Rethinking speech sound disorder (SSD) in non-syndromic cleft lip and palate: The importance of recognizing phonological and language difficulties.
Stephanie van Eeden, Cristina McKean, Helen Stringer
PMID 39821517WHAT IT FOUND
Children with cleft palate and phonological speech errors had significantly lower language scores than those with typical speech or cleft-specific articulation errors.
The combined phonological and cleft group was over ten times more likely to have expressive language difficulties, warranting full language assessment.
Key findings
01Participants with combined cleft speech characteristics and developmental speech characteristics were over ten times more likely to have low expressive language scores compared with the group with typical speech for their age.
0240% of all participants scored below 1 standard deviation on the Formulated Sentences subtest, a complex syntax task, with the combined disorder group averaging a scaled score of 5.6.
03Children with cleft speech characteristics only had language scores similar to those with typically developing speech, while those with developmental speech characteristics had poorer language skills.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The cross-sectional design prevents determining causal relationships or tracking developmental trajectories over time. Subgroup analyses were underpowered due to small numbers in the CSC only and combined CSC + DSC groups (both under 20 participants), leading to wide confidence intervals. The normative data for the CELF-5 UK included a higher proportion of children from degree-educated families than the study sample, which was predominantly from lower socio-economic backgrounds, potentially affecting the interpretation of mean scores. Auditory skills were not analyzed in this specific paper, limiting the view on how hearing might interact with these findings.
Declared interests
The authors declared no conflicts of interest. The study was funded by the National Institute for Health and Care Research (NIHR).
The easy way to misread this
Do not interpret the lack of significant difference in the overall group's mean language scores as evidence that language is unaffected in this population. The risk is concentrated in specific speech subtypes, particularly those with phonological errors, who may have normal average scores but high prevalence of low individual scores.