Do children with cleft palate have expressive and receptive language impairment?

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Do children with cleft palate have expressive and
receptive language impairment?

• The NSW Cleft Palate EBP Group

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The NSW Cleft Palate EBP Group

• Jana Carr
• Sharyn Greig
• Melissa Parkin
• Amanda Simon
• Alison Purcell

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Background Information Cleft Lip and Palate
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Incidence

• Internationally
• 0.4 2.2 per 1000 live births
• Australia
• 1 per 700 live births

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Treatment Challenges

• Feeding
• Surgical repair
• Hearing loss
• Communication disorders
• Dental development
• Psychosocial problems

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Communication disorders

• Speech
• Articulation
• Phonology

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Resonance

• Hypernasality
• Hyponasality
• Mixed resonance

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Phonation

• Soft
• Hoarse
• Dysphonic

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Other CLP phenotypic features

• Asymmetry
• Non-right handedness
• Craniofacial morphology
• Dental anomalies
• Obicularis oris muscle defects
• Structural brain and vertebral anomalies
• Minor physical anomalies
• Velopharyngeal dysfunction

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Family Traits

• Unaffected relatives
• Facial morphology differs from controls
• Increased facial width
• Dentition differs

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CLP Phenotype

• Language
• Learning
• Reading
• Cognition
• Social skills

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Nation (1970)
Cleftness syndrome
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Clinical question

• Do children with cleft lip and palate have a
  higher incidence of expressive and expressive
  language impairment compared to children without
  cleft palate?

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Search of the evidence

• Cleft palate EBP members
• Hearing and Speech students
• Selection Criteria
• The last 10 years
• Any type of cleft but no additional syndrome
• Language and learning
• Not pre-linguistic language

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Information sources

• Cochrane library
• Medline
• CIAP
• OVID

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Evidence reviewed
Authors Year Number of Participants Age of Participants
1. Kapp-Simon McGuire 1997 13 12 - 14 yrs
2. Chapman et al. 1998 20 3.7 - 4.9 yrs 7.6 - 9.6 yrs
3. Schonweiler Lisson 1999 370 4.5 yrs 5 - 10 yrs
4. Pamplona et al. 2000 58 3 - 8 yrs
5. Morris Ozanne 2003 20 2 and 3 yrs
6. Synder Synder 2004 20 1.5 2.5 yrs
7. Frederickson et al. 2006 17 2.9 - 3.8 yrs
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Strength of the evidence
Number of Studies
Level of Evidence
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Speech Pathology Practice Guidelines (Clinic
bottom line)

• Limited evidence that children with CP have
  increased receptive and expressive language
  impairment

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Risk factors

• On-going hearing loss
• Co-occurring articulation impairment
• Low socio-economic status

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Speech Pathology Practice Guidelines

• Specialist Cleft Palate Clinics
• Cross centre annual language assessments
• 12 months
• 24 months
• 3 years
• 4 years etc

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Speech Pathology Practice Guidelines

• Community Speech Pathology Clinics
• Monitor language development
• Parent language enrichment and education
• School readiness programs
• Monitor later language development
• Monitor academic achievement

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Speech Pathology Practice Guidelines

• Further research to expand the phenotype
• Language development
• Family history of language impairment
• Genetics

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Thank You!