Master of Science

thesisThe purpose of this study was to examine the speech/language skills of children with cleft palate and their noncleft peers at 39 months, profile the speech/language outcomes of children with cleft palate at 39 months, and extend previous studies examining pre- and postsurgery speech/language skills that predict later speech/language outcomes of children with cleft palate at 39 months. Participants included 66 children, 43 children with cleft palate and 23 noncleft children. Spontaneous speech/language samples were collected at 9 months, postsurgery (approximately 13 months), 21 months, and 39 months of age in the child's home during an interaction with the caregiver. Speech and language measures were calculated using computer software programs and hand calculations. Children were classified into one of the four speech/language outcome profiles using descriptive statistics. Results of the between-group comparisons revealed the children with cleft palate had fewer consonant sounds, produced less accurate consonants for the majority of the place and manner categories, and had lower mean length of utterances than their noncleft peers. Within-group comparisons revealed the risk factors gender, maternal education, and resonance were associated with poorer speech outcomes for children with cleft palate at 39 months. The profile normal velopharyngeal mechanism and delayed speech and/or language had the highest membership (41%). Correlations between pre- and postsurgery measures and later speech/language outcomes at 39 months revealed negative correlations between 9 month predictors and all outcome measures. All other predictors were positively correlated with the speech outcome measures at 39 months. True consonant inventory and stop production measures at 21 months were the best predictors of the profile normal velopharyngeal mechanism and normal speech/language. These results suggest that children with cleft palate have poorer speech/language outcomes than noncleft peers at 39 months of age. There is a need for children with cleft palate to receive earlier speech/language intervention to help them catch up with their noncleft peers. Finally, the strongest correlations were found between true consonant inventory and stop production at age 21 months, suggesting that 21 months is the best predictive age for speech and language outcomes at 39 months

Assessment of Single-Word Production for Children under Three Years of Age: Comparison of Children with and without Cleft Palate

Background. This study reports comparative phonological assessment results for children with cleft lip and/or palate (CLP) to typically developing peers using an evaluation tool for early phonological skills. Methods. Children without clefts (NC = noncleft) and 24 children with CLP, ages of 18–36 months, were evaluated using the Profile of Early Expressive Phonological Skills (PEEPSs) [1]. Children interacted with toy manipulatives to elicit a representative sample of target English consonants and syllable structures that are typically acquired by children between 18 and 27 months of age. Results. Results revealed significant differences between the two groups with regard to measures of consonant inventory, place of articulation, manner of production, accuracy, and error patterns. Syllable structure did not indicate differences, with the exception of initial consonant clusters. Conclusions. findings provide support for PEEPS as a viable option for single-word assessment of children with CLP prior to 3 years of age

Assessment of Single-Word Production for Children under Three Years of Age: Comparison of Children with and without Cleft Palate

Background. This study reports comparative phonological assessment results for children with cleft lip and/or palate (CLP) to typically developing peers using an evaluation tool for early phonological skills. Methods. Children without clefts (NC = noncleft) and 24 children with CLP, ages of 18–36 months, were evaluated using the Profile of Early Expressive Phonological Skills (PEEPSs) [1]. Children interacted with toy manipulatives to elicit a representative sample of target English consonants and syllable structures that are typically acquired by children between 18 and 27 months of age. Results. Results revealed significant differences between the two groups with regard to measures of consonant inventory, place of articulation, manner of production, accuracy, and error patterns. Syllable structure did not indicate differences, with the exception of initial consonant clusters. Conclusions. findings provide support for PEEPS as a viable option for single-word assessment of children with CLP prior to 3 years of age

DEVELOPMENT OF EXPRESSIVE VOCABULARY AND GRAMMAR IN YOUNG CHILDREN WITH REPAIRED CLEFT PALATE, CHILDREN WITH A HISTORY OF OTITIS MEDIA, AND CHILDREN WITH TYPICAL DEVELOPMENT

