Changes in Phonological Awareness Following Combined Phonetic-Phonological Intervention in Children With Cleft Palate

Phonological awareness (PA) is a foundational skill for literacy development and may be impacted in children with cleft palate with or without cleft lip (CP ± L), as studies have reported associations between atypical speech sound production in this population and reduced PA skills. This study examined (a) the relationship between pre-intervention PA and the presence of nonoral compensatory speech errors in children with CP ± L and (b) the effects of phonetic-based versus combined phonetic-phonological speech and language intervention on PA across syllabic, intrasyllabic, and phonemic levels.

Fourteen Dutch-speaking children with CP ± L (M_age = 7.13 years) participated in a randomized controlled trial. Participants received phonetic-based or combined phonetic-phonological intervention for 10 hr across 1 week. PA was assessed pre-intervention, post-intervention, and at 3-month follow-up using two standardized tools: the Dutch version of the Clinical Evaluation of Language Fundamentals (CELF-IV-NL) and the Dutch Phonological Awareness Test (D-PAT). One-way analyses of variance assessed relationships between error severity and baseline PA; linear mixed models evaluated PA change over time by intervention type.

Greater number of nonoral cleft-related speech errors present in the child's speech was significantly associated with lower PA scores at all levels (syllabic, intrasyllabic, and phonemic). Post-intervention, both groups showed PA improvements. However, children receiving the combined therapy exhibited significantly greater and more sustained gains in syllabic and phonemic awareness (CELF-IV-NL) and in syllabic and intrasyllabic awareness (D-PAT). These effects remained at the 3-month follow-up.

Children with a greater number of nonoral compensatory errors exhibited poorer PA, highlighting the interconnectedness of speech output and phonological processing. The combined phonetic-phonological group demonstrated more improved levels of PA and maintained improvement over time. This supports the integration of phonological training in speech therapy for children with CP ± L and suggests that a holistic therapy targeting both articulatory and cognitive-linguistic domains might be appropriate for some clients.