What is a lisp?
A lisp is a
Functional
Speech Disorder (FSD). A functional speech disorder is a
difficulty learning to make a specific speech sound, or a few
specific speech sounds.
The word 'functional' means that the cause of the
disorder is not known. Indeed, in some (recent) literature FSDs
are referred to as "speech delay of unknown origin" or
"speech disorder of unknown origin".
Functional speech disorders,
or speech delays of unknown origin, may persist into adolescence and adulthood
as "residual errors". They can be
treated successfully in motivated children and adults.
Historically,
FSDs were referred to as "dyslalia" and within that category,
difficulty saying /s/ and /z/ was called "sigmatism".
Where does
the problem lie?
The speech
difficulty in a child with a functional speech disorder is probably at a phonetic
level: that is, the child has a particular difficulty producing certain
sounds
correctly. Alternatively, the child has learned to say a sound, or
sounds, the wrong way, and the incorrect pronunciation has become a habit.
This is different from the
situation of children with
developmental
phonological disorders who can usually make the individual
speech sounds, or be taught to reasonably easily, but have difficulties
organising their speech sounds into patterns. In these children
phonological
processes persist beyond typical age
expectations.
Functional
speech disorders are speech disorders, while developmental
phonological disorders are linguistic (language) disorders.
Co-occurrence
Functional speech
disorders and developmental phonological disorders can co-exist, so
you might find a child with a developmental phonological disorder who also
lisps. In other words, and rather more technically, phonetic and phonemic
speech sound deviations can occur in the same individual.
A 'lay'
term
Problems
saying 's', 'z, 'r', 'l' and 'th' are common in functional speech disorders.
If they use it at all, speech-language
pathologists usually use the lay term "lisp" to refer to a
difficulty achieving the correct tongue position when pronouncing the /s/
and /z/ sounds.
Characteristics
of lisping
Typically,
when a person lisps their tongue either protrudes between, or touches,
their front teeth and the sound they make is more like a 'th' than a /s/
or /z/.
Protruding
the tongue between the front teeth while attempting /s/ or /z/ is referred
to as 'interdental' production, and touching the front teeth with the
tongue while attempting to produce /s/ or /z/ is called 'dentalised'
production.
There
are two other types of lisp: the lateral lisp, and the palatal lisp. In a
lateral lisp the person produces the 's' and 'z' sounds with the air
escaping over the sides of the tongue, while in a palatal lisp they
attempt to make the sounds with the tongue in contact with the
palate.
The
four types of lisp are described
in more detail below.
Is a lisp
ever 'normal'?
It is a perfectly normal
developmental phase for some (not all) children to produce interdental or dentalised
/s/ and /z/ sounds until they are about 4½ years of age.
There are age
norms
here.
On
the other hand, neither lateral or
palatal lisps are part of
the normal developmental progression. The speech of a child with a lateral
or palatal lisp should be assessed, by a speech-language pathologist,
without delay.
Intelligibility
Lisping, as an isolated speech
characteristic, does not usually reduce the person's
intelligibility
unduly.
Most people can easily understand what the person with a lisp is
saying.
Image
While
there is usually little impact on intelligibility, the impact of a lisp on
a child's "image" can be quite powerful. Of course, some
children grow up in an environment where their lisp goes unnoticed, or
where it is not regarded as cause for concern. Other children gain
positive recognition because they lisp, particularly when the lisp is
regarded as sweet, funny, or endearing. By contrast, others face
criticism, ridicule, nagging and teasing.
Grow up now
Sometimes
children's lisps are regarded as cute until they reach a certain age at
which time the same adults who have almost been encouraging them to lisp
decide abruptly that it is high time they "grew out of it". I
have often wondered what it can be like for four and five year olds in
this situation.
Four types of
lisp
1.
Interdental (frontal) lisp
In an interdental lisp
(or frontal lisp) the tongue protrudes between the front teeth and the
air-flow is directed forwards. The /s/ and /z/ sound like 'th'.
Children
developing speech along typical lines may have interdental lisps until
they are about 4½
- after which they disappear. If they don't 'disappear' an SLP assessment
is indicated.
Interdental
/s/
Words
such as 'soup', 'missing' and 'pass', which all contain the voiceless
alveolar fricative consonant /s/ are pronounced 'thoop', 'mithing' and
'path'. The voiceless 'th' sound that occurs in a word like 'thing' (or a
sound very much like it) replaces the /s/.
