Abstract
Introduction: Speech assessments at age-3 years are needed to identify children with cleft palate ± cleft lip (CP±L) who are at risk of poor speech at age-5 years. It is important to identify children in this population who require further management, either therapeutic, surgical or a combination of both, as soon as possible. Currently, there are no published, valid, and reliable speech assessment protocols in English at age-3 years for the cleft palate +/- cleft lip (CP±L) population.Aim: To propose a valid and reliable assessment framework to assess speech outcomes in 3-year old patients with CP±L. To achieve this through the examination of different speech samples, rating methods and scales on listener reliability and validity, and the evaluation of the acceptability and usability of the assessment to Speech & Language Therapists (SLTs).
Methods: Two speech samples were specifically developed for 3-year olds with CP±L and were used alongside an assessment framework, the Adapted CAPS-A, to assess speech outcomes at 3-years. Twenty-five 3-year olds participated (20 with CP±L; five without CP±L). Two speech samples were undertaken (Sample A: spontaneous speech and picture naming; Sample B: short sentence repetition). Completion rates of the speech samples were recorded. Seven SLTs from five UK cleft teams analysed video recordings of the speech samples for the following parameters of speech: Cleft speech characteristics (CSCs), phonology, resonance, nasal airflow errors (NAE), and a judgment of velopharyngeal (VP) function for speech. VP function and hypernasality were additionally measured using Visual Analogue Scales (VAS). Listener reliability was examined. SLTs completed an electronic questionnaire about the acceptability of the assessment methods used.
Results: Seventy percent of children in the CP±L group completed both speech samples in full. More children attempted some or all of Speech Sample A (85%) compared to Sample B (70%). Both speech samples had good reliability for resonance, NAE and CSCs. However, when only fully completed speech samples are considered Sample A had superior reliability for VPC-Rate and CSCs. Inter-rater reliability relating to the classification of phonological processes was suboptimal for both speech samples. The VAS had poorer reliability scores compared to ordinal scales for both speech samples (most notable for Speech Sample A). Children without a cleft were not rated as having speech difficulties associated with CP±L. The SLTs supported the use of the Adapted CAPS-A to measure speech outcomes at age-3 years.
Conclusions: It is possible to reliably assess speech in 3-year olds with CP±L when using speech samples and an assessment framework designed for use with this age group. Both of the speech samples designed in the study are appropriate for use when assessing speech in 3-year olds with CP±L. A new assessment framework to assess speech outcomes at age-3 years is proposed.
| Date of Award | Jul 2023 |
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| Original language | English |
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| Supervisor | Tanya Rihtman (Supervisor) & Jane Coad (Supervisor) |