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(#32)  Top-Ten Tips for

Hello, fellow SLP!

“Just blow air over your tongue. Uh, well, oh boy--heard that ffffff, again. Try not to lift your lip up to your teeth—it’sthhhumb, notthhh-f-umb. Let’s give it another go—just the tongue this time—th-th-th… okaaay…”
 
“Th” looks easy to say and remediate, but it isn’t. Once a substituted movement pattern has been established, it’s difficult to replace. But not impossible!
 
Both theunvoiced and the voiced productions are different from other lingual speech sounds and require different strategies. In today’s offering, you’ll learn about those differences, why they’re critically important, and what to do about them in therapy.
 
Like /r/, the “th” is a later developing speech sound. The “th” is one that many of us put off treating in hopes it will develop. When the child is in third grade (or sometimes second), and it hasn’t developed (and it’s not in transition), it’s time to treat—especially the /f/ for “th” substitution.
 
Interestingly, the later developing /r/, /l/, and both “th’s” require a lingual motoric maneuvernot characteristic in any other speech sound.
 
The unique motoric maneuver is the simultaneous occurrence of lingual tension (by intrinsic tongue muscles) + movement through space (by extrinsic muscles) + the ability to pinpoint and land on its destination, and hold for a moment in time.
 
  • For /r/: the tongue contracts, retracts, and lands on the retromolar pads (etc.).
  • For /l/: the tongue contracts, elevates, and lands on the alveolar ridge (etc.).
  • For “th”: the tongue contracts, moves anteriorly, and lands in close proximity to the front teeth (etc.).
 
No doubt, this motoric and “layered” complexity contributes to later sound development in some children, and to the difficulty re-learning the correct speech sound for others.
 
Therefore, a good “th” requires the ability to synthesize (layer) the following:
  • Contract and move the tongue horizontally through space while touching the cutting surfaces of the top side teeth,
  • Move into close approximation with the front teeth,
  • Hold,
  • Initiate centralized air flow, and
  • Add phonation as appropriate.
▪ ▪ ▪
 
First, the therapy sequence, then the ten-tips. The tips include need-to-know info that pertains to therapy, and, sound-stim suggestions and other strategies.
 

The Therapy Sequence

Consider the following therapy sequence--it worked pretty well for my th-kids through the years! 
  • Introduce and progressively shape theunvoiced “th” first.
  • First, practice moving a non-tense tongue out and in; add jaw stabilization if needed.
  • Do horizontal, hit-the-anterior-mark practice and lightly interact with the front teeth. Do drill and instill (a little movement forward, a little movement back) to build in the core horizontal movement memory to replace the former movement pattern.
  • Practice tongue tighten-loosen (for a week at least).
  • Then practice moving the contracted tongue; contraction plus horizontal movement.
  • Continue to do horizontal tongue movement practice plus “the slide.” The surface perimeter of the tongue slides forward on the cutting surfaces of the top, back teeth.
  • Then add centralized airflow. No phonation. Continue to drill-and-instill the movement pattern for the unvoiced “th.”
  • Then, add phonation. Continue to drill-and-instill.
  • Advance into minimal context pairs. Select which one is easiest for the child to do, the voiced “th” or theunvoiced. Download and print thePhonetic Context Probe.
  • Then, of course, add and practice words; download and print theTH Deep Screening Probe, etc.

The Top-Ten Features and Strategies

Let’s dig even deeper. Following are additional detailed production features and explanations to remember, address, and share in therapy, along with several remediation tips and techniques to stim theunvoiced and voiced “th” speech sounds.
1. Both “Th’s” are Horizontal Speech Sounds (not vertical)
 
Most speech sounds are produced up within (more or less) the upper dental arch. The two “th’s,” however, are produced at the horizontal midline of the mouth. They are the only consonant speech sounds produced at the horizontal midline.
 
Also, most lingual consonant speech sounds are producedvertically. Thefront-tongue moves vertically for t, d, n, l, s, z, sh, zh, ch, and j, and theback-tongue moves vertically for k, g, ng, and r. Conversely, theunvoiced “th” and the voiced “th” requireanterior movement of theentire tongue on thehorizontal movement plane.
 
2. Both “Th’s” Require Significant Lingual Tension (not as much as /r/, however)
 
Have you ever tried to teach a child that has a “floppy” tongue to say “th?” It doesn’t work. The tongue flutters and sounds like an infant’s “raspberry.”
 
Bottom line: The tongue MUST contract during the production. Not killer-contraction, but enough to maintain overall internal tongue-stability while the air moves across it.
 
