Vocabulary Growth From 18 to 24 Months of Age in Children With and Without Repaired Cleft Palate

Diagnosis and Treatment of Speech Disorders in Children With a Cleft (Lip and) Palate: A State-Of-The-Art Overview

In children born with a cleft in the palate with or without a cleft in the lip (CP±L), velopharyngeal insufficiency may persist even after successful surgical closure of the palate. This results in speech disorders including both resonance and speech sound disorders. These speech disorders may have a severe impact on the children's speech understandability and speech acceptability which may, in turn, influence psychosocial well-being, quality of life, and inclusion into society. This article provides an overview of the most important speech characteristics per age group (ie, 0-4​​​​​​, 4-6, 6-12, and >12 y). In addition, a state-of-the-art overview of current practices in speech diagnosis and speech intervention is included.

A meta-analysis of the relationship between speech and language development in children with nonsyndromic cleft palate with or without cleft lip

OBJECTIVE

Children with nonsyndromic cleft palate with or without cleft lip are at risk of speech production and language delays. In typical development, a strong relationship exists between speech and expressive language development. However, the understanding of this relationship in children with nonsyndromic cleft palate with or without cleft lip is incomplete. The objective of this study was to determine the average correlation between consonant inventory and two expressive language skills in children with NSCP ± L.

DESIGN

The study used a random effects meta-analyses design. Articles were included by searching PubMed, APA PsycINFO, and ERIC.

MAIN OUTCOME MEASURES

Correlations between consonant inventory and (1) expressive vocabulary and (2) mean length of utterance.

RESULT

Based on eight studies representing 187 children with nonsyndromic cleft palate with or without cleft lip, consonant inventory was positively correlated with expressive vocabulary size (k = 8, z = 0.74, SE = .16, p < .001, [0.424, 1.052]). Using data from four studies, representing 83 children with nonsyndromic cleft palate with or without cleft lip, consonant inventory had a positive nonsignificant correlation with mean length of utterance (k = 4, z = 0.513, SE = 0.293, p = .081, [-0.063, 1.088]).

CONCLUSION

Results support a connection between consonant inventory and expressive vocabulary size in children with nonsyndromic cleft palate with or without cleft lip across four languages. Small consonant inventories are often associated with expressive language delays.

An Enhanced Audiologic Protocol for Early Identification of Conductive Hearing Loss in Patients with Cleft Palate

OBJECTIVE

To characterize the onset and prevalence of conductive hearing loss (CHL) in pediatric patients with cleft palate (CP) prior to palatoplasty with an enhanced audiologic protocol.

DESIGN

Retrospective cohort study.

SETTING

Multidisciplinary cleft and craniofacial clinic at a tertiary care center.

PATIENTS

Patients with CP who received audiologic workup pre-operatively. Patients with bilateral permanent hearing loss, expiration prior to palatoplasty, or no pre-operative data were excluded.

INTERVENTIONS

Patients with CP born February 2019 to November 2019 who passed newborn hearing screening (NBHS) received audiologic testing at 9 months of age (standard protocol). Patients born December 2019 to September 2020 underwent testing prior to 9 months of age (enhanced protocol).

MAIN OUTCOME MEASURES

Age of identification of CHL in patients after implementation of the enhanced audiologic protocol.

RESULTS

The number of patients who passed their NBHS in the standard protocol (n = 14, 54%) and the enhanced protocol (n = 25, 66%) did not differ. Infants who passed their NBHS, but demonstrated hearing loss on subsequent audiologic testing did not differ between enhanced (n = 25, 66%) and standard cohort (n = 14, 54%). Of patients who passed NBHS in the enhanced protocol, 48% (n = 12) had CHL identified by 3 months, and 20% (n = 5) by 6 months of age. With the enhanced protocol, patients who did not undergo additional testing post NBHS significantly dropped from 44.9% (n = 22) to 4.2% (n = 2) (P < .0001).

CONCLUSION

Even with passed NBHS, CHL is still present for infants with CP pre-operatively. Earlier and more frequent testing for this population is recommended.

The impact of enhanced Milieu teaching with phonological emphasis (EMT + PE) on the speech and language outcomes for toddlers with cleft palate in Brazil and the United States of America

PURPOSE

The purpose of this study was to compare the speech and language outcomes of children with cleft palate with or without cleft lip (CP+/-L) in the USA to children with CP+/-L in Brazil who underwent intervention with enhanced Milieu teaching with phonological emphasis (EMT + PE), as there are few cross-country intervention comparisons for children with CP+/-L.

METHOD

This is a retrospective analysis of 29 participants from the USA and 24 participants from Brazil who were matched on age. The US participants were between the ages of 13-35 months (M = 23.76), spoke Standard American English in the home, and were recruited from East Tennessee State University and Vanderbilt University. The Brazilian participants were between the ages of 20-34 months (M = 25.04), spoke Brazilian Portuguese in the home, and were recruited from the Hospital de Reabilitação de Anomalias Craniofaciais-Universidade de São Paulo. All treatment participants received EMT + PE from trained speech-language pathologists in hospital-university clinics.

