Parenting / 7 July, 2019 / My Baba

Lisps In Young Children: Should I Be Worried And How Can I Help?

Fiona Barry is a Speech and Language Therapist working within the NHS and in independent practice.  Alongside this work she created the TalkingTipsForKids app and website. She lives in Berkshire with her husband and two sons. 

In my work as a speech and language therapist, I find parents can be very worried about their child having a lisp. In fact, lisps are very common in preschool children and are not a huge cause for concern until after the age of 4 ½  years.

What is a lisp?

A lisp is an articulation disorder where a child has difficulty accurately saying the ‘s’ and ‘z’ sound and can also affect the ‘sh’, ‘ch’ and ‘j’ sounds. There are four types of lisps, two of which are commonly seen in youngsters with typically developing speech and two which are more unusual.

Let’s think about the way we produce an accurate ‘s’ and ‘z’ sound first as this helps us understand what is going wrong when a child lisps. The tongue needs to be behind the teeth with the tip of the tongue behind the top teeth. The sides of the tongue are raised to touch the upper row of side teeth forming a groove along the middle of the tongue. Air flows along this groove and produces the sound. For a ‘s’ sound the there is no voice used and for a ‘z’ sound voice is used, both sounds are made in the same way apart from the absence or presence of voice. We will focus on the ‘s’ sound for now.

If a child has a lisp they are having trouble putting their tongue in the position to form an accurate ‘s’ sound. The following two types of lisps are often seen in typically developing speech:

1) Interdental lisp – this is where the child’s tongue tip sticks out between the teeth instead of staying tucked behind the top teeth.  This produces a ‘th’ sound e.g. ‘thun’ instead of ‘sun’ or ‘thweet’ instead of ‘sweet’. We consider this as developmentally appropriate until about 4 ½ years of age. A child will tend to grow out of this after this age and often the growth of adult teeth will help push the tongue back behind the teeth where it should be for ‘s’ production.

2) Dentalised Lisp – this occurs when the tongue is actually pushing against the front teeth rather than fully poking out and again this is considered normal until about 4 ½ years of age.

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The following two types of lisp are not part of typical speech development and are more likely to require work with a speech and language therapist:

1) Lateral lisp: This occurs when the tongue position is more like that required to produce a ‘l’ sound and instead of the air flowing down the groove in the middle of the tongue it escapes round the sides of the tongue. This produces something a little bit like the ‘ll’ sound used in the Welsh language and is often referred to as a ‘slushy s’. This is not considered as a normal part of typical speech development and a child would need to see a speech and language therapist to have this assessed and treated.

2) Palatal lisp: For this error the middle part of the tongue is in contact much further back in the mouth, roughly where the soft palate, is and can sound a bit like the child is producing a ‘h’ quickly followed by a ‘y’ sound. Again this is not a normal feature of speech development and would require assessment and possibly therapy.

I think my child has a lisp, what should I do?

As I’ve already mentioned we would consider an interdental or dentalised lisp as developmentally appropriate up until a certain age and we would not think about giving therapy for this before that age. In fact there is some debate in the field about what age a lisp should be considered as no longer age-appropriate. Some therapists say therapy should start soon after about 4 ½ years as long as the child is considered ready for therapy. Factors such as the child’s attention and listening skills, ability to understand and follow instructions and whether they can produce the sound on its own should all be taken into consideration.

Other therapists feel it’s best to wait until the age of about 7 or 8 as some research suggests that within the typical range of development the ‘s’ sound can take until that age to be fully mastered in some children. I personally feel it’s good to aim to seek help sooner rather than later, as the later you leave it the harder it is to change the engrained pattern of speech production.

Another really important factor to consider in when to give therapy is how much it is affecting the child’s self-esteem or ability to socialise with others. Some children are blissfully unaware of their lisp and have never had others make negative comments. Other children can be acutely aware and may have experienced some unintentionally hurtful comments from other children (and adults!). The emotional impact of having a lisp should always be put into the mix when making this decision.

Lastly a child’s motivation to work on their speech is also crucial. It would be up to you and the therapist to judge whether your child actually wants to change the way they say ‘s’ or not. Sometimes its best to wait until your child is fully motivated to do this rather than clashing in a battle of wills which risks completely switching them off from speech work forever!

With regard to the lateral and palatal lisps it’s wise to seek help as early as possible. A therapist would be able to assess your child’s speech sound system as a whole to see if there are any other causes for concern and would work on ways of getting your child to be able to produce the ‘s’ sound accurately on its on (before attempting it in words).

Can I do anything to help?

