Jj is for Jottings 139.  Speech Sound Problems:/s/.

Probably one of the first sounds that springs to mind when one thinks of speech sound problems would be /s/ and, more specifically, a lisp.  (Remember that the slashes / / mean that we pronounce the sound; ‘s‘ or s means to say the letter name.  I think I may have done both at some point.  Certainly it is underlined in Aa is for Alpacas.)

The word “lisp” generally refers to the tongue tip protruding between the teeth for /s,z/.  (Note that /s,z/ are minimal pairs, and therefore have the same error. For the sake of ease I shall refer to just /s/ from now on, but remember that what refers to /s/ also refers to /z/.)   Some definitions of a lisp are much broader, and refer to any speech sound problem involving any or all sibilant sounds.  Since this is cause for confusion, I am not going to use the term “lisp” at all.  This particular /s/ problem is called an interdental /s/.  “Inter” means “between”, and of course “dental” means “teeth”, so there can be no confusion about what it is.

DIFFERENT KINDS OF /S/ SOUND PROBLEMS.

The two most commonly observed /s/ errors are the interdental /s/ and the lateral /s/.  There are also dentalised /s/, which is actually a lesser version of the interdental /s/, and palatal /s/.  Let’s deal with each type in turn.

The Interdental /s/.

As described above, this sound is a result of the tongue tip sitting between the front teeth rather than behind them.  Developmentally, it is quite normal to have the tongue in this position for /s/ up to a certain age.  There is a tongue thrust reflex in infants which assists with breast and bottle feeding. This should last for 5-6 months and can protect the baby from choking.  As you will see from this article on correcting your child’s speech, children can still have difficulty with /s/ at 5 years and beyond.

Since an interdental /s/ is part of normal development, it does make it a bit more difficult to gauge whether and when therapy will be necessary.  Statistics and opinions vary, but I usually consider that about 6 ½ years is a good time to think about addressing an interdental /s/.  Some children need more time, and others can cope with it earlier.  And of course many children never display an interdental /s/ at all.  You just have to sample it to see how readily a child is capable of producing a correct sound.  If you can stimulate the sound (i.e. find a way in which that particular child can produce the sound correctly and without too much difficulty), then you can begin therapy.  If not, you may need to wait a few months and try again.

The forward tongue pattern can also affect /sh,ʒ [the sound in the middle of “measure”]/, /ch,j/, /t,d,n,l/.  It may or may not be accompanied by a tongue thrust swallow.

An interdental /s/ is not all that bad.

An interdental /s/ doesn’t interfere too much with speech intelligibility so it couldn’t be considered a severe speech sound problem.  But it can still have a marked effect on a person’s confidence. This was brought home to me clearly when I was still a student.  I met a school friend on the train one day, whom I hadn’t seen since school.  She had a marked interdental /s/, but it didn’t seem to impede her in any way at school.  She was bright, vivacious, talkative, lovely.  Knowing I was studying speech pathology, she urged me to tell her that she didn’t have a lisp, did she?  Clearly it bothered her a great deal.  I told her gently that she did (which of course she knew perfectly well), and then her feelings about the lisp and its effects on her came pouring out.

Even mild sound errors can interfere with learning sound-letter links.  In this case it can cause confusion between /s/ and /th/.

Speech sound problems with /s/.  Now there’s an interdental /s/!

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The Dentalised /s/.

This is when the tongue is too far forward and touching the teeth, but not between the teeth. It is more subtle than the interdental /s/, both in appearance and sound, and many people would be unaware of it.  If you do decide to remediate it, it is much more difficult for therapist, parents and child.  This is because it is harder to hear the difference the error and the correct sound.  It is also more difficult for the child to make the finer adjustments between tongue placement for the error sound and the correct sound.

The Palatal /s/.

I suspect that there may even be some speech pathologists who are not aware of this sound.  Instead of using the tongue tip to make the /s/ sound, the child is using the blade – i.e. the middle – of the tongue against the middle of the roof of the mouth.  So the whole operation is taking place further back in the mouth, resulting in a different sound quality.  It is uncommon and quite difficult to remediate, and that’s probably all I need to say.

The Lateral /s/.

“Lateral” means “side”.  A lateral /s/ occurs when the child sends the air out the side/s of the mouth rather than straight down the middle.  Unlike the interdental /s/, this not part of normal development and is therefore unlikely to correct itself over time.  The airstream can come out to the right, to the left, or both.  It can be way round to the side or just a little off centre.  The further round to the side it is, the more obvious the sound error.  A lateral /s/ sounds slushy.