RESULT

The treatment groups demonstrated greater gains than comparison groups in percent consonants correct, number of different words, and expressive/receptive vocabulary. There was no main effect nor interaction by country.

CONCLUSION

The application of EMT + PE in a second culture and language is a viable early intervention option for participants with CP+/-L.

Language abilities and associated risk factors of school-aged children with cleft lip and palate

Previous research on children with cleft lip and palate (CLP) reported unequivocal findings with regard to language skills, with the majority suggesting persistent difficulties in early childhood. While expressive language deficits improved with age, receptive language skills were consistently lower than peers. Further study investigating the long term and persistent impact of language deficits amongst school-aged children with CLP is warranted. This was a cross-sectional study, aimed to determine the language abilities and explore the associated risk factors in Malay speaking children with CLP in Malaysia. Fifty-two children with CLP aged 7- to 12-year-old participated in this study. Language skills were assessed using the Malay Preschool Language Assessment Tool and the adapted Subway-School-age Language & Assessment Measures. Findings revealed that 14 (26.92%) school-aged children with CLP demonstrated language deficits. Children with CLP performed significantly poorer in reading comprehension (p = 0.031) and narrative (p = 0.026) skills. It was found that the age significantly influenced total receptive language score (β = 0.421, p = 0.003) and total expressive language score (β = 0.477, p = 0.000). Findings suggested that children with CLP may continue to have persistent language deficits into their school-age years. Recommendations for regular monitoring of language performance especially for those from younger age groups is warranted to help maximize school attainment.

A protocol for a randomized-controlled trial to investigate the effect of infant sign training on the speech-language development in young children born with cleft palate

BACKGROUND

Children born with a cleft palate with or without cleft lip (CP ± L) are known to be at risk for speech-language disorders that impact educational and social-emotional growth. It is hypothesized that speech-language intervention delivered before the age of 3 years could decrease the impact of CP ± L on speech-language development. Infant sign training in combination with verbal input expands the natural communication of young children including multimodal speech-language input (i.e., verbal and manual input) via caregivers who act as co-therapists.

AIMS

To determine the effectiveness of infant sign training in 1-year-old children with CP ± L by comparing different interventions.

METHODS & PROCEDURES

This is a two-centre, randomized, parallel-group, longitudinal, controlled trial. Children are randomized to either an infant sign training group (IST group), a verbal training group (VT group) or no intervention control group (C group). Caregivers of children who are assigned to the IST group or VT group will participate in three caregiver training meetings to practise knowledge and skills to stimulate speech-language development. Outcome measures include a combination of questionnaires, language tests and observational analyses of communicative acts.

OUTCOMES & RESULTS

It is hypothesized that speech-language development of children with CP ± L will benefit more from IST compared with VT and no intervention. Additionally, the number and quality of communicative acts of both children and caregivers are expected to be higher after IST.

CONCLUSIONS & IMPLICATIONS

This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years.

WHAT THIS PAPER ADDS

What is already known on the subject Children with CP ± L are known to be at risk for speech-language delays that impact educational and social emotional growth. Given the limited scientific prove of the impact of early speech-language intervention, no standardized clinical practice guidelines are available yet for children with CP ± L under the age of 3 years. Early intervention in this population mostly focuses on improving verbal input via caregivers or professionals without including a multimodal language input. A growing scientific interest has been seen in the use of infant signs to support speech-language development and caregiver-child interaction in typically developing children and children with developmental delays. What this study adds to existing knowledge No evidence is yet available for the effectiveness and feasibility of early intervention based on infant sign training in combination with verbal input to improve speech-language skills in young children with CP ± L. The current project will investigate the effect of infant sign training on the speech-language development in this population. Outcome measures are compared with those of two control groups: verbal training only and no intervention. It is hypothesized that infant signs may support the intelligibility of verbal utterances produced by children with CP ± L. Improving children's intelligibility may increase the opportunities for these children to engage in early, frequent and high-quality interactions with their caregivers resulting in a richer social and linguistic environment. As a result, infant sign training may result in better speech-language skills compared with the control interventions. What are the potential or actual clinical implications of this work? If providing early intervention based on infant sign training is effective, there is the potential for improved speech-language outcomes in early childhood, resulting in increased speech intelligibility, increased well-being of the child and family and less need for speech-language therapy on the long-term. This project will contribute to the development of evidence-based clinical practice guidelines regarding early speech-language intervention in children with CP ± L under the age of 3 years.

