Parent questionnaire for screening early language development in children with cleft palate

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.

Exploration of the Utility of the Generic ICHOM Standard Set Measures in Evaluating the Speech of Patients with Cleft Lip/Palate

Background

The International Consortium of Health Outcome Measurements (ICHOM) standard set for cleft care appraisal recommends clinicians assess articulation with percentage consonants correct (PCC) and velopharyngeal function with velopharyngeal competency rating (VPC-R). This study explores the utility and limitations of these generic measures in detecting cleft speech sound disorders by comparing them with two cleft-specific speech-rating systems, cleft audit protocol of speech-augmented Americleft modification (CAPS-A-AM) and Pittsburgh weighted speech scale (PWSS).

Methods

Consecutive children with repaired, nonsyndromic cleft lip/palate, aged 5 years or older (n = 27) underwent prospective speech evaluations conducted at a single academic institution. These evaluations were conducted, recorded, and evaluated by blinded speech-language pathologists experienced with all tools.

Results

When comparing measures of articulation, PCC scores correlated better with scores for relevant subcomponents of CAPS-A-AM than PWSS. When comparing measures of velopharyngeal function, VPC-R scores correlated well with relevant components of both scales. Using a "screening test versus diagnostic test" analogy, VPC-R ratings were 87.5% sensitive and 73.7% specific for detecting velopharyngeal dysfunction according to subcomponents of CAPS-A-AM, and 70.6% sensitive and 100% specific according to subcomponents of PWSS.

Conclusions

This exploratory study demonstrates that PCC and VPC-R perform moderately well in detecting articulatory and velopharyngeal dysfunction in patients with cleft lip/palate; however, these tools cannot describe nuances of cleft speech sound disorder. Thus, although PCC and VPC-R adequately track basic minimum outcomes, we encourage teams to consider extending the standard set by adopting a cleft-specific measurement system for further evaluation of the tools.

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.

Early Communication Behaviors in Infants With Cleft Palate With and Without Robin Sequence: A Preliminary Study

OBJECTIVE

To investigate the early communication behaviors in infants with nonsyndromic isolated cleft palate (iCP) and Robin sequence (RS).

DESIGN

Group comparison using parent report.

PARTICIPANTS

There were 106 participants included in this study. Two groups were selected from the UK Cleft Collective resource. Parents had completed the Language ENvironment Analysis Developmental Snapshot questionnaire when their child turned 13 months. There were 78 participants in the iCP group and 28 in the RS group.

MAIN OUTCOME MEASURE(S)

Total number of communication behaviors reported on the questionnaire. Subdomains for expressive and receptive language and social communication behaviors were also analyzed.

RESULTS

There were no statistically significant group differences. Parents of infants with RS reported fewer later communication behaviors compared to the iCP group. Infants in both groups had fewer communication behaviors compared to the normative sample. Across the whole sample, post hoc analysis revealed a significant correlation between severity of the cleft and social communication behaviors and expressive but not receptive language. Infants with a cleft of the hard and soft palate were more likely to be in the RS group (odds ratio: 7.04 [95% CI: 1.55-32.04]; P = .01).

CONCLUSIONS

Both groups reported similar levels of early communication. Some divergence of more complex language skills was seen, although there were no significant group differences. A relationship with the diagnosis of a cleft of the hard or soft palate with expressive language behaviors was found. Further study into the impact of cleft severity on early speech development and the relationship with later language skills is needed along with longitudinal follow-up of this population.

Technical Reading and Writing Skills and Their Relationship with Linguistic Processes in Children with a Cleft (Lip and) Palate: A Comparison with Peers

<b><i>Introduction:</i></b> Poor word decoding skills and writing skills can impact job opportunities and psychosocial functioning. Despite the importance of identifying possible literacy problems for the child’s future performance, there seems to be no consensus on this topic in children with a cleft of the palate with or without a cleft of the lip (CP±L). The aim of this study was to investigate reading and writing skills and their relationship with linguistic processes in Dutch-speaking children with a CP±L compared to a group of children without a CP±L. <b><i>Methods:</i></b> Twelve children with a CP±L and 12 children without a CP±L (age range 7–12 years) were included in the study. The 2 groups were matched based on age, gender, and socioeconomic status. An assessment battery including language, reading, and writing tests was administered to both groups. <b><i>Results:</i></b> No statistically significant differences in reading and writing skills were found when comparing children with and without a CP±L. Interestingly, a moderate correlation was found between the children’s reading skills and phonological awareness. Moderate correlations were also revealed between writing skills and several working memory tasks. <b><i>Discussion/Conclusion:</i></b> Our findings did not provide evidence for any difference in word decoding skills and writing skills between children with a CP±L and their peers. Some linguistic processes, more specifically phonological awareness and working memory, are important factors that contribute to the child’s literacy development. Identification of these linguistic skills can provide important information on the child’s future reading and writing performance. Future studies should increase sample sizes to confirm these results.

