S.M. Goorhuis-Brouwer

Speech and language development in toddlers with and without cleft palate

OBJECTIVEnThe effect of early palate closure on speech and language development in children with cleft palate.nnnDESIGNnComparative study.nnnSETTINGnUniversity Medical Center Groningen, Cleft Palate Team (The Netherlands).nnnMATERIALS AND METHODSnForty-three toddlers with cleft palate and thirty-two toddlers without cleft palate were analyzed with standardized tests for language comprehension and language production. Moreover articulation and hyper nasality were examined by trained speech therapists.nnnRESULTSnFor language comprehension, language production and articulation there were no significant differences between the children with and without cleft lip and/or palate. This is despite the high percentage of conductive hearing loss (55%) in children with clefts. Significant difference was found for hyper nasality (mean: 35% vs. 0%, p=0.001). In both groups articulation problems raise to a higher percentage than language production problems (63-20%; 24-4%).nnnCONCLUSIONSnEarly surgical treatment is effective for a part of the communicative development, i.e. language development and articulation. Besides conductive hearing loss hyper nasality remains a serious problem in 30-50% of the children with cleft palate. Therefore, speech therapy and pharyngoplasty also are part of the treatment procedure. Because of the high amount articulation problems in all children, standards for articulation development are perhaps too strict. Future research should be carried out after normal variations in articulation development.

Communicative abilities in toddlers and in early school age children with cleft palate.

OBJECTIVESnEvaluation of improvement in communicative abilities in children with nonsyndromic cleft palate.nnnMETHODSnLongitudinal retrospective case history study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL+/-A; n=10, 5%), unilateral cleft lip and palate (UCLP; n=23, 37%), bilateral cleft lip and palate (BCLP; n=9, 14%) and isolated cleft palate (CP; n=21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed.nnnRESULTSnExcept for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p=0.00), language production problems from 21% to 6% (p=0.01), articulation problems from 57% to 25% (p=0.00) and hypernasality from 38% to 10% (p=0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31% (p=0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL+/-A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a success rate of 86%.nnnCONCLUSIONSnAt early school age, in children with clefts, speech and language problems were significantly improved following a multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat.

Efficacy of speech therapy in children with language disorders: specific language impairment compared with language impairment in comorbidity with cognitive delay

OBJECTIVEnthis article discusses the effect of speech therapy on language comprehension, language production and non-verbal functioning in two groups of children with developmental language disorders.nnnDESIGNnretrospective study-a follow-up after a mean of 2 years.nnnMATERIALS AND METHODSnverbal and non-verbal functioning before and after therapy were examined in 31 language-impaired children with normal hearing and good health. In 16 children the language functioning was substantial behind their non-verbal functioning. They were categorised as children with specific language impairment (SLI). In 15 children the language problem was in comorbidity with cognitive delay, and these were categorised as children with non-SLI. At the first examination the children were at the age of 1;5-5;4 years and at the second examination they were at the age of 3;4-6;11 years. The children were examined for language comprehension (Standardised Dutch version of the Reynell Developmental Comprehension Scale), spontaneous language production (Groningen Diagnostic Speech norms) and non-verbal functioning (Snijders-Oomen non-verbal intelligence scale for children between 2 1/2 and 7 years).nnnRESULTSnin both groups, a significant improvement was found in language functioning as well as in non-verbal functioning. Language comprehension and non-verbal IQ-scores in both groups improved by about the same amount. Language production made significantly more progress in the SLI group than in the non-SLI group. The improvements in the SLI group were mainly reached by speech therapy, whereas in the non-SLI group this was less the case.nnnCONCLUSIONSnverbal and non-verbal development can improve in young children with developmental language delay. This underlines the idea that language and cognitive development are interacting and influencing each other in a positive way. Children with SLI seem to benefit more from speech therapy, whereas children with cognitive delay seem to benefit more from special education.

Nasometry normative data for young Dutch children

OBJECTIVEnHypernasality is a common problem in cleft care. It should be treated before the age of six, because of the impact it can have on speech sound development in young children. An objective method of nasalance evaluation is nasometry. To decide whether a nasometer test result is normal or abnormal, normative data and cut off points are needed. Normative data for children are not available for every language and age. For Dutch children two sets of Dutch speech stimuli, the Van Zundert sentences or the Moolenaar-Bijl, sentences, are often used in the diagnostic process for hypernasality. Primary goal of this study is to determine normative data and cut off points for two sets of Dutch speech stimuli for Dutch children from four to six years of age. Secondary is to compare those two sets of oral sentences.nnnMETHODnChildren without clefts were recruited from schools. According to their teachers their speech was normal. They were tested with the nasometer with the two sets of speech stimuli. The set from Van Zundert has oral and oronasal sentences, the Moolenaar-Bijl set only has oral sentences.nnnRESULTSn118 children were recruited. Out of these children, 55 produced recording samples which were suitable for analysis. There were no significant differences between age groups or gender. The two different sets of speech stimuli used were significantly different, but the confidence intervals overlapped.nnnCONCLUSIONSnNormal nasalance scores of the tested sentences are between 3 and 19% for oral sentences and between 17 and 37% for oronasal sentences. The Moolenaar-Bijl speech sentences are preferred to evaluate hypernasality in young Dutch children, because of the shortness and intelligibility. Normative nasalance scores are applicable to the whole group of children from four to six years of age.

