The child born with a cleft palate may have many associated problems in feeding, respiration, dentition, hearing, speech, language, and intellectual development as well as in psycho-social development. If the cleft is associated with a specific craniofacial syndrome, other physical problems may be present such as cardiac, kidney, digital, and visual involvement. The need for an extensive treatment program can extend from birth through adulthood. Important to the successful habilitation of these children is the early involvement of a multitude of specialists working together with the family in a team approach. The primary task of the team is to make decisions concerning timing and sequence of intervention for each individual patient. Several models for the delivery of health care services to the patient with a cleft palate are now in use. A community-based team model will be described in this article as a unique approach to the management of this population and as one that may be implemented in a cost-effective manner in communities where cleft palate teams presently do not exist.
Approximately 47,200 spontaneous utterances of four nonstuttering children were analyzed for the occurrence of developmental disfluency from the time of one-word utterances through the emergence of beginning syntax. Disfluency profiles were drawn for each child at each of four mean length of utterance (MLU) levels. The frequencv of total disfluency and the frequency and distribution of specified disfluency types were computed. Variations were found among the children's profiles with systematic changes in disfluency profiles tor the individual child at each succeeding MLU level. The observed changes were related to the psycholinguistic features of discourse, imitation, and grammatical complexity in the children's language development.
From a corpus of over 47,000 spontaneous utterances from four nonstuttering preschool children who were beginning to use syntax, 4,881 multiword, disfluent utterances were identified. Semantic-syntactic structures were identified among the disfluent multiword utterances and differences in frequeney of structures were examined. There was variability in the developmental disfluency of the individual children, but each child's pattern of disfluency was systematic across time. Developmental disflueney shifted across structures systematically for each child and appeared to reflect a "practice effect" for those children beginning to learn syntax. The co-occurrence of disfluency with specific syntactic structures supported the premise that developmental disfluency was more strongly attached to the syntax of utterances than to the production of particular words.
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