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The purpose of the current research was to compare the lexical-grammatical skills of two-year-old children with and without repaired cleft palate (CP), accounting for the effect of variables such as vocabulary size at 18 months of age, maternal education level, and gender. Participants included 52 children with CP and 25 typically developing (TD) children. The CDI-WS was employed to measure vocabulary and grammatical skills. Significant differences were observed between the CP and TD groups with respect to the number of words, word forms (irregular nouns and verbs), word endings (overuse of plural (-s) and past tense (-ed) markers), the mean number of morphemes in their three longest utterances (M3L), and sentence complexity. In addition, compared to TD children, significantly smaller proportions of children with CP were observed to use words to talk about past and future events or use words to talk about an absent object. The difference between the CP and TD groups in terms of the size of vocabulary at 24 months of age remained statistically significant in the multivariable model. Among all predictors, the size of vocabulary at 18 months of age was identified as the most robust precursor of lexical and grammatical skills at 24 months of age. Gender was identified as a predictor of the M3L measure as an index for syntactic ability.

Purpose This study determined the time course of the emergence of prevocalic stop consonants in young children with cleft palate following surgical repair. Method A total of 120 children in four cohorts from three institutions were followed from 12 to 24 months of age: (a) 24 with repaired cleft lip and palate (CLP), (b) 36 with repaired cleft palate only (CP), (c) 33 without clefts but with histories of frequent otitis media and ventilation tubes (OM), and (d) 27 typically developing (TD) children without clefts or OM. Emergence of prevocalic stops and symbolic language skills were determined during administration of the Communication and Symbolic Behavioral Scales Developmental Profile. Parametric survival models were fitted with and without covariates-recruitment site, gender, maternal education level, middle ear status, language ability, and age at surgery for children with clefts-to describe the time course of the emergence of prevocalic stops. Results The estimated age at which 80% of children demonstrated prevocalic stop emergence was 15.0, 15.3, 18.9, and 21.8 months for TD, OM, CP, and CLP groups, respectively ( p < .001, unadjusted model). Both CP and CLP cohorts had a significantly longer time to stop emergence than either the TD or OM cohorts, even after adjusting for covariates. Abnormal middle ear status, lower symbolic language ability, and older age at palatal surgery were significantly associated with delayed stop emergence. Conclusions Survival model estimates show that four out of five children with repaired cleft palate will achieve emergence of prevocalic stop consonants by 19-22 months of age, corresponding to 9-12 months following palate repair. Clinical implications are discussed.

Objective: To determine vocabulary and lexical selectivity characteristics of children with and without repaired cleft palate at 24 months of age, based on parent report., Participants: Forty-nine children with repaired cleft palate, with or without cleft lip (CP±L; 25 males; 21 cleft lip and palate, 28 CP only), 29 children with a history of otitis media (OM) and ventilation tubes (21 males), and 25 typically developing (TD) children (13 males)., Main Outcome Measure(s): Parent-reported expressive vocabulary was determined using the MacArthur Communicative Development Inventory: Words and Sentences., Results: Vocabulary size was reduced for children with repaired CP±L compared to children in the TD group ( P = .025) but not the OM group ( P = .403). Mean percentage of words beginning with sonorants did not differ across groups ( P = .383). Vocabulary size predicted sonorant use for all groups ( P = .001)., Conclusions: Children with repaired CP±L exhibit similar lexical selectivity relative to word initial sounds compared to noncleft TD and OM peers at 24 months of age, based on parent report.

Purpose This study investigated vocabulary growth from 18 to 24 months of age in young children with repaired cleft palate (CP), children with otitis media, and typically developing (TD) children. In addition, the contributions of factors such as hearing level, middle ear status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary were explored. Method Vocabulary size of 40 children with repaired CP, 29 children with otitis media, and 25 TD children was measured using the parent report on MacArthur-Bates Communicative Development Inventories: Words and Sentences (Fenson et al., 2007) at 18 and 24 months of age. All participants underwent sound field audiometry at 12 months of age and tympanometry at 18 months of age. A multiple linear regression with and without covariates was used to model vocabulary growth from 18 to 24 months of age across the 3 groups. Results Children with CP produced a significantly smaller number of words at 24 months of age and showed significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children ( p < .05). Although middle ear status was found to predict vocabulary growth from 18 to 24 months of age across the 3 groups ( p < .05), the confidence interval was large, suggesting the effect should be interpreted with caution. Conclusions Children with CP showed slower expressive vocabulary growth relative to their age-matched TD peers. Middle ear status may be associated with development of vocabulary skills for some children.

