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Julie Hoffmann, M.A., CCC-SLP

2/17/2003

I am struggling with my students that have lateral lisps. Frontal lisps seem fairly easy to understand and teach but I am struggling with eliminating airflow from the sides and directing it through the front. Do you have any good techniques that have worked successfully? We have tried the straw technique but that proved unsuccessful. Please Help.

Incorrect tongue position and poor jaw stability are often the causes of the lateral lisp, however, other factors may play into the problem including, upper respiratory problems, dentition and sensory integration issues. Keep this in mind as you are choosing techniques to remediate the lateral lisp.

Using a bite block can help to stabilize the jaw by having the client bite softly down on the straw with side molars on the right or left side (Note: I use the smallest straw possible for the bite block--coffee or drink stirrers). Some clients exhibit too much tension initially, however with verbal and visual cues, you can assist in decreasing the tension. The bite block stabilizes the jaw immediately for some effective practice. If this does not improve /s/, /z/, 'ch', 'sh', 'j' strident sound productions, you will need to use the bite block in a central position by having the straw stick straight out of the client's mouth between the front teeth. Make sure the straw is within the oral cavity at least ½ inch, in order to create the necessary sagittal groove in the tongue for a precise sound production. I often note that the sides of the tongue naturally become tense and do not allow air to escape laterally when using the bite block in this way. As you practice sound productions using the bite block, the client begins to master jaw stability and a sagittal groove. This allows you to gradually remove the bite block as the client is able to complete these tasks without support. If needed, I allow the client to use a tactile cue to assist with jaw stabilization by holding the thumb under the chin and the pointer finger on the chin or elbows on the table with hands folded under the chin. Lip rounding is important for the palatal stridents and lip unrounding (ie. smile) is necessary for /s/ and /z/ productions.

I also suggest beginning practice of the lateralized sounds at isolation and syllable levels. As the client becomes proficient at these levels, you will be able to move the client to more varied syllable structures (ie. words). A sound modification approach may also prove successful, especially with an aspirated /t/ or /ts/ produced in rapid, repeated successions to achieve an accurate sound. Some clients are initially more successful with initial consonant blend productions with /s/, 'sh' and 'ch'. Infusing oral-motor activities within practice may be necessary including, stimulating the lateral portions of the tongue and the inside of the upper molars and gums with a small toothbrush; tongue-jaw differentiation activities; and varied blowing activities (ie. harmonica blowing only one pitch, trumpet).

I also want to stress the importance of caregiver involvement if your client is a child. More frequent, shorter practice times allow more success in decreasing the lateral lisp for the client. Home practice is crucial.

References:

Bauman-Waengler, J. (2000). Articulatory and phonological impairments: A clinical focus. Needham Heights, MA: Allyn & Bacon.

Folk, J. (1992). Straight speech. Vero Beach, FL: The Speech Bin.

Marshalla, P. (2000). Oral-motor techniques in articulation and phonological therapy. Kirkland, WA: Marshalla Speech and Language.

Plass, B. (2002). Sparc R and S. East Moline, IL: LinguiSystems.

Rosenfeld-Johnson, S. (1999). Horns as therapy tools. Advance Magazine for Speech-Language Pathologists and Audiologists. 31 May, 1999.

www.members.tripod.com/Caroline_Bowen/lisping.htm

Julie Hoffmann, M.A., CCC-SLP received her M.A. in Speech-Language Pathology from Northeast Missouri State University (Truman) in 1988. Currently, she is a clinical instructor at Saint Louis University. She teaches the courses of Phonetics, Articulation/Phonology Development & Disorders and Speech-Language Development & Disorder for the Classroom Teacher. She also provides graduate students with clinical instruction for diagnostics and therapy. Her areas of interest include: children with severe articulatory disorders, apraxia, fluency disorders and phonological awareness. She currently serves as Missouri Speech-Language-Hearing Association president.