Speech Production in Children with Repaired Cleft Palate A thesis submitted for the degree of Doctor of Philosophy By Baharak Baranian Supervisors: Prof. Bill Wells & Dr. Anne Harding-Bell Department of Human Communication Sciences 2016 Abstract Studies have shown that a history of cleft palate often affects speech production. While similar patterns of atypical speech production have been reported across a variety of different,
Table 2.4 Order of acquisition of Farsi vowels and consonants in children aged 12-17 months prior to using these sounds for meaningful speech of pre-speech sound acquisition Vowels First: [æ] and [i] Then: [ɒ] and [u] Finally: [e] and [o] Consonants Manner of articulation Nasal and plosive consonants: [t, d, b, n, k, m] Fricative, affricate and approximant consonants: [ʧ, h, l] Trill consonants: [r] of articulation Bilabial and alveolar consonants: [b, p, t, d, m, n] Post alveolar, palatal, velar, uvular: [ʧ, j, k, G] Glottal and labiodental: [ʔ, f] ) also provides data on of consonant acquisition in the speech of children as old as 42 months. There is no information about how she has found this data. Table 2.5 below summarises the order of consonant acquisition by Farsi-speaking children.
Table 2.5 Order of consonant acquisition in children up to 42 months. Reproduced with permission. Table 2.5 Order of consonant acquisition in children up to 42 months Age Consonant Example 12-17m /d, t, m, n, ʔ, k, h, p, b, j, l/ /mɒmɒ/, /næ/ 18-23m /x, ɡ, ʧ, ʃ, ʤ, s, z/ /ɡo/, /ʧi/ 24-29m /f, v, ɾ, G/ /boɾo/, /Gos/ 36-42m /ʒ/ /mæʒik/ In general, there is a tendency for nasals, plosives and anterior consonants, such as bilabials and alveolars, to be acquired first, whereas fricatives and sounds typically produced at posterior places, such as velars and uvulars appear to be acquired late. According to Dodd et al. (2003) in appendix 1 this is true in languages in general. Table 2.6 shows the results of all speech acquisition studies discussed in this section. Table 2.6 Summary of Farsi speech acquisition studies Name of the researcher Participant’s information Age of the participants Method Aim Result Geraminejad (1983) 8 monolingual typically developing children who speak Farsi 1 to 5;6 ----- To examine the acquisition of fricatives in the Farsi consonants inventory and vowels children can produce all vowels before they are 19 months old and produce fricative consonants correctly by two years old Rahemi and Salehi (1992) 50 children who speak Farsi 3;0 to 6;0 sentence repetition as a speech to find normative data for articulation More than 75% of Farsi speaking children produce majority of developing
Table 6.8 Developmental phonological processes and specific patterns in Bardia’s speech Phonological process Pattern Target Realisation Position Fronting (post-alveolar to alveolar) /ʃ/→[s] /ʃæb/ /muʃ/ [sæb] [mɒsin] [mus] Car Mouse SIWI Single word SIWW Single word SFWF Single word Deaffrication /ʧ/→[t] /bæʧe/ /piʧ/ [bate] [pit] Screw SIWW Single word SFWF Single word 6.2.4 Mahtisa (CA 8;1) There are some realisations in the speech of Mahtisa which are illustrated in table 6.9. Similar to Bardia, some of post-alveolar consonants were realised as alveolars, such as /ʃ/→[s] in all speech samples or /ʤ/→[d]. 6.9 Consonant realisations in the speech of Mahtisa Place Bilabial Alveolar Post-Alveolar Palatal Velar Uvular Glottal target m p b f v n l t d s z r ʃ ʒ ʧ ʤ j k ɡ x G ʔ h SIWI m p b f v n l t d s z r s ʒ ʧ d j k ɡ x G ʔ h SIWW m p b f v n l t d s z r s ʒ t d j k ɡ x G ʔ h SFWF m p p f v n l t d s z r s ʒ ʃ ʤ j k ɡ x G h