Posterior nasal fricatives (PNFs) are unusual articulations that occur in some children with and without cleft palate. The etiology of PNFs is unclear. A young girl with repaired cleft palate is described who exhibited inconsistent obligatory nasal turbulence during production of stops at 2 years of age. At 3 years of age, she exhibited various phonological processes and used PNFs to replace sibilants and affricates. Pressure-flow testing showed a relatively small velopharyngeal area during production of stops. These observations are consistent with obligatory nasal turbulence triggering the development of PNFs as an unusual phonological process, perhaps facilitated by reduced hearing.

Two cases are presented that show increased loudness as contributory to the occurrence of audible posterior nasal turbulence as an obligatory symptom. Case 1 was an 18-month-old boy with repaired cleft palate who exhibited sporadic posterior nasal turbulence with velar flutter that was associated with increased loudness. Case 2 was a 4-year-old boy with repaired cleft palate who exhibited relatively frequent posterior nasal turbulence with velar flutter that was associated with pervasive and excessive loudness. Following 3 therapy sessions, loudness was reduced and audible nasal turbulence was eliminated. Clinical implications are discussed.

Purpose: The main objective was to examine temporal parameters of stop-plosives in Persian-speaking children with repaired cleft lip and palate (CLP)., Method: Eleven children with repaired bilateral CLP and 20 typically-developing children participated in the study. Stop-gap duration (SGD) and voice-onset time (VOT) were measured based on digital waveform and spectrographic displays., Result: Separate linear mixed model analyses showed significantly longer SGDs for children with CLP for all plosives in word-mid and final positions. Furthermore, children with CLP tend to produce longer VOTs for all voiceless plosives., Conclusion: Persian-speaking children with repaired CLP prolong stop-gap segments, similar to findings reported for English-speaking children with CLP. Prolonged segments may be due to an active strategy to increase oral air pressure and/or improve perceptual accuracy of speech segments.

Purpose: The objective was to determine velopharyngeal (VP) status of stop consonants and vowels produced by young children with repaired cleft palate (CP) and typically developing (TD) children from 12 to 18 months of age., Method: Nasal ram pressure (NRP) was monitored in 9 children (5 boys, 4 girls) with repaired CP with or without cleft lip and 9 TD children (5 boys, 4 girls) at 12, 14, and 18 months of age. VP status was categorized as open or closed for oral stops and vowels in three contexts-consonant-vowel syllables, vowel-consonant-vowel syllables, and isolated vowels-on the basis of the presence or absence of positive nasal ram pressure., Results: At 12 months of age, TD children produced 98% of stops and vowels in syllables with VP closure throughout the entire segment compared with 81% of stops and vowels for children with CP (p < .0001). There were no significant group differences at 14 or 18 months of age., Conclusions: TD children exhibit consistent VP closure for stop consonants and vowels at 12 months of age. Some children with repaired CP do not achieve consistent closure until 14 months of age, approximately 3 to 4 months following palate repair.

