Speech Therapy for a Lisp (Ultimate SLP Guide)
Speech pathologists treating speech sound disorders will no doubt want some tips and ideas for correcting a lisp in speech therapy. Many different speech errors are addressed in articulation therapy, and correct production of s and z requires some skill and hard work to accomplish. While your coworkers and the internet may offer good advice, it’s helpful to have all of that information in one location. So, if you are a speech therapist, make sure to bookmark this post and reference it often when you need new ideas for correcting that lisp!
What is a Lisp?
What, exactly, is a lisp?
A lisp falls under the realm of a speech sound disorder.
It involves the misarticulation of some specific speech sounds (sibilants), including s and z, as the result of inaccurate tongue placement. In addition, one must also simultaneously maintain the proper amount of expiratory air pressure.
The Underlying Cause of a Lisp
What is the underlying cause of the lisp?
Three possibilities include:
- an orofacial myofunctional disorder
- high-frequency hearing loss
- structural changes, such as missing teeth
Reference:
Bauman-Waengler, J. A. (2013). In Articulatory and phonological impairments: A clinical focus (pp. 256–270). essay, Pearson Education Limited.
Orofacial Myofuctional Disorder
One should consider the possibility of an orofacial myofuctional disorder. SLPs might also be familiar with the terms “tongue thrust” or “oral muscle pattern disorders”.
According to ASHA, signs or symptoms of orofacial myofunctional disorders can include difficulty saying some sounds, such as the s sound. (Reference: Orofacial Myofunctional Disorders. (2023). Retrieved 5 June 2023, from https://www.asha.org/public/speech/disorders/orofacial-myofunctional-disorders/)
The Academy of Orofacial Myofunctional Therapy reported that people with ‘abnormal oral muscle patterns may suffer a lisp‘ (reference: (2023). Retrieved 5 June 2023, from https://aomtinfo.org/myofunctional-therapy/).
And, from my own clinical experience and CEU learning (I took Sandra Holtzman’s 28 hour CEU course), it’s important to note that anything that is causing abnormal resting posture can be a culprit. And by that I mean, anything causing the incorrect placement of the tongue. Because if the tongue isn’t in that correct “starting place” for speech, correct pronunciation will not occur for many sounds.
I have personally encountered several students or clients through the years who presented with severe lisps and learned through parent interviews about present or past negative oral habits.
The most common negative habits included sucking the thumb and going to bed with sippy cups.
It is important to note, however, that an interdental lisp is considered developmentally appropriate in young children. So, if you are hearing more of a ‘th’ sound for ‘s’ when small children talk (“thun” for “sun”), this articulation error might correct itself in time.
Hearing Loss
Another possible underlying cause of a lisp could be high-frequency hearing loss.
Reference:
Bauman-Waengler, J. A. (2013). In Articulatory and phonological impairments: A clinical focus (pp. 256–270). essay, Pearson Education Limited.
Structural Changes
It is also possible that structural changes can contribute to a lisp. Examples might include missing front teeth for children- or for adults, new dentures!
Reference:
Bauman-Waengler, J. A. (2013). In Articulatory and phonological impairments: A clinical focus (pp. 256–270). essay, Pearson Education Limited.
The Different Kinds of Lisps
You have likely heard of a frontal lisp or a lateral lisp, but there are actually several main types of lisps.
It is very important to distinguish which type of lisp a child is experiencing. The correct diagnosis can help the SLP provide better feedback and support during speech therapy sessions.
For example, if the kind of lisp the student is exhibiting is an interdental lisp, he would need feedback to reposition the tongue tip in and angle up toward the alveolar ridge, as opposed to pushing out and forward between the front teeth.
Some types of lisps include:
- interdental lisp
- addental lisp
- strident lisp
- palatal lisp
- lateral lisp
Read all about the different types of lisps.
Reference: Articulatory and Phonological Impairments: A Clinical Focus, Third Edition. By Jacqueline Bauman-Waengler
Correct Production of S and Z
S and z are both fricative sounds.
The s sound is a lingua-alveolar fricative sound. It is a voiceless sound, meaning the vocal folds do not vibrate. The z sound is voiced.
The soft palate is raised during both s and z production.
The jaw is in a high position, but it shifts forward slightly during the production of s.
S and z can be made with the “tongue tip up” (aka apico-alveolar) or the “tongue tip down” (predorsal-alveolar).
In either production, the lateral sides of the tongue need to be elevated and touch the sides of the upper top teeth (the upper molars). This allows for sagittal grooving of the tongue.
Also, it is important the sides of the tongue are high and raised so that air does not escape out of the sides of the mouth!
