Frontal Lisp and Reverse Swallow

By Pam Marshalla

Q: Is it efficacious to work on a frontal lisp when a child has a reverse swallow, or does the swallow have to be addressed first or concurrently?

In the ideal situation, the speech problem, the reverse swallow, the dentition problem (if any), and the oral habit (if any) are address all together in one plan or action.

In the orofacial myofunctional literature, the recommendation generally is to work in the following order:

  1. Eliminate oral habits
  2. Establish correct oral rest position
  3. Establish correct swallowing pattern
  4. Establish correct articulation patterns

However, the unfolding chronology of the plan can be individualized per client. Some clients can fix up their articulation problem without addressing the other problems, but others cannot. This depends upon the severity of the oral rest, thrusting, and habit problems. These problems can range from mild-to-severe just like anything else.

Thinking in terms of an RTI (response to intervention) model one could, I suppose, enroll the client in articulation therapy only, and measure the progress in speech without working on the other issues. If the client demonstrates that speech therapy alone will remediate the speech error, then the other problems may not have to be addressed. If however, after several weeks/months of treatment, the client shows no change in articulation, then an approach that addresses the habit, rest, and swallow patterns first will/may be in order.

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