Question
I am currently working on /k/ and /g/ with a 4
Answer
I previously provided some ideas for teaching production of /k/ and /g/ in another Ask the Expert question. In considering the special case of a youngster with a hypersensitive gag reflex, there are a couple of approaches to consider. One possibility is to work on reducing the hypersensitivity. However, I would explore some other possibilities before working directly on hypersensitivity. The gag reflex serves a protective function and is present throughout the life span (Bahr, 2001). One thing to consider is whether the child is trying to produce the /k/ and /g/ too far back in the mouth. As a child matures beyond infancy, the gag reflex is triggered by a stimulus further back on the tongue and in the pharynx (Bahr, 2001; Pinder & Faherty, 1999). A child would be more likely to gag if her or she were making /k/ and /g/ with a very back position. Also consider whether the child can make "ng" without gagging. If yes, you might consider changing treatment strategies, perhaps trying to find a correct context or working from "ng" to /k/ and /g/ as described in my previous answer.
Actual strategies to reduce a hypersensitive gag are discussed most often in the literature on oral motor disorders and infant feeding and swallowing disorders (Bahr, 2001; Pinder & Faherty, 1999). Asking a knowledgeable informant about the child's feeding history would be a good idea. Techniques are available to work directly on hypersensitivity, including a hypersensitive gag. Bahr (2001) suggested that oral massage could be effective in reducing a hypersensitive gag and provides information on oral massage in her book. Pinder and Faherty (1999) also provide information on treating hypersensitivity in the context of treating pediatric feeding and swallowing disorders. Speech-language pathologists generally need specialized training to use these techniques or need to work in conjunction with a clinician who has this expertise.
References
Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Boston, Allyn and Bacon.
Pinder, G. L., & Faherty, A. S. (1999). Issues in pediatric feeding and swallowing. In A. J. Caruso, & E. A. Strand (Eds.), Clinical management of motor speech disorders in children (pp. 281 - 318). New York: Theime Medical Publishers.
Dr. Lauren K. Nelson began her career as a speech-language pathologist in 1978. She has been on the faculty at the University of Northern Iowa in Cedar Falls, Iowa since 1990. Dr. Nelson can be reached at lauren.nelson@uni.edu.
