Two different professionals can look at the same child and describe two different problems. The pediatrician hears a five-year-old say "thumb" as "fumb" and suggests speech therapy. The orthodontist looks at the same child's open bite and the tongue resting between the front teeth and suggests myofunctional therapy. Both are right, and neither is describing the whole picture.
Adults hit the same confusion from the other direction. A dentist mentions myofunctional therapy for grinding, mouth breathing, or an orthodontic relapse — and the first search result explains it is done by speech therapists, which makes no obvious sense if you have no trouble speaking.
Here is what actually separates the two fields, where they overlap, and how to tell which evaluation you need first.
The Short Answer
Speech therapy treats communication and swallowing: how sounds are produced, how language is understood and used, fluency, voice, social communication, and whether eating and swallowing are safe and efficient.
Orofacial myofunctional therapy treats the resting posture and function of the tongue, lips, and jaw: where the tongue sits when it is not doing anything, whether air moves through the nose or the mouth, what the tongue does during the hundreds of swallows a person completes each day, and habits like thumb sucking that reshape that pattern over time.
The shorthand that helps most families: speech therapy asks how are you communicating? Myofunctional therapy asks what are your mouth and airway doing all day — including the twenty-three hours you are not talking?
What Speech Therapy Treats
Speech-language pathologists evaluate and treat communication and swallowing disorders. ASHA's Scope of Practice in Speech-Language Pathology defines communication as covering "speech production and fluency, language, cognition, voice, resonance, and hearing," and swallowing as "all aspects of swallowing, including related feeding behaviors."
In everyday practice, that means:
- Speech sound production — articulation and phonological disorders, including unclear speech and lisps
- Motor speech disorders — including childhood apraxia of speech, where the difficulty is planning and sequencing movement rather than producing individual sounds
- Receptive and expressive language — language delays, following directions, vocabulary, sentence structure
- Fluency — stuttering and related fluency disorders
- Voice and resonance — hoarseness, vocal strain, nasality
- Social communication — conversation, turn-taking, using language flexibly
- Feeding and swallowing — the oral-motor mechanics of biting, chewing, and swallowing safely
Our speech therapy services overview breaks these down by concern.
What Myofunctional Therapy Treats
Orofacial myofunctional therapy is narrower and, at first, stranger-sounding. It targets a set of muscle patterns rather than a communication skill. ASHA's clinical guidance on orofacial myofunctional disorders describes treatment goals that include establishing nasal airway clearance and a closed-mouth resting posture, achieving lip and lingual-palatal seals, improving speech sound placement, eliminating prolonged nonnutritive sucking habits, and modifying swallowing patterns for saliva, liquids, and solids.
Translated into the reasons people actually walk in the door:
- Tongue thrust — the tongue pushing forward against or between the teeth during swallowing and at rest
- Chronic mouth breathing — habitual open-mouth posture, often persisting after the original nasal obstruction is resolved
- Thumb, finger, and pacifier habits — and the bite changes that follow prolonged habits
- Tongue tie — restricted tongue mobility, usually alongside a release procedure rather than instead of one
- Orthodontic stability — protecting the result after braces, when the tongue's resting position is the force working against retention
- TMJ discomfort and sleep-disordered breathing — as one part of a team approach, not a standalone cure
If you want the full explainer, start with what myofunctional therapy is and our myofunctional therapy overview.
Where the Two Overlap
Most of the confusion lives in three places, and in all three the overlap is genuine rather than a turf dispute.
1. The lisp that will not resolve
A frontal lisp — the s and z sounds produced with the tongue against or between the front teeth — is a speech sound disorder. A tongue thrust is a myofunctional disorder. They are frequently the same tongue doing the same thing in two different jobs.
This matters practically. Articulation therapy can teach a child to place the tongue correctly for s during a session and still lose ground, because the other several hundred daily swallows keep rehearsing the forward pattern. When a lisp keeps returning after clean articulation work, the resting posture and swallow are usually the reason.
2. Speech clarity and oral function
ASHA's OMD guidance lists "improving speech sound articulatory placement" as one of the treatment targets for orofacial myofunctional disorders, which is a direct acknowledgment that the two areas share territory. A tongue that rests low and forward, or a mouth that stays open by default, changes the starting position for a lot of speech sounds — most visibly the s, z, t, d, n, and l group.
3. Feeding and chewing
Both fields touch eating, and they touch different parts of it. Feeding therapy addresses whether a child can bite, chew, manage textures, and swallow safely. Myofunctional therapy addresses the swallow pattern — whether the tongue presses up against the palate or pushes forward — along with chewing efficiency and lip closure during meals.
Who Provides Each
This is the part that trips people up, because the two credentials are not parallel.
Speech-language pathologists hold a master's or doctoral degree from an accredited program, a state license, and the CCC-SLP — the Certificate of Clinical Competence issued by ASHA. ASHA's certification standards require a minimum of 400 clock hours of supervised clinical practicum, a Clinical Fellowship of "no less than 36 weeks of full-time professional experience," and a passing score on the national examination.
