Description of Child:

• Dysphagia, thin lips though tone seems ok
• Lips retracted, reduced tongue movements, doesn’t open very wide
• Resistant to direct therapy (when she pushes her, she loses her)

Ideas for Therapy:

• Since there is dysphagia as well, I would suspect some sort of motor problem that’s contributing to this.  I would check medical records and consult with PT or OT to see if there are any other physical problems
• Try sounds in isolation to work on stimulability, make into fun games if the child doesn’t want to do drill work, use counting books/toys but say a sound for each one to count instead of saying the numbers,
• Start by practicing easiest sounds to give the child some success and motivate her to keep working.  Praise her effort, not her results (at first)
• Try sound exercises where she must change her mouth position between sounds, like “puh, kuh, puh, kuh” or “oh, ee, oh, ee, oh, ee”.  Use sounds that are easier for her to produce in isolation.  Start slow and then increase speed.
• Practice saying words with exaggerated mouth movements in hopes that it will carry-over to slightly larger mouth movements in regular speech
• Practice sounds that require a more open mouth position to get her used to speaking that way (“ahh”, “eh”, “uh”)