Speech pathology telepractice for children with cleft palate in the times of COVID-19 pandemic

OBJECTIVE

To study whether providing Speech and Language Pathology (SLP) interventions by telepractice (TP) could effectively improve speech performance in children with cleft palate (CCP).

METHODS

Forty-three CCP were treated with TP intervention in 45 min sessions, 2 times per week for a period of one month. Children ages ranged 4-12 years (X = 7.04; SD = 2.59). All children presented with velopharyngeal insufficiency (VPI) and compensatory articulation (CA) after palatal repair. TP was provided in small groups (5-6 children) following the principles of the Whole Language Model (WLM). Severity of CA was evaluated by a standardized scale at the onset and at the end of the TP period.

RESULTS

At the onset of the TP intervention period, 84% of the patients demonstrated severe CA. At the end of the TP period there was a significant improvement in severity of CA (p < 0.001).

CONCLUSION

The results of this study suggests that TP can be a safe and reliable tool for improving CA. Considering that the COVID-19 pandemic will radically modify the delivery of Health Care services in the long term, alternate modes of service delivery should be studied and implemented.

Does the narrative ability during retelling differ in 5-year-olds born with and without unilateral cleft lip and palate?

BACKGROUND

A previous study has indicated poorer narrative ability during retelling in 5-year-olds with unilateral cleft lip and palate (UCLP) as a group, compared to peers without UCLP.

AIM

To investigate if there are any differences between 5-year-olds with and without UCLP in narrative ability during retelling.

METHODS

A total of 83 children participated, 51 with UCLP and 32 without. They had no known additional malformations or syndromes. The children were audio recorded while performing the Bus Story Test (BST). The recordings were orthographically transcribed. From the transcriptions the BST information score was calculated. The macrostructure of the narratives was assessed with the Narrative Scoring Scheme (NSS), and the microstructure with mean length of utterance in words, grammaticality, grammatical complexity and lexical diversity. Results for children with and without UCLP were compared.

RESULTS

The group with UCLP performed better than the group without UCLP in the NSS sub-category Conclusion. No other significant differences were seen between the groups. The UCLP group had a larger standard deviation for the information score than the group without UCLP.

CONCLUSIONS

The group with UCLP displayed at least as good results as the group without UCLP, but the information score was more varied for the UCLP group than for the group without UCLP.

Linguistic and auditory processing skills in non-syndromic children with cleft palate: A scoping review

BACKGROUND

Cleft lip and/or palate (CL/P) is the most common congenital craniofacial condition. Children born with CL/P are at increased risk of persistent speech difficulties related to velopharyngeal incompetence (VPI) and compensatory articulation problems. It has also been reported that they achieve poorer results academically than their peers. There is a further body of evidence to suggest delayed language skills. These potentially related outcomes are often reported separately.

AIM

To review published and unpublished research into the nature of difficulties related to spoken and written language across all non-syndromic cleft diagnoses. To review any evidence of associations between comorbidities.

METHOD

A scoping review was carried out in October 2016 and updated in June 2019 following published methodology (Arksey & O'Malley, 2005; Levac et al. 2010).

RESULTS

A search of the literature over the two time points found 38 papers in total. Three main themes were found: oral language skills, reading and auditory processing difficulties.

CONCLUSIONS

There is evidence of early language delay in children born with CL/P. Evidence of persistent oral language problems is less conclusive. Many studies have reported scores within the average range for language, auditory processing and reading but poorer outcomes when compared to non-cleft control groups. However, studies have used a range of outcome measures, making comparisons difficult. Moreover there is no clear evidence how these difficulties might relate to speech outcomes or educational achievement and no comparison to other populations with speech, language and communication needs (SLCN).

