Exploring the relationship between cleft type and speech outcome in 4-to-6-year-olds with non-syndromic cleft palate using different measures: A preliminary report.

Cleft type affects speech outcomes, but exact relationships remain unclear as outcome measures vary. The primary aim was to investigate the relationship between cleft type and speech outcome using different measures in 4-to-6-year-olds with non-syndromic clefts. Secondary aims were to explore the relationships between (i) speech measures used; and (ii) parent perception of speech intelligibility and listener familiarity. Twenty-two pre-schoolers with clefts, plus one parent for each child, were recruited through a hospital outpatient clinic. Children with cleft lip and palate (CLP; n = 11) and those with cleft palate only (CP; n = 11), matched on age and time of palate repair, were compared on Percentage Consonants Correct (PCC), clinician-reported speech intelligibility, and parent rating on the Intelligibility-in-Context Scale (ICS). Children with CLP had significantly lower PCC scores than children with CP (p = .020), but had no significant differences in their clinician- or parent-reported speech intelligibility. Clinician-reported speech intelligibility correlated significantly with both PCC (τ = .594, p < 0.01) and ICS (τ = .424, p = 0.009). No significant correlation was found between PCC and ICS (τ =.197, p = 0.113). Overall, parents rated their child's intelligibility higher for familiar compared to unfamiliar communication partners (τ = 2.325, p = 0.001, r = .76). Cleft type is crucial for intervention planning when objective measures are employed. Speech outcomes should be evaluated at impairment, activity, and participation levels, and by different communication partners, to comprehensively evaluate communicative effectiveness.

Effect of dialect on phonological analysis.

It is important to understand a child's language background, to ensure appropriate assessment, diagnosis and treatment of speech sound disorders. Singapore is home to various cultures and languages, and local speech norms are needed to provide an accurate reference for assessing phonological disorders in the local population. This study aims to establish normative data and better understand the English phonological development of English-Mandarin bilingual preschoolers in Singapore, aged 3; 6-4; 5 years. The Articulation and Phonology subtests of the Diagnostic Evaluation of Articulation and Phonology - UK were used to collect speech data from 146 preschoolers. Responses were scored against two standards - British Standard English (BSE) and Singapore English (SGE), in terms of speech sound accuracy, and the frequency and type of error patterns present. The effect of language dominance on the children's English phonological abilities was explored. Results showed that the preschoolers' speech sound accuracy increased significantly when scored against SGE versus BSE targets. The number of children identified to be using several error patterns was reduced when SGE targets were used instead of BSE targets. English-dominant children scored significantly higher than their Mandarin-dominant peers on measures of speech sound accuracy. The identification of error patterns also differed between the two groups. These results show that it is important to take dialectal variation and language dominance into account in assessment, to determine if speech characteristics are due to a speech sound disorder or just normal dialectal variations.

Early Reading Abilities of Bilingual Children With Nonsyndromic Orofacial Clefts.

OBJECTIVE: To investigate the early reading abilities, and related cognitive-linguistic processes, in bilingual children with nonsyndromic cleft lip and/or palate (CL/P), and to identify deficits that might be amenable to intervention. DESIGN AND PARTICIPANTS: Bilingual participants with CL/P aged 5 to 6 years who were English-dominant ( n=17) or Mandarin-dominant ( n=18) were recruited using consecutive sampling from a national cleft treatment center and matched pairwise to a sample of typically developing (TD) children on language dominance, age, and socioeconomic status. All participants were assessed in English on single-word reading accuracy using the Wide Range Achievement Test (4th Ed), and key cognitive-linguistic factors associated with reading development: phonological awareness, rapid automatized naming (RAN), receptive and expressive vocabulary, and verbal short-term and working memory. RESULTS: CL/P and TD groups were compared within language dominance group (Mandarin or English) for all measures. The Mandarin-dominant CL/P group had significantly poorer reading accuracy and phonological awareness than their TD peers. Additionally, regardless of language dominance, faster RAN correlated significantly with better reading accuracy in both the CL/P groups but not the TD groups. CONCLUSIONS: Children with CL/P who are learning English as a second language are at greater risk of reading difficulties. Furthermore, the cognitive-linguistic processes underlying early reading in bilingual children with CL/P differ from those of their TD peers. Routine screening and tailored intervention is advisable.

Results of Primary Repair of Submucous Cleft Palate With Furlow Palatoplasty in Both Syndromic and Nonsyndromic Children.

