Children's perception of nasal resonance

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.

Interlocutor accommodation of gradually altered nasal signal levels in a model speaker

BACKGROUND

Phonetic accommodation is observed when interacting speakers gradually converge (or diverge) on phonetic features over the course of a conversation. The present experiment investigated whether gradual changes in the nasal signal levels of a pre-recorded model speaker would lead to accommodation in the nasalance scores of the interlocutor in a speech-shadowing experiment.

METHODS

Twenty female speakers in two groups repeated sentences after a pre-recorded model speaker whose nasal signal level was gradually increased or decreased over the course of the experiment. Outcome measures were the mean nasalance scores at the initial baseline, maximum nasal signal level, minimum nasal signal level and final baseline conditions. The order of presentation of the maximum and minimum nasal signal levels was varied between the two groups.

RESULTS

The results showed a significant effect of condition in F(3) = 2.86, p = 0.045. Both groups of participants demonstrated lower nasalance scores in response to increased nasal signal levels in the model (phonetic divergence). The group that was first presented with the maximum nasal signal levels demonstrated lower nasalance scores for the minimum nasal signal level condition (phonetic convergence).

CONCLUSION

Speakers showed a consistent divergent reaction to a more nasal-sounding model speaker, but their response to a less nasal-sounding model may depend on the order of presentation of the manipulations. More research is needed to investigate the effects of increased versus decreased nasality in the speech of an interlocutor.

A comparison of health-related quality of life in 5- and 10-year-old Swedish children with and without cleft lip and/or palate

BACKGROUND

The current understanding on health-related quality of life (HRQoL) in young Swedish children with cleft lip and/or palate (CL/P) is sparse, and therefore, research on impact of CL/P on HRQoL in children is needed.

AIMS

To investigate HRQoL in 5- and 10-year-old Swedish children with CL/P in comparison with non-cleft controls. Also to analyse whether there were any differences in HRQoL between children with cleft lip (with or without cleft palate, CL ± P) and cleft palate only (CP) and/or gender differences.

DESIGN

A total of 137 children with CL/P and 305 non-cleft controls participated. HRQoL was measured with KIDSCREEN-52.

RESULTS

All children in the study exhibited HRQoL within or above the age-matched reference interval of the method with similar results in both groups; however, in the dimension 'social support and peers', the 10-year-old children with CL/P perceived lower HRQoL than the non-cleft controls, but it did not reach statistical significance. Type of cleft or gender did not influence HRQoL.

CONCLUSIONS

Both 5- and 10-year-old Swedish children with CL/P had HRQoL in the normal reference interval. Their general life situations were well adjusted to their clefts, but the older children with CL/P felt more excluded and less supported by peers.

Video Game Rehabilitation of Velopharyngeal Dysfunction: A Case Series

PURPOSE

Video games provide a promising platform for rehabilitation of speech disorders. Although video games have been used to train speech perception in foreign language learners and have been proposed for aural rehabilitation, their use in speech therapy has been limited thus far. We present feasibility results from at-home use in a case series of children with velopharyngeal dysfunction (VPD) using an interactive video game that provided real-time biofeedback to facilitate appropriate nasalization.

METHOD

Five participants were recruited across a range of ages, VPD severities, and VPD etiologies. Participants completed multiple weeks of individual game play with a video game that provides feedback on nasalization measured via nasal accelerometry. Nasalization was assessed before and after training by using nasometry, aerodynamic measures, and expert perceptual judgments.

RESULTS

Four participants used the game at home or school, with the remaining participant unwilling to have the nasal accelerometer secured to his nasal skin, perhaps due to his young age. The remaining participants showed a tendency toward decreased nasalization after training, particularly for the words explicitly trained in the video game.

CONCLUSION

Results suggest that video game-based systems may provide a useful rehabilitation platform for providing real-time feedback of speech nasalization in VPD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.5116828.

Children's Attitudes toward Peers with Unintelligible Speech Associated with Cleft Lip and/or Palate

Objective

The objective of this study was to investigate whether reduced speech intelligibility in children with cleft palate affects social and personal attribute judgments made by typically developing children of different ages.

