Aim
We investigated how accurate observations of canonical babbling (CB) were and explored predictive babbling measures in children with and without medical diagnoses of conditions that can lead to ...speech and language problems.
Methods
From 2012 to 2014 this Stockholm‐based study recruited 38 children aged nine months to 21 months with medical diagnoses and 30 children aged 10 months without diagnoses and included 21 previously studied 12‐month‐old children without medical diagnoses. CB and consonant sound production were directly observed by video recording natural play with a caregiver. The percentage of CB was calculated from each recording, and a validated observation form was used. How accurately the children with and without CB were classified was investigated with sensitivity and specificity. The groups were compared using predictive babbling variables.
Results
The observation method identified children with and without CB well, with a specificity of 0.89 and sensitivity of 0.93, respectively. Children with predictive babbling measures were identified in the clinical group (specificity 0.93–0.97), and a lack of these measures indicated a risk of being in the clinical group (odds ratios > 10). The sensitivity was low (0.32–0.42).
Conclusion
Observation effectively identified a lack of CB and supported the importance of assessing babbling measures.
Aim
To describe speech ability in a population‐based study of children with cerebral palsy (CP), in relation to CP subtype, motor function, cognitive level and neuroimaging findings.
Methods
A ...retrospective chart review of 129 children (66 girls, 63 boys) with CP, born in 1999–2002, was carried out. Speech ability and background information, such as type of CP, motor function, cognitive level and neuroimaging data, were collected and analysed.
Results
Speech disorders were found in 21% of the children and were present in all types of CP. Forty‐one per cent of the children with speech disorders also had mental retardation, and 42% were able to walk independently. A further 32% of the children were nonverbal, and maldevelopment and basal ganglia lesions were most common in this group. The remaining 47% had no speech disorders, and this group was most likely to display white matter lesions of immaturity.
Conclusion
More than half of the children in this CP cohort had a speech disorder (21%) or were nonverbal (32%). Speech ability was related to the type of CP, gross motor function, the presence of mental retardation and the localization of brain maldevelopment and lesions. Neuroimaging results differed between the three speech ability groups.
Aim
We evaluated the concurrent and predictive validity of questions to parents of 10‐month‐old children about babbling.
Methods
Children with at least one native Swedish‐speaking parent were ...eligible for inclusion in this prospective longitudinal study. The parents were asked three questions about babbling at a routine healthcare visit. If parents reported a lack of canonical babbling (CB), children were assessed by a speech and language pathologist to evaluate the questions' concurrent validity. We then examined whether the babbling questions predicted which children would fail the routine language screening at 2.5/3 years.
Results
Fifteen of the 1126 children lacked CB according to the parent responses and the expert assessment confirmed 12 of these cases, providing a concurrent validity of 80%. The sensitivity to predict routine language screening was 8% (95% confidence interval 3–17), and the positive predictive value was 40% (95% confidence interval 20%–65%). However, only six of the children lacking CB at 10 months were among the 71 children who failed later language screening.
Conclusion
This study suggests that the babbling questions could be included in the 10‐month surveillance at the child health services as valid measures of babbling development, but they cannot predict language screening result at 2.5/3 years.
Objective:
To compare speech outcome and self-reported speech and communicative ability (SOK) in young adults treated with one-stage (OS) or two-stage (TS) palatal repair. Furthermore, to compare ...with normative data on individuals without cleft lip and palate and to study the relationship between patients’ and experts’ judgments.
Design:
A cross-sectional group comparison study with long-term follow-up. Participants: Patients born with unilateral cleft lip and palate treated at 2 cleft centers; 17 with OS at 14 months and 25 with TS, soft palate repair at 7 months and hard palate repair at 6.2 years. Pharyngeal flap surgery was performed in 53% (OS) and 24% (TS) of patients.
Main Outcome Measure(s):
Speech characteristics were blindly assessed by speech and language pathologist from audio recordings, SOK at 19 years of age.
