Persisting speech difficulties at 7–8 years of age – a longitudinal study of speech production in internationally adopted children with cleft lip and palate

Abstract

Aim

To longitudinally investigate speech production (consonant proficiency, consonant errors and perceived velopharyngeal competence) in 17 internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) at three time points.

Method

Consonant proficiency (percent consonants correct, consonant inventory) and number and type of consonant errors were calculated based on blind phonetic transcriptions of words from the Swedish Test of Articulation and Nasality (SVANTE). Velopharyngeal competence was perceptually rated by three blinded experienced speech-language pathologists at the ages of 3, 5 and 7–8 years.

Results

A significant positive development of speech production was found, although most children still scored very low for consonant proficiency at the age of 7–8 compared with normative values: the median for percent consonants correct was 79.7 and many children still had persisting cleft-related and developmental consonant errors. At the age of 7–8, almost half of the children were rated as having a competent velopharyngeal function and only three as having an incompetent velopharyngeal function.

Conclusion

Persisting speech difficulties at school age in IA children with UCLP were found in the present study, which is one of the very few longitudinal studies. Our results highlight the need for detailed follow-up of speech production in clinical settings. Speech disorders may have a severe impact on a child’s intelligibility and participation with peers, and there is a need for more studies investigating the actual everyday effect of the difficulties found.

Keywords:

• Speech production
• cleft lip and palate
• longitudinal
• internationally adopted
• velopharyngeal incompetence

Acknowledgements

We wish to thank all participating children and their parents. We would also like to acknowledge Johnna Sahlsten Schölin, Justin Weinfeld, Ida Johansson, Loisa Sandström, Cecilia Lindberg and Ellen Svensson for their contributions to this project.

Disclosure statement

The authors have no conflicts of interest to report.

Additional information

Funding

This study was funded by grants from the Majblommans forskningsfond, the Health-care sub-committee of the Västra Götaland Region (Hälso- och sjukvårdsutskottet, Regionstyrelsen), the Local Research and Development Board for Gothenburg and Södra Bohuslän, the Wilhelm och Martina Lundgrens vetenskapsfond and the Swedish State under the ALF agreement between the central government and the country councils (ALFGBG-602271 and ALFGBG-785211). Parts of the results of the present study were presented at the congress of the European Cleft Palate Craniofacial Association held at Utrecht, Netherlands, in June 2019.

Notes on contributors

AnnaKarin Larsson

AnnaKarin Larsson, PhD, is a speech-language pathologist and works at the Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, as well as within the child health services of the Region Västra Götaland. Her research focus is cleft palate, speech and language development, and developmental language disorder.

Carmela Miniscalco

Carmela Miniscalco is Adjunct Professor of Speech Language Pathology at the Gillberg Neuropsychiatry Centre, University of Gothenburg. Her research focus is language development in children with language disorders and the presence of language disorders in various clinical groups, e.g. children with autism. Another area of interest is screening and early identification of language disorders.

Hans Mark

Hans Mark is Associate Professor of Plastic Surgery at the Institute of Clinical Sciences, University of Gothenburg.

Radoslava Jönsson

Radoslava Jönsson is Lecturer and Senior Consultant in ENT and Audiology at the Institute of Clinical Sciences, University of Gothenburg, and at the Sahlgrenska University Hospital. Her research focuses on children and adults with significant hearing loss, rehabilitation and implants.

Christina Persson

Christina Persson is Professor of Speech Language Pathology at the Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, and at the Sahlgrenska University Hospital. Her research focus is speech outcome in children, adolescents and young adults born with cleft palate +/-lip or 22q11.2 deletion syndrome. Another area of interest is methodologies for assessment of articulation and velopharyngeal function.