Consonant Proficiency From 18 Months to 10 Years in Swedish Children With Unilateral Cleft Lip and Palate

Longitudinal speech results in children born with cleft palate with or without cleft lip are sparse. The aim of this study was to investigate the longitudinal development of consonant proficiency in Swedish children born with unilateral cleft lip and palate (UCLP).

Previously collected data on Swedish children with UCLP treated in Gothenburg and Stockholm were retrieved from the Scandcleft datasets. Only children with complete data on babbling at 18 months, and speech variables based on phonetic transcription at 3, 5 and 10 years of age were included (n = 32). Three surgical procedures for palatal closure were represented. At both centres, half of the children had undergone a two-stage palatal repair with soft palate closure at 6 months and hard palate closure at 12 months. The remaining children received either the same procedure but with hard palatal repair at 3 years (after the 3-year assessment), or a one-stage complete palatal repair at 12 months. Data were analysed using descriptive statistics on Percentage of Consonants Correct (PCC) and on oronasal symptoms at 3, 5, and 10 years of age, and for PCC also with correlation and regression analyses to examine the predictive value of early consonant production.

Despite substantial individual variation, there were no significant group-level differences in the main outcomes across primary surgical procedures, with the exception of a higher prevalence of oronasal symptoms at 3 years in the subgroup with unrepaired hard palate. Average PCC improved by age but remained below that of peers at all time points. Presence of oral stops at 18 months was the only variable that predicted a higher PCC at later ages. The percentage of oronasal symptoms decreased with age. Children who had not undergone secondary surgery and had a low number of speech therapy visits (indicating less need) exhibited the highest PCC and the lowest percentage of oronasal symptoms.

The findings suggest that early consonant production may serve as a predictor of later consonant proficiency. The large individual variation indicates that a need for individualised speech-language follow-up in addition to standardised documentation, and that factors beyond the surgical protocol influence speech outcomes.

What is already known on this subject Both early consonant production and later consonant proficiency in children with cleft palate with or without cleft lip have been shown to be poorer than in peers. However, the longitudinal aspect has been sparsely investigated, and true longitudinal data are needed. What this paper adds to existing knowledge The longitudinal outcome regarding consonant proficiency support previous findings indicating a small or negligible impact of primary surgical protocol. Furthermore, although the study group was small, the findings were consistent with results from the main Scandcleft project. This was also the case for the lack of impact from secondary surgery and speech therapy visits. The individual variation was substantial. However, the presence of oral stops at 18 months was a strong predictor for consonant proficiency at later ages. What are the potential or actual clinical implications of this work? Soft palate repair is crucial for establishing the prerequisites for oral stop production during babbling. However, also factors beyond the surgical protocol influence speech outcomes. Individualised speech-language follow-up in addition to standardised documentation is recommended. This should aim to identify outliers and offer parent-implemented support to individual infants with delayed babbling.