Gestalt Language Processing

Let’s unpack some buzz words that you may have been hearing lately:

“Echolalia” is the repetition of language spoken by others. It can be repeated either immediately or after some delay. With echolalia, language is stored as a “chunk”, or a whole unit.

“Scripting” is another term that refers to echolalia. “To infinity…and beyond!” is an example of a script from media. “See you later alligator” is an example of a script that may be heard in conversation. When children are “scripting”, they may be observed reciting dialogue from a TV show, singing lyrics from a YouTube song, or copying phrases they’ve heard other people use. The message is often identical to the source where they heard it, and has the same melody.

“GLP” stands for Gestalt Language Processing. This is a form of language development where children learn the meaning of language in chunks first, then over time learn to break the chunks down and formulate their own original language.

Let’s bust some myths:

Are most autistic children GLPs? YES!

Does being a GLP automatically mean a child is on the Autism Spectrum? NO! Some neurotypical children learn language via chunks as well. 

Unsure if your child may be a “GLP”? Here are some common signs:

1. They echo back what you say or the last part of phrases you say, without appearing to process the language.

2. They have difficulty answering questions in conversation.

3. They like to hum or sing songs rhythmically. 

4. They have a preference for intonation-rich sound input, such as music or videos.

5. They replay certain portions of video clips over and over.

6. They like to repeat play scenes in the same way over and over.

7. They like to play with the WHOLE set – if a figurine is missing, they are not pleased. They are seeing the world in a “gestalt” way.

8. They like to label objects they see around them and can recite their ABCs or count 1-2-3, though have trouble using their language to ask for help or communicate other important functions. 

I think my child is a GLP… Now what?

1. Find a Speech-Language Pathologist near you that has been trained in Gestalt Language Processing. They can help determine which stage of the Natural Language Acquisition framework your child is in and give tailored advice on how to support your child’s language development at home. 

2. Follow social media accounts such as @meaningfulspeech and @bohospeechie, which provide brief, useful posts related to GLP.

3. Take a look at free resources on the website If you have extra time, consider taking Meaningful Speech’s parent friendly course. 

4. Check out Marge Blanc’s book, “Natural Language Acquisition on the Autism Spectrum. The Journey from Echolalia to Self-Generated Language.”

Things to Keep in Mind:

  • Echolalia is not just a “stimming behavior” that should be ignored, decreased or extinguished… Echolalia communicates. 
  • We should acknowledge children’s scripts by nodding our heads or repeating back what they say, even if we are unsure what they mean.
  • Speech therapists are here to help! 

By Julia Navarra MA CCC-SLP

The Top 10 Tools and Activities Used by Occupational Therapists

April is Occupational Therapy Month. This month is designated to celebrate the field of occupational therapy and what occupational therapists do to support their clients and families in living life to their fullest potential. In a pediatric setting, this includes supporting children with their participation in age appropriate activities of daily living (ADLs), play activities, feeding activities, educational activities, as well as any activity that is meaningful to the child and their family. Occupational therapists use a variety of techniques and activities to support their clients in building a variety of skills. In honor of occupational therapy month, here are the top 10 tools and activities therapists use during pediatric occupational therapy sessions. 

10 of Our Therapists Favorite Tools and Activities

1. Swings – Swings can be used in a variety of ways. Swings provide vestibular input which is sensory input that tells the brain and body how they are moving in relation to the environment.  Vestibular input can be calming or alerting to the child’s body depending on how the therapist directs the swing movement. Swings can also be used in a variety of ways other than for swinging movement. A swing can be a balance beam, or a surfboard, or a log. Using swings in a variety of imaginative ways can target lots of different skills. 

2. Climbing Items- Climbing uses a child’s muscles in ways that can help regulate their sensory systems and support their self regulation abilities. Climbing also supports a child’s gross motor skill development and helps them learn more about where their body is and improve their body awareness.

