How to Consider a Differential Diagnosis

By Pam Marshalla

Medical PaperworkQ: My client misarticulates all the lingua-alveolar consonants–– T, D, N, L, S, Z. Can you give me some advice for how to fix them?

Designing methods to “fix” a phoneme all depends upon what is wrong with it.  Therefore in order to recommend methods to address these lingua-alveolars, one would need to know––

  • Are they completely absent from the client’s repertoire?
  • Are they backed?
  • Are they lateralized?
  • Are they interdentalized?
  • Are they nasalized?
  • Is there a lack of plosiveness on the stops?
  • Is there lack of frication on the sibilants?

We also need to know what is going on with his oral-motor skills.

  • Do his movements look clumsy?
  • Is the jaw unstable?
  • Does the jaw sit too low?
  • Does the jaw lateralize, protrude, or retract?
  • Is the tongue anchored in the back?
  • Does the tongue-tip elevate to the alveolar ridge? If not, why not?

Therapy is not just a random assortment of techniques that one selects will-nilly; Therapy is a process of differentially diagnosing the problem and then coming up with solutions to address the specific problem that is causing the client to mispronounce the targets.

3 thoughts on “How to Consider a Differential Diagnosis”

  1. My son just turned 5 and has been having difficulties in his articulation for several years especially with D, T, TH, S, Z, N and H. also he has difficulties in putting letters together such as D-O-G. he is able do only when we go really slow and draw them out but is unable for most words to combine the sounds to form the word without drawing them out.He sucks in when trying to make the S sound, How can my husband and I help him with this?

    1. Natasha-
      It sounds like your son is having a lot of difficulty with speech. The severity of what you describe requires the assistance of a professional Speech-Language Pathologist (SLP) — I hope he is seeing one at school or privately. There is very little I can say about a serious problem like this to a parent in an email, other than to give general advice about reading to him, helping his practice sounds and words, and so forth. This is going to require a long-term plan, and the SLP should help guide you through this.

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