Ask A Therapist: Proper Tongue Elevation & Retraction

I need advice please! I am seeing a 5 year old child with severe childhood apraxia of speech together with dysarthria (specifically weakness of tongue and lips). So far his lip strength and movement has improved a lot, but I am really struggling with his tongue. He can protrude his tongue beautifully, retraction we are working on, but he is doing okay so far. Lateral movements we are also working on, but tongue elevation seems impossible!  Both posterior and anterior tongue movements just aren’t happening! Any advice will be appreciated!!!

Kind Regards,


Hi Denise,

Thank you for your email.  I understand your frustration!  I can tell you this… In looking at motor development, tongue tip elevation does not occur if you do not yet have retraction and stability, along with lateral border stability. Retraction and stability all allow the tongue tip to develop… So it may just be a matter of continuing to work on the underlying skills necessary for tongue tip dissociation.

Often, children who have motor planning deficits in conjunction with oral motor weakness can progress at a rather slow pace. Therapy can be difficult when compared to children who only have Dysarthria.

I’m happy to help you sort out what might be missing!  I often find that the order I do treatment in can be as important as the exercise itself.  For example, many children with CAS and Dysarthria have difficulty isolating the motor skill I’m looking for. Thus, a good sensory-motor program may be useful immediately before targeting the motor task I have as a goal.

I’m not sure what education you have in TalkTools, but I recommend Three Part Treatment Plan. This course teaches of our systematic approach to motor speech disorders based on normal development. I look forward to hearing from you!

Renee Roy Hill, MS, CCC-SLP

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