3. Arts and Crafts Materials- Paper, pipe cleaners, tissue paper, beads, you name it, we have probably used it in our sessions at some point. Whether it’s ripping, cutting, gluing, or stringing there are a variety of skills that can be developed through craft activities. While fine motor control and visual motor skills can be developed through the use of arts and crafts we can also work on executive functioning, motor planning, and attention skills through crafts that have multiple steps or parts. Arts and crafts can also be tailored to a child’s interest, getting the child excited about working on a lot of skills at once.

4. Putty/Playdoh- Playdoh and putty can be used for a wide variety of things. Therapists use these activities to build hand strength, work on tactile differentiation (the kids have to find items in the putty-feel the differences between the putty and the item), using both hands together, spatial awareness (the play doh has to be rolled big enough to fit the cookie cutter), and many other skills. 

5. Crash pads/Bean Bags- Kids can have the opportunity to crash or get under crash pads or get squeezed by bean bags. This can support a child’s sensory processing skills and therefore allow them to have greater self-regulation abilities. 

6. Games – Not only do games help therapists teach social skills through sharing and turn taking but they can often be paired with gross motor activities to support kids sensory processing skills and abilities while also incorporating a variety of skills that can be targeted depending on the game. Using games also allows the child some choice in the session activities and creates greater buy-in. 

7. Dressing tools/items- One of the things that OTs work on with children is their ability to dress themselves and tolerate a variety of clothing textures. Using button boards, zipper boards, as well as, socks, shoes, shirts, and pants are important tools to support building those skills. 

8. Crayons, Markers, and Pencils- One of the most common things people think occupational therapists work on is handwriting. While it is just one of many things that we address. Using crayons, markers, and pencils are important to help a child build an appropriate grasp. Using small markers, broken crayons, or writing on a vertical surface all help facilitate an appropriate grasp. 

9. Weighted Items- Using weighted items can support a child’s sensory processing and increase their attention, engagement, and regulation. Weighted vests and ankle weights can be worn during a variety of activities to provide the child with additional sensory input and therefore increase regulation. Therapists also use weighted blankets, lap pads or stuffed animals to help a child calm their body and attend to a task for a greater period of time. 

10. Balls- Balls of all shapes and sizes are wonderful tools to use in occupational therapy sessions. Balls can be used at chairs to allow the child to wiggle a little extra while sitting at the table. They can be used under a child’s belly to build their core, shoulder and hand muscles while they support themselves. A therapist can use throwing and catching a ball as a way to build the child’s hand eye coordination, as well as, their upper limb coordination. Balls can also be used to apply pressure to a child’s body through rolling over their back, legs or arms, to support increased sensory regulation. 

Bonus Number 11: Messy Play Activities- Messy play activities, such as shaving cream, water, slime, finger painting, etc., can be a great way for children to decrease their tactile sensitivities (or their resistance to having dirty hands) through exposure in a fun way. Messy play can also work on a child’s sensory processing abilities that support feeding skills. Therapists will sometimes use messy play for development of visual motor skills as well, drawing in shaving cream or paint can help a child learn the way to make letters and shapes without the added skill of needing to hold a pencil. 

Occupational therapists use a variety of activities in conventional and sometimes very creative ways to support the skill development of the kids they treat. The most important part of all the activities used by pediatric occupational therapists is to ensure that they are fun and that the kids are motivated by them. Sometimes that requires some really impressive imagination! Skill development through play is the goal of pediatric occupational therapists at SmallTalk. 

By Erin Christensen, OTR/L

Feeding the Picky Eater 

Eating is a very complex and sometimes challenging task for some of our friends with sensory processing challenges. The looks, smells, textures, and tastes of foods can sometimes be very overwhelming for these kiddos. When it comes to meal times which include foods not on their, sometimes minimal, list of preferred foods, these overwhelming feelings can result in big behaviors or even shutting down completely.  Below are some simple strategies to encourage your child to explore new foods at mealtimes while taking the pressure and stress out of the situation. 

