Articulation, Resources, Therapy Tools

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!

Thoughts and Inspirations

American Girl Dreams

I almost didn’t post this entry. I admit that I am probably over-dramatic, and posts like these probably detract from the competent, professional image I often try to project. But I am trying to be authentic in my blogging efforts, and perhaps admitting that I often feel rather incompetent in the scope of my work is very authentic indeed. No downloadable resources in this post; sorry…today is a day for a bit of reflection. Enjoy, or not….this is me, doing my best to LiveSpeakLove.


Today I entered the beautiful, picturesque world of American Girl. After years of playing super heroes, dragons and ninjas with my older boys, I was now perfectly delighted to sigh and squeal in delight at exquisite eighteen-inch dolls and their miniature shoes, clothes and numerous accessories. I had no idea how inconspicuously captivating this world would be. Visiting one of their stores today was admittedly a sensory-rich experience, with endless displays of distinctive dolls in various poses. Their charming accessories, furnishings, pets and attire all documented their participation in the most wonderfully enjoyable activities. Slumber parties, sports games, music & theater performances, cooking extravaganzas and acrobatics…these American Girls were apparently living the American Dream. I watched my own American Girl, her eager smile and glazed expression slowly taking in the scenes around her. The hours she had previously spent in  “research,” poring over each page of all the catalogues that came in the mail could not have prepared her (or me) for the hypnotic confections that surrounded us as we walked through the store. I watched her eyes dance and shine, her breath catching a bit as she glimpsed one item after another which brought delight to her mind and heart.

My girl carefully but adamantly chose the doll with glasses, Molly, and a cooking kit so Molly could bake cupcakes (generous gifts from her grandmother.) We then lunched in the Bistro with Molly, who sat in a high chair provided by the restaurant. The day was carefree, fun; full of wonder and possibility. We cheerfully left the store feeling happy and content. As we drove home, my girl clutched her doll tightly and whispered to her throughout the ride. My thoughts drifted to the scenes of the day….my mind recalling the swarms of girls entering the store; group after group all having similar, wonderful experiences. All of the girls beaming with excitement to share in this real-yet-make-believe world.

My mind then drifted to my students at work, and it dawned on me that many of the girls in my school might never have even a similar experience. Never. I took note of this abject disparity –as a mom, I felt grateful to share days like today with my girl; her pure delight in this perfect, childhood experience warmed my heart. As an SLP working with some complicated kids, I ached to give these same experiences to all of the children on my caseload. My thoughts acknowledged that many of my students could not have tolerated the sensory input of the store, and many of their families could not have afforded the gifts that we were given today. The SLP in me sat thoughtful for a long while, dreaming for a way to make things different.

Dilemmas like this one strike me every so often. I wish there were a way to help my students, in all of the ways they need to be helped. The work I do with and for these children is often over-shadowed by clouds of paperwork, federal IEP timelines, caseload management constraints and factors over which I know I have no control. While I do my very best to give students engaging, differentiated therapy experiences to promote growth and success, I always wish that I could do more. I wish I could fix the disorders; dissolve the difficulties. I wish I could give disadvantaged families the money they need. I wish I could give parent-less students a stable home life. I wish I could erase harsh moments that forever shadow a student’s life. I wish I could give them all exactly what they need; give them everything they need, with lives as abundant  and rich as the fictitious characters of the American Girl world. But I know I can’t.

Tomorrow, I will go to work and immerse myself in the therapy activities I have planned; collecting data, writing reports and helping each child to the best of my abilities. My work will help them progress toward mastery of IEP goals and objectives. Their skills will slowly improve.  Tomorrow I will teach, and my students will learn. But today; right now, I wish that I could take each child on a trip to the American Girl Store.

Thoughts and Inspirations

Birth of a Blog

“What inspires you?”  A friend recently asked me this question about my work as a speech-language pathologist, and I found myself pondering the idea longer than I expected. As a busy mom and full-time school-based SLP, I admit that it is often easy to get lost in the routines, the necessities and basics of everyday life–with more on my daily to-do list than often seems feasible. I prefer to check items off as they are completed; nice, neat little boxes with the checks in order and the plans made in advance. I feel great when I can look back and see the plans, the check marks and the accomplishments. However, as many busy SLPs and moms in this crazy world know….life is not about the to-do lists or the check marks. It’s not about whether you accomplish everything on your agenda for the day, or whether your plans are even realistic. As I acknowledged these thoughts and continued to ponder the question of what inspires me (and all the daily challenges that often preclude any degree of inspiration) a memory suddenly emerged in my mind. A simple recollection of a moment during a speech therapy session, when the small boy I was instructing stopped and smiled at me. It wasn’t a huge grin or an animated expression. Rather, it was a brief flash of a smile that spoke to me in a subtle tone, “I get it now.” That sweet glimpse of a smile that suddenly appeared in my mind triggered dozens of examples that all whispered, “inspiration.” I finally nodded to my friend as I matter-of-factly answered her question, “I am inspired by opportunities to connect with other people.”

If you have connected with someone in a meaningful way, you may know the feeling of what I consider to be truly inspiring. Inspiration seems to often occur in those incidental encounters that can’t be planned carefully or placed on an industrious to-do list. For me, inspiration occurs at that moment when I realize that perhaps my best-laid plans need to be moved aside to make room for the unexpected.  It’s in the look on a child’s face when they are captivated, or even confused. It’s in that chance to really connect with someone else and add something to their life–in whatever small ways possible. At the risk of sounding too cliché or pretentiously altruistic, I believe my inspiration often comes from the chance to make a difference in the lives of those in need — to help them live, speak, love.

Not surprisingly, what inspires me as a speech-language pathologist is what also inspires me as a mom–and as a person. I find personal satisfaction and enjoyment in searching for new ways to connect with my kids, run my household or teach the students on my caseload. I get excited about creating opportunities for building connections through new ideas or tools to use– perhaps a clever theme-based lesson plan, a fascinating use of technology, or a simple-but-brilliant idea for using something old in a completely new way. I admit to scouring the internet in the wee hours of the night for the next bright idea, and every now and then I come up with a good idea all on my own! Yes, it is true that ideas sometimes need to be set aside to make room for spontaneous connections in life, but it is also true that creative ideas tend to spark ways of embellishing everyday moments. For me,  it’s those everyday moments that make all the difference.

And so begins my season of blogging…my newest plan for how I can connect with others in a meaningful way. I hope to share what inspires me, so that others may also be inspired. We all know that life is full of unexpected challenges, worries and setbacks. To-do lists and check marks really do not tell the whole story of who we are or what we find important in life. Despite all our planning and preparation, busy days run into the next until we discover a chance to stop and ask (or be asked) the question, “what inspires you?” I hope you find some answers in this blog, and some ideas to inspire or connect with someone else.

P.S. Please be patient as I develop my blog; I have a lot on my to-do list. 🙂