Oral Motor Exercises to Help Speech in Toddlers and Preschoolers – Why Science Says They Don’t Work

Recently I’ve heard of mothers who are telling other mothers that they’d better be doing oral motor exercises at home with their kids and find SLPs who will do these with their kids to help their toddlers learn to speak more clearly. I wanted to let you all in on apparently what some SLPs aren’t telling you.

There’s a whole lot of research in the past few years that tell us that oral motor exercises DON’T work to help children learn to speak more clearly. Before all of you get fired up and start a campaign to write in to tell me how crazy I am, let’s take a look at what science says………..

In his ASHA presentation in November 2006, Dr. Gregory Lof, a PhD level speech-language pathologist from MGH Institute of Health Professions in Boston, titled his work, “Logic, Theory and Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sound Productions.”

In real words – he’s saying that common sense tells you that these exercises don’t work to make children speak more clearly, and then he cites a whole bunch of scientific studies that back him up.

For those of you who are really confused, he’s defined “non-speech oral motor exercises” as “any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities” and “a collection of non-speech methods and procedures that claim to influence tongue, lip, and jaw resting postures, increase strength, improve muscle tone, facilitate range of motion, and develop muscle control.”

Again, but in English please! He’s talking about all of those mouth “exercises” or “games” that SLPs tell you to do including blowing, tongue push ups, pucker-smile, tongue wags, big smile, tongue to nose to chin, cheek puffing, blowing kisses, and tongue curling.

Basically, he’s saying any “game” or “exercise” that you have your child do that DOES NOT INVOLVE him making a speech sound is not going to help him learn to talk. This means that all the blowing, sucking, tongue exercises, and lip games you’ve been doing will not do one bit of good when it comes to helping him produce clearer speech. OUCH!

Now I can’t say that I’m an SLP who has over-relied on this kind of stuff. I’m a talker, and I push functional communication whether it be with signs or words in play practically every minute of the time I provide direct treatment to a child. I hardly spend any time doing oral motor stuff in sessions because, frankly, I feel like my time is better spent doing “REAL” therapy stuff, and in my opinion, that’s language-language-language.

I do not write goals that say, “Johnny will perform 10-15 repetitions of oral motor exercises to improve strength and coordination for intelligible speech.” I do not make claims that these kinds of activities will “improve muscle tone,” but I know lots of SLPs who do and who base their whole treatment plan around these kinds of goals and strategies for non-verbal children and for children who are struggling with speech intelligibility.

I’d like to say that I haven’t done lots of oral motor activities in sessions because it didn’t make sense to me clinically. But the truth is, it’s because I hadn’t found a way to make them fun enough to do on a consistent basis or for any length of time. Because of this, it never really felt right or worth pursuing for me, or especially for a kid.

Besides – have you ever really tried to get a 2 or 3 year old to do these kinds of things for more than a minute or two? You might have an initial novel period where they sit with you and try to do it, but unless you make it super fun and whacky, I’ve found it wasn’t successful for very long. It’s usually pretty hard for them to do, and again, it’s usually pretty boring.

BUT I have routinely recommended, out of some kind of SLP obligation, at least in my initial assessments, that mom and dad do these kinds of things with my little clients as part of “homework.” I have even recommended these kinds of things for kids without low muscle tone or who don’t have sensory issues that are negatively affecting feeding. Why? Because it’s somehow ingrained in how we’ve been trained as SLPs. There are whole catalogues, entire textbooks, countless treatment manuals, and week-end long continuing education courses devoted to telling us how effective these are and how to do these.

As a matter of fact, Dr. Lof cited that 85% of SLPs in America who were surveyed said they use non-speech oral motor exercises to change speech sound production. Results were the same for Canadian SLPs. He cited other interesting statistics including the most frequently used exercises, the reported benefits, and the diagnoses of children when these kinds of exercises were used.

I will tell you that every “diagnosis” for kids I see were on that list including dysarthria (which is unintelligible speech due to low muscle tone), childhood apraxia of speech, structural anomalies (probably cleft lip/palate but not specified), Down Syndrome, enrollment in early intervention, late talker diagnosis, phonological impairment, hearing impairment, and functional misarticulations (meaning sound substitutions). This tells us that MOST SLPs are recommending this kind of task for MOST clients that they see – even toddlers enrolled in early intervention programs.

