Seven-Year-Olds Describe Speech of Peers with Cleft Lip/Palate

ACPAACPA News, Journal

  • By age 7, children are comparing themselves to others and peers become important
  • Speech impairment associated with CL/P can have a negative impact on physical and emotional development
  • A wider focus on speech outcomes could have a positive effect on treatment strategies for patients with CL/P.

CHAPEL HILL, N.C. / June 16, 2020 – How would seven-year-olds describe the speech of their peers with cleft lip/palate (CL/P)? This was the focus of a recent research study “’She Sounds Like a Small Child or Perhaps She has Problems’—Peers’ Descriptions of Speech in 7-Year-Olds Born With Cleft Palate” published in the May 2020 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

Cleft lip and palate (CL/P) and its treatment can pose many challenges that affect speech, and psychological and social functioning. A person’s speech characteristics can influence the listener’s attitudes and judgments about the speaker’s age, health, and social and educational ability. This can lead to negative stereotyping that may cause psychological, educational, and employment disadvantages.

“By the age of seven years, children begin to compare themselves to others and, in some ways, peer groups become more important than their family with regard to forming identity,” said Jill Nyberg, PhD, lead researcher. “In this study, we explored how 7-year-old peers who were unfamiliar with the speakers described cleft-related speech impairments—in their own words—and allowed them to speculate about any consequences for communication and social interaction the speakers might encounter. We also wanted to examine whether peers perceived signs of velopharyngeal incompetence (VPI) and articulation errors and, if so, what terminology they would use.”

Study participants were recruited from two first-grade school classes from two primary schools in different suburbs of Stockholm. Twenty 7-year-olds (12 boys and eight girls) participated in the study’s focus group interviews. Parents also answered a brief questionnaire about their child’s development, hearing, and previous contact or experience with a person who was speech-impaired. Audio files featuring 7-year-olds who were born with CL/P were played for each focus group. Participants were then asked to describe what they heard, what they thought of the speaker’s personal traits, and how others might perceive the speaker. Researchers also noted the emotional reaction that study participants had to hearing the recordings.

Analysis of participants’ responses were organized into four interlinked categories, and each category had four or five subcategories. Glottal articulation and severe signs of VPI caused the most negative emotional reactions and were described as sounding scary and incomprehensible. The children also speculated on the risk of social rejection that the speakers might experience. Retracted oral articulation was also noted.

“Our findings indicate a need for a wider focus on speech outcomes. To provide effective treatment intervention for patients with CL/P, affected children need to be asked about their communicative experiences and how they feel about speaking in various situations,” Nyberg said. “Knowledge about environmental aspects needs to be expanded and validated and, for this purpose, an assessment tool adapted to young listeners could offer more information about how a speech impairment is perceived.”

“Findings from this study further underscore the value of collaborative team care. Speech-Language Pathologists are aware of the psychosocial implications of aberrant speech. For this reason, often Speech-Language Pathologists target remediation of such errors before the child enters the school system. This study expands our understanding by identifying which specific speech errors are viewed more negatively among peers at the age of 7 years. Furthermore, this study emphasizes the importance of collaborative care by showing the strong connection between speech and psychosocial development,” said Jamie L. Perry, PhD, CCC-SLP, editor of The Cleft Palate-Craniofacial Journal.

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit