University of Copenhagen, Department of Nordic Studies and Linguistics, Copenhagen, Denmark.
Int J Lang Commun Disord. 2020 Jan;55(1):121-135. doi: 10.1111/1460-6984.12508. Epub 2019 Nov 11.
Speech-sound development in preschoolers with unilateral cleft lip and palate (UCLP) as a group is delayed/disordered, and obstruents comprise the most vulnerable sound class.
To evaluate the development of obstruent correctness (PCC-obs) and error types (cleft speech characteristics (CSCs) and developmental speech characteristics (DSCs)) from ages 3-5 and to investigate possible predictors (error types, velopharyngeal dysfunction (VPD) and gender) of PCC-obs at age 5 in two groups of children with UCLP.
METHODS & PROCEDURES: Subgroup analysis was conducted within a multicentre randomized controlled trial (RCT) of primary surgery (Scandcleft Project). A total of 125 Danish children with UCLP received lip and soft palate repair around 4 months of age and early hard palate closure at 12 months (EHPC group) or late hard palate closure at 36 months (LHPC group). Audio and video recordings of a naming test were available for 108 children at ages 3 and 5, and recordings were transcribed phonetically by blinded raters.
OUTCOMES & RESULTS: PCC-obs scores increased significantly from ages 3-5 in both groups, but with small effect sizes in the EHPC group that had higher scores at age 3 than the LHPC group. DSCs decreased in both groups whereas CSCs only decreased in the LHPC group that had more CSCs at age 3 than the EHPC group. The frequency of CSCs at age 3 was a significant predictor of PCC-obs scores at age 5 in both groups. DSCs significantly improved the logistic regression model in the EHPC group, whereas VPD and gender did not significantly improve the model in either group.
CONCLUSIONS & IMPLICATIONS: Although PCC-obs developed significantly from ages 3 to 5, children with UCLP as a group did not catch up to typically developing Danish children at age 5. Furthermore, the LHPC group at age 5 did not reach the 3-year level of the EHPC group, which means that delaying hard palate closure until age 3 is detrimental to obstruent development. Both CSCs and DSCs at age 3 were important predictors of PCC-obs at age 5 and should be considered when determining need for intervention.
唇腭裂（UCLP）学龄前儿童的言语发展总体上是延迟/紊乱的，阻塞音是最脆弱的音类。
评估 3-5 岁期间阻塞音正确性（PCC-obs）和错误类型（腭裂语音特征（CSC）和发展性语音特征（DSC））的发展，并在唇腭裂的两组儿童中调查可能的预测因素（错误类型、腭咽功能不全（VPD）和性别）5 岁时的 PCC-obs。
在一项主要手术（Scandcleft 项目）的多中心随机对照试验（RCT）中进行了亚组分析。共有 125 名丹麦唇腭裂儿童在 4 个月大时接受唇裂和软腭裂修复术，12 个月大时接受早期硬腭裂闭合术（EHPC 组）或 36 个月大时接受晚期硬腭裂闭合术（LHPC 组）。在 3 岁和 5 岁时，108 名儿童的命名测试的音频和视频记录可用，并且记录由盲审员进行语音转录。
在两组中，PCC-obs 评分从 3 岁到 5 岁都显著增加，但 EHPC 组的效果较小，该组在 3 岁时的评分高于 LHPC 组。DSC 在两组中均降低，而 CSC 仅在 LHPC 组中降低，该组在 3 岁时的 CSC 较多。3 岁时 CSC 的频率是两组儿童 5 岁时 PCC-obs 评分的显著预测因素。在 EHPC 组中，DSC 显著改善了逻辑回归模型，而 VPD 和性别在两组中均未显著改善模型。
尽管 PCC-obs 从 3 岁到 5 岁显著发展，但唇腭裂儿童总体上在 5 岁时仍未赶上丹麦正常发育儿童。此外，LHPC 组在 5 岁时并未达到 EHPC 组 3 岁时的水平，这意味着将硬腭裂闭合术延迟至 3 岁不利于阻塞音的发展。3 岁时的 CSC 和 DSC 都是 5 岁时 PCC-obs 的重要预测因素，在确定干预需求时应予以考虑。
