Tongue training: Why tongue placement matters for clear speech

ByLondon Speech and Feeding
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As speech and Language therapists (SLTs), we know that where your tongue goes, so goes your sound. This blog post will explore why tongue placement is so vital for speech correction and how we use tools and techniques to help our clients find their ‘sweet spot’ for sound production.

Let me show you here a little video clip where I am using my dentist’s mouth/teeth model to help my clients navigate their tongue movements.

The tongue: A tiny muscle with a big job

The tongue is a small but mighty muscle. It’s incredibly versatile, playing a key role in eating, swallowing, and, of course, speaking. For each speech sound, the tongue, along with the lips and jaw, needs to move to a very specific spot. Think of it like a dance: every part of your mouth has a choreographed movement to produce the correct sound. If the tongue is out of sync, the sound comes out muffled, distorted, or just plain wrong.

The trouble with our tongue movements is that most of us never think about how the tongue has to move and what it does to: swallow, chew, drink, suck and speak. Most parents when asked to think about their own tongue placement for say the /S/ sound are completely lost as to what their tongue is doing. Yet, of course, they produce a perfect /S/ and perfect speech in general. The same goes for swallowing. When did you last think about what happens in your mouth when you swallow? I bet you have not thought about it. We ‘just do it’, right?

Why is tongue placement so important?

Accurate tongue placement is the foundation of clear articulation. When a child struggles with a particular sound, it’s often because his or her tongue isn’t quite reaching the right spot or moving in the correct way. For example, the /S/ sound requires the tongue to be slightly raised and positioned behind the top teeth, creating a narrow channel for air to flow through. If the tongue is too far forward, you might get a /TH/ sound instead. If it’s too far back, the /S/ can sound muffled.

Visual aids: Our secret weapon

We SLTs love our visual aids! They’re incredibly helpful for showing clients exactly where their tongue needs to be. Here are some of our favourite tools:

  • Mirrors: Mirrors provide instant feedback. Clients can see their tongue’s position and make adjustments in real-time. We often use hand mirrors or even the mirror on a compact for quick checks.
  • Tongue depressors: These simple tools can gently guide the tongue to the correct position. We might use them to show where the tongue tip should rest for the /L/ sound or how the sides of the tongue should touch the molars for the /K/ and /G/ sounds.
  • Diagrams and models: Pictures and models of the mouth can help clients visualise the tongue’s movements. We might use a cross-section diagram of the mouth to show how the tongue forms different sounds.

Beyond the tongue: The jaw’s role

While the tongue takes centre stage, the jaw plays a supporting role. It provides a stable base for the tongue and helps control the opening and closing of the mouth. Sometimes, jaw stability is an issue, and we might use techniques to help clients find a comfortable and stable jaw position.

Making it fun and engaging

Learning correct tongue placement can be challenging, but we make it fun! We use games, stories, and playful activities to keep clients motivated. For younger children, we might use silly voices or pretend to be animals. For older children, we might incorporate their interests, like using a car analogy for tongue movements.

The takeaway

Correct tongue placement is essential for clear speech. By using visual aids, interactive techniques, and a bit of creativity, we can help our clients master their speech sounds and communicate with confidence.

If you have any concerns about your child’s speech, don’t hesitate to reach out to a qualified speech and language therapist, we are here to help! Contact me via my contact form.

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.

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    Tongue-tie, or ankyloglossia, is a condition where the lingual frenulum, the thin piece of tissue that connects the underside of the tongue to the floor of the mouth, is too short or tight. Tongue-tie is quite common in babies and is often not detected after birth. Tongue-tie can lead to a difficult start with breast feeding as it makes it very difficult for the baby to latch effectively.

    In my clinical experience as a feeding therapist, I have seen many babies who were not able to latch well due to the frenulum being tight. In many cases an experienced feeding speech therapist/lactation consultant can really make a difference and help a new mum to latch the baby even though the tongue is tethered to the floor of the baby’s mouth. In some cases the frenulum can be divided and once this has been done, in some cases, feeding improves immediately or soon after the division. But this is not always the case. I have seen several babies who have had as many as four tongue-tie divisions and feeding was still difficult.