Receptive and Expressive Vocabulary Skills and Their Correlates in Mandarin-Speaking Infants with Unrepaired Cleft Lip and/or Palate

Background: Vocabulary skills in infants with cleft lip and/or palate (CL/P) are related to various factors. They remain underexplored among Mandarin-speaking infants with CL/P. This study identified receptive and expressive vocabulary skills among Mandarin-speaking infants with unrepaired CL/P prior to cleft palate surgery and their associated factors. Methods: This is a cross-sectional study involving patients at the Cleft Lip and Palate Center of the Stomatological Hospital of Xi’an Jiaotong University between July 2017 and December 2018. The Putonghua Communicative Development Inventories-Short Form (PCDI-SF) was used to assess early vocabulary skills. Results: A total of 134 children aged 9–16 months prior to cleft palate surgery were included in the study. The prevalences of delays in receptive and expressive vocabulary skills were 72.39% (95% CI: 64.00–79.76%) and 85.07% (95% CI: 77.89–90.64%), respectively. Multiple logistic regression identified that children aged 11–13 months (OR = 6.46, 95% CI: 1.76–23.76) and 14–16 months (OR = 24.32, 95% CI: 3.86–153.05), and those with hard/soft cleft palate and soft cleft palate (HSCP/SCP) (OR = 5.63, 95% CI: 1.02–31.01) were more likely to be delayed in receptive vocabulary skills. Conclusions: Delays in vocabulary skills were common among Mandarin-speaking CL/P infants, and age was positively associated with impaired and lagging vocabulary skills. The findings suggest the necessity and importance of early and effective identification of CL/P, and early intervention programs and effective treatment are recommended for Chinese CL/P infants.

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.

Early Speech and Language Development in Children With Nonsyndromic Cleft Lip and/or Palate: A Meta-Analysis

Objective The aim of the study was to conduct a meta-analysis of research examining the early speech and language functioning of young children, birth to age 8;11 (years;months), with nonsyndromic cleft lip and/or palate (NSCL/P) compared to their peers without NSCL/P. Method We conducted a random-effects metaregression using 241 effect sizes from 31 studies comparing 955 young children with NSCL/P to 938 typically developing peers on measures of speech and language functioning. Moderators were sample characteristics (i.e., age, cleft type, publication year, and study location) and measurement characteristics (i.e., speech sample material, language modality and domain, and assessment type). Results Young children with NSCL/P scored significantly lower on measures of speech and language compared to children without NSCL/P. Children with NSCL/P had smaller consonant inventories (standardized mean difference effect size [ESg] = -1.24), less accurate articulation (ESg = -1.13), and more speech errors (ESg = 0.93) than their peers. Additionally, children with NSCL/P had poorer expressive (ESg = -0.57) and receptive (ESg = -0.59) language skills than their peers. Age and assessment type moderated effect sizes for expressive language. As children with NSCL/P aged, their expressive language performance became more similar to their peers. Expressive language effect sizes from parent reports and observational language measures (estimated effect size = -0.74) were significantly lower than those from standardized norm-referenced tests (estimated effect size = -0.45). Conclusions These findings suggest that young children with NSCL/P experience delays relative to their peers across multiple speech and language constructs. Differences between children with NSCL/P and their typically developing peers appear to decrease with age. Supplemental Material https://doi.org/10.23641/asha.11356904.

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

Purpose This study investigated vocabulary growth from 18 to 24 months of age in young children with repaired cleft palate (CP), children with otitis media, and typically developing (TD) children. In addition, the contributions of factors such as hearing level, middle ear status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary were explored. Method Vocabulary size of 40 children with repaired CP, 29 children with otitis media, and 25 TD children was measured using the parent report on MacArthur-Bates Communicative Development Inventories: Words and Sentences (Fenson et al., 2007) at 18 and 24 months of age. All participants underwent sound field audiometry at 12 months of age and tympanometry at 18 months of age. A multiple linear regression with and without covariates was used to model vocabulary growth from 18 to 24 months of age across the 3 groups. Results Children with CP produced a significantly smaller number of words at 24 months of age and showed significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children (p < .05). Although middle ear status was found to predict vocabulary growth from 18 to 24 months of age across the 3 groups (p < .05), the confidence interval was large, suggesting the effect should be interpreted with caution. Conclusions Children with CP showed slower expressive vocabulary growth relative to their age-matched TD peers. Middle ear status may be associated with development of vocabulary skills for some children.

Associations Between Hypernasality, Intelligibility, and Language and Reading Skills in 10-Year-Old Children With a Palatal Cleft

Background:

This study investigated the associations between hypernasality and intelligibility, and language and reading skills in 10-year old children with a cleft palate ± lip.

