Last updated 2026-07-11
TL;DR
NSOMEs are tongue, lip, and jaw movements practiced outside of speaking, like blowing bubbles or tongue push-ups. They're still common in clinics and schools, but ASHA's evidence review and multiple peer-reviewed studies find no reliable evidence they improve speech sound production. Most speech-language pathologists now treat them as unsupported for articulation goals.
What are NSOMEs and why do so many therapists still use them?
NSOME stands for non-speech oral motor exercise. The category covers any movement of the tongue, lips, jaw, cheeks, or soft palate that happens outside of actual speech. Blowing bubbles. Blowing whistles. Tongue push-ups against a depressor, lip trills, chewing on textured tubing, and dozens of similar tasks. The theory is that strengthening or coordinating these structures first will help a child produce speech sounds more clearly.
The approach has been around for decades. Generations of SLPs were trained with it, and it spread into schools, early intervention programs, and home practice kits faster than the research could keep up. Parents see their kids doing something active and visible, which feels productive. Children often enjoy blowing bubbles more than sitting through drill work. The exercises are easy to explain and easy to do at home, so therapists hand them out as homework.
Popularity and face validity are not the same thing as evidence. And the evidence, when researchers actually looked for it carefully, wasn't there [1].
What does ASHA's official position say about oral motor exercises?
The American Speech-Language-Hearing Association does not endorse NSOMEs for speech sound disorders. ASHA's evidence review, published through its National Center for Evidence-Based Practice in Communication Disorders, concluded that the research does not support using oral motor exercises to change speech production [1].
This is not a blanket ban on touching the face or using oral structures therapeutically. The line ASHA draws is between exercises aimed at strengthening or coordinating muscles in isolation versus actual speech practice, which is motor learning through speech itself. ASHA's guidance points toward motor-learning principles: high-repetition practice of real speech targets, with appropriate feedback, is what builds speech motor patterns [2].
Be precise here. ASHA does not expel members for using NSOMEs, and the organization stops short of calling them harmful in every context. What the guidance says clearly is that no evidence shows they help with speech sound production, and that therapy time spent on them is time not spent on approaches that do have evidence.
What does the actual research show?
Several teams have run systematic reviews on this exact question, and the findings line up. Gregory Lof and Margaret Watson published a widely cited 2008 survey in Language, Speech, and Hearing Services in Schools. It found that 85% of the SLPs surveyed used some form of oral motor exercise, but the reasons they gave were mostly tradition and clinical intuition rather than research support [3]. Lof has been one of the loudest critics. His argument: the muscles used in speech are not weak in most children with speech sound disorders, so strengthening exercises address a problem that doesn't exist [11].
The motor learning literature matters too. Research on how humans acquire complex motor skills shows that you get better at a movement by practicing that exact movement, not a related one. Speech is a highly specific motor task. The timing, sequencing, and coordination involved in producing /s/ or /r/ are not the same as the movements involved in blowing through a straw, even if some of the same muscles fire. No documented transfer runs from non-speech to speech movement patterns [4].
A 2012 review in EBP Briefs by Rvachew and Brosseau-Lapre examined the theoretical basis for oral motor training and found the same gap: the oral structures involved in speech are not typically weak, and even if they were, strengthening through non-speech tasks would not produce speech-specific motor learning [5].
Nobody has good long-term randomized trial data comparing children who got NSOME-heavy therapy against those who got purely phonological or motor speech approaches over years. The closest studies are short-term comparisons, and they consistently favor speech-specific practice.
If the evidence is so thin, why is NSOME use still widespread?
A few reasons, and they're worth taking seriously rather than dismissing.
There's a training lag. SLPs who graduated 10 to 20 years ago were often trained in oral motor approaches described by practitioners like Diane Bahr or Sara Rosenfeld-Johnson, whose books and workshops were influential. Some clinicians absorbed these methods so thoroughly that re-examining them feels like being told their whole clinical foundation is wrong. That's uncomfortable, and people resist it.
