The Speechberg – Unveiling the Speech Problem


Do you ever feel like you’re going round and round in circles when it comes to treating your health or speech problem? Has it occurred to you that your lack of progress is due to having the wrong picture of the problem?

This idea resonates with me both personally (as someone with chronic autoimmune disease) and professionally. The reason why I pursued specialist training in Orofacial Myology is that I realised that there was a missing key with a set of my speech clients. I was trying to fix a surface issue, rather than the underlying muscular and breathing problems.

At Sandra Coulson’s Masterclass for Orofacial Myology, I was introduced to the concept of the “bergs”. The idea is that the symptoms which are obvious to the patient and clinician are often a clue to underlying problems. As the saying goes, the ice we see floating on the surface of the water only represents approximately 10% of the total iceberg, because we can’t see what lies beneath the water surface. Sandra and her colleague, Roger Price, spoke of the dental problems, jaw/TMJ problems and sleep/breathing problems that are obvious, and the less obvious problems which may be underlying these.

This got me thinking about the speech/articulation problems I see in my clinic, and the Speechberg was born (with Sandra’s permission). I hope that this graphic challenges other Speech Pathologists to consider how underlying problems may be impacting on their clients’ speech problems. And I hope it will inspire my clients and their families to keep working to address the underlying problems.

Problems which may be most obvious to the person/parent and clinician include:

  • Speech problems
  • Hearing problems – eg. conductive hearing loss due to frequent ear infections
  • Drooling
  • Crooked teeth.

Problems which may go unnoticed or not be seen as connected with the speech problem include:

  • Oral ties – eg. tongue tie
  • Allergies
  • Nasal congestion
  • Enlarged tonsils/adenoid
  • Sucking habits – eg. thumb sucking, dummy sucking
  • Muscle dysfunction – eg. low tone, low tongue resting position
  • Genetics
  • Dysfunctional breathing – eg. mouth breathing
  • Malocclusion – problems with the way the upper and lower teeth come together
  • Tongue thrust.

A classic example in my experience is the (interdental) lisp. It is usually associated with tongue thrust swallow pattern and low tongue resting position, and may also be associated with tongue tie and airway issues, warranting assessment with other professionals like ENT and dentist.

One little sidenote: it is not always clear about causation and association, which is why I’m avoiding use of the word “cause”. I hope the Speechberg helps you to see that there can be complex factors at work, so clinicians need to put on their detective gear and investigate all possible factors. I’ve found that Orofacial Myology training gave me a whole new set of skills in investigation as well as treatment.