Peer attitudes toward children with cleft (lip and) palate related to speech intelligibility, hypernasality and articulation

Peer attitudes towards children with cleft lip and palate: An interaction of visual and auditory cues?

BACKGROUND AND AIMS

For children with speech disorders related to cleft palate with or without cleft lip (CP±L), effective communication presents significant challenges. Listeners often form judgments based on the speech signal, contributing to stigmatization and negative stereotyping. When a child also has a cleft lip, perceptions may be further influenced. Limited research has explored peer attitudes towards individuals with CP±L using audiovisual stimuli. This study aimed to examine peer attitudes of children towards children with CP±L, analyzing how these attitudes vary based on auditory, visual, and audiovisual cues and cleft type. Additionally, the relationship between speech intelligibility, speech acceptability, and social acceptance was evaluated.

METHOD

Audio samples, photographs, and audiovisual samples were collected from 11 Caucasian children: four with cleft palate (CP), four with cleft lip and palate (CLP) and three typically developing children without cleft. These stimuli were judged by 48 typically developing peers aged 7 to 12 (24 boys, 24 girls) based on three attitude components, i.e. cognitive, affective and behavioral. They also rated speech intelligibility and acceptability. Correlations were calculated between the attitude components and speech intelligibility/acceptability. The impact of the medium on peer attitudes per cleft type was verified.

RESULTS

Strong and significant positive correlations were found between all attitude dimensions and the mean speech intelligibility and speech acceptability scores given by peers, particularly with audio and audiovisual samples. Deviant speech (audio) negatively influenced all peer attitudes, whereas variations in facial appearance alone (photo) did not substantially impact peer attitudes. When speech and appearance were combined (audiovisual), deviant speech negatively influenced cognitive attitudes without substantial impact of variation in appearance. Affective and behavioral attitudes were negatively influenced when deviant speech was present in combination with a cleft lip.

CONCLUSION

This study underscores the importance of multidimensional approaches to understanding and improving peer attitudes towards children with CP±L. Addressing both auditory and visual aspects of cleft-related disorders can better support these children's social inclusion and well-being. Further research should explore the long-term impact of speech and psychological interventions and educational programs on peer attitudes and examine specific visual cues' roles in social perceptions.

Psychometric properties of the Intelligibility in Context Scale in monolingual Spanish-speaking children with and without speech sound disorders from Peru

PURPOSE

This study explored the construct validity, internal consistency, and criterion validity of The Intelligibility in Context Scale: Spanish (ICS-S) with monolingual Spanish-speakers from Peru.

METHOD

Participants included 40 Spanish-speaking children (3 years and 3 months to 10 years and 11 months of age), n = 21 with typical speech, and n = 19 with speech sound disorders (SSD). Caregivers completed the ICS-S and children completed a single word articulation test; percent of consonants correct (PCC) were calculated. To evaluate construct validity, correlations were run between the ICS-S mean and the 7 ICS items; mean ICS-S scores in those with and without an SSD were compared using the Wilcoxon rank-sum test. Additionally, correlations were conducted between PCC and ICS-S mean scores to assess criterion validity and Chronbach's alpha was used to assess internal consistency. Because eight participants were rated as having both an SSD and severe hypernasality (defined as EAI=4), we ran sensitivity analyses with these participants excluded.

RESULTS

The mean ICS-S score for the children with SSD was 3.5 and for the children with typical speech was 4.4. Correlations between item and total mean on the ICS-S were significant (p = 0.000 - 0.004) in all but one case (parent's rating with the ICS-S mean score for the children with typical speech and those without CP; p = 0.203 & 0.131). Mean ICS-S scores were significantly lower in those with SSDs (p < 0.001). Criterion validity between PCC and the ICS-S mean score was r = 0.564, CI= 0.307 - 0.745 p < 0.001 and internal consistency between all the test items on the ICS-S was α = 0.913. Most results (except one) remained consistent when the eight with SSD and severe hypernasality were excluded.

CONCLUSIONS

The ICS-S demonstrated construct and criterion validity as well as internal consistency for a cohort of monolingual Spanish children with and without SSD. These findings support the use of the ICS-S for screening for speech sound disorders (SSDs) in Spanish-speaking children.

