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.
AinodaNYamashitaKTsukadaS. Articulation at age 4 in children with early repair of cleft palate. Annals of Plastic Surg. 1985:15(5);415–422.
2.
AlbustanjiYMAlbustanjiMMHegaziMMAmayrehMM. Prevalence and types of articulation errors in Saudi Arabic-speaking children with repaired cleft lip and palate. Int J Pediatr Otorhinolaryngol. 2014;78(10):1707–1715.
3.
AlighieriCBettensKBruneelLSerembaDMusasiziDOjokIVan LierdeK. Comparison of motor-phonetic versus phonetic-phonological speech therapy approaches in patients with a cleft (lip and) palate: a study in Uganda. Int J Ped Otorhinolaryngol. 2020a;131:1–9.
4.
AlighieriCBettensKBruneelLD’haeseleerEDVan GaeverEVan LierdeK.Effectiveness of speech intervention in patients with a cleft palate: comparison of motor-phonetic versus linguistic-phonological speech approaches. J Speech Lang Hear Res. 2020b;63(12):3909–3933.
5.
BaekRKimBJeongJHAhnTParkMHanJ. The effect of age at surgery and compensatory articulation on speech outcome in submucous cleft palate patients treated with double-opposing z-plasty: a 10-year experience. Plast Reconstr Surg. 2017;70(5):646–652.
6.
BaillieLSellD. Benchmarking speech, velopharyngeal function outcomes and surgical characteristics following the Sommerlad protocol and palate repair technique. Cleft Palate Craniofac J. 2020;57(10):1197–1215.
ChapmanKLHardin-JonesMSchulteJHalterKA. Vocal development of 9-month-old babies with cleft palate. J Speech Lang Hear Res. 2001;44(6):1268–1283.
9.
ChapmanKLBaylisACorderoKNDixonADobbelsteynCTrost-CardamoneJWilsonKStoddardG.An intercenter comparison of speech outcomes: the Americleft speech project. Presented at the European Cleft Palate Craniofacial Association Congress; June2019; Utrecht, Netherlands.
10.
ChapmanKLHardin-JonesMA. Compensatory articulation production in preschoolers with cleft palate. Presented at the Meeting of the American Cleft Palate-Craniofacial Annual; April2011; San Juan, Puerto Rico.
11.
ChapmanKLWilladsenE.The development of speech in children with cleft palate. In: HowardSLohmanderA, eds. Cleft Palate Speech. Wiley-Blackwell; 2011.
12.
CombsCMMartinJAM. The pronunciation of stops in consonant-vowel-consonant (CVC) words: a comparison between normal and speech-disordered preschool children. J Commun Disord. 1987;20(4):281–294.
13.
D’AntonioLLSchererNJMillerLLKalbfleischJHBartleyJA. Analyasis of speech charaxteristics in children with Velocardiofacial Syndrome (VCFS) and children with phenotypic overlap without VCFS. Cleft Palate Craniofacial J. 2001;38(5):455–467.
EshghiMZajacDJ. Uvular/pharyngeal fricatives and glottal stops in the presence of velopharyngeal closure in toddlers with cleft lip and palate: Case reports. Presentation at the Meeting of the American Cleft Palate-Craniofacial Association; April2018; Pittsburgh, PA.
16.
GibbonFLeeA. Electropalatography for older children and adults with residual speech errors. Semin Speech Lang. 2015;36(4):271–282.
17.
Golding-KushnerK. Therapy Techniques for Cleft Palate Speech and Related Disorders. Delmar Cengage Learning; 2001.
18.
Golding-KushnerKJ.The effect of articulation therapy on velopharyngeal closure. Oral presentation at: Fourth International Congress on Cleft Palate and Related Craniofacial Anomalies; 1981; Acapulco, Mexico.
19.
Golding-KushnerKJ. Commentary: a cineradiographic study of velopharyngeal movements for deviant versus nondeviant articulation. Cleft Palate-Craniofac J. 1991;28(1):117–118.
20.
Golding-KushnerKJ. Treatment of articulation and resonance disorders associated with cleft palate and VPI. In: ShprintzenRJBardachJ, eds. Cleft Palate Speech Management. Mosby-Year Book; 1995.
21.