Setting up the Environment 

How and where the child is sitting during mealtimes can be the first consideration in allowing for the greatest success at mealtime. Giving children the appropriate postural support while sitting at the table allows them to focus more on the food presented and less on having to use their muscles to sit. It is ideal to position your child so that they are seated with their hips, knees, and ankles all bent at a 90-degree angle with their feet resting on something. If your child’s feet can not reach the ground while sitting in the chair, try putting a box or stool under their feet to give them something to rest their feet on. If the dining room chair is too deep for them to keep their hips and knees at 90-degrees, try putting a pillow behind their back to help them maintain that upright position. Another key aspect of setting up the optimal environment for mealtimes is to turn off screens. When screens are not present, this allows kids to engage with the foods with all of their senses, building new sensory pathways and flexibility in order to support engaging with more foods in the future. 

Increasing Engagement with Foods 

There are a few different ways to increase your child’s engagement with novel and different foods. If your child has a really limited diet and only eats a few foods, one way to modify their foods and increase engagement is to change the shape or color of their preferred foods. Get your kids involved in changing the color by allowing them to add a drop or two of food coloring or allow them to change the shape of their foods by using a cookie cutter. Another way to increase engagement around food is to talk about the food during mealtime. Talk about the shape of the foods, the color of the foods, the smell of the foods, how they feel about the foods, etc. Talking about the sensory aspects of the foods can support the foundational sensory pathways that support adding new foods to their diet. Serving foods family-style and allowing your child to scoop the amount of food they want on their plate is another way to increase engagement with foods during meal time. 

Presentation of New Foods

When presenting new foods to your child, first take all pressure out of eating it. Provide choices to your child about how they want to interact with the new food. For example, “Do you want the food on your plate or on the napkin next to your plate?” Giving your child options in how they engage with the new foods allows them to feel a little more in control in a situation where their sensory systems often feel out of control. Also, when presenting new foods, encourage your child to play with them. Can your child drive the green bean like a car or make their cracker smash the pea? What about, sneeze the piece of chicken off their head or draw a mustache with the soup? Encouraging play with foods allows the child to experience these foods and exposes their sensory systems to the various sights, textures, and smells of these foods without the pressure of actually eating the novel or non-preferred food. 

Feeding these kiddos with sensory processing challenges can definitely be tricky for all involved. By setting up the environment for success, making small changes to their preferred foods and getting them to engage with foods in novel ways you can support them in growing their food repertoire and hopefully make mealtimes less stressful for everyone.

By Erin Christensen, OTR/L

OT’s Favorite Toys

As the holidays approach, we’re hearing many parents ask for gift recommendations! We
thought we’d put together another gift guide for 2022.

Experience Gifts

Your family could make gingerbread houses, bake a family recipe together, or play some
seasonal music while going for a drive to look at the lights in festive neighborhoods. Consider
packing dinner and going to see a seasonal movie together at the Santee Drive in. A family day
trip out to Julian or to Mt Laguna after a big rain to see the snow is often treasured more than
any gift or gadget! Experience gifts are wonderful ways to share new sensory experiences
together, and you can build in options for flexibility to support your children.

Gross Motor Play

For your busy child who seeks movement, consider obstacle course materials like balance
stones or beams, a mini trampoline, a pop up tunnel, or even a three-wheeled scooter or a
balance bike! If you’ve got outdoor space, perhaps consider a climbing dome or a new swing
or trapeze attachment for your play structure. For items that can be easily packed away, we
love the floor is lava game, parachutes, basketball hoops that hook anywhere, and bean
bags. Your child’s occupational therapist would love to show you at least 4 different exercises
for your child on a child-sized therapy ball. Our other favorite balls for indoor or outdoor play
include soft weighted balls, playground balls, and beach balls or balloons for children still
learning how to catch.

Pretend Play

You name it, they’ve made it: doctor’s kits, cash registers, dress up outfits, tool sets, and
sets with pots, pans, and pretend food. Pretend play enables children to experiment with the
social and emotional roles of life. They take another person’s perspective and enjoy controlling
the narrative. Children tend to develop skills in pretend play which start with familiar, everyday
experiences (sleeping, eating.), expand to less frequent experiences (visiting the doctor, going
on a plane). Children may feel more competent acting out scenes of a movie they’ve seen many
times than pretending to be adults they’ve only encountered a few times like a doctor or even a
grocery clerk. Start with your children’s strengths and interests, and build from there!

