PamT...question, if your not too busy 
Moms View Message Board: General Discussion: Archive May 2004:
PamT...question, if your not too busy
I hate to bother you but I have a question regarding my son's speech. He has just completed his second year in speech in his elementary school. He attends twice a week, for about 20 minutes with several other children. He will be entering the second grade.
He is working on the sounds th,r,s and z. I don't think he is progressing very much. I'm not sure at what age we should become alarmed and consider taking him to a private therapist who can give him more attention. I don't want him to start being teased or not understood for his poor speech. Is he in the normal age range that he could still recover proper speech with this limited time?
My ds nursed for nine months then went to sippy cup. I have heard that maybe his tongue never developed proper movement, etc. Do you know what I mean? This could/is probably the reason for his poor speech.
My dd saw the same speech teacher for 1 1/2, she progressed nicely but only had to work on her r sound.
Thanks for any input or suggestions. I have his progress report and could fax it to you. My email isn't working very well. If you have the time
I have done therapy in every context there is, I think...clinic, hospital, home health, school, etc. and school was by far the most frustrating. Sure the hours are great and you are off when the kids are off, BUT having large groups of children for small amounts of time was so frustrating for me personally. Kids make little or no progress because public school speech therapists have overwhelming caseloads and tons of paperwork! Sorry for the vent, but I understand why your DS isn't making progress. Realistically when you get a group of 3-5 kids together for 20 minutes of speech therapy, each child is actually probably getting 2-3 minutes of "real" therapy each session when you account for getting the kids, getting them settled and focused on a task, explaining the task, etc.
Summer is a great time to get additional therapy. I have quite a few kids on my caseload that I just see for them summer. With the right therapist, you two following through on his home program, and the right amount of therapy there is a great possibility that he won't need therapy at all when he goes back to school.
Usually we expect that most children will have no articulation errors at all by age 6-7, so while there are some other kids his age with some errors, most will have resolved by this time. Te error sounds you mentioned are very common and the most difficult sounds to produce. In any elementary school across the nation you will find many 1st-3rd graders in speech tx working on /r, s, z, l, "th"/. If your insurance covers it (most won't  ) or you can afford it, I would look at summer therapy just to nip this in the bud and so he won't have to have speech at school next year. Don't you live in FL? I was thinking P'cola or did I imagine that? If so, the Univ of W FL has a speech therapy program and would be a great place to find reasonable therapy. If you don't live there, I can still probably locate some services for you if you email me your city (speech-chick@ cox.net).
A reverse swallow pattern if often, but not always, a contributing factor to an s/z lisp. You can check for this by having your DS swallow some water with his lips parted, but teeth together. If you see his tongue push against his teeth or thru his teeth, then he likely has a tongue thrust which needs a different type of a treatment approach than other s/z errors. I usually recommend a child be a mature 8 y/o or an average 10 y/o for tongue thrust tx, because it requires a great committment to a home program to be successful.
You can probably correct the "th" yourself at home. There are 2 types of "th"--voiced (like in "this/they/that, bathing, other, smoothe") and unvoiced (like in "thumb, toothbrush, bath"). To teach "th" I tell kids that this is the one time it is polite to stick out their tongues . Have your DS stick out his tongue and gently bite it with his top teeth. Start with unvoiced "th" words (they are easier to picture) with "th" in the initial position of a word. Start by showing him how to say it each time, then keep going through the words until he can say them without your help. Do the same for final, and medial "th." I would get the initial sound down first with just a little help from you , then add final and medial in that order. The medial sound is the hardest. Start with a lot of cues and assistance and then fade it away. Once words are mastered with "th" in a particular position, then start with the same phrase like "This is a ____" or "I see a ____" Progress from phrases to repeated sentences to sentences he makes up to conversation. You may be at different stages all at the same time like self-generated sentences with inital "th", phrase with final "th", and words with moderate cueing for medial "th." He will probably progress pretty quickly. Once he has the concept of how to produce "th" and is doing it some of the time, I usually just correct voiced "th" in conversation..typically by playing dumb and saying "You want some of dat?" And he will probably chime in without any direct intervention from you and say "No, THAT!"
"R" is really tough to remediate and will require a professional. Personally, I hate working on "r" because it is so hard to get a child to understand how to produce it and "r" takes many forms depending if it is attached to a vowel (four) or makes the "-er" sound like "girl" or "butter." s/z will depend on the tongue thrust issue, but may be corrected by your son just learning to smile and keep his teeth together while make "s" or "z" (which are the same sound, except "z" is voiced and "s" is not).
"TH" words for practice:
thumb, thorn, thought, think, thin, thick, thirst, thigh
bath, tooth, teeth, math, wreath, earth, booth, cloth
toothbrush, toothpaste, bathmat, birthday, athlete, bathtub
voiced: this, that, they, these, those, the, them, mother, father, another, other, brother, smoothe, bathe
Hope this helps!
Pam, I just wanted to thank you, even though I didn't ask for the help. My 5 year old has had some trouble the past few years with his speech. He has improved A LOT, but still has problems with "th". We are using your suggestions, and he is getting the idea. The "sticking out your tongue" helped to make it easier and fun!
Hi Pam. If you have a chance, would you please read my post on the Children With Special Needs Board in regard to diagnosing oral motor problems? I would greatly appreciate any advice or suggestions.
Thanks,
Ame
Thank you so much for the information and so fast. Yes, I do live in P'cola and UWF is about 20 minutes away. We do not have insurance at the moment but would be willing to take money out of savings to cover the costs.
Generally, how much does a summer program cost, how often would he attend and would it be one on one?
Thank you so much, Pam!
Pam, I wanted to add a thank you. My son has some articulation problems that we have been working on at home and in his therapy program but this broke it down in a very easy to understand way. His problems are mostly with the s and l sound but th is a problem with some words. Thank you for the help you offer to us.
I would also like to say thank you! My 6 year old son is seeing a speech therapist every two weeks (insurance won't pay, so we are only able to do two a month). We have been working on "th", "g" vs. "d", "l" and "s". The "th" sounds were easy, but "s" has been very difficult for him. Thanks for the information.
Annie, re: costs and frequency of therapy---that just really depends. UWF would probably be your most economical option since university clinics usually charge at a reduced rate and/or sliding scale because they need kids for the students to practice on. That said, I think you get good therapy at a clinic because you have students working hard for a grade and being observed frequently and you have a Master's or Ph.D. clinician with a lot of experience overseeing the whole process.
Speech therapy at a private clinic or practice is expensive. I think where I work they charge $86 for a 45 minute session. Evaluations are quite a bit more. However, you might be able to find a school therapist to see him at your home or hers for much less. When I did private practice in my home I charged $40/50 minutes, but that was in small town Midwest and was pretty darn cheap by other standards. Usually therapy is recommended 1-2 times per week and most sessions are 45-60 minutes in length. You can request more or less therapy depending on financial considerations, or reduce the amount of time.
P.S. Thanks for the kind words. Keep in mind that I am just throwing out suggestions though, if you have concerns you need to see a real live spech pathologist in person.
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