Adaptive early intervention for children with cleft palate: When to focus on speech sound production?

Background/Purpose: Young children with repaired cleft palate are a diverse clinical population, who vary in their acquisition of speech and vocabulary skills during early development following palatoplasty. The purpose of this study was to examine an early intervention database for participant characteristics associated with changes in speech and vocabulary growth of children with repaired cleft palate who received an Enhanced Milieu Teaching Plus Phonological Emphasis (EMT + PE) (Scherer & Kaiser, 2010) intervention compared to children in a "business‐as‐usual" (BAU) control condition who were receiving routine interventions and follow‐up in the community. Methods/Description: Participants: Twenty‐nine children with repaired cleft palate were randomly assigned (stratified by gender and age) at initial screening to a business‐as‐usual (BAU) condition or to the EMT + PE intervention condition. Participants were between the ages of 15 and 36 months, received their primary palatoplasty prior to 12 months of age, and had cognitive scale composite scores of 80 or greater on the Bayley Scales of Infant and Toddler Development‐III. Measures and Assessments: The language and speech skills of the children were evaluated at 3 time points: (a) preintervention, (b) immediately postintervention, and (c) follow‐up 3 months after postintervention. Assessments included: (1) A parent‐completed form describing the child's medical, developmental, and family history. (2) The Profiles of Early Expressive Phonological Skills (PEEPS: Stoel‐Gammon & Williams, 2013), consonant inventory, percent consonant accuracy (PCC) for total words and by manner. (3) Preschool Language Scale (PLS‐4), (4) Total number of words (TNW) and number of different words (NDW) derived from the automated Systematic Analysis of Language Transcripts (SALT; Miller & Chapman, 2008). (5) MacArthur Communicative Development Inventories (MCDI: Fenson et al, 2007) intervention procedure in the Enhanced Milieu Teaching (EMT; Kaiser et al., 1998) plus Phonological Emphasis (EMT + PE) condition a trained SLP used naturalistic intervention strategies to facilitate vocabulary and speech development (Scherer & Kaiser, 2010). Participants in the EMT + PE group received individualized therapy during 30‐minute clinic sessions twice weekly for 6 months (48 sessions). Results: Preintervention PLS‐4 scores, PCC, and words per minute (WPM) showed large effect sizes (ie, r2 > 0.68) MCDI raw score and NDW had moderate effect sizes (r2 between 0.60 and 0.65) were correlated with better outcomes postintervention. Given the importance of rate of word use as demonstrated by WPM's high correlation with intervention outcome, we examined the descriptive statistics for WPM in the whole sample (M = 6.81, SD = 5.94, range = [0‐17.10], median = 6.10). We split the treatment and controls samples at 10 WPM and completed a series of post hoc analyses comparing the changes from pre‐ to postintervention for place and manner.