    It is important to say that while tongue-tie can sometimes impact speech and feeding, it’s important to note that it’s not always the root cause of these difficulties. In recent years, there has been a surge of interest in tongue-tie division surgeries, with some cases being unnecessary. It’s crucial to understand the complexities of tongue-tie and the role of speech therapy in addressing related challenges.

    The impact of tongue-tie on speech and feeding

    When tongue-tie is severe, it can interfere with the tongue’s ability to move freely, affecting speech production and swallowing. Some common speech and feeding difficulties associated with tongue-tie include:

    • Feeding difficulties: Challenges with sucking, chewing, and swallowing.
    • Drooling: Excessive drooling due to difficulty controlling saliva.
    • Speech problems: Difficulty producing certain sounds, such as /l/, /r/, /t/, /s/ and /d/.

    The importance of comprehensive assessment

    Before considering any surgical intervention for tongue-tie, it’s essential to undergo a thorough evaluation by a qualified speech-language therapist (SLT). An SLT can assess the severity of the tongue-tie, its impact on speech and feeding, and determine if surgery is necessary.

    • Functional assessment: The SLT will assess the tongue’s range of motion, its impact on speech sounds, and the child’s overall oral motor skills.
    • Feeding evaluation: The SLT will observe the child’s feeding patterns and identify any difficulties related to tongue-tie.
    • Differential diagnosis: The SLT will rule out other potential causes of speech and feeding difficulties, such as apraxia of speech, dysarthria, or sensory processing disorders.

    The role of speech therapy

    Even in cases where tongue-tie is present, speech therapy can often be highly effective in addressing speech and feeding difficulties. Here’s how speech therapy can help:

    • Articulation therapy: Targeting specific speech sounds that may be affected by tongue-tie.
    • Childhood Apraxia of Speech (CAS): if the diagnosis by the SLT has shown that in fact the child has motor planning difficulties then there are very specific and effective treatment programmes that help with this and can make a real difference over time.
    • Feeding therapy: Strategies to improve swallowing, chewing, and oral-motor skills.
    • Sensory integration: Addressing underlying sensory processing issues that may contribute to feeding difficulties.

    London Speech and Feeding Case Study: The importance of comprehensive assessment

    One of my clients was initially diagnosed with tongue-tie and recommended for surgery at the age of eight years old. His speech had been perceived by parents and teachers as ‘mumbled and unclear’.

    However, after a thorough evaluation, I was able to determine that the child’s primary issue was apraxia of speech, a neurological disorder that affects motor planning for speech. Parents decided to wait with surgery and trust my judgment and we proceeded with weekly intensive speech therapy to address motor planning difficulties around tricky sounds and words. I am delighted to say that the child’s speech has improved significantly, demonstrating the importance of comprehensive assessment and individualised treatment. He is no longer seen as a candidate for an operation, which would have been traumatic for him at his age and, as it turned out, entirely unnecessary.

    Below is a short video clip of my working on the /l/ sound with this child.

    Using the Gingo Puppet from GingoTalk

    Conclusion

    Tongue-tie is a complex issue that requires careful evaluation and individualised treatment. While surgery may certainly be necessary in some cases, it’s essential to consider the potential benefits and risks. Speech therapy can be a highly effective approach for addressing speech and feeding difficulties associated with tongue-tie, even in cases where surgery is still required. By working with a qualified speech-language therapist, parents can ensure that their child receives the best possible care and support.

    Please feel free to contact me.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

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    The London Speech and Feeding Practice

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    • Focus on modelling language from the child’s perspective or a joint perspective.
    • Avoid correcting pronouns in the early stages.
    • Trust the process and support the child’s natural language development.

    Let’s celebrate the diverse ways our children learn to communicate and empower them to find their unique voice!

    If you have any questions or would like some help with understanding your little gestalt language learner, please get in touch with me via my contact form.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    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.

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    As a speech therapist, few things are as rewarding as helping a child find their clear, confident voice. Among the various speech sound disorders, the ‘lateral lisp’ – often described as a ‘slushy’ or ‘wet’ /S/ sound – presents a unique challenge. While it can be tricky to treat, I’m thrilled to share that I’ve had significant success in helping children overcome this particular hurdle.

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    • Subtle differences: The difference between a lateral lisp and a correct /S/ sound can be quite subtle to perceive, both for the child and sometimes even for parents. This makes it harder for the child to self-monitor and correct.
    • Oral motor control: It requires fine motor control of the tongue muscles to create and maintain that central groove for airflow.

