Age of Treatment Onset for Frontal Lisp

By Pam Marshalla

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.

5 thoughts on “Age of Treatment Onset for Frontal Lisp”

  1. The frontal lisp is a problem of a lack of oral stability. In the case of a frontal lisp, the tongue juts forward because of a lack of oral stability, the jaw lowers too far because of oral instability, and, in your case, the lips shift to one side because of oral instability. The solution is to establish oral stability, and this is a deep concept that stretches further than a short answer like this can support. I have written one paper on oral stability that is on my website — address below 🙂 Also, my next book will have a whole chapter on tis topic– what oral stability is and how to develop it.


  2. I am a school based SLP who recently evaluated a 7 y/o who exhibits a frontal lisp with the /s/ and /z/. Formal testing did not produce a qualifying score that met our state’s guidelines. Informal assessment/observation indicated she was able to identify her errors and correctly produce these sounds on her own without instruction from me. When asked why she stuck her tongue out for these sounds she stated that she does so because she doesn’t like the way her tongue feels when she keeps it inside her mouth. I did not recommend therapy instead I recommended a home program be implemented by the parents and teachers. My reasoning was she already possesses the skills we would target in therapy and would have to work on these skills outside of speech therapy. Therefore, direct speech therapy services from a SLP are not needed. I provided a home packet to the parent and also provided strategies to use both at home and at school in order to promote good speech. I’m curious, what are you’re thoughts on this situation?

    1. I would be concerned as lisps are often visible and noticeable to the average listener. Lips are often thought of as “cute” by adults. Older students and adults with lisps are often thought of as “not smart.” I see this having a direct negative impact socially with this student, as she gets older (i.e., middle school/high school). If RTI does not prove successful, I would reconsider.

  3. I am an adult female who has the ‘most common’ lisp- the frontal lisp. I first went to speech therapy at about age 7. My mother would often point out my lisp and after the age of thirteen, I elected to stop speech therapy due to impacting my class time in junior high school and general anger over my mother’s insistence and humiliation of me. I come from an emotionally abusive family of origin where my sister, who is 11 months younger than me, also has a frontal lisp. Medical and dental causes were ruled out.
    My psychologist and psychiatrist suggested my (and my sister’s ) lisp may have psychological cause.
    I was never a thumb sucking child and I am aware that pacifiers were not given to us after the age of one year old.
    Any thoughts are greatly appreciated.

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