Design

The study (1) measured the correlation between intelligibility scores of speech samples from children with cleft palate and social and personal attribute judgments made by typically developing children based on these samples and (2) compared the attitude judgments made by children of different ages.

Participants

A total of 90 typically developing children, 30 in each of three age groups (7 to 8 years, 9 to 10 years, and 11 to 12 years).

Outcome Measures

Speech intelligibility scores and typically developing children s attitudes were measured using eight social and personal attributes on a three-point rating scale.

Results

There was a significant correlation between the speech intelligibility scores and attitude judgments for a number of traits: “sick-healthy” as rated by the children aged 7 to 8 years, “no friends-friends” by the children aged 9 to 10 years, and “ugly-good looking” and “no friends-friends” by the children aged 11 to 12 years. Children aged 7 to 8 years gave significantly lower ratings for “mean-kind” but higher ratings for “shy-outgoing” when compared with the other two groups.

Conclusions

Typically developing children tended to make negative social and personal attribute judgments about children with cleft palate based solely on the intelligibility of their speech. Society, educators, and health professionals should work together to ensure that children with cleft palate are not stigmatized by their peers.

Effects of Biofeedback on Control and Generalization of Nasalization in Typical Speakers

PURPOSE

The purpose of this study was to determine the effects of biofeedback on control of nasalization in individuals with typical speech.

METHOD

Forty-eight individuals with typical speech attempted to increase and decrease vowel nasalization. During training, stimuli consisted of consonant-vowel-consonant (CVC) tokens with the center vowels /a/ or /i/ in either a nasal or nonnasal phonemic context (e.g., /mim/ vs. /bib/), depending on the participant's training group. Half of the participants had access to augmentative visual feedback during training, which was based on a less-invasive acoustic, accelerometric measure of vowel nasalization-the Horii oral-nasal coupling (HONC) score. During pre- and posttraining assessments, acoustically based nasalance was also measured from the center vowels /a/, /i/, /æ/, and /u/ of CVCs in both nasal and nonnasal contexts.

RESULTS

Linear regressions indicated that both phonemic contexts (nasal or nonnasal) and the presence of augmentative visual feedback during training were significant predictors for changes in nasalance scores from pre- to posttraining.

CONCLUSIONS

Participants were able to change the nasalization of their speech following a training period with HONC biofeedback. Future work is necessary to examine the effect of such training in individuals with velopharyngeal dysfunction.

Speech in 10-Year-Olds Born with Cleft Lip and Palate: What Do Peers Say?

Objective

The aim of this study was to explore how 10-year-olds describe speech and communicative participation in children born with unilateral cleft lip and palate in their own words, whether they perceive signs of velopharyngeal insufficiency (VPI) and articulation errors of different degrees, and if so, which terminology they use.

Methods/Participants

Nineteen 10-year-olds participated in three focus group interviews where they listened to 10 to 12 speech samples with different types of cleft speech characteristics assessed by speech and language pathologists (SLPs) and described what they heard. The interviews were transcribed and analyzed with qualitative content analysis.

Results

The analysis resulted in three interlinked categories encompassing different aspects of speech, personality, and social implications: descriptions of speech, thoughts on causes and consequences, and emotional reactions and associations. Each category contains four subcategories exemplified with quotes from the children's statements. More pronounced signs of VPI were perceived but referred to in terms relevant to 10-year-olds. Articulatory difficulties, even minor ones, were noted. Peers reflected on the risk to teasing and bullying and on how children with impaired speech might experience their situation. The SLPs and peers did not agree on minor signs of VPI, but they were unanimous in their analysis of clinically normal and more severely impaired speech.

Conclusions

Articulatory impairments may be more important to treat than minor signs of VPI based on what peers say.

