By Pam Marshalla
Q: I’m working on /r/ with a 4th grade boy that simply does not care about his speech. The parents are upset about his refusals and are blaming me for it! Help! A Few Ideas for the Client Let him opt out for now. Tell him he does not have to fix this now, and that he can do it later. Make it matter-of-fact and no big deal. Some kids will stay in therapy when they know they can get…
By Pam Marshalla
Q: Can you correct a frontal lisp in a toddler? We can help a child with a frontal lisp beginning at two years of age, however, most SLP’s hold off until these kids are 7, 8, or 9 years of age because of developmental norms. In a private practice, one can see these clients at any age, however one usually counsels the parents that the child does not really need therapy until later because the error is considered “normal” until…
By Pam Marshalla
Q: This seems perhaps silly, but I have to admit that I am afraid of labeling a client with apraxia or dysarthria. Perhaps it is because I took no formal class on motor speech disorders while I was in college, and I have had to piece information together myself. Can you advise me? I too was afraid of motor speech for years. In fact people asked me to speak about it for some 20 years before I felt brave enough…
By Pam Marshalla
Q: How do you teach young children to keep their mouths closed? I am working with a 28-month-old with an open mouth resting posture. He also sucks his thumb and uses a sippy cup. This question is a huge one that requires a lot of background. I will be writing a full chapter on this in my next book, called 21st Century Articulation Therapy to be published in 2012. Let me write a few main ideas here: Medical We always have…
By Pam Marshalla
Q: Where do you get the very specific word lists you use for the articulation training you describe for R and the Lisps? You are talking about organizing word lists by vowels when working on phoneme R or the sibilants. I use a variety of dictionaries, thesauruses, and rhyming dictionaries. I also use the popular book called 40,000 Selected Words: Organized by Letter, Sound, Syllable by Valeda Blockcolsky, Joan M. Frazer, and Douglas H. Frazer. I always keep on hand a…
By Pam Marshalla
Q: I am looking for oral motor exercises that will teach and promote chewing. My client prefers a diet of soft foods that he can form into a bolus with his tongue against the roof of his mouth and swallow whole without moving the food to his molars and cheeks. The best book on the topic is: Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for mealtime development, 2nd edition. Austin, TX: Therapy Skill Builders (Harcourt…
By Pam Marshalla
Q: What can I do from a muscle-based perspective to engage the upper lip? There have been many methods of stimulating lip movement in the articulation, motor speech, oral motor, feeding, dysphagia, and orofacial myofunctional literature. The following sources are my favorite ones for activities to facilitate lip mobility. [Presented alphabetically] Dworkin, J. P. (1991). Motor speech disorders: A treatment guide. St. Louis: Mosby. Garliner, D. (1981) Myofunctional therapy. Coral Gables: Institute for Myofunctional Therapy. Marshalla, P. J. (1992). Oral…
By Pam Marshalla
Q: I have heard you say that you have a real problem with Evidence-Based Practice (EBP). Why would you be opposed to something that so clearly will help and protect our clients? I am not against using EBP. I am for EBP. However, I am concerned about several recent results of the EBP philosophy. I am especially opposed to three new ideas: I am against throwing out everything we have learned through a century of trial-and-error speech-language therapy just because we…
By Pam Marshalla
Once again I shall take a run at the question of what oral motor treatment is, and what are the differences between oral motor treatment and non-speech oral-motor exercises. This answer ensued from an email dialogue I was having with someone very concerned that SLP’s have begun to use non-speech oral-motor exercises INSTEAD of methods to facilitate sound and word productions. I tried to explain how this is wrong. ALL methods to improve speech are “oral” techniques, and they are…
By Pam Marshalla
Q: Our son is 28 months old and just starting to talk. He may be apraxic and he sucks a pacifier all day and night. He seems to be very bright. What is your opinion about the pacifier? I have seen otherwise normally-developing two-year-olds who do not talk at all become completely verbal within a few weeks after their pacifier is tossed out. I always recommend elimination of the pacifier in cases of speech delay, except in those rare cases…
