Answer: When oral hyposensitivity and open-mouth posture are present, speech progress (including /sh/) is more likely when you assess and address the full orofacial myofunctional picture—especially airway, feeding, and structure—while using an “outside-in” sensory approach (often with OT support) and consistent, positive practice.
Oral hyposensitivity (reduced oral sensory awareness) can contribute to unclear speech placement, limited tongue awareness, jaw instability, food stuffing, and an open-mouth resting posture. When oral hyposensitivity shows up alongside a frontal lisp and tongue thrust, speech progress (including /sh/) is more likely when you assess and address the full orofacial myofunctional picture (airway, feeding, structure, and speech) while using an “outside-in” sensory approach and consistent, positive practice.
The question (from an SLP)
Hello, I am a speech pathologist working with children, and I have attended some of the TalkTools workshops in recent years.
I currently have a 7;6-year-old child who came to me because his parents are concerned with him not producing the /sh/ sound (he is producing /s/ sound instead). He has a significant frontal lisp, a tongue thrust, and most of the time an open mouth position when he is at rest.
I have checked his sensory responses with a Toothie and he enjoyed the vibration so much… and had no gag response on his tongue or on his palate. I also checked his chewing and he doesn’t have a rotary chewing, and sometimes stuffing food. His jaw is very unstable while speaking.
I suspect a tongue tie, but I could not see a tied frenulum, so maybe it is a posterior tongue tie.
My question is how to target his hyposensitivity in the mouth as was obtained with the Toothie, for the purpose of his speech production, and for the purpose of his resting position. His parents are mainly interested in his speech, so currently I will not work on his chewing.
Thank you very much!
Therapist answer
Hello, and thanks for the inquiry.
The child described seems to present with an orofacial myofunctional disorder (OMD). When an OMD is present, we need a detailed assessment of the 4 MYO Domains of 1) airway 2) feeding 3) structure and 4) speech. Speech will not improve without investigating and treating the first 3 domains.
I suggest working with an OT to look at a whole body approach to desensitizing the mouth and this starts from the outside in. Toothie is one tool, the Sensi and Jiggler are other tools that can help.
The book I co-authored with Lori Overland, A Sensory-Motor Approach to Feeding, is helpful for teaching this, as well as the coordinating class.
Consistency, small trials, and positive reinforcers all help.
Keep in mind, a tongue thrust is a symptom, not the problem and is usually caused by structural or airway issues. That articulation error is a side effect of this.
The course MYOTools 101 can help provide you with a deeper understanding, or the e-learning course Solutions to the Pesky Lisp. Hope this helps!
–Robyn Merkel-Walsh, MA, CCC-SLP, COM®️
Practical “outside-in” sequence (general)
- Face and cheeks
- Lips and jaw boundaries
- Gums and teeth
- Inside cheeks
- Tongue awareness (tip to mid, then sides)
- Palate input as tolerated
Keep it consistent and positive
Use short, predictable trials. Pair with motivating reinforcers. Aim for frequent practice that feels successful.
Oral hyposensitivity, tongue thrust, and the frontal lisp (/s/ for /sh/)
Tongue thrust is often a symptom rather than the root cause. When airway or structural factors drive open-mouth posture and reduced oral awareness, articulation errors like a frontal lisp can persist. Addressing oral hyposensitivity and the broader OMD picture can support more stable /sh/ placement and better carryover.
Key takeaways
- If you suspect an OMD, assess airway, feeding, and structure alongside speech.
- Consider an outside-in sensory approach with OT collaboration for oral hyposensitivity.
- Tools mentioned: Toothie, TalkTools® Sensi®, TalkTools® Jiggler®.
- Consistency, small trials, and positive reinforcement support progress.
Recommended TalkTools resources mentioned
FAQ
Can you fix a frontal lisp (/s/ for /sh/) without addressing airway/structure?
When an OMD is present, speech may not improve without investigating and treating the airway, feeding, and structure first.
What does “outside-in” desensitizing mean?
It refers to building oral sensory tolerance by starting externally and gradually moving inward, often as part of a whole-body sensory approach with OT support.
Which tools were recommended for oral sensory awareness?
Toothie, TalkTools® Sensi®, and TalkTools® Jiggler® were named as options that can help.
Is tongue thrust the main problem?
Tongue thrust is described as a symptom, often related to structural or airway issues, with articulation errors as a side effect.