The exercises aren't always harmful in isolation. If a child has a genuine structural issue, low muscle tone affecting the whole body (as sometimes seen in Down syndrome or certain neurological conditions), or real feeding difficulties, orofacial myofunctional approaches and oral motor work may have a role in non-speech goals. The controversy is specifically about using NSOMEs to fix speech sound errors in otherwise typically developing children or in children with speech sound disorders, not about every possible use of every technique [6].
Parents ask for them. A parent watching their child struggle to say /r/ finds bubbles and tongue exercises intuitive. The idea that you'd practice the movement first and then layer speech on top makes common sense, even though it contradicts how motor learning actually works.
Some clinicians conflate oral motor work with tactile cueing, which is a different thing. Touching the face to cue articulatory placement during actual speech production, as in PROMPT, is not non-speech exercise. The distinction matters, and the controversy sometimes blurs it [7].
How is NSOME different from legitimate oral motor work in feeding therapy?
This is where the debate gets genuinely nuanced, and parents of kids with both speech and feeding challenges need to understand the split.
Feeding therapy often involves work on the oral structures: jaw grading, tongue lateralization, lip closure during chewing. Some of it looks like NSOMEs. The difference is the target. Feeding therapists are working toward functional feeding behaviors, not speech sounds. If a child can't lateralize their tongue well enough to manage solid foods safely, tongue lateralization practice ties directly to the feeding goal. That's a different claim than "tongue lateralization practice will help them say /l/ better" [6].
Children with Down syndrome, cerebral palsy, or significant hypotonia do have oral motor differences that affect both feeding and speech. For these kids the picture is more complicated, and sweeping statements that oral motor work is always useless can mislead families. The research base specifically critiques NSOME for speech sound disorders in children who don't have those structural or neurological differences.
If your child has both a feeding therapist and a speech therapist, make sure each knows the other exists and that goals are coordinated. Feeding work and speech work can run side by side without the feeding rationale getting imported into speech sound treatment where it doesn't belong.
What should parents ask their child's SLP about this?
You don't need to walk into a session with a printed literature review. You do have the right to ask questions, and a good clinician will welcome them.
Start by asking what approach the SLP uses and what the evidence base is for it. For speech sound disorders, evidence-supported approaches include motor learning-based therapy, phonological approaches, and for suspected childhood apraxia of speech, specific frameworks like Dynamic Temporal and Tactile Cueing (DTTC) or the Nuffield Dyspraxia Programme [7]. You can read more about how motor planning issues intersect with speech in our overview of childhood apraxia of speech.
If the SLP mentions oral motor exercises, ask directly: "What speech target is this exercise working toward, and how?" A clinician who can walk you through the mechanism connecting the exercise to the speech goal is in a very different position than one who says "we do this to strengthen the tongue." Tongue strength is rarely the limiting factor in speech sound errors.
Ask about the split of session time too. Actual speech practice versus preparatory activities. If your child spends 20 minutes blowing bubbles and 10 minutes on speech sounds in a 30-minute session, the balance is off no matter where you land on the NSOME debate.
For families using early intervention services, this matters even more. Sessions are short and infrequent, often 30 to 60 minutes once or twice a week. Every minute on an activity with no evidence base is a minute not spent on something that works.
Does this controversy apply to children with autism or other complex profiles?
The NSOME debate started mostly around functional speech sound disorders in children without other diagnoses. Bring autism, childhood apraxia of speech, Down syndrome, or other complex profiles into it, and the question gets harder.
For children with autism who have speech, the same basic principle holds: practicing actual speech beats practicing non-speech movements. Motor learning is motor learning. If a child is working on speech sounds, those sounds should be the practice target [8]. You can read more about what the evidence says in our piece on autism spectrum speech therapy.
For children who are minimally verbal or use AAC, the NSOME question matters less, because the goal isn't speech sound accuracy, it's communication. Oral motor exercises are not a path to verbal speech for children who are significantly delayed or nonspeaking, and framing them that way to families is misleading. AAC devices and aided language input have far stronger evidence for this population.