Design:

Cross-sectional data collected during routine assessments of speech and language in a centralized treatment setting.

Participants:

Children aged 10, born with cleft palate ± lip from 4 birth cohorts (N = 123).

Outcome Measures:

Hypernasality and intelligibility: Swedish Articulation and Nasality Test-N; language: Language 6-16 (Sentence recall, Serial recall, Vocabulary); reading: word chain test and reading comprehension test.

Results:

A total of 71.3% of the children had no occurrence of hypernasality and 82.8% had intelligibility scores within the normal range. For all children with hypernasality and intelligibility within the normal range, reading and language scores were also within normal ranges. Children with presence of hypernasality had significantly lower language skills, with mean scores within the lower normal range. Children with reduced intelligibility had lower scores on reading comprehension.

Conclusions:

The findings highlight a possible association between hypernasality and language skills, and intelligibility and reading skills. Cleft teams should consider routine assessments of language and reading skills in children with speech impairment, in order to identify potential needs for intervention as early as possible.

Speech and Language Issues in the Cleft Palate Population: The State of the Art

Objective

State-of-the-art activity demands a look back, a look around, and, importantly, a look into the new millennium. The area of speech and language has been an integral part of cleft palate care from the very beginning. This article reviews the development and progression of our knowledge base over the last several decades in the areas of speech; language; anatomy and physiology of the velopharynx; assessment of velopharyngeal function; and treatment, both behavioral and physical, for velopharyngeal problems.

Method

The clear focus is on the cleft palate condition. However, much of what is reviewed applies to persons with other craniofacial disorders and with other underlying causes of velopharyngeal impairment. A major challenge in the next several years is to sort through speech disorders that have a clear anatomic underpinning, and thus are more amenable to physical management, versus those that may be treated successfully using behavioral approaches. Speech professionals must do a better job of finding and applying ways of treating individuals with less severe velopharyngeal impairment, thus avoiding the need for physical management in these persons or ignoring the speech problem altogether.

Conclusion

Early and aggressive management for speech and language disorders should be conducted. For most individuals born with cleft conditions, a realistic goal should be normal speech and language usage by the time the child reaches the school-age years.

Conversational Skills of Children with Cleft Lip and Palate: A Replication and Extension

Objective

To replicate and to extend a previous study examining the conversational skills of children with cleft lip and palate.

Participants

Thirty-four children (33 to 44 months) participated: 17 children with cleft lip and palate and 17 noncleft children.

Methods

The children were observed during an interaction with caregivers in their homes. Samples of caregiver-child interactions were coded as assertive or responsive, for type of conversational act, and for discourse level categories. Profiles of conversational activity were determined for each child based on the coding. Correlations were performed to examine the relationship between assertiveness and speech variables (articulation and resonance) for the children with cleft lip and palate.

Results

Group comparisons revealed that the children with cleft lip and palate produced fewer assertive utterances, were less likely to respond adequately to comments by caregivers, and produced more topic maintaining and fewer topic extending utterances than did their noncleft peers during conversational interactions. Examination of individual child data indicated that 35% of the children with cleft lip and palate exhibited conversational profiles characterized by either low assertiveness or low responsiveness. Finally, a significant positive correlation was noted between conversational assertiveness and speech production skills.

Conclusion

These findings suggested that the children with cleft lip and palate were less conversationally assertive than their noncleft peers. Further, there appeared to be a relationship between speech production skills and conversational skills, suggesting that poor speech may be impacting language performance for these children.

The Effects of Enhanced Milieu Teaching With Phonological Emphasis on the Speech and Language Skills of Young Children With Cleft Palate: A Pilot Study

PURPOSE

The purpose of this pilot study was to investigate the extent to which a naturalistic communication intervention, enhanced milieu teaching with phonological emphasis (EMT+ PE), improved the language and speech outcomes of toddlers with cleft lip and/or palate (CL/P).

METHOD

Nineteen children between 15 and 36 months (M = 25 months) with nonsyndromic CL/P and typical cognitive development were randomly assigned to a treatment (EMT+PE) or nontreatment, business-as-usual (BAU), experimental condition. Participants in the treatment group received forty-eight 30-min sessions, biweekly during a 6-month period. Treatment was delivered in a university clinic by trained speech language pathologists; fidelity of treatment was high across participants.

RESULTS

Children in the treatment group had significantly better receptive language scores and a larger percentage of consonants correct than children in the BAU group at the end of intervention. Children in the treatment group made greater gains than children in the BAU group on most language measures; however, only receptive language, expressive vocabulary (per parent report), and consonants correct were significant.