OBJECTIVE: We hypothesize that primary repair of submucous cleft palate (SMCP) with Furlow palatoplasty will not lead to significant differences in speech outcomes for syndromic and nonsyndromic children. DESIGN: Retrospective analysis of patients with primary Furlow repair of SMCP between 2004 and 2012. SETTING: Tertiary care center. PATIENTS/PARTICIPANTS: Thirty-four patients (15 boys; 44%) satisfied our inclusion criteria: multidisciplinary consensus on diagnosis of SMCP, failed trial of speech-language rehabilitation, at least 4 years old at the time of primary surgery, at least 6 months follow-up with a repeat set of postoperative speech assessments. INTERVENTIONS: Primary Furlow palatoplasty for SMCP. MAIN OUTCOME MEASURES: Primary outcomes were based on postoperative perceptual speech assessments and the need for revision surgery. Secondary outcomes included improvement in nasalance scores, postoperative complications, and change in and time to normalization of velar closing ratios. RESULTS: Mean age at surgery = 7.7 years. Of the patients, 17 (50%) were syndromic and 11 (32%) had associated hearing loss. Mean follow-up = 48 months. No patients had postoperative complications, such as wound dehiscence or fistula; however, two patients (one syndromic, one nonsyndromic) required secondary procedures. Velar closing ratios for all patients increased (P < .05) and approached normal at an average of 1.3 years postoperatively. CONCLUSIONS: Although the Furlow palatoplasty can correct anatomic anomalies, it cannot achieve normal perceptual resonance in syndromic patients, possibly because of inherent higher-order deficiencies that affect speech production. Further studies with greater patient numbers are necessary to achieve population statistical significance.

Spelling Processes of Children With Nonsyndromic Cleft Lip and/or Palate: A Preliminary Study.

Objective : To compare the cognitive-linguistic processes underlying spelling performance of children with cleft lip and/or palate with those of typically developing children. Design : An assessment battery including tests of hearing, articulation, verbal short-term and working memory, and phonological awareness, as well as word and nonword spelling, was administered to both groups. Participants : A total of 15 children with nonsyndromic cleft lip and/or palate were case-matched by age and sex to 15 typically developing children. The children were aged between 6 and 8 years and were bilingual, with English the dominant language. Results : Wilcoxon signed-rank tests revealed that the performance of children with cleft lip and/or palate was significantly poorer on phoneme deletion and nonword spelling (P < .05) compared with typically developing children. Spearman correlation analyses revealed different relationships between the cognitive-linguistic and spelling measures for the cleft lip and/or palate and typically developing groups. Conclusions : Children with cleft lip and/or palate underachieve in phonological awareness and spelling skills. To facilitate early intervention for literacy problems, speech-language pathologists should routinely assess the cognitive-linguistic processing of children with cleft lip and/or palate, especially phonological awareness, as part of their case management protocols.

Bilingual children with nonsyndromic cleft lip and/or palate: language and memory skills.

PURPOSE: Research shows that monolingual children with cleft lip and/or palate (CLP) have a higher incidence of cognitive-linguistic deficits, but it is not clear whether bilingual preschool children with CLP are especially vulnerable because they need to acquire 2 languages. We tested the hypothesis that bilingual children with CLP score lower than bilingual children with typical development (TD) on receptive vocabulary, verbal memory, and visuospatial memory. METHOD: Participants were 86 bilingual CLP children and 100 TD children 3-6 years of age, dominant in English or Mandarin. Each child completed assessments of English and Mandarin vocabulary, verbal and visuospatial short-term and working memory, hearing, and articulation. RESULTS: With analysis of covariance controlling for age and dominant language, no group differences were found between the CLP and TD bilingual children, although a correlational analysis indicated discrepancies in the relationship between variables. CONCLUSIONS: The findings do not support the hypothesis that preschool children with CLP score lower than preschool children with TD on receptive vocabulary and memory measures. Longitudinal research examining literacy skill development is needed to establish whether the deficits reported for school-age monolingual children with CLP become more obvious in bilingual children in later years, especially when the medium of instruction is the child's nondominant language.

Communication and cognition profiles in parents of children with nonsyndromic cleft lip and/or palate.

The main aim of the study was to ascertain whether parents of children with nonsyndromic cleft lip and/or palate (P-CLP) perform differently than parents of children without CLP (P-control) on a nonword repetition (NWR) test. Given that children with CLP frequently demonstrate communication and cognitive difficulties, a link between NWR performance and group would lend support to a familial risk factor in nonsyndromic CLP. The NWR test, a well-documented assessment to identify language and cognitive impairment, was used, together with a parent questionnaire to gather demographic data and family history information on medical, communication, and/or cognitive difficulties for 260 parents. Group differences on NWR performance and family history of communication and cognition difficulties were not demonstrated. Also, no significant difference on NWR score was seen in the P-CLP group based on child's CLP type. Correlation analysis showed that having more years of schooling, English as the dominant language, living in private housing, and being in skilled occupations were positively correlated to NWR score. Controlling for these known background variables did not alter NWR performance between P-CLP and P-control, however, only years of schooling significantly and consistently predicted NWR performance. Having significantly fewer years of schooling in the P-CLP group could be suggestive of an increased risk of communication and cognitive difficulties these parents face, and the potential difficulties their children with CLP may encounter. These results may inform early and rigorous intervention strategies for children with CLP.