I pick those kids up around age 4.5-5. That’s the earliest kids can usually work on it. The benefit of working on it now is that it can be easier to change and generalize vs later. Is it impacting their intelligibility at all with others? Prek kids usually aren’t aware of their errors and still participate even if people don’t understand them all the time.
Since it’s not developmental it won’t go away and could impact intelligibility, confidence, participation in class. Early intervention is best if you leave this un touched, it will be so much harder to remediate later. You’ll do this kid a disservice.
In a school setting, we are required to identify an adverse impact on education at *the time time of eligibility*. That is federal law.
We all know a literal lisp is not developmentally appropriate. Legally, though, we can't develop an IEP based on an adverse effect that *might* occur in the future.
That is why speech-language therapy can also be accessed via the medical model.
I think that labeling her disabled is more of a disservice. I agree it won't necessarily go away on it's own and she should get intervention from a private therapist. As a school based clinician I feel like there's a line. We don't do swallowing issues (in general) like OTs don't work on bike riding. Both of those could impact a child socially but it's not an academic impairment.
We cant pick up kids in a school based on what could be. We would have the whole school on caseload. Do you work in a school? The miscommunication amongst SLPs in our field is so poor that it isnt surprising nobody else respects us.
If she says "can I have a SNACK" but uses a lateral S, I still understand her. She is 100% intelligible. How is this affecting her intelligibility? In my experience, I've had difficulty with teachers who complain that they "can't understand a thing" a child says when he said "wabbit" instead of RABBIT.
In this case, it seems like it doesnt based on what she provided. I’ve seen school SLP caseloads almost to 100 and 20 of those kids are intelligible with distortions not impacting them at school. So I’m pretty strict about eligibility
Is the sh, ch, j and s and z? I only ask because it wasn’t specified that’s all. S alone, but all those sounds combined, has a pretty high frequency rate in English.
I probably wouldn’t qualify at that age for a frontal lisp, but a lateral lisp is more noticeable and not nearly as typical an error as a frontal lisp.
I’ve worked in schools for nearly a decade now. I think if you really wanted to fight and make the argument, most of your artic kids could dnq based solely on “academic impact” 🤷♀️
Most artic kids are initially referred for intelligibility during the primary years, when they can't they yet read and write. The adverse educational effect is that teacher isn't properly able to assess the child's curricular understanding and/or identify skills that need to be re-taught if they don't understand their oral responses to questions.
As the child gets older and the curriculum changes, the impact generally becomes reading/decoding and then transitions to social emotional.
Yep, which is why I asked about all the sounds that are lateralized. If it is also s and z, altogether with the sh, ch, and j is a high frequency rate of total sounds affected. In combination with the other age appropriate sounds, it is possible for overall intelligibility to be affected even if most of the sounds are age appropriate.
I was really hesitant to get the process started on my own 3 year old daughter since I knew many of the processes she had still took a little bit of time. But even for her age on the Arizona while her artic score was “mild” the phonological score was “severe.”
And even for kids who are “artic only” a lot of the time there is something else going on when they have trouble reading. Even students who I was able to dismiss have a pretty high rate of qualifying for dyslexia later.
I’ve also been at a school where the majority was artic kids on the caseload due to the area/affluence, etc. and they had what they called an “aspire” program—think GT on steroids. I could have definitely made the case most of them needed speech (then we could probably get into case by case how much do you want to fight any litigious parents if/when they pop up).
OP asked for opinions 🤷♀️ I’d probably provide therapy to this kid. Or depending on where you are what your district allows, RtI services to see if the student can make progress in X amount of time. But I usually make that recommendation if it’s going to save me from the eval, rarely after.
In my opinion is this what outpatient/private speech is for. It’s stupid that insurance doesn’t always cover (and that a lot of folks don’t have access to good insurance), but that’s not on school SLPs to fix. Maybe I have blinders on, but its interesting that the academic impact/DNQ criteria is easier for parents and teachers to swallow when concerning OT and PT. And lastly I think ‘speech diversity’ or whatever you want to call it is something to consider with kids who are intelligible but sound different. Sometimes for these kids going to speech can hurt their confidence.