CONCLUSIONS

The results of this preliminary study indicate that EMT+PE is a promising early intervention for young children with CL/P. Replication with a larger sample and long-term follow-up measures are needed.

Language Development in Children With Cleft Palate With or Without Cleft Lip Adopted From Non-English-Speaking Countries

PURPOSE

The purpose of this study was to determine whether language skills differed between children with cleft palate or cleft lip and palate (CP±CL) who were adopted into an English-speaking home from a non-English-speaking country (late English exposure [LE]) and children with CP±CL raised from birth in an English-speaking home (early English exposure [EE]).

METHOD

Children (51 LE, 67 EE), ages 3;0 (years;months) to 9;0, completed the Clinical Evaluation of Language Fundamentals (CELF), Preschool Second Edition or Fourth Edition. Linear regression analysis was used to assess the impact of age of adoption and time in an English-speaking home on language skills, as measured by the CELF-P2 and CELF-4.

RESULTS

Children with CP±CL who were adopted scored less well on all language indices, with mean adjusted differences between LE and EE children ranging from 0.4 to 0.7 SD on the CELF index scales. Only 53% of the EE children and 57% of the LE children obtained scores above 90 on all indices. For LE children, younger age at adoption was associated with better language skills.

CONCLUSION

CP±CL increases risk for language delay, with the highest risk for LE children. LE children with CP±CL should receive language services soon after adoption.

Early Lexical Characteristics of Toddlers with Cleft Lip and Palate

Objective

To examine development of early expressive lexicons in toddlers with cleft palate to determine whether they differ from those of noncleft toddlers in terms of size and lexical selectivity.

Design

Retrospective.

Patients

A total of 37 toddlers with cleft palate and 22 noncleft toddlers.

Main Outcome Measures

The groups were compared for size of expressive lexicon reported on the MacArthur Communicative Development Inventory and the percentage of words beginning with obstruents and sonorants produced in a language sample. Differences between groups in the percentage of word initial consonants correct on the language sample were also examined.

Results

Although expressive vocabulary was comparable at 13 months of age for both groups, size of the lexicon for the cleft group was significantly smaller than that for the noncleft group at 21 and 27 months of age. Toddlers with cleft palate produced significantly more words beginning with sonorants and fewer words beginning with obstruents in their spontaneous speech samples. They were also less accurate when producing word initial obstruents compared with the noncleft group.

Conclusions

Toddlers with cleft palate demonstrate a slower rate of lexical development compared with their noncleft peers. The preference that toddlers with cleft palate demonstrate for words beginning with sonorants could suggest they are selecting words that begin with consonants that are easier for them to produce. An alternative explanation might be that because these children are less accurate in the production of obstruent consonants, listeners may not always identify obstruents when they occur.

Influence of Timing of Hard Palate Repair in a Two-Stage Procedure on Early Speech Development in Danish Children with Cleft Palate

Objective

To investigate the influence of timing of hard palate closure on early speech development from 18 months to 3 years of age.

Design

A prospective, randomized clinical trial.

Participants

Thirty-four children with unilateral cleft lip and palate (UCLP) with velum closure at 4 months of age, and hard palate closure at 12 months (early hard palate repair, EarlyHPR) or 36 months (late hard palate unrepaired, LateHPU) by random assignment. Thirty-five control children were matched for gender and age.

Methods

All children were video recorded during a play interaction with a parent at 18 months of age. These recordings were transcribed according to the International Phonetic Alphabet. At 36 months a single word naming test was administered.

Results

At 18 months the LateHPU group produced fewer labial stops and more velar stops than the EarlyHPR group. Unlike the EarlyHPR group, the LateHPU group produced fewer vocalizations, consonants, and consonants permissible in word-initial position than the control group. Additionally, both cleft palate groups had a smaller productive vocabulary than the control group, but unlike the EarlyHPR group, the LateHPU group produced a smaller number of word tokens in social interaction than the control group. By 3 years of age, the LateHPU group had a (severely) restricted phonological system and produced more cleft speech characteristics than the EarlyHPR group.

Conclusions

Surgical timing of hard palate repair in a two-stage procedure appears to have an influence on early speech development in children with cleft palate.

Neuropsychological functioning in children with non-syndromic cleft of the lip and/or palate

OBJECTIVE

Evaluate neuropsychological functioning in children with non-syndromic cleft of the lip and/or palate (NSCL/P) through profile variance within type of cleft and comparisons to controls.