For children with suspected or confirmed childhood apraxia of speech, tactile cueing during real speech practice is part of some evidence-supported protocols. That's different from NSOME, but parents sometimes see face-touching during therapy and assume it's the same thing. If your child has apraxia, ask which protocol your SLP uses and whether it appears on the apraxia-kids list of approaches with research support [9].
What does a better alternative to NSOME look like in practice?
Motor learning research points to a few steady principles for building speech motor skills. High repetitions of the actual target. Varied practice contexts rather than identical drill. Feedback that informs but isn't so constant the child stops self-monitoring. And gradual reduction of support as accuracy climbs [4].
In practice, a session focused on /s/ has the child producing words, phrases, or sentences with /s/ many times, with the SLP giving feedback on accuracy and maybe tactile or visual cues during the sound itself, not before it with a non-speech warm-up. Games and activities carry the high repetitions. They aren't a break from the real work.
For children with motor planning difficulties, approaches like DTTC start with maximum support (simultaneous production with the therapist) and systematically fade it. Every trial involves actual speech.
Parents doing home practice can run the same play. Read books, play games, narrate activities, and set up situations where the target sound comes up naturally and often. That kind of embedded practice beats a daily tongue exercise routine. Tools like the Little Words app can support structured repetition of real speech targets in a way that keeps kids engaged, which is the actual goal.
If you're working with a therapist who leans heavily on NSOMEs, that isn't automatically a reason to switch providers. It might be a chance to open a conversation, ask about the evidence, and watch how the clinician responds. Curiosity on both sides goes a long way.
Is there any scenario where oral motor exercises might actually help?
Honest answer: possibly, in narrow circumstances, but the evidence isn't strong enough to say definitively yes even then.
For orofacial myofunctional disorders (OMDs), things like tongue thrust or open-mouth resting posture, myofunctional therapy includes exercises targeting resting posture, nasal breathing, and swallowing patterns. Some research supports myofunctional therapy for OMDs, though the evidence quality varies [10]. The American Academy of Pediatric Dentistry has recognized myofunctional therapy as part of managing certain dental and airway concerns. The goal there is the orofacial pattern itself, not speech sound production.
For children with very significant hypotonia affecting the whole system, some clinicians and researchers believe there may be a role for building awareness and activation of oral structures, though this stays contested and the research is thin [6].
The honest summary: if someone promises that oral motor exercises will fix your child's speech sounds, that claim has no research support. If someone uses specific orofacial techniques for feeding, swallowing, or orofacial posture, with goals specific to those functions, that's a different conversation with a somewhat different evidence landscape.
How can parents tell if a therapy approach is evidence-based?
This is one of the most practical questions a family can ask, and it has a few reliable shortcuts.
ASHA maintains resources on evidence-based practice, and its National Center for Evidence-Based Practice in Communication Disorders publishes technical reports and systematic reviews on specific approaches [1]. The apraxia-kids organization (formerly CASANA) maintains a list of treatment approaches with varying levels of evidence for childhood apraxia of speech specifically [9].
The general rubric for judging any approach: Is there peer-reviewed research in reputable journals showing this specific technique improves the specific outcome you care about, in children with a profile like your child's? Has that research been replicated? Is the proposed mechanism (why would this work?) scientifically plausible?
NSOMEs fail on all three. The mechanism (strengthen muscles first, then speak) doesn't match what we know about motor learning. Research showing speech sound improvement from oral motor exercises doesn't exist at the level needed to recommend the approach. And the absence has been replicated. Multiple independent reviews reached the same conclusion [3][5].
A clinician who follows the literature won't get defensive about these questions. One who insists the research "doesn't capture what they see in the clinic" without pointing to any peer-reviewed evidence is telling you something about how they make clinical decisions.
For speech therapy in general, you want a provider who can name the approach, describe the evidence for it, and set measurable goals so you can see whether progress is happening.
What's the bottom line for a parent trying to make sense of this debate?
