Lateral Lisps

Description:

There are two main types of lisps that we deal with: frontal lisps and lateral lisps.  With a lateral lisp, air is forced over the sides of the tongue for sounds like /s/, /z/, and “sh” instead of out the front.  This results in a slushy kind of quality to the speech.  It may sound like the child has too much saliva in the mouth.  Children who have a lisp may have difficulty being understood by adults and peers.  This may impact their social relationships and affect their teacher’s ability to assess knowledge.  Lisps can also affect reading and writing skills if not corrected.  Here are some resources to help you treat lisps.

Task Analysis (How To):

Now comes the fun part!  Here’s where we break this larger skill down into manageable, bite-size pieces.  Here’s how to break this skill down for therapy:
  1. Take an Inventory: First, let’s find out if the child can say any of the target words without lisping.  Some children will naturally have a facilitating context where they can already say the word.  For this, just have the child say a big long list of words that contain the lisped sounds. 
  2.  Sound in Isolation: Help the child produce the any of the lisped sounds in isolation without lisping. You can use any facilitating contexts that you found in the last step or use some elicitation techniques.  Find one that the child is most successful with.
  3. Sound in Syllables: Pair the newly discovered sound with vowels to make nonsense syllables
  4. Sound in Words: Moving on up!  Time to try that sound in some single words
  5. Sound in Sentences: Practice the sound in words in sentences.  Make sure you’re practicing the sound in a variety of word positions.
  6. Work on the Other Sound: Now that the child has mastered one of those sounds in sentences, go back and work on the other ones from the start.  If the child was able to do /s/ to begin with, go back and work on /z/ now in isolation and move through the steps again.
  7. Sounds in Conversation: Once the child can say all sounds in sentences, time to start working on it in conversation.  Start with structured conversation and then move up to unstructured conversation.

Activities:

Now for some practical strategies and activities that you can do in therapy for each of these steps.  Click on the task analysis level to drop down the list of activities:

I highly recommend that when you’re collecting a sample of words, you try as many different words as possible.  I also recommend you sample all of the different sounds that the child is having trouble with.  You will often find that there is some context that the child is able to produce the sound correctly in.  For example, perhaps the child can say the /s/ sound correctly when it is followed by the /o/ sound, like “soap.” or when it is found in a blend with /t/ at the end of the word, like “best”.  Try this word list for a starting point:

Word Lists for Lateral Lisps

Try to find a word or context that the child can use these sounds in correctly and build from there.  However, if the child does not already have a facilitating context, try some elicitation techniques.

For example, here’s a case study from a girl named Rebecca (name changed) that I treated: 

For this step, I looked for other sounds that Rebecca was able to produce with forward air flow that were similar to the sounds she was having trouble with.  For example, Rebecca could produce a very clear /t/ sound with forward air flow.  This sound is very similar to /s/ because the tongue is in approximately the same position and the voice is turned off.  The only difference is that /t/ is a short burst of air while /s/ has a continuous flow of air.  I also found that Rebecca could produce a “th” sound with forward air flow.  This sound is also similar to /s/ as it has continuous air flow and the voice is turned off.  The only difference there is the position of the tongue (slightly forward for “th”).

I assigned Rebecca two assignments to practice at home for the upcoming week.  The first one was to produce the /t/ but try to hold it out a little.  The result was something like this:

“t…t…t…tsssss”

We called this “exploding /t/”.  I instructed her to say /t/ three times and then on the fourth time, she was to make the /t/ explode into a longer sound.  I didn’t tell her right away that this was producing the /s/ sound because I didn’t want to psych her out.

The next activity was to produce the “th” sound but then to pull the tongue back inside the mouth.  I instructed her to start with “th” and then slowly pull the tongue back until it was behind the closed teeth.  Again, I did not tell her that this produced the /s/ sound.

After the week of practice, I had her demonstrate both strategies for me.  I found that the exploding /t/ activity allowed her to produce a beautiful /s/ sound whereas the backward “th” activity did not.  We ditched the backward “th” and kept practicing the exploding /t/ until it was solid.

Here are some more ideas for elicitation techniques:

Elicitation Techniques for /s/ and /z/

Troubleshooting the Stubborn /s/, “sh”, & “ch”
Full hour-long webinar recording from Laura Powell where she shows her tips for fixing these tricky sounds

Elicitation Techniques for “sh”

What if /t/, /d/ and /n/ are incorrect as well?

Try these great resources for helping your clients pair the target sound with vowels to make nonsense syllables.

Sound Syllable Spiders
These cute little spiders will help your clients practice pairing consonants with different vowels

What to Do When a Child Can’t Move Past Isolation

Now it’s time to put those sounds into words!  Check out these resources to help you do just that:

Articulation Worksheets:
One for every sound!  Single words that contain the sound in all word positions.  Use these in therapy or send them home for homework!

Use the sound worksheets from the last step to have the child use the sound in sentences.  Or, have the child read sentences from these reading passages:

Reading Paragraph for /s/

Reading Passage for /ts/

(Great for getting forward air flow!)

Now I don’t know of any research that specifies when you must do this step, but this is the timing that has worked for me in the past.  I’ve helped the child get to the sentence level with one sound before going back to the other.  You can always do them simultaneously or just see how your client is doing.  If you seem to get stuck at a step earlier than this, go back and try the other sound a little sooner.  Individualize this to what your client needs.

Let’s try some of these simple structured conversation prompts to practice the sound in a more complex environment:

Sounds in Structured Conversation Pack

Now comes the hard part, getting them to do it the rest of the time in every-day conversation!  

Tips for Encouraging Speech Sounds in Conversation

Speech Sound Carry-Over Challenge

 

Troubleshooting:

What do you do if these things don’t work the way they’re supposed to?  Well, nothing’s ever easy, is it?  Try these great troubleshooting tips that some of our other members have found helpful.  Click the problem to drop down the link to the solution.

If a child lacks awareness of his articulators, it will be difficult to encourage him to move his tongue to the different locations to work on a lisp.  Try these tips:

 

If a child is producing /t/, /d/ or /n/ with an incorrect tongue position, it may be affecting his/her ability to produce the /s/, /z/, and other sounds correctly.  Learn how to establish proper position for /t/, /d/, and /n/ so you can have a strong foundation upon which to target more difficult sounds: 

Resources, Tools, and Training for Speech-Language Professionals

*** The SLP Solution is for informational and educational purposes only and does not provide medical or psychological advice.  We provide general resources but cannot tell you exactly what should be done for a specific client.  Every client is different and your clinical judgement should be used when making decisions about specific individuals.

 

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