Muscle Problem vs. Cognition Level

By Pam Marshalla

Five-Year-Old GirlQ: My 5-year-old daughter has below average intelligence and she can say Bah, Mah, S, Da, and Nnn, but no real words. She has had speech therapy for two years. Could you suggest an oral appliance that can help her to improve oral muscles and tongue movement awareness?

I am going to be very blunt here, and probably more straight forward than I would in a real therapy session in which I would gently lead you toward this idea over many weeks or months of therapy..

Your child’s problem is not in oral movement. She needs no oral appliance to get her mouth to move better.  Her mouth moves well enough for now.

Your daughter’s real problem is in cognition.  She has not begun to understand that concept of “word”.  Before she learns any more sounds she needs to learn how to use the sounds she already has with meaning.

She needs to learn how to use B, M, S, D, N, and M to mean something.  I would choose one meaning for each sound.  She only will need more sound once she begins to use the sounds she already has meaningfully.

Let me suggest the following, but please adjust it however you see fit––

Sound She Makes

Have It Mean One of These Functional Words


Bye, ball, or bottle


Mom, my, me, more, move


Please, funny (kids often make an S to laugh), or snake sound


Dad, dog, or that


No, nose, or nice


3 thoughts on “Muscle Problem vs. Cognition Level”

  1. Pam, I love your candid response. I’ve always believed that diplomatic honesty is so much better than stringing along a parent to believe that an appliance or articulation therapy can cure a cognition deficit. I’m an SLP for severely handicapped children and I think we should be as frank as possible to avoid giving parents false or unrealistic hopes. Thank you, I love your responses and have learned a lot from you.

  2. I would also strongly encourage the use of some sort of voice output communication device. This can be a very powerful way to help a child learn the power of communication.

  3. As a school-based SLP, I worked with a developmentally delayed five-year-old girl weekly, who also received private speech therapy more frequently. They encouraged sign and speak, while this girl had only two sounds she could articulate, with little meaning attached, and poor fine motor skills to approximate a sign. This continued for a year with little progress. On the other hand, she LOVED pictures/visuals, but her parents did not want anything to do with any type of picture exchange system, even with suggestions and examples of how it may benefit everyone to help her communicate her wants and needs. To make a long story short: try a picture exchange system if verbalizing is not working for her.

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