/r/ →[l] /ræf'te/ /su'rɒx/ /mɒr/ [læf'te] [mɒl] SIWI SIWW SFWF ‘has gone’ ‘hole’ ‘snake’ /x/ → [Ø] /jæx/ [jæ] SFWF ‘ice’ Sepanta 6;7 /t/ → [tʰ] /ketɒbet/ [ketɒbe tʰ] SFWF ‘your book’ /d/ →[Ø] [komo] SFWF ‘wardrobe’ /ʒ/ → [ʃ] /ʃufɒʒ/ [ʃufɒʃ] SFWF ‘heater’ /ʤ/ → [d] /kæʤ/ [kæd] SFWF ‘slant’ Bardia 7;0 /t/ → [d] /ketɒbet/ [ketɒbed] SFWF ‘your book’ /ʃ/ → [s] /ʃæb/ /mɒʃin/ /muʃ/ [sæb] [mɒsin] [mus] SIWI SIWW SFWF ‘car’ ‘mouse’ /ʒ/ → [z] /ʒɒkete/ /ʃufɒʒ/ [zɒkete] SIWI SIWW ‘jacket’ ‘heater’ /ʧ/ → [t] /bætʃe/ /piʧ/ [bæte] [pit] SIWW SFWF ‘screw’ /ʤ/ → [d] /ʤibe/ /mæʤid/ /kæʤ/ [dibe] [mædid] [kæd] SIWI SIWW SFWF ‘pocket’ ‘name’ ‘slant’ Mahtisa 8;1 /b/ →[p] /tɒb/ [tɒp] SFWF ‘swing’
AM.H 5;1 /file/ /ʔænɒro/ /zæn/ /mipæze/ /ɡɒz/ /ʃæb/ /ʒɒle/ /ʔɒhu/ SIWI SIWI SIWI SIWW SFWF SIWI SIWI SIWW ‘elephant’ ‘pomegranate and’ ‘lady’ ‘cooks’ ‘oven’ ‘night’ ‘girl’s name’ ‘deer’ M.A 5;4 /kilido/ SIWW ‘key and’ MH.N 5;9 /ʒɒkæte/ SIWI ‘Jacket of’ M.H 6;1 /ketɒbet/ /ketɒbet/ /dære/ SIWW SFWF SIWI ‘your book’ ‘your book’ ‘door of’ F.R 7;1 /ʔænɒro/ SIWW M.R 7;3 /tupo/ /pɒkæt/ SIWI SIWW ‘Ball and’ ‘envelope’ AS.R 7;8 /komod/ /mipæze/ /ʤibe/ /mæʤid/ SFWF SIWW SIWI SIWW ‘Wardrobe’ ‘pocket of’ ‘boy’s name’ M.G 9;9 /ʤibe/ /mæʤid/ /kæʤ/ SIWI SIWW SFWF ‘pocket of’ ‘boy’s name’ ‘slant’
7.2.1.1.3 Lateral articulation/lateralisation An articulation in which the airflow is directed around the sides of the tongue while the tongue closes the centre route is called lateral (Ladefoged & Maddieson, 1996). 7.2.1.1.3.1 Lateral articulation Lateral articulation was recorded in the speech of children. It was mostly perceived in the syllable initial word initial position. Three children used lateral articulation for different target consonants (Table 7.5). 7.5 Patterns and words illustrating lateral articulation Participant Age Pattern Target Realisation Word position in the sentences Gloss A.R 5;3 /j/→[ɮ] /jɒs/ [ɮɒҫ] SIWI ‘Girl’s name’ R.E 6;1 /ʒ/→[ɮ] /ʒ/→[ɮ] /t/→[ɬ] /p/→[ɬ] /ʃæb/ /ʒɒle/ /mɒʒik/ /ketɒbet/ /sup/ [ɬæm] [ɮɒle] [mɒɮik] [ҫeɬɒve] [ҫuɬ] SIWI SIWI Single word SIWW SFWF ‘girl’s name’ ‘Marker’ ‘Your book’ ‘Soup’ As.R 7;8 /f/→[ɮ] /file/ [ɮile] SIWI ‘the elephant’ One child, A.R (5;3), realised the central palatal approximant /j/ as a lateral fricative [ɮ] while she used palatal articulation for most of the consonants in her speech. Therefore, it
AM.E 5;0 /ʃ/→[ҫ] /ʒ/→[j] /ʃæb/ /mɒʃin/ /muʃ/ /ʒɒkete/ [ҫæb] [mɒҫin] [muҫ] SIWI SIWW SFWF SIWI ‘Night’ ‘Car’ ‘Jacket of’ H.S 5;1 /G/→[j] /ʧɒGe/ [ʃɒje] SIWW ‘Fat’ MH.N 5;9 /l/→[j] /s/→[ҫ] /s/→[ҫˡ] /z/→[ҫ] /r/→[j] /ʃ/→[ҫ] /ʃ/→[ҫˡ] /ʧ/→[ҫˡ] / ʒ /→[j] / ʒ /→[ҫ] /livɒn/ /kelido/ /ɡol/ /se/ /ʔærus/ /ʔæsæl/ /zæn/ /mipæze/ /ɡɒz/ /ræfte/ /surɒx/ /mɒr/ /ʃæb/ /muʃ/ /mɒʃin/ /piʧ/ / ʒ /mɒ ʒ ik/ [kejido] [ɡoj] [ҫe] [ʔæjuҫ] [ʔæҫˡæj] [ҫæjn] [mipæҫe] [ʔɒҫ] [jæfte] [ҫujɒx] [mɒj] [ҫæb] [muҫ] [mɒҫˡin] [piҫˡ] [jɒkede] [mɒҫik] SIWI SIWW SFWF SIWI SFWF SIWW SIWI SIWW SFWF SIWI SIWW SFWF SIWI SFWF SIWW SFWF SIWI ‘SIWW in Single word’ ‘Glass’ ‘Key and’ ‘Flower’ ‘Three’ ‘Bride’ ‘Honey’ ‘Lady’ ‘cooks’ ‘Oven’ ‘Has gone’ ‘Whole’ ‘Snake’ ‘Car’ ‘Jacket of’ ‘Marker’ P.D 5;9 /k/→[c] /ɡ/→[c] /xuk/ /sæg/ [xuc] [ȿæc] SFWF SFWF ‘Pig’ ‘Dog’