Hands-On (Fine Motor and Tactile) Play

From creative activities like drawing or painting to scooping and digging through kinetic sand,
play activities that build up the muscles of the hand are excellent for your child’s development.
We love easels you can put outside for a messy paint project or in the house for drawing on the
whiteboard. Some children may engage better while standing and working at a vertical surface
than seated at a table. We love dot-to-dot or maze books for quiet times. For children who
need extra pizazz with this type of play, we love jumbo chalk along with a water spray bottle
to erase, doodle boards that light up or play music when you draw, scratch paper books, and
of course, you can never go wrong with a fresh batch of playdoh.

Food-Related Play

If you’re looking for tools to bring your child into the kitchen, we’ve got a few favorites! Toddler
towers or kitchen helpers can provide opportunity for your child to get in among the action,
drizzling (or dumping!) ingredients together, using plastic tongs to move foods from one
container to another, or even just small measuring scoops and a sponge to play with soapy
water at the sink (and to keep them busy while you cook!). For children old enough to
participate, consider child-safe kitchen knives, shaped like a real knife but with a plastic/nylon
blade, or perhaps pick out a child-friendly cookbook together.

Constructional Play

To support your child’s skills in problem solving, fine motor control, dexterity, and spatial
awareness, consider constructional play materials. We love wooden block sets, lincoln logs,
marble runs, and of course the tried and true lego (or duplo / mega blocks for younger
children). We like constructional play activities that come with picture cards that provide a visual
goal for what to build, like light bright or k’nex, and we also love toys that encourage children
to ditch the models and create their own ideas. And for the child who loves a challenge,
stacking rocks as well as magnet building tiles may build both caution and resilience.

Social and Emotional Play

We love games and materials that encourage expression of a wide range of emotions, like
wooden eggspressions toys, the Big Feelings Pineapple, or books like Grumpy Monkey or
The Color Monster. Board games are a wonderful gift for family fun. For children who often
end competitive games with a chip on their shoulder, we love cooperative board games like
Mermaid Island, Dinosaur Escape, and Count your Chickens. We also love social
inferencing games like Hedbandz or Charades.

For more ideas on gifts specific to your child, check out our article from 2021! If you’d like ideas
specific to your child, please don’t hesitate to ask your child’s therapist for their input.

By Rachel Marshall, OTR/L

My child was just diagnosed with autism spectrum disorder… Now what?

Step 1: Take a deep breath!

Learning that your child has been diagnosed with Autism Spectrum Disorder, or ASD,
can understandably flood parents and caregivers with a range of overwhelming emotions.
It’s easy to feel trapped or condemned by a label. When the “what ifs” start to invade,
remember that this new information does not change who your child is or who you
already know them to be. It is simply an identification of a root cause for various
symptoms and the first step to helping your child reach their full potential.

Step 2: Free your child (and yourself) from expectations

Following a diagnosis of ASD, it is common for parents and caregivers to experience a
period of mourning for “normality” and feelings of uneasiness when thinking about the
future. However, the new diagnosis is not a predictor of the future, let alone a sentence to
a life of failure or unhappiness. Taking one day at a time and celebrating any progress,
no matter how small, is key in cultivating both acceptance and a sense of hope.

Step 3: Advocate for your child

With a new diagnosis comes a plethora of recommendations from medical and school
professionals. Always remember, though these recommendations are backed by research
and have been proven to help, you have the final say in your child’s treatment. Though
30 hours of therapy per week might be recommended, you may feel that is too much. Go
with your instinct! Your child’s team of professionals will work with you to ensure the
best possible treatment to match your child’s individual needs.

