1. Assessment Considerations for Young Children with Cleft Palate Introduction CLEFT LIP AND/OR PALATE Cleft lip and/or palate (CLP) is the fourth most common birth defect Effects 1 in every 750 births in the United States Children with nonsyndromic CLP are not at-risk for intellectual or other disabilities but are at-risk for delays in speech sound acquisition and early language development SPEECH AND LANAGUE ASSESSMENT Children’s communication skills are assessed to: Understand communication strengths and needs Establish treatment goals Monitor progress over time THE ISSUE In practice, standardized, norm-referenced assessments often are used to determine a child’s eligibility to receive services These assessments do not provide information about children’s use of language in naturalistic contexts These assessments may not provide information about gaps between language competence and language performance Objectives The purpose of this study was to: 1.) examine speech and language assessment results across a range of measures for two populations: (a) toddlers with nonsyndromic, repaired cleft palate with or without cleft lip and (b) toddlers with typical speech and language development 2.) propose recommendations for assessment and early language intervention for young children with CLP Methods Participants with typical language development were age and gender matched to participants with repaired CLP Language skills were assessed using (a) standardized, norm-referenced assessments; (b) language samples, (c) parent-child interaction play sessions in a clinic, and (d) parent report A speech language pathologist or master’s level research assistant conducted all assessments PARTICIPANTS Results Conclusions No statistical differences on standardized measures for children with and without CLP Significant differences observed in spoken language during language samples with a clinician and play-sessions with a parent in a clinic between young children with and without CLP Findings from this study illustrate the importance of choice of language measure and measurement context when evaluating language skills of young children with CLP Several implications for both assessment and early language intervention for young children with repaired, nonsyndromic CLP IMPLICATIONS FOR ASSESSMENT Measurement context should be considered when evaluating the language skills of young children with CLP Standardized measures should be supplemented with play-based language assessments with unfamiliar and familiar adults in multiple contexts (e.g., clinic and home or classroom and home) When making eligibility decisions, specialists should examine data from language samples and parent-child interactions instead of relying solely on standardized assessment results IMPLICATIONS FOR INTERVENTION Although the language competence of children with and without CLP, as measured by standardized tests, was within the average range, differences in spoken language of children with and without CLP suggest there is a gap between language competence and language performance Intervention should address this gap Focus on increasing language productivity (e.g., TNW, NDW) Focus on increasing complexity of spoken language (e.g., MLUm) Differences in spoken language during language samples and parent-child interaction sessions suggest a need for cross-setting support and intervention in multiple contexts to increase the verbal productivity with less familiar conversational partners For Additional Information Contact Jennifer Frey jrfrey@gwu.edu Acknowledgements This research was supported by the NIDCD (IR21DC009654), the Vanderbilt VICTR CTSSA grants (UL1 RR024975), and the Melyvn I Semmel Dissertation Award at Vanderbilt University. Jennifer R. Frey a,b, Ann P. Kaiser b, & Nancy J. Scherer c a The George Washington University, b Vanderbilt University, c East Tennessee State University Participants Thirty-eight children participated in this study: 19 children with nonsyndromic, repaired CLP and 19 children with typical language development. Participants were selected from 2 larger studies. Children with CLP were included if they: Were between 15 and 36 months old Had a cognitive scale composite score of 80 or above on the Bayley-III Could produce at least 5 different words per parent report on the MCDI Demonstrated at least one type of articulatory error Children with typical language were included if they: Were between 12 and 42 months old Had a cognitive scaled score of 90 or above and a language composite score of 90 or above on the Bayley-III Had receptive and expressive communication subtest scaled scores of 9 or greater on the Bayley-III Children w/ CLPChildren w/ TL Frequency% % Gender Male1368.41368.4 Female631.66 Race Caucasian15781473.7 African American15.3526.3 Asian315.800 SES < $25,00015.3315.8 $30,000 - $45,000421.115.3 $50,000 - $70,000526.3421.1 $75,000 - $90,000842.11157.9 Not reported15.300 Children w/ CLPChildren w/ TL MeanSDRangeMeanSDRange Child Age (Months)28.114.75(18, 36)28.115.03(17, 37) Parent Age (Years)31.946.18(21, 43)34.584.68(24, 44) Age at CLP Repair (Months)11.914.43(9, 27) MEASURES Preschool Language Scales – IV (PLS-IV) Auditory Comprehension, Expressive Communication, Total Language MacArthur-Bates Communicative Development Inventory (MCDI) Total words Language Sample (LS) Total number of words (TNW), Number of Different Words (NDW), MLU in morphemes (MLUm), Words per Minute (WPM), % Intelligibility Parent-Child Interaction (PCX) Total number of words (TNW), Number of Different Words (NDW), MLU in morphemes (MLUm), Words per Minute (WPM), % Intelligibility Children with CLPChildren with TLEffect Size MeanSDRangeMeanSDRanged Bayley Cognitive101.0510.75(80, 120)98.424.73(90, 110)0.37 PLS AC101.1116.10(67, 128)104.7914.01(85, 136)-0.24 PLS EC99.4716.88(74, 128)104.7916.47(85, 147)-0.32 PLS TC100.4217.16(68, 129)105.4215.89(85, 146)-0.30 MCDI total words333.44227.51(7, 642)354.33195.50(17, 654)-0.10 LS – NDW*33.4229.37(3, 91)68.2148.40(7, 166)-0.87 LS – TNW*90.7484.96(3, 257)305.74274.53(20, 1167)-1.06 LS – MLUm1.730.75(1, 3.84)2.181.13(1, 4.57)-0.47 LS - % Intelligibility*48.9520.14(11, 90)6013.19(29, 86)-0.65 PCX - NDW24.6316.41(0, 57)35.5320.95(5, 71)-0.58 PCX – TNW*45.5229.82(0, 92)82.8956.29(8, 185)-0.83 PCX – WPM*9.625.12(1.4, 17.1)14.669.62(1.7, 36.9)-0.65 PCX – MLUm*1.530.52(1, 2.84)1.970.81(1, 3.71)-0.65 PCX - % Intelligibility45.8420.4(0, 75)57.3714.26(30, 85)-0.66 No significant differences were observed on standardized cognitive and language measures for children with and without CLP Significant differences were observed in the spoken language of children with and without CLP as measured by the mean length of utterance in morphemes (MLUm), total number of words spoken (TNW), number of different words used (NDW), and words spoken per minute (WPM) in language samples and parent-child interaction sessions Language Samples No significant differences in MLUm were observed between the two groups (F (1, 36) = 2.09, p = 0.16) Significant differences in NDW and TNW were observed Children with CLP had fewer NDW (F (1, 36) = 7.17, p = 0.01) Children with CLP had fewer TNW (F (1, 36) = 10.64, p = 0.002) Parent-Child Interaction Sessions Children with typical language had higher MLUm and spoke more WPM than children with CLP Significant differences in MLUm (F (1, 36) = 4.01, p =.053), TNW (F 1, 36) = 6.58, p =.015), and WPM (F (1, 36) = 4.074, p = 0.51) between children with and without CLP Effect Sizes Across Measures Effect sizes across measures show, on average, children with CLP performed worse than children with typical language development on all measures, except for the Bayley-III Cognitive Scale The greatest difference observed was on the TNW spoken during the language sample (d = -1.06) *p <.05