Q: I have been working with a 10-year-old girl with a significant lateral lisp that affects all of her sibilant sounds. I have been focusing on establishing /s/ and /z/, but have not been able to progress very far because her ability to achieve the correct tongue position is so inconsistent. I have taught her the “Butterfly Position” to help her lift the side margins of her tongue, and am using the “Long T Method” from Frontal Lisp, Lateral Lisp.

My client is able to obtain a midline air stream and side margin elevation using these techniques, but she cannot sustain it from one production to the next, nor can she transfer it to anything beyond a syllable or short word. Her ability to distinguish accurate from inaccurate productions is also very inconsistent. I am only able to see her twice a week and though I have been assigning her daily home practice, her parents are very minimally involved in helping her. What is your experience with children with lateral lisps like this? Is it typical for progress to take so long? Is seeing her twice a week sufficient? Might I be missing something that is preventing her from progressing?

It sounds like you are doing everything right, but you may be trying to move toooooooo fast. She may need to stay on “Ts” for many weeks, even months.

Work to habituate the motor pattern. Don’t try to generalize – she won’t be able to. Be patient. Build habitual motor patterns that she can control in rote practice. Work on Ts in syllables, words, phrases and sentences in every session, but consider using only 1-3 target words.

For example, the target word “hats”:

• Practice rote two-word phrases: “two hats, three hats, four hats…”
• Practice longer rote phrases: “two big green hats, three big green hats…”
• Practice rote sentences: “Mom made two hats. Mom made three hats…”
• Practice longer rote sentences: “Two hats fell onto the floor. Three hats fell onto the floor…”

Help her learn to take the one motor pattern she has learned and to pack other syllables and words around it. Help her produce gradually more sophisticated utterance, but stick to the same oral motor pattern.

Be patient. You are training her to use a new motor pattern. Ask yourself this: How long does it take a child to learn a cartwheel? That’s how long it may take her to learn this motor pattern. Motor learning takes time.

I see kids with frontal and/or lateral lisp once per week for 30 minutes. This is enough. It is not more therapy now that makes the difference, it is good therapy over the long haul. It takes time to change motor behaviors and motor habits.

Also, she should practice at home only those things that she has mastered perfectly in the therapy room.

“Practice is the key variable thought necessary for mastery of any skilled motor behavior … Initially there is a sluggishness in the execution of motor skills because the learner is acquiring the movement. With practice, the motor skill is perfected and stabilized. Ultimately, the skill becomes a part of the learner’s repertoire of skilled movements and becomes automatic for the speaker.”

Bernthal, J. E., & Bankson, N. W. (2004). Articulation and phonological disorders. Boston: Pearson, p. 295.