Banter Speech & Language

Sydney speech pathologists helping adults and children speak for themselves.

lisp

The Pesky Lisp Fixer: a new evidence-based approach for kids whose interdental lisps won’t stay fixed!

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Don’t you hate those pesky interdental lisps? You know, the ones that won’t stay fixed?

To fix an interdental lisp – those lisps where your tongue sticks out between your teeth when you try to say /s/ – speech pathologists used to start with simple tasks, like saying an /s/ on its own. Once the child had mastered their /s/, we progressed in tiny hops (like baby bunny kittens) to slightly harder tasks. This traditional approach works.

But it’s SO SLOW!

Many kids – particularly older and more mature kids – hate being treated like babies. And, even after finishing traditional treatment, many kids have difficulties using their “new /s/” on words they haven’t practised and in more natural tasks, like story-telling and conversation. Which is, of course, the main point of trying to fix a lisp!

A new approach

More recent research evidence supports a different route for better results. Once a child can say the sound on his or her own, randomly mixing up hard and easy tasks can have quicker results that transfer more efficiently to real-world, lisp-free speech (e.g. see Skelton, 2004).

(You can read more about why using randomised practice, non-word practice and other principles of motor learning and speech here).

Our Pesky Lisp Fixer program has three stages

  1. Auditory Bombardment: 2 minutes per day – listening and tuning into the sound and practising it on its own. Audio file included!
  2. Our /s/-Syllable Boot Camp: Based on principles of motor speech, the boot camp involves 10-15 minutes a day of high repetition practice of nonsense syllables designed to get the tongue, lips and teeth working together with different vowel and consonant sequences in random order.
  3. Randomised Practice: Once you’ve conquered the boot camp, this gives you 20-30 minute sessions of imitating and naming words with /s/ in them, across all word positions. Again using a high repetition, randomised approach, we mix imitation, naming, and sentence generation tasks, with old-fashioned story telling, using over 200 high quality photographs – no cutesy vector clip art.

This program works best if an adult is around to give clear feedback every now and then – but no more than occasionally.

So download the Pesky Lisp Fixer today and get straight into getting rid of that pesky lisp!

access the pesky lisp fixer from our teachers pay teachers store

Related articles:

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

I’m an adult who lisps. Do I need speech therapy?

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Not unless you want help.

Before the age of six, it’s relatively common for children to lisp /s/ and /z/ sounds. But, for some adults, a lisp can be embarrassing, affecting their social activities and/or professional life.

But lots of adults lisp and there is some evidence to suggest that it’s becoming more common among some groups of young adults and acceptable to society at large (e.g. Van Borsel et al., 2007).

What the research says

The evidence about adults who lisp is actually pretty patchy. But here’s what some of the published studies suggest:

  • Men: compared to men who do not lisp, men who lisp are perceived by strangers as having lower levels of:
    • speaking ability;
    • intelligence;
    • education;
    • masculinity; and
    • friendliness (Mower et al., 1978).
  • Women: Compared to women who do not lisp, women who lisp were considered by strangers to be less:
    • cooperative;
    • kind;
    • friendly; and
    • “nice” (!) (Syrett & Rorson, 2005).
  • Men and women:
    • 16.3% of people who lisped or who had problems with /r/ said that they thought people had problems understanding them; and
    • 38.9% of people who lisped or had problems with /r/ said that they felt insecure in speech situations and that their speech differences interfered with their work or social life (Verissimo et al., 2012).

Should adults who lisp be “treated”?

Let’s be very clear on this. Many adults who lisp do not want speech therapy. And nor should they.

Lisps are usually considered minor errors and rarely have a big impact on your intelligibility (Verissimo et al., 2012). Some people, including some celebrities, see their lisp as part of their personal trademark or image. Some people don’t care at all about what others think about their pronunciation of /s/. Obviously, none of these people need “treatment”.

For a speech difference to be considered a speech disorder, you need more than a few folk you’ve never met having a vaguely negative reaction to your speech on their first listen. Someone’s first impressions often don’t give you any idea of the impact of a person’s speech difference on their “real world” (Mower et al., 1978). To warrant the label “disorder”, a speech difference like a lisp also needs to interfere with your communication (Van Riper, 1972) and participation in social and/or work activities that matter to you (ICF, 2001). It’s clear from the Verissimo study that the majority of adults who lisp do not think that their speech differences affect their work or social life, although a sizeable minority do.