Management of Velopharyngeal Impairment in Adults With Dysarthria: A Systematic Review

PURPOSE

Velopharyngeal impairment (VPI) is a common manifestation of dysarthria, yet there is uncertainty regarding the evidence for treatment options. The aim of this systematic review was to identify and evaluate published intervention studies of VPI and to update the original Practice Guidelines for VPI, as part of the Dysarthria Writing Group of the Evidence-Based Clinical Research Committee of the Academy of Neurologic Communication Disorders and Sciences.

METHOD

Four electronic databases were searched for articles published through September 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. Multiple indices of methodological quality and risk of bias were used to evaluate studies.

RESULTS

The search yielded 1,347 articles, of which 31 met inclusion criteria and were reviewed by two blinded co-investigators and a third consensus reviewer. Therapeutic approaches centered on prosthetic treatment (n = 13), prosthetic treatment combined with another form of therapy (n = 7), and behavioral exercise (n = 7), with four additional studies reporting unconventional approaches (e.g., use of medication). No single treatment approach garnered strong evidence. However, converging moderate evidence suggests positive treatment outcomes for prosthetic approaches for moderate-severe speakers with flaccid/spastic dysarthria and behavioral treatment approaches for speakers spanning a range of nonprogressive dysarthrias.

CONCLUSIONS

There is a critical need for well-controlled treatment studies of VPI that incorporate comprehensive and systematic description of baseline speech function, treatment protocols, and operationally defined outcome measures, particularly related to social validity and participation goals. Suggestions for how clinicians can apply extant research findings to practice are provided.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27655566.

Association between sex of the individual with untreated cleft lip and social judgement made by lay persons: A cross-sectional study

OBJECTIVE

To assess whether there is an association between an individual's sex and social judgements made by lay persons regarding untreated cleft lip.

MATERIALS AND METHODS

Lay individuals over 18 years old were recruited through an application to respond online to two questionnaires: a sociodemographic survey and the Brazilian Version of Lay Persons' Social Judgements about Cleft-lip Scale (B-LSojCleft-S). B-LSojCleft-S comprises 14 items evaluating social judgements made by laypersons concerning different types of untreated cleft lips in teenagers. The 14 items are linked to 8 images featuring untreated cleft lips and 1 image without a cleft (control). Higher scores represented more favourable social judgements. Independent samples t-test, paired, and multiple linear regression were conducted (P < 0.05). The study assessed judgements of untreated cleft lips in male and female adolescents using the B-LSojCleft-S.

RESULTS

The mean age of the 217 participants was 37.78 ± 12.39 years, predominantly women (72.7%), married (47.7%), with a monthly income below three minimum wages (35.6%) in the majority of cases. Significantly higher social judgement scores were observed in the control group (no cleft) compared to any type of cleft (P < 0.001), with similar scores obtained for the same types of clefts with female or male images (P > 0.05). The participant's sex is associated with social judgement scores (F [1, 214] = 6.318, P = 0.013; adjusted R2 = 0.024), with females making more favourable judgements than males (P < 0.05).

CONCLUSIONS

Individuals with cleft lips receive more negative social judgement scores, regardless of their own sex. Women make better social judgements than men.

A retrospective analysis of factors affecting speech production in school-aged children with cleft palate (+- cleft lip)

OBJECTIVE

The present investigation examined how factors such as cleft type, age of primary palatal surgery, diagnosed syndromes, hearing problems, and malocclusions could predict persistent speech difficulties and the need for speech services in school-aged children with cleft palate.

METHODS

Participants included 100 school-aged children with cleft palate. Americleft speech protocol was used to assess the perceptual aspects of speech production. The logistic regression was performed to evaluate the impact of independent variables (IV) on the dependent variables (DV): intelligibility, posterior oral CSCs, audible nasal emission, hypernasality, anterior oral CSCs, and speech therapy required.

RESULTS

Sixty-five percent of the children were enrolled in (or had received) speech therapy. The logistic regression model shows a good fit to the data for the need for speech therapy (Hosmer and Lemeshow's χ2(8)=9.647,p=.291). No IVs were found to have a significant impact on the need for speech therapy. A diagnosed syndrome was associated with poorer intelligibility (Pulkstenis-Robinson's χ2(11)=7.120,p=.789). Children with diagnosed syndromes have about six times the odds of a higher hypernasality rating (Odds Ratio = 5.703) than others. The cleft type was significantly associated with audible nasal emission (Fisher'sexactp=.006). At the same time, malocclusion had a significant association with anterior oral CSCs (Fisher'sexactp=.005).

