English 311,"Introduction
to Linguistics"
Causes and Treatment of the Speech Disorder: Lisps
The importance of correct speech cannot be overstated in our current society.
Many children and adults suffer from many different functional speech disorders.
It is estimated that between 3-5% of all children at one point have suffered
from different articulation disorders (Gibbon). Patrick Griffith suggests that
up to 25% of children age three to four lisp, with the percentage going down to
15% for seven year olds. However, lisping is a disorder that affects adults as
well. I can relate to this disorder because I also have been diagnosed with a
frontal lisp. The purpose of this paper is to examine four aspects of lisping. I
will examine the four types of lisps, causes of lisps, possible therapy, and
personal views I have regarding my lisp. Phonological disorders and functional
disorders are many times mistaken to be the same disorder.
To begin it is important to distinguish between a developmental phonological
disorder and a functional speech disorder. Caroline Bowen PhD is a speech
language pathologist who accurately defines many articulation and phonological
disorders. His views of the difference between functional and phonological
disorders are as follows: A functional speech disorder refers to the difficulty
of making a specific speech sound (or more than one); also these speech delays
are of an unknown origin. A developmental phonological disorder is the
difficulty of organizing speech sounds into patterns. People can with reason
easily correct speech sounds, but this disorder persists far beyond typical ages
(Bowen).
Most lisps are functional speech disorders in which certain phonemes are not
articulated correctly. A lisp is a functional speech disorder (FSD) because the
causes are not completely known. In most lisps, /s/ and /z/ phonemes are
substituted by the /ð/ or the /Θ/ phonemes. These are the English "th"
or "eth" (z) sound. Linguists who have studied articulator phonetics
have come to the conclusion that the most common cause of a lisp is when a
person’s tongue touches or protrudes between the front teeth. A regular /s/
requires the tongue to be placed at the edge of the palate, in order to create
the correct /s/. Consequently, this is referred to a frontal lisp. However there
are other types of lisps that are produced in different ways. In FSDs lisps are
also referred to dyslalia, and within this category they are referred to as
sigmatism. (Bowen) Sigmatisms are derived from the 18th letter of the
Greek alphabet which corresponds to the /s/ phoneme. However, not all lisps are
abnormal in child development.
It is completely natural for some children to lisp. Phonological development
is measured in relationship to age and the acquirement of certain phonemes
(meaningfully distinct speech sounds). There is a relative norm, but many
children acquire language sooner, or later than others. Some linguists believe a
normal /s/ is usually acquired by the age of 48 months. Others believe the /s/
sound should be correctly articulated by the age of 4 years 6 months (Kilminster).
Depending on the child, some children may take less time.
There are four basic types of lisps: interdental (frontal) lisp, dentalised
lisp, lateral lisp, and finally palatal lisp. An interdental lisp, also know as
a frontal lisp, is produced when the tongue is not correctly placed at the edge
of the palate. The "th" sound replaces the /s/. Also, the interdental
/z/ sound, which is a voiced alveolar fricative consonant is pronounced
incorrectly. The person with a lisp will pronounce /s/ completely wrong.
However, it is important to remember that it is perfectly normal for young
children to lisp at some point in their phonological development.
The second type of lisp is a dentalised lisp. According to Caroline Bowen , a
dentalised lisp "is not an ‘official’ diagnostic term. It is an
expression that Speech Language Pathologists use to describe the way an
individual is producing certain sounds. The tongue rests on, or pushes against,
the front teeth; the airflow is directed forwards, producing a slightly muffled
sound (Bowen). Bowen suggests that children produce these sounds until the age
of 4 ½ years; then they grow out of it. If they do not grow out of it a speech
language assessment is required. It is important to be sure that no
physiological abnormalities are present in the child.
The third type of lisp is a lateral lisp. According to Bowen, a lateral lisp
is very close to the formation of the /l/ sound and the airflow directed over
the sides of the tongue. She writes, "Because of the way it sounds, this
sort of lisp is sometimes referred to ‘slushy ess’ or a ‘slushy lisp’. A
lateral lisp often sounds ‘wet’ or ‘spitty’. (Bowen). One example of
this is the word soup. A lateral lisper would pronounce it "shlluop."
