By Pam Marshalla
Q: When a child can produce his new sound correctly, do we go for the next level – syllabic level – in the same session? Don’t we have to dedicate a whole session for one goal to be sure that we have achieved the desired result? I always do as much as possible in every session I have with my clients. I try to work on phoneme, syllable, word, phrase, sentence, paragraph, and conversation all in the same session if…
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: Age what age should a child with an isolated Frontal Lisp be seen for therapy? When to see a child with a frontal lisp is a controversial thing. We CAN help a child like this from the age of two and older. But most SLP’s still hold off until they are older. Most school districts do not let a child like this enter therapy until age 7, 8, or 9 years of age. In a private practice, one can…
By Pam Marshalla
Q: Can you explain how to follow sanitary procedures when using hands or objects in the mouth? SLPs need to follow sanitary procedures at all times when touching a client with the hands or other objects in, on, or around the mouth. The following summarizes the basics of: (1) Scrubbing and gloving, (2) Handling objects in sanitary ways, and (3) Sanitizing objects for re-use.* 1. Scrubbing and Gloving Procedure: Adhere to the following procedure at all times when touching a…
By Pam Marshalla
Q: Does a client have to be stimulable for a sound, or sound class, before therapy should be initiated? No. Sometimes we target a phoneme or class for which the client is stimulable. Other times we teach the client a new phoneme or a new sound class for which the client is not stimulable. For example, the client who cannot pronounce R needs to learn R. He is un-stimulable for R and must learn it. I have worked with hundreds…
By Pam Marshalla
Q: My daughter is almost 4 and her speech is rarely understood by anyone outside of our family. While my daughter absolutely loves her therapist and has made some progress, she has been stuck at a plateau for a while. My daughter is very bright and has a high level of understanding and of vocabulary. However, she never says her word endings, many letters are omitted, she talks in a very rapid rate, S is always slurred, and she can’t…
By Pam Marshalla
Q: I have a student with a restricting lingua frenulum that limits his tongue mobility and impacts his speech intelligibility. What do you write in the referral letter to the physician? Write a letter that explains how the restricting lingua frenulum is impacting as many of the following six areas as you can: speech, oral rest, preparation for swallow, the swallow, health, and social appearance. The letter is sent in the hopes that the primary physician will refer the client…
By Pam Marshalla
Q: When it comes to giving homework in articulation therapy, should the SLP wait until the student masters it in the speech room? I view learning new phonemes as the process of learning new movements. Therefore, I only have kids practice at home what they can do with 100% accuracy with me in the therapy room. I am a very picky and exacting teacher! Rigidity such as this is not critical when the client has a general articulation delay. When…
By Pam Marshalla
Q: I have heard you say that although most school districts seem to have excellent entrance criteria for therapy, they tend to have very poor exit criteria. Could you speak to this in regard to a client’s willingness to participate and in regard to cognitive level? Because I have been in private practice for 25 years, I have not had to agree with anyone on exit criteria, and therefore I have taken it on a case-by-case basis. In all honesty,…
By Pam Marshalla
Q: What is your opinion about writing goals for oral motor exercises when a client has a functional articulation disorder? My training would suggest that working on oral motor skills is appropriate only when there is a motor speech disorder. When asked how to write OM goals, I say, “Don’t write OM goals!” Oral movement is not your goal. The speech sound production is your goal. Write speech goals. Speech is movement. Whether you are working with clients who have…
