Speech and expressive language in Swedish-speaking children with unilateral cleft lip and palate

Introduction and aims: A cleft palate may hamper development of speech and expressive language. Expressive language, including phonology, has been sparsely explored in children with cleft lip and palate, and extended knowledge is essential in order to improve intervention for this patient group. The aims of the project were to assess the effectiveness of different speech materials used when evaluating cleft palate speech, to assess the development of speech and expressive language in children born with unilateral cleft lip and palate, and to identify variables in early speech production, which may be associated with later expressive language.

Material and methods: Thirty children with unilateral cleft lip and palate, treated with three different methods for primary palatal surgery, and 20 children without cleft lip and palate participated. Speech was longitudinally documented at 18 months, 3 years, and 5 years of age. The effectiveness of four different speech materials for assessing cleft palate speech was explored. Articulation/phonology at 3 and 5 years were studied, and the outcomes were correlated with earlier outcomes of consonant production. Speech and phonology in children treated with different methods for primary palatal surgery were assessed. Expressive language in narrative retelling was assessed and the outcomes were compared with outcomes of articulation/phonology.

Results: The best speech performance and reliability were achieved in single word naming. The reliability in sentence repetition was good, and speech performance was equally good as in conversational speech. The group with unilateral cleft lip and palate displayed deviant phonology at 3 and 5 years of age, compared with peers without cleft palate. Measures of consonant production at 18 months of age correlated significantly with the outcomes at 3 years of age, and there also was a significant correlation between the outcomes at 3 and 5 years of age. The results indicated a two-stage palatal surgery with hard palate closure as late as 3 years of age to be disadvantageous for the development of speech and phonology. At 5 years of age, a larger proportion of the children with unilateral cleft lip and palate than peers without cleft had problems retelling information and these problems were not related to surgical method, gender, or articulatory/phonological competence.

Conclusions: Word naming, in combination with sentence repetition, is recommended for evaluation of cleft palate speech when best performance and performance in coherent speech are assessed. Many children with unilateral cleft lip and palate have phonological problems at up to 5 years of age. It seems possible to identify children at risk for impaired phonology at earlier ages for possible prevention of persistent problems. Two-stage palatal surgery with hard palate closure as late as 3 years of age should be avoided since it may hamper phonological development. In addition, many children with unilateral cleft lip and palate have problems retelling information at 5 years of age, unrelated to articulatory and phonological ability, and may be in need of further language intervention.

List of scientific papers

I. Klintö K, Salameh E K, Svensson H, Lohmander A. The impact of speech material on speech judgement in children with and without cleft palate. International Journal of Language and Communication Disorders. 2011, 46(3):348–360.
https://doi.org/10.3109/13682822.2010.507615

II. Klintö K, Salameh E K, Olsson M, Flynn T, Svensson H, Lohmander A. Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months. International Journal of Language and Communication Disorders. 2014, 49(2): 240–254.
https://doi.org/10.1111/1460-6984.12068

III. Klintö K, Svensson H, Elander A, Lohmander A. Speech and phonology in Swedish-speaking 3-year-olds with unilateral complete cleft lip and palate following different methods for primary palatal surgery. Cleft Palate- Craniofacial Journal. 2014, 51(3): 274-282.
https://doi.org/10.1597/12-299

IV. Klintö K, Salameh E K, Lohmander A. Phonological aspects in Swedishspeaking 5-year-olds born with unilateral cleft lip and palate. [Submitted]

V. Klintö K, Salameh E K, Lohmander A. Verbal competence in narrative retelling in 5-year-olds with unilateral cleft lip and palate. International Journal of Language and Communication Disorders. [Accepted]
https://doi.org/10.1111/1460-6984.12127