Lexicogrammatical skills in 2-year-old children with and without repaired cleft palate

The purpose of the current research was to compare the lexical-grammatical skills of two-year-old children with and without repaired cleft palate (CP), accounting for the effect of variables such as vocabulary size at 18 months of age, maternal education level, and gender. Participants included 52 children with CP and 25 typically developing (TD) children. The CDI-WS was employed to measure vocabulary and grammatical skills. Significant differences were observed between the CP and TD groups with respect to the number of words, word forms (irregular nouns and verbs), word endings (overuse of plural (-s) and past tense (-ed) markers), the mean number of morphemes in their three longest utterances (M3L), and sentence complexity. In addition, compared to TD children, significantly smaller proportions of children with CP were observed to use words to talk about past and future events or use words to talk about an absent object. The difference between the CP and TD groups in terms of the size of vocabulary at 24 months of age remained statistically significant in the multivariable model. Among all predictors, the size of vocabulary at 18 months of age was identified as the most robust precursor of lexical and grammatical skills at 24 months of age. Gender was identified as a predictor of the M3L measure as an index for syntactic ability.

Longitudinal Study of Vocal Development and Language Environments in Infants With Cleft Palate

OBJECTIVE

This study investigated vocalization and language environment longitudinally in infants with cleft palate (CP) based on day-long audio recordings collected in their natural environments.

DESIGN

Language Environment Analysis (LENA) data from all-day recordings at home were collected at 3-month intervals for infants from 4-6 to 16-18 months of age. The recordings were analyzed using experimentally blinded human coding as well as LENA automated analysis.

PARTICIPANTS

Ten infants with CP (± cleft lip) and 10 age-matched infants without CP.

MAIN OUTCOME MEASURES

Several measurements were obtained from the LENA automated analysis software. In addition, human coded measurements of vocalization and language environment, including the true canonical babbling ratio and the infant-directed speech ratio, were analyzed for each time point of data collection for each infant. Statistical analyses were performed to conduct group and age comparisons for each measure of vocalization and language environment.

RESULTS

No group differences emerged in number of syllables produced. Infants with CP exhibited late onset and fewer productions of canonical syllables compared to infants without CP. Infants with CP did not show significant differences from infants without CP in measures related to language environment across ages.

CONCLUSION

This study provides detailed information through naturalistic all-day home recordings about vocal development and early language environments in infants with CP before and after palatal repair. Clinical implications for early intervention are discussed.

Emergence of Prevocalic Stop Consonants in Children With Repaired Cleft Palate

Purpose This study determined the time course of the emergence of prevocalic stop consonants in young children with cleft palate following surgical repair. Method A total of 120 children in four cohorts from three institutions were followed from 12 to 24 months of age: (a) 24 with repaired cleft lip and palate (CLP), (b) 36 with repaired cleft palate only (CP), (c) 33 without clefts but with histories of frequent otitis media and ventilation tubes (OM), and (d) 27 typically developing (TD) children without clefts or OM. Emergence of prevocalic stops and symbolic language skills were determined during administration of the Communication and Symbolic Behavioral Scales Developmental Profile. Parametric survival models were fitted with and without covariates-recruitment site, gender, maternal education level, middle ear status, language ability, and age at surgery for children with clefts-to describe the time course of the emergence of prevocalic stops. Results The estimated age at which 80% of children demonstrated prevocalic stop emergence was 15.0, 15.3, 18.9, and 21.8 months for TD, OM, CP, and CLP groups, respectively (p < .001, unadjusted model). Both CP and CLP cohorts had a significantly longer time to stop emergence than either the TD or OM cohorts, even after adjusting for covariates. Abnormal middle ear status, lower symbolic language ability, and older age at palatal surgery were significantly associated with delayed stop emergence. Conclusions Survival model estimates show that four out of five children with repaired cleft palate will achieve emergence of prevocalic stop consonants by 19-22 months of age, corresponding to 9-12 months following palate repair. Clinical implications are discussed.

Lexical Selectivity of 2-Year-Old Children With and Without Repaired Cleft Palate Based on Parent Report

OBJECTIVE

To determine vocabulary and lexical selectivity characteristics of children with and without repaired cleft palate at 24 months of age, based on parent report.

PARTICIPANTS

Forty-nine children with repaired cleft palate, with or without cleft lip (CP±L; 25 males; 21 cleft lip and palate, 28 CP only), 29 children with a history of otitis media (OM) and ventilation tubes (21 males), and 25 typically developing (TD) children (13 males).

MAIN OUTCOME MEASURE(S)

Parent-reported expressive vocabulary was determined using the MacArthur Communicative Development Inventory: Words and Sentences.

RESULTS

Vocabulary size was reduced for children with repaired CP±L compared to children in the TD group (P = .025) but not the OM group (P = .403). Mean percentage of words beginning with sonorants did not differ across groups (P = .383). Vocabulary size predicted sonorant use for all groups (P = .001).

CONCLUSIONS

Children with repaired CP±L exhibit similar lexical selectivity relative to word initial sounds compared to noncleft TD and OM peers at 24 months of age, based on parent report.