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About speech, language and swallowing therapy

“Speech disorders occur when a person has difficulty producing speech sounds correctly or fluently (e.g., stuttering is a form of disfluency) or has problems with his or her voice or resonance.” (ASHA, 2018). Speech therapy consists of the remediation and training of speech patterns so that an individual can be understood by others.

“Language disorders occur when a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings (expressive language). Language disorders may be spoken or written and may involve the form (phonology, morphology, syntax), content (semantics), and/or use (pragmatics) of language in functional and socially appropriate ways.” (ASHA, 2018). Language therapy includes treatment of receptive (understanding) and expressive (speaking) language as well as social language.

“Swallowing disorders (dysphagia) are feeding and swallowing difficulties.” (ASHA, 2018). Swallowing disorders can affect people of all ages, from babies to adults. Swallowing therapy is used to treat individuals who have difficulty feeding (i.e., baby nursing), eating, chewing, swallowing, etc. so that they may achieve adequate nutritional intake.

Visit the American Speech-Language and Hearing Association (ASHA) website for more information about these disorders and their therapies: https://www.asha.org/Students/Speech-Language-Pathologists/

About Tongue-ties and Lip-ties

Tongue-Tie or Ankyloglossia is a remnant of tissue in the midline between the undersurface of the tongue and the floor of the mouth that restricts normal tongue movement (IATP, 2016). Lip-Tie is “an attachment of the upper lip to the maxillary gingival (gum) tissue” (IATP, 2016). A frenectomy may need to be completed in order to release the restricted tissue under the tongue or lip. Oral motor exercises and therapy are recommended before and after a frenectomy is completed in order to keep the tissue under the tongue mobile and less restricted. Signs that a child may have a tongue-tie and/or lip-tie include: tongue thrusting, excessive gagging while eating or sucking, breastfeeding issues, snoring, mouth breathing, reflux symptoms, baby colic, sleep apnea, and articulation errors.

Impact of tongue-ties on breastfeeding:

  • Maternal pain and discomfort
  • Difficulty latching
  • Difficulty cupping the tongue to support the nipple
  • Difficulty coordinating suck-swallow-breath
  • Difficulty establishing a good seal resulting in air swallowing

Impact of tongue-ties on bottle feeding:

  • Difficulty cupping the tongue to support the bottle teat
  • Difficulty establishing a good seal resulting in air swallowing
  • Difficulty coordinating suck-swallow-breath

Impact of tongue-ties on eating:

  • Absence of rotary chew pattern
  • Excessive gagging or choking
  • Audible and hard swallows
  • Difficulty collecting and transporting food with the tongue

Impact of tongue-ties on speech:

  • Difficulty elevating the tongue tip to produce /t, d, n, l, s, z/ sounds
  • Difficulty retracting the tongue to produce the /r/ sound
  • Difficulty protruding the tongue to produce the “th” sound
  • Slurred and unclear connected speech

Resources for Families:

International Affiliation of Tongue-tie Professionals (IATP):

About Ankyloglossia:

Tongue tie and breastfeeding:

Resources for SLPs:

Orofacial Myology – Relationship to Ankyloglossia and Restricted Labial Frena:

Ankyloglossia: The Orofacial Myology Perspective:

Prevalence of breastfeeding difficulties in newborns with a lingual frenulum: a prospective cohort series:

Guidance on Pediatric Oral Surgery (AAPD):

About minimal pairs and phonological processes

Phonological Processes can be categorized into three types: Assimilation Processes, Syllable Structure Processes, Substitution Processes. Assimilation Processes occur when the child changes one sound to become more like another sound. The processes that fall in this category include: Denasalization, Assimilation, Post-Vocalic Devoicing, and Pre-Vocalic Voicing. Syllable Structure Processes occur when the child makes changes to modify the syllabic structure of a word. The processes that fall in this category include: Syllable Reduction, Unstressed Syllable Deletion, Reduplication, Epenthesis, Cluster Reduction, Initial Consonant Deletion, and Final Consonant Deletion. Substitution Processes occur when the child substitutes one class of sound for another class of sound. The processes that fall in this category include: Affrication, Velar and Palatal Fronting, Backing, Depalatalization, Deaffrication, Alveolarization, Labialization, Gliding, Vocalization, and Stopping. If a child presents with multiple phonological processes, the processes should be addressed in the following order: Assimilation Processes, Syllable Structure Processes, and Substitution Processes.

Minimal pairs are a set of two words that differ by one phoneme. The minimal pair therapy approach is generally used for reduction of phonological processes, but can be used for auditory habilitation and awareness tasks. Children who present with a phonological disorder typically demonstrate difficulty acquiring phonological knowledge which allows them to express meaning. Appropriate phonological therapy is necessary to help rearrange the child’s linguistic system. This allows the child to organize sounds into classes and sequences into structures, which leads to a greater understanding of the phonological system.

During minimal pair therapy the clinician uses few prompts and increases natural instances of communication breakdowns. This allows the child to confront these breakdowns, which helps him not only identify errors he is making, but also correct those errors. When minimal pair therapy is used, the child begins to recognize patterns of speech sounds in words and understand how similarities and differences between sounds create differences in the meaning of words.

Minimal pair therapy should first begin with the child demonstrating auditory awareness of the spoken target words by pointing to the corresponding pictures when named. Directions for playing the “I’m Aware” game are located on page iiB. After the child demonstrates the ability to identify the spoken target words, the clinician moves to the “Say It!” game, where the child is given the chance to produce the target words. Directions for this game are located on pages iii and iiiB.


Game Directions

Directions 1
Directions 2
Directions 3
Directions 4


American Speech-Language and Hearing Association (ASHA). (2018). Speech-Language Pathologists: About Speech-Language Pathology.
Baker, E., & McLeod, S. (2004). Evidence-based management of phonological impairment in children. Child Language Teaching and Therapy, 20,265–285.
Bauman-Waengler, J. (2004). Articulatory and phonological impairments: A clinical focus. Boston: Allyn & Bacon.
Dodd, B., Crosbie, S., McIntosh, B., Holm, A., Harvey, C., Liddy, M., Fontyne, K., Pinchin, B. & Rigby, H. (2008). The impact of selecting different contrasts in phonological therapy. International Journal of Speech-Language Pathology. 10, 334-34
Gierut, J. (1998) Treatment efficacy: Functional phonological disorders in children. Journal of Speech, Language, and Hearing Research. 41, S85 – S100.
Gierut, J. (2001). Complexity in phonological treatment: Clinical factors. Language, Speech and Hearing Services in Schools. 32, 229-241.
International Affiliation of Tongue-Tie Professionals (IATP). (2016). About Tongue-tie. Retrieved from https://tonguetieprofessionals.org/about-tongue-tie/
Ingram, D. & Ingram, K. (2001). A whole-word approach to phonological analysis and intervention. Language, Speech, and Hearing Services in Schools. 32, 271-283
Kamhi, A. (2006). Treatment decisions of children with Speech-Sound Disorders. Language, Speech, and Hearing Services in Schools. 37, 271-279.
Merkel-Walsh, R. & Overland, L. (2018). Functional Assessment and Remediation of TOTs (Tethered Oral Tissues). Charleston, SC: TalkTools.
Shoaf, K., Iyer, S., & Bothe, A. (2009). Using a single-subject experimental design to implement nonlinear phonology approach to target selection.Contemporary Issues in Communication Science and Disorders. 36, 77-88.