CONCLUSIONS

According to the latest data in the Cleft Registry and Audit Network Annual Report for the UK, the majority of children with cleft palate attain typical speech by age five. However, it is crucial to delve into the factors that may influence the continuation of speech disorders beyond this age. This understanding is vital for formulating intervention strategies aimed at mitigating the long-term effects of speech disorders as individuals grow older.

Columbia-Suicide Severity Rating Scale (C-SSRS) Reveals High Rates of Suicidality in 602 Patients With Cleft and Craniofacial Conditions

INTRODUCTION

Little is known about rates of suicidal ideation and behavior among youth with cleft lip and/or palate (CLP) and other craniofacial conditions.

METHODS

Records of patients ages 6 and older who were administered the Columbia-Suicide Severity Rating Scale (C-SSRS) Lifetime Version during routine multidisciplinary cleft or craniofacial team visits between 2019 and 2023 were examined. Demographics information, C-SSRS data, and diagnoses were assessed with statistics including t tests, the Fisher exact test, and odds ratios.

RESULTS

A total of 1140 C-SSRS questionnaires across 602 (433 CLP and 169 craniofacial) patients with an average age of 11.2±3.7 years were included. Eighty-four (13.6%) patients endorsed lifetime suicidal ideation, 9 (1.5%) had at least one instance of suicidal behavior, 30 (5.0%) endorsed nonsuicidal self-injury, and 2 (0.3%) engaged in self-injurious behavior. Compared with CLP, those with other craniofacial conditions had similar odds of endorsing suicidal ideation and behavior ( P ≥0.05). Compared with those with isolated cleft palates, CLP had greater odds of endorsing suicidal ideation and behavior, though those differences were not significant ( P ≥0.05). Incidence of suicidality was unchanged before, during, and after the COVID-19 pandemic ( P ≥0.05). Dividing patients by sex or insurance type revealed no difference in suicidality ( P ≥0.05).

CONCLUSION

Patients with CLP and craniofacial conditions have a high incidence of suicidal ideation and behavior, though levels are similar between these groups. Suicidality in these patients was not negatively impacted by the COVID-19 pandemic. Early identification of safety risks and psychosocial challenges through regular screening can facilitate connection with appropriate clinical interventions.

Persisting speech difficulties at 7-8 years of age - a longitudinal study of speech production in internationally adopted children with cleft lip and palate

AIM

To longitudinally investigate speech production (consonant proficiency, consonant errors and perceived velopharyngeal competence) in 17 internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) at three time points.

METHOD

Consonant proficiency (percent consonants correct, consonant inventory) and number and type of consonant errors were calculated based on blind phonetic transcriptions of words from the Swedish Test of Articulation and Nasality (SVANTE). Velopharyngeal competence was perceptually rated by three blinded experienced speech-language pathologists at the ages of 3, 5 and 7-8 years.

RESULTS

A significant positive development of speech production was found, although most children still scored very low for consonant proficiency at the age of 7-8 compared with normative values: the median for percent consonants correct was 79.7 and many children still had persisting cleft-related and developmental consonant errors. At the age of 7-8, almost half of the children were rated as having a competent velopharyngeal function and only three as having an incompetent velopharyngeal function.

CONCLUSION

Persisting speech difficulties at school age in IA children with UCLP were found in the present study, which is one of the very few longitudinal studies. Our results highlight the need for detailed follow-up of speech production in clinical settings. Speech disorders may have a severe impact on a child's intelligibility and participation with peers, and there is a need for more studies investigating the actual everyday effect of the difficulties found.

Peer attitudes towards adolescents with speech disorders due to cleft lip and palate

BACKGROUND AND AIMS

Individuals with speech disorders are often judged more negatively than peers without speech disorders. A limited number of studies examined the attitudes of adolescents toward peers with speech disorders due to a cleft lip with or without a cleft of the palate (CL ± P). Therefore, the aim of the present study was to investigate the attitudes of peers toward the speech of adolescents with CL ± P.

METHOD

Seventy-eight typically developing adolescents (15-18 years, 26 boys, 52 girls) judged audio and audiovisual samples of two adolescents with CL ± P based on three attitude components, i.e., cognitive, affective, and behavioral. The degree of speech intelligibility was also scored by their peers. The study investigated whether the three attitudes were determined by speech intelligibility or appearance of an individual with CL ± P. Furthermore, the influence of knowing someone with a cleft, the age, and gender of the listeners on their attitudes were explored.