Keep in mind, the mid-tongue contraction needed for a “th” is not a “bowl,” it’s more of a “saucer.” The core, mid-tongue contraction radiates tension to the rest of the tongue.
 
3. Stabilization, Mobilization and the “Th” Placement
 
All speech sounds are stabilized and mobilized; one part of the lips or tongue anchors while the other part moves to generate the speech sound. This is also true for the two “th’s.”
 
As mentioned above, “th” requires lingual tension. The internal tension provides internal stabilization.
 
In addition, light external stabilization is also maintained on the perimeter surface of the tongue as it moves anteriorly. The perimeter lightly touches the cutting surfaces of the top side teeth. Unlike /s/ where the tongue-sides literally push against the insides of the top back teeth, this does not occur in the “th’s.” The light lingua-dental contact guides the centralized air flow. Also, the underneath part of the tongue touches the edges of the bottom incisors.
 
The visible part of the tongue is either between the cutting edges of the top incisors, or in close proximity to the lower third of the back of the top incisors.
 
Excessive tongue protrusion is inappropriate and not conducive to quick lingual movement. It’s effortful and will not successfully carryover into coarticulated speech.
 

Sound-Stim Tasks Via Successive Approximations

4. Sound Stim from /i/ (ee)
 
The /i/ is a high, tense front vowel that stabilizes on the lingual sides (usually the cusps) of the top back teeth.
 
Produce /i/, sustain, then slide the tongue forward along the “rails” of the sides/cutting edges of the top teeth, to just between the incisors; add airflow and say ”th.” Be sure the jaw lowers and does not move forward in an effort to assist in the tongue’s movement.
 
5. Sound Stim from /n/
 
Sustain the /n/ production and slide forward to theunvoiced “th” placement. The /n/ a nice, close approximation: just slide forward and down the contour of the top incisors; then add airflow. The slide helps to provide tactile guidance for the tongue as it moves. This slide, however, doesn’t work as well for the voiced “th.”
 
6. Sound Stim from an Interdental /t/
 
Produce a forward, against-the-edges-of-the-front-teeth mildly plosive /t/. Just the tongue moves and interacts; make sure it’s not jaw-driven. Then progressively over-aspirate the sound, sustain the airflow, and shape the tongue into a “th” placement.
 

Additional Techniques

7. Placement and Movement Practice: To and From the “Th” Placement
 
Once the “th” (either theunvoiced or voiced) is pretty consistent, add simulated oral movement. First, ask him to place his lips, tongue and jaw into the good resting position (lips are closed, the tongue is up, and the jaw is gently relaxed). Then, with eyes closed, ask him to focus and feel his tongue’s movement as it moves into the “th” placement, say the sound, then move back to the resting position. Practice this mini-movement several times over two weeks, at least.
 
8. Stabilize the Jaw
 
You need three small tongue depressors and scotch tape to make a bite-block. Stack the tongue depressors together and wrap the tape around the middle. To keep the jaw still, place one end of the taped tongue depressors between the top and bottom molars on one side; gently bite down. This keeps the jaw “busy” and creates a static oral environment for the tongue to maneuver and learn. Practice the “th” out-in movement, etc.
 
9. Restrict the Lower Lip
 
Some kids have a hard time letting go of the /f/ lip involvement while trying to learn the “th.” In some cases, the lip almost reflexively lifts to make contact with the teeth for /f/. This interferes with the independent horizontal tongue movement and subtle tongue-teeth contact for “th.”
 
You’ll need either a tongue depressor or a 10” piece of Rep Tubing (Amazon.com; the orange or the green). Use either of these (the Rep Tubing works best, however) to restrain the lower lip and keep it from elevating up to the top incisors. While he moves his tongue anteriorly-posteriorly and interacts with the top, front teeth, place the Rep Tubing horizontally across the surface of the bottom lip. Repeat, repeat, repeat. This is not a sound-stim technique. It’s a re-patterning of the oral movements.
 
10. Spatial Feedback: Make the Paper Flutter and Feel the Vibrations
 
For this one you need a small piece of plastic wrap or wax paper; not writing paper because you’re putting in the mouth.
 
Hold the paper taut in your fingers with both hands. Open the jaw (about half way) and lower the tongue and place the paper on the surface of the front-tongue. Raise the jaw and place the tongue in the “th” placement, close to and barely touching the top incisors. Continue to hold the paper taut and say the unvoiced “th.” The paper will gently flutter. Then say the voiced “th;” the paper will gently vibrate. This helps to give feedback and establish the lingua-dental spatial distance.
 
Thanks so much for all the good things you do with your therapy-kids! Do know, you are appreciated.
 
See you next week,
Char

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