Early Speech and Language Development in Children With Nonsyndromic Cleft Lip and/or Palate: A Meta-Analysis

Abstract

Objective The aim of the study was to conduct a meta-analysis of research examining the early speech and language functioning of young children, birth to age 8;11 (years;months), with nonsyndromic cleft lip and/or palate (NSCL/P) compared to their peers without NSCL/P. Method We conducted a random-effects metaregression using 241 effect sizes from 31 studies comparing 955 young children with NSCL/P to 938 typically developing peers on measures of speech and language functioning. Moderators were sample characteristics (i.e., age, cleft type, publication year, and study location) and measurement characteristics (i.e., speech sample material, language modality and domain, and assessment type). Results Young children with NSCL/P scored significantly lower on measures of speech and language compared to children without NSCL/P. Children with NSCL/P had smaller consonant inventories (standardized mean difference effect size [ES g ] = −1.24), less accurate articulation (ES g = −1.13), and more speech errors (ES g = 0.93) than their peers. Additionally, children with NSCL/P had poorer expressive (ES g = −0.57) and receptive (ES g = −0.59) language skills than their peers. Age and assessment type moderated effect sizes for expressive language. As children with NSCL/P aged, their expressive language performance became more similar to their peers. Expressive language effect sizes from parent reports and observational language measures (estimated effect size = −0.74) were significantly lower than those from standardized norm-referenced tests (estimated effect size = −0.45). Conclusions These findings suggest that young children with NSCL/P experience delays relative to their peers across multiple speech and language constructs. Differences between children with NSCL/P and their typically developing peers appear to decrease with age. Supplemental Material https://doi.org/10.23641/asha.11356904

Early Assessment of Speech: Useful Clinical Indicators of Later Outcomes

“…The development of speech sounds directly influences the words that a child uses in their vocabulary, meaning that the more sounds produced early on will lead to a greater early vocabulary as the child develops. The consequences of these early delays are not known, but studies have shown that children born with a cleft perform poorly compared to peers in tests of language [26,27]. Although the presence of cleft articulation errors at 12-months was not found to be a significant predictor in this study, the early identification of non-oral and posterior articulation in very young children is of benefit in order for SLPs to provide timely intervention before these patterns become entrenched.…”

Orofacial Function, Articulation Proficiency, and Intelligibility in 5-Year-Old Children Born With Cleft Lip and Palate

“…A catch-up due to maturation is reported, resulting in non-significant differences compared to language competence in non-cleft peers (Boyce, Kilpatrick, Reilly, Da Costa, & Morgan, 2018;Collett, Leroux, & Speltz, 2010). In a recent meta-analysis, the conclusions were similar, after examining the literature (n=31) on speech and language development in children with nonsyndromic cleft lip ± palate from 1950 to 2018, including ages 0 through 8:11 (Lancaster et al, 2020). Both expressive and receptive language competence were examined, resulting in an average effect size of -0.57 SD unit lower for expressive language competence and -0.59 SD unit lower for receptive language skills for children with non-syndromic CP±L compared to competence of peers without clefts.…”

“…Both expressive and receptive language competence were examined, resulting in an average effect size of -0.57 SD unit lower for expressive language competence and -0.59 SD unit lower for receptive language skills for children with non-syndromic CP±L compared to competence of peers without clefts. The overall conclusion about language development and competence in children with non-syndromic CP±L was that of early onset language delay but with a decreasing negative impact over time (Lancaster et al, 2020). However, two studies not included in the analysis targeting language competence in preschool and early school-aged children with non-syndromic CP±L reported DLD in 14% to 20% (Klintö et al, 2019;Morgan et al, 2017), indicating that there are both children with and without cooccurring DLD in the heterogeneous group of children born with non-syndromic CP±L.…”

Canonical Babbling and Early Consonant Development Related to Hearing in Children With Otitis Media With Effusion With or Without Cleft Palate

“…Children with CP+L experience a higher prevalence of OME which is often associated with a conductive HL (Flynn et al, 2009;Tengroth et al, 2020). Nevertheless, hearing within CP+L literature has not been consistently reported and remains an unexplained variance in speech outcomes (Sparks Lancaster et al, 2020). Compared to children with normal hearing, children with CP+L, as well as children with hearing impairment demonstrate restrictions in their early consonant development.…”