Step 4: Find community

No one has to face the journey alone! Consider joining a virtual or in-person support
group for parents and caregivers of children with Autism, or an online forum. Sometimes
well-meaning family and friends can misunderstand and unintentionally cause more pain,
so it can be important to connect with people who do understand. Autism Society San Diego offers both support groups for parents/caregivers and fun events for the entire family. Military families can take advantage of the Exceptional Family Member Program
(EFMP) for a range of family support. When in doubt, is a great place to

Step 5: Take care of yourself!

Self-care is often placed on the backburner when caring for a child who has an ASD
diagnosis. However, burn-out is not only emotionally draining for you, but is also
unhelpful for your child. It’s important to seek Respite Care services if you don’t have a
friend or family member to babysit while you take time for yourself to recharge. In
addition, pick your battles with your child. Rome wasn’t built in a day, so anticipating
immediate results and/or perfection can contribute to high stress levels.

Checklist, in no particular order:

  • Developmental evaluation (medical) through your doctor or San Diego Regional Center. It is important to get a medical diagnosis, not just an educational label
    through the school district. This is not the same as a formal diagnosis.
  • Speech therapy (medical/outpatient)
  • Occupational therapy (medical/outpatient)
  • Behavioral therapy (e.g., ABA) (in home or in facility)
  • Apply for school services at age 2 and 10 months to begin at age 3. This will determine eligibility for services through the school district such as, speech
    therapy, occupational therapy, and behavioral therapy. Your child can receive these therapies in both the medical and school setting, as medical and educational
    services are autonomous from one another.

Written by: Kat Winger, MS CCC-SLP

Comparing/contrasting occupational therapy school vs. clinic based services

Happy August! I hope that our families are currently enjoying this home stretch of summer, perhaps taking in a few more beach days or afternoons at the park, going on fun trips out of town, having play dates with friends, and simply indulging in this time before our thoughts turn to autumn. No doubt, many of us are already planning for returning to the “school routine” of classes, schedules, and services, including keeping up therapies in school and in-clinic. It can be a lot to juggle!

In case you are wondering what the similarities and differences are (or would be) between your child’s occupational therapy (OT) services at school vs. in the clinic, here is a basic principle: outpatient OT can address any deficit area within our scope of practice, as long as funding sources allow, and school-based OT addresses deficit areas that directly impact the student’s access to their education. In the latter case, the student must have an IEP (Individualized Education Program).

In our outpatient clinic setting, we may directly address areas of need such as:

  • Fine motor / visual-motor skills
  • Gross motor skills
  • Overall coordination, core strength, balance
  • Sensory processing
  • Self-regulation / emotional regulation
  • Activities of Daily Living (ADLs): dressing, hygiene, grooming, etc.
  • Feeding and oral-motor skills
  • Executive functioning
  • … plus others!

School-based OT services also address the above areas, however, the goals must be related to deficits seen within the student’s educational setting. For example:

  • Fine motor and visual-motor skills related to writing, typing, completing assignments and homework
  • ADLs within the school day: changing into gym clothes, independence at lunch time, etc.
  • Executive functioning skills for organization, attention, planning, time management, getting through a routine schedule
  • Sensory processing challenges that affects the student’s ability to participate in their school day
  • Core strength, affecting the student’s ability to maintain appropriate posture for attending to and completing school tasks

Of course there are many more differences between these two OT settings, and the best advice is to consult with your child’s physician, clinic Occupational therapist, and/or educational team to determine which kind of services are appropriate and necessary.

Lastly, if your child already receives both clinic and school-based OT, we’ve found that it’s often beneficial for both therapists to sometimes consult and be aware of what the other is working on, for an even more harmonious OT experience for your child!

Written by: Pam Verde, MOT, OTR/L

Incorporating basic concepts into america’s holidays

Happy Birthday month to our beautiful country, America! To many families, Fourth of July means fireworks, family reunions, concerts, barbecues, picnics, parades, and baseball games. For our speech therapists, holidays are a great opportunity to target several different language goals such as temporal, spatial, and quantitative concepts. It is important to remember that before a child can use the concept in their speech (expressive language), we must first be sure they have a full understanding (receptive language).