It’s best to seek help at any age if you suspect your child has a lateral or palatal lisp, or if you’re not sure it may be helpful to get this checked out. If your child has an interdental or dental lisp then there are some things you can try at home, bearing in mind that until the age of 4 ½ years we would consider this not to be a huge cause for concern. After this age, you could contact a therapist and this will help you work out whether it’s the right time to start therapy for your child.

• With children younger than 4 ½ try to avoid overtly correct their ‘s’ errors. Instead just model back the sound or word in the correct way so if they say ‘Look, my thock’ you say ‘Yes it’s your sssock’. Do not expect them to repeat back what you have said; it’s very helpful for them to just to hear the correct sound production modelled back for them (as it is with all speech sounds).
• If your child is about 4 ½ years old or more then have a think about whether it’s a good idea to talk to them about their speech. You are the expert in your child and so only you can make this decision initially. You could chat generally about how we use our mouths to make sounds and look in the mirror together to see how you both make all the different sounds.
• Talk about how you make the ‘s’ sound.  You could say ‘put your tongue behind your teeth, close your teeth by biting down, then smile and blow out’. Sounds complicated but practice this on yourself in the mirror before trying it with your child!
• If you want to see if your child can make an accurate ‘s’ there is a trick that therapists will often use which is asking your child to say ‘t t t t t ‘ as fast as they can. If done fast enough this naturally turns into a ‘s’ sound. Starting with the ‘t’ production in this way gets the tongue tip behind the teeth where it should be. Practice this yourself before sharing it with your child.
• You could talk about the tongue as ‘Mr. Tongue’ and his house is the child’s mouth. Play games where you and your child poke your tongue in and out in front of the mirror and talk about whether Mr. Tongue is safely in his house or has escaped outside. Once this idea is established and your child has built up an awareness of their tongue being in or out, you can use this as a prompt to remind them to us their new ‘s’ sound e.g. ‘Well done you kept Mr. Tongue in his house!’ or ‘Let’s try that sound again with Mr. Tongue back in his house, he escaped that time!’.
• Try using a picture of a snake or a toy snake to represent the new ‘s’ sound. As speech sounds are quite an abstracts thing to think about children often need something visual to support their understanding of what they are working on.

A speech and language therapist will always work in clear and small steps with speech sound work, so that’s why it’s best to seek help. We will start with a child’s ability to say the sound on its own, then with a vowel in little nonsense words like ‘soo’, ‘see’, ‘sah’. Once a child can smoothly blend the ‘s’ followed by the vowel we move onto words beginning with ‘s’ followed by a vowel (sun, sea, soup, sit). Once these are accurate we move onto saying ‘s’ words in phrases, then sentences and eventually in connected, spontaneous speech. These steps would be repeated for ‘s’ in the middle and at the end of words. A child won’t be able to go from saying the sound in isolation to generalising it into everyday speech without the steps in between, so bear this in mind!

Some other issues to consider:

Understandably parents do get very concerned about lisps but it’s extremely important to realise that children must have age appropriate abilities in a while range of skills associated with speech, language and communication. These include:

• Attention and listening skills (the ability to listen and pay attention to spoken information)
• Play skills (whether a child is using pretend play actions like feeding teddy)
• Social skills (things like eye contact, ability to initiate communication with others, turn taking, ability to have successful conversations with others)
• Understanding of language (receptive language skills – what types of words or spoken instructions a child can understand and follow)
• Expressive Language (talking – the words and sentences a child can say)
• Speech (pronunciation – the sounds a child is using when they talk)

Often it’s the last two skills – expressive language and speech sounds  – that parents will notice as we can actually hear if a child is not saying as much as they should do for their age or if their speech is difficult to understand. However, a speech and language therapist will want to check if all the other skills listed before these are also as they should be.

What is considered typical in speech and language development?

Like with most things there is a wide range of what is considered typical with speech and language development. It’s wise for parents to check out what is expected for a child’s particular age.

It’s essential that parents are aware that children who have a good foundation in talking and listening skills are more likely to grow up to make friends easily, do well at school, stay out of trouble with the law and thrive in the workplace. In fact, the amount of words a child can use and understand at the age of 5 is a very strong predictor of the qualifications that child will achieve at school leaving age and beyond.

The good news is that we now know that what parents do at home with their children is more important to later language skills than anything to do with their income, education, class or ethnic background. Parents are the key to unlocking their child’s talking talents and it’s never too early or late to start.

The way you play, talk and interact with your child has a real impact on how their speech and language develops. And it’s this idea that has led me to devising a range of videos to equip parents with the tools to help their child reach their full communication potential.

Small changes in how you communicate can make big changes in how your child communicates! Words are free – but they’re also priceless!

By Fiona Barry, Talking Tips For Kids

For more information on Fiona and her work visit www.TalkingTipsForKids.com or Twitter @TalkTipsForKids

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