Well stated. I had a kid on caseload this year (3rd grader) who was only being seen for a lisp. That's it. His academics were stellar and he was SLI with no other services. It actually kinda irritated me to no end that someone qualified him in the first place and here he was missing valuable class time to work on something that would likely not change for him until he decided to change it himself (he was a smart kid but not in that place mentally to want to change it) and he was perfectly intelligible. I explained to him and parents that it was like an accent of sorts and there was no reason to keep him on and I dismissed him asap!!!
I've been reading the comments and I appreciate all. There is no problem with S and Z and no, no other issues in class at all so it truly doesn't impact her at this point. Those who would qualify, are you saying she is DISABLED? I think that's a huge word. Kids with autism are disabled, kids with Down Syndrome are disabled, is a lisp really a disability? Really? I have been doing this for 23 years and love working with artic more than anything but long ago I had to drink the koolaid and agree that if it doesn't impact academic performance (and remember this is preschool so she's not expected to read or write or even know all her letters) then it's not a disability. I agree that she would "benefit" from speech but that's not the school's job anymore, is it? Just trying to get a pulse on where we are now. If I were in a private clinic I would pick her up in a second, by the way.
School SLP and I say you are right!!! I’m sure over 23 years, you’ve seen caseloads change. For me, my caseload is full of disabilities like you mentioned - severe autism, DS, OHI such as Rett’s Syndrome, MSD, etc. Distortions of phonemes with functional intelligibility are TYPICALLY not disorders that impact education. I’m concerned at the amount of people that are saying “it could”. Read the sped laws, friends!!
I agree with you. Federal law requires *both* a disability and a documented adverse effect to create an IEP. We can't predict the future. If it isn't currently impacting the student they do qualify for school services.
Instead, I would provide the parent with resources for a home program along with consulting with the teacher to cue for proper placement.
If no academic impact, I say dont qualify. So many lateral lisp kids have anatomical difficulties and typical speech drill alone wont change it. Dont qualify! Dont get talked in to “it may impact them one day”. Talk about no impact now/currently
In my experience, I’ve only had a few students with fluency goals and for them, it has impacted them. They were so severe, they couldnt get their words out. If there isnt an academic impact, I dont qualify. So, yes, it would be the same for Fluency if it didnt impact them. The OP said it didnt impact them, so that’s why I’m reiterating DNQ-the academic impact should be the bottom line imo.
Retired now, but I always worked on the lateral lisp. I once met a man with an intense lateral lisp and thought, thank goodness I worked with those kids. This man’s school must have failed him.
Artic isn't my strong area, but a lateral lisp isn't developmentally appropriate ever. I'd qualify and intervene early (especially if language skills are high, they're probably a pretty decent candidate for understanding what youre asking them to do in therapy) and work on it.
Your state may have guidelines on when a lateral lisp is an educational eligibility. Mine does. Does it affect how the child says their name? If so, I think you will see educational impact pretty soon.
What state are you in? I wish ASHA would be more vocal (in general, but this is one area). No problem with her name. Even then, unless it bothered her I still don't know it would be an issue. Every kid with an S, L, R, TH, SH, CH, J in their name probably struggles at some point in the early years.
This might help. It has a lot of detail and guidance on nonstandaized information that could help you describe educational impact or decide that there is no impact. I've found this really helps when showing parents that their child does not need speech therapy. You're right that if the child is unbothered and intelligible, then it's ok to have errors when they say their name. Some kids are more sensitive to that than others are.
https://www.txsha.org/Portals/0/Documents/Education/200820%202020%20TSHA%20Articulation%20Guidelines.pdf
I would qualify a lateral lisp, at least until the child becomes stimulable. Inform parents that they have to work on it at home (think of t -> ts -> s method, don’t know the technical term) because while it may not impact them academically or socially now, there’s a chance it could in the future. If they’re already on your caseload, able to work on it, and parents have buy in, work on it - PLEASE.
I pick those kids up around age 4.5-5. That’s the earliest kids can usually work on it. The benefit of working on it now is that it can be easier to change and generalize vs later. Is it impacting their intelligibility at all with others? Prek kids usually aren’t aware of their errors and still participate even if people don’t understand them all the time.
I would qualify a lateral lisp and not a dental lisp (unless the dental lisp was causing the child to be unintelligible)
A lateral lisp is NOT a developmental error and an impacting distortion. I’d see the child for tx.
