This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Tongue-Tie and Speech
By Pam Marshalla
Q: How does a “tongue tie” interfere with speech development?
In my experience, a “tongue tie” (a restricting lingua frenulum) can influence speech in certain ways depending upon the severity of tip restriction. The more the restriction, the more the influence on tongue tip movement.
- The restricting lingua frenulum can bring about an inability to elevate the tongue-tip to the alveolus. As such the English lingua-alveolar phonemes /t/, /d/, /n/ and /l/ must be produced with elevation of the tongue blade instead. This can cause a mild distortion that, by itself, will cause little concern.
- Production of the retroflex /r/ (“Tip R”) will be influenced, however. This is because the client will be unable to curl the tip back toward the velum to make the retroflex /r/. The client should be able to produce a “Back R” with high elevation of the back lateral margins, however. The Back R is made with a somewhat retracted yet low tip position.
- Sibilants “S” (soap), “Z” (zoo), “Sh” (shoe) and “Zh” (television) should not be disturbed by a restricted lingua frenulum. That is because these phonemes are made with a central groove that is formed by keeping the midline and tip of the tongue low. This central channel is not corrupted by the restriction of the tip at midline.
- However, the sibilants often are influenced by a restricting lingua frenum. Why? Because the restriction caused the client to over-use the blade and, as a result, the sibilants often are produced with the blade bulging upward toward the alveolus or upper central incisors. A bladed lisp, or a lateral lisp, will result.
- Sibilants “Ch” and “J” (jump) will be disrupted in that same way the /t/ and /d/ are.
My 5-year-old client has a lateral lisp for /s/ and /z/, but he is completely independently able to fix his tongue positioning and airflow to produce the sounds correctly while we are in speech therapy. However, we’ve had no success with carryover outside of therapy sessions. I suspect there may be a tongue tie. How does one determine if surgical repair is necessary? Is possible that with age he will eventually generalize his newly acquired articulation skills to everyday life? Thanks!