Q: I have a student I’ve worked with for a few years and she has several problems. I have tried everything I know, and nothing seems to help. She cannot say R, J, Sh, or Ch. She has difficulty with exhalation (i.e. she cannot blow out a candle) and therefore her speech is very quiet. She cannot even yell very loud. I’ve done some oral motor therapy (horn blowing hierarchy) and other things to address this, but it has not helped. Her conversational speech is so hard to understand because of these problems. Any ideas?

I hope you are using the horns to help her inhale more deeply and to exhale with more control, or to help with gross lip puckering. I hope you are not using horns and expecting your client’s problems with R, J, Sh, and Ch to go away.

Blowing horns is not the be-all and end-all of oral motor treatment! Where did people get this idea?! Who is spreading this false notion?!

Blowing horns and other instruments has nothing to do with the refined tongue movements needed by a client who cannot produce R, J, Sh, and Ch. Horn-blowing is only one tiny piece of treatment for respiration and phonation. A horn only wakes a client up to his respiration system. It gives him a glimpse into breathing. And a horn can wake up the lips – encouraging them to pucker.

Blowing a horn can wake up the respiratory system, however, blowing a horn does not teach a client to inhale better for speech, to speak up, to speak out, to project her voice, to speak more clearly, to speak syllables more distinctly, etc. She needs to be taught those things. She needs to be taught to elocute.

In terms of R, J, Sh, and Ch, your client needs techniques specific to getting the tongue in the right position for these phonemes. From your letter, it is clear that the over-riding issue is the need for spreading the middle and back of the tongue to make a wide groove.

What are you doing to help her learn to spread the back of her tongue for these phonemes? I have written all about this in three books:

• Oral-motor Techniques in Articulation and Phonological Therapy
• Successful R Therapy
• Frontal Lisp, Lateral Lisp

P.S. In addition to a horn, I would use a harmonica, a whistle straw, a siren, and an inspiration-expiration spirometer. These tools help the client learn to inhale AND exhale.