Speech is as innate and hard-wired in the human brain as is walking and breathing. We may have to learn from infancy how to do it, but it is an elemental part of our existence. Even those born without the ability to physically articulate speech evolve their own methods of speech, such as American Sign Language (ASL).
Each year scores of children are born with a congenital oral defect that can be a huge stumbling block to vocal development and a trigger for language disorder. Cleft palate affects 1 in 2,500 infants around the world annually. (Momenti, 2002) Though its severity varies from a small notch in the center of the upper lip (cleft lip) to a complete fissure extending from the soft tissue all the way into the hard palate of the oral cavity and nose (cleft palate), children suffering from this abnormality tend to have significantly affected vocal development which creates a language disorder, a special need that most will have in some form or another for life. (Turnbull, et al., 2007) This article will examine the relationship between cleft palate and language disorder in young children.
Causes of Cleft Palate
Generally speaking, the causes of cleft palate are not known. Cleft palate happens in the earliest stages of an infant’s development in utero, when the primary palate is forming at about 35 days gestation. (Witt, 2006) A child’s lips are fully formed at about six weeks gestation. If a cleft is present, it is frequently identifiable through ultrasound at 20 weeks gestation.
While the causes for cleft palate are not determined, children with a sibling or parent with the defect are at higher risk. Additionally, studies have shown that maternal exposure to steroids, alcohol, hypoxia, dietary deficiencies (especially of folic acid), and other environmental factors can contribute to the overall risk. Cleft palate can occur with or without cleft lip. Males are more likely to have cleft lip, and girls are more likely to have cleft palate without cleft lip. (Grayson, 2003) Some races seem more prone to the defect when it is syndromatic (part of a genetic defect). (Witt, 2006)
Impact on Vocal Development and Language Disorder
Cleft palate (and even the less-severe cleft lip) inevitably impacts a child’s vocal development because the alveolar ridge is fissured and oral muscles are displaced. Additionally, due to the fissure and the resulting impact on the nasal cavity, children with cleft palate are especially prone to fluid buildup in the middle ear and ear infections. Typical children with no cleft palate or lip who experience ear infections between ages eight and 18 months have shown a marked decrease in their vocal development, although they are able to catch up. (Rvachew, et al., 2005) However, children with cleft palate who experience the complication of fluid buildup in the middle ear and ear infections often experience such a degree of auditory interruption over the typical 18 years of treatment that their vocal development may be significantly impacted. This is in addition to the physical obstacles of speech presented by the cleft itself. Several studies have shown that children with cleft palate at 24 months of age perform well below (though generally still within normal range) of typical children on the Bayley Scales of Infant Development and other assessments. The differences noted between these two groups of children were verbal rather than nonverbal. (Chapman, et al., 2001)
From a physical standpoint, the fissure in the alveolar ridge causes problems with the articulation of utterances formed in that region of the oral cavity, such as [t], [d], [n], [s], [z], [l], and [r]. Additionally, if the lip is involved in the abnormality, labial utterances are affected, such as [p], [b], [m], [f], [v], and [w]. Severity of the cleft can also affect nasal, palatal, labiodental, interdental, and bilabial sounds. (Fromkin, et al., 2006) Researchers have also found that the intraoral muscles of children with cleft palate are attached in the wrong areas of the mouth, causing problems on many fronts. This muscular problem and the resulting velopharyngeal dysfunction (VPD) causes increased difficulty in pronouncing the consonants s, z, j, g, and pressure consonants p, b, t, d, k, and g. VPD impedes the child’s ability to close the velopharyngeal sphincter, which is essential for producing nonnasal sounds. (Witt, 2006) In cases where the cleft is severe enough to impact a child’s auditory capability, speech is even further disadvantaged.
Cleft Palate Challenges Physical and Vocal Development
Children born with cleft palate face numerous challenges, chief among them the need to have the physical abnormality corrected. With appropriate medical and therapeutic intervention, these children can overcome nearly all issues related to the birth defect and face a positive outlook. However, many of these children will ultimately experience difficulties related to the condition that impact language development and may result in language disorder.
Sources:
Chapman, K., et al. (January, 2001). "Vocal Development of 9-Month-Old Babies With Cleft Palate." Journal of Speech, Language, and Hearing Research. 44(6), 1268.
Fromkin, V., et al. An Introduction to Language, Seventh Edition.2003. Heinle: Boston.
Grayson, C. (September, 2003). "Cleft Palate and Cleft Lip." The Cleveland Clinic. p. 1-5.
Molmenti, H. (December, 2002). "Cleft Lip and Palate." AllRefer.
Rvachew, S., et al. (June 2005). "Vocal development of infants with verylow birth weight." Clinical Linguistics & Phonetics, 19(4), p.275-294.
Turnbull, A., et al. Exceptional Lives: Special Education in Today’s Schools, Sixth Edition. 2007. Merrill: Columbus.
Witt, P. (April, 2006). "Craniofacial, Cleft Palate." EMedicine. p. 1-9.
Jennifer Hooks - Jennifer Hooks has written articles for both national and international markets. She writes on topics including leadership, creative ...
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