Has she been seen by a craniofacial team? If not they should recommend a course of action. They always have a speech therapist who will evaluate and suggest a needd. My son is 9 1/2 and is also in fourth grade. Like you he had speech therapy at the same age but seems okay now. ocassionally still slurs his ssss and teee. Your school may also have a a speech therapist who can evaluate the need for therapy.