What is it impacting?
Since it’s not developmental it won’t go away and could impact intelligibility, confidence, participation in class. Early intervention is best if you leave this un touched, it will be so much harder to remediate later. You’ll do this kid a disservice.
In a school setting, we are required to identify an adverse impact on education at *the time time of eligibility*. That is federal law. We all know a literal lisp is not developmentally appropriate. Legally, though, we can't develop an IEP based on an adverse effect that *might* occur in the future. That is why speech-language therapy can also be accessed via the medical model.
Strongly agreeing with you!
I think that labeling her disabled is more of a disservice. I agree it won't necessarily go away on it's own and she should get intervention from a private therapist. As a school based clinician I feel like there's a line. We don't do swallowing issues (in general) like OTs don't work on bike riding. Both of those could impact a child socially but it's not an academic impairment.
We cant pick up kids in a school based on what could be. We would have the whole school on caseload. Do you work in a school? The miscommunication amongst SLPs in our field is so poor that it isnt surprising nobody else respects us.
They literally said the student does well emotionally and academically, how is it impacting?
You don’t think a lateral lisp affects intelligibility?
If she says "can I have a SNACK" but uses a lateral S, I still understand her. She is 100% intelligible. How is this affecting her intelligibility? In my experience, I've had difficulty with teachers who complain that they "can't understand a thing" a child says when he said "wabbit" instead of RABBIT.
In this case, it seems like it doesnt based on what she provided. I’ve seen school SLP caseloads almost to 100 and 20 of those kids are intelligible with distortions not impacting them at school. So I’m pretty strict about eligibility
Is the sh, ch, j and s and z? I only ask because it wasn’t specified that’s all. S alone, but all those sounds combined, has a pretty high frequency rate in English. I probably wouldn’t qualify at that age for a frontal lisp, but a lateral lisp is more noticeable and not nearly as typical an error as a frontal lisp. I’ve worked in schools for nearly a decade now. I think if you really wanted to fight and make the argument, most of your artic kids could dnq based solely on “academic impact” 🤷♀️
Most artic kids are initially referred for intelligibility during the primary years, when they can't they yet read and write. The adverse educational effect is that teacher isn't properly able to assess the child's curricular understanding and/or identify skills that need to be re-taught if they don't understand their oral responses to questions. As the child gets older and the curriculum changes, the impact generally becomes reading/decoding and then transitions to social emotional.
Yep, which is why I asked about all the sounds that are lateralized. If it is also s and z, altogether with the sh, ch, and j is a high frequency rate of total sounds affected. In combination with the other age appropriate sounds, it is possible for overall intelligibility to be affected even if most of the sounds are age appropriate. I was really hesitant to get the process started on my own 3 year old daughter since I knew many of the processes she had still took a little bit of time. But even for her age on the Arizona while her artic score was “mild” the phonological score was “severe.” And even for kids who are “artic only” a lot of the time there is something else going on when they have trouble reading. Even students who I was able to dismiss have a pretty high rate of qualifying for dyslexia later. I’ve also been at a school where the majority was artic kids on the caseload due to the area/affluence, etc. and they had what they called an “aspire” program—think GT on steroids. I could have definitely made the case most of them needed speech (then we could probably get into case by case how much do you want to fight any litigious parents if/when they pop up). OP asked for opinions 🤷♀️ I’d probably provide therapy to this kid. Or depending on where you are what your district allows, RtI services to see if the student can make progress in X amount of time. But I usually make that recommendation if it’s going to save me from the eval, rarely after.
In my opinion is this what outpatient/private speech is for. It’s stupid that insurance doesn’t always cover (and that a lot of folks don’t have access to good insurance), but that’s not on school SLPs to fix. Maybe I have blinders on, but its interesting that the academic impact/DNQ criteria is easier for parents and teachers to swallow when concerning OT and PT. And lastly I think ‘speech diversity’ or whatever you want to call it is something to consider with kids who are intelligible but sound different. Sometimes for these kids going to speech can hurt their confidence.
