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Metacognitive strategies for enhancing language development in children with cleft palate



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

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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.

Ethical standards

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.

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Correspondence to Pablo Antonio Ysunza.

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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).

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  • Cleft palate
  • Language
  • Speech
  • Therapy