To find out exactly where the air is coming out, have the child say a very long /s/ as you run a straw slowly around their lower lip.  When you hear the airstream coming down the straw, you’ve located the position of the lateral /s/.  (Of course it should be coming straight down the middle!)  This can be really useful during therapy, as a clear indicator of where the airstream is and what adjustments to make. But the downside of that is that the air turbulence coming down the straw masks the quality of the target sound.  So it is only really useful when establishing the new sound.

Developmental Readiness.

Developmental readiness is important, as always.  I have found that you may have to wait longer for a child to be ready for therapy for lateral /s/.  I suspect this is partly because there is not much difference in the appearance of a person producing a lateral /s/.  Unless they pull the side of their mouth down, which sometimes happens, you can’t see a lateral /s/, but you can see an interdental one.  So therapy for lateral /s/ happens by listening only, which makes it more difficult compared with being able to use visual cues.

As for the interdental /s/, lateral /s/ may occur just as a problem with /s,z/, or accompanied by lateral affect /sh,ʒ [the sound in the middle of “measure”]/, /ch,j/.

A developmental readiness story.

I had a perfect example of readiness for lateral remediation many years ago.  A child transferred from a clinic in another part of the state because her family had relocated.  All the above sounds were lateral, and therapy had been unsuccessful.  She was in late primary school by the time she came to me, and we fixed the lot in about six therapy sessions.  Her parents kept saying what a wonderful therapist I was, and that they weren’t impressed with the previous therapist.  I kept saying that wasn’t fair, the child probably just wasn’t ready before, and the time between previous therapy and getting to see me was just the time she needed to become ready.  I don’t think I managed to convince them, though.

CAUSES OF /S/ SOUND PROBLEMS.

Interdental/Dentalised /s/.

You don’t always know the cause.  There could be anatomical factors, such as a large tongue or a narrow palate; a thumb-sucking habit which encourages a forward tongue position.  It could be that the infant tongue thrust reflex is still hanging around.  I suspect that children who have a dummy for several years are likely to retain a forward tongue habit. And I have seen children with such huge tonsils, they were like pillows at the back of the mouth pushing the tongue forward.  It isn’t always necessary to know the cause, but sometimes it can be helpful for making decisions about therapy.

Lateral /s/.

Once again, we often can’t find the cause – maybe just a bad tongue placement habit.  However, I am fairly sure that children who are allowed to talk with a dummy in their mouth are at risk.  I have seen this on a number of occasions.  It stands to reason: /s/ has the airstream coming straight down the middle.  The dummy impedes the central airflow and sends it around the dummy, and therefore out the side/s of the mouth.  That’s the only way the air can get out.  Voilà – a lateral /s,z/ and maybe the other sounds, too.

A BRIEF NOTE ON THERAPY  FOR /S/ SOUND PROBLEMS.

You would think that therapy for any one type of /s/ sound error would be pretty standard across all children. Treat one interdental /s/ and then rinse and repeat for all others.  Wrong.  There are almost as many variations as there are children.  In some cases it is easy for the child to imitate the correct sound; in others the therapist must try several different strategies to get a good sound.  Most children can achieve a perfect /s/; some can never quite get it perfect.  Here are some common strategies for achieving a good /s/.  If these don’t work one has to get very creative and fiddle around to find a way for that particular child to achieve the sound.  (Remember that s isn’t the only letter which makes /s/.  There is also soft ‘c’.)

• Teach from /ts/. The /t/ places the tongue behind the front teeth in the correct position (as long as it doesn’t slip forward when the /s/ part comes).  If a child can do it this way, the therapy path is quite easy.  You dispense with the /t/ crutch (that’s what I call it) when they are ready.  Obviously this doesn’t work if the child also has interdental /t,d,n,l/.  That makes it really tricky.
• Be a steam train coming into the station: t-t-t-t-t-t-t-t and slowing down to the final hiss of steam tsssssssss.
• Say t-t-t-t-t-t as quickly as possible, so they run together. It’s a variation on the steam train, but sometimes one works and the other doesn’t.
• Put a dab of yeast extract behind the top front teeth for the child to place their tongue tip correctly.

Some children find that putting their tongue up behind their top front teeth doesn’t work for them.  They may achieve /s/ more comfortably with their tongue tip behind their lower front teeth, with the blade of the tongue behind their top front teeth.  That is how I produce /s/.  In this case you would put the yeast extract behind the lower teeth.  Speech therapy is more complex than it looks!

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