Lisp or sigmatism is the term for a widespread and well-known speech disorder. Especially in children, this phenomenon occurs frequently. A particular characteristic of lisp is the deficient or phonetically deviant formation of the S and Z sounds when speaking.
What is lisping?
In young children, lisping can be a normal phenomenon. However, lisping is often an expression of a speech disorder in the affected person. According to scientific definition, lisping belongs to the so-called articulation disorders. The term lisp is used to describe difficulties of an affected person in the formation of sibilants (such as the ‘s’ or the ‘z’). Lisping can be divided into several forms. The most common is an impairment of the sound ‘s’. Since the Greek name for this letter is ‘sigma’, the corresponding form of lisp is also called sigmatism. People who do not have a sigmatic lisp usually form the ‘s’ while the tongue remains behind the teeth. In lisping, on the other hand, the ‘s’ is formed while the tongue is on or between the front teeth. If the lisp affects the formation of the sound ‘sch’ (in German), science refers to it as schetism; ‘chitism’ names a lisp that affects the formation of the sound ‘ch’.
Causes
A lisp can have several causes. Since children usually learn the sibilants comparatively late in the course of their speech development, lisping is a common phenomenon in them and is therefore usually not yet referred to as an articulation disorder in the narrower sense. However, in some children, a hearing disorder may be hidden behind the occurrence of a lisp; as a result, correct pronunciation of the sibilants is not possible. Lisping can also be caused or promoted by malocclusions of the teeth or jaw (see malocclusion of the jaw). Disorders of the musculature in the area of the face can also lead to the occurrence of a lisp. Possible further causes of lisping are, last but not least, paralysis or tumors affecting the tongue or oral cavity.
Symptoms, complaints and signs
In lisping, the sound “s” cannot be formed correctly. Related sounds are often affected as well, especially the “sh,” “z,” and “ch.” Depending on which sounds cause difficulties for the affected person, it is sigmatism, chitism or schetism. An “s” weakness is known as sigmatism. People with this speech disorder often emphasize the “s” unintentionally as a result. The sound sounds exaggeratedly hissing because a lot of air is forced out of the mouth uncontrollably when speaking. In addition, a whistling sound may occur. Conversely, it is also possible that the “s” sounds too soft and is more reminiscent of the “th” from English. In chitism, the “ch” is formed incorrectly. Instead, the affected person uses, for example, a “sh” or “s”. If the lisp occurs with the “sh”, it is a case of schetism. Here, too, the central symptom is incorrect phonation. Affected persons articulate the “sch” like “ch”, “s”, “t” or “d”. In addition, other symptoms are possible that arise as a result of the lisp. These secondary symptoms include shyness and lack of self-confidence. Both children and adults are often teased because of the articulation disorder. However, this type of discomfort is only indirectly related to the lisp: the lisp itself is not responsible for it, but the way it is handled.
Diagnosis and course
Lisping is diagnosed on the basis of the characteristically defective phonation of an affected person. In this context, lisping in the sense of a medically relevant articulation disorder in children is usually only diagnosed when a sufficient stage of speech development has been reached. If there is a suspicion of pathological processes underlying the lisp (such as disorders of hearing or musculature), this can be checked by appropriate diagnostic steps. The course of a lisp varies from person to person. A developmental lisp in children often disappears at the latest after the change of teeth. However, if a lisp persists and/or is very pronounced, a diagnosis of the cause and speech therapy treatment may become important.
Complications
Psychological complaints can develop as a result of the lisp, especially in childhood. The speech defect can promote bullying and exclusion and subsequently lead to reduced self-esteem and depression. Speech inhibition can make the lisp worse and mental discomfort increases. This does not only apply to congenital lisping. Lisping that has developed after a stroke or due to a brain tumor can also be a psychological burden for those affected. In most cases, these problems are accompanied by physical complaints and concomitant diseases, which, in conjunction with the triggering disease, lead to a decrease in general well-being. As a result, further complications may arise that require independent treatment. Complications can also arise in the course of therapy for lisping. For example, tooth correction can lead to instability of the entire periodontal apparatus. Surgical intervention in the oral cavity can be associated with bleeding, sensory disturbances and nerve injuries. Thus, since lisping can cause many complications, treatment of the speech disorder is recommended. Especially with children who have a lisp, appropriate speech training should be carried out quickly to avoid the formation of psychological problems.
When should you go to the doctor?
