Psychological Implications of Articulation Disorders in Cleft Palate Children

Abstract

The nature of speech problems in children with cleft palate has been discussed broadly in the literature (4, 6, 8, .9, 11, 15, 18, 1.9, 22). Investiga— tions of the type and extent of articulation errors, speculations about their etiology, attempts to relate their presence to velopharyngeal anatomy and physiology—even the conflicts in evidence—have led gradually to a level of understanding that could hardly have been envisioned twenty years ago. However, the psychological components of the problem are still an enigma, and the suspected relationships between the adequacy of speech and the adequacy of the person have been difficult to delineate. Children with clefts have often been described as maladjusted (2), and, indeed, have, in certain studies, given evidence of such problems as oral fixation (1), distortion of body image (5, 14), reduction in verbal output (17), lowered creativity (16), increased bodily tension (21), more extra— punitive needs, and greater aggression ('7). Conversely, they have also been characterized as essentially normal (3, 20, 23, 24). In actual practice, clinicians often reflect the uncertainty in the literature by suspecting emotional deviations but doing little of a direct nature to assess or treat them. SUBJECTS. The present study was undertaken in an effort to discover Whether or not psychological factors are related to speech performance. One hundred seventy children were divided into three groups on the basis of nasality ratings made by a speech pathologist and a plastic surgeon and consonant articulation inventories prepared by experienced speech pathologists. Group I consisted of 32 children judged to have normal voice quality and accurate consonant production. Group II was composed of 77 children whose voice quality was considered to be normal but who had varying degrees of consonant misarticulation that seemed unrelated to velopharyngeal function. Group III contained 61 children who were judged to have hypernasality with consonant articulation patterns at least partially related to velopharyngeal seal. Intelligibility was rated by the speech pathologists on a six-point scale with one representing complete intelligibility and six representing unintel-ligible speech. Intelligibility was not a problem for Group I speakers. For Group II, ratings were from one to four with a mean of 1.2. Ratings for