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Yusof MS, Ibrahim H, Bressmann T, Hasbi AM. Facilitators, barriers, and strategies of communication in Malaysian school-age children with non-syndromic cleft lip and palate: Results of in-depth online qualitative interviews. CLINICAL LINGUISTICS & PHONETICS 2024:1-19. [PMID: 38637977 DOI: 10.1080/02699206.2024.2341304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
This study explores the perceptions of facilitators, barriers to communication and strategies in Malaysian school-aged children with non-syndromic cleft lip and palate (CL/P), parents, and teachers. Fourteen children with non-syndromic CL/P aged 7 to 12 years, their parents (n = 16), and their teachers (n = 10) were recruited via purposive sampling. Participants were selected based on resilience scores (RS-10; (Wagnild, 2015) distinguishing low (<34) from high resilience (35-40) (Wagnild, 2015). Individual in-depth interviews were conducted online and evaluated qualitatively. The analyses were conducted utilising the guidelines by Braun and Clarke (2006). Inductive thematic analysis was performed. Facilitators for communication identified by children, parents and teachers were the child's personal attributes, common interests, and helping others. Barriers that were identified were unfamiliar conversation partners, and insensitive comments or questions. Children used passive (e.g. ignored) and active (e.g. retorted, explained the condition) strategies to address social communication issues. Children with high resilience responded more actively than children with low resilience. Strategies that were described by the parents included accepting the child, empowering themselves, following the cleft management plan, and empowering the child. Teachers adopted general approaches such as giving encouragement, increasing confidence, and teaching empathy. The presence of face masks was perceived as both a facilitator and a barrier to communication. The study provides information on challenges encountered and coping mechanisms used by children with non-syndromic CL/P, their parents and their teachers. This knowledge may help the development of targeted interventions to support the communication of children with non-syndromic CL/P in school.
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Affiliation(s)
- Muhammad Safwan Yusof
- Faculty of Health Sciences, National University of Malaysia, Bangi, Malaysia
- Speech Therapy Unit, Otorhinolaryngology Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Hasherah Ibrahim
- Faculty of Health Sciences, National University of Malaysia, Bangi, Malaysia
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Toronto, Canada
| | - Alia Munirah Hasbi
- Faculty of Health Sciences, National University of Malaysia, Bangi, Malaysia
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Larsson A, Miniscalco C, Mark H, Jönsson R, Persson C. Persisting speech difficulties at 7-8 years of age - a longitudinal study of speech production in internationally adopted children with cleft lip and palate. LOGOP PHONIATR VOCO 2024; 49:1-10. [PMID: 35833222 DOI: 10.1080/14015439.2022.2083673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 10/17/2022]
Abstract
AIM To longitudinally investigate speech production (consonant proficiency, consonant errors and perceived velopharyngeal competence) in 17 internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) at three time points. METHOD Consonant proficiency (percent consonants correct, consonant inventory) and number and type of consonant errors were calculated based on blind phonetic transcriptions of words from the Swedish Test of Articulation and Nasality (SVANTE). Velopharyngeal competence was perceptually rated by three blinded experienced speech-language pathologists at the ages of 3, 5 and 7-8 years. RESULTS A significant positive development of speech production was found, although most children still scored very low for consonant proficiency at the age of 7-8 compared with normative values: the median for percent consonants correct was 79.7 and many children still had persisting cleft-related and developmental consonant errors. At the age of 7-8, almost half of the children were rated as having a competent velopharyngeal function and only three as having an incompetent velopharyngeal function. CONCLUSION Persisting speech difficulties at school age in IA children with UCLP were found in the present study, which is one of the very few longitudinal studies. Our results highlight the need for detailed follow-up of speech production in clinical settings. Speech disorders may have a severe impact on a child's intelligibility and participation with peers, and there is a need for more studies investigating the actual everyday effect of the difficulties found.
