36 Chapter 2
phonemes when it is spoken by the clinician. Then he learns to distinguish the /s/ phoneme from
other fricatives. During the final stages of the auditory perceptual training, Seth learns to distin-
guish correct from incorrect productions of the /s/ phoneme in the clinician’s speech. Fi nally, he
correctly identifies correct and incorrect productions of the /s/ phoneme in his own speech. The
clinician uses a game during the auditory perceptual training to make the learning experience
enjoyable. Each time Seth makes a correct perceptual judgment, he puts an M&M in a cardboard
box. At the end of the therapy sessions, he gets to keep the candy.
During the production phase of the sensorimotor approach, the clinician, using a clinical mir-
ror, shows Seth the proper articulatory placement for the /s/ phoneme. Seth places his tongue in the
correct position directly behind his upper incisors. He learns that the tongue should not contact
the alveolar ridge, but instead provide a “tunnel” for the air to escape. Using the be hav ior modifi-
cation princi ple of shaping, the clinician rewards Seth for successively closer approximations to the
correct speech sound production. Each time he produces the /s/ phoneme correctly, the clinician
gives him praise and a token. A local bread com pany has donated to the clinic colorful wrapping
tabs used to seal loaves of bread for use as tokens. The tabs can be used to purchase toys, candy,
stickers, and games from the clinic’s store. Seth has his eye on a remote- controlled pickup truck
and works hard in therapy to obtain enough tokens to buy it.
On Friday after noon, the clinician meets with Seth’s father, who explains that he is concerned
about his son’s sexual orientation. He suspects that he may be gay, given the lisp, and he is worried
because Seth does not enjoy the activities popu lar with other boys of his age. He is deeply concerned
and won ders what steps can be taken to reverse his son’s apparently developing homo sexuality.
The clinician is surprised at the father’s concern and his reaction to Seth’s speech disorder,
but does not dismiss his fear, realizing that a parent’s worry is never irrelevant or inappropriate.
The clinician simply accepts the father’s report as genuine concern for his son and as a product
of misinformation and stereotyping. The clinician tells him that lisping is a speech pathology
and is not indicative of sexual orientation. In Seth’s case, it is a result of misdirecting the air-
stream during speech production, a common speech disorder in children. The clinician also
notes that Seth is making excellent pro gress in therapy and that his lisp will likely dis appear.
The father accepts the explanation and seems relieved, but the clinician recommends that he
seek counseling to discuss his concerns. There may be larger parenting issues that should be
addressed by a family counselor.
Case Study 2-3: An Unintelligible Child With a
Phonologically Based Articulation Disorder
China’s teacher was concerned about her speech development. As a first- year Head Start
enrollee, she was completely unintelligible. Although China initiated conversations and responded
verbally, all the teacher could discern were strings of unintelligible speech sounds. Because China
was only 3 years old, her speech was not a major concern for the teacher. However, when China
enrolled in the second year of the Head Start program and her speech remained unintelligible, the
teacher reported it to the speech- language pathologist.