It explains some things... (Calling for tongue-tie experts)

So here's the situation. Earlier this week I took the children to the dentist. She informed me that Michael has a mild-moderate tongue-tie. My mental response: Umm what? Are you sure? How on earth could I have possibly missed that!!! Did you make that determination based upon physical examination or behaviors?

I wasn't present for his examination because they accidentally scheduled the children at the same time and I was busy with Ava keeping her very overloaded sensory system calmed down just enough to get a little cleaning in through holding her in my lap, trying to simultaneously cover her ears and hold her hands, and singing soothing songs. But that's another story and I digress.

I knew Michael can't raise his tongue on command and that he can't stick it out very well. When you ask him to stick his tongue out he can get it out, but it curls down and sticks to the outside of his lower lip. He cannot stick it out forward at all. He can't raise it at all. I had always assumed that that was part of the same motor-planning spectrum that I've become so familiar with in Ava - or possibly a weakness issue. Well, look at where assumptions get you.

When we got home, I grabbed a clean cloth and pried up his tongue. Sure enough, you can't get it up very far and his lingual frenulum extends pretty far towards the tip of his tongue. On top of that, the lingual frenulum doesn't stretch at all and therefore even with some gentle manual pulling you can't get a lot of distance between the tongue and the bottom of his mouth. On top of that, he cannot get any upward curl of the tip of his tongue at all.

Let's summarize. Michael does appear to have a mild-moderate physical tongue tie. He has speech problems with /f, v, s, z, and th/. He produces all of those sounds as an interdental /s/ that is produced auditorily as a nice sharp /s/ sound. So, his /s/ sounds sound fine but are produced "incorrectly" and his /th/ sounds are produced with proper placement but sound like an /s/. He can, however, produce /t, d, and l/ just fine and those involve alveolar placement.

So here's my question for anyone out there who wants to chime in with an opinion. Given that he can produce /t, d, and l/ is it likely that the tongue-tie is the issue with the other speech errors? If there is no functional consequence of the tongue-tie I'm reluctant to have it clipped. However, if it is likely that the tongue-tie is impacting his speech errors, even in part, getting it clipped seems like an option to consider.

I already have a pediatrician appointment set up for Friday to discuss Michael's chronic mouth-breathing and nasal congestion and I intend to get her opinion about the tongue-tie issue then. However, she's not a speech-path so her opinion on whether it is effecting his speech isn't going to be an expert one. She's more the person to offer information and pros and cons on the procedure itself.

Thoughts and opinions from SLPs with some experience with tongue-tie? Please. :-) I tried to get some pictures for reference, but it was tricky. I had to try to manipulate his tongue with my left hand while taking the picture one-handed with my right. I apologize for the picture quality.

The first picture is what he does if you just instruct him to stick his tongue out.

The second picture is what he can do if you model sticking the tongue straight out without letting it curl downward.

The third is his attempt to curl his tongue up. He tilts his entire head backward and tries to push it up with his bottom lip and bottom jaw.

The fourth picture is my attempt to get an actual picture of his lingual frenulum.

Speech Card Set Activity: Magnetic Speech Cards

As the next installment in my quest to slow the kids down so I can focus on quality s-blend productions I decided to make some of our /s/ blend cards into magnetic cards.

It took me a good half hour to get the magnetic speech cards ready. I printed two copies of my chosen card set and put purple dot stickers on one set and green dot stickers on the other set. I had 22 cards total. Then I cut 22 rectangles out of a cardboard box. The rectangles were slightly bigger than the speech cards. I taped two jumbo paper clips onto each piece of cardboard and then taped the speech cards over the paper clips. Voila. Now I had a speech card set that would attract to magnetic wands. (You could get the same effect by just putting staples or paperclips onto the plain cards, but they wouldn't be as durable.) This is my set when I was finished.

I played several games with the kids. First I just put all the cards face down in a pile and mixed them up. I told Michael that the green ones were his and Ava that the purple ones were hers. They fished one out of the pile with their magnet wand and said the word for me. They got to keep the card if it was their color and had to put it back in the pile if it was not their color. They continued to take turns until all the cards had been distributed. This worked really well. The kids liked playing with their cards while the other child took their turn. Michael lined all of his up in a row to display them with pride.

Next we played a memory game with the cards. The kids liked the novelty of playing memory with magnetic cards and so they were very engaged.

As one last game we piled all the cards in the middle again. They took turns trying to fish out as many cards as possible at one time with their wand. Michael managed to get six at once on one of his tries. They would then pull them off, count them, and say each word they had "caught".

One activity we didn't get to, but I intend to try soon is to bury the cards in a bin filled with rice, beans, or dried pasta and then try to fish them out using the magnetic wands. I think they'll really enjoy that one too.



If you liked this card set activity you might also like:

• 10 Card Set Game and Activity Ideas
• Simple Speech Card Puzzles
• Speech Card Stories
• Speech Card Caterpillar
• Speech Card Game: What's Hiding?
• Speech Card Game: Speech Switcheroo (An Uno-Style Game)

Initial /s/ Homework Booklet: Free Speech Therapy Articulation Picture Book

Initial /s/ Homework Booklet

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock for durability.

Description

This articulation homework booklet is designed to be an extension of my single-syllable card sets. The target words are all CV or CVC in syllable shape and include no blends or vocalic /r/ sounds. This booklet is designed to be read by a parent (or therapist, older sibling, classmate, teacher...) and child together. The child should be familiar with the target therapy words/pictures from working with the initial /s/ card set. The helper reads the typewritten words pausing for the child to "read" the picture words. Each time the book is read, the helper can put a sticker/stamp/checkmark in one of the boxes on the front of the book. This will encourage multiple practice readings. The child's fluency should increase with each repeated reading. The words on the back page can be used for either auditory bombardment before reading the book together or for drill after finishing reading the book (or both). The target audience for these cards are children with severe speech delays who are ready to practice initial /s/ sound in a more natural context. Move to these exercises to add complexity and increase generalization after the child has achieved good accuracy with single word, single word repetitions, and simple alternating single words with the initial /s/ picture cards.

Key Features

• This booklet features 12 initial /s/ words incorporated into a simple story to be read by a helper and child together.
• The words are CV or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.

Permissions

I give permission to copy, print, or distribute this booklet provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this booklet. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More card sets and related printables are on my Free Speech Therapy Articulation Cards page.

Here is a picture of a homework booklet (the /l/ booklet) printed on cardstock and folded into the booklet. It slides nicely in between board books to be pulled out and read during bedtime story time.

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One year ago I wrote about how to use songs and rhymes and a cloze technique to get a young child to verbalize.