Therapy Archives | Page 2 of 2

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

Educational, Speech Therapy, Therapy | May 23, 2022 4 min read

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?

Educational, Speech Therapy, Therapy | May 04, 2022 3 min read

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.

References

Fairbanks, G. (1940) Voice and Articulation Drillbookt. New York: Harper and Row.
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
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

What is Pediatric Occupational Therapy and how would I know if my child would benefit?

Educational, Featured, Psychology, Speech Therapy, Therapy | Apr 04, 2022 6 min read

Occupation refers to functional tasks or activities that bring meaning to your life. And our children’s main activity is PLAY. Did you know that kids play to learn and that play requires motor, sensory processing, cognitive, and social skills? All these skills work together for learning. However, when the necessary skills for play are observably difficult, it can make grasping new competencies challenging for kids.

Occupational therapy addresses all the skills needed for play. It works on strength, coordination, and control to support their movement. OT also helps with sensory processing difficulties by identifying the way your toddler receives or responds to sensory input and teaching fun ways for you to support your child. And finally, Occupational Therapy promotes executive function skills building on motor, attention, and regulation foundations for learning.

Though play can look different and vary from child to child, there are general toddler development skill ranges necessary for learning to happen. When these are not progressing or missing, they can inhibit engaging in and learning through play.

The development of sensory processing and motor skills begins immediately at birth. The brain is where all the magic happens. Newborns take in sensations, but their body is unable to organize them—their reflexes are neurological responses to stimulation, including the senses of light, sound, touch, or pressure input such as stroking and vestibular sensory input with sudden movement.

The sensory processing and motor skill development looks random and clumsy at first with the baby’s initial kicking of their legs or trying to find their mouth with their hand. As they continue to be exposed to the sensation and repeat the movement, it becomes more purposeful.

Babies are holding, pulling, pushing, and dropping toys as they learn about cause and effect. More and more skills work together to explore and learn through play.

For your toddler, the years from 1 to 3 are very busy. They are essential years of curiosity, trial and error, and learning about what they can do. At age one, toddlers are very active. Give them a container, and everything comes out; maybe a few things go back inside. Set something on the table, and they pull up to see if they can get it. They make sounds and babble and may tug on your heart with Ma Ma or Da Da words!

Toddlers are in a transition of building more independence. During the terrible twos, a stage that everyone stresses about, they continue to learn about their environment, manipulate things, and communicate their experiences. Their development takes all the work that the baby’s brain and body did and uses it in play to build confidence, control movement, and explore new sensations. Toddlers experience big emotions. They must learn about these feelings and how their body responds to them. How we react and support them is important.

They also learn to transition from one activity to another, even when they don’t want to.
For example, two-year-olds usually can stack a few blocks, string a few large beads on a shoelace, feed themselves with a spoon, drink from an open cup or a straw, remove/pull on clothing, brush teeth, help wash their body at bath time, jump, run, and walk up and down a few steps. They can also throw a small ball toward a target, help clean up, and put toys away. Though the terrible twos try on parents and toddlers, they don’t last long. And both parents and kids learn a great deal!

As we strive to develop more patience during these times, our toddlers are growing far more in their quest for independence. Two-year-olds should be able to attend and learn a new play activity for 4-6 minutes. Some research even suggests that this age group should be able to focus on a task for 10 minutes.

Though many toddlers can sit and play for extended periods of time with preferred toys or activities they have initiated themselves, a better learning opportunity is to give them a new task to work on to develop manipulation skills like using a tool to scoop, fill a container, feed themselves with a spoon or fork, stack or build with blocks, lace beads on a string, or roll a ball back and forth.

Notice how your child works through activities. When development is not smooth, there will be clues in how your child moves, plays, speaks, or acts. See if you observe any of these challenges:

unable to manipulate toys in play, they continue to dump, empty containers, or throw them around the room
difficulty using tools to scoop, squeeze, hammer, draw
unable to demonstrate repetitive play activities. May run around, only roll the car back and forth
moves between many play activities quickly, not engaging in any of them
requiring or demanding your attention and unable to initiate or engage in play by themselves for short periods
difficulty imitating actions in movement, imitating mouth or tongue movements, silly faces, or being unable to throw a ball at a target. Difficulty moving from sitting to moving under structures, crawling through a tunnel
unable or very clumsy with jumping, climbing, moving between different level surfaces, climbing ladder to slide
unable to take turns in play activities such as rolling ball back to you, stacking blocks
seems fixated on the television, tablet, or phone and unable to engage with other toys in play
difficulty putting things together such as connecting blocks, lacing, and beads
unable to tolerate play on a swing, on a slide
unable to play near or with other children
unable to tolerate tactile messy play or engagement with media like play-doh, finger paint, or shaving cream
difficulty removing pull on clothing from dress-up activities

Play is one of the most significant areas that can provide clues about your toddler’s development. As we’ve outlined, there is so much growth happening during this time. If you see your child struggling in any of the areas we mentioned, occupational therapy can help develop and strengthen the skills needed for learning.

