SO MANY good points have been made on this topic in recent posts. I've been reading but haven't had time to reply until now. 

Lisa Marasco said: "It became clear to me that the SP profession in general was not much higher on the ankyloglossia learning curve than the pediatricians, and thus likely reinforced each other's opinions on the topic."

Sadly, this is true for the most part, though I do like to think that any good SLP out there who really does thorough oral motor exams would at least *note* that there was ankyloglossia present even if her/his bias was that it did not impact speech. We do get education in our anatomy classes in both undergrad and grad school that covers at least the anterior type tongue ties. Even before I ventured into the breastfeeding world I was aware of ankylosglossia and had worked with children who I could easily see that their tt was at least a portion of their speech problem. I am sure I am not the only SLP in the world that is/was doing thorough oral motor examinations and noting tt when I saw it.

Jennifer Tow said:  "I do not think we can ever tell a mother that we are certain that any outcome will result from any intervention or lack thereof... 
No matter what research exists, I will continue to discuss my personal and clinical experiences of TT as relates to speech."

I totally agree, on both points. I think it's particularly beneficial and important for us to share our information and experiences in the totally embarrassing absence of any real research on ankyloglossia in the speech world. I am also really disappointed that the therapist you mentioned was not interested in the immediate miraculous improvement of the speech of a child on her case load. Not all SLPs are created equal...

We don't have crystal balls and we don't know for certain which kids will have problems and which won't. (Too bad, that would make life a lot easier!) But as Lisa Anderegg mentioned we can often get A LOT of information by looking at, listening to and questioning the parents. Certainly the parent who still has audible articulation errors or who reports having speech difficulties or therapy as a child is more likely to have a child with speech problems. I will add though, that even if these tongue tied adults are obviously making their speech sounds in a different manner and with different tongue placement than a non-tongue tied individual most SLPs would not consider this a speech disorder. If the production *sounds* correct it is correct no matter how it was actually made. 

One more random story I want to throw out there, in response to Cathy Genna's commentary on neurological hard wiring and the thought that perhaps we are permanently reinforcing incorrect motor patterns by *not* clipping early (which theoretically makes perfect sense and does seem to correlate to many LCs experiences of a baby having a hard time figuring out how to "use" his tongue after getting it clipped): My first year as a licensed SLP I worked in an elementary school. One of my students was a 9 year old with Down Syndrome and a pretty significant type 1 tt. Lingual elevation was very restricted and he had the classic "w" for "l", etc. About one month into the school year his mother asked me if I thought she should get his tongue clipped. We talked about the potential costs and benefits. I expressed my reservations that he was already 9 years old and had cognitive deficits and his motor speech programs were probably pretty ingrained at this point so even if his tongue were "freed" he might continue to have difficulty with correct tongue placement for speech sounds. This mom felt like she didn't have anything to lose per se and decided to go ahead with the surgery. Well, I about fell out of my chair when one week post surgery this kid starts saying the /l/ sound in the initial position of short words. He couldn't even repeat an /l/ by itself before the surgery. He did progress more slowly than some of the other kiddos people have described on lactnet but he definitely made huge strides that I am sure he wouldn't have if his tongue wasn't clipped. SO even at that age and with less than ideal cognition there was still enough plasticity somewhere in the system to allow him to make those sounds appropriately once he was able. Human beings are pretty amazing creatures, huh?

This SLP, for one, does NOT know it all and is really grateful for this amazing community to hash out these problems with and compare notes on various experiences!

Laura Wasielewski MS, CCC-SLP, IBCLC
Los Angeles, CA
   

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