Myofunctional therapy has no single license. It is a certification layered on top of an existing clinical credential. The International Association of Orofacial Myology awards the COM® designation and states that its holders "have undergone rigorous training and have attained the highest qualifications in the field of orofacial myology"; eligible backgrounds include speech-language pathologists, registered dental hygienists, dentists, physicians, physical therapists, and occupational therapists. Other training programs award their own designations, including QOM (Qualified Orofacial Myologist).
Two consequences follow, and they are the most useful things in this article:
- Not every myofunctional therapist is a speech therapist. Many are dental hygienists, which is a legitimate path — but it means the provider may not be able to treat an accompanying speech sound disorder.
- Not every speech therapist does myofunctional therapy. ASHA is explicit that "SLPs who serve this population should be specifically educated and appropriately trained to do so." The CCC-SLP by itself is not myofunctional training. Ask what additional certification the person holds.
Laura Friedman holds both — CCC-SLP and QOM — which is why the lisp-plus-tongue-thrust case gets evaluated once rather than twice here. Our guide on how to choose a speech therapist covers what else to ask.
"Families come in having been told two different things by two different providers, and they assume one of them must be wrong. Usually both are right and nobody connected them. If the tongue is pushing forward during every swallow, fixing the s sound in a therapy room is only half the job — and the half that does not hold." — Laura Friedman, MS, CCC-SLP, QOM
Which One Do You Need First?
Start with who raised the concern and what it was.
Lean toward a myofunctional evaluation if: a dentist or orthodontist flagged an open bite, a flared or spaced front tooth pattern, or relapse after braces; you or your child sleeps with the mouth open or breathes through the mouth during the day; a thumb, finger, or pacifier habit has continued past the preschool years; food is pushed forward during swallowing or meals are messy well past the expected age; or a tongue tie release is planned or was recently done.
Lean toward a speech-language evaluation if: the concern is being understood, late talking, few words compared to peers, difficulty following directions, stuttering, voice quality, or trouble putting sentences together. Our signs your child may need speech therapy guide and the speech milestones by age reference are the right starting points.
When it is a lisp, a persistent s distortion, or a mix of both lists — book with someone qualified in both areas. That is the single case where the evaluator's credentials change the answer, because a provider trained on only one side will describe only that side of the problem.
Two Practical Differences to Plan For
Age. Speech therapy starts early — early intervention for late talkers routinely begins before age three. Formal myofunctional exercise programs usually wait until around age seven or eight, when a child can follow multi-step directions and practice at home with some independence. Habit elimination work is the exception and can start younger.
Coverage. Speech therapy is a long-established medical benefit on many plans when there is a documented diagnosis; see our speech therapy insurance guide. Myofunctional therapy is covered far less consistently — sometimes reimbursed under speech-language pathology codes when tied to a swallowing or speech diagnosis, often treated as a non-covered service. Our myofunctional therapy cost and insurance guide explains how to check your specific plan before you commit.
A Related Question
If you are also weighing a third referral, our comparison of speech therapy vs. occupational therapy covers where those two divide — a different boundary, and one parents are asked about just as often.
Frequently Asked Questions
What is the difference between myofunctional therapy and speech therapy?
Speech therapy treats communication and swallowing — speech sound production, language, fluency, voice, social communication, and eating safely. Myofunctional therapy treats the resting posture and function of the tongue, lips, and jaw: tongue position at rest, nasal versus mouth breathing, the swallow pattern, and oral habits.
Is myofunctional therapy a type of speech therapy?
It is a specialty area that falls inside the speech-language pathology scope of practice but is not limited to it. ASHA lists orofacial myofunctional disorders within the SLP scope, and dental hygienists, dentists, and other licensed professionals can also earn certification in orofacial myology.
Do I need myofunctional therapy or speech therapy?
Follow the referral. A dentist or orthodontist concern — open bite, relapse, tongue between the teeth, mouth breathing, thumb habit — points to a myofunctional evaluation. A communication concern — late talking, unclear speech, stuttering, following directions — points to a speech-language evaluation. A lisp can belong to either.
Can you do myofunctional therapy and speech therapy at the same time?
Yes, and when the two problems are connected it is usually the efficient choice. A tongue thrust and a frontal lisp are often the same tongue placement approached from two directions.
Can a speech therapist do myofunctional therapy?
Only with specific training in orofacial myology. The CCC-SLP alone does not cover it, and ASHA states that SLPs serving this population should be specifically educated and appropriately trained. Ask what additional certification the therapist holds.
Not Sure Which Evaluation You Need?
You do not have to decide before you call. Schedule a consultation with Laura Friedman — CCC-SLP and Qualified Orofacial Myologist — in person in Dallas or online nationwide. If what you are describing is a speech issue, a myofunctional issue, or both wearing the same disguise, you will get a straight answer about which one to start with.