Lisping in adults is not rare. For example, one study of almost 750 Dutch-speaking university students found that almost a quarter (23.3%) of them lisped, with no significant difference in prevalence between men and women (Van Borsel et al., 2007). For English-speaking populations, these results may need to be read with a grain of salt because of language and phonology differences between Dutch and English. But the study does provide compelling evidence that adult lisping may not be as rare as many speech pathologists think. The researchers in that study also speculated that people might be more tolerant of minor speech differences these days than in days past.

Interestingly, one variable not considered by any of the studies referenced above is sexual preference. It’s a popular stereotype that many gay men lisp, and some gay men proudly lisp to express their sexual preference and identity (Van Borsel et al., 2007). This may explain, in part, why some of the enquiries for help I receive from adults who lisp are from straight men.

Recent studies suggest that:

  • speakers who lisp may be conscious of their speech differences, but, overall, the impact on their professional and social life appears to be limited; and
  • interestingly, adults in “speaking professions” are, on average, more secure in their speech differences than adults who do not speak as part of their professional activities (Verissimo et al., 2012).

Clinical bottom line

Many adults from all walks of life and cultural backgrounds lisp. Lisps are not rare. Some people celebrate their lisps. Others, don’t care about them one way or another. These people do not want – and they certainly don’t need – speech therapy.

Some adults who lisp are self-conscious about it and may feel their speech differences are interfering with their communication, confidence, and pursuit of work and life goals. For these people, speech pathologists can help with therapy (or “training” if the term is preferred), ideally based on principles of motor speech. But only for people who want help to get rid of their lisp.

If you have a lisp and want help, we’ve developed a course for you. Welcome!

Go to the lisp fixer course

Related articles:

Principal sources:

  1. Verissimo, A., Van Borsel, J., De Britto Pereira, M. (2012). Residual /s/ and /r/ distortions: The perspective of the speaker. International Journal of Speech-Language Pathology, 14(2), 183-186.
  2. Van Borsel, J., Van Rentergem, S., Verhaeghe, L. (2007). The prevalence of lisping in young adults. Journal of Communication Disorders, 40, 493-502.

Image: http://tinyurl.com/zbkk9nu

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

Beyond flashcards and gluesticks: what to do if you or your 9-25 year old still has speech sound issues

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When most of us think about speech sound disorders, we think of little kids: 3-6 year olds.*

But what about older kids and young adults?

What we know

Research is sketchy, but our best evidence is that:

  • 1 to 2% of the young adult population present with speech sound errors that are:
    • ‘residual’ – leftovers from treated speech sound disorders; or
    • ‘persistent’ – untreated speech sound errors that haven’t fixed themselves with time;
  • these young adults tend to ‘distort’ sounds like:
  • sometimes, the sounds are completely wrong, like saying /w/ for /r/ or /l/, or /s/ and /z/ with a slushy, lateral lisp;
  • other times, the sounds are almost right, but still different enough from their peers’ speech for people to notice;
  • usually (not always), these speech problems do not affect:
    • intelligibility: people can still understand them; and
    • academic achievement;
  • but these speech errors can hurt an older child or young adult’s:
    • social life; and
    • employment prospects; and
    • overall quality of life (e.g. Crowe Hall, 1991; Allard et al., 2008).

Do young adult speech problems self-correct?

Good news: we think that about 60-75% of young adults with residual speech problems will sort them out by the end of high school without special help.

Bad news: we don’t know which young adults will self-correct their errors (or why or even how)!

Is it too late to seek help from a speech pathologist?

Absolutely not.

Early intervention is the best option (if you have the option). And the longer the client makes the error, the harder it can be to shift.

But speech sound errors can be treated at any age.