Temporal concepts

Temporal concepts (before, after, during, first, next, last) are words that are used to describe time. Celebrating special days that occur at the same time every year help provide children with a sense of time that passes in the duration of a year. We can converse with our kids about the upcoming holiday and model using temporal concepts. We may also show them a calendar and allow them to flip through and visualize the temporal order.

Verbal model examples: “Before the Fourth of July, we celebrate Valentine’s Day. After the Fourth of July, we celebrate Christmas. First is Valentine’s Day, next is Fourth of July, and last is Christmas. During the Fourth of July, we will have a cookout and watch fireworks.”

Visual examples: Try showing your child a calendar with pictures on each holiday. Allow them to flip through and visualize the temporal order. Start with two holidays and discuss before and after. You can also try three holidays using first, next, and last. For the children that are new to learning the concept, see if they can use their receptive language and flip to the first holiday! To target expressive language, ask your child a question such as “Which holiday comes first?”

Spatial concepts

Spatial concepts (in/out, up/down, on/off, over/under, behind/in front, next to/in between) or prepositions describe an object’s location in relation to another object. Understanding spatial concepts is critical for following directions and describing objects. Just like temporal concepts, we can use spatial concepts in conversation with our children as well as incorporating visuals to aid in understanding.

Verbal model examples: “Let’s shoot the fireworks up in the sky”, “Should we put the flag on the pole?”, “The float is in front of the dancers!”

Visual examples: Grab a cup and any mini object at home. First, see if your child can follow simple directions such as, “Put the eraser under the cup”. Once your child has mastered this, now you can move the object and ask the child “Where is the eraser?”. If you notice that the open task becomes too difficult, you can also provide your child with two options such as “Is it on top or under?”, changing it to a closed question that will be easier to answer while still prompting the child to use expressive language.

Quantitative concepts

Quantitative concepts (a little/a lot, all/none, more/less, most/least) can describe the size and amount of an object. Similar to spatial concepts, understanding quantitative concepts is important for following directions and describing objects.

Verbal model examples: “I hope we receive a lot of candy at the parade!”, “Do you think this is more candy than last year?”, “I wonder who found the most candy”.

Visual examples: Beginning with receptive language, pull out a large quantity of something such as legos, blocks, or marbles. Ask your child to give you all of the blocks, a little bit of legos, and a lot of marbles. You can also try this while cooking with your child; asking for more chocolate chips, a little bit of sugar, and less flour.

Holidays are a great way to organize our year with temporal concepts and use themes to make language concepts more fun for everyone!

Written by: Alexa Murman, MS CCC-SLP

Let’s play outside!

Summer is here and what better way to spend it than playing outside! Studies have shown that being outdoors promotes mental wellness; therefore, not only will your child benefit from being outdoors, but so can the whole family. Outdoor play can be anywhere from the backyard, your neighborhood park, the beach or a hiking trail. Summer also means school is out and your child might have some extra energy to burn. This is the perfect time to plan an activity incorporating all of the eight senses that your child may be working on during their occupational therapy sessions.

Eight senses:

  • Auditory: how we process sounds
  • Gustatory: how we process taste
  • Interoception: how we process what we feel within our body (hunger, toileting, stomach ache)
  • Olfactory: how we process smell
  • Proprioception: how we process where our body is in space
  • Tactile: how we process touch
  • Vestibular: how we process movement and balance
  • Visual: how we process what we see

Let’s go to the beach:

  • Tactile play/fine motor skills – Building a sand castle
  • Hand strength/grading of force – carrying a bucket of water, digging a hole in the sand
  • Visual scanning – Looking for seashells or rocks
  • Proprioceptive Input – Getting buried in the sand or running with the waves
  • Body/Safety awareness – Being aware of their surroundings and not wandering too far
  • Auditory – listening to the sounds of the waves

Let’s go on a nature walk:

  • Proprioceptive/vestibular input – walking up a hill or steep incline, safely balancing on a tree stump
  • Visual scanning – I spy a/some….
  • Tactile play – picking up different leaves and flowers
  • Auditory – listening to the sound of birds
  • Olfactory – smelling flowers