Results:
No group differences were found. Although the occurrence of nasality symptoms was low in both groups, only 60% (OS)/65% (TS) were assessed with competent velopharyngeal function (VPC). Articulation proficiency (percentage of consonants correct PCC) was 91%/97%, the /s/-sound specifically 87%/91%. Good intelligibility was found in 91%/87%. Patient opinion was in agreement with norms and significantly associated with intelligibility (rs = 0.436, P < .01), PCC (rs = −0.534, P < .01), and correct /s/ (rs = −0.354, P < .05).
Conclusions:
No differences in speech outcome were related to operation method. The low prevalence of VPC was not clearly reflected in nasality symptoms. Patient opinion was related to articulation and intelligibility. A higher burden of care in terms of pharyngeal flap surgery was seen after the OS technique.
To define the age when the higher prevalence of abnormal middle ear dissipates in individuals with cleft lip and palate and to investigate how this may affect hearing sensitivity over time.
...Retrospective and prospective cohort study.
University hospital.
Three groups of individuals with unilateral cleft lip and palate from the same cleft center: 1) a group of individuals followed longitudinally from 1 to 5 years of age (n = 22), 2) another group of individuals followed longitudinally from 7 to 16 years of age (n = 24), and 3) a group which encompasses young adults between 20 and 31 years of age (n = 26).
Abnormal middle ear status and hearing sensitivity.
The prevalence of abnormal middle ear status decreases as the individuals within the 3 groups age from 89% at age 1 year to 10% in young adulthood. Hearing statistically improved as children became older up to 13 years of age and then worsened in the high frequencies between 16 and 20 to 31 years of age.
There is a high prevalence of abnormal middle ear status in individuals with cleft lip and palate. This higher prevalence of abnormal middle ear status may lead to poorer high-frequency hearing, which could potentially lead to challenges in academics and difficulties understanding speech in social situations. Further investigation into these, the prevalence of abnormal middle ear status and hearing in comparison to a control group is warranted.
Objectives/Hypothesis
To study longitudinal prevalence of otitis media with effusion (OME) in children between 7 and 16 years of age by cleft group, and hearing sensitivity across time and across ...frequencies.
Study Design
Retrospective and longitudinal.
Methods
All children with cleft palate born from 1991 to 1993 were included in the study (n = 58). Audiological and otological data were reviewed at 7, 10, 13, and 16 years of age. The group was divided by cleft type (24 unilateral cleft lip and palate, 23 cleft palate only, and 11 bilateral cleft lip and palate).
Results
The prevalence of abnormal middle ear status decreased significantly with age. When comparing cleft types, the isolated cleft palate group presented with a significantly lower prevalence of abnormal middle ear status than the other groups at 7 and 16 years of age (21% as compared to 32% in the unilateral group and 38% in the bilateral group). The pure‐tone average improved with age, while the high‐frequency pure‐tone average did not. When cleft types were compared, the bilateral group demonstrated significantly poorer hearing in the high frequencies than the other groups.
Conclusion
Children with cleft palate need regular audiological and otological follow‐up to ensure management is appropriate and timely. The increased hearing thresholds in the high frequencies may be due to the increased episodes of OME.
Level of Evidence
2B.
This longitudinal study aimed to investigate early consonant production and the impact of hearing aid (HA) use, and aided audibility in Swedish children with moderate hearing loss (CHL) who received ...amplification before 6 months of age. CHL (n = 11) and children with normal hearing (CNH) (n = 11) were followed-up at 10, 18, and 36 months of age. At 10 months of age, the CHL used significantly fewer oral stops (p < 0.01), dental/alveolar stops (p < 0.05) and had a significantly fewer number of different true consonants (p < 0.01). At 18 months, there were no significant differences between the groups regarding presence of oral stops, and dental/alveolar stops, but the significant difference in the number of different true consonants remained (p < 0.00). At 36 months of age, consonant proficiency did not differ between the groups. A higher number of hours of HA use was associated with the presence of consonant variables at 10 months. Aided audibility showed weak to moderate correlations with number of consonants produced and proficiency. This group of children presented with initial delays in their early consonant production but seemed to catch up as they aged. Consistency of HA use from initial fitting is an important factor that may decrease the possible delays in the development of early consonant production and proficiency in CHL by 36 months of age.
Objective:
To present the methodology for speech assessment in the Scandcleft project and discuss issues from a pilot study.
