Q: I am scheduled to see a 14-year-old male with a lisp on /s/. He recently got braces and the dentist told his mother that the child had better see a speech language pathologist if the braces are to help at all. Can you help me organize this diagnosis?

Focus on the speech first. You must know exactly what phonemes are affected. Look at ALL of them, not just /s/. Look at all the sibilants, and all other phonemes, especially the lingua-alveolar ones. You are looking for patterns on speech production first. Is this a frontal lisp or a lateral lisp? Is this a bilateral lisp or a unilateral lisp?

Then you are looking at the child’s supporting mechanism in terms of both structure and function:

• Oral Habits – Does he have any and how might they be interfering with speech development?
• Eating and Swallowing Skills – Does the client have age-appropriate eating and swallowing skills? Are Stages 1 and 2 of the swallow correct? Is there a reverse (infantile) swallow?
• Oral Rest Position – Is the client using correct oral rest position?
• Neutral Position – Is the client using appropriate oral stability as reflected in the neutral position?
• Oral Structure – Are there differences in oral structure that are contributing to the lisp?
• Dentition and Occlusion – As a part of oral structure, are there differences in dentition and occlusion that are contributing to the lisp?

Then you are putting all this information together to compile a complete assessment of the lisp. The remediation plan stems from all the needs identified in the assessment. I would suggest my book Frontal Lisp, Lateral Lisp to help you get a bigger picture of the lisps.