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Affiliation(s)
- AnnaKarin Larsson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Child Health Unit Gothenburg & Södra Bohuslän, Regionhälsan, Region Västra Götaland, Göteborg, Sweden
| | - Carmela Miniscalco
- Institute of Neuroscience and Physiology, Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Queen Silvia Children's Hospital, Department of Child Neuropsychiatry and Paediatric Speech and Language Pathology, Gothenburg, Sweden
| | - Hans Mark
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Radoslava Jönsson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology and Audiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Havstam C, Brunnegård K, Hagberg E, Nelli C, Okhiria Å, Klintö K. Speech in 7- and 10-year-olds born with a unilateral cleft lip and palate: a continued prospective Swedish intercentre study. J Plast Surg Hand Surg 2023; 58:149-154. [PMID: 38108470 DOI: 10.2340/jphs.v58.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/10/2023] [Indexed: 12/19/2023]
Abstract
The aim of this study was to report longitudinal speech results in consecutively selected children from each of the six cleft centres in Sweden and to compare the results between centres. The children were born with a non-syndromic unilateral cleft lip and palate, and results from the same cohort at 5 years of age have previously been reported. Background data on medical care in terms of surgery, speech therapy, and hearing between 5 and 10 years of age were collected. Speech recordings of 56 children at 7 years and 54 at 10 years of age were blindly and independently assessed by four speech-language pathologists experienced in cleft palate speech. This resulted in measures of percent consonant correct (PCC) and perceived velopharyngeal competence rated on a three-tier scale. No statistically significant differences were found between centres. PCC scores at 7 years of age ranged from 44-100% (median 97.5) and at 10 years of age from 86-100% (median 100). Competent or marginally incompetent velopharyngeal function was found in 95% of the 7-year-olds and 98% of the 10-year-olds. Speech results were slightly better than previous reports of speech in children born with a unilateral cleft lip and palate.
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Affiliation(s)
- Christina Havstam
- Department of Otorhinolaryngology, Speech and Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Karin Brunnegård
- Department of Clinical Sciences, Speech and Language Pathology, Umeå University, Sweden
| | - Emilie Hagberg
- Medical Unit Speech and Language Pathology and Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden; Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Nelli
- Speech and Language Pathology Unit, Otorhinolaryngology Clinic, University Hospital Linköping, Sweden
| | - Åsa Okhiria
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden
| | - Kristina Klintö
- Division of Speech Language Pathology, Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden; Division of Speech Language Pathology, Phoniatrics and Audiology, Department of Clinical Sciences in Lund, Lund University, Sweden
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Butterworth S, Fitzsimons KJ, Medina J, Britton L, Van Eeden S, Wahedally H, Park MH, van Der Muelen J, Russell CJH. Investigating the Impact of Patient-Related Factors on Speech Outcomes at 5 Years of Age in Children With a Cleft Palate. Cleft Palate Craniofac J 2023; 60:1578-1590. [PMID: 35733360 DOI: 10.1177/10556656221110094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To investigate the relationship between patient-related factors (sex, cleft type, cleft extent, and Robin Sequence [RS]) and speech outcome at 5 years of age for children born with a cleft palate ± lip (CP ± L). 3157 Children (1426 female:1731 male) with a nonsyndromic CP ± L, born between 2006 and 2014 in England, Wales, and Northern Ireland. Perceptual speech analysis utilized the Cleft Audit Protocol for Speech-Augmented (CAPS-A) rating and UK National Speech Outcome Standards: Speech Standard 1 (SS1)-speech within the normal range, SS2a-no structurally related speech difficulties or history of speech surgery, and SS3-speech without significant cleft-related articulation difficulties. Odds of achieving SS1 were lower among boys (aOR 0.771 [CI 0.660-0.901]), those with clefts involving the lip and palate (vs palate only) (UCLP-aOR 0.719 [CI 0.591-0.875]; BCLP-aOR 0.360 [CI 0.279-0.463]), and clefts involving the hard palate (incomplete-aOR 0.701 [CI 0.540-0.909]; complete-aOR 0.393 [CI 0.308-0.501]). Similar relationships with these patient factors were observed for SS3. SS2 was affected by the extent of hard palate involvement (complete; aOR 0.449 [CI 0.348-0.580]). Although those with CP and RS were less likely to meet all 3 standards than those without RS, odds ratios were not significant when adjusting for sex and cleft extent. Sex, cleft type, and extent of hard palate involvement have a significant impact on speech outcome at 5 years of age. Incorporating these factors into risk-adjustment models for service-level outcome reporting is recommended.
