Do children with cleft palate have expressive and receptive language impairment? The NSW Cleft Palate EBP Group The NSW Cleft Palate EBP Group • • • • • Jana Carr Sharyn Greig Melissa Parkin Amanda Simon Alison Purcell* Background Information – Cleft Lip and Palate Incidence • Internationally – 0.4 – 2.2 per 1000 live births • Australia – 1 per 700 live births Treatment Challenges • • • • • • Feeding Surgical repair Hearing loss Communication disorders Dental development Psychosocial problems Communication disorders • Speech – – Articulation Phonology Resonance – Hypernasality – Hyponasality – Mixed resonance Phonation • Soft • Hoarse • Dysphonic Other CLP phenotypic features – – – – – – – – Asymmetry Non-right handedness Craniofacial morphology Dental anomalies Obicularis oris muscle defects Structural brain and vertebral anomalies Minor physical anomalies Velopharyngeal dysfunction Family Traits • Unaffected relatives – Facial morphology differs from controls • Increased facial width – Dentition differs CLP Phenotype • • • • • Language Learning Reading Cognition Social skills Nation (1970) “Cleftness” syndrome Clinical question Do children with cleft lip and palate have a higher incidence of expressive and expressive language impairment compared to children without cleft palate? Search of the evidence • Cleft palate EBP members • Hearing and Speech students – Selection Criteria • • • • The last 10 years Any type of cleft but no additional syndrome Language and learning Not pre-linguistic language Information sources • • • • Cochrane library Medline CIAP OVID Evidence reviewed Authors Year Number of Participants Age of Participants 1. Kapp-Simon & McGuire 1997 13 12 - 14 yrs 2. Chapman et al. 1998 20 3.7 - 4.9 yrs 7.6 - 9.6 yrs 3. Schonweiler & Lisson 1999 370 4.5 yrs 5 - 10 yrs 4. Pamplona et al. 2000 58 3 - 8 yrs 5. Morris & Ozanne 2003 20 2 and 3 yrs 6. Synder & Synder 2004 20 1.5 – 2.5 yrs 7. Frederickson et al. 2006 17 2.9 - 3.8 yrs Strength of the evidence 5 4 Number of Studies 3 2 1 0 1 2 3.1 3.2 Level of Evidence 3.3 4 Speech Pathology Practice Guidelines – (Clinic bottom line) Limited evidence that children with CP have increased receptive and expressive language impairment Risk factors • On-going hearing loss • Co-occurring articulation impairment • Low socio-economic status Speech Pathology Practice Guidelines • Specialist Cleft Palate Clinics – Cross centre annual language assessments • • • • 12 months 24 months 3 years 4 years etc Speech Pathology Practice Guidelines • Community Speech Pathology Clinics – – – – – Monitor language development Parent language enrichment and education School readiness programs Monitor later language development Monitor academic achievement Speech Pathology Practice Guidelines • Further research to expand the phenotype – Language development – Family history of language impairment – Genetics Thank You!