It is not always necessary to see a doctor for lisping. In many cases, the phonetic disorder does not show any disease value from a medical point of view and does not need to be treated. This is based on the fact that there is usually no other physical or organic problem that could be treated. In the case of a slightly unclean or disturbed pronunciation, the affected person can achieve an improvement in his or her speech by practicing on his or her own. In some children, the lisp is caused by a hearing disorder. A visit to the doctor is therefore necessary in these cases as soon as there are disturbances in the hearing power or a reduced hearing ability is perceived in the child. A visit to the doctor is also advisable in the case of malocclusions of the teeth or irregularities in the position of the jaws. If the altered phonation is caused by the dental apparatus, possible causes of the alteration can be discussed in a medical consultation. If the lisp is based on the temporary wearing of braces, the affected person should specifically practice speaking with the foreign body in the mouth. A further visit to the doctor is not necessary. If the lisp causes emotional or psychological problems, consultation with a doctor is recommended. In the case of reduced self-confidence, behavioral problems or problems in everyday life in dealing with other people, a visit to the doctor is advisable. Targeted voice training can be used in speech therapy to improve phonetics.
Treatment and therapy
Due to the importance of the change of teeth for the course of lisping in children, experts often advise to start a possible treatment of lisping only after the permanent front teeth are fully formed. Whether therapy is actually sought in a corresponding child or also in an adult should usually be discussed in consultation with a treating physician. In the case of adults who wish to have their lisp treated, there is usually a need to suffer due to the present articulation disorder. A commonly used procedure for the treatment of lisping is logopedic (voice therapy). Depending on the form in which a lisp occurs, such therapy primarily includes training in correct phonation. However, medical and, if necessary, psychological counseling are also frequently part of the therapy concept for lisping. A lisp can usually be successfully treated, especially in children. If a lisp is based on physical factors such as malpositions in the oral cavity, injuries or various diseases that can impair hearing and speech, an important therapy component is the treatment of these underlying problems. In these cases, cause treatment and speech therapy often complement each other.
Outlook and prognosis
The greatest chance of sustainably remedying the lisp exists within the framework of therapy in childhood. At the same time, treatment should not be started immediately. The cause research has to take up a wide area. Because sometimes the lisp disappears by itself. For example, if a malocclusion favors the lisp, the removal of the milk teeth can solve the problem without therapy.If, on the other hand, tongue paralysis proves to be the cause, the prognosis is rather poor. Logopedic guidance can offer help to form similar sounds. A high degree of mobility significantly improves the prospect of conflict-free communication. However, the defective sound formation remains audible. If the lisp results from hearing problems, success depends on alleviating partial deafness. If aids can correct the perceptual deficit, speech therapists work successfully with the patient on phonation. The extent to which lisping affects professional success is controversial. Prominent examples seem to refute possible disadvantages. But the fact is that children with a speech disorder are more likely to experience exclusion than peers with perfect pronunciation. There is a risk of reduced self-confidence and isolation. Therefore, parents should keep an eye on their child’s speech ability.
Prevention
Lisping can be prevented in several ways. For example, early hearing tests in infants can limit the risk of a lisp later on. Treatment of any malocclusions of teeth or other health conditions that may promote a lisp also often has a preventive effect. A lisp in the child can also counteract a clear pronunciation of the caregivers.
Aftercare
Whether aftercare is necessary at all for an articulation disorder that has been treated depends on the individual case. In general, forms of dyslalia treated in childhood have an excellent prognosis and the therapies are considered effective. Relapses are rare, but possible. This often depends on personal circumstances and possible psychological stress. Follow-up care would consist, in the broadest sense, of occasional further visits to therapy services. In addition, self-control exercises can be applied, which affected persons can continue to solve their dyslalia even after therapy, in order to constantly control themselves. Control examinations are usually not necessary, since a flare-up of an articulation disorder can be noticed by the affected person himself and by his environment. None of the therapeutic and logopedic measures involve medication, and accordingly there is no need for follow-up care. Under certain circumstances, there is increased psychological stress due to the lisp. This is mostly due to the reactions of the environment and the patient’s own insecurities. In such cases, aftercare may also include rebuilding and strengthening missing self-confidence.
Here’s what you can do yourself
In many cases, lisp can be addressed by doing it yourself. In the case of a weakly pronounced articulation disorder, it is usually sufficient to perform regular speech exercises to gradually improve articulation. An example: place the tongue just behind the teeth at the throat and consciously practice the clean “S”. Other letters and words can also be practiced in this way and should lead to better pronunciation if practiced regularly in front of a mirror. If the lisp is caused by fixed braces, only patience will help. As soon as the appliance is removed, the pronunciation usually improves and the lisp disappears on its own. If the above measures do not have any effect, a speech therapist can help. He or she can suggest special exercises against the lisp and give further tips and assistance for a clean pronunciation. Nevertheless, it is sometimes necessary to take causal action against the lisp – for example, if a malposition in the oral cavity or a disease triggers the articulation disorder. Which means and ways are available in detail is best clarified during a logopedic consultation.