Effects of spectral content on Horii Oral-Nasal Coupling scores in children

A miniature accelerometer and microphone can be used to obtain Horii Oral-Nasal Coupling (HONC) scores to objectively measure nasalization of speech. While this instrumentation compares favorably in terms of size and cost relative to other objective measures of nasality, the metric has not been well characterized in children. Furthermore, the measure is known to be affected by vowel loading, as speech loaded with "high" vowels is consistently scored as more nasal than speech loaded with "low" vowels. Filtering the signals used in computation of the HONC score to better isolate the correlates of nasalization has been shown to reduce vowel-related effects on the metric, but the efficacy of filtering has thus far only been explored in adults. Here, HONC scores for running speech and the vowel portions of consonant-vowel-consonant tokens were calculated for the speech of 26 children, aged 4-9 yrs. Scores were computed using the broadband accelerometer and speech signals, as well as using filtered, low-frequency versions of these signals. HONC scores obtained using both broadband and filtered signals resulted in well-separated scores for nasal and non-nasal speech. HONC scores computed using filtered signals were found to exhibit less within-participant variability.

Relationship between the Perception of Hypernasality and Social Judgments in School-Aged Children

Purpose

This study investigated both the ability of children to rate nasality and the relationship of those ratings to expert ratings and social acceptance judgments.

Method

A total of 10 speech samples were judged for nasality by 44 children ranging in age from 8 to 11 and by an expert judge. Listeners rated nasality on a 3-point response scale. The peer listeners also made five social acceptance ratings about each speaker.

Results

Kappas for interrater reliability were moderate to substantial. There was no difference between peer ratings and expert ratings. As ratings of nasality increased, social acceptance ratings became more negative.

Conclusion

Professionals who evaluate and treat children with cleft palate should consider the negative social consequences of even mild hypernasality.

A comprehensive description of functioning and disability in children with velopharyngeal insufficiency

Children with velopharyngeal insufficiency (VPI) experience functional impairments in a variety of areas that extend beyond the primary physical impairment associated with this disorder. At present, the physical deficits associated with VPI have been studied extensively; however, a comprehensive description of social and communicative participation in this population is needed. Therefore, a biopsychosocial framework such as the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), may offer an enhanced understanding of the daily experiences of children with VPI. Specifically, the ICF-CY framework is intended to model complex nonlinear systems, and as such, to describe functioning as the interaction of multiple components from which a limitation in communicative participation may emerge. This paper describes how the ICF-CY framework can be utilized to comprehensively describe functioning and disability in children with VPI by describing the interaction of components of this framework.

LEARNING OUTCOMES

As a result of this activity, the reader will be able to: (1) discuss the utility of the ICF-CY in describing the multi-dimensional nature of velopharyngeal insufficiency (VPI); (2) describe interrelationships between functioning and disability in children with VPI; and (3) identify how limitations in communicative participation may emerge from the interaction of components of the ICF-CY in children with VPI.

Parental perceptions of posterior pharyngeal wall augmentation using autologous fat for treating velopharyngeal dysfunction

Posterior pharyngeal wall augmentation using autologous fat to treat velopharyngeal dysfunction (VPD) is an alternative surgical procedure to more commonly used invasive procedures such as the pharyngeal flap. However, limited research exists on this technique. The aim of this study was to qualitatively investigate parental perceptions of posterior pharyngeal wall augmentation using autologous fat when treating velopharyngeal dysfunction. Furthermore, this research aimed to examine parent's perspectives of their child's speech and quality-of-life following this procedure. A qualitative collective case study methodology was used in the form of semi-structured interviews with seven participants. These were then analysed using constant comparative analysis. Four distinct themes emerged: post-surgical outcomes; speech-language pathology, not just medicine; factors for successful post-operative speech and resonance; and long-term sustainability and worthiness of the procedure. Six out of seven participants expressed positive post-operative speech and resonance results. Five further expressed long-term satisfaction up to 6 years post-operatively. Overall the majority of participants were satisfied that this procedure provided their child with long-term successful speech outcomes. The participants also discussed the importance of receiving speech-language pathology services alongside surgery and the positive impact of the procedure on their child's quality-of-life including social interactions, confidence, friendships, as well as eating and drinking.

