The lateral S can come from a combination of oral motor and instability elsewhere in the body. The jaw will deviate. The middle of the tongue is often used to stabilize instead of the trunk or core. They’ve been building a neural neighborhood that says “SLSHHH” instead of “SSS”. Every time they reinforce that position, the stronger the connection. The SLP that has had enough will go to extremes to clean it up.
We use our knowledge of neurology. (Bet you thought I was going to mention peanut butter and tongue wagging). We know that mirror neurons are activated when the child sees/hears us produce the sound- even if they are not making the sound there is ACTIVATION. Where there is neural activation, there is the beginning of a neural connection that we are going to hijack for that skinny S. The more correct productions result in activation spikes which carry down the synapse to the dendrites which connect with other neurons and more connections are created. We build a new neural neighborhood.
We are going to use the main concept in every motor/muscle based regimen the world over and require PERFECT PRACTICE.
We are going to get the sound established so we can do the perfect practice.
We will use dynamic systems theory and utilize any underlying systems that are related: the swallow pattern and hearing history. We'll activate core and trunk stability, systems that support the jaw and tongue working independently of each other.
We will provide support on the side of jaw deviation when eliciting the sound.
We may make a snack hat and give the kid symmetry and resistive movement when practicing.
We may place straws to the labial frenum to get that tongue to follow the straw movement for perfect S placement on the alveolar ridge.
We may need to address that swallow pattern if we can’t get the correct placement.
We will use diagnostic treatment to determine if the kid is a bottom S and need to change tactics. We will use diagnostic treatment so the treatment is most appropriate.
We will use pop rocks and alert the oral motor system that this is what VERTICAL feels like. We will use the pop rock placement as a cue for placement.
We will amplify sound and bombard that auditory system with the correct sound.
We may put kids on therapy balls, anything that activates the core, while producing the sound. Activating the core facilitates jaw/tongue differentiation and supports the stability for the S without too much verbal instruction.
We will use the midline (because-corpus callosum) to our advantage and have kids cross midline to promote the blending and elongation of the S. This can be swinging the arm across midline while speaking or talking and moving a sticker to the other side of a paper. It may be puppets with a big attitude. We are creative after all. We know that the more interesting we can be, the more acetylcholine is released and this is the glue that makes learning stick.
Practice must be perfect. It must be individualized for each child.
Family is the biggest part of this entire process. Parent coaching is key. Parents and child must be empowered.
This sound can take forever to correct if the underlying systems aren’t incorporated to support the correct placement and production. But we are the communication specialists. We get that sound. The family does their part. We get a neural neighborhood with a skinny S. Years later, the child vaguely remembers speech therapy with a lady with crazy hair and ridiculous puppets. WE know that incorporated in all those fun activities was science from our field and others that created that effortless neural neighborhood.