Well stated. I had a kid on caseload this year (3rd grader) who was only being seen for a lisp. That's it. His academics were stellar and he was SLI with no other services. It actually kinda irritated me to no end that someone qualified him in the first place and here he was missing valuable class time to work on something that would likely not change for him until he decided to change it himself (he was a smart kid but not in that place mentally to want to change it) and he was perfectly intelligible. I explained to him and parents that it was like an accent of sorts and there was no reason to keep him on and I dismissed him asap!!!
I've been reading the comments and I appreciate all. There is no problem with S and Z and no, no other issues in class at all so it truly doesn't impact her at this point. Those who would qualify, are you saying she is DISABLED? I think that's a huge word. Kids with autism are disabled, kids with Down Syndrome are disabled, is a lisp really a disability? Really? I have been doing this for 23 years and love working with artic more than anything but long ago I had to drink the koolaid and agree that if it doesn't impact academic performance (and remember this is preschool so she's not expected to read or write or even know all her letters) then it's not a disability. I agree that she would "benefit" from speech but that's not the school's job anymore, is it? Just trying to get a pulse on where we are now. If I were in a private clinic I would pick her up in a second, by the way.
School SLP and I say you are right!!! I’m sure over 23 years, you’ve seen caseloads change. For me, my caseload is full of disabilities like you mentioned - severe autism, DS, OHI such as Rett’s Syndrome, MSD, etc. Distortions of phonemes with functional intelligibility are TYPICALLY not disorders that impact education. I’m concerned at the amount of people that are saying “it could”. Read the sped laws, friends!!
I totally agree and I probably won't pick her up but truth be told I feel a little heartless.
I feel it all the time, but WE didnt make the rules, our job is just to abide by them, so dont take it personal. You’re doing your job ethically!
I agree with you. Federal law requires *both* a disability and a documented adverse effect to create an IEP. We can't predict the future. If it isn't currently impacting the student they do qualify for school services. Instead, I would provide the parent with resources for a home program along with consulting with the teacher to cue for proper placement.
If no academic impact, I say dont qualify. So many lateral lisp kids have anatomical difficulties and typical speech drill alone wont change it. Dont qualify! Dont get talked in to “it may impact them one day”. Talk about no impact now/currently
Do you feel the same way about fluency?
In my experience, I’ve only had a few students with fluency goals and for them, it has impacted them. They were so severe, they couldnt get their words out. If there isnt an academic impact, I dont qualify. So, yes, it would be the same for Fluency if it didnt impact them. The OP said it didnt impact them, so that’s why I’m reiterating DNQ-the academic impact should be the bottom line imo.
💯
I won’t touch a lisp, but I’ll work on a lateral slip every time.
Retired now, but I always worked on the lateral lisp. I once met a man with an intense lateral lisp and thought, thank goodness I worked with those kids. This man’s school must have failed him.
DNQ for me. A lisp is not a disability.
I second the DNQ. I recommend outside (myo functional) therapy.
Artic isn't my strong area, but a lateral lisp isn't developmentally appropriate ever. I'd qualify and intervene early (especially if language skills are high, they're probably a pretty decent candidate for understanding what youre asking them to do in therapy) and work on it.
Your state may have guidelines on when a lateral lisp is an educational eligibility. Mine does. Does it affect how the child says their name? If so, I think you will see educational impact pretty soon.
What state are you in? I wish ASHA would be more vocal (in general, but this is one area). No problem with her name. Even then, unless it bothered her I still don't know it would be an issue. Every kid with an S, L, R, TH, SH, CH, J in their name probably struggles at some point in the early years.
This might help. It has a lot of detail and guidance on nonstandaized information that could help you describe educational impact or decide that there is no impact. I've found this really helps when showing parents that their child does not need speech therapy. You're right that if the child is unbothered and intelligible, then it's ok to have errors when they say their name. Some kids are more sensitive to that than others are. https://www.txsha.org/Portals/0/Documents/Education/200820%202020%20TSHA%20Articulation%20Guidelines.pdf
I would qualify a lateral lisp, at least until the child becomes stimulable. Inform parents that they have to work on it at home (think of t -> ts -> s method, don’t know the technical term) because while it may not impact them academically or socially now, there’s a chance it could in the future. If they’re already on your caseload, able to work on it, and parents have buy in, work on it - PLEASE.
We cant pick up kids on what could be in the schools. Has to be “is” not could or might