Speech and language

Why are you collecting speech and language data?

Although clefts are generally repaired within the first years of life in the UK, and some affected children develop typical speech patterns, there is evidence that more than 50% of children born with a cleft palate require SLT intervention at some point (1,2). Indeed, a review of speech outcomes from the Cleft Speech Audit Group found that 19% of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or only just intelligible to strangers (3).

When problems with speech persist, either because of reduced intelligibility or acceptability, there can be lifelong consequences. Whilst the type and degree of cleft are undoubtedly important in speech outcome, other factors related to the child's physical and psycho-social development as well as environmental and genetic factors are thought to play a part. The Cleft Collective Cohort Studies provide a unique opportunity to look at the speech and language development in a large group of children born with cleft palate alongside a wide range of other factors which may play a part in explaining the variance in speech outcome. The findings from this study will help clinicians, particularly speech and language therapists, as the data will provide information on which factors are important and should be encouraged and promoted in interventions.

(1) Hardin-Jones M, Jones D. Speech production of preschoolers with cleft palate. Cleft Palate-Craniofacial Journal 2005;42(1):7.
(2) Peterson-Falzone SJ, Hardin-Jones MA, Karnell M. Cleft Palate Speech. 4th ed. St Louis, MO: Mosby Inc; 2009.
(3) Sell D, Grunwell P, Mildenhall S, Murphy T, Cornish T, Bearn D,,,,Sandy J. Cleft lip and palate care in the United Kingdom -- the Clinical Standards Advisory Group (CSAG) Study. Part 3: speech outcomes. Cleft Palate-Craniofacial Journal 2001 Jan, 38 (1);38(1):30-7.

What data are you collecting?

We are collecting data on children’s early vocalisations and interactions with their caregivers as well as data on their speech and language development at different time points, hearing and surgical history.

Data relating to the social, emotional, behavioural and cognitive development of the child, and the social, economic, psychological and health status of the mother and her partner, collected by The Cleft Collective Birth Cohort study will also be included in the analysis. A timeline (PDF, 61kB) which shows what data is being collected and when is available.

How and when are you collecting the data?

The first stage of data collection specific to this study will be at 13 months. Recordings of children's speech and interaction patterns made over the course of a single typical day when the child is aged 13 months using the LENA (Language Environment Analysis) system will be carried out. This will provide a sample of the child’s vocalisations at this early stage in their development plus information on conversational turns between the adult caregiver and the child. Parents will be sent the device along with instructions on how to use it. The instructions (PDF, 322kB) for interest. Further information on this system is available at: http://www.lenafoundation.org/ProSystem/Overview.aspx.

In addition, parents will be asked to complete a questionnaire on their child's speech and language development at this time point. Parents will also be given a hearing record which they will be asked to take with them to all hearing assessment appointments. They will also be asked to take this to speech and language therapy appointments. A copy of the hearing record  is available.

The information on this record will be of interest to the speech and language therapist and will inform their management. Further data will be collected from speech and language therapists during routine speech and language therapy assessments at ages 24 months (where available) and 36 months. The hearing record will be collected at this latter appointment and sent to the Cleft Collective base at the University of Bristol.

What will happen to the data?

The LENA recordings will provide an automatic analysis of the number of conversational turns used throughout the day, the number of child vocalisations and the quality of the audio environment. In addition, between four and six 5-minute segments of the sample of child vocalisations will be analysed in terms of phonetic inventories and syllable/babble patterns. The scores from all these analyses will be uploaded to a database together with the results from the developmental questionnaire given to parents at age 13 months, the hearing record and the speech and language assessments at age 24months and 36months.

These data will form a dataset which, in combination with the dataset from The Cleft Collective Cohort Studies, will become a large and comprehensive resource for future researchers. The initial investigation for The Cleft Collective Speech and Language study will use statistical analysis (multiple linear regression) to look for associations between speech outcome at age 36 months and possible risk factors identified through the psychology questionnaires, parent interaction measures, babbling and speech patterns at age 12 months and speech output at age 24 months.

How can I get involved?

This research plan has been developed in consultation with the lead speech and language therapists for cleft palate throughout the UK. If you want to know more about the study, please talk to your local cleft centre speech and language therapy team if you are based in the UK, or contact Dr Yvonne Wren, principal investigator for this study: yvonne.wren@bristol.ac.uk

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