Unfortunately, lateral lisps are not normal phonological sounds created by
children, as interdental and dentalised lisps are. If a parent believes a child
has a lateralized lisp, he or she must seek advice from his or her family
doctor. This lisp is not as common as the others.
The fourth type of lisp is a palatal lisp. Once again, this type of lisp is
not found in normal speech development. Bowen describes the palatal lisp,
"Here, the mid-section of the tongue comes in contact with the soft palate,
quite far back. If you try to produce the /ç/-or a ‘h’ closely followed by
a ‘y’ and prolong it, you more or less have the sound" (Bowen).
Although the causes of most lisps are unknown, it is important to understand the
known causes of lisps.
There are many ideas for the causes of lisps although there is little
concrete evidence of why physiologically sound people lisp. Some linguists
believe lisps are hereditary. But this is usually the anomaly. Most lispers do
not have immediate family members who lisp. Some doctors and linguists believe
thumb sucking in infants causes lisps. This occurs when infants thumb suck
excessively for a number of years. Nevertheless, it is important to realize that
infants thumb sucking provide a necessary function as well. Thumb sucking
creates endorphins that stimulate a sense of pleasure and of well being (Sue
Theo). Prolonged bottle-feeding can also cause the same negative effects of
thumb sucking. Generally, if a child is thumb sucking over the age of five,
intervention is necessary.
Another basic belief is that many people did not learn how to properly
articulate the /s/ sound. With years of pronouncing it the wrong way, many
people cannot successfully pronounce it the right way. There are also other
physiological factors that can cause delay in speech and phonological disorders,
one of which is cleft palate. Cleft palate is a congenial abnormality, in which
there is an opening in the roof of the palate. This abnormality may also cause a
velo-cardo-facial syndrome known as Shrprintzen syndrome(Albertine). These
abnormalities can be cured by extensive surgery. Consequently, these
abnormalities are known causes for lisps. A person usually requires extensive
speech therapy after undergoing surgery.
Other possible causes of lisps in adults are strokes or accidents. Adults who
have strokes or heart attacks many times damage parts of the brain responsible
for the dynamics of speech. Moreover, other cerebral vascular accidents
cause lisps. The area of the brain are responsible for comprehension and the
expressive aspects of language (Albertine), the Broca area is specifically
concerned with motor speech. When people have a stroke or accident, they often
damage this part of the brain, resulting in the inability to correctly
articulate many speech sounds. Many lose speech altogether, while others develop
a lisp, or other speech disorders.
Lisps can also be caused by paralysis, or hemiplegia. This disease, which
results from injury in the motor cortex of the brain, causes paralysis on the
side opposite or the injured part of the brain. For example, if the left side of
the brain is injured, the right side of the body will undergo paralysis.
Consequently, the cranial nerves in the head and neck will also undergo
paralysis. The result of this is paralysis of the facial, throat, and eyes
muscles, which in turn cause difficulty speaking and and correctly pronouncing
different phonemes. People suffering paralysis may never recover function in
many parts of the brain, or in their body. Many suffer lisps and other
articulation disorders.
It is important to realize that linguists cannot give a clear answer for the
cause of speech impediments in completely healthy children and adults. There is
a lot of speculation, but the conclusion is some children (and adults), for some
reason, do not acquire speech and language as easily as others. Some argue that
there are external factors such as the environment, parental control, improper
nutrition, that inhibit correct speech to be learned. Other linguists may argue
that people do not learn because of intrinsic factors such as a lack of
motivation, or lack of mental capacity. Whichever theory one may adopt is
completely up to the linguist, therapist, or patient, but it is important to
know the steps to take in resolving a speech impediment.