Let’s go to the park:

  • Vestibular input – Going down the slide and swinging
  • Proprioceptive input/motor planning – climbing up the play structure
  • Visual scanning – I spy a/some…
  • Tactile: playing in the sand box

Let’s play in the backyard:

  • Tactile/fine motor skills – water play: filling up containers to pour and scoop water
  • Vestibular input – Setting up a little obstacle course to climb, crawl, and jump to get from one end to another
  • Proprioceptive input/motor planning: animal walks around the backyard
  • Visual motor skills – drawing on the sidewalk with chalk

All of these examples will not only target the eight senses but it can also work on core and upper body strengthening, motor coordination, sequencing, endurance, self-regulation, social skills and building your child’s confidence to navigate their natural environment. Children learn more about themselves via play and can become more aware of their surroundings when playing outside. Studies have shown that there has been a decrease in outside play due to screen time and busy school schedules with extracurricular activities. Being around green plants and play yards reduce children’s stress levels; the natural space and surroundings can stimulate a child’s imagination and creativity. While playing outside, children can also benefit from natural sunlight, fresh and natural elements that contribute to bone development, a stronger immune system and physical activity. Green outdoor environments also promote improved attention and mental well-being.

June is safety awareness month and with outdoor play, it is important that your child also learns to be aware of their surroundings and their peers. You can practice having your child safely navigate their environment and provide verbal cues to stay within safe boundaries. You can initiate outdoor play in a smaller space before moving into a large space to practice safety. Although you want your child to engage in free play outside, it is important to create rules, safe zones and buddy systems. Remember to explore, have fun, let your child get dirty and enjoy the outdoors!

Monica Kem, M.S. OTR/L, SWC

What is a tongue-tie and how can it impact my child’s speech?

Tongue-tie (medically known as ankyloglossia) occurs when the lingual frenulum – the membrane beneath the tongue which attaches the tongue to the mouth base – is too large and restricts tongue movement. This anatomical change restricts the tongue from reaching certain points in the mouth, often necessary for producing certain speech sounds. A tongue that lacks a full range of motion may fall short of the target placement required to make certain speech sounds, causing an articulation disorder. Tongue-tie may also impact feeding and oral hygiene.

Doctors typically recommend Lingual frenectomies when infants exhibit difficulty latching or suckling during nursing. In older children, their tongue may protrude out when drinking from a cup or eating from a utensil, increasing the chance of choking and resulting in messy eating.

Visually, the tongue may appear fattened due to the inability to completely extend to its full length without great effort. In more severe cases, it may appear heart-shaped with a cleft in the center from being pulled back.

How does a tongue-tie impact speech?

Because many speech sounds require the lifting or retraction of the tongue to produce, there is evidence that in many cases, a tongue-tie may contribute to speech sound errors. Sometimes, sounds impacted are “l” and “r .” In other instances, tongue-tie may contribute to a lisp. For example, since the production of “s” and “z” requires the tongue tip to lift up to the alveolar ridge, they may not be able to be produced if the tongue is anchored down.

To compensate for this inability, the jaw and tongue body is often thrust forward, causing the tongue tip to emerge between the teeth in a lisp. As a result, single words, phrases, or short sentences may be produced without errors. Still, the demands made on the tongue during conversation (i.e., fast rate and a variety of surrounding speech sounds requiring complex movements) become too great for the anchored tongue, resulting in disordered speech.

Why should my child get a frenectomy?

Scheduling a lingual frenectomy to correct tongue-tie is recommended for those with resulting speech and feeding issues as these issues will likely persist without treatment. While children with untreated tongue-tie can improve their speech through skilled therapy, progress may be slow or limited by the anatomical restriction. While many parents are concerned about their child’s short-term discomfort, surgery is fast – often performed with a laser by a pediatric dentist – and the incision heals quickly.