P.D 5;9 /l/→[ɭ] /s/→[ʂ] /z/→[ʐ] /livɒn/ /kelid/ /ɡol/ /se/ /ʔæsæl/ /zæn/ /mipæze/ /ɡɒz/ [ɭivɒn] [ceɭiɖo] [ɡoɭ] [ʂe] [ʔæʂæɭ] [ʔæɽuʂ] [ʐæn] [mipæʐe] [ɡɒʐ] SIWI SIWW SFWF SIWI SIWW SFWF SIWI SIWW SFWF ‘Glass’ ‘Key and’ ‘Flower’ ‘Honey’ ‘Lady’ ‘cooks’ ‘Oven’ AS.R 7;8 /r/→ [ɽ] /mɒr/ [mɒɽ] SFWF M.G 9;9 /d/→[ɖ] /t/→[ʈ] /dære/ /ʧɒdor/ /komod/ /ketɒbet/ /ketɒbet/ [ɖæɽe] [ʧɒɖoɽ] [komoɖ] [keʈɒbeʈ] [keʈɒbeʈ] SIWI SIWW SFWF SIWW SFWF ‘Door of’ ‘Scarf’ ‘Wardrobe’ ‘Your book’ ‘Your book’ 7.3 Vowels Hypernasality was observed as the main atypical features in the production of vowels. Many vowels were categorised as nasalized, using the Farsi GOS.SP.ASS convention for rating the severity of resonance. Another atypical production of vowel was applied only in the speech of one of the children with cleft palate, MH.N (5;9), who substituted [ʊ] for /o/ in word /holu/ ‘peach’. As mentioned in chapter 6, this type of substitution was observed in the speech of one typically-developing child in this word. It could be an instance of vowel harmony because in this word the vowel is followed by the back close vowel /u/. 7.4 Resonance and airflow
(Kummer, 2011). For example, in the Farsi data /z/ is affected by interdental articulation, palatal articulation, backing, pharyngeal articulation, glottal articulation, active nasal fricative, weak nasalized articulation, nasal realisation of fricative, gliding of fricative. In a clinical context, oral examination and instrumental investigation and hearing assessment would help to determine whether a particular child’s substitutions could be directly attributed to structural abnormalities associated with the cleft palate, to hearing loss or to developmental phonological difficulties. Analysis of the speech data facilitated identification of possible contributing factors and co-existing conditions. Maintaining the distinction between CSCs and non-cleft developmental patterns in this study facilitated the identification of aspects of speech that were not cleft related and might benefit from other management. For example, the lateral realisation of the target tap/trill in the current study was observed in the speech of four children. As lateral articulation/lateralisation as a cleft speech characteristic was not seen in their realisation of any other consonants, this type of articulation is most likely related to typical phonological development in Farsi. It is suggested that this pattern need not therefore be a priority in intervention because this is age appropriate. This pattern was found in the speech of typically-developing children who are the same age as the cleft group in this study. 