Mary A. Hardin-Jones

Speech production of preschoolers with cleft palate.

Objective The present investigation was conducted to examine the prevalence of preschoolers with cleft palate who require speech therapy, demonstrate significant nasalization of speech, and produce compensatory articulations. The relationship among these three dependent variables and the independent variables of cleft type and age of primary palatal surgery was also examined. Participants The participants included 212 preschoolers with repaired cleft palate aged 2 years 10 months to 5 years 6 months. Main Outcome Measures Chi-square analyses were performed to examine the relationship between two independent variables (cleft type and age of surgery) and three dependent variables (percentage of children requiring speech therapy, percentage demonstrating moderate to severe hypernasality and receiving secondary management for velopharyngeal insufficiency, and percentage producing glottal/pharyngeal substitutions). Results Sixty-eight percent of the children were enrolled in (or had previously received) speech therapy. Thirty-seven percent of the children demonstrated moderate-severe hypernasality or had received secondary surgical management for velopharyngeal insufficiency. Chi-square analyses revealed a significant relationship between cleft type and the number of children referred for speech therapy as well as the number of children with significant hypernasality. The analyses also revealed a significant relationship between age of palatal surgery and number of children with significant hypernasality. Conclusions Despite advances in surgical management and the advantages offered by team care, the majority of preschoolers with cleft palate continue to demonstrate delays in speech sound development that require direct speech therapy. An optimal treatment regimen for these children is one that includes primary palatal surgery no later than 13 months of age.

Timing of palatal surgery and speech outcome.

Objective: To examine the impact of age and lexical status at the time of primary palatal surgery on speech outcome of preschoolers with cleft palate. Participants: Forty children (33 to 42 months) with nonsyndromic cleft palate participated in the study. Twenty children (Group 1) were less lexically advanced and younger (mean age  =  11 months) and 20 children (Group 2) were more lexically advanced and older (mean age  =  15 months) when palatal surgery was performed. Main Outcome Measures: Samples of the childrens spontaneous speech were compared on 11 speech production measures (e.g., size of consonant inventory, total consonants correct, % correct for manner of articulation categories, compensatory articulation usage, etc.). Next, listeners rated a 30-second sample of each childs connected speech for articulation proficiency and hypernasality, separately, using direct magnitude estimation (DME). Results: Group differences were noted for 4 of the 11 speech production measures. Children in Group 1 exhibited larger consonant inventories (and true consonant inventories) and more accurate production of nasals and liquids compared to children in Group 2. On the DME task, significant group differences were found for ratings of articulation proficiency and hypernasality. Children in Group 1 exhibited better articulation and less hypernasality than children in Group 2. Conclusions: The findings suggested that children who were less lexically advanced and younger at the time of palatal surgery exhibited better articulation and resonance outcomes at 3 years of age.

The relationship between early speech and later speech and language performance for children with cleft lip and palate

This study examined the relationship between speech measures at presurgery/9 months and postsurgery/13 months and speech and language performance at 21 months for children with cleft lip and palate and their noncleft peers. Comparisons were also made between the speech and lexical development of children with cleft lip and palate and noncleft children at 21 months of age. The participants included 30 children; 15 with cleft lip and palate and 15 noncleft children. Results revealed differences between the groups for several measures of speech and lexical development at 21 months. For the children with cleft palate, correlational analyses suggested that true stop production, both immediately before and after palatal surgery, was positively correlated with a majority of the speech production measures at 21 months. At postsurgery/13 months, true stop production was related to later vocabulary development, and size of true consonant inventory was related to all measure of speech production and one measure of lexical development at 21 months. For the noncleft group, true canonical babbling ratio at 13 months was the only measure that was significantly correlated with any of the speech and/or language measures at 21 months. The impact of clefting on prelinguistic and later speech and language skills is discussed.

Reliability of listener transcriptions of compensatory articulations.

OBJECTIVE This study examined the ability of speech-language pathologists to transcribe compensatory articulation errors. DESIGN Speech-language pathologists phonetically transcribed audiorecordings of 130 monosyllabic words, 70 of which contained compensatory articulations. PARTICIPANTS The participants for this study were two groups of 10 speech-language pathologists. Group I included speech-language pathologists who were experienced in evaluating children with cleft palate, and group II speech-language pathologists were not. RESULTS Marked variability was evident across listeners, with percentages of agreement ranging from 19 to 71 (mean agreement = 41%). The experienced listeners performed significantly better on the transcription task than the inexperienced listeners, but poor interjudge agreement was evident across both groups. CONCLUSIONS The results of this study suggest that speech-language pathologists may differ in their understanding of the auditory perceptual characteristics of compensatory articulations. The results underscore the need for increased training and standardization of transcription procedures.

Conversational skills of children with cleft lip and palate: A replication and extension

Objective To replicate and to extend a previous study examining the conversational skills of children with cleft lip and palate. Participants Thirty-four children (33 to 44 months) participated: 17 children with cleft lip and palate and 17 noncleft children. Methods The children were observed during an interaction with caregivers in their homes. Samples of caregiver-child interactions were coded as assertive or responsive, for type of conversational act, and for discourse level categories. Profiles of conversational activity were determined for each child based on the coding. Correlations were performed to examine the relationship between assertiveness and speech variables (articulation and resonance) for the children with cleft lip and palate. Results Group comparisons revealed that the children with cleft lip and palate produced fewer assertive utterances, were less likely to respond adequately to comments by caregivers, and produced more topic maintaining and fewer topic extending utterances than did their noncleft peers during conversational interactions. Examination of individual child data indicated that 35% of the children with cleft lip and palate exhibited conversational profiles characterized by either low assertiveness or low responsiveness. Finally, a significant positive correlation was noted between conversational assertiveness and speech production skills. Conclusion These findings suggested that the children with cleft lip and palate were less conversationally assertive than their noncleft peers. Further, there appeared to be a relationship between speech production skills and conversational skills, suggesting that poor speech may be impacting language performance for these children.

