Lisping - Symptoms, Causes, and Treatment

Introduction

Normal speech requires the brain to send signals and coordinate various body parts like the larynx, vocal cords, teeth, tongue, lips, and the respiratory system. Unfortunately, this normal speech can be disrupted due to congenital disabilities like cleft palate (a hole in the roof of the mouth), trauma, stroke, gapped teeth, crowded teeth, and overbite. In addition, speech disorders like 'stuttering' can be hereditary.

What Are the Common Speech Disorders?

• Articulatory Disorder - People who stutter, stammer, clutter the words, or lisp have a speech disorder of the articulatory type. They tend to add, omit or substitute sounds to form the words. For example, 'lisp' might be pronounced as 'lithp'.

• Voice Disorder (Dysphonia) - Voice disorder can arise when the voice box (larynx) is affected by trauma, issues in the pituitary gland, or due to paralysis. The voice of the person suffering from this disorder is usually gruff and breathy.

• Language Disorder - This condition arises when there is a hindrance in brain development. This disorder tends to run in families.

• Oral-Motor Speech Disorder (Verbal Apraxia or Dyspraxia) - Incoordination between the muscles and the body parts involved in speech production causes this disorder.

• Medical Issues - Certain medical issues like a stroke can lead to unclear pronunciation as these people have poor muscle control that controls speech. Disabilities like hearing loss, tongue tie (structural malformation), and intellectual deterioration too can affect speech.

What Are the Causes of Lisping?

Lisping is a very common speech disorder that usually occurs during the developmental stage but can also occur during the later stages. Tongue position and misalignment of the jaw contribute to lisping. A condition called 'tongue-tie' (ankyloglossia), wherein the tip of the tongue is anchored to the floor of the mouth, can cause one to lisp. In addition, certain habits such as thumb sucking, use of pacifiers or artificial nipples, and bottle feeding make the tongue flat affecting muscle movement, which causes the tongue to leap forward when individual attempts to talk, thereby creating a lisp.

Kids with no abnormality in tongue placement can lisp if they mimic someone or intentionally lisp to gain attention. For example, when mouth breathers tend to pronounce words with 's' and 'z' by closing their mouth, there is an obstruction in airflow, which makes them lisp.

What Are the Types of Lisps?

Apart from having difficulty pronouncing 's' and 'z' sounds, the person who lisps can also find it difficult to pronounce 'sh', 'ch', and 'j' sounds. The following are the various types of lisps:

• Frontal Lisp - Thrusting the tongue forward in front of the anterior teeth (front row of teeth) affects the free flow of air, thereby creating a frontal lisp. A person with frontal lisp substitutes' s' and 'z' sounds with 'th'. For example, 'swing' might be pronounced as 'thwing' and 'zip' as 'thip.'

• Dental Lisp - In a frontal lisp, the tongue forces its way in front of the anterior teeth, whereas, in a dental lisp, the tongue presses itself against the teeth.

• Palatal Lisp - The roof of the mouth is called the palate. In normal individuals, the tongue stays halfway through while producing the sounds' s' and 'z.' But in individuals with a palatal lisp, the tongue touches the roof of the mouth, making it challenging to spell words with 's' and 'z' sounds.

• Lateral Lisp - The tongue in the lateral lisp positions itself to a side which causes increased airflow and creates a whirling, hissing sound while pronouncing words with 's' and 'z.' Unlike other kinds of lisps, further diagnosis is required to find the cause of lateral lisp.

When to Consult a Doctor for Lisping?

Lisping is a common speech-related issue, and it is estimated that 23 % of clients of speech-language pathologists (experts who treat speech-related disorders) have lisps. Parents should be concerned when a child lisps even beyond four and a half years of age and seek medical help. A physician generally takes a detailed medical history of the child, assesses the speaking and reading ability, and checks for structural abnormalities like tongue-tie, enlarged adenoids (patch of tissue high on the throat behind the nose), respiratory problems, allergies, or any infection. The speech-language pathologist will further evaluate this. Underlying medical conditions, if any, must first be treated and then referred to the speech-language pathologist. Attending the issue at an early stage prevents lisping from slipping into adulthood.

How Can Lisping Be Corrected?

• Be Aware of Lisping - Lisping can lower the confidence in a child, especially when they are teased. Consulting a speech-language pathologist early can help the child overcome the issue easily. Speech-language pathologists assist the child in differentiating between correct and incorrect pronunciations, and parents at home can follow the same.

• Placement of Tongue - Since the tongue's position plays an important role in lisping, the speech-language pathologist guides the child to move the tongue so that the child does not lisp when using the consonants' s' and 'z.' In case of anomalies like tongue-tie, a simple procedure called 'frenotomy' (the excess tissue that anchors the tongue to the floor of the mouth is cut) can be performed. In severe cases, 'frenuloplasty' (surgery done to release the tissue that attaches the tongue to the floor of the mouth) might be required.

• Use of a Straw - Though this is not a primary mode of treatment, drinking through a straw can aid the tongue to be pulled back rather than plunging forward.

How to Choose the Correct Speech-Language Therapist?

A speech-language pathologist or therapist usually has a certification from the American Speech-Language-Hearing Association (ASHA). This certification shows that the therapist has expertise in handling a child, knowledge about various speech disorders, and when and how to treat them. The therapists start the treatment by getting the child to practice pronouncing the words that start with 's' and 'z' initially, then with words containing 's' in the middle, and later with words that end with these consonants. Slowly the therapists work their way up by moving to phrases, sentences, and, finally with, conversations. At this point, the child will be confident enough to converse with anyone without lisping.

Conclusion

Lisping can prevent the child from socializing with friends, and family members can taunt them. This lowers their confidence and self-esteem. One must remember that help is always available in the form of speech therapy. Parents must pay attention to lisping in their kids and seek a speech therapist as early as possible. Adults with lisps may also be intimidated to participate in social gatherings and keep themselves aloof. Though the treatment might take some time in adults, they too can approach a speech-language therapist and get the issue corrected. As a social responsibility, peers, too, must withhold themselves from mocking individuals who lisp.