Holistic Communication Assessment for Young Children With Cleft Palate Using the International Classification of Functioning, Disability and Health:Children and Youth

Abstract

Purpose Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007 ) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Checklist of relevant ICF categories for speech and language development

“…By investigating the perception of family members in cases of speech and language alterations, the literature points out (10) the importance of considering other components for the speech therapy field given the predominance of analysis by professionals regarding body functions. Herein and in the design of the checklist, the categories of activities and participation were considered as body functions.…”

“…The possibilities of adopting the ICF allow the creation of new instruments, such as interviews and questionnaires (8,9) , especially the acknowledgments of different points of view on the same topic based on relevant aspects for the user (10) and caretakers (11) . The ICF organization allows professionals to enlarge their view on child development, including different expectations and goals regarding the communication performance of the child in a given context (12) .…”

Intelligibility in Context Scale: Growth Curves for Typically Developing English-Speaking Children Between Ages 2;6 and 9;11

“…Thus, another advantage of using the ICS is an estimation of a child's speech intelligibility with listeners who vary in familiarity ( McLeod et al, 2012 ). The ICS has been recommended as a screening tool for children who may have speech disorders ( McLeod et al, 2015 ), as one of the speech outcome measures of a standard set of cleft palate–specific outcome measures ( Apon et al, 2021 ), and as one of the procedures for a holistic assessment of speech abilities ( Cronin et al, 2020 ; Pascoe & McLeod, 2016 ; Sakash et al, 2021 ).…”

Measuring oral health—How can the International Classification of Functioning help?

“…It has been adapted as a self‐report outcome measure (the BSQN‐H&N questionnaire) 98 that is used to define the priorities of HNC patients 99 and to develop a clinical guideline and screening tool 100 . The ICF has also been used to describe the impact of dysphagia following HNC 101 and as an assessment tool in cleft lip and palate 102 …”