Interdental
/z/
Words
like 'zoo', 'easy' and 'buzz' which all contain the voiced alveolar
fricative consonant /z/ are pronounced 'thoo', 'eethee' and 'buth'. The
voiced 'th' sound that occurs in a word like 'them' (or a sound very much
like it) replaces the /z/.
2.
'Dentalised lisp'
'Dentalised lisp' is
not an 'official' diagnostic term. It is an expression (like 'dentalised
production') that SLPs use to describe the way an individual is producing
certain sounds. The tongue rests on, or pushes against, the front teeth, the
air-flow is directed forwards, producing a slightly muffled sound.
Typically developing children (in terms of their speech) may produce
dentalised variants of /s/ and /z/ until around 4½
years - and then grow out of it. If they don't grow out of it, an SLP
assessment is indicated.
3.
Lateral lisp
Lateral lisps are not
found in typical speech development. The tongue position for a lateral
lisp is very close to the normal position for /l/ and the sound is made
with the air-flow directed over the sides of the tongue. Because of the
way it sounds, this sort of lisp is sometimes referred to as a 'slushy
ess' or a 'slushy lisp'. A lateral lisp often sounds 'wet' or 'spitty'.
Unlike
interdental and dentalised lisps, lateral lisps are not characteristic of
normal development. An SLP assessment is indicated for anyone with a
lateral lisp.
4.
Palatal lisp
Palatal lisps are not
found in typical speech development. Here, the mid-section of the tongue
comes in contact with the soft palate, quite far back. If you try to
produce a /ç/ - or a 'h' closely followed by a 'y', and prolong it, you
more or less have the sound.
Unlike
interdental and dentalised lisps, palatal lisps are not characteristic of
normal development. An SLP assessment is indicated for anyone with a
palatal lisp.
'sh', 'zh', 'ch',
'j'
Sometimes
children and adults who lisp when they attempt to say /s/ and /z/ also
have tongue placement problems when they try to say 'sh' as in 'shoe', 'zh'
as in measure, 'ch' as in 'chair', and 'j' as in 'jump'.
They may
dentalise these sounds, or produce them interdentally, or produce them
with lateral air escape, or with excessive palate to tongue contact.
"...everything
seems interdental"
Some
children produce many sounds interdentally. Tongue protrusion, or very
'forward' or 'anterior' tongue placement may be observed when they say not only /s/,
/z/, 'sh', 'zh', 'ch' and 'j', but also /n/, /l/ and other sounds.
In some children "everything" seems interdental. This may
sometimes be an indication that the nose is constantly obstructed, due
for instance, to allergy, infection, large adenoids or
craniofacial anomalies,
or may be associated with habitual mouth breathing,
tongue thrust,
or sucking habits.
Waiting
Studies to confirm it
are unavailable as far as I know, but I think most SLPs would agree that
in their clinical experience there is a greater likelihood that children
will "grow out of" interdental or dentalised lisps than lateral
or palatal lisps.
I did a quick
Web search
and found a lot of advice about lisping on the web - some of it very
accurate and sensible. It worried me though, that many sites included the
advice to WAIT until a child is 7 or 8 years of age before becoming
concerned about lisping.
Waiting well
past 4½ is not good advice. The longer the child waits the stronger any
"habit factor" will be. It is true that some children are
not ready for therapy at 4½, but it is advisable to let a properly
qualified professional (SLP / SALT) provide guidance in relation to the
individual child, working on the results of face-to-face assessment.
The
"right" age for therapy for one child may be different from the
"right" age for another, even within the same family.
Referral and
assessment
Young
children
are usually referred for assessment of lisps by their parents or
caregivers, often on the advice of pre-school teachers.
It
is, of course, uncommon for SLPs to attempt to treat an interdental lisp,
or dentalised production of /s/ and /z/, in children under 4½
years of age, because it is regarded as normal for them to produce the
sounds that way. They may, however, be interested in assessing
children under 4½ who are reported to be lisping, in order to see whether
it is a lisp, and, if so, what type of lisp it is. Treatment for a
lateral or palatal lisp may be appropriate in children under 4½.
The
assessment process
Assessment
involves screening all areas of communicative function.
