Answers & Advice Blog - Page 23 of 52 - Marshalla Speech & Language

Why Rag on the EBP?

By Pam Marshalla

Q: Why do you keep harping on about the evidence-based practice (EBP)? I keep “harping on” about the EBP for four main reasons: Because therapists from all over the world continue to submit questions to me about the EBP. Because therapists in my seminars continue to tell me about the problems they are having with the EBP––problems they are having with certain colleagues, administrators, or parents because of it. Because therapists in my seminars continue to tell me that they…

Tapping the Tongue to Stimulate the Lingua-alveolars––T, D, N, L

By Pam Marshalla

Q: My client backs every lingua-alveolar phoneme. He can do a rudimentary L once in a while, but he substitutes k/t, g/d, and ng/n all the time. What can I do? You probably are trying to get your client to elevate the tongue-tip to learn T, D, N, and L. This is to assume that the child can be taught to produce these sounds in the adult form. You have to revert back to teaching your client how to produce…

Outgrow jaw instability?

By Pam Marshalla

Q: My four-year-old client has apraxia and jaw instability. The mom wants to know if jaw stability will improve on its own. There is no way to know that. Certainly jaw stability improves with time, but it may not improve in this child without help. He is developing oral motor patterns that may stay with him until he receives therapy to change them. He should have jaw stability by now, so the question is, why doesn’t he? Whatever is preventing…

Lateral Lisp, Missing Teeth, and Malocclusion

By Pam Marshalla

Q: My client has no incisors and an underbite, and she distorts both S and Z. These errors sound like a lateral lisp, however when I use your straw testing method, there is no airflow coming out the sides, only the front. My colleague tells me that this is a lateral lisp. But how can it be if the air doesn’t come out the sides? Your colleague is wrong: If the airstream is not coming out the sides (as tested…

Frequency of Therapy

By Pam Marshalla

Q: How often do you see your clients? I always set once per week as my “must have” level. That is unless they are only on consult, follow-up, or the later stages of carryover. Over 35 years, I have found that once per week is sufficient for most kids, both the easy kids and the low functioning ones. Easy kids can do perfectly well with once per week, and low functioning clients do not move fast enough to warrant more…

Getting the Mouth to Open

By Pam Marshalla

Q: I have a preschool client who talks with his mouth closed. He can imitate me when I model an open mouth posture, but he always closes it when he says a word. I know that he is struggling with motor planning, but I just don’t know where to go from here. Any advice? This client can open his mouth, meaning that the mechanics are good. He also can imitate the posture, meaning that he has control over this movement….

Oral Habits and Dentition

By Pam Marshalla

Q: Why does an oral habit like thumb sucking effect the oral structures in some children but not others? I have seen kids who suck their thumbs who have no dental problems, and I have seen kids who suck their thumbs who have terrible open bites. As I understand things, any oral habit can affect oral structures depending upon the following three factors–– Frequency –– How often the client engages in the habit. Once per day? Ten times per day?…

Substituting N for L

By Pam Marshalla

Q: My 5-year-old client substitutes N for L. I cannot seem to help him make the sound oral and not nasal. These are the types of things I would try… Use a Vowel Have her open her mouth wide and say “Ah.” Then have her prolong “Ah” for 5 seconds or more. Then have her continue to say “Ah” while she lifts and lowers her tongue-tip up to the alveolar ridge about 5 times. Tell her, “Don’t try to say…

Apraxia and Dysarthria and Real Oral Motor Therapy

By Pam Marshalla

Q: Would you agree with the following statement: Children with apraxia will respond to structured production of increasingly difficult syllable shapes, while children with dysarthria need supplementing with oral motor exercises to address muscle weakness. Before I answer your question, let me say a few things about “muscle weakness” and dysarthria because many SLPs––including professors of articulation and phonology––do not seem to understand this area very well. The muscle weakness seen in dysarthria can have many different causes, and the…

Labeling Toddlers with Apraxia or Autism

By Pam Marshalla

Q: My son is 2 years and 2 months, and he jargons mostly. His therapists can’t seem to figure out if this is apraxia or autism. Why is this? It can be very difficulty to determine if a child has autism or apraxia when they are under three years of age. This is because so many of the problems overlap. Both disorders cause the child to be non-verbal or minimally so. Both cause much refusal to follow directions and answer…