Speech prompts and strategies I use in Speech Sound Therapy
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Speech prompts and strategies I use in Speech Sound Therapy

This particular student has a mild motor planning difficulty and six weeks ago he came to me with a very strong lisp. In addition to the lisp he is struggling to produce a number of sounds, SH and L on its own and all the clusters (FL/BL/KL/PL) but also CH together with some vowel difficulties.

The prompts are a mix partially from the DTTC (Dynamic Temporal and Tactile Cueing) model by Dr Edythe Strand as well as phonological models I have learned over the years, and some of them are my own.

Visual/picture prompts and Images

Here I use the ‘Flat Tyre’ Sound, to offer as an image for a new S sound and the ‘Tick Tock’ Sound for a new image of the T sound. Both cards are from the Bjorem Speech Sound Deck, which I love and use almost daily.

Gestural Cues

I like to use all the ‘cued articulation’ hand cues by Jane Passy for consonants and fricatives. Here we use our fingers and hand to illustrate what our tongue does, and we also show whether a sound is voiced or voiceless. When I use one finger it is voiceless (k/f/s/p) and when I use two fingers for the same cue it means that the voice needs to be turned on: (g/v/z/b/n/m). For vowels I like to use Pam Marshalla’s cue system.

Simultaneous production

We say the word together.

Direct imitation

I say the word and my student copies me directly.

Imitation after a delay

I say the word and then after a little wait my student says the word.

Spontaneous production

My student has now learned to say the word by him/herself.

Offering feedback

It sounds like… I just heard… I didn’t hear the first sound there? Can you try again?

Letting the student reflect

By just shaking my head or by looking quizzical so that my student realises something didn’t quite go right.

Postitive reinforcement

‘Yes that was it, do it again, nice one…’

Cognitive reframing

This is a technique where we identify different semantic cues and metaphors or imagery cues, so instead of teaching or focusing on a sound we try out viewing each syllable from a different point of view.

For example: ‘yellow’. I have had great success with this one: we start with just saying ‘yeah yeah yeah’. I might make a little joke and say something like ‘imagine your mum says tidy your bedroom, what do you say or what do you think?’ Answer: ‘yeah yeah yeah’. Then we practice ‘low’ together, I might blow some bubbles high and low and we talk about ‘low’. And then we put ‘Yeah’ and ‘Low’ together and now we have YELLOW!! It might at first still sound a bit odd, like ‘yea-low’ but we soon shape that up and have the real word.

Each student is different and having a great rapport is crucial to our success.

Then a little game break after some 7–10 or so repetitions and always trying to finish on a positive note.

What game breaks do I use:

Very quick ones! Students can post something, place a counter in a game, take out a Jenga block from the tower, pop in a counter for ‘connect 4’, stick a sword into the Pop the Pirate barrel or add a couple of Lego blocks to something they are building.

I hope this is helpful, please contact me for any questions.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

Living life with a lisp
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Living life with a lisp

You may be questioning ‘will my child grow out of having a lisp?’ There are so many myths out there that it’s sometimes difficult to find your way out of a complex maze of information.

The good news: lisps can be successfully treated by a Speech and Language Therapist and the earlier it’s resolved, the better. We know from the evidence base that some children’s lisps will resolve and, as always, it is completely age appropriate to have this speech pattern up until aged 4 ½.

As with any speech and language targets your child will need to be motivated to practise their newly acquired techniques, at home and in other settings. They will eventually be able to generalise this skill, but it takes lots of practice. So, think carefully about if your child is ready and motivated before commencing Speech and Language Therapy.

There are essentially two ways in which your child has acquired a lisp. It’s key here to mention that parents have no blame in this.

  1. They’ve mis-learned it and now incorrect production has become a habit
  2. Children have difficulties organising the sounds to make a clear production

You may be surprised to realise that there are different types of lisps. But all the techniques will be the same.

  1. Interdental lisp

When your child pushes their tongue too far forward, they will make a /th/ sound instead of /s/ and /z/

  1. Dental lisp

This is where your child’s tongue pushes against their teeth

  1. Lateral lisp

Air comes over the top of the tongue and down the sides

  1. Palatal lisp

Your palate is the roof of your child’s mouth. Sometimes they will touch their palate when making certain sounds (e.g., /s/ and /z/)

It’s useful for you to know what type of lisp your child has because you can then support them to make the correct production. You’ll be able to talk about where in the mouth their tongue is and where it needs to be to produce a clear sound. Your Speech and Language Therapist will be able to help you with this.

