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

Abstract

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.

Keywords

cleft palate lexical development phonological development surgical timing

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References

Akamatsu

Tanino

Osada

Sakum

Influences of different palatoplasties on palatal growth and speech development: comparison between Osada's two-stage palatoplasty and one-stage mucosal flap procedure. Tokai J Exp Clin Med. 2004; 29: 111–122.

Bardach

Morris

H.L.

Olin

W.H.

Late results of primary veloplasty: the Marburg project. Plast Reconstr Surg. 1984; 73: 207–215.

Bearn

Midinhall

Murphy

Murray

J.J.

Sell

Shaw

W.C.

Williams

A.C.

Sandy

J.R.

Cleft lip and palate care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 4: outcome comparisons, training, and conclusions. Cleft Palate Craniofac J. 2001; 1: 38–43.

Broen

P.A.

Devers

M.C.

Doyle

S.S.

Prouty

J.S.C.

Moller

K.T.

Acquisition of linguistic and cognitive skills by children with cleft palate. J Speech Lang Hear Res. 1998; 41: 676–687.

Bzoch

K.R.

League

Receptive-Expressive Emergent Language Test. A Method for Assessing the Language Skills of Infants. 2nd ed. Austin: PRO-ED; 1991.

Chapman

K.L.

Hardin-Jones

M.A.

Halter

K.A.

The relationship between early speech and later speech and language performance for children with cleft lip and palate. Clin Linguist Phon. 2003; 17: 173–197.

Chapman

K.L.

Hardin-Jones

M.A.

Schulte

Halter

K.A.

Vocal development of 9-month-old babies with cleft palate. J Speech Hear Res. 2001; 44: 1268–1283.

Cosman

Falk

A.S.

Delayed hard palate repair: a cautionary report. Cleft Palate J. 1980; 17: 27–33.

Duckworth

Allen

Harcastle

Ball

Extensions to the International Alphabet for the transcription of atypical speech. Clin Linguist Phon. 1990; 4: 273–284.

10.

Ferguson

C.A.

Farwell

C.B.

Words and sounds in early language acquisition. Language. 1975; 51: 419–439.

11.

Friede

Möller

Lilja

Lauritzen

Johanson

Facial morphology and occlusion at the stage of early mixed dentition in cleft lip and palate patients treated with delayed closure of the hard palate. Scand J Plast Reconstr Surg Hand Surg. 1987; 21: 65–71.

12.

Fry

D.B.

The development of the phonological system in the normal and the deaf child. In: Smith

Miller

, eds. The Genesis of Language: A Psycholinguistic Approach. Cambridge: M.I.T. Press; 1966.

13.

Grunwell

Analysing Cleft Palate Speech. London: Whurr; 1993.

14.

Grunwell

Russell

Phonological development in children with cleft lip and palate. Clin Linguist Phon. 1988; 2: 75–95.

15.

Grønnum

Fonetik og Fonologi, Almen og Dansk. Copenhagen: Akademisk Forlag; 2005.

16.

Hardin-Jones

M.A.

Jones

D.L.

Speech production of preschoolers with cleft palate. Cleft Palate Craniofac J. 2005; 42: 7–13.

17.

Henningsson

Hutters

Perceptual assessment of cleft palate speech, with special reference to minimum standards for inter-centre comparisons of speech outcome. In: Lee

S.T.

, ed. Transactions of the 8th International Congress on Cleft Palate and Related Craniofacial Anomalies, Stamford Press Pte Ltd, Singapore, pp. xxxiii–xxxvii.

18.

Hoff-Ginsberg

The relation of birth order and socioeconomic status to children's language experience and language development. Appl Psycholinguist. 1998; 19: 603–629.

19.

Holland

Gabbay

J.S.

Heller

J.B.

O'Hara

Hurwitz

Ford

M.D.

Sauder

A.S.

Bradley

J.P.

Delayed closure of the hard palate leads to speech problems and deleterious maxillary growth. Plast Reconstr Surg. 2007; 119: 1302–1310.

20.

Holmgren

Lindblom

Aurelius

Jailing

Zetterstrom

On the phonetics of infant vocalization. In: Lindblom

Zetterstrom

, eds. Precursors of Early Speech. New York: Stockton Press; 1986: 51–63.

21.

Hubbard

T.W.

Paradise

J.L.

McWilliams

B.J.

Elster

B.A.

Taylor

F.H.

Consequences of unremitting middle-ear disease in early life: otologic, audiologic and developmental findings in children with cleft palate. N Engl J Med. 1985; 312: 1529–1534.

22.

Hutters

Bau

Danske indskolingsbørns udtale af /s/ med særligt henblik på tæsp [in Danish]. Dansk Audiologopædi. 2006; 1: 16–28.

23.

Hutters

Bau

Brondsted

A longitudinal group study of speech development in Danish children born with and without cleft lip and palate. Int J Lang Commun Disord. 2001; 36: 447–470.

24.

International Phonetic Association. Handbook of IPA. Cambridge: Cambridge University Press; 1999.

25.

Karling

Larson

Henningsson

Oronasal fistulas in cleft palate patients and their influence on speech. Scand J Plast Reconstr Surg Hand Surg. 1993; 27: 193–201.

26.

Konst

E.M.

Rietveld

Peters

H.F.M.

Kuijpers-Jagtman

A.M.

Language skills of young children with cleft lip and palate following infant orthopaedics: a randomized clinical trial. Cleft Palate Craniofac J. 2003; 40: 356–362.

27.

Kuijpers-Jagtman

A.M.

Long

R.E.