GoochJLHardin-JonesMChapmanKLTrost-CardamoneJESussmanJ. Reliability of listener transcriptions of compensatory articulations. Cleft Palate Craniofac J. 2001;38(1):59–67.
22.
HallCGolding-KushnerKJ. Long-term follow-up of 500 patients after palate repair performed prior to 18 months of age. Presented at the Sixth International Congress on Cleft Palate and Related Craniofacial Anomalies; 1989; Jerusalem, Israel.
23.
HallPKTomlinJB.Case study: therapy procedures and remediation of a nasal lisp. Lang Speech Hear Serv Sch. 1975;6(1):29–32.
24.
HardingAGrunwellP. Active versus passive cleft-type speech characteristics. Int. J. Lang Comm Dis.
1998;33(3):329–352.
25.
Hardin-JonesMAChapmanKL. The implications of nasal substitutions in the early phonology of toddlers with repaired cleft palate. Cleft Palate-Craniofac J. 2018;55(9):1258–1266.
26.
Hardin-JonesMAJonesDLDolezalR. Opinions of speech-language pathologists regarding speech management for children with cleft lip and palate. Cleft Palate-Craniofac J. 2020;57(1):55–64.
27.
Hardin-JonesMAJonesDL. Speech production patterns of preschoolers with cleft palate. Cleft-Palate-Craniofac J. 2005;42(1):7–13.
28.
HenningssonGIsbergA. A cineradiographic study of velopharyngeal movements for deviant versus nondeviant articulation. Cleft Palate-Craniofac J. 1991;28(1):115–117.
29.
HochLGolding-KushnerKSiegel-SadewitzVLShprintzenRJ. Speech therapy. In McWilliamsBJ, ed. Current methods of assessing and treating children with cleft palates. Seminars in Speech and Language. Thieme; 1986.
30.
HodsonBWChinLRedmondBSimpsonR.Phonological evaluation and remediation of speech deviations of a child with a repaired cleft palate: a case study. J Speech Hear Disord. 1983;48(1):93–98.
31.
HodsonBWPadenE. Phonological processes which characterize unintelligible and intelligible speech in early childhood. J Speech Hear Dis. 1981;46(4):369–373.
32.
Hortis-DzierzbickaMRadkowskaESteckoEDudzinskiLFudalejPS. Speech outcome in complete unilateral cleft lip and palate- a comparison of three methods of the hard palate closure. J Oral Rehab. 2014;41(11):809–815.
33.
HowardS. Compensatory articulatory behaviours in adolescents with cleft palate: comparing the perceptual and instrumental evidence. Clin Ling Phon. 2004;18(4-5):313–340.
34.
HowardSHeselwoodBHardin-BellA.Phonetic constraints and phonological consequences in cleft palate speech. In: Harding-BellA, ed. Case Studies in Cleft Palate Speech. J&R Press; 2019.
35.
JacksonOStranskyCAJawadAFBastaMSolotCCohenMKirschnerRLowDWRandallPLaRossaD. The Children’s Hospital of Philadelphia modification of the Furlow double opposing z-palatoplasty: 30 year experience and long-term speech outcomes. Plast Reconstr Surg. 2013;132(3):613–622.
36.
JonesCEChapmanKLHardin-JonesMA. Speech development of children with cleft palate before and after palatal surgery. Cleft Palate Craniofac J. 2003;40(1):19–31.
37.
KatzelEBBasilePKoltzPFMarcusJ RGirottoJA. Current surgical practices in cleft care: cleft palate repair techniques and postoperative care. Plast Reconstr Surg. 2009;124(3):899–906.
38.
KlintoKSalamehEOlssonMFlynnTSvenssonHLohmanderA. Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months. Int J Lang Commun Disord. 2014;49(2):240–254.
39.
KummerAW. Cleft Palate and Craniofacial Conditions: A Comprehensive Guide to Clinical Management. 4th ed. Jones & Bartlett Learning; 2020.
40.
LeBlancEMCisnerosGJ. The dynamics of speech and orthodontic management in cleft lip and palate. In: ShprintzenRJBardachJ, eds. Cleft Palate Speech Management. Mosby-Year Book; 1995.
41.
LockeJL. Phonological Acquisition and Change. Academic Press; 1983.
