Normal Speech and Hearing by Age 5 as a Goal for Children With Cleft Palate

The authors report the results of a 4-year project to influence speech and hearing outcomes, employing direct program-management strategies with both multidiscipline professionals and family members of children born with oral clefts. Early and continuing speech and hearing diagnosis (12–60 months), parent education as speech aides, timely professional speech habilitation, including use of temporary speech appliances, and early medical care for ears were used in seeking a goal of normal oral-nasal resonance balance, developmentally normal articulation 1 and normal hearing by age 5 for 90% of children with cleft palate ± cleft lip. The project involved 41 children. This resulted in normal oral-nasal resonance in 93% (38) of the group at age 5. Normal developmental articulation proposed by Sander for "customary production" was also achieved by 93% at age 5. Thirty-eight of the 41 subjects produced 14 of 15 test phonemes correctly. Of the 15 test phonemes, / r / was most frequently in error. Twenty-seven percent (11) failed to produce this phoneme sucessfully. Sander norms require that 66% (not 100%) of 5-year-olds correctly produce this phoneme in two positions. When oral-nasal resonance balance and articulation were combined in each child, those children who achieved both normal oral-nasal resonance balance and normal articulation (per age expectancy) amounted to 88% (36). During the project, 98% (40) had normal hearing in at least one ear at age 5. Language screened normally for the group, as well. Twenty-two percent (8) of the subjects wore temporary speech appliances during the project. The effect of associated anomalies/abnormalities in 15 of the 41 subjects is also reported.