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.
BayleyN. Bayley Scales of Infant Development. San Antonio, TX: The Psychological Corporation; 1993.
2.
BrittonLAlberyLBowdenMHardin-BellAPhippenGSellD. A cross-sectional cohort study of speech in five-year-olds with cleft palate + lip to support development of national audit standards. Cleft Palate-Craniofac J. 2014;51(4):431–451.
3.
BroenPADoyleSSBaconCK. The velopharyngeally inadequate child: phonologic change with intervention. Cleft Palate-Craniofac J. 1993;30(5):500–507.
4.
ChapmanKL. Is presurgery and early postsurgery performance related to speech and language outcomes at 3 year of age for children with cleft palate?Clin Linguist Phon. 2004;18(4-5):235–257.
5.
ChapmanKLHardin-JonesMAGoldsteinJAHalterKAHavlikRJSchulteJ. Timing of palatal surgery and speech outcome. Cleft Palate Craniofac J. 2008;45(3):297–308.
6.
D’AntonioLLAchauerBMVander KamVM. Results of a survey of cleft palate teams concerning the use of nasoendoscopy. Cleft Palate Craniofac J. 1993;30(1):35–39.
7.
DeversMBroenPDoyleSCarlstromJMollerKT. Early speech patterns of children with cleft palate who require secondary surgical management. Presented at the Meeting of the American Speech-Language-Hearing Association; November 2000; Washington, DC.
8.
EstremTBroenPA. Early speech production of children with cleft palate. J Speech Hear Res. 1989;32(1):12–23.
9.
FergusonCAFarwellCB. Words and sounds in early language acquisition. Language. 1975;51:419–439.
10.
HaSKohKSMoonHJungSOhTS. Clinical outcomes of primary palatal surgery in children with nonsyndromic cleft palate with and without cleft lip. Biomed Res Int. 2015;2015:5. doi:10.1155/2015/185459. Epub 2015 Jul 27.
11.
Hardin-JonesMAChapmanKL. Early lexical characteristics of toddlers with cleft palate. Cleft Palate Craniofac J. 2014;51:622–631.
12.
Hardin-JonesMAJonesDL. Speech production of preschoolers with cleft palate. Cleft Palate Craniofac J. 2005;42(1):7–13.
13.
Hardin-JonesMAChapmanKLSchererNJ. Children with Cleft Lip and Palate: A Parent’s Guide to Early Speech-Language Development and Treatment. Bethesda, MD: Woodbine House; 2015.
14.
Hardin-JonesMAChapmanKLSchererNJ. Early intervention for children with cleft palate. ASHA Lead. 2006;11:8–10.
15.
HardingAGrunwellP. Active versus passive cleft-type speech characteristics. Int J Lang Commun Disord. 1998;33(3):329–352.
16.
Harding-BellAHowardS. Phonological approaches to speech difficulties associated with cleft palate. In HowardSLohmanderA, eds. Cleft Palate Speech: Assessment and Intervention. Chichester, West Sussex: Wiley-Blackwell; 2011:275–291.
17.
HodsonBPadenE. Phonological processes which characterize unintelligible and intelligible speech in early childhood. J Speech Hear Dis. 1981;46:369–373.
18.
HodsonBChinLRedmondBSimpsonR. Phonological evaluation and remediation of speech deviations of a child with a repaired cleft palate: a case study. J Speech Hear Dis. 1983;48(1):93–98.
19.
HowardSJ. Articulatory constraints on a phonological system: a case study of cleft palate speech. Clin Linguist Phon. 1993;7(4):299–317.
20.
International Phonetic Association. International Phonetic Alphabet. Victoria, British Columbia, Canada; 1989.
21.
JacksonOStranskyCAJawadAFBastaMSolotCCohenMKirschnerRLowDWRandallPLaRossaD. The children’s hospital of Philadelphia modification of the Furlow double-opposing Z-palatoplasty: 30-year experience and long-term speech outcome. Plast Reconstr Surg. 2013;132(3):613–622.
22.
KatzelEBBasileP.KoltzPFMarcusJRGirottaJA. Current surgical practices in cleft care: cleft palate repair techniques and postoperative care. Plast Reconstr Surg. 2009;124(3):899–906.
23.
KlintoKSalamehEKOlssonMFlynnTSvenssonHLohmanderA. Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months. Int J Commun Disord. 2014;49(2):240–254.
24.