Objective: The purpose of this study was to determine the influence of age and selected phonetic factors on velar flutter as a component of nasal turbulence in children with repaired cleft palate., Participants: A total of 30 children with repaired cleft palate with or without cleft lip ranging in age from 4 to 13 years (mean, 8.6 years; standard deviation, 2.4 years) who exhibited nasal turbulence characterized by velar flutter participated in the study., Measures: The headset of a nasometer was used to record the children producing multiple repetitions of consonant-vowel (CV) syllables that contrasted the stops /p/ and /t/ with the fricatives /f/ and /s/ and the high-front vowel /i/ with the low mid-central vowel /Λ/. All targeted consonants were coded relative to the presence of flutter using both perceptual and spectral criteria. Percentages of syllables coded for flutter were calculated as a function of consonant and vowel types. Intra-and interjudge reliability of coding was high., Results: Percentages of syllables with velar flutter ranged from a high of 100% to a low of 4% among the participants. A Spearman rank-order correlation between age and percentage of syllables with flutter was nonsignificant. Mantel-Haenszel tests for repeated measures indicated that flutter occurred more often during production of syllables containing /i/ (62%) when compared with /Λ/ (50%) (P = .029)., Conclusions: Velar flutter as a component of nasal turbulence varies widely among children with repaired cleft palate. CV syllables with high vowels appear to trigger velar flutter more often than syllables with low vowels.

Objective: To determine whether children with repaired cleft palate and adequate velopharyngeal closure exhibit abrupt laryngeal engagement during stop plosive-vowel transitions as compared with children without cleft palate., Design: A prospective group design was used with convenience sampling of patients at a university craniofacial center., Participants: PARTICIPANTS were 25 children (15 boys, 10 girls) with repaired cleft palate (mean age = 10.9 years, standard deviation = 1.5 years) and 20 children (10 boys, 10 girls) without cleft palate (mean age = 10.8 years, standard deviation = 1.8 years). All children with cleft palate had adequate velopharyngeal closure as determined by aerodynamic testing., Main Outcome Measures: (1) Peak oral airflow was determined during the release of /t/ in the word "two" during a counting task. (2) An index of laryngeal engagement defined as the ratio of the maximum oral airflow declination to peak oral airflow was calculated during the release of /t/. (3) Sound pressure level was determined during the vowel of the word "two.", Results: Children with cleft palate exhibited significantly more negative laryngeal engagement ratios (i.e., more abrupt adduction) (P = .002) and greater sound pressure level (P = .049) than controls. There was a significant negative relationship between laryngeal engagement and sound pressure level for all children (r = -.428, P = .003)., Conclusions: Children with repaired cleft palate and adequate velopharyngeal function appear to use a strategy of abrupt laryngeal adduction during stop plosive-vowel transitions. This strategy-perhaps learned even prior to palate surgery-may help to achieve either adequate sound pressure level and/or velopharyngeal closure.

Purpose: To determine if children with repaired cleft palate and normal velopharyngeal (VP) closure as determined by aerodynamic testing exhibit greater acoustic nasalance than control children without cleft palate., Method: Pressure-flow procedures were used to identify 2 groups of children based on VP closure during the production of /p/ in the word hamper: (a) children with repaired cleft palate and normal VP closure ( n = 23) and (b) controls without cleft palate and with normal VP closure ( n = 16). Acoustic nasalance scores were obtained for all children during the production of syllables with high-pressure consonants and sentences with low-pressure consonants (i.e., low-pressure sentences)., Results: Nasalance scores were generally higher for children with repaired cleft palate and normal VP function as compared to controls; however, a significant difference occurred only for low-pressure sentences ( p = .005)., Conclusion: Results partially support a pressure-sensitive theory of VP function in that some children with repaired cleft palate may achieve VP closure during the production of high-pressure consonants but fail to do so during the production of vowels and low-pressure consonants. Clinical implications are discussed.

Spectral moment analysis (SMA) was used to describe voiceless alveolar and velar stop-plosive production in Persian-speaking children with repaired cleft lip and palate (CLP). Participants included 11 children with bilateral CLP who were undergoing maxillary expansion and 20 children without any type of orofacial clefts. Four of the children with CLP also exhibited backed (palatal) placement for alveolar stops. All children produced consonant-vowel-consonant nonsense words that targeted the plosives /t/ and /k/. SMA revealed that children with CLP had significantly reduced first spectral moment of /t/ and /t/-/k/ difference. Children with CLP who produced palatal stops for alveolar targets also had lower but non-significant first spectral moments for /t/ as compared with children with CLP who did not produce palatal stops. The results are consistent with previously reported findings for English-speaking children with repaired CLP and further suggest that maxillary arch constriction may be a contributing factor for (a) reduced spectral distinction of alveolar targets and/or (b) palatal substitutions for alveolar targets.

