jaw from a stabile body, and a tongue that is stable in the back. I don’t know if you know how to do that. This is dysarthria.

2) Don’t worry about S and Z so much when a client has no lingua-alveolars as you said your did. The lingua-alveolar phonemes emerge because the jaw begins to move up-and-down, not because the tongue begins to move. I would stimulate him for T, D, N, L, S, and Z all at this time, but I would let his jaw do the work. That means that he will substitute Th/S and Th/A. He should do that. That’s where his OM skill development is. He is at an infantile level of jaw-lip-tongue control. Therefore he will produce these phonemes like an infant would––by mostly using his jaw, and by positioning the tongue forward. Get the jaw to move MORE to stimulate these anterior phonemes.

3) He needs to learn how to move his tongue independently from his jaw. This occurs as the jaw begins to stabilize in an upward position. Therefore, I also would stimulate T, D, N, L, S, and Z with the jaw stabilized. Place something between his molars to force the tongue to move independently. Stabilize the jaw LOW for T, D, N, L to force the tip to elevate higher. Stabilize the jaw HIGH for S and Z to force the tongue to stay in the mouth more.

4) Unintelligibility also is due usually to imprecise vowels, dropped syllables, rapid rate, etc. Work on exaggerating speech. Have him speak up, speak out, and exaggerate. Practice words, phrases, and sentences of 1-5 syllables in BIG, JIGANTIC PRONUNCIATIONS.  Over-exaggerate. Practice “elephant” as “E-LE-PHANT!” Focus on the syllables. Focus on the roundness and full resonance of the vowels. Make the productions BIG. And teach him to listen to himself do all of this.

5) In regard to the clusters, I usually find it easier to get the clusters first in the final position — Cats, rats lights, boats, books, bikes… This is easier for these kids than Sp, St, Sk… It seems to be easier to sequence frication AFTER the other consonants that before them. It’s easier to say Ts that St… That way you can bring frication in right away.