Top therapy tips for lisps

  1. Awareness is key. Does your child know where their tongue and teeth are (i.e., are they behind their teeth)? Do they notice the air escaping? Use a mirror so that your child can see not only themselves but also you in the mirror.
  2. Repetition! As with most therapeutic intervention, practice makes perfect. So little and often is key!
  3. Make sessions fun, perhaps around your child’s interests or allow them to drink from a straw
  4. Comment on how the sound is produced (e.g., /z/ is like a bee, /s/ is like a snake)
  5. Use tactile cues. Your child’s vocal folds vibrate when they produce a sound like /z/ but not with /s/. You could use the words ‘loud’ and ‘quiet’ to describe this.
  6. Start with a /t/ sound and gradually elongate the sound to an /s/

Having a lisp may not be problematic for some, but for other children, it can have a significant impact on their emotional wellbeing. Intervening at an early age can prevent this from happening. We always advocate for early intervention!

Contact Sonja for support on resolving your child’s lisp.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

Succeed with lisps at London Speech and Feeding

Succeed with lisps at London Speech and Feeding

A child is on the right-hand side, touching their lips and holding a mirror. They're facing an adult on the left hand side, also holding their hand to their lisps.
Mirror game

You may notice that your child or young person finds certain sounds difficult to produce. With a lisp, the sounds /s/ and /z/ are more problematic. You may notice that your child’s speech is affecting their confidence. They are quiet, and the teacher reports they don’t engage in classroom conversations. You feel it’s impacting on their social and emotional wellbeing. The good news is that with the support of a Speech and Language Therapist and the determination and motivation of your child, we can treat a lisp can.

You feel you have so many questions and you don’t know where to begin. Let’s start by answering some of the most frequently asked questions.

1. Is it normal for my child to have a lisp?

It’s important to remember that we can expect a lisp in a child up until four and a half years of age.

2. Can I do anything for my child’s lisp?

The best approach you can take is to provide a good model. You can show the correct sound and you can talk about where in the mouth your tongue or lips are. Your Speech and Language Therapist can recommend you on what you can say.

3. Should I wait to see if my child’s lisp resolves on its own?

As always, early intervention is advised as producing sounds as a lisp can be more ingrained the longer your child waits for therapy. It is true that some children’s lisps resolve on their own.

Therapy depends on many factors, one of which is deciding on whether your child is ready for therapy. It’s best to seek advice from a qualified Speech and Language Therapist about whether your child is ready for therapy. It takes motivation, determination, and practice.

4. What should I expect from a Speech and Language Therapist when they see my child?

Your Speech and Language Therapist will ask you as parents and carers about your child’s history. This is because they’ll want to confirm it is a lisp and no other areas of communication are affected. They may ask your child about the impact of their lisp on them (if your child is aware of their speech difficulty).

They will then assess your child using a speech assessment. Your Speech and Language Therapist will confirm their findings and will put a plan in place with you.

5. How will my child’s therapist fix my child’s lisp?

  • The start to fixing any sound is looking at discrimination between the sound your child is making vs the correct sound. Can your child hear the sound they should be making?
  • Your therapist may still get your child to discriminate two sounds. They will begin to work on the sound in isolation, so saying the child’s tricky sound by itself (e.g., /s/)
  • Then they will ask your child to say their tricky sound with a vowel, with a breath between the consonant and the vowel (e.g., s-oo, s-ow, s-ee, s-aa, s-ai)
  • Your child will then remove the gap between (e.g., soo, sow, see, saa, sai)
  • Your child will then be ready to move onto consonant-vowel-consonant words (e.g., sat, sit, seen, sown)
  • Your child’s therapist will tell that the next step is to produce sentences using your child’s tricky sound, /s/ in this example (e.g., Simon says silly sausages)
  • Your child is working towards generalising their ability but there are a few steps before this happens
  • Choose a context where your child can practise their talking, focusing on one sound (e.g., during 10 minutes of special time). This is an ideal environment as you can create opportunities for your child.
  • The next stage is saying the sounds correctly in general conversation
  • You’ll want your child to be less reliant on you for modelling the sound, so you’ll want to start to phase this out
  • It’s important for your child to self-correct and self-monitor. Encouraging this is the final stage to correcting your child’s lisp.

