JCPSLP Vol 18 No. 1Mar 2016

and Ryan (2003) found that the children with CL/P who had reading disability scored significantly lower on rapid naming and verbal expression than the group of children with CL/P who did not have reading disability. However, there was no difference found between participants’ phonemic awareness skills. Earlier research with children without CL/P has also shown a link between rapid naming and reading disability (e.g., Wolf, Bowers, & Biddle, 2000). Richman and Ryan (2003) suggested that the lack of any significant differences between the groups on phonemic awareness may mean that a model of reading disability based on phonemic awareness may not apply to children with CL/P. It is important to note however that this measure of phonemic awareness was based only on the children’s ability to blend sounds into meaningful words, which represents only one aspect of phonological awareness, indicating a need for further research into the broader phonological awareness skills of children with CL/P. More recently, Collett et al. (2010) investigated reading and associated foundational reading skills in 85 children aged between 5;0 and 7;0 years with (n = 42) and without CL/P (n = 43). Results of this study indicated that the reading abilities of children with CL/P were poorer than the control participants, with noted difficulties in single word and non-word reading tasks, as well as reading comprehension, reading fluency, and non-word repetition. The children with CL/P also had poorer phonological awareness skills compared with their typically developing peers. Given these difficulties, Collett et al. (2010) identified a greater need to monitor these children as they progress academically. Although Collett et al. (2010) observed poorer phonological awareness skills in children with CL/P, the influence of other variables, such as speech production and middle ear function, on phonological awareness skills were not explored. Given speech production and middle ear function may be compromised in children with CL/P, and both speech production and middle ear function are intricately related to phonological awareness, it is imperative that the relationship between these skills be further investigated. The current study aimed to examine phonological awareness skills in children with CL/P and to investigate the relationship between phonological awareness skills and language skills, speech production, middle ear function, and velopharynngeal function. The study sought to test the following hypotheses: (a) the relationship between middle ear function and phonological awareness will be significant, such that children with poorer phonological awareness skills will have impaired middle ear function; (b) the relationship between speech production and phonological awareness will be significant, such that children with poorer phonological awareness skills will have poorer speech production skills; and (c) a significant relationship between velopharyngeal function and phonological awareness will be conditional to a significant relationship between phonological awareness and speech production and middle ear function. Methods Participants A total of 30 children with CL/P aged between 5;0 and 6;0 years (mean = 5;2 years; SD = 3.39) with clinical data in an existing outpatient hospital database were included in this retrospective cohort study from 43 potential participants. Children were selected for inclusion according to the following criteria: (a) 5;0 to 6;0 years of age; (b) Australian English as only language; (c) repaired CL/P; (d) no history of

Table 1. Summary of participant demographics for type of cleft lip and/or palate, speech diagnosis, velophargyngeal function, and middle ear function (N = 30) Participant variables Variable categories

n %



19 63.3


11 36.7

Type of cleft

Submucousal cleft, unrepaired

3 10

Soft palate only

3 10

Cleftofhardandsoft palate Unilateralcleftlipand palate Bilateral cleft lip and palate

10 33.3

10 33.3

2 6.7


1 3.3

Softpalateonly,with PierreRobinsequence

1 3.3

Speech diagnosis


6 20.0

Speech difficulties

24 80.0

Velopharyngealfunction Not adequate

10 33.3


20 66.7

5 26.7

Middle ear function Normal middle ear function(TypeA)inat least one ear

Bilateral Type B tympanometry

13 43.3

12 30.0

Abnormal middle ear function (Type C tympanometry)inat least one ear

impairment of the central nervous system; (e) no sensorineural hearing loss; and (f) complete dataset in the database. All children who met these criteria were included in the analyses. Children were excluded from this study if other diagnosed syndromes or medical conditions were present. Participant demographics are presented in Table 1. Measures Standardised assessments of phonological awareness, language skills, and speech production, and informal assessments of middle ear function and velopharyngeal function were administered to participants, as part of standard clinical care at 5;0 years of age. The assessments described below were completed on a routine basis for all children with CL/P on the speech pathology caseload. The phonological awareness, speech production, language, and velopharyngeal assessments were completed by five qualified SLPs, all trained in the management of children with CL/P. Administration of assessments occurred in one session and adhered to standard testing protocols. Participants were assessed individually and video- and


JCPSLP Volume 18, Number 1 2016

Journal of Clinical Practice in Speech-Language Pathology

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