Taking Charge of Communication: Adults' Descriptions of Growing up with a Cleft-Related Speech Impairment

Objective

To obtain descriptions of the experience of growing up with a cleft-related speech impairment and how it was dealt with.

Design

Semistructured interviews were tape-recorded, transcribed verbatim, and analyzed using a qualitative approach inspired by grounded theory methodology.

Setting

Interviews took place at participants' homes or workplaces or at the university.

Participants

Thirteen young adults (25 to 34 years of age) born with cleft palate with or without cleft lip.

Results

The analysis resulted in the core category Taking charge of communication, which comprised three main categories: Forming an idea of one's speech, Learning about one's communication, and Taking responsibility for communication. The first main category was made up of three subcategories and the other two had two. The categories emerged as parallel processes in the understanding and active handling of communicative interaction.

Conclusions

The participants described the processes that had enabled them to take charge of their communication. Seeing things from the listener's perspective and being open about the cleft and the speech disorder emerged as important parts of taking active responsibility for communication, as well as accepting their present speech and communication. Communicative participation should be assessed more thoroughly to understand the individual needs of people born with a cleft who have a speech impairment into adolescence.

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: an ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.

Making Sense of the Cleft

Individuals born with a cleft lip and palate risk developing a deviant appearance and speech during childhood and sometimes also as adults. In this study, 13 young adults born with a cleft (lip and) palate, who had had deviant speech in adolescence, participated in semi-structured interviews. The core category Making sense of the cleft, comprising the two categories Shaping one’s attitude to the cleft and Dealing with being different with seven subcategories, describes the processes of developing self-image in relation to the cleft. The findings are believed to be relevant for individuals born with a cleft, their parents and caregivers.

Listeners’ perceptions of the personality of male alaryngeal speakers

Currently, there is limited information on listeners' perceptions of an individual with a laryngectomy. The purpose of this study is to determine whether listeners have different impressions of a laryngectomized speaker's personality based on mode of alaryngeal speech. Fifty-one listeners were presented with a reading passage produced by three male, alaryngeal speakers. Listeners were instructed to rate each speaker's personality and overall speech on a seven-point scale. Results showed that listeners' perceptions of personality were not affected by mode of alaryngeal speech, although listener's perceptions of overall speech were shown to be significantly affected by mode. Results, however, should be interpreted with caution due to small sample size and limited speaker representation. A portion of this information was previously presented at the American Speech Language and Hearing Association (ASHA) Annual Convention, Chicago, IL, November 13-15, 2003.

Effects of audio-visual information and mode of speech on listener perceptions of alaryngeal speakers

There is minimal research on listener perceptions of an individual with a laryngectomy (IWL) based on audio-visual information. The aim of this research was to provide preliminary insight into whether listeners have different perceptions of an individual with a laryngectomy based on mode of presentation (audio-only vs. audio-visual) and mode of speech (tracheoesophageal, oesophageal, electrolaryngeal, normal). Thirty-four naïve listeners were randomly presented with a standard reading passage produced by one typical speaker from each mode of speech in both audio-only and audio-visual presentation mode. Listeners used a visual analogue scale (10 cm line) to indicate their perceptions of each speaker's personality. A significant effect for mode of speech was present. There was no significant difference in listener perceptions between mode of presentation using individual ratings. However, principal component analysis showed ratings were more favourable in the audio-visual mode. Results of this study suggest that visual information may only have a minor impact on listener perceptions of a speakers' personality and that mode of speech and degree of speech proficiency may only play a small role in listener perceptions. However, results should be interpreted with caution as results are based on only one speaker per mode of speech.

School-age children's perceptions of a person who stutters

The present study examined the perceptions school-age children have of stutterers. Four groups of fourth and fifth grade students viewed a videotape with either the speaker stuttering or not stuttering while reading a poem. A semantic differential scale of bi-polar adjective pairs was used to rate the speaker on intelligence and personality traits. The current study found that there is a significant difference between school-age children's perceptions of stutterers and nonstutterers with the ratings for the disfluent speaker more negative than the ratings for the fluent speaker. It was found that children did not rate personality and intelligence related traits differently. This information can be used to validate the need for education regarding stuttering for children and those who work with children.

