By Pam Marshalla
Q: I work in the Early Intervention setting and increasingly encounter late talking children (frequently boys) who prefer a frontal tongue posture. What’s the correction? In my experience, this problem does not need to be fixed in a two-year-old boy who is delayed in SL. First, tongue protrusion is normal in two-year-olds. Second, the child is late in talking and therefore should be using the pattern of a one-year-old. The only thing I would do over the next year is…
By Pam Marshalla
Q: I am seeing a child who substitutes K for T. He can click his tongue, can touch the alveolar ridge adequately with his tongue, and he understands the tongue placement for T. But he is not able to raise his tongue tip to the alveolar ridge during his attempt to articulate T. He has good phonemic discrimination, too. The lingua-alveolar consonants emerge when the jaw begins to move up-and-down, not when the tongue moves. So begin by teaching the…
By Pam Marshalla
Q: I am working with a 5 year old boy who is unable to lingua-alveolar consonants except an occasional N in isolation and occasionally in the initial position of syllables. I am able to get the tongue placement for /t/ and /d/ but as soon as he tries to say the sound, he makes the /k/ or /g/. Any suggestions would be most appreciated! The anterior consonants T, D, N, L, S, Z come in because the jaw begins to…
By Pam Marshalla
Q: How do you tell if a client is clenching the jaw when producing a target phoneme? The best way to determine if a client is clenching is to palpate the masseters. Do this on yourself first to learn the feeling. Place your fingertips on your masseters and then clench. Do you feel the bulge? Now do this with your client. If the jaw is clenching you will feel the muscle belly bulge. If it isn’t, then you won’t.
By Pam Marshalla
Q: In your workshop on the lisps and R, you said that we now have numbers to define jaw stability. Can you share them here? Yes! I would love to! As we all know, the mouth can move in a range that far exceeds that necessary for correct speech articulation, therefore it has to have mechanisms to hold its moving parts in place. This process is called oral stability. Oral stability consists of three parts: jaw stability, lip stability, and…
By Pam Marshalla
Q: I have a client who uses a velar fricative for the sibilants. I was experimenting with some of your self-assessment exercises in your book Frontal Lisp, Lateral Lisp, and I noticed that as I dropped my jaw to produce /s/, the sound eventually became a velar fricative. Do you think jaw grading or stability exercises will help my client with this? Position of the tongue relative to the palate is directly related to jaw position, height, and stability as…
By Pam Marshalla
Q: Could you talk about young kids with articulation disorders who demonstrate significant jaw sliding? What causes this when there is no neuromuscular problems? Jaw sliding left and right pulls the tongue laterally away from its alignment with the palate. This causes articulation of the tongue to the palate to be off and this distorts sound quality. Treatment is to stabilize the jaw at midline. There is no telling why these things occur. All movements are asymmetrical to a certain…
By Pam Marshalla
Q: My client lowers the jaw too much when he speaks, and he has a frontal lisp. He tends to clench the jaw when I tell him to hold the jaw up. I may have taught him this when using a bite stick to position the jaw. Not sure what to do now. As you have discovered, making a strong crushing bite on a firm object is not what he needs. The term “jaw stability” does not mean “jaw rigidity.”…
By Pam Marshalla
Q: My preschool client with apraxia can only say “K” when he bobs his head around. Should I ignore this as part of the learning process? Some clients seem to need extraneous movement to initiate a phoneme’s movements, but they do not need them for long. I see them as gross movements that will become more refined with time. I usually let my clients do all this extra movement at first, and I even emphasize it by imitating it back…
By Pam Marshalla
Q: My two-year-old client with Down syndrome has dysphasia and the classic forward tongue posture. Which of your books will guide me to work on oral-motor skills so I can strengthen the oral structure for swallowing and speech? Therapy is rarely about “strengthening” oral movements. Therapy for developing expressive speech in a toddler with Down syndrome usually includes the following: Activities to encourage a wide variety of oral movement through feeding and oral play activities. Activities to get the…