METHODS

Children ages 7 to 17 years participated; 66 had a diagnosis of NSCL/P and 87 were healthy controls. Neuropsychological tests of language, visual-perceptual, executive functioning, and memory skills were administered. Between- and within-group differences were assessed.

RESULTS

Within cleft types, children with NSCLP had an even profile with equal Verbal and Performance IQ (VIQ and PIQ, respectively). Children with non-syndromic cleft palate only (NSCP) had significantly lower VIQ than PIQ, while children with non-syndromic cleft lip only (NSCL) showed a nonsignificant trend for higher VIQ than PIQ. Overall, subjects with NSCL/P performed lower on measures of expressive language and verbal memory than controls.

CONCLUSIONS

While deficits in verbal and memory skills for children with NSCL/P remain apparent, there is still uncertainty around the possible influence of cleft type on the pattern of deficits.

Neuropsychological, behavioral, and academic sequelae of cleft: early developmental, school age, and adolescent/young adult outcomes

This article reviews behavioral, neuropsychological, and academic outcomes of individuals with cleft across three age levels: (1) infancy/early development, (2) school age, and (3) adolescence/young adulthood. The review points out that attachment, neurocognitive functioning, academic performance/learning, and adjustment outcomes are the result of a complex interaction between biological and environmental factors and vary with developmental level, sex, and craniofacial anomaly diagnosis. The degree to which associated genetic or neurodevelopmental conditions may explain inconsistent findings is unknown and suggests the need for caution in generalizing from group data on cleft.

Cry Melody in 2-Month-Old Infants with and without Clefts

Objective

To investigate cry melody properties in infants with clefts using objective methods and to identify early differences in cry development in relation to infants without clefts that may indicate special developmental risks.

Design

Melody analysis was carried out on cries from the second month of life. The cry properties of infants with a cleft lip and palate (CLP) and infants with a cleft palate only (CP) were quantitatively compared. Both groups were compared to infants without clefts.

Participants

Twenty-one infants with nonsyndromic clefts, including 11 infants with CLP and 10 infants with CP, were compared to 50 healthy controls.

Main Outcome Measures

Frequency spectrograms and melody diagrams of about 7000 cries were analyzed. For each infant's crying, melodic and rhythmic properties were investigated and expressed by appropriate quantitative indices. Based on previous studies, the degree of melody complexity in an infants’ crying was used as an indicator of their present prespeech developmental status.

Results

The cleft groups did not significantly differ from each other with respect to their cry melody development. However, both groups were significantly different from the control group, exhibiting a lower proportion of complex cry melodies and a deviation in rhythmicity. No significant correlation to hearing performances was found that could explain the differences.

Conclusions

Infants with clefts differ in their cry development from infants without clefts at 2 months of life. This early difference occurs before the infants undergo any surgical intervention or other treatment.

The Relationship between Early Reading Skills and Speech and Language Performance in Young Children with Cleft Lip and Palate

Objective

To examine the early reading skills of young children with cleft lip and palate and to examine the relationship between early reading skills and speech and language performance.

Participants

A total of 56 children participated in the study: 28 children with cleft lip and palate and 28 noncleft children matched for age (mean age, 5 years 7 months), gender, and months of formal schooling.

Main Outcome Measures

The two groups of children were compared ( t tests) on the Test of Early Reading-3. Pearson product moment correlations were performed to examine separately the relationship between early reading skills speech production abilities and between early reading skills and receptive and expressive language abilities for the two groups.

Results

Statistically significant group differences were noted on the Test of Early Reading-3. The mean score of 99 obtained by the group of children with cleft lip and palate was within normal limits compared with the norms for the Test of Early Reading-3; however, 14% of the children with cleft lip and palate scored outside the normal range on the Test of Early Reading-3. Statistically significant correlations were obtained between early reading skills and speech production abilities and between early reading skills and language abilities.

Conclusions

Children with cleft lip and palate differed from noncleft peers in speech and early reading skills. Children with the most severe speech problems were the children with the poorest performance on the Test of Early Reading-3. Management of children with cleft lip and palate should include early identification of and intervention for delays in speech, language, and reading.

The Effects of Unrepaired Cleft Palate on Early Language Development in Chinese Infants

Objective

To investigate the effects of unrepaired cleft palate on the development of vocabulary comprehension and expression of Chinese children aged 8 to 15 months.