After a lingual frenectomy has been completed, the tongue is typically still weak from being anchored down, so skilled speech therapy is still needed in most cases. The degree of success in speech outcomes following a frenectomy will also be affected by individual factors such as the size of the oral cavity and the tongue’s posture. The child’s age also plays a significant role; Children typically undergo frenectomies before the age of 3. Speech outcomes are best when frenectomies occur at this young age because children over the age of 3 have passed the age of orofacial development. As a result, more skilled therapy will still be necessary to instruct jaw and tongue positioning after age 3.

Research has long shown a correlation between tongue-tie and articulation disorders. Increasing the tongue’s range of motion allows for less effortful lingual placement during speech. In light of this science, the long-term benefits of a lingual frenectomy on articulation far outweigh short-term discomfort.

If your child is experiencing speech sound distortions and has a tongue-tie, to maximize speech therapy outcomes, talk with your ENT or pediatric dentist about scheduling a lingual frenectomy as soon as possible. It may be critical for your child’s success in speech.

Kat Winger, M.S. CCC-SLP

Can speech therapy correct a lisp?

What is a lisp?

Lisping is one of the most common and most well-known articulation disorders resulting from abnormal tongue positioning, which causes a perceived sound distortion. It is estimated that 90% of speakers who have some kind of articulation difficulty exhibit some degree of lisping behavior1. While lisping most frequently impacts “s” and “z,” it can affect other sounds as well, such as “th” and “sh.”

Lisping is considered a mechanical issue that may be either structural, from an overbite or underbite, or behavioral, from a tongue thrust. Factors that impact it includes tongue weakness or jaw instability, as a lowered jaw impacts the ability of the tongue to lift. Typically, jaw instability and tongue weakness coexist when a lisp is present. However, causes are nearly always behavioral and can be treated with skilled therapy.

What are some common types of lisps?

The most common and well-known variety is a “frontal lisp” or “interdental lisp.” Most people think of a frontal lisp as a “th” substitution, as in the production of “thun” for “sun .” However, this is not the case. The tongue does not protrude as far out as during a “th” production. Instead, it may not even protrude, positioned on or between the teeth, and is frequently visible during “s” production. Frontal lisps are nearly always behavioral in nature, not often resulting from structural issues. As a result, they are not a concern for children below 5. Following age 5, it is considered disordered and requires skilled therapy to treat.

Another common type of lisp is known as a “lateral lisp.” This is never developmentally appropriate, meaning that it is disordered in a child of any age and must always be treated with skilled therapy. It results from a flattened tongue so that airflow, rather than moving in a forward trajectory, emits out the sides of the mouth, causing a “slushy” sound. Treatment of lateral lisps involves an emphasis on lifting the tongue to streamline airflow. Ensuring the child’s self-awareness and ability to monitor their speech is also essential during treatment.

Why should a lisp be treated in speech therapy?

While overall intelligibility is not as significantly impacted as with other articulation disorders, the effects of a lisp often have social-emotional ramifications. One study by Ellen-Marie Silverman indicated that lisps draw negative attention and impact perceptions relating to intelligence, personality, and likability.2 The phenomenon of lisping impacts the perceptions of others and the self. In a study by Veríssimo et al., participants who presented with lisps felt insecure and that their speech disorder negatively impacted their social life or work.3

Many parents first seek out speech therapy in elementary school when their child begins to feel shame or experiences bullying related to their speech. Then, the child, parent, and speech therapist can work together to resolve the issue. Following articulation therapy, children are proud of their speech and confident in their ability to communicate with their peers.


  1. Fairbanks, G. (1940) Voice and Articulation Drillbookt. New York: Harper and Row.
  2. Silverman, E. (1976). Listeners’ impressions of speakers with lateral lisps. Journal of Speech and Hearing Disorders, 41(4), 547-552. doi: 10.1044/jshd.4104.547
  3. Veríssimo, A., Van Borsel, J., & de Britto Pereira, M. (2012). Residual /s/ and /r/ distortions: The perspective of the speaker. International Journal of Speech-Language Pathology, 14(2), 183–186.

Kat Winger, M.S. CCC-SLP

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