    My success with children aged six years and over

    I’ve found great success in treating lateral lisps, particularly with children aged six years and older. Why this age group? By this age, children typically have:

    • Increased awareness: They are more aware of their speech and often more motivated to make changes. They can better perceive the difference between their ‘slushy’ /S/ and a clear one.
    • Improved cognitive skills: They can understand and follow more complex instructions and strategies.
    • Better self-monitoring: Their ability to listen to themselves and correct their own speech improves significantly.
    • Enhanced oral motor control: Their fine motor skills, including those of the tongue, are more developed, allowing for greater precision.

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    It is crucial to understand tongue functioning and focusing on correcting improper oral resting posture and muscle function, which are often significant contributors to a lateral lisp. For example, if the tongue rests low and wide in the mouth consistently, or if there’s a tongue thrust during swallowing, these habits can prevent the tongue from achieving the precise, midline placement necessary for a clear /S/ or /Z/ sound. Through targeted exercises I aim to re-educate the oral and facial muscles, promoting correct tongue posture at rest, during swallowing, and, ultimately, during speech production. By strengthening the muscles responsible for tongue lifting and encouraging a more appropriate swallowing pattern we can establish the correct oral motor skills needed to overcome a lateral lisp and achieve clearer articulation.

    The recipe for success: Little and often

    The single most crucial ingredient for success in treating a lateral lisp is daily home practice of all the strategies given. This isn’t about long, arduous sessions; it’s about consistency. Think of it like building a muscle: short, frequent workouts yield better results than sporadic, intense ones.

    My recommended formula is ‘little and often’. This means:

    • Short, focused sessions: Aim for 5-10 minutes of practice, 2-3 times a day. This prevents fatigue and keeps the child engaged.
    • Integrate into daily routines: Practise while waiting for dinner, during a car ride, or before bedtime. Make it a natural part of their day.
    • Positive reinforcement: Celebrate every small success! Encouragement goes a long way in building confidence and motivation.
    • Parental involvement: Parents play a vital role in providing consistent cues and encouragement at home. I equip families with clear, easy-to-follow strategies.

    Overcoming a lateral lisp requires dedication, but with the right guidance and consistent practice, a clear, confident /S/ sound is achievable. If your child is struggling with a ‘slushy’ /S/, please don’t hesitate to reach out. Together, we can achieve success!

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    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.

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    Discover speech and language regression in autistic children and how you can support your child

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    Discover speech and language regression in autistic children and how you can support your child

    There’s often this idea that autistic children have extensive vocabulary and knowledge, but this is not always the case. In fact, 30% of autistic children have language regression.

    Goldberg (2003) suggested that speech and language regression refers to the decline in a young child’s speech and communication abilities. We know that regression in speech, language and communication skills often occur before the age of two years. 25% of autistic children develop language at word level between 12 and 18 months of age before losing this language they have learned. As you’re probably aware this regression in communication is a diagnostic indicator of Autism.

    We understand that you want your child to progress, and you struggle to watch as their frustration grows as you feel helpless. I want to provide you with tips so that you can feel empowered to support your autistic child and reduce the impact their communication skills have on the family.

    1. Reduce frustration by providing visuals to support their communication
    2. Model gestalts. We know that autistic children are often gestalt language processors. Learn more about gestalt language processors in one of my previous posts.
    3. Praise the ability to communicate. Focus on what they say not how they say it. E.g., good listening, nice talking.
    4. Provide your child with choices (using real objects to represent your choices). E.g., do you want an apple or banana?
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    7. There’s this idea that we need to teach children eye contact. This is not always the case. Your child is unique, we do not want to take their unique skills away.
    8. Model words which are concrete. E.g., words such as ‘finished’, ‘more’. You can model these several times within the day. You can use a gesture to make the word more visual (see the images below). We know that autistic children are often visual learners.
    Makaton fro "more"
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    Makaton for "finished"
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    Credit: Little Dots Makaton, Polkadot World

    Remember that if your child has speech, language and communication regression, it doesn’t mean your child will stay static.

    It’s vital that you seek support from a qualified Speech and Language Therapist. We can tell you at what point in the communication development that your child is at. And we can support you through the process. We can provide you with an individualised plan specifically for your child to ensure you maximise their potential.