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Affiliation(s)
- Sophie Butterworth
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Kate J Fitzsimons
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Jibby Medina
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Lorraine Britton
- Trent Regional Cleft Network, Nottingham University Hospital NHS Trust, Nottingham, UK
| | | | | | - Min Hae Park
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jan van Der Muelen
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Craig J H Russell
- Royal Hospital for Children, Queen Elisabeth University Hospital, Glasgow, UK
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Heppner CE, Crerand CE, Crilly Bellucci C, Sheikh F, Woodard S, Albert M, Conrad AL, Kapp-Simon KA. A Multisite Study Investigating Child and Parent Proxy Reported Quality of Life in Children With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2023; 60:1474-1483. [PMID: 35675171 DOI: 10.1177/10556656221105766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This observational, multisite cohort study explored health-related quality of life (HRQoL) in children with cleft lip and/or palate (CL/P), including interrater agreement and ratings for this group relative to clinical cutoff scores and published means for healthy and chronically ill children. Participants (338 children ages 8-10 years, 45.9% male and their parents, 82.0% female) across 6 sites completed the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL). Intraclass correlation revealed poor interrater agreement for most HRQoL domains. Although ratings were generally higher than those expected for children with a chronic illness, child ratings were below healthy means for school functioning, and parent proxy ratings were below healthy means for all domains except physical functioning. Lower ratings consistent with chronic illness means were found for self-reported emotional and psychosocial functioning in children with cleft lip and palate (CLP), as well as parent proxy-reported emotional, school, and psychosocial functioning for children with cleft palate (CP). Scores were most likely to be in the clinical range for children with CP for social, school, and total functioning. Although parent proxy report provides important information about observed functioning, poor interrater agreement indicates that both child and parent proxy reported HRQoL should be included in outcomes assessment for CL/P. HRQoL ratings may be higher for children with CL/P compared to youth with other chronic illnesses, but psychosocial functioning may be negatively impacted when compared with healthy youth, particularly for emotional, social, and school functioning in children with CLP or CP.
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Affiliation(s)
- Celia E Heppner
- Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
- Fogelson Plastic and Craniofacial Surgery Center, Children's Health/Children's Medical Center, Dallas, TX, USA
| | - Canice E Crerand
- Department of Pediatrics, The Ohio State University College of Medicine and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University College of Medicine and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA
| | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA
- Craniofacial Center, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Amy L Conrad
- Division of Developmental and Behavioral Pediatrics, The Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kathleen A Kapp-Simon
- Craniofacial Center, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
- Cleft-Craniofacial Clinic, Department of Research, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
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Speech Symptoms of Velopharyngeal Insufficiency and the Incidence of Secondary Speech Surgery in 10-Year-Old Children With Unilateral Cleft Lip and Palate: Comparison of 2 Randomized Surgical Methods for Primary Palatal Surgery. J Craniofac Surg 2023; 34:461-466. [PMID: 36000743 DOI: 10.1097/scs.0000000000008926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare speech symptoms of velopharyngeal insufficiency (VPI) and incidence of secondary speech surgery in 10-year-old Finnish children with unilateral cleft lip and palate (UCLP) following primary palatal surgery using 2 surgical methods. DESIGN Single center analysis within the Scandcleft multicenter randomized controlled trial of primary surgery for UCLP. MATERIALS AND METHODS Patients comprised 79 nonsyndromic 10-year-old children with UCLP. Two randomized surgical methods were used in the primary palatal surgery: soft palate closure at 4 months and hard palate closure at 12 months (Arm A) and closure of both the soft and hard palate at 12 months (Arm C). Speech symptoms of VPI were analyzed from standardized video recordings by 2 experienced speech pathologists. The incidences of surgery for correcting VPI, fistula closure, and speech therapy were evaluated retrospectively from patient records. RESULTS No differences in speech symptoms of VPI, need for VPI surgery or speech therapy were found between the surgical methods. Of all 79 children, 33% had had VPI surgery and 61% had speech therapy. The number of fistulas was significantly higher in Arm A (25%) than in Arm C (2%). Moderate to severe speech symptoms of VPI (hypernasality, continuous nasal air leakage, weak pressure consonants, and/or compensatory articulation) were found in 11% of the children. CONCLUSION No differences were present between groups in speech symptoms of VPI or need for VPI surgery or speech therapy between the 2 surgical methods. One third of the children had undergone VPI surgery. Most of the children (89%) had good or relatively good speech.
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