Long-term speech results of cleft palate patients with primary palatoplasty.

This investigation examined the influence of cleft type, type of surgery, age at surgery, and gender on speech proficiency of 204 patients with cleft palate who required only primary palatoplasty. Speech measures were obtained for each subject from at least three annual examinations between the ages of 4 and 16 years. Neither age at surgery nor type of surgery were discriminating factors. The less extensive cleft type, i.e., soft palate only, was associated with greater rates of change in the performance variables than were the other three cleft types. Females showed greater rate changes than males.

The impact of early palatal obturation on consonant development in babies with unrepaired cleft palate

OBJECTIVE The purpose of this investigation was to determine whether palatal obturators enhance consonant development during babbling for babies with unrepaired cleft palate. PARTICIPANTS Fourteen babies with cleft palate who had worn anterior palatal obturators prior to palatal surgery were matched to 14 unobturated babies according to cleft type, sex, and age at time of presurgical evaluation. MAIN OUTCOME MEASURES Spontaneous vocalizations of the obturated and unobturated groups were compared to determine whether differences were evident in size of consonant inventory as well as place and manner of consonant production. RESULTS Paired t tests revealed no significant differences between the groups in size of consonant inventory or place and manner of consonant production. There was a trend for babies in the obturated group to produce more glottal consonants. CONCLUSIONS In general, the findings of this study suggested that palatal obturators do not appear to facilitate production of anterior palatal consonants during babbling.

Cognitive and language issues associated with cleft lip and palate

Language and cognitive performance of children with cleft palate with/without cleft lip (CP ± L) have received relatively little attention in the literature to date. The lack of attention directed toward these areas is probably attributed to two factors. First, the speech characteristics associated with velopharyngeal inadequacy are undoubtedly the most salient problems encountered by clinicians treating these children and thus have taken priority in research for many years. Second, early findings suggesting little difference between these children and their typically developing peers in language and cognition simply discouraged additional study. More recent investigations, however, have expanded the scope of study to include toddlers and adults and utilized alternative methodologies to study this population. In this article, we will summarize the literature and explore recent findings associated with language and cognition in children with CP ± L. In addition, we will also examine performance of children with velocardiofacial syndrome-a common syndrome associated with CP ± L.

Early Lexical Characteristics of Toddlers With Cleft Lip and Palate

Objective To examine development of early expressive lexicons in toddlers with cleft palate to determine whether they differ from those of noncleft toddlers in terms of size and lexical selectivity. Design Retrospective. Patients A total of 37 toddlers with cleft palate and 22 noncleft toddlers. Main Outcome Measures The groups were compared for size of expressive lexicon reported on the MacArthur Communicative Development Inventory and the percentage of words beginning with obstruents and sonorants produced in a language sample. Differences between groups in the percentage of word initial consonants correct on the language sample were also examined. Results Although expressive vocabulary was comparable at 13 months of age for both groups, size of the lexicon for the cleft group was significantly smaller than that for the noncleft group at 21 and 27 months of age. Toddlers with cleft palate produced significantly more words beginning with sonorants and fewer words beginning with obstruents in their spontaneous speech samples. They were also less accurate when producing word initial obstruents compared with the noncleft group. Conclusions Toddlers with cleft palate demonstrate a slower rate of lexical development compared with their noncleft peers. The preference that toddlers with cleft palate demonstrate for words beginning with sonorants could suggest they are selecting words that begin with consonants that are easier for them to produce. An alternative explanation might be that because these children are less accurate in the production of obstruent consonants, listeners may not always identify obstruents when they occur.

The impact of cleft type on early vocal development in babies with cleft palate

OBJECTIVE The purpose of the present investigation was to examine the impact of cleft type on early sound development in children with cleft palate (with or without cleft lip). PARTICIPANTS The participants included 53 babies with unrepaired cleft palate aged 8 to 10 months. Thirty-five babies had cleft lip and palate (CLP) and 18 had cleft palate only (CPO). MAIN OUTCOME MEASURES Spontaneous vocalizations of the CLP and CPO groups were compared to determine whether differences were evident in canonical babbling, size of consonant inventory as well as place and manner of consonant production, and frequency of vocalization. RESULTS Students t tests revealed no significant differences between the groups in canonical babbling, size of consonant inventory, place and manner of consonant production, or frequency of vocalization. However, there was a trend for babies in the CPO group to produce fewer compensatory stop consonants and more anterior place features. In addition, a larger percentage of children in the CPO group had entered the canonical babbling stage at the time of this study. CONCLUSIONS In general, the findings of this study suggested that cleft type does not appear to play a significant role in early consonant development for babies with cleft palate. Additional study using a larger CPO group is recommended to further investigate the trend toward better performance noted in this group.