Hi icommunicate,

I am a speech and language pathologist from the States. I am working with a boy of 6 who has had a cleft palate repair. Although he is several years post his repair, his speech is still severely delayed. Nasality is one issue, but his inability to make certain sounds continues, despite being an intelligent boy. He is not always the most receptive when it come to therapy activities, but despite long term therapy and practice at home we continue to progress very slowly.

Do you, or anyone reading this have any advice.

Thanks Jill Green New York

Hi Jill,

It is a tough one, but it may well be there is some other underlying difficulty that is causing the speech delay. Assuming his hearing is fine and he has regular check-ups with the cleft palate team at the hospital (who can check the success of his repair), I can only assume it may be some form of phonological disorder or dyspraxia.

I would try and give him a thorough phonological assessment, with particular attention to activities where he has to listen and discriminate, thus taking the burden off his speech. A dyspraxia assessment would also be worthwhile. From this try to plan some very small goals, but try and find some activities that are both challenging and fun to keep his interest. Hopefully the parents will also be on-board as daily practice is essential.

Hope this helps Jill, let us know if you have any more questions.

Regards Johan

If I may put my 2 cents worth in - great site by the way Johan.

I agree with what Johan said, hearing impairment is so closely linked to cleft palate it is important to make sure this is checked out, an indicator of hearing problems could be vowel distortions, final consonant deletion, voiceing etc.

Differentially diagnosing between articulation and phonological delay/disorder is essential. Is he stimulable - can he produce the target sounds to model or cue, if he can it is not articualtion, if he can't then you need to go back to the surgical team and look at what is the anatomical problem, I would also suggest doing a videoflurosopy of his speech to look at the structures movement during speech. If you rule out articualtion then you could be dealing with over learned behaviours becoming phonologically encoded if this is the case as Joe said start with a program of discrimination.

If you suspect dyspraxia then you would expect the problem to get worse with increase complexity eg. mulitsyllabic words, sentence level and so on.

I would advise reading or searching for work by Dr Anne Harding Bell.

The answer lies in the errors being made. Listen to what the child is doing and then clincially reason what could be the underlying cause and develop treatment from there. I would advise to make sure your goals are functional to him, what woudl motivate him to make his speec clearer, focus on clarity not on sound accuraccy.

good luck

Simone

Hi Simone,

Thanks for your input, it is appreciated. Once the site is marketed in the next few weeks and our membership grows, hopefully we can get more SLT's to share their knowledge. This is exactly want I want to achieve with this Forum, other professionals with different areas of expertise adding their thoughts and wisdom.

Many Thanks Johan