The SLP takes a detailed history, examines the anatomy of
the mouth and the movements it can make (checking for
tongue tie,
palate structure and function, swallowing patterns and so on),
takes a speech and language sample for analysis, and observes voice
quality, fluency, and semantic and
pragmatic skills skills.
Sometimes
it may emerge that although a child is having difficulty saying /s/ and
/z/, he or she is not actually lisping. These children may have some other
speech sound disorder.
Omitting
/s/ and /z/ (sun = un, tease = tee) or replacing them with consonants like
/w/ or /d/ (sun = wun, so = doe) are not forms of lisping. Children with
these sound replacements may be having phonological
difficulties.
Therapy
In
my own experience, and that of my immediate colleagues, therapy for
lisps in young children is usually short-term and successful. Opinions
vary among speech and language professionals with regard to how
difficult or easy it is to help a child to overcome a lisp, and how long
it will usually take.
Most
speech-language pathologists will use a "Traditional
Articulation Therapy"
approach, or variations of it (see Judith Duchan's site for an
interesting
history of its development).
Let's say that the client in the following example has an
interdental lisp. In essence, her therapy will be like this:
- We will determine that the client can
hear the difference between /s/ and 'th' as individual sounds, and in
words (e.g., sink / think).
- We will do some
auditory
bombardment or focused auditory
input. There are word lists and word contrasts
here
that could be used at this stage.
- Using tactile, auditory
and motoric cues we
will teach the client to make the new /s/ sound.
- We will choose a
word-position (let's say, for the sake of the example, that we choose
the initial position).
- Using motor cues we
teach the client to imitate and the produce independently /s/ in
isolation
- ... in broken syllables
(s-oo s-ee s-or s-ie s-oh...)
- …in syllables
(soo see sor sie soh...)
- …in words
(Sue see saw sigh sew...sun sip soap...)
- …in phrases
(so silly, send sam, seven seals)
- …in sentences
(I see a sock...)
- …in controlled
conversational contexts
(e.g., during dinner)
- …in conversation
- …phasing out modelling
and reinforcement
- ...and working towards
self-monitoring and self-correction.
At each step in the process
the client will practice under the supervision of an adult. Brief,
frequent practice periods work best.
There is a good description
of various approaches and techniques in this book:
Bernthal, J. E., Bankson, N.
W., & Flipsen, P., Jr. (2009). Articulation and Phonological
Disorders, 6th Ed. Boston, MA: Pearson Education.
LINK
The Butterfly
Procedure
Imagery and
the Butterfly Position
Adults who lisp
Functional
speech disorders, such as lisps, or difficulties saying /r/, /l/ or 'th'
can persist into adulthood, especially in people who "dropped
out" of therapy as children, or who did not receive treatment. 
No
prrroblem!
Some
adults who lisp have no desire to seek therapy and are happy to accept
their speech the way it is. There are many well known people (and and a
few cats) in public life, and some colourful characters
who have 'trade-mark' lisps as part of their
image or persona.
Frustration
But
there are also adults who lisp who are extremely unhappy about it. Some
send email (here
are just a few
examples)
expressing frustration, embarrassment, and feelings of low self esteem and
defeat. They often fear that it may be 'too late' to change their speech,
and many of them say that their lisp colours the way other people regard
them. It is quite common, for example, for teenage boys and young men to
tell me that people (incorrectly) assume that they are gay because they
lisp. Does that suggest that to you that gay men who don't lisp are
actually straight? I don't think so.
Me Talk Pretty One Day (Chapter 1) by David Sedaris
provides an astonishing insight into one person's experience of being
dragooned into "therapy" (for a lisp) in the fifth grade.
Essential reading for SLPs who work with children.
The
assessment process
Adults
who lisp, and who do want help generally seek the help of a speech-language pathologist on their
own behalf, often with the encouragement of a friend, family member, colleague or
partner.
Therapy
Therapy
for adults is along the same lines as therapy for children. Adults are
usually very motivated to practice, but they sometimes find it difficult
to find someone to help them with their "homework". It is vital
to have someone to "supervise" your practice, giving you
accurate feedback, and encouragement, just as a parent would working with
their own child.
Who can help?
The most effective way of managing a lisp is to seek the professional
services of a speech-language pathologist. Some adults like the idea
of a do-it-yourself program, but I have never actually heard of success
with one of these.
How
do I find an SLP?
There are links to help you find services
here.
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