Are you tearing your hair out over a persistent lisp? Do you have a client with a lateral lisp that resists correction? If so, then this podcast can help you understand what to look at in order to correct that lisp once and for all. 

—– Episode Links —–

 Episode 30 – PROMPT Therapy Overview

Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Denise: And this is what is really interesting about the lateral lisps. I almost always find that the client lacks that good grading of movement. They lack freedom of movement and it used to be that I hated lateral lisps. I would like, do not send a lateral lisp my way, because I don’t know how to fix it. Um, I don’t know how to fix it, so it stays fixed when they go home. But using these same principles, the lateral lisps get corrected too.

Dan: Welcome to The Mindful SLP, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Dan, here with co-host Denise Stratton. And today we’re talking about lisps persistent lisps, lateral lisps, interdental lisps. Oh my goodness, you know that she wrote this for me because I have no idea about what those different lisps are. Denise, what are we talking about?

Denise: We’re talking about how to understand the principles that underlie a lisp. So just real quick, I want to say that I am a PROMPT-trained therapist and PROMPT helped me understand some of these principles we’re going to talk about. And if you want to know more about PROMPT, that’s all, what episode 30 was about.

Okay. I want to start with an analogy about the raspberry trellis that we built a couple of years ago.

Dan: Ah, yes, the raspberry trellis.

Denise: So, um, our raspberries are in a grow box and so we took two supports and screwed them to the outside of the grow box. Right.

Dan: They look like little, uh, telephone poles there on the edges.

Denise: And then we put wire in between them.

Dan: And then I tension them up and it just about pulled the little supports off the ends of the box and just about broke the box.

Denise: Yeah. Because it was pulling in too hard, right? So then what did we do?

Dan: Well, then I bought some ground anchors and some straps and gave some counterbalancing tension on those supports so that they would pull back out and transfer that tension into the ground, which doesn’t seem to want to move fortunately.

Denise: So it was kind of a matter of physics. It pulled too hard one way, and then it pulled too hard the other way. And we had to get it balanced.

Dan: Correct. So that’s how you fix a lisp, is you balancing things out. All right. Well, thanks for listening today. That’s all there is to it, just fix it, unless there’s a lot more to it.

Denise: Okay. Let me give you an example of a client who came to me, who was about 12 and had been in speech therapy a long time, a persistent interdental lisp. And interdental list is your tongue’s between your teeth. And so he got into the therapy room, had gotten in front of me. He got into therapy mode and he wasn’t really lisping for me.

Dan: The car never makes any strange sounds at the mechanics either.

Denise: But at home he was lisping. So that’s why it wasn’t corrected. And so I took a video of him in conversation and, uh, watched it later and I could see subtle things happening. The muscles above his eyebrows were moving in a way you wouldn’t expect. The muscles around his nose were moving in a way that looked a little bit odd.

So I showed it to him when he came again. And I said, do you notice anything? He was like, yeah, my face is doing funny things. So he could see it. So I thought, okay, we’ve got to get rid of that extra tension before I even start to work on the S sound. Let’s just get rid of that extra tension.

And so what happened when he was able to control all those muscles in his face, so that they didn’t, his eyebrows didn’t dance, and he didn’t have that movement around his nose. Well, then he started lisping in therapy.

Dan: Uh-oh, so now he’s worse.

Denise: Yeah. He got worse before he got better. It’s like the raspberry trellis. So first it pulled too hard one way, and then it didn’t really pull too hard the other way. But then he, the underlying problem was able to show up and able to be addressed. And after that he was able to correct his lisp.

Dan: Okay. And then you just use the normal techniques for correcting the lisp?

Denise: Yeah. But he had to get that the tension thing figured out.

Dan: That makes sense. So give me some ideas of ways to watch for things besides extra tension.

Denise: You need to watch for well clients are grading their movement. So jaw grading is a term for how wide they open their mouths.

Okay. So if I’m talking like dish, my mouse is not very wide open.

No, you don’t have good grading there. So it sounds like S, your jaw is really high, or E or ooh, those are what we call high vowels, and then you have some vowels in the middle. Um, and, uh, and O and a, a little bit more open. You have an ahh and an ehh, and then the widest vowel is ahh. That’s where your jaw goes the widest. So a lot of clients who come to me with a lisp and they’re in junior high or whatever, aren’t using the full range of motion of their jaw. Okay. You take a video of him, you watch it later and you see they’re talking with their jaw pretty high up, um, and it’s really with the vowels that your mouth opens. You know, it’s really the vowels you’re watching for. You wouldn’t think that that would affect a tongue sound like S, but it actually does. I mean, it’s a leap of faith. It’s a leap of faith, therapists, to say, I’m going to work on this jaw grading, and that’s going to help me with the S. I swear, it works.

