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JCPSLP Volume 18, Number 1 2016 36
described above. For the purposes of this study,
velopharyngeal function was categorised by the researchers
into two groups: (a) adequate; or (b) not adequate based on
assessment data and clinical observations contained within
written speech pathology assessment reports. Written reports
indicating that velopharyngeal function was ‘probably
adequate’ and ‘borderline’ were categorised as inadequate
by the researchers. The assessment data and clinical
observations reported by speech pathologists were informed
by ratings of resonance (i.e., hyper-nasal or hypo-nasal),
and nasal airflow (i.e., nasal emission/turbulence).
Middle ear function
Tympanometry is a clinical measure of middle ear function,
which is used to examine the condition of the middle ear,
mobility of the tympanic membrane (or ear drum), and the
volume of the ear canal (Hamid & Brookler, 2007). For the
purposes of this study, middle ear function was categorised
into three groups: Type A tympanometry in at least one ear,
suggestive of normal middle ear function; Type B
tympanometry, suggestive of middle ear dysfunction and
often associated with the presence of middle ear effusion;
and Type C tympanometry, suggestive of significant
negative middle ear pressure, which may indicate middle
ear pathology.
Procedure
Ethical approval was obtained from The University of
Queensland Behavioural and Social Sciences Ethics Review
Committee, and the relevant hospital human research
ethics committee. After gaining approval to access an
established clinical database at the hospital, a search was
conducted to identify children who met the inclusion
criteria. After identifying all potential participants, information
on their demographics as well as on the variables of interest
was obtained from the database and medical charts
namely: phonological awareness skills, language skills,
speech production skills, velopharyngeal function, and
middle ear function. Medical charts were reviewed to
confirm existing information in the database and retrieve
missing data relevant to the variables of interest.
Participants with complete datasets were subsequently
included in this study.
Data analysis
All analyses were conducted using the Statistical Package
for Social Sciences (SPSS) Version 21.0 for Windows. To
address the first aim of the study, descriptive statistics were
used to explore the phonological awareness skills of
participants’ according to the five subtests of the PIPA. A
one-way repeated measures ANOVA was conducted to
compare scores on these five subtests of the PIPA, with
PIPA subtest scores and composite PIPA scores used to
explore the phonological awareness skills of participants.
Regression analysis was used to address the second
aim of the study, namely to investigate the relationship
between phonological awareness skills and language
standard scores (a continuous variable), and the three
ordinal categorical variables, namely speech diagnosis,
velopharyngeal function, and middle ear function. Prior to
analysis, normality of the dependent variable, phonological
awareness, was examined and confirmed. Examination
of the data also revealed no outlying data scores. The
variables of interest (i.e., language standard scores, speech
diagnosis, velopharyngeal function, and middle ear function)
were initially selected as possible candidate variables for
a multivariate regression model. Bivariate analyses were
audio-taped. Audiologists completed the assessment of
middle ear function. Each assessment is described below.
Phonological awareness
The Preschool and Primary Inventory of Phonological
Awareness (PIPA; Dodd, McIntosh, Teitzel, & Ozanne,,
2000) consists of five subtests normed on Australian
children, namely Syllable Segmentation (the ability to
identify syllables within a word), Rhyme Awareness (the
ability to identify similar sounding word endings), Alliteration
Awareness (the ability to identify and produce words
beginning with the same sound), Phoneme Isolation (the
ability to recognise individual sounds in words), and
Phoneme Segmentation (the ability to segment individual
sounds of a word). In each subtest of the PIPA there are 12
items. A standard score between 7 and 13 indicates skills
within normal limits. For the purposes of this study, the
standard scores from each PIPA subtest were added to
form a composite score for analysis.
Speech production
Participants’ speech production skills were assessed using
the Diagnostic Evaluation of Articulation and Phonology
(DEAP; Dodd, Hua, Crosbie, Holm, & Ozanne, 2002), the
Great Ormond Street Speech Assessment (Gos.Sp.Ass.;
Sell, Harding, & Grunwell, 1999), or the Cleft Audit Protocol
for Speech – Augmented (CAPS-A; John, Sell, Sweeney,
Harding-Bell, &Williams, 2006). The Phonology
Assessment component of the DEAP was administered
with 21 participants. The sentences section of the Gos.
Sp.Ass. and/or CAPS-A was administered with the
remaining 9 participants. For the purposes of analysis,
speech diagnosis was classified into two categorical
variables, namely speech difficulties and no speech
difficulties. This categorisation was informed by the
presence or absence of delayed and/or disordered speech
production processes, including consideration of the
presence or absence of both articulatory errors and
phonological processes.
Language
The Clinical Evaluation of Language Fundamentals –
Preschool 2nd Edition (CELF-P2; Wiig, Secord, & Semel,,
2004) or the Clinical Evaluation of Language Fundamentals
4th Edition (CELF-4; Semel, Wiig, & Secord,, 2003) were
used to formally assess participants’ language skills
depending on the age of the child at assessment. The age
range for the CELF-P is 3;0 to 6;11 years, whereas the
CELF-4 is designed for children aged 5;0 to 21;0 years.
Due to the clinical nature of the data collected for this study,
the decision to use either the CELF-P or the CELF-4 was
dependent on the child’s level of language skills and ability
to attend to stimuli. Due to variability in attention and
compliance, subtests administered with each participant
varied; however, each participant completed the minimum
number of relevant subtests to derive either a Core
Language Score (CLS) or a Receptive Language Index
(RLI). The CLS (n = 15) or RLI (n = 15) scores were used for
the purposes of statistical analysis in this study. Expressive
language scores were not included for analysis as scores
may have been affected by reduced intelligibility or
articulation errors associated with structural issues in a cleft
palate population, particularly with morphemes including
high pressure consonants (e.g., /s/ and /z/ in particular).
Velopharngeal function
Velopharyngeal function was assessed using the Gos.Sp.Ass
(Sell et al., 1999) or CAPS-A (John et al., 2006) as