In my work with older children and young adults, I’ve found long-term speech errors:

  • are more therapy-resistant than short-term ones;
  • can be tricky if the wrong sound has been reinforced inadvertently for years, e.g. by applauding a child’s story about the ‘thilly wittle wabbit’ (cute at 3, not so much at 15);
  • take creativity (and a good sense of humour!) to tackle in an age-appropriate and engaging way.  For example, I have been experimenting recently with randomised practice kits based on principles of motor learning tied to a client’s passion (whether it be Minecraft or Katy Perry);
  • require team work, respecting the client as an adult, partner and decision maker, not a passive subject; and
  • can be fixed with hard work, resilience and determination – but only if the client wants to change the sound(s) and is willing to do the work.

Finding the right time to do the work, the right speech pathologist for the client, and agreeing specific goals and workloads before you start are key to achieving good outcomes – especially with teens and young adults.

Related articles:

Related resources:

Principal source: Flipsen Jr., P. (2015). Emergence and Prevalence of Persistent and Residual Speech Disorders. Seminars in Speech and Language, 36(4) 217.

* We (speech pathologists) accidentally reinforce the idea that speech disorders are things that happen just to pre-schoolers, festooning our signs, speech blogs and client newsletters with eye-catching or click-worthy pics of grinning pre-schoolers.  I can understand why: articles on this website featuring pre-schoolers get about five times as many readers as articles with pictures of older kids or adults.  The temptation to keep posting perfect pre-schooler pics is something I’m keen to resist in my quest to publish useful information for older kids and adults, even if I don’t catch as many eyeballs!

Image: http://bit.ly/1OjLbAN

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

FAQ: Lisps

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1. A minor problem?

Many people think lisps are minor ‘first world problems’, like getting the wrong coffee at Starbucks or your iPhone earplugs getting tangled in your pocket. That attitude really gets me riled up.

Compared to disorders like severe apraxia of speech, specific language impairment or dyslexia, lisps can seem cosmetic – unless you or your child has one. Consider two examples:

  • A 6 year old boy with a very minor lisp who is bullied mercilessly every day for an entire school term.  He has to change schools to escape the taunts.
  • An adult stroke patient with aphasia tears up when presented with a list of /s/ words to practice – the memories of his former colleagues paying him out for his lisp still haunt him, though he faces much bigger challenges re-learning to use language.

Of course, some adults aren’t troubled by their lisps in the slightest. I read about an entrepreneur who considered her lisp to be part of her ‘personal brand’!

When assessing lisps, it’s important to consider the severity of the problem. But it’s also essential to assess how (if at all) the lisp affects the person’s activities and participation in the real world (including school or work). In other words, does the lisp affect the client’s quality of life?

2. A potted history 

The lisp is probably one of the most well-known – and widely mocked – kinds of speech disorder. The word has its roots in Old English, and there are historical accounts of people with lisps dating back thousands of years. Those who lisp include:

  • historical figures such as Alcibiades;
  • celebrities such as Ita Buttrose and Drew Barrymore; and
  • characters like Sylvester the Cat, Grubby from dirtgirlworld and Pontius Pilate in Life of Brian.

Throughout history, people who lisp have been teased, taunted and humiliated – you just have to read Aristophanes’ thinly-veiled swipe at Alcibiades in The Wasps to understand that nothing is new under the sun when it comes to being teased for a lisp.

3. What is a lisp?

Unlike phonological problems, a lisp is a speech (not a language) problem. It is an inability to produce a specific speech sound or sounds correctly – most commonly /s/ and/or /z/.

Some speech-pathologists give a lisp technical-sounding names like ‘a sub-type of functional speech disorder’.  For clarity, we prefer to call a lisp a lisp, unless the client has an aversion to the word, e.g. if a  school-aged child has been labeled a ‘lisper’ by his peers.

4. What causes lisps?

Theories abound, though no-one knows for sure.

Speech is a learned skill that becomes increasingly automatic with practice – like driving a car or playing the piano. Many theorists talk about people who lisp learning or ‘overlearning’ the wrong patterns for their /s/ or /z/ sounds. There’s evidence that some children fail to learn the correct sound because they don’t hear themselves making errors. Sometimes the client has produced /s/ in that way for years and has never been corrected, until they are teased for it at school. Other times, the client may have received a lot of praise as a young child for sounding ‘cute’ and just kept doing it. Some children have problems with both articulation (speech) and phonology (language) that affect /s/ and /z/, making treatment especially tricky.

Though it seems like an odd thing to say, the research tells us we don’t need to know the cause of a particular lisp to fix it.