This Dissertation composes of two related studies. Study1 aimed to investigate the expressive vocabulary skill of 40 children with repaired cleft palate (CP), 29 children with histories of otitis media (OM), and 25 typically developing (TD) children at 18 and 24 months of age and compared the three groups in terms of the vocabulary growth from 18 to 24 months of age. In addition, the contribution of factors such as hearing level, tympanogram status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary was explored. The purpose of the second study was to examine the lexical-grammatical skills of 26 children with CP with consistent velopharyngeal (VP) closure, 27 children with OM, and 20 TD children at two years of age. Further, the association between early vocabulary skills and grammatical attainment as well as the precursors of early lexical-grammatical development were explored. The MacArthur Communicative Development Inventory: Words and Sentences (CDI-WS; Fenson et al., 2007) was employed to measure the size of vocabulary as well as the grammatical ability of children in the three groups. Consistency of VP function was made objectively through nasal ram pressure (NRP) monitoring. For the second study, however, NRP data for four children with CP were missing and assessment of VP function was based on perceptual judgments. Because these studies are part of a larger longitudinal study, sound-field audiometry screenings were performed at 12 and 24 months of age. Bilateral tympanogram data were obtained at 18 and 24 months of age. Results of the first study showed that children with CP produced a significantly smaller number of words at 24 months of age and a significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children (p< 0.05). The observed difference remained significant when the model was adjusted for the effect of hearing level, tympanogram status, size of consonant inventory, and sociodemographic variables. However, among all variables, only the tympanogram status significantly predicted the vocabulary growth from 18 to 24 months of age across the three groups. Findings of the second study revealed significant differences among the three groups with respect to the size of vocabulary and mean number of morphemes in their three longest utterances (M3L). The difference between CP and TD groups remained statistically significant when adjusting singly for hearing level, tympanogram status, and gender. Further, significant positive associations were found between the number of words and M3L and sentence complexity in each group (p< 0.05). Weak performance of children with CP on measures of expressive vocabulary and grammar were accounted for by poorer hearing levels, more frequent instances of abnormal tympanogram status, as well as lower levels of maternal education. Findings highlighted the importance of comprehensive speech and language assessments to identify children with CP who need intervention services as early speech and expressive language management has the potential to considerably mitigate the effects of later language delays.Doctor of Philosoph

Babbling, speech and language in children with neurological disabilities : development, validity of measures and effect of intervention

Children with neurological disabilities (ND) such as cerebral palsy, Down syndrome or other genetic syndromes often have speech and language disorder. In Sweden, children with ND often receive team-based habilitation services – with teams including speech and language pathologists – from an early age, but even so, many things are still unknown when it comes to the expected development of speech and language abilities. Furthermore, service delivery for speech and language difficulties has rarely been studied in the Swedish context and even internationally there is a lack of studies examining the effects of intervention. Babbling is an important precursor to speech and has been studied in many groups of children at risk of speech and language disorder. Thus, it shows promise as a field of study for children with neurological disabilies as well. One commonly studied babbling milestone is the onset of canonical babbling, when children produce speech-like syllables consisting of consonants and vowels. However, the most frequently used canonical babbling measure – the canonical babbling ratio (CBR) – has not been thoroughly validated. This thesis aimed to validate the CBR measure, to examine babbling, speech and language in a group of children with ND and to evaluate an intervention for young children with ND, specifically cerebral palsy. The thesis consists of five studies. In study I and II, a new and simplified version of the CBR measure (CBRUTTER ) was validated. It was found to be valid compared to other versions of the CBR and to babbling observation, suggesting it as an alternative to more laborious measures. Study II also evaluated the CBR criterion for the canonical babbling stage. A child is commonly considered to be in the canonical babbling stage when 15% or more of their babbling is canonical, that is a CBR of ≥ 0.15. Study II suggests that 0.14 may be a more appropriate criterion and emphasizes the need for proper discussion among babbling researchers on criteria for having entered the canonical babbling stage. In study I, III and IV, babbling, speech and language were examined at ages 1, 5 and 7 in a group of 18 children with neurological disabilities who received habilitation services from an early age. Compared to data from typically developing children, babbling milestones were delayed in the group of children with ND. At 5 and 7 years of age, speech and language disorder was very common, with only one participant presenting with results at age level on all measures. The severity of speech and language disorder was very varied, but a majority of participants had severe communication activity limitations. Despite this, parents rated the frequency of received SLP services as low. The results accentuate the need to closely follow speech and language development in children with ND, and to provide intervention as needed. In study V, a parent-implemented intervention for speech/language disorder was examined in young children with cerebral palsy. In a single case A-B study, four children received an intervention aimed at improving expressive vocabulary using a focused stimulation technique. Two children clearly improved their expressive vocabulary following the intervention, one showed less clear gains and one did not improve. Focused stimulation may thus be successful in children with cerebral palsy and speech/language difficulties and could be a valuable addition when it comes to SLP intervention options in children with neurological disabilities. In summary, this thesis presents new insights on the validity of the CBR measure, emphasizes the need to assess speech and language in children with neurological disability, and suggests an intervention for young children with cerebral palsy

