By Pam Marshalla
Q: My client had a frontal lisp, but when I taught him to keep his tongue behind his teeth, he switched it to a lateral lisp. Have you seen this? What should I do? I am going to answer this question as if you already have taken my class on the lisps, or you have read my book Frontal Lisp, Lateral Lisp… I think it is somewhat common for a child with a frontal lisp to switch to a lateral lisp…
By Pam Marshalla
Q: What is the difference between lingual-palatal suction and tongue-tip elevation? I have a student with cerebral palsy who can do suctioning but not tip elevation. Can you tell me why? There is a significant difference between lingua-palatal suctioning and tongue-tip elevation. To understand these subtle differences in tongue movement means to have studied feeding development (ala Morris and Klein, 2000). Tongue-tip elevation is accomplished by elevating the tongue-tip actively upward to the alveolar ridge. It requires the tongue to be functioning…
By Pam Marshalla
Q: I am a CFY and my supervisor will not let me attend your seminars because she says that you teach oral-motor techniques for which there is no proof. I need help with the lateral lisp and the distorted R. What can I tell her to convince her to let me go? First of all, what right does your supervisor have to determine which continuing education seminars you can and cannot attend? Why are you giving her this power over…
By Pam Marshalla
Q: One of my second graders is making no progress on R. On closer inspection, I noticed his tonsils are huge. He also can put the Nuk brush way back on his tongue with no gag reflex. Is his lack of gag and large tonsils related to his slow progress? Lack of a gag reflex can indicate poor oral-tactile sensitivity and awareness, meaning that the client has a very high threshold of sensitivity and may have difficulty perceiving what is…
By Pam Marshalla
Q: I have a 4th grade student who has trouble saying multi-syllable words in conversations. Do you have any suggestions for working with a student like him who doesn’t have any specific phoneme errors? Charles Van Riper called these clients “clumsy-mouthed individuals.” In my opinion, this is mild dysarthria. The key to treatment at this level is to teach the client to over-pronounce while he learns to self-monitor. Teach him how to do the following: Speak up Speak out Punch…
By Pam Marshalla
Q: My preschool client can produce all the consonants and vowels, but his speech is somewhat unintelligible at times. I seem to be working on just general enunciation. Is this correct? Should I be doing more? Yes! You are on the right track. Teach him to enunciate. This is the essence of therapy at this level, and it applies to all clients of all ages and ability levels. This is part of what I call “Lessons from the Elocutionists”. Teach…
By Pam Marshalla
Q: I have worked with a 4-year-old for two years who had a frenectomy about 3 months ago. His speech is quite intelligible now, but he still has heart-shaped tongue, he cannot dissociate his tongue movements from his jaw movements, and he cannot sweep his tongue around lips to clean himself. He stabilizes his tongue with his teeth and can barely extend it beyond lower lip even after surgery. Since speech is good would you still see him for therapy?…
By Pam Marshalla
Q: My adolescent client can produce a postvocalic R, but it is effortful and sounds fluttery like a trill. I am afraid that it is a habit now. Help! If I hear any other junk on an R, I simply refocus on the correct acoustic quality by training R from scratch. Teach him to get the correct sound. A trill or flutter on R is not the correct sound in standard North American English.
By Pam Marshalla
Q: My 12-year-old client can produce an R, but he hesitates on either side of it. For example, he says, “I’m [slight pause] ready.” This pause is for a fraction of a second. Do you have any thoughts or suggestions? This is an example of one of the limitless number of ways clients can mess up a perfectly good R. Your client can produce R, therefore his problem is not with R at this point. His problem is in the…
By Pam Marshalla
Q: My client has an anterior open bite, a very strong thumbsucking habit, and a frontal lisp of S and Z. My first impression is to wait to work on speech until after the teeth are firmly in place and the sucking habit is eliminated. Do you agree with this? Yes. In regard to the teeth, it is my opinion that it does no good to work on the sibilants until the “anterior dental barrier” (consisting of the front teeth)…
