Do children with cleft palate have expressive and receptive language impairment? The NSW Cleft Palate EBP Group

Jana Carr Sharyn Greig Melissa Parkin Amanda Simon Alison Purcell*

Background Information – Cleft Lip and Palate

Incidence Internationally –0.4 – 2.2 per 1000 live births Australia –1 per 700 live births

Treatment Challenges Feeding Surgical repair Hearing loss Communication disorders Dental development Psychosocial problems

Communication disorders Speech –Articulation –Phonology

Resonance –Hypernasality –Hyponasality –Mixed resonance

Phonation Soft Hoarse Dysphonic

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

Family Traits Unaffected relatives –Facial morphology differs from controls Increased facial width –Dentition differs

CLP Phenotype Language Learning Reading Cognition Social skills

Nation (1970) “Cleftness” syndrome

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?

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

Information sources Cochrane library Medline CIAP OVID

Evidence reviewed AuthorsYearNumber of Participants Age of Participants 1. Kapp-Simon & McGuire yrs 2. Chapman et al yrs yrs 3. Schonweiler & Lisson yrs yrs 4. Pamplona et al yrs 5. Morris & Ozanne and 3 yrs 6. Synder & Synder – 2.5 yrs 7. Frederickson et al yrs

Strength of the evidence Number of Studies Level of Evidence

Speech Pathology Practice Guidelines – (Clinic bottom line) Limited evidence that children with CP have increased receptive and expressive language impairment

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

Speech Pathology Practice Guidelines Specialist Cleft Palate Clinics –Cross centre annual language assessments 12 months 24 months 3 years 4 years etc

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

Speech Pathology Practice Guidelines Further research to expand the phenotype –Language development –Family history of language impairment –Genetics

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