Early Assessment of Speech: Useful Clinical Indicators of Later Outcomes

Children born with cleft lip and/or palate are at risk of speech problems. These may be related to nasality or to articulation difficulties. In many countries specialist speech and language therapists monitor these children from an early age. For clinicians and families, it is useful to know which children are at risk of later problems so that resources can be allocated appropriately, and families given clear information. The purpose of this study was to investigate whether it was possible to identify risk factors at age 12-months in a clinical setting. Speech assessments from 3-years were compared to findings at 12-months. The following speech variables were analyzed: canonical babbling, presence of anterior plosives and presence of cleft articulation errors. The findings showed that the presence of anterior plosives at 12-months was a predictor of later velopharyngeal function and articulation. These findings support the need for early assessment to determine the provision of early speech therapy intervention for children with cleft lip and/or palate

ENVIRONMENTAL CATALYSTS AND OROFACIAL KINEMATICS OF EMERGENT CANONICAL SYLLABLES

The vocalizations and jaw kinematics of 30 infants aged 6-8 months were recorded using a Motion Analysis System and audiovisual technologies. This study represents the first attempt to determine the effect of play environment on infants' rate of vocalization and jaw movement. Four play conditions were compared: watching videos, social interaction with an adult, playing alone with small toys, and playing alone with large toys. The fewest vocalizations and the least amount of spontaneous movement was observed when infants were watching videos and social interaction with an adult. Infants vocalized most when playing with large toys. The gross motor movement (e.g. waving, banging, shaking) naturally elicited by small toys was predicted to be the reason it educed fewer vocalizations than large toy play. This study was also the first to examine the kinematics of both vocalized and non-vocalized jaw movements from infants 6-8 months of age. Infants produced many spontaneous jaw movements without vocalization. When vocalizing, infants were not likely to move their jaw. This contradicts current theories that infants' canonical-stage vocalizations are jaw-dominant. Also, the onset of canonical babbling has been predicted to be driven by a change in oromotor skill. However, no differences were found in the jaw kinematics of infants who were canonical babbling versus those who were not. Results of the current study can inform both environmental and motor theories of infants' canonical babbling

Promoting Speech and Vocabulary Development through Specialized Storybooks in Children with and without Cleft Palate.

This study investigated changes in vocabulary and speech production in response to storybooks embedded with specialized language prompts and speech recasts. Six children received intervention, 3 with cleft palate (CLP), displaying speech-language delays, and 3 with nonclefts, each 12-24 months of age. A multiple baseline design across behaviors was implemented by a clinician. Results indicated all children increased use of target vocabulary and production of stop consonants, while reducing compensatory articulation errors. Generalization of targets to a picture-naming task, a free-play task, and to the home was observed. Effect sizes were moderate-to-high. Children with CLP required more sessions to achieve criterion. Analysis of 20-minute language samples, collected pre- and post-intervention, showed that both groups increased their vocabulary and speech measures