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JCPSLP
Volume 18, Number 1 2016
Journal of Clinical Practice in Speech-Language Pathology
impairment of the central nervous system; (e) no
sensorineural hearing loss; and (f) complete dataset in the
database. All children who met these criteria were included
in the analyses. Children were excluded from this study if
other diagnosed syndromes or medical conditions were
present. Participant demographics are presented in Table 1.
Measures
Standardised assessments of phonological awareness,
language skills, and speech production, and informal
assessments of middle ear function and velopharyngeal
function were administered to participants, as part of
standard clinical care at 5;0 years of age. The assessments
described below were completed on a routine basis for all
children with CL/P on the speech pathology caseload. The
phonological awareness, speech production, language, and
velopharyngeal assessments were completed by five
qualified SLPs, all trained in the management of children
with CL/P. Administration of assessments occurred in one
session and adhered to standard testing protocols.
Participants were assessed individually and video- and
and Ryan (2003) found that the children with CL/P who had
reading disability scored significantly lower on rapid naming
and verbal expression than the group of children with
CL/P who did not have reading disability. However, there
was no difference found between participants’ phonemic
awareness skills. Earlier research with children without CL/P
has also shown a link between rapid naming and reading
disability (e.g., Wolf, Bowers, & Biddle, 2000). Richman
and Ryan (2003) suggested that the lack of any significant
differences between the groups on phonemic awareness
may mean that a model of reading disability based on
phonemic awareness may not apply to children with CL/P. It
is important to note however that this measure of phonemic
awareness was based only on the children’s ability to blend
sounds into meaningful words, which represents only one
aspect of phonological awareness, indicating a need for
further research into the broader phonological awareness
skills of children with CL/P.
More recently, Collett et al. (2010) investigated reading
and associated foundational reading skills in 85 children
aged between 5;0 and 7;0 years with (n = 42) and without
CL/P (n = 43). Results of this study indicated that the
reading abilities of children with CL/P were poorer than
the control participants, with noted difficulties in single
word and non-word reading tasks, as well as reading
comprehension, reading fluency, and non-word repetition.
The children with CL/P also had poorer phonological
awareness skills compared with their typically developing
peers. Given these difficulties, Collett et al. (2010) identified
a greater need to monitor these children as they progress
academically.
Although Collett et al. (2010) observed poorer phonological
awareness skills in children with CL/P, the influence of other
variables, such as speech production and middle ear
function, on phonological awareness skills were not explored.
Given speech production and middle ear function may be
compromised in children with CL/P, and both speech
production and middle ear function are intricately related to
phonological awareness, it is imperative that the relationship
between these skills be further investigated. The current
study aimed to examine phonological awareness skills in
children with CL/P and to investigate the relationship
between phonological awareness skills and language skills,
speech production, middle ear function, and velopharynngeal
function. The study sought to test the following hypotheses:
(a) the relationship between middle ear function and
phonological awareness will be significant, such that
children with poorer phonological awareness skills will have
impaired middle ear function; (b) the relationship between
speech production and phonological awareness will be
significant, such that children with poorer phonological
awareness skills will have poorer speech production skills;
and (c) a significant relationship between velopharyngeal
function and phonological awareness will be conditional to
a significant relationship between phonological awareness
and speech production and middle ear function.
Methods
Participants
A total of 30 children with CL/P aged between 5;0 and 6;0
years (mean = 5;2 years; SD = 3.39) with clinical data in an
existing outpatient hospital database were included in this
retrospective cohort study from 43 potential participants.
Children were selected for inclusion according to the
following criteria: (a) 5;0 to 6;0 years of age; (b) Australian
English as only language; (c) repaired CL/P; (d) no history of
Table 1. Summary of participant demographics for
type of cleft lip and/or palate, speech diagnosis,
velophargyngeal function, and middle ear function
(N = 30)
Participant variables
Variable categories
n %
Gender
Male
19 63.3
Female
11 36.7
Type of cleft
Submucousal cleft,
unrepaired
3 10
Soft palate only
3 10
Cleftofhardandsoft
palate
10 33.3
Unilateralcleftlipand
palate
10 33.3
Bilateral cleft lip and
palate
2 6.7
Cleftlipandalveolous
1 3.3
Softpalateonly,with
PierreRobinsequence
1 3.3
Speech diagnosis
Nospeechdifficulties
6 20.0
Speech difficulties
24 80.0
Velopharyngealfunction Not adequate
10 33.3
Adequate
20 66.7
Middle ear function Normal middle ear
function(TypeA)inat
least one ear
5 26.7
Bilateral Type B
tympanometry
13 43.3
Abnormal middle
ear function (Type C
tympanometry)inat
least one ear
12 30.0