Global developmental delay in guanidionacetate methyltransferase deficiency: differences in formal testing and clinical observation

Guanidinoacetate N-methyltransferase (GAMT) deficiency is a defect in the biosynthesis of creatine (Cr). So far, reports have not focused on the description of developmental abilities in this disorder. Here, we present the result of formal testing of developmental abilities in a GAMT-deficient patient. Our patient, a 3-year-old boy with GAMT deficiency, presented clinically with a severe language production delay and nearly normal nonverbal development. Treatment with oral Cr supplementation led to partial restoration of the cerebral Cr concentration and a clinically remarkable acceleration of language production development. In contrast to clinical observation, formal testing showed a rather harmonic developmental delay before therapy and a general improvement, but no specific acceleration of language development after therapy. From our case, we conclude that in GAMT deficiency language delay is not always more prominent than delays in other developmental areas. The discrepancy between the clinical impression and formal testing underscores the importance of applying standardized tests in children with developmental delays. Screening for Cr deficiency by metabolite analysis of body fluids or proton magnetic resonance spectroscopy of the brain deficiency should be considered in any child with global developmental delay/mental retardation lacking clues for an alternative etiology.

Behavioural problems in young children with language problems

OBJECTIVEnAnalysis of behavioural problems in young children with language problems.nnnMATERIALS AND METHODSnFrom 38 children diagnosed with a language problem, the opinion of the parents about the behaviour of their child, scored by the Child Behaviour Checklist 1.5-5 was compared with the behavioural problems in the Dutch population with the Chi-square test. T-tests and Mc Nemar tests were used to compare the opinion of the fathers about the behavioural problems with the opinion of the mothers and to compare the scores on internalizing problems with scores on externalizing problems. Plots display the measurement of the mean behavioural problems of the parents against the discrepancy between the parents and of the total behavioural problems against the discrepancy between internalizing and externalizing problems. The relation between the behavioural problems, the language score and the non-verbal intelligence score was also compared and is presented in a bar chart.nnnRESULTSnAll children had an inadequate language production (GDS). Twenty-seven children had an adequate and 11 children had an inadequate Language Comprehension Quotient (LCQ). Twenty-eight children had an adequate and 10 children had an inadequate non-verbal IQ (SON-IQ). In the clinical population mothers report more internalizing behavioural problems than in Dutch peers. The fathers also experience differences, but these are not significant. There is agreement between the parents in how they experience problems on the internalizing, externalizing and total problem scale. And there are no significant differences between the internalizing and externalizing problem scales, between boys and girls, and in behavioural problems in children with both adequate LCQ and SON-IQ and with inadequate LCQ and/or SON-IQ.nnnCONCLUSIONnCompared to their peers in the Dutch population, young children with language problems show more internalizing problems according to their mothers. The fathers also experience differences, but these are not significant. Fathers and mothers agree on the behaviour analysis of their child and there are no differences between the occurrences of internalizing or externalizing problems and between boys and girls. There is also no relation between the behavioural problems and the severity of the language problem or the level of non-verbal functioning.

Problems in speech sound production in young children. An inventory study of the opinions of speech therapists

OBJECTIVEnAnalysis of examination procedure and diagnosis of articulation problems by speech therapists.nnnSTUDY DESIGNnSurvey study.nnnMATERIALS AND METHODSnEighty-five Dutch speech therapists (23% response), working in private practises or involved in language screening procedures in Youth Health Care, were questioned regarding the incidence of articulation problems in their practices, the manner of examination, the normative data used, and the importance attached to identifying articulation problems.nnnRESULTSnAccording to the speech therapists, articulation problems are present in the majority of children (90%) in their practices. In children between 2 and 5 years of age, 45%; in children between 5 and 8 years of age, 36%; above age 8, about 14% of the children still have articulation problems. Despite their opinion that articulation problems often form a separate aspect of language development, all respondents indicated that they always investigate the speech sound development as part of a total speech and language examination. Frequently, more than one instrument is used. However, none of these instruments are standardised. The speech therapists prefer to examine the children at about 4 years of age, despite their opinion that the speech sounds develop until about 6 years of age. For them, this raises the problem to distinguish between articulation in development and articulation problems. They have the opinion that early treatment is important because of assumed relations with social-emotional development and reading and writing abilities later on.nnnCONCLUSIONnThe speech therapists taking part in this study have a good view of the speech sound development of young children. However, due to their concern about communication, social-emotional development, and reading and writing abilities later on, they prefer to identify and treat articulation problems at an early age. More detailed research into the variations in speech sound development, in relation to language development, is needed in order to arrive at effective normative data.