The first step a person must take in regards to any articulation or
phonological disorder is to refer the problem to one’s doctor. Many people
erroneously believe that "all" speech disorders will naturally
"go away." But this mentality only further complicates the resolution
in the future. After a child has passed the age of 4 ½ years, it is not a good
idea to "wait" for any type of lisp to go away. A doctor will analyze
the person and determine if there are any physiological abnormalities such as
cleft palate. If the doctor diagnoses the problem as a speech impediment, or
other articulatory disorder, he or she will usually refer the patient to a
Speech Language Pathologist (SLP). It is important to realize prescription
drugs, psychological therapy, surgery, or other traditional roles of medical
doctors or psychologists cannot correct lisps. Perhaps a psychologist may help
"deal" with the psychological affects a lisp may bring. But he or she
cannot correct the lisp itself.
The function of an SLP is to assess where the problem lies, which phonemes
cannot be articulated correctly, the assessment usually involving screening of
all the areas of communication, patient history, and linguistic effects. Many
SLPs have the patient read rhymes that include all the letters of the alphabet,
one example of which would be Sister Suzie sewing shirts for soldiers. These
rhymes are repeated emphasizing different phones and phonemes. This type of
assessment helps to pinpoint where the speech impediment is more or less
prevalent. For example, some patients may have an interdental lisp, but they
seem to articulate some /s/ correctly in parts of words only. Some people only
lisp in the initial, medial, or final parts of words. Or they have more problems
in some parts of words. One example of this is a person articulating only the
medial /s/ correctly in the word "subsist." After the speech problem
is pinpointed speech therapy is usually prescribed.
Speech therapy is the most successful treatment for speech impediments. It is
more successful in children than adults. Although many people do not overcome
their lisp, there are many success stories of people, including adults, who have
overcome them. Caroline Bowen has a 14-point guide of what therapy should
contain, for a person with a lisp.
1. We will determine that the client can hear the difference between /s/ and
'th' as individual sounds, and in words (e.g., sink / think).
2. 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.
3. Using tactile, auditory and motoric cues we will teach the client to make
the new /s/ sound.
4. We will choose a word-position (let's say, for the sake of the example,
that we choose the initial position).
5. Using motor cues we teach the client to imitate and the produce
independently /s/ in isolation
6. ... in broken syllables
(s-oo s-ee s-or s-ie s-oh...)
7. …in syllables
(soo see sor sie soh...)
8. …in words
(Sue see saw sigh sew...sun sip soap...)
9. …in phrases
(so silly, send sam, seven seals)
10 …in sentences
(I see a sock...)
11. …in controlled conversational contexts
(e.g., during dinner)
12. …in conversation
13. …phasing out modelling and reinforcement
14. ...and working towards self-monitoring and self-correction.
(http://members.tripod.com/Caroline_Bowen/lisping.htm)
Speech therapy in itself can be practiced in many forms. However, all therapy
must be individualized in order to suit each patient. There is not a "one
size fits all" paradigm in speech therapy. Each patient will have
individual needs and levels of progress and success. The most common type of
speech therapy is strengthening muscles inside the mouth that are not used
properly or frequently. Giving the patient exercises that suit his or her level
of need does this. The exercises are done relatively slowly, then progress to
higher speeds. Videos are available via the Internet allowing the patient to
practice at home (Dickson). The videos demonstrate the correct way to
articulate, using the correct muscles in the mouth. Most speech therapy includes
practice and imitation with a speech therapist. The speech therapist must
correctly show the patient how to articulate the correct sounds. He or she must
also show the patient where and when he or she is erring. Some therapists have
created their own clinical version of speech therapy.
New speech therapies have evolved using foreign objects. A pioneer in this
field, Sara Rosenfeld-Johnson is the owner and director of Innovative Therapists
International in Tucson Arizona. She is also an SLP who has worked extensively
with clients with many speech disorders. What is unique about Johnson is she has
developed her own method of speech therapy that involves inserting foreign
objects into the patient’s mouth. This is done to strengthen muscles in the
mouth and to help correct the positioning of the tongue.
She describes the uses, "At the therapeutic level, straws have the
promise of addressing a multiple array of disorders and muscle groups far beyond
traditional practice ( Manning)." Rosenfeld-Johnson further explains
the function on the outset of therapy, "I provide a simple, straight straw
of regular diameter to see how they will use it, allowing them to drink from it
normally like they would (Manning)." She then measures the straw to
determine if the patient is either suckling or biting it. She measures the
length from the entry point to the tip of straw inside the mouth. If the straw
is more than ¼ to ½ inch in the mouth, the patient may have jaw instability.