42.
LouQWangXChenY. Speech outcomes comparison between adult velopharyngeal insufficiency and patients with unrepaired cleft palate. J Craniofac Surg. 2021;32(2):655–659.
43.
MorleyME. Cleft Palate and Speech. Williams and Wilkins Co; 1962.
44.
MorleyME. Cleft Palate and Speech. Williams and Wilkins Co; 1967.
45.
MorrisHL. Cleft palate. In: WestonAJ, ed. Communication Disorders: An Appraisal. CC Thomas; 1972.
46.
NybergJNeoviusELohmanderA. Speech outcomes at 5 and 10 years of age after one-stage palatal repair with muscle reconstruction in children born with isolated cleft palate. J Plast Surg Hand Surg. 2018;52(1):20–29.
47.
NybergJPetersonPLohmanderA. Speech outcomes at age 5 and 10 years in unilateral cleft lip and palate after one-stage palatal repair with minimal incision technique- a longitudinal perspective. Int J Pediatr Otorhinolaryngol. 2014;78(10):1662–1670.
48.
OllerDKWeimanLADoyleWJRossC. Infant babbling and speech. J Child Lang. 1976;3(1):1–11.
49.
PamplonaMYsunzaAEspinosaJ. A comparative trial of two modalities of speech intervention for compensatory articulation in cleft palate children, phonologic approach versus articulatory approach. Int J. Ped Otorhinolaryngol.
1999:49(1);21–26.
50.
PamplonaMYsunzaAGonzalezMRamirezEPatinoC. Linguistic development in cleft palate patients with and without compensatory articulation disorder. Int J Ped Otorhinolaryngol. 2000:54(2-3);81–91.
51.
PamplonaMYsunzaAGuerreroMMeyerIGarcia-VelascoM. Surgical correction of velopharyngeal insufficiency with and without compensatory articulation. Int J Ped Otorhinolaryngol. 1996;34(1-2):53–59.
52.
ParkSSasoYItoOTokiokaKTakatoTKatoKKitanoI. The outcome of long-term follow-up after palatoplasty. Plast Reconstr Surg. 2000;105(1):12–17.
53.
PasickCMShayPLStranskyCASolotCBCohenMAJacksonOA. Long term speech outcomes following late cleft palate repair using the modified Furlow technique. Int J Ped Otorhingolaryngol. 2014;78(12):2275–2280.
54.
PerssonCLohmanderAElanderA. Speech in children with an isolated cleft palate: a longitudinal perspective. Cleft Palate Craniofac J. 2006;43(3):295–309.
55.
PerssonCLohmanderAJonssonROskarsdottirSSoderpalmE. A prospective cross-sectional study of speech in patients with the 22q11 deletion syndrome. J Commun Disord. 2003;36(1):13–47.
56.
Peterson-FalzoneSJ. A cross-sectional analysis of speech results following palatal closure. In: BardachJMorrisHL, eds. Multidisciplinary Management of Cleft Lip and Palate. W.B. Saunders; 1990.
57.
Peterson-FalzoneSJGrahamMS. Phoneme-specific nasal emission in children with and without physical anomalies of the velopharyngeal mechanism. J Speech Hear Dis. 1990;55(1):132–139.
Peterson-FalzoneSJTrost-CardamoneJEKarnellMPHardin-JonesMA. The Clinician’s Guide to Treating Cleft Palate Speech. Mosby; 2006.
60.
Peterson-FalzoneSJTrost-CardamoneJEKarnellMPHardin-JonesMA. The Clinician’s Guide to Treating Cleft Palate Speech. 2nd ed. Mosby; 2017.
61.
RenfrewCE. Present day problems in cleft palate speech. Logopeden. 1960. As cited by Moll KL: Speech characteristics of individuals with cleft lip and palate. In: SpriestersbachDCShermanD, eds. Cleft Palate and Communication. Academic Press; 1968.
62.
RezaeiPPoorjavadMAbdaliH. Speech outcomes after palatal closure in 3-7-year-old children. Braz J Otorhinolaryngol. 2020;S1808-8694(20):30152–X. doi:10.1016/j.bjorl.2020.07.006
63.
