Examining Factors That Impact Speech Acceptability and Intelligibility in 4- to 7-Year-Old Children With Cleft Palate

Objective Examine factors that impact ratings of speech acceptability and parent-reported speech intelligibility using the Intelligibility in Context Scale (ICS). Design Prospective, cross-sectional study. Setting Public research university. Patients Thirty children 4 to 7 years old with a repaired cleft palate. Variables Perceptual ratings derived from the Cleft Audit Protocol for Speech-Augmented-Americleft Modification, ICS, percent consonants correct (PCC), age, and sex. Main Outcome Measure(s) Factors associated with speech accepatability were assessed using Spearman's rho (ρ) and chi-square tests. Factors that predicted the average score on the ICS were assessed using linear regression. Results Hypernasality ratings and PCC were associated with ratings of speech acceptability. There was a moderate, positive correlation between ratings of hypernasality and ratings of speech acceptability [ρ = .51, P < .01]. As hypernasality ratings increased, speech was rated as less acceptable. There was a moderate, negative correlation between PCC and ratings of speech acceptability [ρ = −.67, P < .01]. Children who produced more consonants correct were rated as having more acceptable speech. PCC predicted ( P = .010) the average total score on the ICS. As PCC increased, the average score on the ICS also increased. While PCC predicted ICS scores, hypernasality ratings significantly predicted PCC ( P = .023) and percent of compensatory misarticulation errors used ( P = .001). Conclusions Speech-language pathologists need to develop individualized treatment plans that may include (1) recommending speech therapy to increase consonant accuracy that would improve both speech acceptability and intelligibility and (2) identifying children who require surgical intervention to address moderate-to-severe hypernasality, which may be impacting consonant production.