Dan: Kind of, yeah. I can see where that could be kind of counterintuitive.

Denise: It’s a leap of faith for parents, if you say, this is what I’m going to work on. And I think, well, why aren’t you working on the tongue? It’s the tongue that’s the problem, right? Well, no, it’s an underlying issue that’s the problem because they’ve been working on S for years and it’s not corrected.

Dan: Okay, that makes sense.

Denise: So here’s another story. A client came to me. I think he was 13. Um, this lisp that had never been worked on, actually, and he was able to, um, keep his tongue behind his teeth, but the sides of his tongue pushed out between his teeth.

Dan: I’m trying to do this. I can’t even picture.

Denise: I had to show him in a mirror. I just didn’t even know how he did it. And it didn’t sound like a lateral lisp. It was just, it was strange. Um, it got corrected when he finally understood how to open his jaw as wide as he should for the low vowels. Now we talked about it and we talked about it, but he didn’t really get it until the day it clicked, and he started just using that full range of motion. And then it was like, then he was graduated in two weeks.

Dan: What about lateral lisps?

Denise: The same principles apply, believe it or not. And it used to be that I hated lateral lisps, I would like do not send a lateral lisp my way, because I don’t know how to fix it. Um, I don’t know how to fix it so it stays fixed when they go home. But using these same principles, the lateral lisps get corrected too. And this is what is really interesting about the lateral lisps, I almost always find that the client lacks that good grading of movement. They lack freedom of movement being able to move their jaw open and shut freely. I mean, it kind of like sticks in certain places, almost like the tin man, who’s a jaw needed to be oiled so he could move it. It seems to kind of stick in certain places. So freely moving up and down. And when I work on those things, then I just listen for an S to emerge, or I might, um, say hey, can you say this word see or something like that?

And once they can do it, I mean, it just happens without me working on the S. I’m working on these other things, and then all of a sudden they can say S. And from there, I just go, um, regular speech therapy. This is how I’m going to fix the S. I do approach it a little bit differently than I used to, now that I understand about jaw grading.

So once I have that good S, it usually happens in a word like see, because there’s hardly any change of movement from the S to the E. Right. And you’re retracted. And that’s how they, that’s how most of my clients with a lateral lisp usually get a really good S as in the word see, so we’ll get see really good, and we’ll get like, easy words like that.

We’ve got the E, and then we’ll go to A. So I got like say or ace, and then we’ll go to an ehh or an ahh, sad or said, words like that. And finally, the saw, I say that for the very last, because that’s going to be the hardest for them to do that’s that wide open jaw with the S and the most change in your jaw position.

And then we’ll do those with S at the end to an S in the middle, but then it’s just kind of regular speech therapy. And then you add in the Z when they’re ready. Cause Z’s a little bit harder because of the voicing. There you go.

Dan: So this is kind of like what you do with the Impossible R, you, you find an S sound that they do, and you build on that in going through the different levels of what’d you call it openness.

Denise: Grading, yes. But the really cool thing is that you can fix these really hard lateral lisps by not actually working on the S. First. You work on other things first, and then you hear that really good S, your first good S you’re like, yes, that’s it. That’s the word that’s we’re going to go from there.

Dan: It’s just like what you’ve been saying all along with it’s these simple things, these foundational things that if you can get that shored up and, and, and stable, then the complex will take care of itself.

Denise: Yes. All the work comes at the front end. I mean, it’s not easy to get that jaw open. You may think it is. Yeah. It’s an easy movement for them to make, perhaps, but it’s not easy for them to understand how to do it easily, how to do it freely, how to do it consistently. So that’s where the hard work is.

And then them controlling their tongue, it almost happens by magic. And that’s where the fun begins. And you just kind of sail along. Oh yeah.

Dan: And it stays fixed.

Denise: Yes. It generalizes.

Dan: That’s the best part. We want to thank Marissa for asking for this topic today. She asked Denise, what does she think about lisps? So if you have a topic that you would like, Denise to cover, please let us know at SLP proadvisor.com. We want to thank you for listening today, and please share this podcast with some of your other speech therapist friends, and leave us a rating on Apple podcasts, Google, Stitcher, Spotify, all those places where you listen to podcasts, we’ll be back next week with another topic. Have a great week.

Thank you for listening to The Mindful SLP. We hope you found some simple tools that will have optimal outcomes in your practice. This podcast is sponsored by SLP pro-advisor visit SLP pro-advisor dot com for more tools, including Impossible R Made Possible, Denise’s highly effective course for treating those troublesome Rs.

A link is in the show notes. If you enjoyed this podcast, please give us a five-star rating and tell your fellow SLPs. And please let us know what you think. Join the conversation at SLP pro-advisor dot com.