JCPSLP Vol 18 No. 1Mar 2016

Prediction and Prognosis

Phonological awareness skills in children with cleft lip and/or palate Lilian Anderson, Nerina Scarinci, and Helen Morris

An exploratory retrospective cohort study was conducted to explore the phonological awareness skills of 30 children with cleft lip and/or palate (CL/P) aged between 5;0 and 6;0 years and to investigate the relationship between phonological awareness skills and language skills, speech production, middle ear function, and velopharnyngeal function. Participants’ phonological awareness scores were highly variable, with children having the most difficulty with rhyme awareness. Regression analysis revealed that language skills was the only variable of interest that was marginally associated with phonological awareness (R 2 = .328, p = .054). The findings suggest that phonological awareness and language skills of children with CL/P are related. Management of children with CL/P should take a holistic approach, and include early clinician involvement, including parental instruction on how to enhance phonological awareness and language development. O ro-facial clefts are heterogeneous, congenital conditions that result from incomplete formation of structures separating the nasal and oral cavities (Samanich, 2009). According to the World Health Organization (WHO), orofacial clefts occur in 1 in 500–700 births (WHO, 2012). Research has shown that children with cleft lip and/or palate (CL/P) may have difficulty with reading (e.g., Chapman, 2011; Collett, Stott-Miller, Kapp-Simon, Cunningham, & Speltz, 2010) and difficulties with reading are commonly associated with poorer phonological awareness skills (Lyon et al., 2003). Phonological awareness is defined as the ability to detect, combine, and manipulate sound units in a language, and is consequently a prerequisite to the development of reading and literacy in alphabetic languages (Francis & Anthony, 2005). Children’s phonological awareness builds in a three-step progression: (a) syllable awareness (the ability detect syllables in words); (b) onset-rime awareness (detecting and generating rhyming words); and (c) phoneme awareness (the understanding that words consist of individual sounds) (Gillon, 2005). Phonological awareness

development is a dynamic process, whereby children refine earlier developing skills as they learn more new, and more complex skills (Francis & Anthony, 2005). Hence, although phonological awareness tasks appear seemingly simple, these tasks evidently contain many components and their complexity should not be overlooked. There are a number of factors that may contribute to the development of phonological awareness skills, and research suggests that children with CL/P often have significant difficulties in these related skill areas, including language skills, speech production, velopharyngeal function, and middle ear function (e.g., da Silva, Collares, & da Costa, 2010; Hardin- Jones & Chapman, 2011; Hardin-Jones & Jones, 2005; Morris & Ozanne, 2003; Rudnick & Sie, 2008; Scherer, Oravkinova, & McBee, 2013). Due to the prevalence of these communication difficulties in children with CL/P and the important relationship between phonological awareness and later reading success (Castles & Coltheart, 2004), it is imperative that research address the relationship between phonological awareness and language skills, speech production, middle ear function, and velopharyngeal function in children with CL/P. Although the majority of research in this field has examined these skill areas independently, a number of studies have explored reading skills in children with CL/P and the relationship between reading performance, and other areas of functioning. These studies have shown that children with CL/P often demonstrate poorer reading skills compared with their peers, especially in reading comprehension and reading fluency at single word and non-word levels (e.g., Collett et al., 2010; Richman, Eliason, & Lindgren, 1988). Chapman (2011) examined early reading skills of children with and without CL/P to identify the relationship between speech production, language skills, and early reading skills. In this study, the speech, language, and reading abilities of 56 children aged between 5;0 and 6;0 years with (n = 28) and without (n = 28) CL/P were assessed. Participants were matched for age, months of formal schooling, and gender. Chapman (2011) found no relationship between the presence of CL/P and speech, language, and reading skills. Although the reading skills and alphabetic knowledge of children with CL/P in this study were within normal limits, they were still below the performance of their peers without CL/P. Further statistical comparisons revealed a moderate correlation between speech production, language skills, and reading skills (Chapman, 2011). In another study of children with nonsyndromic CL/P, with (n = 46) and without (n = 46) reading disability, Richman

Keywords cleft palate hearing language middle ear function phonological awareness speech velopharyn- gealfunction Thisarticle has been peer- reviewed

Lilian Anderson (top), Nerina Scarinci (centre), and Helen Morris

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JCPSLP Volume 18, Number 1 2016

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