4½ to 5
My experience has been that if you can intervene early, soon after 4½ years of age, the probability of reasonably quick success is enhanced.

Marianne
Marianne, a school-based SLP in America, prompted me to realise that  this statement requires some explanation! 

I have a question - as a school-based SLP, I often have cases where remediation of a lisp takes a LONG time - maybe two school years for a few kids. I almost printed out your page to show a parent, but the note about lisp remediation being quick just doesn't work for me. I find that so many kids cannot remediate a lisp until grade 2-3 with a lot of success. When we start them too young, I don't believe the majority of them are ready. Do you have any data on what age you recommend to start? Marianne, SLP

In my particular work situation, and with my particular caseload, the children I see are referred YOUNG. The children I take onto my caseload are referred for the full range speech and language delays and disorders. Mostly I first see them (for initial consultation) as two, three or four year olds. What this means is that I am in a perfect position to "watch and wait" for readiness, and to provide therapy for their lisps, if indicated, at the earliest opportunity.  Within the population that I see, a small number of children are referred simply because they lisp.

Drawing on my clinical observations of the children on my caseload:

1. if intervention begins between 4½ and 5, and
2. if the child is co-operative and interested, and 
3. if caregivers follow up conscientiously with regular, enjoyable (for the child) homework (5 minutes, two or three times a day)

a good 75% of the children's lisps will resolve with about 10 x 40 minute therapy sessions plus homework. 

The remaining 25% includes:

1. children who need more therapy (up to 20 x 40 minute therapy sessions - occasionally even more); 
2. children whose lisps resolve and then return - so that they require another burst of therapy; and of course, 
3. children whose lisps do not get better. 

Success and failure
In relation to the sub-group that do not get better, there is probably no treatment for any disorder or disability that does not have a "failure rate" as well as a "success rate". The children whose lisps do not get better include 

1. those who drop out of therapy, 

2. those who do not practice between therapy sessions, and 

3. the ones who seem impossible (for me) to motivate.

Priorities
Therapy for lisping may not be a priority for some 4½ to 5 year olds. Included in this population may be children with more complex speech sound disorders, children with specific language impairments, or those with significant difficulties with fluency. Attention to lisping may be deferred while these more pressing issues take precedence.

Readiness
Some children, whose only speech problem is lisping, are not ready for direct work on their lisps at 4½ to 5. When they are assessed in the SLP's "clinical judgement" it is apparent that immediate intervention is not appropriate. 

I have deferred treatment with this "immature" or "unready" or "unmotivated" group to around 7 or 7½ - by which time most of them will respond favourably to therapy, though, again it must be said, there is the inevitable failure rate.

Evidence-based practice
I am in the fortunate position, in most instances, in consultation with parents, of being able to continue treatment until I think it is time to stop. 

This freedom to apply the principles of evidence based practice, and to administer therapy according to what I believe is "optimal" for each individual child, is a privilege that not all SLPs enjoy. Speech pathologists, for example, working in remote areas, providing therapy on a consultative basis, or constrained by bureaucracies, may not always be free to provide services in exactly the way they would wish.

Feedback from other SLPs
Colleagues working in very different settings from my own have commented on this article raising important issues relating to the way the nature of our caseloads, workplaces and work practices can influence our experience of different communication disorders.

Mary
Mary, an SLP in the school system in the US, wrote:

I find it interesting that lisping is such a topic of major discussion!!! We don't even pick those kids up in our school district anymore unless it happens to be part of a more involved articulation disorder. And I'm dismissing my last one as soon as possible as he's completely corrected. Great first grader! Mary, SLP

I asked Mary to elaborate, and she explained the situation where she is in Texas:

Your lisping page is really excellent. The thing I like the most is that even the lay person can understand it. Makes me nuts when professionals lord their knowledge over others by using too much professional jargon. 

Anyway, on to your question: I'm in Texas, in the good ol' USA. 

We who are in the public schools are considered academic personnel and work with kids toward academic goals. Children who are placed in speech therapy are considered to be special education students with everything that goes with being special education in this country. 

