Ask a Therapist: Targeting Hyposensitivity in the Mouth for Speech Production and Open-Mouth Posture

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 years 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 lisps, 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 in 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! 

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, 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®️

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