Resources are tight in the National Health Service: think one full time therapist with a caseload of around 125 children. So we have to pay close attention during our initial assessments to make sure children meet our criteria for therapy.

For speech sound therapy, children need to have at least 3 processes and reduced intelligibility, as well as age appropriate language and attention skills to qualify. So we give children with lisps, or difficulties with /th/, activities to practise at home, and discharge them. In some cases that’s easier said than done …

I can understand why parents are anxious about lisps; they worry about teasing and bullying. Sometimes I find it hard to reason with them; they’re trying to do the best for their child and I’m trying to manage the needs of a large caseload. We’re in conflict.

I almost want to play them video clips of my pre-verbal child with autism, my dyspraxic child, or my child with a severe stammer and explain that these children are my priority. Not great for confidentiality and probably not effective either!

Empowering parents to support their own child seems like the best strategy. If I can elicit an accurate /s/ in isolation during the session, I can usually convince the parents to agree to discharge. I explain the hierarchy for generalising the sound into conversation and give them written instructions for home practice.

If I can’t prompt the child to produce the correct sound in isolation (I find those lateral lisps tricky!) I tend to go down the ‘your child is not stimulable / ready’ route. I ask the parents to practise discrimination tasks with their child, talk about how the sound is produced and come back in 6 months to a year if the child hasn’t made progress and they’re still concerned.

How do you deal with parents who won’t accept that their child doesn’t meet the criteria for intervention?