The NSOME controversy isn't a minor academic squabble. It's about whether large amounts of therapy time, money, and a child's limited attention are going toward activities with no evidence of benefit.
ASHA's position is clear: oral motor exercises do not have evidence supporting their use for speech sound production [1]. The theory behind them is weak. The research that exists keeps failing to show transfer from non-speech movement to speech. And the opportunity cost is real, because approaches with actual evidence exist.
All that said, don't panic if your child's SLP has used some of these techniques. One bubble-blowing session didn't wreck your child's speech trajectory. The concern is when NSOME becomes the primary or only approach, when it crowds out real speech practice, or when it's sold as a required prerequisite to speaking.
The best thing you can do is stay curious, ask questions, and track outcomes. Is your child making progress on their speech goals? Can the SLP tell you what method they're using and why? If progress stalls and the sessions are heavy on oral motor work, raise it directly.
Families working through this for neurodivergent kids can also lean on tools and communities built around evidence-based approaches. The Little Words quiz can help you figure out where your child is and what approaches might fit their profile, as a starting point for those conversations.
Frequently asked questions
Are tongue exercises actually bad for speech development?
They're not documented as harmful in most cases, but they're not documented as helpful for speech sound production either. The real problem is opportunity cost: time spent on tongue push-ups is time not spent on actual speech practice, which does have evidence. If your child's session is dominated by oral motor exercises, that's worth raising with the SLP.
Does ASHA say oral motor exercises are banned or unethical?
No. ASHA's position is that NSOMEs lack evidence supporting their use for speech sound disorders, and that SLPs should follow evidence-based practice principles. The organization does not expel members for using them, but its technical reports make clear there is no research basis for recommending them as a speech sound intervention.
What is the difference between NSOME and PROMPT therapy?
PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) applies tactile-kinesthetic cues to the face and jaw during actual speech production. That contact happens while the child produces real speech targets, not as a separate exercise. NSOMEs involve movement outside of speech. The distinction matters because PROMPT has a different theoretical basis and some research support.
My child's SLP does bubble blowing every session. Should I be worried?
It depends on how long it takes and what else happens. If bubble blowing is a five-minute warm-up before significant real speech practice, it's probably not derailing anything. If it eats 20 minutes of a 30-minute session and the SLP can't explain how it connects to a specific speech target, that's a fair thing to ask about directly.
Do oral motor exercises help children with Down syndrome?
The evidence is more complicated for children with significant hypotonia or structural differences. Some clinicians use oral motor approaches for feeding goals in children with Down syndrome, and that's a different target than speech sound production. For speech specifically, the same principle applies: practicing real speech targets is more effective than non-speech exercise, even in this population.
What speech therapy approaches actually have evidence for speech sound disorders?
For phonological disorders, approaches like cycles therapy, minimal pairs, and PACT have research support. For motor planning difficulties including childhood apraxia of speech, DTTC, ReST, and the Nuffield Dyspraxia Programme have peer-reviewed evidence behind them. ASHA and the apraxia-kids organization both maintain resources listing approaches with varying levels of research support.
Can a child's tongue be too weak to speak clearly?
In most children with speech sound disorders, tongue weakness is not the cause. The muscles involved in speech fire constantly for swallowing and other functions and are not typically undertrained. Motor planning, phonological processing, and auditory feedback loops are far more common sources of speech errors than muscle weakness in otherwise healthy children.
How do I find an SLP who uses evidence-based methods?
Ask directly: what approach do you use for speech sound disorders, and can you point me to the research? ASHA's ProFind tool lets you search by state and specialty. Asking for a clinician who uses motor learning-based approaches or is trained in a named, researched protocol (like DTTC for apraxia) is a reasonable filter.
Is blowing through a straw or whistle blowing a useful speech exercise?
No research supports blowing exercises as a way to improve speech sounds. The airflow in blowing a whistle or straw is entirely different from the controlled airflow of speech production. These activities can be fun and may have uses in breath support training for voice, but for speech sound errors in children, they have no documented benefit.