10.3.4 Factors affecting take-up of speech therapy in Iran Although all the children in the cleft group had had palatal surgery several years before their speech was assessed for this study, most of them still showed residual speech difficulties which are related to cleft palate. As suggested in the previous section, use of the Farsi GOS.SP.ASS may help in more accurate assessment of the child’s speech difficulties as a basis for effective intervention. Speech therapy sessions are likely to be beneficial for such children, on the assumption that they attend regularly (Smith & Guyette, 2004; Persson et al., 2006). However, in Iran attending speech therapy sessions on a regular basis is not easy for children who live far from the capital city. Additionally, there are not enough hospitals that provide
Chapman, K. L., Hardin-Jones, M., & Halter, K. A. (2003). The relationship between early speech and later speech and language performance for children with cleft palate. Clinical Linguistics & Phonetics, 17, 173-197. Chen, M. Y. (1997). Acoustic correlates of English and French nasalized vowels. Journal of Acoustic Society of America, 102, 2360-2370. Copeland, M. (1990). The effect of very early palatal repair on speech. British Journal of Plastic Surgery, 43(6), 676-682. Coplan, J., & Gleason, J.R. (1988). Unclear speech: recognition and significance of unintelligible speech in preschool children. Pediatrics, 82, 447-452. Crary, M. A. (1983). Phonological process analysis from spontaneous speech: The influence of sample size. [doi: 10.1016/0021-9924(83)90044-8]. Journal of Communication Disorders, 16(2), 133-141. Cucchiarini, C. (1996). Assessing transcription agreement: methodological aspects. Clinical Linguistics & Phonetics, 10, 131-156. D’Antonio, L. L., & Scherer, N. J. (1995). The evaluation of speech disorders associated with clefting. In R. J. Shprintzen & J. Bardach (Eds.), Cleft palate speech management: a multidisciplinary approach. St. Louis, MO: Mosby.
Drotar, D., Baskiewisz, A., Irvin, H., Kennell, J. and Claus, M. (1975). The adaptation of parents to the birth of an infant with a congenital malformation: a hypothetical model. Pediatrics. 56: 710-717. Duckworth, M., Allen, G., Hardcastle, W., & Ball, M. J. (1990). Extensions to the International Phonetic Alphabet for the transcription of atypical speech. Clinical Linguistics & Phonetics, 4, 273-280. A. T., & Amayreh, M.M., (2000). Phonological errors and sound changes in Arabic- speaking children. Clinical Linguistics and Phonetics, 14 (2), 79- 109. T., & Doyle, P. (2002). Direct magnitude estimation and interval scaling of pleasantness and severity in dysphonic and normal speakers. The Journal of the Acoustic Society of America. 112:3014–3021. Edwards, J., Beckman, M. E., & Munson, B. (2004). The interaction between vocabulary size and phonotactic probability effects on children’s production accuracy and fluency in nonword repetition. Journal of Speech, Language, and Hearing Research, 47, 421-436. Edwards, J., & Beckman, M. E. (2008). Some cross-linguistic evidence for modulation of implicational universals by language-specific frequency effects in phonological development. Language Learning and Development, 4(2), 122-156. Edwards, J., Munson, B., & Beckman, M. E. (2011). Lexicon-phonology relationships and dynamics of early language development. Journal of Child Language, 38, 35-40.
