Title: Speech processing in children born with cleft palate and its relationship to speech articulation at age 5.
Funder: Health Education England

Abstract: Background: Children born with cleft palate are at high risk of developing disordered speech articulation patterns in relation to their anatomical structure known as Cleft Speech Characteristics (CSCs). For many children with cleft palate, these patterns persist beyond the age of 5 which is then described as a Persistent Speech Disorder (PSD). PSD is associated with an increased risk of poorer life outcomes including education attainment and employment prospects. Routine Speech and Language Therapy care for children born with cleft palate in the UK currently focuses on the anatomical function post reconstruction. The development of speech processing, which is the focus of assessment and intervention in children with non-cleft related speech problems, is equally important for the development of intelligible speech but is not currently assessed as part of routine care for children born with cleft palate. The relationship between speech processing and the acquisition of speech in children born with cleft palate, including the development and resolution of CSCs, is therefore poorly understood and the degree to which speech processing problems contribute to the development of PSD and its importance in clinical care for this group is unknown. Aims:To describe the speech processing of children born with cleft palate at age 5.To establish whether there are relationships between speech processing, CSCs and their resolution which may contribute to PSD in some children.To make recommendations regarding Speech and Language Therapy assessment of these skills in this population.To make recommendations for further study, particularly intervention studies based on the outcomes of this piece of work.Research Questions:In children born with cleft palate, is there a difference in speech processing between those who present with CSCs and those who have no CSCs at age 5?What is the profile of speech processing sub-skills in children born with cleft palate?What is the relationship between speech processing and other factors known to impact on speech outcome in children born with cleft palate?Plan of Investigation: A cross-sectional, observational study of 5 year old children born with non-syndromic cleft palate +/- cleft lip will be undertaken. Eligible patients will be invited to participate once they have completed their routine clinical speech assessment at age 5. Most participants will be part of a larger national cohort study, the Cleft Collective (www.cleftcollective.org.uk/Bristol). Participating children will complete detailed speech processing assessments and a screen of their language abilities. This will involve standardised assessments which include age matched normative data. Additional variables which may impact on speech and speech processing skills will be included in the analysis. This will include data which will have been collected as part of the larger national cohort study. Speech processing skills will be described in detail and statistical analysis undertaken in order to identify differences between groups of children with cleft palate in terms of their speech processing. Relationships between variables and specifically the role that speech processing plays in the speech development of children born with cleft palate, who present with and without CSCs, will be explored. Potential benefits to patients and the NHS: Understanding the role that speech processing plays in the speech development of this population, particularly in those children who present with CSCs, may enable earlier identification of speech processing difficulties and facilitate appropriate targeting of skills in speech therapy. This could result in earlier resolution of CSCs in some children, improved longer term life outcomes and more effective and efficient use of NHS Speech and Language Therapy resources.

Lay abstract: Children born with cleft palate are at high risk of developing speech problems which involve them learning to make speech sounds in unusual ways. These are known as Cleft Speech Characteristics (CSCs) and they can cause children to sound different to their peers and/or be difficult to understand. When these speech problems continue to be present beyond the age of 5, it is known as Persistent Speech Disorder (PSD) which is associated with an increased risk of poor life outcomes, including education attainment and employment prospects. A child's cleft palate is usually repaired in the first year of life. Speech and Language Therapy assessment for children born with cleft palate in the UK focusses on whether the repaired palate is functioning well enough for speech and whether any CSCs have been learnt. There are however many factors which can impact on speech development in children, one of which is speech processing. Speech processing is the term used to describe the cognitive activity which takes place in the brain when a child hears or produces a word. Speech processing skills include identifying words which rhyme or start with the same sound and the ability to blend single sounds and groups of sounds together to form words. Children born with cleft palate could be at greater risk of PSD because of poor speech processing in addition to anatomical differences and CSCs. Relationships between speech processing, CSCs and their resolution are not well understood and speech processing abilities are not currently examined as part of routine cleft care in the UK. The aims of this project are therefore to:Describe the speech processing skills of children born with cleft palate at age 5.Understand the extent to which speech processing contributes to speech development, CSC resolution and PSD in children born with cleft palate.Inform the clinical management of children born with cleft palate by Speech and Language Therapists.Inform further research into the speech development of children born with cleft palate and interventions which may improve their speech outcomes.Families with children born with cleft palate will be invited to participate in the study when their child has completed their routine clinical review and speech assessment at age 5. Assessments of speech processing will be completed with participating children and information regarding other factors which can impact on speech development will also be collected. This will include information on their hearing, speech therapy intervention they have received and any further surgery they have undergone to help speech following the initial palate repair. The process of inviting families to participate and for completing additional assessments has been informed by parents of children with cleft palate. The information given to families explaining the study and inviting them to be involved will also be designed in consultation with parents. The speech processing skills of children born with cleft palate will be described and analysed to see if there are differences between children who have CSCs at age 5 and those who do not. The information on other factors which can impact on speech development in these children will be analysed in relation to speech processing skills. This will establish if difficulties with speech processing might explain why some children with cleft palate find it difficult to resolve CSCs and develop a PSD. If it is found that speech processing problems are a factor contributing to PSD for many children born with cleft palate, follow-on work from this study will look at how/when we can most effectively assess for difficulties with these skills. This may include devising and testing an appropriate assessment tool. Further study would also devise and test interventions aiming to reduce speech processing problems in this group of children in the most effective and cost-efficient ways. The findings of this study will be shared and discussed with the national group of clinicians working with children born with cleft palate in the UK, particularly the national group of Speech and Language Therapists specialising in working with children with cleft palate. This will be particularly important if there are recommendations to be made regarding changes in practice. The researcher will work with this group of Speech and Language Therapists to agree and manage the implementation of any changes that are indicated. The findings will also be shared with patient/parent representative groups and the international community of people working with and interested in the speech development of children born with cleft palate through conferences, meetings and publications.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: ORAL AND GASTROINTESTINAL