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…
By Pam Marshalla
Q: My client has been in therapy for a long time for many error phonemes, and now we are working on the sibilants. He is doing them well now, but he tends to pull his right cheek to the side. It sounds correct but looks funny. Does the facial position matter if it sounds okay? If it sounds correct, I would not worry about that cheek pulling to the side until he is well on his way toward establishing the…
By Pam Marshalla
Q: I work with infants and often reference the developmental material you present in Apraxia Uncovered. I have a little fellow with an unrepaired cleft palate. He is doing all the skills prior to raspberries and none after. Should I stimulate the raspberries with him? Are raspberries possible with an unrepaired cleft? How much intraoral pressure is needed for them? I have not worked with babies like this, so I don’t really know the answer to any of your questions. I would…
By Pam Marshalla
Q: Do you think that physical maturation alone can be all that a particular client may need to help his speech improve? Yes, clearly some children outgrow their speech problems. But the only way to know this is to let time pass without therapy. I sometimes recommend that a child go 6-12 months with no therapy to see what happens. I make sure the parents know that I am doing this and why. Often the parents and I alone, or…
By Pam Marshalla
Q: How young do you see children with a lateral lisps? Most SLPs leave the lateral lisp alone until age 6-8. However, I and many other therapists address it earlier with children 4 and 5 years of age. I work on the following with younger kids– I make sure that T and D are midline and not lateral. If they are lateral, I straighten them out. I use a straw for this– They produce T into the straw held outside…
By Pam Marshalla
Q: I have been teaching R using your L-to-R sliding and tapping methods. However the further back my client tries to pull his tongue-tip the more it pulls to his left. He cannot keep it at midline past the middle of his palate, and he is not able to get a good R. I have not encountered this, but these are the methods I would use to address it– Have him use his finger, or another tool, and trace down…
