Pam Marshalla, Author at Marshalla Speech & Language

Author: Pam Marshalla

L and R with Tonsils/Adenoids Problems

By Pam Marshalla

Q: I am seeing two elementary age brothers with a history of enlarged tonsils and adenoids that are not significant enough to warrant surgery according to the ENT. Both are difficult to understand because of their resonance issues. We are working on R and L with limited progress. I don’t know where to go with them. Speech is starting to impact reading and writing. A child with mild-to-moderate upper respiratory problems and minor articulation errors is one of the most…

Use the Client’s R

By Pam Marshalla

Q: I attended your R course recently. It was wonderful! But I am stuck with one client. He has achieved a Tip R, but not a Back R. How much longer should I spend trying to help him get a Back R? If the Tip R works to get the sound quality you want, then that’s what you do, and you forget about the Back R. It does not matter which one he gets. Focus on what he can do….

When to Refer to Orthodontia and ENT

By Pam Marshalla

Q: You mentioned orthodontic referral in one of your lectures on the lisps and R. I am wondering if you also refer to ENTs for issues relating to and resulting from mouth breathing. I follow standard practices in SLP. Therefore I refer clients to orthodontics when there are indications that a dental malocclusion may exist, and when it seems to be interfering with sound production. I refer clients to an ENT when there are indications that there may be upper…

Frontal Lisp and Oral Stability

By Pam Marshalla

Q: I am seeing a 5-year-old male with interdental S, T, D, N, and L. He can say every sound correctly when reminded to keep back teeth together. Do I address all sounds at once or just S first? Should I still do cornerstone approach since he is stimulable or just work on drill and carryover? As you know, each child is different. This is the process of trial and error. You will have to figure out what works best…

Eliminating Tooth Grinding

By Pam Marshalla

Q: I have two girls with Down syndrome who grind their teeth on a regular basis. They are the same age and function at about the same level. What strategies would you use to help with this area? This is a tough question. We have no widely accepted strategies to eliminate tooth grinding other than the dental guard recommended by dentists. But my thinking has always been that if you can pinpoint the cause, then you can design a solution…

Robotic Speech

By Pam Marshalla

Q: My 7-year-old male client has a robotic speech presentation that interferes with intelligibility. He has low tone in the trunk and poor breath support. Do you have suggestions? Usually a robotic voice makes an unintelligible child more intelligible. So maybe your client is using the robotic presentation to help him be more intelligible. In other words, maybe he knows (unconsciously) that when he speaks with equal stress on each syllable more people can understand him more often. He may…

Oral-Motor/Artic Client

By Pam Marshalla

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…

The Long T (again)

By Pam Marshalla

Q: I bought your book Frontal Lisp, Lateral Lisp recently and am trying your “Long T Method.” My client can do T but not Ts. Is there still hope that I can use the Long T method or should I skip to something else? I only tried an aspirated T during one session so far. Patience! One session is not enough to know if a method will work or not. Also, you seem to be trying to get him to…

Work the Lateral Lisp Slowly

By Pam Marshalla

Q: I have had success with your “Long T Method” for teaching S and Z with my adolescent lateral lisper, but he continues to break down in reading and in conversation, he can do Sh and Zh on words, but he can’t do Ch or J at all. Where do I go from here? Can I expect braces to help improve his speech? Braces will not help. This is not a tooth problem. It is a tongue movement problem. You…

The Tools of Articulation Training

By Pam Marshalla

Q: I am confused over the term NS-OME (Non Speech Oral Motor Exercises). Some people are saying that we cannot use things like toothettes, bite sticks, whistles, or straws in therapy. I use many things like this in therapy. Shouldn’t we do whatever we can to help our clients learn to make speech sounds? Your question is a good one. Yes, we are supposed to use whatever we can to help our clients learn to produce speech sounds. Van Riper…