Methods

The parents or caregivers of 40 infants with unrepaired cleft palate were recruited from the Cleft Lip and Palate Center at the Stomatology School of Peking University. Vocabulary development was assessed using a parent report protocol, the Chinese Communicative Development Inventory: Infant, for Putonghua (PCDI: Infant). The scores for vocabulary comprehension and expression of infants with clefts were compared with typically developing infants in the same age group.

Results

All infants with unrepaired cleft palate performed below the typically developing infants in vocabulary comprehension, but there were no significant differences from 8 to 15 months of age. No significant differences were found from 8 to 13 months of age on the expressive vocabulary portion of the Chinese Communicative Development Inventory: Infant, for Putonghua. However, a significant difference appeared at 14 and 15 months, with infants with cleft palate performing at a significantly lower level than the typically developing infants.

Conclusion

The development of vocabulary comprehension in Chinese infants younger than 14 months with unrepaired cleft palate is not significantly delayed. At 14 and 15 months, however, the development of vocabulary expression is delayed. The reasons may be found in the specific phonetic characteristics of Putonghua.

Parental Report of Infant Language Skills: A Review of the Development and Application of the Communicative Development Inventories

The Communicative Development Inventories (CDIs) are parent report measures of vocabulary and other aspects of language development in very young children. They have evolved over the past 20 years to be one of the most well recognised assessments of infant language. Of particular significance is the fact that the CDIs are the first measures of their kind to be widely translated and adapted for use in many different languages. The inventories have served a variety of functions including measuring early language acquisition, deriving normative data on language acquisition, and both identifying and describing children whose early language is significantly delayed. This review describes the development of the CDIs, summarises the volume of research that has been generated in a range of applications of the measures, and evaluates their current standing both as a research tool and as a clinical measure. Issues around the sensitivity and predictive value of the CDIs are also considered.

Timing of Palatal Surgery and Speech Outcome

Objective:

To examine the impact of age and lexical status at the time of primary palatal surgery on speech outcome of preschoolers with cleft palate.

Participants:

Forty children (33 to 42 months) with nonsyndromic cleft palate participated in the study. Twenty children (Group 1) were less lexically advanced and younger (mean age  =  11 months) and 20 children (Group 2) were more lexically advanced and older (mean age  =  15 months) when palatal surgery was performed.

Main Outcome Measures:

Samples of the children's spontaneous speech were compared on 11 speech production measures (e.g., size of consonant inventory, total consonants correct, % correct for manner of articulation categories, compensatory articulation usage, etc.). Next, listeners rated a 30-second sample of each child's connected speech for articulation proficiency and hypernasality, separately, using direct magnitude estimation (DME).

Results:

Group differences were noted for 4 of the 11 speech production measures. Children in Group 1 exhibited larger consonant inventories (and true consonant inventories) and more accurate production of nasals and liquids compared to children in Group 2. On the DME task, significant group differences were found for ratings of articulation proficiency and hypernasality. Children in Group 1 exhibited better articulation and less hypernasality than children in Group 2.

Conclusions:

The findings suggested that children who were less lexically advanced and younger at the time of palatal surgery exhibited better articulation and resonance outcomes at 3 years of age.

A study of speech, language, hearing, and dentition in children with cleft lip only

OBJECTIVE

To examine the prevalence of speech, language, hearing, and dental problems in children with an initial diagnosis of isolated cleft lip only (CL), for which evidence-based practice can be developed.

DESIGN

Retrospective chart review of 95 patients with cleft lip (age range, 2.8 to 3.7 years; mean, 3.1 years).

RESULTS

Speech and language impairment was documented in 13% and 18% of the patients, respectively. Thirty-three percent of the children presented with middle ear effusion. Thirteen percent had abnormal hearing. With one exception, the type and degree of hearing loss was a mild conductive loss most often attributed to the presence of effusion. Dental and/or occlusal anomalies were documented in 62% of the patients. A supernumerary tooth was the most frequently occurring dental anomaly and crossbite the most frequently occurring occlusal anomaly. Two children had a submucous cleft palate. Resonance was abnormal in 5% of the children.

CONCLUSION

Children with an initial diagnosis of CL need to be monitored by the interdisciplinary team for speech, language, ear disease, hearing, and dentition beginning in infancy and followed until all management needs are met.

Global and Specific Behavioral Measures of Pain in Children With Cerebral Palsy

OBJECTIVES

The aim of this research was to validate global and behavioral observation methods for measuring pain in children with cerebral palsy (CP).

