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Speech production changes during early intervention: Children with cleft palate

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Speech production changes during early intervention: Children with cleft palate. Nancy J. Scherer a , A. Lynn Williams b , Ann Kaiser c , Kristin Mullins c , Lila Totino c

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Speech production changes during early intervention:

Children with cleft palate

Nancy J. Scherera, A. Lynn Williamsb, Ann Kaiserc, Kristin Mullinsc, Lila Totinoc

aDepartment of Audiology and Speech-Language Pathology, b Department of Education, East Tennessee State University

c Department of Special Education, Vanderbilt University

  • Introduction
  • Characteristics of Early Speech and Language Development for children with CLP
  • Delayed in onset of canonical babbling
  • Composition of babbling is less complex
  • Smaller consonant inventories
  • Poorer speech accuracy (Percent Consonants Correct)
  • Delayed onset and acquisition of words
  • Lexical selectivity
  • Produce more words beginning with the sounds they can
  • produce (nasals, glides, vowels) and fewer beginning with high pressure consonants
  • Preference for sounds at the extremes of the vocal tract
  • (labials, velars, and glottals)
  • Model of Early Speech/Language Development in Children with Clefts
  • Methods
    • Pre/Post Treatment Descriptive Measures Pre-Post Assessments for EMT/PE and BAU
    • EMT/PE Intervention
    • Clinician implemented
    • 48 sessions
    • 5 speech targets identified from single word
    • naming test (PEEPS) embedded in language goals
    • 5 play activities with at least 2 targets in each session
    • Criteria for exposure: At least 10 presentations
    • of the targets in each play activity
    • BAU Control

Results Cont.

  • Pre and post intervention assessments were compared using OLS regression models controlling for age, study group and pre intervention performance. Significant differences were noted between the groups on:
  • Global receptive/expressive measures
  • Number of different words from the language sample
  • Intelligibility
  • Speech sound accuracy


Limited sound inventories reduce options for words thereby limiting intelligibility. The person interacting with the child then has fewer opportunities to model and expand the child’s communicative attempts. Less feedback to the child in turns limits the child’s practice of speech production.

  • The EMT/PE intervention provided broad improvements in receptive/expressive language, particularly in vocabulary, and speech. EMT/PE was most effective in:
    • increasing the number of different words used in conversation
    • adding consonants to the sound inventories
    • reducing consonant omissions
    • reducing compensatory articulation errors
    • improving intelligibility
  • Speech Results
  • PCC Initial Consonants Medial/Final Consonants
  • Omissions Substitutions Compensatory Errors

While the children in the BAU group did make improvements in the speech and language, the EMT/PE intervention was more efficient in delivering intervention that addressed the critical early speech and vocabulary delays described in children with CLP.

  • Purpose
  • To provide preliminary data exploring a comparison of speech production outcomes in three groups of children:
    • Children with CLP who received an early intervention program utilizing Enhanced Milieu Teaching with Phonological Emphasis (EMT/PE)
  • (b) Children with CLP who were in a “business as usual” (BAU) control group

Figures show pre (blue) and post (red) intervention measures for all children in the BAU (top panel) and EMT/PE (bottom panel). Mean performance of the groups is indicated with filled symbols and best fit regression lines are shown for the groups. The black line shows best fit regression for a group of non-cleft children for comparison.

Clinical Implications

Children with CLP benefit from early intervention that addresses both speech and language development simultaneously rather than interventions that intervene separately in the speech or language domains.

  • Participants
  • 27 children with CLP (15-36 months of age)
  • 14 children in EMT/PE invention
  • 13 children in the BAU
  • Criteria for inclusion in study:
  • Non syndromic cleft lip and/or palate
  • Palate repair <13 months
  • Absence of sensorineural hearing loss
  • English is the language of the home
  • At least 5 words reported by parent
  • Able to imitate words
  • Recruited from 3 sites in middle and
  • east Tennessee
  • The EMT/PE group showed a significant difference pre-post from the BAU group in:
    • Total PCC
    • Reduction in consonant omissions
    • Reduction of compensatory articulation errors

For Additional Information

Contact Nancy J Scherer, Ph.D.

Acknowledgments and Disclosure

This research was supported by a grant from the NIDCD (IR21DC009654) to the first author. A sub-contract from the same grant was awarded to the second author. The third and fourth authors were research assistants on that grant.