5. Are there different kinds of lisp?

Yes. The two most common types are the:

  • interdental (i.e. between the teeth), which occurs when the tongue sticks out between the teeth making /s/ and /z/ sound like ‘th’; and
  • lateral (i.e. sideways), where the tongue is in roughly the right place, but the air is directed over the sides of the tongue, rather than straight down the middle, creating a wet or ‘slushy’ /s/.

Other kinds of lisp include a palatal lisp, where the tongue touches the soft palate – way too far back in the mouth. But interdental and lateral lisps are by far the most common kinds we see in practice.

6. Do lisps fix themselves?

‘Sometimes.’  (Not a satisfying answer!)

Interdental lisps are quite common in children younger than 5, and, in most cases, resolve themselves with practice. Lateral lisps – which are not part of normal speech development – are far less likely to fix themselves.

As far as we know, not much research has been done so far on natural recovery rates, or identifying red flags to indicate when there might be a long-term problem.

7. When should you seek help?

Again, views vary, but research suggests that children are often bullied at school for speech impediments. We also know that lisping, like a bad habit, can become more and more entrenched with time. For interdental lisps, we recommend:

  • parents seek advice from a speech-language pathologist at least six months before their child is due to start school – if possible before their 5th birthday; and
  • adults who lisp be treated as soon as possible.

For lateral lisps, we recommend the client be referred to a speech pathologist for treatment as soon as possible.

8. How do speech pathologists treat lisps?

On the Internet, there is a wealth of great (and not-so-great) information, tips and tricks for treating lisps. Of the good stuff, I thoroughly recommend checking out Caroline Bowen’s information sheet and Heidi Hanks’ discussion of their methods and particular techniques, like the butterfly procedure and training /s/ from /t/. (The questions and comments on Heidi’s post will give you a good feel for how passionately people feel about lisps.)

Underpinning most mainstream intervention approaches, tips and tricks is what is known as ‘traditional articulation therapy’. Since the 1950s – and probably before that – speech-language pathologists have treated lisps using structured, step-by-step programs based on principles of behaviourism. In 1958, Charles Van Riper and John Irwin published ‘Voice and Articulation’, a book that still influences our approach today (I’ve read it a few times and still find helpful suggestions for clients).

Voice and Articulation

Van Riper and Irwin were of the view that, in therapy, the client needs to learn to:

  • scan the back-flow of sounds from his/her mouth – i.e. respond to feedback from his/her ears, mouth and tongue;
  • compare the sounds coming from his/her mouth to the ‘standard’ or correct sound;
  • correct/vary his/her production of the sound, to decrease the error;
  • search for a precise combination of feeling and movement to produce auditory feedback for the sound that matches standard;
  • fixate on the new sound: by strengthening and practising it repeatedly, at first in isolation, then in nonsense syllables based on the targets; then words with the sound at the end, middle and beginning, then sentences laden with the target sound, then structured and unstructured conversations; and
  • stabilise the new sound by holding onto it under emotional stress like fear, excitement and time pressure.

More recently, speech-language pathologists have have started to incorporate the latest research on the principles of motor learning into articulation therapy. Based on studies of sportspeople and others learning a new skill (such as golf, playing a musical instrument or learning to speak), these principles have the potential to revolutionise the way speech pathologists tackle articulation and other speech problems. The most promising part of this research is that incorporating principles of motor learning may result in better ‘real world’ outcomes for clients.

We’ll be writing more about specific principles of motor learning – and how clients with speech disorders can benefit from therapy based on them – in a separate article. We’ve also developed a course for adults who would like to fix their lisps and another for older children with interdental lisps.

9. What to do if a fixed lisp won’t stay fixed 

Though it can take lots of hard work and practice, lisps can often be corrected in the clinic and other controlled settings. The most difficult stage for many clients is using the correct sound consistently in the ‘real world’ – especially when excited, angry or stressed. This is the stabilisation stage of therapy referred to above (also known as generalisation or transfer stage). 

The theory and practice of getting the correct sound to stick in the real world is a very big – and hugely important – topic. We’ll do our best to address it at length soon.

Related articles:

Hi there, I’m David Kinnane.

Principal Speech Pathologist, Banter Speech & Language

Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.

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