So basically, the tongue is wider at the back of the mouth, but more narrow at the tip.
While the sides of the tongue are lifted, the middle of the tongue creates a funnel for airflow.
The tongue tip lowers just slightly to create a channel to let the airflow pass through.
For the “tongue tip up” production, there is a tiny gap where the air flows past between the narrow front or tip of the tongue and the alveolar ridge.
If the s or z is produced as “tongue tip down”, the tongue is arched towards the palate. The tip touches the front bottom teeth.
This takes a lot of practice and coordination!
The airstream moves forward and out of the mouth. The airstream continues while the tongue remains in place.
References:
Articulatory and Phonological Impairments: A Clinical Focus, Third Edition. By Jacqueline Bauman-Waengler
Marshalla, P. (2019). Chapter 25- Stimulating the Fricated Consonants. In The marshalla guide: A topical anthology of Speech Movement techniques for Motor Speech Disorders & articulation deficits. essay, Marshalla Speech and Language.
Why Target a Lisp?
S and z are frequently occurring sounds. Professional help from a qualified speech-language pathologist is often necessary to improve speech production. Speech difficulties such as a lisp could potentially cause low self-esteem, especially during tasks that require speaking aloud in a group.
It is also important to note that articulation and language disorders have been linked to reading difficulties.
S Words for Speech Therapy
Do you need some initial s, medial s, and final s words to use in speech therapy? Check out these s word articulation lists.
Z Words for Speech Therapy
This Z Words for Speech Therapy articulation list contains the z sound in the initial position, medial position, and final position of words.
The Best Ways to Correct a Lisp
Eliminate Negative Oral Habits
First, any negative oral habits need to be eliminated. If a child is still sucking a thumb, using a pacifier, or going to sleep with a sippy cup, this should be addressed. If this is a long term habit, it may be challenging to break.
Establish Normal Lingual Resting Posture
Correct tongue position is so important! In fact, it goes beyond just the tongue.
Normal resting posture means:
- The tongue is lightly suctioned to the roof of the mouth.
- The tongue should NOT be flat. It should “live” within the dental arch.
- The front part, or tip, of the tongue, should be resting at the alveolar ridge- not against the insides of the front teeth.
- The jaw is relaxed, and there is about 2-3 mm of space between the upper and lower teeth.
- The lips are closed. We breathe through the nose.
Reminders to “keep the tongue at home” can be useful during therapy sessions. Check out this Lisp Program with resources.
Try Saying a “New Sound”
Try shaping the /s/ sound from /t/. This approach is known as the “whisper t”, in which one carefully taps the alevolar ridge while producing the /t/ sound. After that, blow more air in a controlled manner to create a “long t”. This part can take quite a bit of practice, but once mastered, should result in an isolated /s/ sound.
TS at the End of Words
Once the “long t” is mastered, final /ts/ words, such as cats, can be introduced. Check out this Lisp Program, which includes a comprehensive set of individual words and phrases for practice.
Utilize the Straw Technique
This is a favorite of mine! It was developed by SLP Vikki Usdan in 1976. It involves the use of a thin straw (such as a coffee straw) and a cup of water. Blowing bubbles through the tiny straw, which is held in place by the tongue tip at the alveolar ridge, is a great way to encourage the child’s tongue to be appropriately placed. Maintaining proper tongue placement and expiratory airflow allows bubbles, the perfect visual, to be created in the cup. Read more about how to use the straw technique to correct a lateral lisp.
Watch the Jaw
It is very important that the tongue can move separately from the jaw. Try using a mirror, or have the child place their hands on their cheeks to feel the movement. With the help of a speech-language pathologist, lingual-mandibular differentiation can be established.
Comprehensive Correct that Lisp Program
It’s not uncommon for SLPs to feel- well- frustrated when trying to treat a lisp. The good news is there is an effective program, based on research, that can alleviate all that stress and help speech language pathologists finally feel confident when treating a lisp!
It all starts with teaching the foundational skills needed to ensure success. If the traditional articulation approach hasn’t worked, this program is an absolute must. That’s because it incorporates the basics of orofacial myology, which ensures that any underlying issues that might impact success are not missed.
Speech therapists won’t have to wonder what steps to take next- everything is laid out. This is your ultimate, correct that lisp gameplan.
Summary
In summary, there can be multiple underlying causes of a lisp. It is beneficial to first address any negative oral habits and teach normal resting posture.
After this, there are several effective techniques that SLPs can use to correct a lisp.
This comprehensive program is a helpful tool for SLPs to use to treat a lisp.
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