SchererNJD'AntonioLLKalbfleischJH. Early speech and language development in childrenwit h velo-cardio-facial syndrome. American J Med Genetics. 1999;88(6):714–723.
64.
SellDHarding-BellA.Speech and velopharyngeal dysfunction. In: Harding-BellA, ed. Case Studies in Cleft Palate Speech. J&R Press; 2019.
65.
SellDMildinhallSAlbery L WillsAKSandyJRNessAR. The cleft care UK study: part 4: perceptual speech outcomes. Orthod Craniofac Res. 2015;18(suppl 2);36–46.
66.
SellDSweeneyT. Percent consonant correct as an outcome measure for cleft speech in an intervention study. Folia Phoniatr Logoped. 2020;72(2):143–151.
67.
ShermanDSpriestersbachDCNollJD. Glottal stops in the speech of children with cleft palates. J Speech Hear Dis. 1959;24(1):37–42.
68.
ShprintzenRJ.Surgery for Speech: The planning of Operations for Velopharyngeal Insufficiency with Emphasis on the Preoperative Assessment of both Pharyngeal Physiology and Articulation. Proceedings of the British Craniofacial Society. Manchester University Press; 1986.
69.
ShribergLDKentRDKarlssonHBMcSweenyJLNadlerCJBrownRL. A diagnostic marker for speech delay associated with otitis media with effusion: backing of obstruents. Clin Ling Phon. 2003;17(7):529–547.
70.
SmithJ. Contraindications for speech therapy for cleft palate speakers. Cleft Palate J. 1969;6(3):202–204.
71.
SolotCBSellDMayneABaylisALPerssonCJacksonOMcDonald-McGinnDM. Speech-language disorders in 22q11.2 deletion syndrome: best practices for diagnosis and management. Am J Speech Lang Path. 2019;28(3):984–999.
72.
SpriestersbachDCMollKLMorrisHL. Subject classification and articulation of speakers with cleft palates. J Speech Hear Res. 1961;4(4):362–372.
73.
Stoel-GammonCCooperJ. Patterns of early lexical and phonological development. J Child Lang. 1984;11(2):247–271.
74.
TrostJE. Articulatory additions to the classical description of the speech of children with cleft palate. Cleft Palate J. 1981;18(3):194–203.
75.
VihmanMMFergusonCAElbertM.Phonological development from babbling to speech: common tendencies and individual differences. Appl Psycholinguist.1986;7(1):3–40.
76.
VihmanMMMackenMAMillerRSimmonsHMillerJ. From babbling to speech: a re-assessment of the continuity issue. Language. 1985;61(2):397–444.
77.
VihmanMM. Early syllables and the construction of phonology. In: FergusonCAMennLStoel-GammonC. eds. Phonological Development: Models, Research, Implications. York Press; 1992:393–422.
WilladsenELohmanderAPerssonCLundeborgIAlaluusuaSAuknerRBauABoersMBowdenMDaviesJ, et al.Scancleft randomized trials of primary surgery for unilateral cleft lip and palate: 5. speech outcomes in 5-year-olds- consonant proficiency and errors. Plast Surg Hand Surg. 2017;51(1);38–51.
YsunzaAPamplonaCMendozaMGarcia-VelascoMAguilarPGuerroE. Speech outcome and maxillary growth in patients with unilateral complete cleft lip/palate operated on at 6 versus 12 months of age. Plast Reconstr Surg. 1998;102(3):675–679.
82.
YsunzaAPamplonaCToledoE.Change in velopharyngeal valving after speech therapy in cleft palate patients. a videonasopharyngoscopic and multi-view videofluoroscopic study. Int J Ped Otorhinolaryngol. 1992;24(1):45–54.
83.
YsunzaAPamplonaMFematTMayerIGarcia-VelascoM. Videonasopharyngoscopy as an instrument for visual biofeedback during speech in cleft palate patients. Int J Pediatr Otorhinolaryngol. 1997;41(3):291–298.
84.
ZajacD.The nature of nasal fricatives: articulatory-perceptual characteristics and etiologic considerations. Perspect Speech Sci Orofac Dis. 2015;25(1):17–28.
85.
ZajacDJVallinoLD. Evaluation and Management of Cleft Lip and Palate: A Developmental Perspective. Plural Publishing; 2015.