Purpose: The purpose of this study was twofold: (a) to determine maxillary arch dimensions of children with repaired cleft lip and palate (CLP) who produced middorsum palatal stops and (b) to describe some spectral characteristics of middorsum palatal stops., Method: Maxillary arch width, length, and height dimensions and first spectral moments of /t/-/k/ contrast words were determined for three groups of children ages 7-11 years: (a) with CLP who were clinically judged to produce middorsum palatal stops ( n = 5), (b) with CLP but without middorsum palatal stops ( n = 6), and (c) typically developing controls ( n = 8). Validity of clinical judgments of middorsum palatal stops was assessed by adult listeners via forced-choice identification of /t/-/k/ contrast words., Results: Listeners confirmed production of middorsum palatal stops for 4 of 5 children with CLP. These children had (a) the narrowest anterior maxillary arch width relative to posterior arch width ( p = .011) and (b) the lowest first spectral moment for /t/ targets ( p = .001) and the lowest /t/-/k/ difference ( p = .010)., Conclusion: Middorsum palatal stops may occur in children with repaired CLP in response to limited anterior oral cavity space due to restricted (or collapsed) maxillary arches. First spectral moment characteristics of middorsum palatal stops are consistent with backed lingual placement during stop release.

Objective: To determine the reliability and validity of a computer-mediated, 50-word intelligibility test designed to be a global measure of severity of speech disability in children with repaired cleft lip and palate., Design: A prospective between-group design was used with convenience sampling of patients from a university craniofacial center., Participants: A total of 38 children between the ages of 4 and 9 years participated. Of these, 22 had repaired cleft lip and palate; whereas, 16 had no clefts. Twenty adults served as listeners., Main Outcome Measure(s): Speech intelligibility scores were calculated for repeated administrations of a single-word test based upon the number of correct orthographically transcribed words by four groups of five listeners per child. Measures of parallel forms, interlistener, and intralistener reliabilities were estimated; measures of construct validity were also determined., Results: All measures of reliability were adequate. Parallel forms reliability of the test based upon mean scores from five listeners per child was high (r = .97). Thirty-seven of 38 children had differences between forms of 11 percentage points or less. Construct validity of the test was shown by (1) significantly lower speech intelligibility scores for children with cleft lip and palate than controls and (2) a moderately high correlation (r = .79) between intelligibility scores and percent consonants correct for all children., Conclusions: A computerized, single-word intelligibility test was described that appears to be a reliable and valid measure of global speech deficits in children with cleft lip and palate. Additional development of the test may further facilitate standardized assessment of children with cleft lip and palate.

Objective: The purpose of this preliminary study was to determine if cleft type and/or history of otitis media with effusion (OM) contribute to backing of /t/ and/or /s/ in young children with and without repaired cleft palate (CP). Method: Participants were 39 children (Mage = 36 months, range: 34-41). Ten children had repaired unilateral cleft lip and palate (CLP), nine had repaired CP only, 12 had no clefts but histories of OM, and eight were typically developing (TD) without clefts or OM history. All children were video- and audio-recorded during administration of the Goldman-Fristoe Test of Articulation--Third Edition (GFTA-3). Standard scores of articulation, frequency of alveolar backing, and first spectral moments of the /t/--/k/ and /s/--/ʃ/ phonetic contrasts were obtained. Results: Children with CLP had lower GFTA-3 scores than both TD (p = .012) and OM (p = .001) groups. Fisher's exact test showed that significantly more children with CLP backed alveolar targets, mostly /s/, than children with CP (p = .020). Children with CLP also had (a) reduced /t/--/k/ spectral difference compared to TD children (p = .016) and (b) reduced /s/--/ʃ/ spectral difference compared to both children with CP (p = .010) and children with OM (p = .018). Children with OM had reduced /t/--/k/ spectral difference compared to TD children (p = .009). Conclusions: Cleft type contributes to alveolar backing and reduced spectral contrast of /s/--/ʃ/ in 3-year-old children with repaired CP. History of OM affects spectral contrast of /t/--/k/ in noncleft children. Etiology and clinical implications of alveolar backing are discussed. [ABSTRACT FROM AUTHOR]