middorsum palatal stops in an adult with repaired cleft palate. Cleft Palate- Craniofacial Journal,38(2), 96-105. Gibbon, F. E., & Crampin, L. (2002). Labial-lingual double articulations in speakers with cleft palate. Cleft Palate Craniofacial Journal, 39(1), 40-49. Gibbon, F., & Hardcastle, W. (1989). Deviant articulation in a palate child following late repair of the hard palate: a description and remediation procedure using electro-palatography (EPG). Clinical Linguistics & phonetics, 3(1), 93-110. Gibbon, F. E., Ellis, L., & Crampin, L. (2004). Articulatory placement for /t/, /d/, /k/ and /g/targets in school age children with speech disorders associated with cleft palate.Clinical Linguistics & Phonetics, 18(6-8), 391-404. Gibbon, F. E., Lee, A., & Yuen, I. (2007). Tongue-palate contact during bilabials in normal speech. Palate Craniofacial Journal, 44(1), 87-91. Gibbon, F. E., Lee, A., & Yuen, I. (2010). Tongue-palate contact during selected vowels in normal speech. Cleft Palate Craniofacial Journal, 47(4), 405-412. Gibbon, F., P., & Crampin, L. (2005). Tongue-palate contact during selected vowels in children with cleft palate. Folia Phoniatr Logop, 57(4), 181-192. Gimson, A. (1989). An introduction to the pronunciation of English, (4th ed). Revised by S. Ramsaran, London: Edward Arnold.
difficulties associated with cleft palate. In S. Howard & A. Lohmander (Eds.), Cleft Palate Speech: assessment and Intervention (pp. 275-292). Chichester: John Wiley & Sons, Ltd. Harding, A., Harland, K., & Razzell, R. (1997). Cleft Audit Protocol for Speech (CAPS) Broomfield,Chelmsford: Speech/Language Therapy Department; St Andrew’s Plastic Surgery Centre. Harkins, С. S., Berlin, A., Harding, R., Longacre, J. J., & Snodgrasse, R. A. (1962). A classification of cleft lip and cleft palate. Plastic and Reconstructive Surgery, 29, Hayward, K. (2000). Experimental Phonetics. New York: Longman. Henningsson, G., & Isberg, A. (1990). Oronasal fistulas and speech production. In J. Bardach & H. L. Morris (Eds.), Multidisciplinary management of cleft lip and palate (pp. 787-792). Philadelphia: W. B. Saunders. Henningsson, G., Kuehn, D. P., Sell, D., Sweeney, T., Trost-Cardamone, J. E., & Whitehill, T. L. (2008). Universal parameters for reporting speech outcomes in individuals with cleft palate. Cleft Palate-Craniofac Journal, 45(1), 1-17. Henningsson, G., & Willadsen, E. (2011). Cross linguistic perspectives on speech assessment in cleft palate. In S. Howard & A. Lohmander (Eds.), Cleft Palate Speech: Assessment and Intervention (pp. 167-180). Chichester: John Wiley & Sons, Ltd.
