By Pam Marshalla
Q: My daughter has a lateral lisp and obesity. The SLP cannot seem to get her to make the correct sounds. Can obesity interfere with learning these sounds? I have never faced this situation with any client. However, from what I know about tongue function and the lisps, I do not see how obesity might interfere with learning correct tongue position for S, Z, Sh, Zh, Ch, or J. Perhaps your SLP does not know how to fix a lateral…
By Pam Marshalla
Q: My client constantly bites her lower lip until it swells and bleeds. She is highly intelligent, five years old, hypertonic, and has vision difficulties. Do you have suggestions? I have never faced this situation, but I believe that the principles of helping a child stop any oral habit would apply. You have to help the child recognize what she is doing, help her understand the problems it causes, help her develop a goal for stopping, set up a reward…
By Pam Marshalla
Q: I have been reading your book Becoming Verbal with Childhood Apraxia. The ideas sound great and very interesting, but I did not see a complete reference list. Are there specific research studies that support the techniques that you were describing in your book? The examples included were helpful. I need some more support because of the emphasis on the evidence-based practice. There is no reference list at the end of the book because these are all my original thoughts…
By Pam Marshalla
Q: There seems to be a shocking lack of knowledge “out there” about how to do articulation therapy. I recently saw a girl with an R distortion who had been in therapy with another therapist for a year with no progress. I was able to get a correct sound from her in 15 minutes! The mother was amazed that I actually worked on tongue movement and placement. I agree, and I think I know why this is occurring. The tried-and-true…
By Pam Marshalla
Q: I am seeing two elementary age brothers with a history of enlarged tonsils and adenoids that are not significant enough to warrant surgery according to the ENT. Both are difficult to understand because of their resonance issues. We are working on R and L with limited progress. I don’t know where to go with them. Speech is starting to impact reading and writing. A child with mild-to-moderate upper respiratory problems and minor articulation errors is one of the most…
By Pam Marshalla
Q: I attended your R course recently. It was wonderful! But I am stuck with one client. He has achieved a Tip R, but not a Back R. How much longer should I spend trying to help him get a Back R? If the Tip R works to get the sound quality you want, then that’s what you do, and you forget about the Back R. It does not matter which one he gets. Focus on what he can do….
By Pam Marshalla
Q: You mentioned orthodontic referral in one of your lectures on the lisps and R. I am wondering if you also refer to ENTs for issues relating to and resulting from mouth breathing. I follow standard practices in SLP. Therefore I refer clients to orthodontics when there are indications that a dental malocclusion may exist, and when it seems to be interfering with sound production. I refer clients to an ENT when there are indications that there may be upper…
By Pam Marshalla
Q: I am seeing a 5-year-old male with interdental S, T, D, N, and L. He can say every sound correctly when reminded to keep back teeth together. Do I address all sounds at once or just S first? Should I still do cornerstone approach since he is stimulable or just work on drill and carryover? As you know, each child is different. This is the process of trial and error. You will have to figure out what works best…
By Pam Marshalla
Q: I have two girls with Down syndrome who grind their teeth on a regular basis. They are the same age and function at about the same level. What strategies would you use to help with this area? This is a tough question. We have no widely accepted strategies to eliminate tooth grinding other than the dental guard recommended by dentists. But my thinking has always been that if you can pinpoint the cause, then you can design a solution…
By Pam Marshalla
Q: My 7-year-old male client has a robotic speech presentation that interferes with intelligibility. He has low tone in the trunk and poor breath support. Do you have suggestions? Usually a robotic voice makes an unintelligible child more intelligible. So maybe your client is using the robotic presentation to help him be more intelligible. In other words, maybe he knows (unconsciously) that when he speaks with equal stress on each syllable more people can understand him more often. He may…
