This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Q: How young will you see a child for an interdental/frontal lisp?
Yours is one of the toughest questions to answer because there are different perspectives and different reasons for early treatment.
If there is a speech problem only, most therapists in the public schools seem to wait for a child with a frontal lisp to turn 7 years of age and older. However, I meet many school SLPs who see these kids in kindergarten and first grade. Therapists in private practice tend to start these clients at anywhere from four-to-six years of age, and I have met private practitioners who begin at age two years. The upshot of all this is that this is completely up to you and your sense of the child and his home situation.
In my private practice, I often see four- and five-year-old children for these types of problems, and I do so when the child is absolutely ready and/or the parent is pushing for it. I like to begin when the child knows s/he has a problem. I also prefer to begin with this age group if a parent does not know how to back off and let the child mature. (There seems a lot more of that these days.) I also make medical and dental referrals as early as possible if there seems to be respiratory or orthodontic issues related to the frontal lisp.
I also have worked on these errors in two- to four-year-old children. For me this therapy usually includes activities to help eliminate sucking habits that are present, and activities to keep the tongue inside the mouth while making the “Snake Sound” (S), the “Quiet Sound” (Sh), and the “Choo-Choo Train Sound” (Ch). I also begin teaching the alphabet song, making sure that they are saying the whole thing with the tongue inside the mouth. I use a mirror, pictures, cues, and over-focus on E position for oral stability, and other simple introductory ideas, and I usually do not work on specific tongue position. Keeping the tongue inside the mouth and producing different forms of stridency are the main ideas. Perfection of sound quality is not a goal for me.
Often I simply show parents how to do this at home. I teach the parents how to have these activities “come up” during the course of the day. In actual fact, this is therapy, but it is not weekly traditional therapy like one might do with an elementary school child.
If the parents are overbearing, obnoxious, demanding, or demeaning to their children, and I do not feel comfortable having them intervene in their child’s speech development, I have these little tykes come in for weekly treatment. This way I can teach the parents how to talk with their children in ways that foster safe and secure growth and development. Occasionally I have to refer these parents for their own psychological counseling.
If teaching a very young child to pull the tongue inside the mouth for all the sibilants results in him producing a lateral lisp (which does occur occasionally), then I back off completely. I focus on T in simple words like “eat” and “out” instead. This provides practice for keeping the tongue inside the mouth, and is the foundational tongue position for all the sibilants.