When the measured length is cut, the straw will have a lip block that will
encourage sealing and rounding. Over many visits, if the patient has progressed,
the length of the lip block is reduced up to the internal tip until the patient
achieves primary retraction of the tongue. It is important to note that
Rosenfeld-Johnson has therapeutic straws manufactured by a company (Manning).
Rosenfeld-Johnson also has created a new therapy in which she uses horns. She
uses 14 different horns; each has a different therapeutic purpose. But, she
stresses that straw and horn therapy should not replace regular therapy; rather,
it should be used in conjunction with it. She works with 14 different horns that
have a numerous number of functions. As for a lisp she states, "The second
horn is a harmonica-like device that teaches further lip closure and the skill
of projecting exhalation in a frontal manner… Used alone, this instrument
works on the standard production of the /s/ by assisting in the correction of a
lateral lisp" (Rosenfeld-Johnson). According to Rosenfeld-Johnson horns
10-14, "work on intensifying the degree of duration of exhalation,
lip-rounding, lip protrusion, tongue retraction/release, abdominal
constriction/tension and they specifically target the correction of an
interdental lisp" (Rosenfeld-Johnson). What is fascinating about the horns
is Rosenfeld-Johnson states that the horns have helped her clients between the
ages of 18 months to 100 years. If these horns and straws indeed are as
effective as she states, this is a revolutionary form of speech therapy. She
appears to be at the top of her field. It is important to find a competent SLP.
The speech language pathologist must be patient and encouraging. Also he/she
must be practical and document progress only when progress is achieved. Many
patients can be discharged without having complete correction of their problem.
Although some patients may never acquire "perfect" speech, many
improve greatly. The important goal is to be as "intelligible" as
possible because lisps usually distract people’s attention. However, to do
this, the patient must do his or her part as well. Speech therapy requires a
great deal of work and effort by the patient. This is mainly done by practicing
at home, as much as possible. Speech therapy with out practice is usually
fruitless.
In order for children to overcome lisps, parents must encourage them to
practice everyday. Also, the parents must be actively involved in the child’s
therapy. The parent must play the role of the speech therapist at home. As for
adults, the motivation is intrinsic. Most adults attempting to correct a speech
impediment have the motivation needed. This is the result of the stigma that is
attached to people with speech impediments, in particular to adults who lisp.
There are many common negative affects of people who lisp. These people range
from children to adults. Lispers suffer a great deal in our current society. If
one cannot clearly communicate, he/she becomes invisible. Our society demands a
certain degree of "normalness" in order for one to be successful.
Without correct speech, many people are written off, and treated as people
without worth. People who lisp are looked down upon. There is a silent group of
people (with speech disorders) who dare not speak for fear of rejection and
humiliation. Others are afraid to succeed because they are afraid to fail.
Tragically, they don’t even try. I know, I was once one of those persons. I
also have noticed "normal" people have given me "strange"
looks when I speak. I have even had college professors give me this look; As if
to say, "He’s intelligent, if only…" If I only I didn’t have a
speech disorder? Ironically all American people have accents, but most are not
looked down upon or labeled as lispers are (Buckhoff).
Having a lisp is to be branded loser, gay, handicap, unintelligent, and many
other stereotypical names. Ironically, people with speech impediments are
usually far from the above-mentioned stereotypes. What is more troubling is the
refusal of people to be open to people who are "different." This
causes feelings of rejection and failure in children and adults. I have met
people with speech impediments who have had to work twice as hard to be accepted
in society, and to have relative success. Unfortunately, people with speech
disorders do not define what "normal" should be. People without
disorders define what is acceptable (or not) in society. Given, not all people
who do not lisp are innately prejudice, there are many who blatantly are.
Charles Van Riper clearly portrays the struggle of people with speech
disorders. His book Speech Correction contains a drawn picture with the
title: Human Waste and Wasted Humans. The picture shows an alley filled with
trash covering the floor. There is a box overflowing with waste, such as cans,
paper, food etc. This is the human waste. In front of the box is a trashcan,
filled with tiny humans who have been discarded. The trashcan has been pushed
over revealing the wasted humans face down, in shame (Van Riper). These are the
people who have been discarded by society because they are different. These
people are the wasted humans. Society may consider me one of these people.
