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 although it is perhaps 75% of our job!  We all have to figure out our own ways of doing this kind of thing.  I don’t think I have any magic answers for you, but here are my thoughts––

1. To avoid this situation, I try to do my evals with the parents in the room, but I don’t talk to the parents much… I talk to the kids.  I spell out the problem to the kids, not the parents.  The parents watch me as I say things like, “These are the sounds you are saying incorrectly.”  I also say things like, “What sounds are causing you trouble?” and “You know that you are not saying these sounds correctly, right?”  It is hard for a parent to deny the problem after you have spelled the problem out to the child already.
2. If I have parents who refuse I might say, “This may not seem important now, but this is going to start bothering her at some point, especially if other kids make fun of her.  I don’t have any problem waiting on this, but the older she gets the harder it can be to change.  But any time she wants to begin this work I am ready.”
3. If the parents are in total denial about the problem, I would not argue with them.  But I would not give them the upper hand, as if they knew more than I do.  I might say, “Oh I see… You can’t hear it!  Oh, that is very common.  You probably can’t hear it because that is the way she has always sounded.”
4. If the parents still refuse to see what is going on, I would do a deep test of the error phonemes.  Make a list of words that have the target phonemes in initial, medial, and final position, and administer it right in front of the parents.  Use it as a time to teach the parents to hear the errors.  They actually probably cannot hear it.
5. If the parents still couldn’t hear it, I would use a straw.  If you have taken my class on lateral lisp, you know that I use a straw to assess the direction of airflow, and to teach the direction of airflow.  This will convince the parents without a doubt that you are right.  In fact, now that I think of it, I usually do not wait until this point to pull out the straw.  I usually pull it out right from the start.  Usually I say, “Let’s use this straw so I can hear it really good.”  Then when the error sound shows itself so glaringly with the straw, I cry out, “Oh! There’s the problem!  Do you hear it!  I see… You are making the sound out the side!”  Ask the parents if they can hear it.  Only the most stubborn parents on the planet could deny the problem at that point.
6. If the parents still deny services even after they finally know what the problem really is, I guess you have to let the parents make the decision, but I would not let them get away with it.  This is the child’s life, not theirs.  The child should make this decision when they are ready.  So keep that door open.  Let the child know that you are there for him when his is ready.  There will be a point when the child will be ready to do what he needs to do for himself despite his parent’s controlling forces.  It’s call adolescence!  Therapy may have to wait until then.