Is Oral Habit Elimination Appropriate at this Time?
Q: I am seeing a 4 year old girl in pre-school for distortion of /ch/, /j/, lateral /s/, and tongue protrusion of /d/, /t/. She sucks her fingers which I know is interfering with success for her distorted sounds. I also understand that oral habits are barriers and should be addressed before commencing with speech therapy approaches. I don’t see her mother very often and have been sending written suggestions to be practiced at home. She has a history of selective mutism but after some confidence building, she talks to me. I am tentative about pushing her too much as she often says “This is hard” when we attempt speech goals. Should I introduce the therapist’s edition of Unplugging the Thumb and try to do it in school without the direct help of the mother? Or perhaps should I tell the mother to purchase the parents’ edition and try it at home?
A: This is a multi-faceted question, to be sure. Has the girl been receiving therapy prior to your seeing her or have you been seeing her for a period of time? It is important that her parent(s) be made aware that the oral habit is directly impeding progress for speech and will continue to do so without addressing the habit. This dilemma is not easy to solve since you don’t see the parent much or only on rare occasion. This might sound a bit strong, but if we consider the child’s best welfare, then there is unlikely to be any progress made with the speech errors while the oral habit is in place. The only solution I see is to somehow involve the parent and assist them with the Unplugging the Thumb program. Then you can ease into the myo methods we taught you in our course, trying as much as possible to include the parent via teletherapy or in person. I don’t know if you have the option of making decisions at the school, if the school and therapy are covered privately with the family, etc. To me, the worst decision would be to ignore the oral habit and proceed with the speech efforts that are likely to fail. I wish I had something else to offer, but sadly I do not. Please keep me posted on your decision and I wish you and the child success.