His conclusion, again based on a number of studies, was that it’s not appropriate for any of them. Double OUCH!

Again, I don’t feel too badly on a personal level since I haven’t used them all that much, but I feel super sad about all of the therapists who have and mostly for the moms they’ve convinced to try to do it.

In this presentation, he also dissected most arguments for using oral motor exercises including that children must first learn to produce isolated movements before they can use a speech sound, that you have to build up articulatory strength when a child has low tone, that these exercises “warm up” the mouth before talking, and that you have to have adequate coordination in non-speech exercises before you talk. He debunked every one of these very persuasive arguments for non-speech exercises with 10 different studies that prove otherwise. His conclusion was that no research supports the use of these for any reason when improving speech is the goal. Triple?OUCH!

His bottom line was this –

“If clinicians want speech to improve, they must work on speech, and not on things that LOOK like they are working on speech.” (GOOD! To learn to talk, you must focus on talking and not blowing, wagging, puffing, etc…!)

“Phonetic placement cues that have been used in traditional speech therapy are NOT the same as non-speech oral motor exercises.” (GOOD! This means you can and should still give your child verbal, visual, and tactile cues about placement of his tongue or lips to help him make a speech sound correctly. The difference here is that you’re actually working on SPEECH and not just a movement.)

“Non-speech Oral Motor Exercises are a procedure and not a goal. The goal of speech therapy is NOT to produce a tongue wag, to have strong articulators, to puff out the cheeks, etc… Rather the goal is to produce intelligible speech.” (GOOD! Goals must have speech and language outcomes. That’s a big duh to me, but again, these never made much sense to me anyway.)

“Speech is special and unlike other motor movements.” (GOOD! He means that using these kinds of exercises to improve feeding do not necessarily correlate to the same movements needed for speech. He cites studies that prove that same function/same structure argument doesn’t hold water. He also means that working on a particular oral exercise like lifting your tongue up and down 10 times in a row may not translate into a kid being able to lift up his tongue to produce a sound like /l/ when saying a word or in a phrase. No kiddin’! I gave up that kind of assumption early into my?2nd year of work when this rarely produced results!)

This last one really gives a kick in the seat of the pants to SLPs who depend on oral motor exercises as a staple in their treatment plans –

“Following the guidelines of evidence-based practice, evidence needs to guild treatment decisions.” (Here’s his parting blow – ) “PARENTS NEED TO BE INFORMED THAT NON-SPEECH ORAL MOTOR EXERCISES HAVE NOT BEEN SHOWN TO BE EFFECTIVE AND THEIR USE MUST BE CONSIDERED EXPERIMENTAL.” (Emphasis was mine, not his.)

My bottom line is this – I won’t be recommending or doing these in therapy anymore for kids whose focus is speech and language, and now not just because young children?don’t like them and won’t do them,?but because science tells me not to bother. Whew! Laura

Here’s the original article’s reference for those of you who want to read it yourself –

http://www.speech-language-therapy.com/Lof-2006-ASHA-06-Handout.pdf

Other articles from experts who’ve looked at the same issues & reached the same conclusion –

Caroline Bowen – http://www.speech-language-therapy.com/cb-oct2005OMT-ACQ.pdf

From the Apraxia Kids Site –

http://www.apraxia-kids.org/site/c.chKMI0PIIsE/b.980831/apps/s/content.asp?ct=464461

In the spirit of fairness, here are?articles that?disagree with Dr. Lof’s findings –

http://www.speech-language-therapy.com/oral-motor-TT-bathel.pdf

http://www.speech-language-therapy.com/williamsetalACQ2006.pdf

One more thing – Another SLP also cited Dr. Lof’s article and arrived at this conclusion which I also agree with –

“Oral Motor therapy does have its uses. While it is ineffective for improving speech production it is effective for treating many issues related to feeding. And that is an important distinction. If your child is drooling, or unable to move food around with his tongue and chew, Oral Motor Therapy can be very effective if provided by a competent therapist.”http://www.speechlanguagefeeding.com/Newsletter.html

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