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Prediction and Prognosis
www.speechpathologyaustralia.org.auJCPSLP
Volume 18, Number 1 2016
34
Keywords
cleft palate
hearing
language
middle ear
function
phonological
awareness
speech
velopharyn-
gealfunction
Thisarticle
has been
peer-
reviewed
Lilian Anderson
(top), Nerina
Scarinci (centre),
and Helen Morris
development is a dynamic process, whereby children
refine earlier developing skills as they learn more new, and
more complex skills (Francis & Anthony, 2005). Hence,
although phonological awareness tasks appear seemingly
simple, these tasks evidently contain many components
and their complexity should not be overlooked. There are a
number of factors that may contribute to the development
of phonological awareness skills, and research suggests
that children with CL/P often have significant difficulties in
these related skill areas, including language skills, speech
production, velopharyngeal function, and middle ear
function (e.g., da Silva, Collares, & da Costa, 2010; Hardin-
Jones & Chapman, 2011; Hardin-Jones & Jones, 2005;
Morris & Ozanne, 2003; Rudnick & Sie, 2008; Scherer,
Oravkinova, & McBee, 2013). Due to the prevalence of
these communication difficulties in children with CL/P and
the important relationship between phonological awareness
and later reading success (Castles & Coltheart, 2004), it is
imperative that research address the relationship between
phonological awareness and language skills, speech
production, middle ear function, and velopharyngeal
function in children with CL/P.
Although the majority of research in this field has
examined these skill areas independently, a number of
studies have explored reading skills in children with CL/P
and the relationship between reading performance, and
other areas of functioning. These studies have shown that
children with CL/P often demonstrate poorer reading skills
compared with their peers, especially in reading
comprehension and reading fluency at single word and
non-word levels (e.g., Collett et al., 2010; Richman, Eliason,
& Lindgren, 1988). Chapman (2011) examined early reading
skills of children with and without CL/P to identify the
relationship between speech production, language skills,
and early reading skills. In this study, the speech, language,
and reading abilities of 56 children aged between 5;0 and
6;0 years with (n = 28) and without (n = 28) CL/P were
assessed. Participants were matched for age, months of
formal schooling, and gender. Chapman (2011) found no
relationship between the presence of CL/P and speech,
language, and reading skills. Although the reading skills and
alphabetic knowledge of children with CL/P in this study were
within normal limits, they were still below the performance
of their peers without CL/P. Further statistical comparisons
revealed a moderate correlation between speech production,
language skills, and reading skills (Chapman, 2011).
In another study of children with nonsyndromic CL/P, with
(n = 46) and without (n = 46) reading disability, Richman
An exploratory retrospective cohort study
was conducted to explore the phonological
awareness skills of 30 children with cleft lip
and/or palate (CL/P) aged between 5;0 and
6;0 years and to investigate the relationship
between phonological awareness skills and
language skills, speech production, middle
ear function, and velopharnyngeal function.
Participants’ phonological awareness scores
were highly variable, with children having the
most difficulty with rhyme awareness.
Regression analysis revealed that language
skills was the only variable of interest that
was marginally associated with phonological
awareness (R
2
= .328, p = .054). The findings
suggest that phonological awareness and
language skills of children with CL/P are
related. Management of children with CL/P
should take a holistic approach, and include
early clinician involvement, including parental
instruction on how to enhance phonological
awareness and language development.
O
ro-facial clefts are heterogeneous, congenital
conditions that result from incomplete formation
of structures separating the nasal and oral
cavities (Samanich, 2009). According to the World
Health Organization (WHO), orofacial clefts occur in 1
in 500–700 births (WHO, 2012). Research has shown
that children with cleft lip and/or palate (CL/P) may have
difficulty with reading (e.g., Chapman, 2011; Collett,
Stott-Miller, Kapp-Simon, Cunningham, & Speltz, 2010)
and difficulties with reading are commonly associated with
poorer phonological awareness skills (Lyon et al., 2003).
Phonological awareness is defined as the ability to detect,
combine, and manipulate sound units in a language,
and is consequently a prerequisite to the development of
reading and literacy in alphabetic languages (Francis &
Anthony, 2005). Children’s phonological awareness builds
in a three-step progression: (a) syllable awareness (the
ability detect syllables in words); (b) onset-rime awareness
(detecting and generating rhyming words); and (c) phoneme
awareness (the understanding that words consist of
individual sounds) (Gillon, 2005). Phonological awareness
Phonological awareness
skills in children with
cleft lip and/or palate
Lilian Anderson, Nerina Scarinci, and Helen Morris