Occupational therapists are experienced experts and can help identify the areas inhibiting your child’s primary occupation and introduce fun activities for successful skill development.

Children are tiny individual humans with varied interests and gifts. We embrace and work together with parents to help children reach their greatest potential.

Come in and check us out in April for Occupational Therapy month!

Author: Pamela Vasiloff, OT

Does my child need Occupational Therapy?

Clinic, Educational, Speech Therapy, Therapy | Jan 03, 2022 3 min read

What is Occupational Therapy? Does that help my child get a job? No! “Occupations” are daily activities, so that means playing and learning for your child. Children develop daily living and self-care skills through actively exploring their environments and playing with others. Occupational therapy addresses sensory processing, motor delays, and social-emotional components that may be impacting your child’s ability to develop independence at home and school. If any of the following characteristics resonate with you, your child may benefit from occupational therapy!

Sensory Processing

Overly sensitive or heightened reactivity to sound, touch, or movement
Under-responsive to certain sensations (e.g., high pain tolerance, doesn’t notice cuts/bruises)
Constantly moving, jumping, crashing, bumping
Easily distracted by visual or auditory stimuli
Emotionally reactive
Difficulty coping with change
Inability to calm self when upset

Social Interaction Skills

Difficulty interacting socially and engaging with family and peers
Difficulty adapting to new environments
Delayed language skills
Overly focused on one subject (e.g., space, universe, dinosaurs, trains)
Can’t cope in the school environment

Play Skills

Needs adult guidance to initiate play
Difficulty with imitative play
Wanders aimlessly without purposeful play
Moves quickly from one activity to the next
Does not explore toys appropriately
Participates in repetitive play for hours (e.g., lining up toys)
Does not join in with peers/siblings when playing
Does not understand concepts of sharing and turn taking

Oral Motor/Oral Sensory

Excessive drool
Chews food in the front of the mouth, rather than on the molars
Difficulty using a cup at an age-appropriate time
Difficulty with drinking from a straw at an age-appropriate time
Lengthy bottle or breast feedings
Tiredness after eating
Baby loses excessive liquid from their lips when bottle or breastfeeding
A child loses excessive liquid or food from his or her mouth when drinking or chewing
A child appears to be excessively picky when eating, only eating certain types or textures of food
A child excessively mouths toys or objects beyond an age-appropriate time

Fine Motor Skills

Manipulating toys and puzzles
Holding a pencil
Using silverware or straws at an age-appropriate time
Using scissors
Using zippers, buttons, shoelaces
Coloring, drawing, tracing, prewriting shapes
Poor handwriting, letter/number formation
Not developing a hand dominance at an age-appropriate time
Avoiding tasks and games that require fine motor skills

Gross Motor Skills

Going up and down stairs at an age appropriate time
Coordinating both sides of the body
Understanding the concept of right and left
Poor ball skills
Poor balance
Fear of feet leaving the ground
Not crossing the midline of their body during play and school tasks
Avoiding tasks and games that require gross motor skills

Visual Processing

Difficulty with the spacing and sizes of letters
Difficulty with recognizing letters
Difficulty with copying shapes or letters
Difficulty with visual tracking and crossing midline
Difficulty finding objects among other objects
Difficulty with copying from the board or another paper
Difficulty with the concept of right and left

Learning Challenges

Unable to concentrate and focus at school
Easily distracted
Difficulty following instructions and completing work
Tires easily with school work
Poor impulse control
Hyperactivity or low energy
Not keeping up with workload at school
Difficulty learning new material
Makes letter or number reversals after age seven

Do you feel like your child has difficulty in any of the areas as mentioned above? Are you questioning whether an Occupational Therapist should see your child? If so, our SmallTalk therapists are here to help strengthen these skills and answer any questions through structured and unstructured table and gym activities with weekly/bi-weekly therapy sessions. Please call to schedule an evaluation today!

Authors: SmallTalk Occupational Therapists