By Pam Marshalla
Q: My son just turned 5. He has been having difficulties with his articulation for several years especially with D, T, TH, S, Z, N and H. also he has difficulties in putting letters together such as D-O-G. He is able say things correctly only when we go really slow and draw out each sound. He also sucks in when trying to make the S sound. How can my husband and I help him with this? The severity of what…
By Pam Marshalla
Q: I work in a school and I have an autistic student 4;0 with limited verbalizations. She also sees a private therapist who keeps telling the parents that my methodology isn’t right, and that is why the girl isn’t making progress. She says that apraxia therapy has to be done a certain way. The child actually is making progress but limited, and the parents are saying that the progress is due to the child’s own development and not because of…
By Pam Marshalla
Q: My client is 4;0 with a frontal lisp with a very small mandible (underbite) and chronic upper respiratory problems––congestion, nasal drip, mouth breathing, snoring, etc. He cannot breath through his nose. Do you think he is capable of learning to keep his tongue in for the sibilants given his underbite? Yours is a very common question for which we have no clear answers. In all likelihood both the under-bite and the upper respiratory problems are contributing to his speech…
By Pam Marshalla
Q: I am faced with cutting my caseload down considerably due to budget cuts. We will see the more severe kids a max of one time per week, and that’s fine. However, we are being asked to cut the mild kids more, and even eliminate them from our caseloads. Do you have any ideas? Many therapists are facing this today. Here is a brainstorm I had that may get you thinking outside the box. The idea is to use four…
By Pam Marshalla
I receive many requests from adults who are seeking help for their minor articulation problems. They find me on the web and write to me asking what they should do. (Sometimes I worry these folks are secret “anti-oral-motor people” writing to catch me doing unethical therapy via email so they can shut me down somehow… That’s the paranoid side of me. But usually I believe that these are honest people who genuinely are seeking advice.) The following is a typical question…
By Pam Marshalla
Q: My male client is six and he has had phonological therapy for three years with another therapist. He was switched to me because he was going nowhere, and now he is going nowhere with me. I think he needs a motor approach but I have no idea how to begin. Can you guide me? Yours is a very common dilemma: You have tried basic phonological therapy that is auditory/cognitive/linguistic in nature and found that your client is not doing…
By Pam Marshalla
Q: Have you tried the SmartPalate? I am considering trying it with a few clients who have stubborn sound errors. I would like some input from people who used it first. The SmartPalate is a clinical electropalatometry tool and I have not used it. I have read all about it, however, and I am sure it will be very useful for some clients, but there are ways to do this without the expense. The SmartPalate provide visual feedback about place of articulation,…
By Pam Marshalla
Q: I received a referral for a 15-month-old diagnosed by a private SLP with apraxia. The child has excellent receptive language and produces 10-15 words. I was told that the child was an “automatic qualifier” coming in with the diagnosis of apraxia. I have huge reservations with this and do not feel as if the diagnosis was made appropriately in just in one session and not over time. There are no indications of motor difficulties elsewhere. Am I out in…
By Pam Marshalla
Q: My 5-year-old daughter has below average intelligence and she can say Bah, Mah, S, Da, and Nnn, but no real words. She has had speech therapy for two years. Could you suggest an oral appliance that can help her to improve oral muscles and tongue movement awareness? I am going to be very blunt here, and probably more straight forward than I would in a real therapy session in which I would gently lead you toward this idea over…
By Pam Marshalla
Q: A pediatrician recommended that a 4-year-old child receive speech therapy for R distortion. When do you recommend starting therapy for R? In my seminars I always say that a preschool child CAN be helped with R, but most therapists don’t feel it is necessary that young. School-based therapists almost never see these kids that young, but therapists in private practice often do. Therapists in private practice do so not because they feel it is absolutely necessary but because the…
