Hi Sara,
I have a student who is turning four years old next month. I have been seeing her for several months for nasal emission on /sh/, /ch/ and /j/. She never had any anatomical problems and has been seen by an ENT. Oddly, she produces /s/ and /z/ just fine in spontaneous speech. I've been trying to work off the /s/ to /sh/, or /h/ to /sh/ by raising the jaw while producing /h/, the butterfly position, etc. I don't think she is able motorically to follow the instructions but then again it could be she doesn't understand due to her age. I can tell she is trying as she will crunch her nose trying to stop the air from coming out. She is bright and discrimination training has been mastered. She understands oral versus nasal sounds. Do you have any suggestions?
Let me begin by saying there may be a few options for her and without seeing this almost 4 year old I can only give some suggestions. You will have to try each of them to see which is the most beneficial.
To begin, the difference between the /s/ and /z/ and the "sh" "ch" and "j" is the increased use of the lateral margins of the tongue resting against the upper palate.
1. If your client can say "ee" then you might want to work from that position rather than from the ones you tried. Show her a picture of the upper jaw with the sides of the tongue resting against the upper jaw. You can find this graphic in the handout for the class, "A Three-Part Treatment Plan for Oral Placement Therapy" if you have taken that class or if not it is also in the book, "Oral Placement Therapy for Speech Clarity and Feeding". Once this child can feel the sides of the tongue elevated and making contact with the upper palate you can have her freeze in that tongue position and try to say the standard "sh." Sometimes it is easier to get the "ch" from this position so I would try both.
2. If that does not work then I would see if she has the ability to elevate the sides of her tongue. The prerequisite movements for this placement would be the ability to a) lateralize her tongue tip to the back molars on alternating sides of her mouth without sliding her jaw, b) elevate and depress her tongue tip from an "ah" jaw position without moving her jaw. If she cannot do these prerequisites then the Straw Hierarchy would help develop these skills. Again you would refer to the book "Oral Placement Therapy for Speech Clarity and Feeding," for complete instructions.
3. You might also want to try the activity entitled, "Oral-Nasal Contrasts" from "Oral Placement Therapy for Speech Clarity and Feeding," as that activity works directly on mobilizing the velum.
I hope this helps,
