Tricky Sounds: Correcting For Lateralized Airflow

I was recently asked to offer some advice about correcting for those tricky sound errors — lisps and lateralized productions of  the sibilants /s/, /z/, /sh/ and /ch/. If you are an SLP, you can probably detect a lisp or a lateralized /s/ on every affected public speaker, casual acquaintance or celebrity you have ever had the pleasure to encounter. My husband makes fun of me for the way my ears perk up and how the expression on my face clearly changes whenever we are listening to someone with an /s/ distortion. I suddenly have the urge to offer these speakers nonverbal feedback as we interact. Sadly, I can’t help it; it’s an affliction. Even if you are not an SLP and have no desire to cure the world of lateralized airflow patterns, you may be able to detect that something is not quite right in the way a person says their /s/ and /z/ sounds— the words come out sounding “slushy,” “sloppy” or even “garbled.” I once had a teacher tell me that their student with a lateralized /s/ sounded like he was “pretending to be a ventriloquist.”  This statement was actually not an off-target description. 

Lateralized airflow sound distortions are unfortunately some of the hardest to correct. While I am an SLP, and therefore, an “expert,” I do not profess to have any secret knowledge or special talent in correcting these tricky sounds. I have struggled along with the rest of you in finding ways to train for correct sound production.  I am happy, however, to share what has worked for me more often than not in the past fifteen years.

In my opinion, the issue of lateralized airflow distortions is two-fold, and requires training on both factors:

1. Students do not have a correct tongue position for these sounds (and often the tongue position at rest is incorrect as well.) These sounds must be produced with the tongue elevated to meet at the alveolar ridge or surrounding area.
2. Students do not have a correct frontal airflow stream (probably secondary to incorrect tongue position) . When the tongue is elevated at the alveolar ridge area, a slight groove is formed in which airflow is then directed in a stream out the front of the mouth. When the tongue remains low and flat, no slight groove in the center of the tongue is formed to direct the airflow out the front. The air escapes out the sides of the tongue and the distortion is produced.

Unfortunately, the tongue and airflow patterns are habitual and must be entirely retrained for correct sound production. Therapy on these sounds begins with ongoing student education for tongue position and airflow. I often begin with pure discussion and education using mouth diagrams, puppets, mirrors, and visuals. I then begin training with some oral motor tools or tricks like dots of icing on the alveolar ridge or other tactile feedback to elicit correct tongue placement. I have students practice in front of mirrors and watch me as well. My school  recently purchased these mirrors for my therapy room so that each student has their own for practice (great for preventing “downtime” while I give individualized feedback to other students in the group):

Once the initial training and tactile feedback has been provided, I quickly move into practicing target sounds in isolation and then in syllables or words. I use a variety of methods including verbal, visual and tactile strategies to help students train for correct placement and airflow. I have visuals for each target sound that offer descriptions so students can more easily remember the placement and manner of the sounds. I usually start by targeting /s/ in isolation, though I do not believe that this sound is scientifically proven easier to produce than any of the others. I just personally find it easiest to elicit, especially when introduced as “the sneaky snake sound” and paired with different snake games/activities. Every therapy session I conduct is structured to include education, discrimination, direct training, and then practice (often using  games or other motivating activities) to target sounds in isolation, syllables and words. These activities all include the following visuals (or similar.)

Below is a visual that introduces each sound and gives them all a “name” to represent sound attributes in some way. At the bottom of this visual is a three-step process chart that helps to elicit correct placement and airflow. I have had very good success using the cue “Teeth Together.”  This cue is something much more concrete and outwardly visible than the more elusive “tongue elevation to the ‘bumpy spot’ behind the teeth.” For some reason, tongue placement seems to greatly improve and inhibit lateral airflow when the upper and lower central incisors meet in front (not in a smile, though, which tends to drop the tongue and foster lateral airflow. Think “show your teeth” in a Lady Gaga kind of way.) Students can see their teeth together; they can replicate it easily, and for whatever reason, it often works when it is done correctly. Students are also trained to hold their hand or finger in front of their lips and feel the airflow as they speak. Sometimes this trick is enough to elicit the frontal airflow pattern and progress is made quickly as the student has built-in cues and biofeedback wherever they go!

Another visual I like to use is this discrimination tool that can be used both with the student listening to modeled productions or when producing on their own. The clinician can provide the feedback using the visual, or the student can self-evaluate their own productions:

 Students are encouraged to practice their sounds on their own using their hand as a self-cueing strategy for frontal airflow detection:

As we move into practice using syllables and words, I select the syllable or word targets to specifically shape and elicit correct tongue placement. I choose syllables and words using vowels that are produced higher in the mouth (usually /i/ and /u/) to move away from the low, flat tongue patterns used in /a/ or with a schwa. I also vary the position of the sound in the word or syllable:

Another way I elicit correct tongue position is to shape sounds across word boundaries using alveolar sounds that the student has already mastered. Here is a visual I use with students to shape the /s/ from /n/ across preceding and subsequent word boundaries:

As a student becomes more independent, the same pictures can be used to create sentences for practice at a higher level. My go-to games are often open-ended game boards, commercial games or interactive activities that can be paired with specific stimuli or picture cards using the currently targeted sound or sounds. I also use barrier games or student-led activities with a focus on peer feedback to encourage generalization to other settings. I often have peer partners that will develop their own nonverbal signal to prompt for correct placement or airflow.

Above all, a student needs to “buy in” to the training and practice their skills in other settings. This is why all of my speech therapy sessions incorporate the pieces of education, discrimination, targeted training and practice. If students are reluctant  to practice or do not self-cue or self-monitor, then progress will likely be much slower. Systematic training in tongue placement, frontal airflow stream,  how to self-cue and monitor, and how to practice are essential components of a treatment program for lateralized airflow sounds. The treatment program may seem endless some days as you train and educate, but eventually, most students “get it.” I consider my work with these students just as important as my work with nonverbal or language-delayed students and I applaud those of you who work tirelessly to improve communication skills on any level. Good luck with using these techniques, and I’d love to hear if there is something else that has worked for you. Please share — it’s exactly what I love about the internet!