Children born with cleft palate frequently show compensatory articulation errors (CA), and they are also at risk for language delays. There is a need of studies on speech–language intervention in this patient group. The purpose of this paper is to study metacognitive strategies for enhancing language development in children with cleft palate.
Twenty-six children with unilateral cleft lip and palate (UCLP) were studied and divided in two groups. The age of the patients ranged from 5 to 8 years. Language and articulation measurements for evaluating language development were made at the beginning and the end of the study. Both groups were treated with previously reported strategies routinely used for enhancing language. In addition, children from one group (active group) were exposed to metacognitive strategies which have been described as useful for enhancing expert thinking processes, such as think-aloud. For evaluating language development, all children were analyzed using the Situational-Discourse-Semantic Model.
The results indicate that children with UCLP and CA benefit from an intervention which also addresses specific aspects of language development. The patients included in the active group in which the metacognitive strategies were used showed a greater improvement as compared with the patients from the control group.
Intervention in children with cleft palate and CA should address not only the articulation processes, but also specific aspects of language development. Metacognitive strategies could be an adequate option for enhancing language performance in this patient group.
Level of Evidence: Level III, therapeutic study
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Golding-Kushner, KJ (2001) Therapy techniques for cleft palate speech and related disorders. San Diego: Singular Thompson Learning. Techniques for Compensatory Articulation 6:69–92.
McWilliams B, Musgrave R (1979) Diagnosis of speech problems in patients with cleft palate. Br J Com Disord Commun 6:26–32
Van Demark D, Morris H, VandeHaar C (1979) Patterns of articulation abilities in speakers with cleft palate. Cleft Palate J 16:230–239
Chapman K (1993) Phonologic processes in children with cleft palate. Cleft Palate Craniofac J 30:64–72
Powers GR, Dunn C, Erickson CB (1990) Speech analysis of four children with repaired cleft palate. J Speech Hear Dis 55:542–549
Pamplona MC, Ysunza A, Espinoza J (1999) A comparative trial of two modalities of speech intervention for compensatory articulation in cleft palate children, phonologic approach versus articulatory approach. Int J Pediatr Otorhinolaryngol 49:21–26
Hoffman P (1992) Clinical forum: phonological assessment and treatment. Synergistic development of phonetic skill. Language, Speech Hear Serv School 23:254–260
Hardin-Jones M, Chapman KL (2011) Cognitive and language issues associated with cleft lip and palate. Semin Speech Lang 32:127–140
Rescorla L, Dale PH (2013) Late talkers. Brookes, Baltimore. Late Talking Toddlers 6:219–240
Pamplona M, Ysunza A, González M, Ramírez E, Patiño C (2000) Linguistic development in cleft palate patients with and without compensatory articulation disorder. Int J Pediatr Otorhinolaryngol 54:81–91
Klinto K, Salameh EK, Lohmander A (2015) Verbal competence in narrative retelling in 5-year-olds with unilateral cleft lip and palate. Int J Lang Commun Disord 50:119–128
Norris J, Hoffman P (1993) Whole language intervention for school-age children. Singular Publishing Group, San Diego, pp 29–105
Norris J, Hoffman P (1990) Language intervention within naturalistic environments. Language Speech Hear Serv Schools 21:72–84
Scherer NJ, Williams L, Proctor-Williams K (2008) Early and later vocalization in children with and without cleft palate. Int J Pediatr Otorhinolaryngol 72:827–840
Chapman KL (2011) The relationship between early reading skills and speech and language performance in young children with cleft lip and palate. Cleft Palate Craniofac J 48:301–311
Collet BR, Leroux B, Speltz ML (2010) Language and early reading among children with orofacial clefts. Cleft Palate Craniofac J 47:284–292
Bessell A, Sell D, Shitting P, Roulstone S, Alvery L, Persson M, Verhoeven A et al (2013) Speech and language therapy intervention for children with cleft palate. A systematic review. Cleft Palate Craniofac J 50:1–17
Flavell JH (1979) Metacognition and cognitive monitoring. Am Psychol 34:906–911
Markman EM (1979) Realizing that you don’t understand elementary school children’s awareness of inconsistencies. Child Dev 50:643–655
Blumer B, Kenton JK (2014) Improving student information search. A metacognitive approach. Chandos, New York. Information Problem Solving and Metacognitive skills 5:45–54
Kernahan DA, Stark RB (1998) A new classification for cleft lip and palate. Plast Reconstr Surg 22:435–443
Ysunza A, Pamplona M, Mendoza M, García-Velasco M, Aguilar M, Guerrero M (1998) Speech outcome and maxillary growth in patients with unilateral complete cleft lip/palate operated at six vs twelve months of age. Plast Reconstr Surg 102:675–679
Oczkus L (2009) Interactive Think-Aloud Lessons. New York: Scholastic. Ready, Set, GO: Engaging Your Students With Interactive Think-Aloud Lessons 1:13–41
Collins BC, Israel S (2004) The ABC’s of performing highly effective think-alouds. Read Teach 58:154–167
Anderson RC, Pearson P (1984) A schema-theoretic view of basic processes in reading comprehension. In PD Pearson (Ed.) Handbook of reading research, New York: Longman, p 255–291
Scarborough H, Dobrich W (1990) Development of children with early language delays. J Speech Child Res 33:70–86
Hoff E (2003) The specificity of environmental influence: socioeconomic status affects early vocabulary development via maternal speech. Child Dev 74:1368–1878
Conflict of interest
Maria Del Carmen Pamplona, Silvia Carolina Solis, Pablo Antonio Ysunza, and Santiago Morales declare that they have no conflict of interest.
This study was funded by Smile Train, USA. The authors would like to express their gratitude to Smile Train for their generous support. It should be pointed out that although Smile Train provided funding, the purpose, methodology, and discussion of results were entirely the work of the authors, and they were not influenced in any way by Smile Train.
This project was approved by the Internal Review Board of Hospital Gea Gonzalez in Mexico City. All procedures for this study were approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. As mentioned in the manuscript, all persons gave their informed consent prior to their inclusion in the study. Moreover, details that might disclose the identity of the subjects under study were omitted.
Rights and permissions
About this article
Cite this article
Pamplona, M.D.C., Silis, S.C., Ysunza, P.A. et al. Metacognitive strategies for enhancing language development in children with cleft palate. Eur J Plast Surg 38, 377–384 (2015). https://doi.org/10.1007/s00238-015-1094-1
- Cleft palate