To treat or not to treat

Hi Sandra, Another case/question for you: I saw a 5 yr old boy last week who was referred by an orthodontist. The ortho does not treat the boy but saw him when he was in with his older siblings. This boy has a pronounced open bite with tongue protruding. A bit of hx on him: Hx of speech therapy in preschool for intelligibility…recently dismissed.  Hx of OT services for fine motor and low muscle tone. Still receiving services. Significant attention issues. Is in K this year and is receiving special education services for learning issues. So…I met with him and mom. He was very distracted. I used a book and little game to keep him engaged and follow along. He was able to make his tongue skinny-fat although not efficiently or automatically. He was able to touch the tip of his tongue to straw during football hold. He was able to click. He was not able to sustain tip up in magic spot–even when I used edible reinforcers. He was not able to correctly produce t, d, n, l  This little boy could really use some help with the gaping hole and tongue protrusion however he is not able to access the whole program due to his attentional issues. I ended up recommending that mom start to introduce tip elevation with cheerios, etc every day. I also recommended that mom contact school SLP to reinstate therapy for production of lingual-alveolar sounds and that she contact me again if school district denies services. I really did not know what else to do. What are your thoughts? Just want to make sure that I am not brushing this family off but do feel that the other factors would get in the way of progress.  As always, thanks so much for your insights, Leslie

Hi, Any hx of ear infections as contributory factors to poor intelligibility?  Could he find the incisive papilla (spot) consistently?  Can he find and hold his tongue to spot any period of time?  Did tongue flip back or go nice and narrow to spot. Did he produce the error sounds dentally? Interdentally? If the mom had the desire and means to see you, I think you should have seen him because you know that you have background and training in this area beyond the average professional.  If you regularly see patients of all types, not just myo, then there are things you could have done, but they would have started at the very basics.  I don’t know if you remember the short videos I had of a 4 year old who’d been kicked out of 3 preschools?!!  I started so basic..soooooooooooooo basic.  I took a session to work on the Knotty Straw exercise and three days later when I saw him again, he’d mastered it.  Seems like slow progress, but it is not…it is building a great foundation.  Also, with the Battle Button, I spent an entire session on it and he had to practice for a few days to do it.  It ended up working just great.  I think the key is to take one very basic goal, vary it during the lesson using turn-taking activities or other fun activities, and get him to the place where some more practice at home will do the trick.  That way, confidence is built up right from the get-go and frustration is minimized.  He’ll be more inclined to try the next exercise, having had early success.  And so it goes…..    I hope this helps in the future.  Just remember: you know more than most others now and with that knowledge comes a “burden”!!!!   Keep up the good work and good questions.