However, I prefer to go against the grain, and not fall to the traps that
society may bring. I have very strong beliefs in regards to my speech
impediment.
I personally believe the disorder is a disorder of the heart, euphemistically
speaking. People with speech disorders are handicapped emotionally, and
psychologically. Growing up my philosophy regarding my speech impediment was
"One must become silent in order to survive," this being my way of
consorting with "regular" people. Of course this paradigm was adopted
as a result of being ridiculed publicly and privately by many people. However,
if one does not talk, he/she limits the life that he/she can live. Humans were
not meant to be silent. This ideology does more to hurt a person than any other
thing I can think of. This philosophy also desensitizes basic human feelings and
emotions; therefore, it becomes a disorder of the heart. Fortunately, I am
coming to terms with my speech impediment, and I have changed my outlook
regarding it. But I still struggle with it at times.
Growing up with a lisp has caused me to question my value and worth as a
person. At some points of my life, I believed I had completely lost any positive
identity I had. I became invisible. This was a result of not communicating with
people. I also found that I have lost many basic communication functions. I
carry conversations, but they are usually limited in content and the amount of
words I use. This is the result of the defense mechanism I adopted (not
speaking). This is also another negative effect of not seeking treatment or
help. Ironically, I am a very opinionated person. I enjoy expressing ideas to
people whom I am close with. Ironically, I am a scholarship boy, literally. I
currently have obtained an educational scholarship for my academic achievements.
I only state this to emphasize the fact that people with speech impediments are
not unintelligent. This leads me to my current views of my speech disorder.
I have learned that I cannot not communicate. I cannot be locked in a
box with no way to escape it. I must speak and live a fruitful life. There are
two major options I have in dealing with my lisp. I can attempt to overcome it
or simply live with it. Amazingly, many people are comfortable with their speech
disorders and have learned to live with them. However, I will attempt to
overcome my lisp. I intend to acquire speech therapy shortly after I acquire
proper health insurance. I know well that I may not be able to overcome it (even
after speech therapy). Unfortunately, many adults are unsuccessful in doing so.
Consequently, many live a life with regrets. But many are successful as well.
One thing for sure is I will put all my effort into it.
If I still cannot overcome it, I will do the only thing I can do. I will
accept it. I will accept the speech impediment as being a part of me. I will
accept the fact that I am peculiar. But I will not accept the negative
connotations that come with having a speech impediment. I will not allow myself
to have a disorder of the heart. And I will not think of myself as
unintelligent. I will accept myself as different only, and yes, I will be a role
model to others with speech disorders.
Albertine, Kurt H. and Tracy, David eds. Anatomica Barnes and Noble
Books October 2001.
Bowen, Caroline. Speech Language Pathologist 3 September 2002
http://members.tripod.com/Caroline_Bowen/lisping.htm
Buckoff, Michael. "Child and Adult Language Acquisition" CSUSB
Lecture 8 August 2002
Dickson, Jackie. "Oral Aerobics" Train Your Brain Co. 3 September
2002 http://www.trainyourbrainco.com/paerobics.htm
Kilminster, M. G. & Laird, E. M. (1978).
"Articulation development in children aged three to nine years."
Australian Journal of Human Communication Disorders. 6,1,
23-30.
Manning, Diana F. and Rosenfeld-Johnson, Sara. "Part I: Straws Using
Simple Motor Tools in Oral-Motor Therapy."
Advance for Speech Language Pathologists & Audiologists http://www.advanceforspanda.com/spfav1.html
Rosenfeld-Johnson, Sara. "Horns as Therapy Tools" Advance
Magazine Published 31 May 1999
Theo, Kelly Sue. "How to stop thumb sucking" http://la.essortment.com/stopthumbsucki_rhxo.htm
Van Riper, Charles. Speech Correction Principles and Methods 5th Edition
New Jersey, Prentice-Hall, Inc, 1972.I