Children born with a cleft palate (+/- cleft lip) can have difficulties communicating, eating, and participating in environments such as early childhood education. Cleft palate is a congenital condition that results from the segments of the face failing to fuse during early embryological development. Surgery to repair the cleft generally occurs in the first year of life; however, it can impact on children’s psychological and social functioning, and that of their family, for many years after. Having a cleft palate may impact a child’s speech sound acquisition (i.e., reduced speech intelligibility), velopharyngeal function (i.e., reduced speech acceptability), or both. Over the past decade, research has been undertaken to examine the early speech development of children with cleft palate. Given that children with cleft palate are at increased risk of speech sound disorders, and that these patterns/sound preferences emerge before their first words, there is continued interest in early intervention for toddlers and pre-schoolers with cleft palate. This project was undertaken to gather resources and strategies to support toddlers with cleft palate and their families. This was done with a view to maximising their speech outcomes, and in turn their well-being and social inclusion.
METHOD The first author received a Churchill Fellowship, and arranged visits to twelve experts working with children with cleft palate and their families. Sites were chosen based on the experts’ experience, published research, and/or interest in early speech intervention. The experts worked in six sites in Brazil, Denmark, New Zealand, and US. Semi-structured interviews were conducted using a topic guide developed after consultation of the literature, and discussion with colleagues and team members. Artefacts were collected to gain a greater understanding of the centres’ practices. Data were also collected through the observation of intervention sessions and multidisciplinary clinics. The interviews were then transcribed verbatim. The interviews, artefacts and observations were analysed qualitatively using inductive and deductive analysis based on a priori categories/themes identified during the planning of the research.
RESULTS There were consistent findings/recommendations across settings, despite the varied languages spoken, access to services, type of surgical repair, and approaches to intervention. Assessment: Monitor early language development, track speech over time (audio recordings), use consistent stimuli for speech samples, and use a developmental screener (track across developmental domains). Intervention: Provide parents with early speech and language development information, use principles and knowledge of typical speech acquisition norms when interpreting speech assessment data for young children with cleft palate, apply innovative models of care (e.g., speech therapy camps, collaborative care with primary SLPs and video feedback of parents in sessions)
DISCUSSION/CONCLUSION Cross-cultural similarities and differences regarding support for toddlers with cleft palate were found. These practices advocated by 12 international experts can be used to generate future research questions and provide expert evidence regarding service delivery for toddlers with cleft palate from around the world, to ensure the best speech outcomes for them, and as a result improved participation and social inclusion.
September 27, 2017
Anna Cronin attended the Early Start Conference in Wollongong in September. She presented a poster titled: Optimising the Communication and Wellbeing of Toddlers with Cleft Palate: Practices Across Four Continents.