Q: One of my second graders is making no progress on R. On closer inspection, I noticed his tonsils are huge. He also can put the Nuk brush way back on his tongue with no gag reflex. Is his lack of gag and large tonsils related to his slow progress?

Lack of a gag reflex can indicate poor oral-tactile sensitivity and awareness, meaning that the client has a very high threshold of sensitivity and may have difficulty perceiving what is going on in his mouth.

Lack of a gag response also can mean that there is nothing wrong with a client’s oral-tactile sensitivity, but that he is very good at suppressing his gag when he needs to.

Enlarged tonsils should not interfere with learning R in therapy.

In any case, you should be able to achieve an R given good therapy methods. This is a very big topic. Have you seen my book called Successful R Therapy or have you been to any of my workshops of the same name? I am not trying to sell you a book or a seminar, but these things are designed specifically to help therapists struggling with R. In the meantime, I have written several Q&A’s on R therapy that have been posted to this blog.