Opening the Black Box of Phonological Awareness: An Exploratory Study Assessing the Different Levels of Phonological Awareness in Children with a Cleft Palate Compared to Peers

Background: The purpose of the present exploratory study was to compare the 3 different levels of phonological awareness (i.e., the syllabic, intrasyllabic, and phonemic levels) between Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) and typically developing peers. Methods: Seven Dutch-speaking children with a CP ± L, aged between 6 and 12 years, were included in this study. A control group consisting of 7 children without a CP ± L was composed and matched based on age, gender, and socio-economic status. Phonological awareness was assessed using 2 tests: (1) the phonological awareness subtest of the Dutch version of the Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-IV-NL), which was administered to all children and (2) the Dutch Phonological Awareness Test (PAT), which was administered only to children younger than 10 years. Differences in phonological awareness were assessed on the syllabic, intrasyllabic, and phonemic levels. Results: No statistically significant differences in scores on the phonological awareness subtest from the CELF-IV-NL were observed between children with and without a CP ± L. When comparing their scores on the different levels of phonological awareness, again no differences could be observed. Similarly, no statistically significant differences were observed in the scores of the Dutch PAT between the 2 groups. However, some descriptive differences could be observed. The median percentile scores of children with a CP ± L were considerably lower than the median score of children without a CP ± L for the subtests “rhyme” and “segmentation” of the PAT. Conclusion: The findings of this exploratory study did not provide evidence of differences in phonological awareness skills between children with CP ± L and their peers across the 3 levels assessed. For some specific phonological tasks (i.e., rhyme and segmentation), lower scores were descriptively observed in children with a CP ± L. Although evidence did not emerge to show differences in the 3 different levels of phonological awareness between children with a CP ± L and their peers, it remains important for speech-language pathologists to be attentive to these different levels, especially considering the relationship between phonological awareness, deficits in speech production, and development of literacy.