A description and classification of the common disorders of speech in children

Considering the role of speech processing in cleft-related speech sound disorders: Implications for causal pathways and classification systems

BACKGROUND

Classification systems in healthcare support shared understanding of conditions for clinical communication, service monitoring and development, and research. Children born with cleft palate with or without cleft lip (CP+/-L) are at high risk of developing cleft-related speech sound disorder (SSD). The way cleft-related SSD is represented and described in SSD classification systems varies. Reflecting on the potential causal pathways for different cleft-related speech features, including the role of speech processing skills, may inform how cleft-related SSD is represented in classification systems.

AIM & APPROACH

To explore and reflect on how cleft-related SSD is represented in current SSD classification systems in the context of considering how speech processing skills and other factors may be involved in causal pathways of cleft speech characteristics (CSCs).

MAIN CONTRIBUTION

Variation in the representation of cleft-related SSD in classification systems is described. Potential causal pathways for passive cleft- related speech features and different active CSCs are explored. The factors involved in the development and/or persistence of different active CSCs may vary. Some factors may be specific to children born with CP+/-L, but if speech processing skills are also involved, this is an overlap with other SSD subtypes. Current evidence regarding relationships between different speech processing skills and active CSCs is limited. Implications for the representation of cleft-related SSD in SSD classification systems are discussed.

CONCLUSION

There are different categories of cleft-related speech features which are essential to understand and identify in children with cleft-related SSD to ensure appropriate management. Representation of these feature categories in classification systems could support understanding of speech in this population. Speech processing skills could be involved in the development and/or persistence of different active CSCs in individual children. Reflection and discussion on how cleft-related SSD is represented in classification systems in relation to other SSD subtypes may inform future iterations of these systems. Further work is needed to understand factors influencing the development and/or persistence of active CSCs, including speech processing skills.

WHAT THIS PAPER ADDS

What is already known on the subject Cleft-related speech sound disorder (SSD) is commonly described as being of known origin. The features of cleft-related SSD have been described extensively and several authors have also examined factors which may contribute to speech development and outcomes in children born with cleft palate +/- lip. There is limited evidence regarding the role of speech processing in the development and persistence of cleft-related SSD. What this study adds This paper reflects on how cleft-related SSD is represented in SSD classification systems in relation to key feature categories of cleft-related SSD and possible causal pathways for passive features and active cleft speech characteristics (CSCs). The role of cognitive speech processing skills is specifically considered alongside other factors that may contribute to the development of active CSCs. What are the clinical implications of this work? Causal pathways for different features of cleft-related SSD may vary, particularly between passive and active features, abut also between different active CSCs. Speech and language therapists (SLTs) need to differentially diagnose passive speech features and active CSCs. Consideration of the role of different speech processing skills and interactions with other potentially influencing factors in relation to active CSCs may inform clinical hypotheses and speech and language therapy (SLT) intervention. Representing key features of cleft-related SSD in classification systems may support understanding of cleft-related SSD in relation to other SSD subtypes.

The Identification of Autism in Children Referred to a Tertiary Speech and Language Clinic and the Implications for Service Delivery

The Edinburgh Children's Hospital speech clinic is a joint paediatric and speech therapy clinic which was first established in 1950 and accepts referrals of children for whom speech and language difficulties are the principal concern. An audit was conducted for children presenting consecutively over January 1993 to January 1994 to identify what proportion of these children had autism and related disorders. The mean age of presentation of all children seen was in their final pre-school year, with 80 percent of children already being managed in the community by other professionals such as speech and language therapists and educational psychologists. Of 103 children, 22 had autism or a related disorder. A retrospective analysis of parental report and clinical assessment at the first clinic consultation confirmed that a complaint of no communication with peers coupled with temper tantrums was highly predictive for membership of this group of disorders. The audit confirmed that the contribution of autism to the children's communication difficulties had not been fully recognized and addressed prior to the speech clinic consultation. The audit has informed our practice and we intend attracting clinical psychology and child psychiatry services into the speech clinic to enhance the service we deliver and also to employ our findings to highlight consideration of autism in the young child with speech and language difficulties.

Psychiatric disorder in children with different types of communication disorders

Children presenting to a community speech clinic were divided into three major groups according to type of communication disorder: a pure speech disorder, a pure language disorder, and a disorder of both speech and language. Psychiatric evaluations of the three groups of children were done employing interviews with the parents, interviews with the children, and questionnaires from the children's teachers and parents. It was found that the prevalence of psychiatric disorder was highest in the language-disordered group and lowest in the speech-disordered group. Development disorders were also most common in the language-disordered group and least common in the speech-disordered group. The types of psychiatric disorders found in the three groups of children also differed. The implications of these findings are discussed.

Congenital ophthalmoplegia. A myopathic aetiology in two siblings

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