By Pam Marshalla
Q: I have a client with a lateral lisp, and I have started trying to elicit an S with the tongue tip down. I call a tip-down S a “dipper” and a tip-up S a “tipper.” The dipper position has helped him, but I can’t find any information about the validity of using such an approach. Can you point me in the right direction? I love your terms “tipper” and “dipper.” Excellent shorthand! The tipper and the dipper are allophonic…
By Pam Marshalla
Q: I am working with an 8-year-old client with severe apraxia who only can produce vowels, M and B. I have tried all the strategies in beginning of your book called Apraxia Uncovered. But this has also not yielded much. Do you have any hints for how to physically prompt other consonants? This child has severe cognitive dysfunction, too. The reason that the information in Apraxia Uncovered was not of much help to you is because although your client may…
By Pam Marshalla
Q: In your presentation called Improving Intelligibility in Apraxia and Dysarthria you mentioned that it is important to practice phonemes that they can do, rather than phonemes they can’t do. Why is that? That’s a good question! Van Riper and other old-time SLPs said that about 75% of every therapy session should be a rehearsal of things the child can do correctly, and about 25% should be material that is new, unfamiliar, and challenging. Most SLPs today spend most…
By Pam Marshalla
Q: My two-year-old son has dysarthria. We have been practicing his target words 100 times every day at home, but when he goes to speech sessions, his SLP only has him practice his words a few times. Can you comment on this? I don’t think she is working him hard enough. Drill has its place, but he is only 2 years old! You are giving him more practice than just about any toddler could handle. You do not want him…
By Pam Marshalla
Q: Do you think that enlarged tonsils and adenoids are related to the lateral lisp? We have no data on this as far as I know. I have seen a few kids where I thought these problems were inter-related. But I would not suspect that all tonsil/adenoid problems cause lateral lisps, or that all lateral lisps are caused by tonsil/adenoid problems. I think you have to determine this for the individual child. We must ask ourselves: Do the tonsil/adenoid problems…
By Pam Marshalla
Q: While I understand that every case is different, as a general rule, at what age do you consider it appropriate to target R when it is the only error? I have taught R to one- and two-year old children, so I know it is possible to do very young. However each therapist must address this question relative to his or her employment situation. Therapists in private practice often see these kids at 4 and 5 years of age. Therapists…
By Pam Marshalla
Q: Do you have any suggestions on how to get a child to place his tongue on “The Spot” (the alveolar ridge)? We tried placing cream cheese as a placement cue but no result. You are on the right track in using tactile stimulation. I call this “Marking the Target” of articulation. But your stimulus is too weak. Cream cheese is barely perceptible in the mouth because it is too smooth, and it adapts quickly to body temperature. You want…
By Pam Marshalla
Q: My client says Sf for initial S words, as in “Sfoap” for “soap.” One simply has to hold the lower lip down and out of the way while practicing the words. This will prevent the lower lip from elevating to produce the F. I probably would have the client use his own fingers to hold the lip down. I call a method like this an “inhibition” technique. You are inhibiting an unwanted movement. At the very least the child’s…
By Pam Marshalla
Q: Is the best approach for ankyloglossia to do a back r? If the tongue-tip is tied down, the client will be unable to stretch the tip up and back far enough for a Tip R (retroflex R). You will have no choice but to teach a Back R. But, as you know, the Back R can be much harder for many kids. That’s an excellent reason to have the frenum surgically altered. I always refer a client with a…
By Pam Marshalla
Q: I am aware that a lateral lisp is not considered a developmental error and that it probably will not be outgrown. But I have had parents decline therapy for their six-year-olds saying that they don’t hear it, or telling me that the child does it only when his is excited. Do you have any advice for educating parents about this type of speech error and helping convey the importance of therapy? Most SLPs are not trained in counseling parents…
