Abstract
To investigate centre-level variation in speech intervention and outcome and factors associated with a speech disorder in children in Cleft Care UK (CCUK). Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate recruited to CCUK. Centre-based therapists undertook audio-video recordings. Perceptual analysis was undertaken using the CAPS-A tool. Speech outcomes were based on structural and articulation scores, and intelligibility/distinctiveness. Between-centre variation in treatment and outcomes were examined using multilevel models. These models were extended to estimate the association between a range of factors (hearing loss, speech intervention, fistula, secondary speech surgery for velopharyngeal insufficiency, socio-economic status, gender, and parental happiness with speech) and speech outcomes. There was centre-level variation in secondary speech surgery, speech intervention, structure and intelligibility outcomes. Children with a history of speech intervention had a lower odds of poor intelligibility/distinctiveness, 0.1 (95% CI: 0.0-0.4). Parental concern was associated with a higher odds of poor intelligibility/distinctiveness, 13.2 (95% CI: 4.9-35.1). Poor speech outcomes were associated with a fistula, secondary speech surgery and history of hearing loss. Within the centralized service there is centre-level variation in secondary speech surgery, intervention and speech outcomes. These findings support the importance of early management of fistulae, effective management of velopharyngeal insufficiency and hearing impairment, and most importantly speech intervention in the preschool years. Parental concern about speech is a good indicator of speech status.
Highlights
It has consistently been reported that there is a group of children and young people, born with cleft palate, who have long-term intractable speech impairment.[1,2] This is important as we know that maximizing speech skills in the preschool years is important for psychosocial well-being and educational reasons
Poor speech outcomes in children born with unilateral cleft lip and palate (UCLP) vary across centres in the UK, with the greatest variation in intelligibility/distinctiveness
Centres vary in treatment of velopharyngeal insufficiency and provision of speech intervention
Summary
It has consistently been reported that there is a group of children and young people, born with cleft palate, who have long-term intractable speech impairment.[1,2] This is important as we know that maximizing speech skills in the preschool years is important for psychosocial well-being and educational reasons. Children with persisting speech concerns at age 5 years are more likely to present with later educational difficulties and long-term socio-economic consequences.[3,4,5,6,7,8,9,10] Identifying the factors associated with poor speech outcomes at 5 years of age may help us to design and target interventions and resources that improve this important outcome. CCUK reported on the outcomes of cleft care in this new model.[15,16,17,18,19,20] Sell et al.[18] reported improvements across several speech parameters, 17% of children still had poor intelligibility at 5 years of age within this centralized service
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