Correspondence between consonant inventories obtained using modified naturalistic listening in real time (NLRT) and parent report.

OBJECTIVE: The current study examined the correspondence between consonant inventories obtained using the modified NLRT approach and parent report. DESIGN: Prospective comparative study. SETTING: Multisite institutional. PARTICIPANTS: Participants included 70 children with repaired CP + L (mean age = 16 months) who were participating in the multicenter study. PROCEDURES: Parents of participants were asked to record approximately two hours of their child's vocalizations/words at home using a Language ENvironmental Analysis (LENATM) recorder. Four ten-minute audio-recorded samples of vocalizations were extracted from the original recording for each participant and analyzed for size of consonant inventory. Parent reported consonant inventory was compared to coder identified consonant inventory. Coders identified an in-inventory consonant using two different criteria: 2+ tokens of each consonant were required in the first analysis and 10+ tokens of each consonant were required in the second analysis. RESULTS: Coder identified consonant inventory was larger (mean = 7.90) than that reported by parents (mean = 6.06) when a minimum of two tokens per consonant was required for inclusion of a consonant in inventory, while the inventory transcribed by coders was smaller (mean = 4.46) than that reported by parents when inclusion criteria required a minimum of ten tokens per consonant. CONCLUSIONS: Although the mean number of consonants in inventory between coders and parents was slightly closer using the 10+ versus 2+ criterion for consonant inclusion, the difference was not significant enough to recommend one protocol over the other.

Non-Oral Compensatory Misarticulations Revisited.

Non-oral compensatory misarticulation patterns are often associated with the speech of children with cleft palate. Despite their saliency, the etiology, frequency, and treatment of these misarticulations have not been studied extensively. The purpose of this commentary is to review what we know about these atypical patterns of articulation and address clinical assumptions regarding their etiology and treatment.

The Implications of Nasal Substitutions in the Early Phonology of Toddlers With Repaired Cleft Palate.

OBJECTIVE: To examine the implications of nasal substitutions in the early words of toddlers with cleft palate. DESIGN: Retrospective. PATIENTS: Thirty-four toddlers with nonsyndromic cleft palate and 20 noncleft toddlers, followed from ages 13 to 39 months. MAIN OUTCOME MEASURES: The groups were compared for the percentage of toddlers who produced nasal substitutions in their early words. The percentage of toddlers with repaired cleft palate who produced nasal substitutions and were later suspected of having velopharyngeal dysfunction (VPD) was also examined. RESULTS: Seventy-six percent of the toddlers in the cleft group (n = 26) and 35% of toddlers in the noncleft group (n = 7) produced nasal substitutions on one or more of their early words. Only 38% (10/26) of the toddlers with cleft palate who produced nasal substitutions in their early words were later diagnosed as having moderate-severe hypernasality and suspected VPD. CONCLUSIONS: The presence of nasal substitutions following palatal surgery was not always an early sign of VPD. These substitutions were present in the early lexicon of children with and without cleft palate.

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.

Speech production of preschoolers with cleft palate.

OBJECTIVE: The present investigation was conducted to examine the prevalence of preschoolers with cleft palate who require speech therapy, demonstrate significant nasalization of speech, and produce compensatory articulations. The relationship among these three dependent variables and the independent variables of cleft type and age of primary palatal surgery was also examined. PARTICIPANTS: The participants included 212 preschoolers with repaired cleft palate aged 2 years 10 months to 5 years 6 months. MAIN OUTCOME MEASURES: Chi-square analyses were performed to examine the relationship between two independent variables (cleft type and age of surgery) and three dependent variables (percentage of children requiring speech therapy, percentage demonstrating moderate to severe hypernasality and receiving secondary management for velopharyngeal insufficiency, and percentage producing glottal/pharyngeal substitutions). RESULTS: Sixty-eight percent of the children were enrolled in (or had previously received) speech therapy. Thirty-seven percent of the children demonstrated moderate-severe hypernasality or had received secondary surgical management for velopharyngeal insufficiency. Chi-square analyses revealed a significant relationship between cleft type and the number of children referred for speech therapy as well as the number of children with significant hypernasality. The analyses also revealed a significant relationship between age of palatal surgery and number of children with significant hypernasality. CONCLUSIONS: Despite advances in surgical management and the advantages offered by team care, the majority of preschoolers with cleft palate continue to demonstrate delays in speech sound development that require direct speech therapy. An optimal treatment regimen for these children is one that includes primary palatal surgery no later than 13 months of age.

Speech development of children with cleft palate before and after palatal surgery.

OBJECTIVE: This study examined the speech production abilities of children with cleft palate before and after palate repair. PARTICIPANTS: Twenty-eight children participated in the study, 14 with cleft palate and 14 without clefts matched for age, gender, and mothers' educational level. MAIN OUTCOME MEASURES: Comparisons were made between the children with cleft palate before and after surgery for canonical babbling ratios, size of consonant inventories, place and manner characteristics, and early developing sounds [p, b, t, d, k, g, m, n, eta]. Also, comparisons were made between the children with cleft palate and their peers without clefts at postsurgery/17 months for the measures described above. RESULTS: Paired t tests revealed differences in pre- and postsurgery performance of the children with cleft palate for production of canonical syllables and size of consonant inventories. Although no significant differences were noted for place and manner features, production of oral stops doubled from the time before surgery to that after surgery. Specifically, production of the bilabial stop [b] showed significant change over time. Results of independent t tests indicated no difference between groups for production of canonical syllables and size of consonant inventories at 17 months. However, significant group differences were noted for production of stops, oral stops, nasals, glides, and alveolars. The children without clefts produced more stops, oral stops, and alveolars. In contrast, more nasals and glides were seen in the vocalizations of the children with cleft palate. CONCLUSIONS: Children with cleft palate made gains in production of canonical syllables and size of consonant inventories postsurgery; however, they continued to show deficits in production of stops and alveolar place features.

The impact of early palatal obturation on consonant development in babies with unrepaired cleft palate.

OBJECTIVE: The purpose of this investigation was to determine whether palatal obturators enhance consonant development during babbling for babies with unrepaired cleft palate. PARTICIPANTS: Fourteen babies with cleft palate who had worn anterior palatal obturators prior to palatal surgery were matched to 14 unobturated babies according to cleft type, sex, and age at time of presurgical evaluation. MAIN OUTCOME MEASURES: Spontaneous vocalizations of the obturated and unobturated groups were compared to determine whether differences were evident in size of consonant inventory as well as place and manner of consonant production. RESULTS: Paired t tests revealed no significant differences between the groups in size of consonant inventory or place and manner of consonant production. There was a trend for babies in the obturated group to produce more glottal consonants. CONCLUSIONS: In general, the findings of this study suggested that palatal obturators do not appear to facilitate production of anterior palatal consonants during babbling.