Internationally Adopted Children With Unilateral Cleft Lip and Palate—Consonant Proficiency and Perceived Velopharyngeal Competence at the Age of 5

Abstract

Objective: To compare consonant proficiency, consonant errors, and the perceived velopharyngeal (VP) competence in internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) and nonadopted (NA) children with the same cleft–palate type at age 5. Design: Case–control study based on phonetic transcriptions of standardized speech recordings of 5-year-olds at a tertiary hospital. Participants: Twenty-five IA children were compared to 20 NA children. All consecutive patients at a cleft lip and palate center participated. Main Outcome Measure(s): Consonant proficiency was measured using percentage consonants correct, percentage consonants correct–adjusted for age, percentage correct place, percentage correct manner, and consonant inventory. Cleft speech characteristics (CSCs), developmental speech characteristics (DSCs), and the perceived VP competence were also measured. Results: The IA children had significantly lower values for all consonant proficiency variables ( p < .05) and a smaller consonant inventory ( p = .001) compared to the NA children. The IA children had a higher frequency of CSCs (IA = 84%, NA = 50%, p < .05) and DSCs (IA = 92%, NA = 65%, p = .057), and twice as many IA children as NA children had perceived VP incompetence (IA = 52%, NA = 25%, p = .17). Conclusions: Severe speech disorder was more common in IA children than in NA children at age 5. Most importantly, the speech disorders seem to be not only cleft-related. More detailed speech assessments with a broader focus are needed for IA children with UCLP. Longitudinal studies are recommended to further investigate the impact of speech difficulties in IA children’s daily lives.

Internationally adopted children with and without a cleft lip and palate showed no differences in language ability at school‐age

“…Previous studies of internationally adopted children with CLP have shown a high risk of speech difficulties, with poor articulation proficiency and velopharyngeal impairment lasting several years post‐adoption 5‐7,9 . In the present study, we found similar results for speech ability in the internationally adopted children with unilateral CLP, with a low PCC score at the age of 7‐8 years.…”

“…Previous studies of internationally adopted children with CLP have shown a high risk of speech difficulties, with poor articulation proficiency and velopharyngeal impairment lasting several years post-adoption. [5][6][7]9 In the present study, we found similar results for speech ability in the internationally adopted children with unilateral CLP, with a low PCC score the of 7-8 years. More 80% of the children with unilateral CLP scored 2 SD below the normative mean, but only 7% of those without CLP.…”

“…A recent study found internationally adopted children with CLP to be at high risk of persistent speech difficulties several years post-adoption. 5 Several studies have also reported a high prevalence of velopharyngeal impairment in this group. 6,7 A competent velopharyngeal function, that is the ability to create a tight seal between the velum and pharyngeal walls to separate the oral and nasal cavities, is a prerequisite for functional speech.…”

“…To date, there are few detailed studies of speech and language development in internationally adopted children born with CLP. A recent study found internationally adopted children with CLP to be at high risk of persistent speech difficulties several years post‐adoption 5 . Several studies have also reported a high prevalence of velopharyngeal impairment in this group 6,7 .…”

The Impact of Race and Ethnicity on Surgical Risk and Outcomes Following Palatoplasty: An Analysis of the NSQIP Pediatric Database

“…18,19 Asian patients were also more likely than other races/ethnicities, with the exception of patients with other/unknown race/ethnicity, to have a complication. Although international adoption has been associated with worse speech outcomes compared to nonadopted infants in other studies, 20,21 a higher incidence of poorer palatoplasty outcomes within the 30-day postoperative period in Asian patients has not been previously described. It is unclear why this outcome disparity exists, especially in the absence of a higher incidence of preoperative surgical risk factors defined in NSQIP.…”