Language disorders in young children: when is speech therapy recommended?

OBJECTIVEnAnalysis of treatment recommendation given by speech therapists. Evaluation of the language abilities in the examined children and re-examination of those abilities after 12 months.nnnMATERIALS AND METHODSnThirty-four children, aged between 2.0 and 5.3 years, referred to speech therapists by their General Practitioners because of possible language problems were included in a prospective study. The number of children receiving speech therapy and the number of speech therapy sessions received during 1 year, and the therapy effect on three quantitative language measures were compiled.nnnRESULTSnIn 97% of the children referred to a speech therapist, speech therapy was recommended. Most of these children showed average to above-average language scores on standardised tests for sentence development (61%) and language comprehension (79%). In addition, for most children spontaneous speech, as screened by the Groningen Diagnostic Speech Norms, was age-adequate (76%). The childrens problems consisted of pronunciation difficulties or periods of stammering. After 12 months for 50% of these children speech therapy was still continued which means that the articulation problems still were present. The mean number of speech therapy sessions was 26.7. The language scores on the three language tests remained relatively stable over the 12-month interval.nnnCONCLUSIONSnIn young children pronunciation difficulties often lead to the recommendation for speech therapy. For a large number of children therapy takes more than a year, indicating that speech therapy cannot influence these problems to a great extent. In addition language scores remained relatively stable. Therefore, language problems and especially articulation problems in young children should be reconsidered regarding maturation and normal variations in speech motor development. A watchful waiting approach should be taken more often.

Age of diagnosis and evaluation of consequences of submucous cleft palate

OBJECTIVESnTo evaluate the frequency of submucous cleft palate (SMCP) in a group of children with clefts. The reason for suspecting submucous cleft, age of diagnosis, effect of age on speech development, problems in speech, hearing and swallowing were compared with previous literature.nnnMETHODSnRetrospective chart review: Out of 33 patients with SMCP, registered by the Groninger cleft team over approximately 20 years (1990 until July 2012), 28 non-syndromic patients with a proven diagnosis of SMCP were included: 17 males and 11 females. Speech and hearing were examined and the number of patients with SMCP and age at time of diagnosis were evaluated. The percentages of problems in resonance, articulation and hearing, present at time of diagnosis, were compared with the percentages of problems found after surgery.nnnRESULTSnOut of 800 patients with clefts, 28 patients (3,5%) were diagnosed with SMCP at a mean age of 3;9 years. All patients presented one or more symptomatic complaints at time of diagnosis: hypernasality (65%), problems in articulation (46%), conductive hearing loss (39%) and/or swallowing problems (32%). A bifid uvula was found in 92%. Following surgery, hypernasal speech and swallowing problems were no longer observed. The articulation problems remained after surgery. Age of diagnosis seems no predictor of articulation problems. An improvement in hearing was observed but normal hearing was not achieved. Pharyngoplasty appeared to be a successful and save treatment of hypernasality.nnnCONCLUSIONSnSMCP is a rare cleft palate which is, despite the presence of a bifid uvula and symptoms of velopharyngeal insufficiency, often diagnosed late. In children with a bifid uvula and mild problems in speech, hearing and swallowing, it is important to be alert to SMCP because SMCP may account for these persistent mild complaints. Therefore, early detecting of SMCP can yield profits.

Phonetic and phonemic acquisition: Normative data in English and Dutch speech sound development

OBJECTIVEnComparison of normative data in English and Dutch speech sound development in young children. Research questions were: Which normative data are present concerning speech sound development in children between two and six years of age? In which way are the speech sounds examined? What are the differences and similarities between the development of speech sounds in different languages?nnnMETHODSnA literature study on the subject was performed to be able to answer the research questions.nnnRESULTSnThe presented normative English data showed that all vowels are present at three years of age, and most consonants (singletons) already at four years of age, except for/ʃ, ɹ, θ, ð/. Consonant clusters develop between 4.5 and 5.5 years of age. The phonological error patterns gliding can be present until six years of age. According to information regarding the Dutch speech sound system, the same ages are found for vowels and single consonants. The age of acquisition of most consonant clusters is present at about six years of age, but the development goes on until ten years of age.nnnCONCLUSIONnThe data from the development of the English and Dutch speech sound system show many similar tendencies. Vowels are mastered by the age of three, most consonants by the age of four and most consonant clusters between 5 and 6-8 years of age. Perhaps, there is a universal trend in speech sound development like there is in language development.