Purpose: This case report describes the development, characteristics, and resolution of anterior nasal fricatives (ANFs)--a learned maladaptive articulation error--in a young girl with repaired bilateral cleft lip and palate. Method: The girl was observed every 2 months from 12 to 24 months of age with follow-ups at 36, 48, and 67 months of age. Results: At 12 months of age, the girl nasalized /b/ inconsistently and had mild conductive hearing loss. At 18 months of age, she exhibited audible nasal air emission on some plosives and used ANFs to replace /s/ and /z/, often with a nasal grimace. At 24 months of age, the child continued to experience mild conductive hearing loss, obligatory nasal air emission, and ANFs for /s/ and /z/. At 36 months of age, pressure-flow testing documented significant velopharyngeal (VP) dysfunction. The girl then used ANFs for /f/ and /s/, phonetically marked by different oral stops. At 48 months of age, although VP impairment continued, speech therapy largely eliminated ANFs. By 67 months of age, VP closure was nearly normal. Conclusions: Multiple factors including VP dysfunction, audible nasal air emission, and conductive hearing loss contributed to the development of ANFs. Clinical and etiological implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: To determine vocabulary and lexical selectivity characteristics of children with and without repaired cleft palate at 24 months of age, based on parent report. Participants: Forty-nine children with repaired cleft palate, with or without cleft lip (CP±L; 25 males; 21 cleft lip and palate, 28 CP only), 29 children with a history of otitis media (OM) and ventilation tubes (21 males), and 25 typically developing (TD) children (13 males). Main Outcome Measure(s): Parent-reported expressive vocabulary was determined using the MacArthur Communicative Development Inventory: Words and Sentences. Results: Vocabulary size was reduced for children with repaired CP±L compared to children in the TD group (P =.025) but not the OM group (P =.403). Mean percentage of words beginning with sonorants did not differ across groups (P =.383). Vocabulary size predicted sonorant use for all groups (P =.001). Conclusions: Children with repaired CP±L exhibit similar lexical selectivity relative to word initial sounds compared to noncleft TD and OM peers at 24 months of age, based on parent report. [ABSTRACT FROM AUTHOR]

Posterior nasal fricatives (PNFs) are unusual articulations that occur in some children with and without cleft palate. The etiology of PNFs is unclear. A young girl with repaired cleft palate is described who exhibited inconsistent obligatory nasal turbulence during production of stops at 2 years of age. At 3 years of age, she exhibited various phonological processes and used PNFs to replace sibilants and affricates. Pressure-flow testing showed a relatively small velopharyngeal area during production of stops. These observations are consistent with obligatory nasal turbulence triggering the development of PNFs as an unusual phonological process, perhaps facilitated by reduced hearing. [ABSTRACT FROM AUTHOR]

Two cases are presented that show increased loudness as contributory to the occurrence of audible posterior nasal turbulence as an obligatory symptom. Case 1 was an 18-month-old boy with repaired cleft palate who exhibited sporadic posterior nasal turbulence with velar flutter that was associated with increased loudness. Case 2 was a 4-year-old boy with repaired cleft palate who exhibited relatively frequent posterior nasal turbulence with velar flutter that was associated with pervasive and excessive loudness. Following 3 therapy sessions, loudness was reduced and audible nasal turbulence was eliminated. Clinical implications are discussed. [ABSTRACT FROM AUTHOR]

The article focuses on a study on influences of age and phonetic factors on velar flutter as a component of nasal turbulence in children with repaired cleft palate. It states that percentages of syllables coded for flutter were calculated as a function of consonant, and mentions that percentages of syllables with velar flutter ranged from high to low among participants. It notes that velar flutter as a component of nasal turbulence varies widely among children with repaired cleft palate.