RESULTS

A significantly positive correlation was found between the speech intelligibility percentage and the three different attitude components: more positive attitudes were observed when the speech intelligibility of the speaker was higher. A different appearance due to a cleft lip does not lead to more negative attitudes. Furthermore, boys seem to have more negative attitudes toward individuals with CL ± P compared to girls.

CONCLUSION

This study provided additional evidence that peers show more negative attitudes toward adolescents with less intelligible speech due to CL ± P. Intervention should focus on changing the cognitive, affective, and behavioral attitudes of peers in a more positive direction and remove the stigma of patients with a cleft. Further research is needed to verify these results.

Training speech pathology students in the perceptual evaluation of speech in patients with cleft palate: Reliability results and the students' perspective

INTRODUCTION

Listener training is necessary to achieve agreement between perceptual ratings. However, evidence is limited regarding the effect of a training in the perceptual evaluation of cleft palate speech on the reliability of students in speech pathology. The aim of this study was to evaluate the short-term and longer-term effect of a training using the Belgian Dutch outcome tool for cleft palate speech on reliability and the students' experiences.

METHODS

A 2-h training was provided during a specialist course for 31 first year master students in speech pathology. Information regarding listener characteristics, speech documentation and speech analysis (speech parameters and rating scales) was discussed. This last part focused on the Belgian Dutch outcome tool for speech in patients with cleft palate, including reference samples and consensus listening exercises. Pre training (T1) and post-training reliability (immediately following the training (T2) and one month later (T3)) were collected for the speech variables speech understandability, speech acceptability, hypernasality, hyponasality, nasal emission and nasal turbulence that were rated by means of ordinal scales. Inter-rater reliability was determined with interclass correlation coefficients whereas percentages of agreement were calculated for the intra-rater reliability.

RESULTS

Qualitative inter-rater ICC categories improved for hyponasality and speech acceptability at T2 and T3, whereas the inter-rater reliability of the other variables remained stable regarding their interpreted categories. All ICC values quantitatively improved at T2, except hypernasality and nasal emission. At T3, three of those variables showed a small drop one month later. Regarding intra-rater reliability, a significant decrease for hypernasality and nasal turbulence was found at T2, whereas a significant increase was observed for nasal turbulence and speech acceptability at T3. All variables, except hypernasality, had improved intra-rater reliability at T3 in comparison with T1. Students experienced fewer difficulties with most variables after training. Evaluation of nasal emission and nasal turbulence remained however difficult and required, in the students' opinion, more attention.

DISCUSSION & CONCLUSION

Overall a positive training effect was noted, especially regarding the inter-rater reliability and the students' confidence in perceptual ratings. However, it remains a challenge to achieve a positive training effect for all target variables that is maintained over-time.

Reliability of Perceptual Judgments of Phonetic Accuracy and Hypernasality Among Speech-Language Pathologists for Children With Dysarthria

Purpose The objectives of this study were to: (a) compare interrater reliability of practicing speech-language pathologists' (SLPs) perceptual judgments of phonetic accuracy and hypernasality between children with dysarthria and those with typical development, and (b) to identify speech factors that influence reliability of these perceptual judgments for children with dysarthria. Method Ten SLPs provided ratings of speech samples from twenty 5-year-old children with dysarthria and twenty 5-year-old children with typical development on two tasks via a web-based platform: a hypernasality judgment task and a phonetic accuracy judgment task. Interrater reliability of SLPs' ratings on both tasks was compared between children with dysarthria and children with typical development. For children with dysarthria, four acoustic speech measures, intelligibility, and a measure of phonetic accuracy (percent stops correct) were examined as predictors of reliability of SLPs' perceptual judgments. Results Reliability of SLPs' phonetic accuracy judgments and hypernasality ratings was significantly lower for children with dysarthria than for children with typical development. Among children with dysarthria, interrater reliability of perceptual judgments ranged from strong to weak. Percent stops correct was the strongest predictor of interrater reliability for both phonetic accuracy judgments and hypernasality ratings. Conclusions Reliability of perceptual phonetic accuracy judgments and hypernasality ratings among practicing SLPs for children with dysarthria is reduced compared to ratings for children with typical development. Findings underscore the need for more reliable methods to assess phonetic accuracy and hypernasality for children with dysarthria.