Category: Articulation

Classic 5-Part Problem (anterior open bite, high arch palate, reverse swallow pattern, frontal lisp, an oral habit like sucking)

By Pam Marshalla

Q: My client has an inter-dental lisp, possibly a tongue thrust, a high narrow palate and an anterior open bite. He also has difficulty with /r/ in all positions. I only saw him one time and do not want to waste time in therapy. Should I send him to the orthodontist before beginning therapy? Is there anything I can do in terms of exercises to help him? This client represents most of what I call the 5-Part Problem: An anterior…

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Vocalic “L”

By Pam Marshalla

Q: I have a fourth grade student who has trouble with the vowelized “L” sound. She can produce final “L” when paired with a high front vowel but not when paired with a low back vowel. Do you have any suggestions for helping her learn how to lower the back of her tongue in order to produce these sounds correctly? Your client can say /l/, but just does not know how to transition from every vowel position to the /l/…

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Stimulation Techniques for /k/ and /g/

By Pam Marshalla

Q: Do you have any suggestions for how to elicit the /k/ and /g/? Pre-speech Vocalization Use the velar raspberry because it is the infant’s precursor to /k/ and /g/. If the child can make a velar raspberry, he is articulating in the back and only needs to refine the sound. Practice the raspberry long and short, loud and soft, big and tiny. Shape it into /k/ if the raspberry is voiceless. Shape it into /g/ if the raspberry is…

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Tongue-Tie and Speech

By Pam Marshalla

Q: How does a “tongue tie” interfere with speech development? In my experience, a “tongue tie” (a restricting lingua frenulum) can influence speech in certain ways depending upon the severity of tip restriction. The more the restriction, the more the influence on tongue tip movement. The restricting lingua frenulum can bring about an inability to elevate the tongue-tip to the alveolus. As such the English lingua-alveolar phonemes /t/, /d/, /n/ and /l/ must be produced with elevation of the tongue…

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Denial of R Therapy: A Dialogue (R/W)

By Pam Marshalla

Q: Is there a website or document that describes the problem of pronouncing R’s as W’s? My friend’s 7-year-old daughter has this speech problem and she is now having reading difficulties. I feel the school has not diagnosed this because both parents are from Puerto Rico and the teachers probably think it’s an accent. I recognize the problem because my brother had it, and it was also not diagnosed because my parents are German and everyone just assumed it was…

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Stopping Prevocalic Sibilants

By Pam Marshalla

Q: I work with a first grade student with multiple articulation errors. He inserts /t/ after /s/ and /sh/ words. For example he says “stay” for “say” and “shtirt” for “shirt.” We’ve slowed the production down to the point of an actual pause between the /s/ and the proceeding vowel and he is 100% accurate. But how do we speed up the motor movement while keeping the production accurate? I have found that the insertion of /t/ before or after…

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Tongue Back Elevation

By Pam Marshalla

Q: What can we do to make the back of the tongue elevate for /k/ and /g/? We can use the Tongue Retraction Response (TRR) as follows: Tactile stimulation down the midline of the tongue from anterior to posterior causes the entire tongue to retract back and up toward the velum. The response occurs about half-way down the tongue, and is elicited after the Tongue Bowl Response (TBR) and before the Tongue Gag Response (TGR). I also have called the…

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Vowels, Diphthongs, Choppiness, Low Intelligibility

By Pam Marshalla

Q: My twin clients have been in therapy for a long time and now can produce all the consonants except /r/ and /s/ in clusters. However, vowels sounds are still inconsistent and their speech is choppy and “staccato-like.” Intelligibility is low. First, kids learn vowels best in isolation, not embedded in the middle of words. Second, choppy and staccato-like rhythm pattern usually is related to diphthongs that are not fully developed. Listen carefully to the diphthongs. You can use the…

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“Popping” and Other Techniques to Teach Voicelessness

By Pam Marshalla

Q: I was at your Improving Intelligibility workshop this winter. On your handout, in regard to teaching voicelessness, you write: “Teach popping with p, t, k.” I did not write anything down and as I look back over the material I have no idea what “popping” is or how to teach it. Help! Ah yes, “Popping” is a term I made up. Let me explain… When children first learn [p], [t] and [k], they do so with productions that are…

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How to Correct a Nasal R

By Pam Marshalla

Q: In your book, Successful R Therapy (pg 62), I read about how to help a client with hypernasality on R. That helped a lot. But I need help with the actual teaching part. How do I get the student to say the R without the nasal sound? Your client first needs to discover that sound comes out his nose and mouth differentially, and he needs to control this as he makes R. Use a flexible tube about 18 inches long and…

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