Design:
Description of methodology and blinded test for speech assessment. ...Speech samples and instructions for data collection and analysis for comparisons of speech outcomes across five included languages were developed and tested.
Participants and Materials:
Randomly selected video recordings of 10 5-year-old children from each language (n = 50) were included in the project. Speech material consisted of test consonants in single words, connected speech, and syllable chains with nasal consonants. Five experienced speech and language pathologists participated as observers.
Main Outcome Measures:
Narrow phonetic transcription of test consonants translated into cleft speech characteristics, ordinal scale rating of resonance, and perceived velopharyngeal closure (VPC). A velopharyngeal composite score (VPC-sum) was extrapolated from raw data. Intra-agreement comparisons were performed.
Results:
Range for intra-agreement for consonant analysis was 53% to 89%, for hypernasality on high vowels in single words the range was 20% to 80%, and the agreement between the VPC-sum and the overall rating of VPC was 78%.
Conclusions:
Pooling data of speakers of different languages in the same trial and comparing speech outcome across trials seems possible if the assessment of speech concerns consonants and is confined to speech units that are phonetically similar across languages. Agreed conventions and rules are important. A composite variable for perceptual assessment of velopharyngeal function during speech seems usable; whereas, the method for hypernasality evaluation requires further testing.
To investigate speech development of children aged 5 and 10 years with repaired unilateral cleft lip and palate (UCLP) and identify speech characteristics when speech proficiency is not at 'peer ...level' at 10 years. Estimate how the number of speech therapy visits are related to speech proficiency at 10 years, and what factors are predictive of whether a child's speech proficiency at 10 years is at 'peer level' or not.
Longitudinal complete datasets from the Scandcleft project.
320 children from nine cleft palate teams in five countries, operated on with one out of four surgical methods.
Secondary velopharyngeal surgery (VP-surgery) and number of speech therapy visits (ST-visits), a proxy for speech intervention.
'Peer level' of percentage of consonants correct (PCC, > 91%) and the composite score of velopharyngeal competence (VPC-Sum, 0-1).
Speech proficiency improved, with only 23% of the participants at 'peer level' at 5 years, compared to 56% at 10 years. A poorer PCC score was the most sensitive marker for the 44% below 'peer level' at 10-year-of-age. The best predictor of 'peer level' speech proficiency at 10 years was speech proficiency at 5 years. A high number of ST-visits received did not improve the probability of achieving 'peer level' speech, and many children seemed to have received excessive amounts of ST-visits without substantial improvement.
It is important to strive for speech at 'peer level' before age 5. Criteria for speech therapy intervention and for methods used needs to be evidence-based.
Objective:
To investigate in-depth speech results in the Scandcleft Trial 2 with comparisons between surgical protocols and centers and with benchmarks from peers without cleft palate.
Design:
A ...prospective randomized clinical trial.
Setting:
Two Swedish and one Finnish Cleft Palate center.
Participants:
One hundred twelve participants were 5-years-old born with unilateral cleft lip and palate randomized to either lip repair and soft palate closure at 4 months and hard palate closure at 12 months or lip repair at 3 to 4 months (Arm A), or a closure of both the soft and hard palate at 12 months (Arm C).
Main Outcome Measures:
A composite measure dichotomized into velopharyngeal competency (VPC) or velopharyngeal incompetency (VPI), overall assessment of velopharyngeal function (VPC-Rate), percentage of consonants correct (PCC score), and consonant errors. In addition, number of speech therapy visits, average hearing thresholds, and secondary surgeries were documented to assess burden of treatment.
Results:
Across the trial, 53.5% demonstrated VPC and 46.5% VPI with no significant differences between arms or centers. In total, 27% reached age-appropriate PCC scores with no statistically significant difference between the arms. The Finnish center had significantly higher PCC scores, the Swedish centers had higher percentages of oral consonant errors. Number of speech therapy visits was significantly higher in the Finnish center.
Conclusion:
At age 5, poor speech outcomes with some differences between participating centers were seen but could not be attributed to surgical protocol. As one center had very few participants, the results from that center should be interpreted with caution.
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