    Contact me for help.

    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.

    1
  • ·

    Principles of motor learning in childhood apraxia of speech: A guide for parents and therapists

    ByLondon Speech and Feeding
    Image by Freepik

    Childhood Apraxia of Speech (CAS) is a complex neurological disorder that affects a child’s ability to plan and coordinate the movements necessary for speech production. Children with CAS often have difficulty with articulation, prosody, and fluency, making it challenging for them to communicate effectively. While there is no cure for CAS, speech and language therapy can significantly improve a child’s communication skills and overall quality of life. Understanding the principles of motor learning is crucial for both parents and speech therapists to support children with CAS on their speech journey.

    What is MOTOR LEARNING?

    Motor learning refers to the process of acquiring and refining new skills through practice and experience. This applies to all aspects of movement, including speech production. The brain constantly receives sensory information about the movements being made and adjusts them based on the desired outcome. A breakdown or interruption of this process can make it difficult for children to plan, sequence, and coordinate the intricate movements involved in speech.

    What key principles do we use in speech and language therapy for motor learning?

    • Task Specificity: Speech Therapy activities that directly target the specific speech sounds or skills your child is working on. For example, if your child is struggling with /p/, practising isolated /p/ sounds, words with /p/, and phrases with /p/ would be most beneficial.
    • Massed vs. Distributed Practice: We consider the optimal amount and distribution of practice sessions throughout the day. Massed practice involves concentrated practice in a single session, while distributed practice spreads practice sessions throughout the day. The best approach depends on the individual child’s learning style and attention span.
    • Feedback: We provide clear and immediate feedback to help your child understand the accuracy and effectiveness of their attempts. This feedback can be auditory, visual, or touch based.
    • Error Correction: We aim to gently correct errors so that we can help your child refine their movements and avoid developing bad habits. The focus is on providing specific cues and guidance rather than simply pointing out mistakes.
    • Variety and Progression: We gradually introduce new challenges and variations in speech therapy activities to prevent plateaus and maintain motivation.
    • Motivation and Engagement: A big part of our work is to make therapy sessions fun and engaging to keep your child motivated and actively participating. We use games, songs, and activities that your child enjoys while incorporating targeted practice opportunities.

    What about home work?

    Yes we need your help and here are some examples of how this could look:

    • Task Specificity: During story time, focus on practising target sounds present in the story. Have your child repeat words or phrases containing the sound and encourage them to identify the sound in other words.
    • Massed vs. Distributed Practice: Instead of one long practice session, try shorter, more frequent sessions throughout the day. This can help maintain focus and prevent fatigue. It is recommended to go for 100 repetitions of the target sound per day, every day in between the sessions. We can decide together how you can best do that through either massed or distributed practice. We can decide after the session.
    • Feedback: Use a mirror to provide visual feedback on lip and tongue placement during sound production. Record the child’s speech and play it back to help them self-monitor their accuracy.

    I quite like this mirror below but any table top mirror will work as long as it is not too small. Your child should see their whole face easily.

    tabletop mirror
    • Error Correction: If the child makes an error, gently model the correct sound or movement without shaming or criticising. Provide specific cues such as ‘lips together’ for /p/ or ‘tongue up’ for /t/.
    • Variety and Progression: We will guide you on exactly what words to practise so this is something you need not worry about.
    • Motivation and Engagement: Use games, songs, and activities that your child enjoys. Play a game of ‘I Spy’ focusing on words with the target sound or create silly sentences with the sound to make practice fun.

    Let’s work together!

    It is crucial for parents, therapists, and other caregivers to work collaboratively to ensure a consistent and comprehensive approach to supporting your child’s speech development. Speech and Language Therapists can provide guidance and resources on implementing these principles at home, while parents can share observations and progress updates to inform therapy sessions.

    Remember, every child with CAS learns at their own pace. By understanding and applying the principles of motor learning, parents and speech therapists can create a supportive and stimulating environment that empowers children with CAS to reach their full communication potential.

    Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

    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.