Shprintzen, R. J., Seigel-Sadewitz, V. L., Amato, J., & Goldberg, R. B. (1985). Anomalies associated with cleft lip, cleft palate, or both. American Journal of Medical Genetics, 20, 585-595. Shprintzen, R. J. (2008). Velo‐cardio‐facial syndrome: 30 Years of study. Developmental Disabilities Research Reviews, 14(1), 3-10. Shriberg, L. D. (2003). Diagnostic markers for child speech-sound disorders: Introductory comments. Clinical Linguistics & Phonetics, 17(7), 501-505. Shriberg, L. D., & Kwiatkowski, J. (1980). Natural Process Analysis: A procedure for phonological analysis of continuous speech samples. New York: Macmillan. Shriberg, L. D., Kwiatkowski, J., & Hoffmann, K. (1984). A procedure for phonetic transcription by consensus. Journal of Speech and Hearing Research, 27(3), 456-465. Shriberg, L., Flipson, P., Kwiatkowski, J., & Mcsweeny, J. (2003). A diagnostic marker for speech associated with Otisis media with effusion: the gap. Clinical linguistic and phonetics, 17:7, 507-528. Shriberg, L. D., & Lof, G. (1991). Reliability studies in broad and narrow phonetic transcription. Clinical Linguistics and Phonetics, 5, 225-279 Skinner, B. F. (1957). Verbal behavior. New York: Appleton-Century-Crofts. Skolnick, M. & Cohn, E. (1989). Springer-Verlag New York Inc. 1st edition Smith, B. & Guyette, T. W. (2004). Evaluation of cleft palate speech. Clinics in Plastic Surgery, 31(2), 251-260.
Smith, N. V. (1973). The acquisition of phonology: a case study. Cambridge: University Press. Smit, A. , Hand, L., Freilinger, J. , Bernthal, J., & Bird, A. (1990). The Iowa articulation norms project and its Nebraska replication. Journal of Speech and Hearing Disorders, 55, 779–798. So, L. (2007). Cantonese speech acquisition. In S. McLeod (Ed.), The International Guide to Speech Acquisition (pp.313-326). USA: Thomson Delmar Learning. Solé, M. J. (2002). Aerodynamic characteristics of trills and phonological patterning. Journal of Phonetics, 30, 655-688. Sommerlad, B. (1999). Management of children with cleft lip and palate – the approach - ‘Surgery’”. International Journal of Paediatric Dentistry; (Supp.1); 9; 71 Speake, J., Howard, S., & Vance, M. (2011). Intelligibility in children with persisting speech disorders: A case study. Journal of Interactional Research in Communication Disorders, 2(1). Speltz, M. L., Goodell, E. W., Endriga, M. C. and Clarren, S. K. (1994). Feeding interactions of infants with unrepaired cleft lip and/ or palate. Infant Behaviur and Development.17: 131-140. V. (1973). A proposed modification for the classification of cleft lip and palate. Cleft Palate Journal, 25-252. Srivastava, G. P. (1974). A child’s acquisition of Hindi consonants. Indian Linguistics, 35, 112–118.
Occlusion □ Class I □ Class II □ Class III □ Anterior open bite Dentition □ Unremarkable □ Supernumerary □ Missing teeth □ Malaligned Tongue □ Unremarkable □ Poor mobility □ Abnormal posture □ Tongue tie Palatal Fistula □ Present □ Absent Fistula Size □ Minute < than 2 mm □ between 2-5 mm □ Medium between 5-8 mm □ Large >8 mm □ Complete breakdown Fistula Location □ Uvula □ Soft palate □ Junction soft/hard palate □ Hard palate-post alveolus □ Buccal sulcus □ Other (describe) □ Hard palate and buccal sulcus Palate Mobility □ Marked □ Moderate □ Slight □ None S.P. □ Bifid uvula □ Notch □ Blue/thin looking □ Suspected incorrect alignment □ Apparently short □ Tonsils □ Apparently deep pharynx □ Pharyngeal wall movement □ Pharyngeal flap Language □Apparently normal □ Delayed □ Disordered Identifiable aetiology □ Suspected VPI □ Confirmed VPI □ Abnormal dentition □Malocclusion □ Diagnosed hearing loss □ Suspected hearing loss □ Oral fistula □ palate history □ Intellectual deficit □ Developmental □ Environmental □ Syndrome Areas requiring further assessment