MATERIALS AND METHODS

Nineteen children diagnosed with CP (2-21 years of age) and their primary caregivers participated in this study. Children and their caregivers were videotaped in their home before, during, and after a stretching exercise, and tests of cognitive and social development were administered. Children who were able to pass a training task were also asked to rate their experience of pain using a numerical rating scale (self-report NRS), but only 5 children (24%) passed so their self-report scores were not included. Healthcare professionals rated videotaped segments for each of the 3 time periods in a randomized order using an observer NRS and the Non-Communicating Children's Pain Checklist-Postoperative Version (NCCPC-PV). Raters trained in the Child Facial Coding System (CFCS) examined the same videotaped segments.

RESULTS

Results showed significantly greater pain behavior (observer NRS, NCCP- PV) during the stretching procedure than during the baseline and recovery segments. There were no significant differences in CFCS scores, across time segments.

CONCLUSIONS

These findings support the hypothesis that children with CP express discernible pain behaviors regardless of cognitive or language ability. These results contribute to multidimensional assessment of pain in children with neurologic impairment.

The role of a language scale for infant and preschool assessment

The PLS-4 (Preschool Language Scale, 4th edition) is a psychometrically sound instrument constructed to assess language skills in children from birth to 6 years 11 months. It is a useful diagnostic and research tool that can be used to identify current comprehension and expressive language skills and can measure changes in language skills over time. The test is individually administered and includes tasks that assess skills in the areas of preverbal behaviors, as well as linguistic skills in the areas of semantics, morphology, syntax, integrative language skills, and preliteracy skills. Extensive reliability and validity evidence are presented. The test has been used extensively in research examining language development of young children from different home environments, children with identified medical conditions, and children participating in a variety of habilitation and intervention programs. Both the previous edition (PLS-3) and the new PLS-4 English and Spanish editions are used extensively in clinical, medical, and research settings to examine developmental language patterns of infants, toddlers, and preschoolers.

Assessing intelligibility in speakers with cleft palate: a critical review of the literature

OBJECTIVE

A literature review was conducted in order to investigate three research questions: how is speech intelligibility being measured in speakers with cleft lip and palate? Is intelligibility adequately being distinguished from related measures such as acceptability? Has there been an increased understanding of intelligibility deficits in speakers with cleft lip and palate? Fifty-seven relevant articles published between 1960 and 1998 were included in the analysis.

RESULTS

The results showed an increase in the number of articles that included a measure of intelligibility or a similar measure. Several concerns were raised as a result of the review, including the reliability and validity of measures being employed, adequate definition and differentiation of terms, and the need to determine speech and nonspeech variables contributing to reductions in intelligibility. Relevant literature on intelligibility from fields outside cleft lip and palate is reviewed, and a number of recommendations are made regarding the measurement of intelligibility in speakers with cleft lip and palate.

Mental development in infants with cleft lip and/or palate

OBJECTIVE

Investigated mental development in infants and toddlers with cleft lip and/or palate (CLP).

DESIGN

This was a retrospective analysis of developmental scores on qualified children between 4 and 36 months of age. Cross-sectional analysis included children in four age groups (6, 12, 18, and 24 months); longitudinal analysis included children at mean age 9.1 (range = 4 to 15) months at Time 1 and 24 months (range = 16 to 36) at Time 2.

PARTICIPANTS

Cross-sectional analysis included 180 children (59% male participants) in four diagnostic groups (cleft lip only [CL], cleft lip and palate [CLP], cleft palate only [CP], and Pierre Robin). The longitudinal sample included 85 children (64% male children) in the same diagnostic groups.

MAIN OUTCOME MEASURES

Mental Scale (MDI) of the Bayley Scales of Infant Development.

RESULTS

Mean MDIs were in the average range but decreased significantly between youngest and oldest groups in both cross-sectional (F(3,179) = 4.9, p<.01) and longitudinal samples (F(1,84) = 6.87, p<.01). There was a significant difference among cleft types (F(3,179) = 3.5, p<.025). Infants with CL obtained the highest scores, and infants with Pierre Robin Sequence obtained the lowest. Perceptual-motor development in the first year of life was predictive of developmental status at age 2.

CONCLUSIONS

The number of children with CLP who may be at risk for developmental problems during the second year of life is greater than would be expected. Children at greatest risk may demonstrate early delays in acquisition of perceptual-motor skills during the first year of life.