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  • A day in my speech clinic: Mastering the /SP/ cluster

    ByLondon Speech and Feeding

    I very often work on /S/ Blends (/SP/ /ST/ /SM/ /SK/ /SN/ and /SL/). When we work on these sound blends (like SPider, STop, or SMile), we are using a clever speech therapy ruse! Because these blends are complex, teaching a child how to master them naturally helps them clear up simpler single sounds (like just /S/ or just /P/) at the same time. Plus, because S-blend words are so common in everyday language think spoon, spy, spot, and spin, practising them gives your child an immediate confidence boost when they are understood much more easily.

    Good news: high-repetition motor practice doesn’t have to be a chore. In fact, the more sensory input we can provide, the faster those new neural pathways are built. Recently, I recorded a series of seven short clips to demonstrate how we can weave intense speech practice into the fabric of play.

    Here is a look at a typical day in the clinic focusing on /SP/ blends.

    1. The sensory sandbox:

    We started our session at the sensory table. Sensory bins can often work well because they provide tactile feedback that grounds the child’s focus (of course they are usually messy, so one needs to have the physical space and energy for it to be fair!).

    • The Activity: I pointed to our ‘I Spy’ board before we dove into the sand. Using a toy spade we dug for hidden objects and named them each time we found one.
    • Every time we scooped, we practised Spade. Every discovery was a spider, a spoon or a spotty animal. By pairing the physical effort of digging with the speech sound, we help the brain synchronise motor planning and vocal execution.

    2. Bingo dabbers rock!

    Next, we moved to making ink marks on paper.

    • The Activity: I demonstrated making spots with coloured bingo dabbers.
    • We treated each ink spot as a visual anchor. Stamp –Spot Stamp –Spot. This creates a rhythmic pacing that prevents the child from rushing. It’s a wonderful way to get 50+ repetitions in under five minutes without the child even realising they are ‘working’.

    3. Drawing spiders

    Building on the previous activity, we took those spots and turned them into something more complex.

    • The Activity: I drew spiders out of the spots we had just made.
    • Drawing the legs provided a perfect opportunity for ‘stretch’ sounds. As we drew a long leg, we practise a long, hissy ‘Sssssssss’, snapping into the /P/ as the pen hits the spot.

    4. Wind-up spinners

    High-energy toys are excellent for eliciting ‘power’ sounds.

    • The Activity: I brought out two mechanical wind-up spinners.
    • Method: The child says Spin or Spinner to get me to wind them up. The anticipation of the toy moving acts as a natural reinforcer.

    5. The Incy Wincy spider game

    • The Activity: I spun a game spinner to determine how many steps our toy spiders would take up the spout.
    • This activity is a triple threat. We practised ‘Spin’, ‘Spider’, and ‘Spout’ all in one go. The visual of the spider moving up the spout also helps with the concept of UP and DOWN of course.

    6. Searching for Spot

    Books are a great tool for generalisation, taking a sound from a single word and moving it into phrases and sentences.

    • The Activity: We went through a ‘Spot the Dog’ book.
    • Instead of just reading, we used the ‘I Spy’ strategy. ‘I spy Spot! He has a big spot on his back!’ This encourages the child to use the target word in a functional, communicative way rather than just repeating it after me.

    7. Finally, sponging off some sand

    We ended the session with some ‘heavy work’ and cleaning.

    • The Activity: We took a soft toy that had gotten a bit ‘dusty’ in the sandbox and used a sponge to clean it down.
    • The action of squeezing the sponge provides proprioceptive input (pressure), which can be very calming and help a child focus on their articulatory placement for those final repetitions of the day.
    A day in my speech clinic: Mastering the /SP/ cluster

    Speech therapy works on motor learning. Just like learning to ride a bike or play the piano, the brain needs thousands of correct repetitions to make a movement automatic. By using /SP/ words in these seven distinct, sensory-rich ways, we:

    1. Reduce frustration: The focus is on the play, not the correction.
    2. Increase engagement: A child who is having fun will stay in the learning zone longer.
    3. Provide context: The child learns that saying /SP/ correctly helps them get the spade, spin the spinner, and find the spider.

    Next time I will show you some more activities for /ST/ and /SM/ words. If you have any super ideas for /S/ cluster words please leave me your suggestions in the comments on instagram, I would appreciate it thank you! 😊

    If you are concerned about your child’s speech, please do not hesitate to get in touch. I would love to help you find some answers.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    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.

    3