EDUCATIONAL OBJECTIVES

The reader will learn about and be able to (1). identify perceptions of stutterers by a variety of groups; (2). discuss the implications of research on perceptions of stutterers; and (3). compare/contrast children and adults and their perceptions.

The effect of information on listeners' attitudes toward speakers with voice or resonance disorders

This study investigated university students' attitudes toward women with voice or resonance disorders and whether providing listeners with information about those disorders affected their attitudes towards the women. Eighty students listened to speech samples of 9 women: 3 with normal voice/resonance, 3 with moderate hoarseness/breathiness, and 3 with moderate hypernasality and nasal emission. Before listening to the speech samples, 40 students read two pages of information about the disorders, and 40 read two pages of neutral information. Attitudes were measured with 24 semantic differential scales. Results indicated that listeners perceived speakers with voice/resonance disorders more negatively than speakers without disorders. The attitudes of listeners who read voice and resonance information did not differ from those of listeners who read neutral information.

Psychological issues in craniofacial care: state of the art

This article is an extensive review of the psychological literature on cleft lip and palate and other craniofacial anomalies. Issues of parental acceptance, social competence, self-concept, emotional adjustment, and cognitive functioning are examined. Cumulative research suggests that many children with craniofacial conditions develop in a typical manner and do not experience psychological problems. However, a significant number of children (30% to 40% in most studies) experience difficulties with internalizing and/or externalizing problems, learning disorders, and social competence. A multifactorial model for examining the domains that are related to both psychological risk and protection is recommended. The need for multicenter studies that are prospective and clinically relevant is emphasized.

Personality attributions based on speech samples of children with repaired cleft palates

OBJECTIVE

This study examined whether or not assumptions made about personality characteristics based on speech samples differed for children with repaired cleft palates (CP) versus unaffected children.

DESIGN

Audiotapes of speech samples were presented in random order to blind raters.

PATIENTS/PARTICIPANTS

The subjects were 20 children (10 females, 10 males) with repaired CP and 16 control (i.e., unaffected) children (8 females, 8 males). All children were 8 to 12 years of age, Caucasian, living in the St. Louis area, and lower-middle to upper-middle class. The raters were 20 (13 females, 7 males) 6th grade Caucasian students who attend a private school in the area.

SETTING

Raters heard tapes in a group setting, but with individual headphones, in their school's cafeteria.

MAIN OUTCOME MEASURE

Each speech sample was rated (7-point Likert scale) by each student rater on a variety of personality characteristics based on the "Big Five" personality factors.

RESULTS

A factor analysis of the items revealed a two-factor solution, although the factors were highly negatively correlated. No significant differences were found between ratings for the CP sample and the control sample for either factor scale (ANOVA, p = .93; p = .67). Similarly, when the two factors were combined to form a single factor, no significant differences were found between the ratings for the CP sample and the control sample (ANOVA, p = .79).

CONCLUSIONS

Overall, it does not appear that children differentially associated personality characteristics based on speech to children with repaired CP versus unaffected children, in the absence of visual input.

Self-concept of children and adolescents with cleft lip and/or palate

The self-concept of 105 children (8 to 11 years) and adolescents (12 to 18 years) with cleft lip and/or palate (CLP) was studied using the Piers-Harris Children's Self-Concept Scale and selected demographic and medical variables. Results indicated that most (98%) of children had average or above average self-concept scores. Further analysis, however, demonstrated an interaction between age and gender: adolescent girls experienced a more negative self-concept in comparison to younger girls and adolescent boys experienced a more positive self-concept in comparison to younger boys. In addition, popularity cluster scores for all children were below the mean for the normed population. Because children with CLP have additional difficulties (i.e., facial disfigurement, speech and language deficits, multiple surgeries), professionals should intercede to prevent or interrupt negative psychosocial outcomes, particularly for adolescent girls.