By Pam Marshalla
Q: What do you think of the consult model? I got into this profession to work directly with children, and now I am being told I have to engage in a pure consult model. I am mad and frustrated. I find several problems with the consult model. Young therapists coming out of school are being asked to consult with parents when they actually have not figured out how to do therapy themselves yet. Without working directly with clients, young therapists…
By Pam Marshalla
Q: My four-year-old client substitutes E for final Er, as in teachee/teacher. Have you seen this before? Should I be extra worried about it? To me this is just another minor problem with R. Nothing special just not very common — kids screw up R in more ways than are imaginable! The kids I have seen like this correct their errors easily. Most of their families thought the error was very cute and were sad to see it go!
By Pam Marshalla
Q: Do you have any treatment for incisor grinding? I wrote about this recently regarding clients who are lower-functioning, but in general — Changing any oral habit is a matter of engaging in the following points: Identify the problem. Help the client become aware of the problem: What can he do to track how often he does this? Get more info about it: E.g., what does the orthodontist/dental say about it and what methods do they recommend. Identifying specifics about…
By Pam Marshalla
Q: I am helping with policy development in my district and we’re facing significant budget cuts. We have to cut mild artic kids from the caseload. Do you have any advice about this? I am wondering if they are considering cutting services for very low functioning kids too. Kids with very low communication skills tend to be seen quite often these days, often 2-3 times per week. On the other hand, high-functioning artic kids are being seen less and less…
By Pam Marshalla
Q: My client adds E after all vocalic Rs. Example: She says “deer” as “Deer-ee”. Is this an oral-motor problem? What can I do? If your client has a correct R in some contexts but not others, then this is no longer about oral motor skill. She already can attain an R position. This is a problem of auditory discrimination. For some reason, she needs the E after the R to make the R correct in the vocalic position. Teach…
By Pam Marshalla
Q: Do you have any treatment for incisor grinding in a client with low cognition? Oral habits are difficult to change when cognition is low. The standard rule of thumb is to recognize that he child is benefitting in some way from the habit. Most people postulate that the grinding relieves boredom and/or it gives tactile stimulation that feels good. Many children with low cognition also have low oral-tactile awareness and discrimination, therefore oral habits feel good. If grinding is…
By Pam Marshalla
Q: I evaluated a 4;6 male with a 4mm open bite. He used a sippy-cup and pacifier. I advised to eliminate the sippy cup and pacifier, but what was noticeable on oral exam was that he had a really long tongue. Is it possible the tongue is just too large for his oral space? Is there a quantitative way to measure this? I find this to be one of those impossible-to-answer questions. We have no way of knowing clinically if…
By Pam Marshalla
Q: I notice that kids who come to me for frontal lisp often have the tongue-tip protruding on T, D, N, and L as well. Should I address these errors too? I always fix tongue-tip problems on T, D, N, and L before I work on S and Z. From a motor develop perspective, correct tongue movement on S and Z is an outgrowth of tongue movement on T, D, N, and L. There is no reason why you can’t work…
By Pam Marshalla
Q: My adolescent client speaks while holding his tongue tensed against the roof of his mouth in an “ing” position all the time. He has had years of therapy due to hearing impairment but can not produce a T, D or N at all. Most all of my oral motor experience has been to increase strength/tone. Any suggestions are greatly appreciated. Ahhhhhh…. You have discovered that “oral motor” needs to be much more than simply “strengthening” the mechanism. In fact,…
By Pam Marshalla
Q: Do you have any tips on how to help a student produce the Spanish R trill? Two methods I have used- Start with a lingua-labial raspberry and then have the client pull the tongue in. Say the word “butter” with a clear D– “Budder”. Say it while making the tongue-tip linger on the palate longer. There also are YouTube videos about how to do this 🙂
