Yes, from an orofacial myology point of view there could be a few things going on. Firstly, prescence of large tonsil and adenoid tissue precipitates the tongue into a ‘fronted’ tongue position and often open mouth posture. Mouth breathing and habitual open mouth posture are also common with enlarged tonsils and adenoids, along with audible breathing and sometimes snoring at night time. This can also commonly leads to excess saliva. Functionally, ‘forward’ tongue posture is most often seen during speech swallowing and chewing with enlarged tonsils and adenoids. Fronted tongue posture and function are best corrected via a course of orofacial myology as without intervention the habits do not commonly resolve on their own and can become long term habits which ultimately impact on development of the facial and jaw bones. Consideration of the impact of the tonsils and adenoids is also important.
I agree with Dr Marget, that use of a soft rubber mouth guard to correct the crossbite can be a very useful, however they do not necessarily correct the ‘tongue fronting’ muscle patterns that have developed.
Ultimately, if speech development is being influenced by tongue fronting habits, you would want to be sure that speech is corrected in conjunction with other oral functions of breathing swallowing and chewing. Tongue fronting can most certainly impact a child's intelligibility and can occur on a wide range of sounds.
A good starting point would be to seek assessment of the speech difficulty from a Speech Pathologist who specialises in orofacialmyology. The fact that your child has already been having speech therapy for about 18 months, is suggestive of other factors influencing his speech and language development and any further assessment would need to take into account the factors influencing late speech and language development including hearing, and look carefully at his rate of progress with therapy to date.
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