KummerAW. Disorders of resonance and airflow secondary to cleft palate and/or velopharyngeal dysfunction. In: KummerAW. Communication Disorders Related to Cleft Palate, Craniofacial Anomalies, and Velopharyngeal Dysfunction. Seminars in Speech and Language. 2011:32;141–149.
25.
MahoneyMSwanMCFisherD. Prospective analysis of presurgical risk factors for outcomes in primary palatoplasty. Plast Reconstr Surg. 2013:132(1);165–171.
26.
MollerKA. Early speech development: the interaction of learning and structure. In: BardachJMorrisHL, eds. Multidisciplinary Management of Cleft Lip and Palate. Philadelphia, PA: W.B. Saunders; 1990.
27.
MollerKTGlazeLE. Cleft Lip and Palate: Interdisciplinary Issues and Treatment. Austin: Pro-Ed Inc.; 2009.
28.
MoonJB. Evaluation of velopharyngeal function. In: MollerKTGlazeLE, eds. Cleft Lip and Palate: Interdisciplinary Issues and Treatment. Austin: Pro-Ed, Inc.; 2009.
29.
MorleyME. Cleft Palate and Speech. London, England: Churchill Livingstone; 1970.
30.
NorrisMHardenJ. Natural processes in the phonologies of four error-rate groups. J Comm Dis. 1981;14:195–213.
OllerDK. The Emergence of the Speech Capacity. Mahwah, NJ: Lawrence Erlbaum Associates; 2000.
33.
OllerDK.EilersRESteffensMLLynchMPUrbanoR. Speech-like vocalizations in infancy: an evaluation of potential risk factors. J Child Lang. 1994;21(1):33–58.
34.
Peterson-FalzoneSJHardin-JonesMAKarnellMP. Cleft Palate Speech. 4th ed. St. Louis: Mosby; 2010.
35.
Peterson-FalzoneSJTrost-CardamoneJEKarnellMPHardin-JonesMA. A Clinician’s Guide to Treating Cleft Palate Speech. St. Louis: Mosby; 2017.
36.
RiskiJE. Secondary management and speech outcome. In HowardSLohmanderA, eds. Cleft Palate Speech: Assessment and intervention. Chichester, West Sussex: Wiley-Blackwell; 2011.
37.
RvachewSBrosseau-LapreF. Developmental Phonological Disorders. San Diego, CA: Plural Publishing; 2012.
38.
SchererNJ. Early linguistic development. In: ZajacDJVallinoLD, eds. Evaluation and Management of Cleft Lip and Palate. San Diego, CA: Plural Publishing; 2017.
39.
SchererNJWilliamsALProctor-WilliamsK. Early and later vocalization skills in children with and without cleft palate. Intern J Ped Otorhinolaryngol. 2008;72(6):827–840.
40.
Stoel-GammonCCooperJA. Patterns of early lexical and phonological development. J Child Lang. 1984;11(2):247–271.
41.
SosaAVStoel-GammonC. Lexical and phonological effects in early word production. J Speech Lang Hear Res. 2006;55(2):596–608.
42.
TimbangMRGharbBBPampazzoAPapayFZinsJDoumitG. A systematic review comparing Furlow double-opposing Z-plasty and straight-line intravelar veloplasty methods of cleft palate repair. Plast Reconstr Surg. 2014;134(5):1014–1022.
VellemanSVihmanMM. Whole-word phonology and templates: trap, bootstrap, or some of each?Lang Speech Hear Serv Sch. 2002;33(1):9–23.
45.
VihmanMM. Early syllables and the construction of phonology. In: FergusonCAMennLStoel-GammonC, eds. Phonological Development: Models, Research, Implications. Timonium, MD: York Press; 1992:393–422.
46.
VihmanMMMackenMAMillerRSimmonsHMillerJ. From babbling to speech: a re-assessment of the continuity issue. Language. 1985;61(2):397–445.
47.
WilladsenE. Lexical selectivity in Danish toddlers with cleft palate. Cleft Palate Craniofac J. 2013;50(4):456–465.
48.
WilladsenEAlbrechtsenH. 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.
49.
ZajacDJVallinoLD. Evaluation and Management of Cleft Lip and Palate. San Diego, CA: Plural Publishing, Inc; 2017.
50.
ZimmermanILSteinerVGPondRE. Preschool Language Scale-3. San Antonio, TX: The Psychological Corporation; 1992.