When we go to an IEP meeting we must answer the question, "In what way does this disability impact the educational progress of this child?"  There must be an educational need. After all, if the government is going to provide money to the district for a special
education service there must be an academic reason for the service to be provided. 

It's virtually impossible to show how a lisp in and of itself impacts academic success. 

Now, if the lisp is one of three or more error phonemes that are impacting intelligibility (per the eligibility criteria in this district which we worked on for almost two years) and therefore possibly spelling and reading, then we can show cause to place them in special education (and therefore ask for funding!). 

We also use developmental criteria. We must service children in special education from the ages of 3 through 21. If a three year old is referred with t/k, th/s, p/f and such errors as those, then the child is considered developmentally appropriate. We do have young children with severe phonological processing disorders or apraxia who receive therapy, but we do not pick up preschoolers in this school district for simple developmental speech errors. [s] is a late developing phoneme on the scale anyway. 

It's not that I personally think kids with lisps shouldn't have therapy...it's that we can't justify it in the public school arena. Therefore, if the parents really want the help they must do so privately.

(BTW I'm not only the speech therapist in my school but the special education coordinator there and I also do helping teacher and content mastery besides speech and language therapy).

I have frequently heard clinicians state that a child with a mild articulation disorder doesn't qualify for services unless intelligibility is a significant factor, and also because it's not "educationally relevant," as stated in IDEA.  I totally disagree with this!  

A child's ability to communicate certainly impacts his / her education.  I realize it's difficult to assess the impact of an  articulation disorder (such as a lisp) on a child's education, but we have to consider the possibility that the child might be VERY aware of his / her deviant speech pattern and might not be fully participating in the classroom as normally developing children.  

IDEA states that we must consider academic and non-academic areas in determining qualification for special services.  Therefore, SLPs need to be more vigilant in gathering data from teachers AND parents regarding a child's communication behavior in all settings.  

It just seems too easy (and unfortunate) to ignore a child like this because he / she is just "shy" or because developmental norms say we shouldn't target that phoneme until age 7.  

What happened to early intervention?  

After receiving therapy in public school myself as a child, I'm appalled to learn that the very professionals I chose to join would snub me if I were a child in elementary school today. Julie

Carolyn
Carolyn from South Australia:

Dear Caroline

I am responding to the therapist who described lispers as being 'snubbed' in schools by our profession .  I work in two workplaces - consultative speech pathology services in schools in South Australia, and in private practice.  

Speech pathologists working in SA schools and preschools do not usually work on lisps because they are considered a mild communication difficulty.  This is not because we do not want to or because we think there is no impact from the lisp on the individual child.  

Our reality is that the demand for services in schools and preschools is huge relative to our actual staffing levels, and in order to provide quality services to those children and teachers that we DO work with, we must actually allow sufficient time to provide a professional and ethical level of service.  The bottom line then is that we cannot see all children, and if we are to make a decision about who we will work with, it is generally in favour of the child whose education is most disadvantaged by their communication difficulty.  For us, this means working with children who have severe communication impairment.  

If we said yes to all the others, including lisps, our service would be completely ineffective and a waste of time for all concerned.  We are faced with saying "No" to large numbers of children, parents and sites everyday.  

Please don't accuse us of not caring, but acknowledge the real issue - huge gaps in services!  Carolyn

Connie
Connie from Ohio

Hello, I am also an SLP in the public schools.  I wanted to comment also on the "snubbing" issue of children with lisps.  

I agree with the previous writer, that with our caseloads, we do have to show that it is educationally relevant to provide services to a child that lisps.  If it is a typical frontal lisp, it very rarely interferes with their education and that is our goal as SLP's within the school setting....their education.  

I left the schools 7 years ago and returned this year.  I was very surprised to see that 95% of my caseload is language disorders.  It's not a "snub" issue, it's a survival issue.  

You could also say the same about all of the distorted "r" sounds that are within the public schools.  Connie

There is more discussion about children's speech sound disorders here. 

Page updated 04 Feb 2010

http://www.speech-language-therapy.com/lisptx.htm