I get a lot of referrals from a local orthodontist to remediate tongue thrust for her patients. She wants her patients to have better tongue positioning so they can either be well prepared to receive the orthodontia, or don’t undo all of the good work that has been done. Having a good tongue position may not be something we think about too often. I know I didn’t think about it before I became a speech therapist! Tongue positioning can affect sleep, swallowing, and speech. Depending upon what your tongue is doing, there will be different diagnoses. Before treating the client, we find out in the initial parent interview if the child has any speech involved with the tongue thrust, so we can see which course of treatment to take.
Whenever we think of the tongue coming forward, and sometimes out of the front of the mouth, we think of a lisp, but that may not be the case. It may be a tongue thrust. The American Speech Language Hearing Association (ASHA) defines a tongue thrust as a tongue moving forward in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and at rest. A tongue thrust is classified as an orofacial myofunctional disorder (OMD). In infancy a tongue thrust is normal. However, as children grow, they develop a more efficient swallow pattern. When they don’t develop the natural posterior moving “wave” of the tongue, then orofacial myology techniques must be used to help the child find proper positioning.
A lisp is a different story but can share the traits of a tongue thrust. A lisp refers to a person’s difficulty in producing /s/, /z/, /sh/, /zh/, /ch/ and /j/ because of incorrect placement of the articulators, namely the tongue and jaw in this case. The tongue may be sticking out between the front teeth, or the sides of the tongue may not be high enough or tense enough in the mouth. These articulation errors result in sound distortions. The jaw is often moving forward and/or hanging low, so that the tongue follows suit. Either way, there is an opportunity for the tongue to move forward and not have the proper positioning of the jaw to support correct placement.
Many speech therapists work only with the tongue, telling the child to put the tongue behind the teeth (the snake in the cage), but not work with the jaw. It is imperative that jaw positioning be corrected as well, otherwise you are only working with half of the problem.
In contrasting how the two are remediated:
Therapy for tongue thrust focuses on training a normal swallow pattern, as well as encouraging a more posterior placement of the tongue at rest and while eating. Therapy for a lisp focuses primarily on training correct placement of articulators. However, having said that, when working with a lisp, it is advisable to also do therapy for tongue thrust since the client will likely have underdeveloped muscle tone and lack of coordination with some articulators, and at the same time overdeveloped compensatory movements for other articulators; such as moving the jaw forward when the tongue moves to produce the above sounds, and the tongue not having enough tone to contact the correct placement. At Vibe Speech Therapy, our speech and language therapists are trained to treat frontal lisps and orofacial myofunctional disorders such as tongue thrust. For more information on what is present in your child, and what can be done to help, contact us at email@example.com to schedule a free consultation.