The influence of surgery and orthopaedic treatment on maxillofacial growth and maxillary arch development in patients treated for orofacial clefts. Cleft Palate Craniofac J. 2000; 37: 527,1–527,12.

28.

Lohmander

Friede

Elander

Persson

Lilja

Speech development in patients with unilateral cleft lip and palate treated with different delays in closure of the hard palate after early velar repair: a longitudinal perspective. Scand J Plast Reconstr Surg Hand Surg. 2006; 40: 267–274.

29.

Lohmander

Lillvik

Friede

The impact of early jaw-orthopaedics on early speech production in toddlers with unilateral cleft lip and palate. Clin Linguist Phon. 2004; 18: 259–284.

30.

Lohmander

Persson

A longitudinal study of speech production in Swedish children with unilateral cleft lip and palate and two-stage palatal repair. Cleft Palate Craniofac J. 2008; 45: 32–41.

31.

Lohmander

Persson

Owmann-Moll

Unrepaired clefts in the hard palate: speech deficits at the ages of 5 and 7 years and their relationship to size of the cleft. Scand J Plast Reconstr Surg Hand Surg. 2002; 22: 332–339.

32.

Lohmander

Willadsen

Persson

Henningsson

Bowden

Hutters

Methodology for speech assessment in the Scandcleft project—an international randomized clinical trial on palatal surgery: experiences from a pilot study. Cleft Palate Craniofac J. 2009; 46: 347–362.

33.

Lohmander-Agerskov

Speech outcome after cleft palate surgery with the Göteborg regimen including delayed hard palate closure. Scand J Plast Reconstr Surg Hand Surg. 1998; 32: 63–80.

34.

Lohmander-Agerskov

Soderpalm

Friede

Persson

Lilja

Pre- speech in children with cleft lip and palate or cleft palate only: phonetic analysis related to morphologic and functional factors. Cleft Palate Craniofac J. 1994; 31: 271–279.

35.

Menn

Evidence for an interactionist-discovery theory of child phonology. Papers and Reports in Child Language Development. 1976; 12: 169–177.

36.

O'Gara

M.M.

Logemann

J.A.

Rademaker

A.W.

Phonetic features by babies with unilateral cleft lip and palate. Cleft Palate Craniofac J. 1994; 31: 446–451.

37.

Oiler

D.K.

The Emergence of the Speech Capacity. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.

38.

Oiler

D.K.

Lynch

M.P.

Infant vocalizations and innovations in infra phonology: towards a broader theory of development and disorders. In: Ferguson

C.A.

Menn

Stoel-Gammon

, eds. Phonological Development: Models, Research, Implications. Timonium, MD: York Press; 1992: 509–539.

39.

Peterson-Falzone

Hardin-Jones

M.A.

Karnell

M.P.

Cleft Palate Speech. 3rd ed. St. Louis: Mosby; 2001: 266–291.

40.

Prahl

Kuijpers-Jagtman

A.M.

van't Hof

M.A.

Prahl-Andersen

A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft). Eur J Oral Sci. 2001; 109: 297–305.

41.

Reynell

J.K.

Manual for the Reynell Developmental Language Scales (revised). NFER Publishing Company; 1977.

42.

Roberts

Hunter

Otitis media and language learning sequelae: current research and controversies. Symposium conducted in May 2002; Arlington, VA.

43.

Ross

R.B.

Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 1987; 24: 5–77.

44.

Scherer

N.J.

d'Antonio

L.L.

Parent questionnaire for screening early language development in children with cleft palate. Cleft Palate Craniofac J. 1995; 32: 7–13.

45.

Schwartz

R.G.

Leonard

L.B.

Do children pick and choose? An examination of phonological selection and avoidance in early lexical acquisition. J Child Lang. 1982; 9: 319–336.

46.

Stoel-Gammon

From babbling to speech: some new evidence. Paper presented at the Child Phonology Conference, Northwestern University; 1989; Evanston, IL.

47.

Stoel-Gammon

Cooper

J.A.

Patterns of early lexical and phonological development. J Child Lang. 1984; 11: 247–271.

48.

Trost-Cardamone

J.E.

The development of speech: assessing cleft palate misarticulations. In: Kernahan

D.A.

Rosenstein

S.W.

, eds. Cleft Lip and Palate: A System of Management. Baltimore: Williams and Wilkins; 1990.

49.

Vihman

M.M.

Phonology and the development of the lexicon: evidence from children's errors. J Child Lang. 1981; 8: 239–264.

50.

Vihman

M.M.

Variable paths to early word production. J Phon. 1993; 21: 61–82.

51.

Vihman

M.M.

Greenlee

Individual differences in phonological development: ages one and three years. J Speech Hear Res. 1987; 30: 503–521.

52.

Vihman

M.M.

McCune

When is a word a word?

J Child Lang. 1994; 21: 517–542.

53.

Willadsen

Albrechtsen

From babbling to speech in ten children with cleft lip and palate. Paper presented at the 9^th International Congress on Cleft Palate and Related Craniofacial anomalies; June, 2001; Göteborg, Sweden.

54.

Willadsen

Albrechtsen

Phonetic description of babbling in Danish toddlers born with and without unilateral cleft lip and palate. Cleft Palate Craniofac J. 2006; 43: 2: 189–200.

55.

Willadsen

Enemark

A comparative study of pre-linguistic vocalizations in two groups of cleft toddlers and a non-cleft group. Cleft Palate Craniofac J. 2000; 37: 172–178.

56.

Witzel

M.A.

Salyer

Ross

Delayed hard palate closure—the philosophy revisited. Cleft Palate J. 1984; 21: 263–269.