Introduction and aims: A cleft palate may hamper development of speech and expressive
language. Expressive language, including phonology, has been sparsely explored in children
with cleft lip and palate, and extended knowledge is essential in order to improve intervention
for this patient group. The aims of the project were to assess the effectiveness of different
speech materials used when evaluating cleft palate speech, to assess the development of
speech and expressive language in children born with unilateral cleft lip and palate, and to
identify variables in early speech production, which may be associated with later expressive
language.
Material and methods: Thirty children with unilateral cleft lip and palate, treated with three
different methods for primary palatal surgery, and 20 children without cleft lip and palate
participated. Speech was longitudinally documented at 18 months, 3 years, and 5 years of
age. The effectiveness of four different speech materials for assessing cleft palate speech was
explored. Articulation/phonology at 3 and 5 years were studied, and the outcomes were
correlated with earlier outcomes of consonant production. Speech and phonology in children
treated with different methods for primary palatal surgery were assessed. Expressive
language in narrative retelling was assessed and the outcomes were compared with outcomes
of articulation/phonology.
Results: The best speech performance and reliability were achieved in single word naming.
The reliability in sentence repetition was good, and speech performance was equally good as
in conversational speech. The group with unilateral cleft lip and palate displayed deviant
phonology at 3 and 5 years of age, compared with peers without cleft palate. Measures of
consonant production at 18 months of age correlated significantly with the outcomes at 3
years of age, and there also was a significant correlation between the outcomes at 3 and 5
years of age. The results indicated a two-stage palatal surgery with hard palate closure as late
as 3 years of age to be disadvantageous for the development of speech and phonology. At 5
years of age, a larger proportion of the children with unilateral cleft lip and palate than peers
without cleft had problems retelling information and these problems were not related to
surgical method, gender, or articulatory/phonological competence.
Conclusions: Word naming, in combination with sentence repetition, is recommended for
evaluation of cleft palate speech when best performance and performance in coherent speech
are assessed. Many children with unilateral cleft lip and palate have phonological problems at
up to 5 years of age. It seems possible to identify children at risk for impaired phonology at
earlier ages for possible prevention of persistent problems. Two-stage palatal surgery with
hard palate closure as late as 3 years of age should be avoided since it may hamper
phonological development. In addition, many children with unilateral cleft lip and palate have
problems retelling information at 5 years of age, unrelated to articulatory and phonological
ability, and may be in need of further language intervention