Objective: To determine whether children with repaired cleft palate and adequate velopharyngeal closure exhibit abrupt laryngeal engagement during stop plosive-vowel transitions as compared with children without cleft palate. Design: A prospective group design was used with convenience sampling of patients at a university craniofacial center. Participants: Participants were 25 children (15 boys, 10 girls) with repaired cleft palate (mean age = 10.9 years, standard deviation - 1.5 years) and 20 children (10 boys, 10 girls) without cleft palate (mean age = 10.8 years, standard deviation = 1.8 years). All children with cleft palate had adequate velopharyngeal closure as determined by aerodynamic testing. Main Outcome Measures: (1) Peak oral airflow was determined during the release of /t/ in the word "two" during a counting task. (2) An index of laryngeal engagement defined as the ratio of the maximum oral airflow declination to peak oral airflow was calculated during the release of /t/. (3) Sound pressure level was determined during the vowel of the word "two." Results: Children with cleft palate exhibited significantly more negative laryngeal engagement ratios (i.e., more abrupt adduction) (P= .002) and greater sound pressure level (P = .049) than controls. There was a significant negative relationship between laryngeal engagement and sound pressure level for all children (r=-.428, P = .003). Conclusions: Children with repaired cleft palate and adequate velopharyngeal function appear to use a strategy of abrupt laryngeal adduction during stop plosive-vowel transitions. This strategy--perhaps learned even prior to palate surgery--may help to achieve either adequate sound pressure level and/or velopharyngeal closure. [ABSTRACT FROM AUTHOR]

Objective: To compare nasal ram pressure (NRP) data with perceptual speech assessments in young children following palatoplasty. Design and Setting: NRP monitoring, a noninvasive technique using a two-pronged nasal cannula that detects nasal airflow during speech, was performed on patients 12 months following palatoplasty in our Craniofacial Center. Patients: Eighteen English-speaking nonsyndromic patients, aged 21 to 28 months, without hearing or language deficits, underwent NRP testing. Main Outcome Measured: During NRP measurement, the number of oral stop consonants produced spontaneously or following prompts was recorded. Stops were considered produced with velopharyngeal closure if NRP demonstrated no nasal airflow. The percentage of closed stops as measured by NRP was compared to the clinical assessment by craniofacial team speech-language pathologists. Results: Eight patients achieved 100% stop closure. Four patients obtained 90% to 96% sto closure. Three patients had stop closure of 85%, 78%, and 50%. Three patients had 0% sto closure; two of these patients subsequently underwent secondary palatal surgery. No significant clinical speech deficits were noted in patients with >90% closure. No association with defect size or cleft type was identified. Conclusions: NRP monitoring is well-tolerated in young children following palatoplasty. Achieving velopharyngeal (VP) closure for >90% of stops is associated with a clinical assessment of adequate speech and VP function. Postoperative NRP testing may serve as a useful adjunct to clinical speech evaluation for early identification of children who require more ntensive speech therapy or secondary palatal surgery. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effects of altered fundamental frequency (F0) on nasalance levels of the vowels /i/ and /a/ produced by adults without cleft palate within a controlled sound pressure level (SPL) range. Design: A prospective group design with convenience sampling from the University of North Carolina at Chapel Hill was used. Participants: 20 men and 20 women participated, aged 18 to 55 years. All were native English speakers with normal speech and language skills and adequate velopharyngeal function. Main Outcome Measures: The outcome measures were percentage nasalance obtained from the Nasometer 6200 (KayPentax) headset and the Computerized Speech Lab Model 4400 (CSL, KayPentax) during vowel production while speakers (1) targeted an SPL range of 75 to 85 dB and (2) targeted the SPL plus F0 range of 165 to 175 Hz. Results: A significant univariate effect was found for the vowels /i/ and /a/ in the targeted SPL condition such that /i/ was produced with higher nasalance than /a/. A significant univariate effect was also found during production of /a/ in the targeted SPL plus F0 condition such that men produced /a/ with higher nasalance than women did. Conclusions: SPL appears to largely account for percentage nasalance differences between the vowels /i/ and /a/ produced by adult male and female speakers. Increased F0 by male speakers appears to influence percentage nasalance during production of the vowel /a/. Clinical implications in regard to assessment of hypernasality are discussed. [ABSTRACT FROM AUTHOR]