A fourth-grader was referred to me by his teacher for a frontal lisp. He had no previous history of speech therapy and no awareness that he had a problem. I saw the student individually for 10 minutes a week over a seven-week period using the response to intervention model.
Using multimodality feedback at our initial meeting, he developed an awareness of the problem. I asked him how the word "thoap" sounded when I said the sentence, "I wash with thoap," and he told me it didn't sound good. I asked him how it looked, and he said it looked funny. When I asked why, he told me that I was sticking out my tongue. I gave him a mirror, and he realized for the first time what he was doing to produce the /s/ sound.
I utilized the oral-motor procedures of differentiation and stabilization as well as a multimodality approach using auditory, visual and tactile cues. I told the student that to correct his problem he needed to stabilize his tongue on his top back teeth. Using a mirror and flashlight, I had him say "EE" with a big smile while biting a tongue depressor on one side of his mouth between the top and bottom teeth to stabilize his jaw and make his productions visible. He could see how the tongue widened and touched the top back molars while the front of the tongue was in the lingua-alveolar position.
I then had him say "EET," lifting the tongue tip while keeping the back of the tongue stabilized on the upper back molars. Like many students with a frontal lisp, this was difficult for him, and he dropped the sides of his tongue when lifting up the tip. I placed an applicator stick against one side of his tongue that was touching his back teeth when he said "EE" and told him to watch and feel that the tongue needs to stay still and continue touching my applicator stick when saying the "t" sound. He got it after a little practice.
We then proceeded to lengthen the duration of the "t" sound so that "EET" became "EETS." Due to the position of the tongue, "EET" is the perfect facilitating context for correct /s/ production. After 50 productions I asked the student to produce "EETS-EE" in order to develop co-articulation that would lead to quicker transfer to conversation. The space between "EETS" and "EE" caused him to use /ts/ post-vocalically. If he started thinking prevocalic "SEE," he would say the word the way he had thousands of times before and it would come out with a lisp. After some practice I asked him to speed up "EETS-EE" so it became "EETSEE," but he thought he was saying "EETS-EE" and not "EET-SEE," even though it sounded like "EET-SEE."
The student's homework for the week was to practice "EETSEE" 50 to 100 times a day, biting the stick and watching his tongue. It was critical that he used the proper stabilization and differentiation of the tongue, with the jaw stabilized in that open position so he could receive visual feedback. Having the mouth open is not ideal for making a perfect /s/ sound, but that was secondary to the tongue placement at this point.
By the second week he had developed proper tongue differentiation and stabilization, keeping the sides still on the top teeth and using only the tip for the "ts" sound. We got rid of the stick, and I had him close his teeth into the proper /s/ position. He produced a perfect /s/ sound in "EETSEE." The word was lengthened into BEETSEEK, and he began the SATPAC Program Generalization Phase lists.1SATPAC is a computer software program that allows therapists to make up customized lists for any sound or phonological process and systematically moves from facilitating a context seed word to using the target sound in every phonetic context.
I eliminated the "th" sounds from the student's lists because they interfered with correct /s/ production. He did well on the first four lists, and these were his homework. He said the nonsense words at a slow conversational rate, needing 80 percent accuracy to proceed to the next list. Every nonsense word on the lists used the facilitating /t/ to help produce the proper /s/ sound.
The student said the final five lists of the SATPAC Generalization Phase during the third week. He used the /s/ sound in every phonetic context, no longer needing the /t/ to facilitate correct production. List 9 is a contrasting sentence list. The student said a sentence, "My BEEJSEEK won a penny," and answered my questions using appropriate prosody. I asked, "Did your BEEJSEEK lose a penny?" and he replied, "No, my BEEJSEEK won a penny." Taking the stress away from the target sound simulated conversational speech and led to quicker transfer into conversation. The five lists were his homework for the week. He said the words and sentences at a slow conversational rate.
The following week the student showed that he had mastered the lists, so we moved into the transfer phase of the program. We used short sentence lists with a prevocalic and post-vocalic /s/ in every sentence (e.g., "she had a soft whisper"). This was his homework for the week.
We reviewed these sentences in week 5, and he was at 90 percent. I gave him longer sentences with up to four /s/ sounds per sentence, and this was his homework. By this time the student was transferring correct /s/ sounds into conversation spontaneously.
He was at 90 percent again when we reviewed the long sentences the following week. We then began conversation, and the student had no problem from this point forward. He understood the concept of the correct /s/, developed the proper placement and motor pattern in a systematic way, and spontaneously transferred this to conversational speech.
The next week we just conversed, and he was at 100 percent accuracy. We talked a month later, and he continued to be at 100 percent.
This student had everything going in his favor. He was bright and motivated, and his mother practiced with him consistently. However, it was the systematic approach to remediation that led to a minimum amount of therapy time. I have used this 10-minute-a-week approach with 30 to 40 students, and the majority have been remediated for /s/ in three hours or less.
1.???Sacks, S., Shine, R.E. (2004). SATPAC (Systematic Articulation Training Program Accessing Computers). Fresno, CA: SATPAC Speech LLC.
Stephen Sacks works for Fresno Unified School District and is the co-owner of SATPAC Speech LLC in Fresno, CA. He can be contacted at firstname.lastname@example.org.