You and your child will need to be motivated, as it’s true: practice makes perfect!

For support on speech sound difficulties, feel free to contact me.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

Correcting A Lisp

Correcting A Lisp

Correcting A Lisp

This is a surprisingly common speech error and it can be corrected really well in my experience. I have helped lots of children of all ages learn how to control their tongue movements and produce clear, sharp /s/ sounds and good /sh/ sounds.

There are some factors which need to be considered before we can dive into therapy proper and these are they, in a nutshell:

  1. Student is not currently displaying negative oral habits such as thumb sucking or excessive sucking on clothing. This is because thumb sucking exerts pressure on the teeth and therefore can, over time, push teeth out of their natural order/position.
  2. Student does not have a restricted lingual frenulum or tongue tie which can cause at times restricted movements of the tongue (pending on how tight the frenulum is attaching the tongue to the base of the oral cavity); equally a labial frenulum or lip-tie can restrict lip movement and therefore physically restrict good speech sound production.
  3. Student does not have enlarged tonsils as they can sometimes push a tongue forward and also cause open mouth posture and open mouth breathing.
  4. Student’s motivation to change their speech pattern is high. (this is an important factor though with younger students I can get round this with a lot of fun games and good parental involvement!)

When I do an Oral Assessment of my student these are the first factors I want to look at and consider. Often I will refer to other agencies such as Orthodontists, dentists or ENT specialists to advise and help with some of these factors before we can get going. However, there are strategies that we can work on almost straight away.

Most of my Lisp Students present with an open mouth posture: that is where the student has their mouth always slightly open for breathing. Over time the tongue starts to fall forward and rests on the front teeth or the bottom lip instead of finding a comfortable resting place either at the alveolar ridge (the bumpy spot behind the upper front teeth) or, alternatively, resting at the bottom of the mouth behind the lower front teeth.

Another common problem is that the tongue is not moving independently from the jaw and so is reluctant to pull back or lift up inside the mouth as the tongue is guided in movement by the jaw.

Combine those two factors and your tongue is not pulling back, or lifting up or doing very much at all without the jaw moving as well. This makes for unclear speech sounds, especially all the sounds we make at the front with our tongue or with our lips: B/P/L//N/ and of course /S/ and /SH/ are particularly hard to make. We often also struggle with the /Y/ sound so /LELLOW/ instead of /yellow/.

But no fear, these problems can be treated over time for sure! We often start with lip, tongue, and jaw exercises that help to move the tongue independently from the Jaw, our student learns that the tongue is a muscle and can be trained to do amazing acrobatic things in the mouth! WOW! It can actually pull back, lift up, and come down again all on its own!

We work on breathing, holding our breath for a bit then pushing it out and then holding it again.

And when it comes to the actual /s/ sound I often try and go a NEW route bypassing the Snake-Sound route if that is what had previously been tried and failed so that we can create completely new sound patterns in our brain and think about our sounds in a completely new way.

We then work on producing the sound /s/ on its own for a bit, at the end of words, then on either side of complimentary sounds, for instance : ‘EASY” – the sound patterns here are EEE-S –EE : the EEE sound is complimentary to the /S/ sound as the tongue is at the right hight for the /S/ already once you have it in place for /EEE/ -……see?! EASY!

And gradually we work towards saying the /S/ sound clearly at the front of short words, then phrases and then sentences.

The process takes some time and it depends on how ready the student is. This varies of course hugely so I can never promise the exact number of sessions we will take to get that Lisp fixed. A lot depends on home practice in between sessions, and this is of course crucial to all therapy! Every day 15-20 mins practice is a good average time to aim for and when this is done it shortens the therapy block drastically.

I always give plenty of home work so there is never a chance of it getting boring or there being “nothing to do”!

Do contact me. I really enjoy working with this type of student and get a great kick out of FIXING THAT LISP!

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.