Did oral motor therapy work for some kids despite the lack of evidence?
Some children in NSOME programs do make speech progress, but that progress likely reflects the other things happening in therapy and at home, plus natural development over time. Correlation isn't causation. Without controlled studies comparing NSOME against a real speech practice condition, there's no way to know whether the exercises added anything beyond the speech practice that also happened.
Is myofunctional therapy the same as NSOME?
Not exactly. Myofunctional therapy targets orofacial resting posture, nasal breathing, tongue position at rest, and swallowing patterns, goals distinct from speech sound production. It has a somewhat separate evidence base and is used by both SLPs and some dental professionals for specific orofacial concerns. Using myofunctional exercises to fix a lisp, for example, is more contested than using them for tongue thrust during swallowing.
How does the NSOME controversy affect what I do at home with my child?
Skip the DIY tongue exercise routines and focus on real talking. Read together, play games that involve naming things, narrate daily activities, and repeat target words in natural contexts. If your child's SLP sends home oral motor exercises as homework, it's fine to ask how those connect to the speech targets you're working on.
Where can I read the original research on this myself?
Lof and Watson's 2008 survey in Language, Speech, and Hearing Services in Schools is a good starting point and is widely cited. ASHA's evidence-based practice resources are publicly available on asha.org. Searching PubMed for 'non-speech oral motor exercises' and 'speech sound disorders' will surface the major systematic reviews. Most are accessible in abstract form without a subscription.
Sources
- ASHA, National Center for Evidence-Based Practice in Communication Disorders, Oral Motor Treatment evidence review: ASHA's evidence review found no research support for using oral motor exercises to change speech production in children with speech sound disorders
- ASHA, Evidence-Based Practice in Communication Disorders position statement: ASHA guidance consistently points toward motor-learning principles and high-repetition practice of real speech targets
- Lof GL, Watson MM. A nationwide survey of nonspeech oral motor exercise use: implications for evidence-based practice. Language, Speech, and Hearing Services in Schools. 2008;39(3):392-407.: 85% of SLPs surveyed used some form of oral motor exercise; rationale was mostly tradition and clinical intuition rather than research support
- Schmidt RA, Lee TD. Motor Control and Learning: A Behavioral Emphasis. 5th ed. Human Kinetics; 2011.: Motor learning research shows you acquire a movement by practicing that exact movement, not a related one; no documented transfer from non-speech to speech movement patterns
- Rvachew S, Brosseau-Lapre F. An Academic's Perspective on the Oral Motor Debate. EBP Briefs. 2012.: Oral structures in speech sound disorders are not typically weak, and strengthening via non-speech tasks would not produce speech-specific motor learning
- McCauley RJ, Strand E, Lof GL, Schooling T, Frymark T. Evidence-based systematic review: Effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology. 2009;18(4):343-360.: Systematic review found insufficient evidence to support NSOME for speech sound production; discussion of contexts including low muscle tone populations
- Apraxia Kids (formerly CASANA), Treatment Approaches for childhood apraxia of speech: Apraxia Kids lists DTTC and Nuffield Dyspraxia Programme as approaches with research support for childhood apraxia of speech; distinguishes tactile cueing during speech from NSOME
- American Academy of Pediatrics, Autism Spectrum Disorder clinical guidance: Evidence-based speech-language intervention for children with autism focuses on functional communication goals, not preparatory oral motor exercises
- Apraxia Kids (formerly CASANA), homepage: Apraxia Kids maintains a list of treatment approaches with varying levels of evidence for childhood apraxia of speech
- American Academy of Pediatric Dentistry, policy on orofacial myofunctional disorders: AAPD has recognized myofunctional therapy as part of managing certain dental and airway concerns related to orofacial patterns
- Lof GL. Logic, theory and evidence against the use of non-speech oral motor exercises to change speech sound productions. ASHA Convention presentation. 2008.: Muscles used in speech are not weak in most children with speech sound disorders; strengthening exercises address a problem that does not exist