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 then. Van Riper’s definition of a speech deficit is useful when making this decision:

“Speech is defective when it deviates so far from the speech of other people that it calls attention to itself, interferes with communication, or causes its possessor to be maladjusted.”

Obviously, a frontal lisp in a two-year-old does not fit Van Riper’s definition of a speech deficit. The frontal lisp in a two-year-old does not deviate from other children of the same age, does not usually interfere with the child’s communication, and does not cause the child to be maladjusted. However, the error may be causing the parents to be maladjusted. Some parents freak out when they see an interdental tongue pattern in their toddlers and preschool children. This is where parents need information about normal development. They need help understanding that this is okay.

Therapy

Occasionally I put toddlers into therapy for a frontal lisp, either because I think the parents needed help understanding what normal is, or because I know I can help the child get rid of the error quite easily at this age. Personally, I would rather fix the error before the faulty pattern sets in place. This is what I generally do in private practice:

I see the child three or four times, spaced over several months, to engage the child in what I call “boost” sessions. I give him a little boost toward correct tongue placement on these sounds.

I teach them to stick out the tongue while they make the Angry Goose Sound (“Th-Th-Th”), which is made with the voice off. And we make Motor Sounds (“Thhhhhhh”), which is made with the voice on. I teach them to “Poke your tongue out” while making these sounds.

Then I teach them to bite their teeth together and keep the tongue inside while they make the Snake Sound (“Ssssss”), the Quiet Sound (“Shhhhhh”), the Choo-Choo Train Sound (“Ch-Ch-Ch”), and the Bubble Bee Sound (“Zzzzzz”).

I also usually teach the kids to make a variety of Raspberries with the lips and tongue. Raspberries are a gross form, or a pre-speech form, of the target phonemes.

I teach the parents simply to “play” with all these sounds with their child. They say them back-and-forth in playful ways. They pretend to be an angry goose or a snake or a bumble bee, and say “Sssss” and “Thhhh” and “Zzzz”. They put a baby doll to bed and say “Shhhh”. They line up big boxes to make a train and ride in them while saying “Ch-Ch-Ch”, and so forth.

I instruct parents that their job is to make sure the child says each one of these sounds at least one time twice per week.

I make sure they understand that this work should be gentle and playful and stress-free.

I help them understand that their child is perfectly normal. I try to help them relax about this minor issue.

I help parent learn how to focus on sounds in storybooks then read to the child.

I make sure they understand what can happen with fluency and self-esteem if a parent pushes their child too far and too fast.

I follow the child a few months (usually just two) and then enroll him in therapy if this does not resolve on its own.

One final note: I also work on this frontal lisp pattern in very young children if they are already in therapy for other reasons, like delayed language, etc. Again, I would rather get the motor pattern straightened up early so that it does not become a firm habit which later has to be broken.

• Van Riper, C. (1947) Speech Correction: Principles and methods. Englewood Cliffs: Prentice-Hall.