It’s not just speech: Association between intelligibility, language and communication skills in children born with cleft palate +/- lip

 The following paper was accepted for publication today. The paper was based on collaborative work undertaken during my Benjamin Meaker  Distinguished Professor Visiting Fellowship to University of Bristol, UK. Congratulations to Amy Davies who lead the paper.

Davies, A., Seifert, M., Southby, L., Harding, S., McLeod, S., & Wren, Y. (2026, in press August). It’s not just speech: Association between intelligibility, language and communication skills in children born with cleft palate +/- lip.  American Journal of Speech-Language Pathology.

Here is the abstract

Purpose: Children born with cleft palate, with or without cleft lip (CP+/-L), are more likely to demonstrate problems with intelligibility. The aim of this study was to examine the relationship between language and communication skills and intelligibility in 3-year-old children born with CP+/-L using questionnaire data from mothers of 674 children in a longitudinal prospective cohort study. 

Method: A Kruskal-Wallis test was used to explore differences in intelligibility (Intelligibility in Context Scale (ICS)) between categories of children’s language and communication skills (communication domain of the Ages and Stages-3 questionnaire (ASQ-3)). Associations were further explored using Tobit regression analyses adjusting for confounders cleft subtype, syndromic status, Robin sequence, biological sex, socio-economic status and child’s age.  

Results: The Kruskal-Wallis test showed strong evidence (χ2(2) = 131.7, p < .001) to suggest a difference in average ICS score between the three ASQ-3 categories of further assessment needed, monitoring needed and on schedule. The fully adjusted model suggested children who were categorised as needing to be monitored would score 0.69 points lower on the average ICS score compared to their peers who were “on schedule” (β= -0.69; 95%CIs= -0.98, -0.41; p < .001). Average ICS score was estimated to reduce by approximately 1.14 points for children needing further assessment compared to children who were on schedule (β= -1.14; 95%CIs= -1.36, -0.92; p < .001). 

Conclusions: Language and communication skills in children born with CP+/-L are associated with their intelligibility. Variability amongst individual children is likely. A multiple-risk model should be considered when planning interventions for children whose intelligibility is below expectations.

Article about the Intelligibility in Context Scale wins JSLHR editor's award!

Congratulations to the team from Department of Communication Sciences and Disorders, Waisman Center,  University of Wisconsin–Madison who have won the Journal of Speech, Language, Hearing - Speech Editor's Award for the following paper:

Soriano, J. U., Mahr, T. J., Rathouz, P. J., & Hustad, K. C. (2025). Characterizing the relationship between the Intelligibility in Context Scale and transcription intelligibility in typically developing English-speaking children between ages 2;6 and 9;11.  American Journal of Speech-Language Pathology, 34(5), 2877-2892. https://doi.org/doi:10.1044/2025_AJSLP-24-00530  

The award was announced here: https://academy.pubs.asha.org/2026/07/2026-asha-journals-awards/

We are thrilled to see the rigor of our Intelligibility in Context Scale (ICS) being applied in such a robust way.

• ICS: https://www.csu.edu.au/research/multilingual-speech/speech-assessments/ics
• Original manuscript: McLeod, S., Harrison, L. J., & McCormack, J. (2012). Intelligibility in Context Scale: Validity and reliability of a subjective rating measure. Journal of Speech, Language, and Hearing Research, 55, 648–656. https://doi.org/10.1044/1092-4388(2011/10-0130) 

 

Week 3 of the Tasmanian Kinder Speech Census begins

 At the beginning of week 3 of our Tasmanian Kinder Speech Census we have:

• 32 schools
• 1,203 Kinder students
• 889 parent consent forms returned 
• LOTS of children who have assented to participating in our research and who have told us how they feel about their speech 
• LOTS of children assessed using the International Speech Screener (ISS). I personally have assessed 208 children so far :)
• 63 control children assessed with the Diagnostic Evaluation of Articulation and Phonology (DEAP)

Another day face-to-face with Kinder students in CET schools

The rest of the week I have been assessing the students and undertaking data analysis via Zoom because I am no longer in Tasmania. 

Enjoying research with rural Tasmanian children during week 2 of the CET speech census

On Thursday and Friday this week I have traveled to rural locations to undertake research with 4- and 5-year-old children in Catholic Education Tasmania schools for our CET speech census. 

 The children have been great - and the staff have been welcoming, resourceful, knowledgeable and supportive. I have learned a lot, and understand more about schools and children's speech - as well as how to create the best processes for screening children's speech across CET in 2027. 

 

Rural locations know how to be welcoming. Thanks for the unexpected latte that arrived mid morning and your enthusiasm about our treehouse poster! https://www.csu.edu.au/research/multilingual-speech/speech-acquisition/learning-english-consonants

 This is the end of week 2 of screening.  Felicity, Lisa, Sarah, Helen, Ally, Emma and myself have been working with children in schools (either in person or via Zoom). We have met a lot of children - but still have more to go. Next week we will continue :) 

Assessing children's speech in Tasmania

I am in Tasmania this week to assess children's speech across the state as part of our research grant with Catholic Education Tasmania. It is wonderful to visit schools with Felicity Laurence and Lisa Johnson.

This is a really important study. One of the speech assistants aptly named this phase of the research the "CET speech census".

We currently have 785 consent forms and ICS data through Qualitrix. 

Some of the unique experiences from this week:

• Monday and Tuesday - Assessing 53 children across 4 different schools using the International Speech Screen (and some with the DEAP Screener) 
• A baby deer was shown to the children in the classroom we were visiting (very tiny and cute!)
• One child came three times to be assessed (he took his sticker off so we didn't remember he had been assessed before)
• Our treehouse speech sound poster (McLeod & Crowe, 2018) was on the speech room wall at one of the schools
• Tuesday - Negotiating the rain as we walked with children from their classrooms to the allocated research space
• Undertaking research in an art room 
• Enthusiastic children wanting it to be their turn :) 

Sharynne and Felicity ready for a day with Kinder children in Hobart

Sharynne  and Kate's treehouse poster was on the wall in the speech room at a school!

Sharynne and Lisa in the rain

Sharynne  and Lisa about to meet the next group of 4-year-olds

We also met with the private speech pathologists who assess CET children as part of the research on Wednesday morning 

CeTasSSD data collection has begun

The day has finally come that we have begun the research with 1,200 Kinder children in Tasmania. We are using the Australian English version of the International Speech Screener (ISS) and a question from the SPAA-C.  Ally Bennett, Emma Scanlon and I assessed 24 children across 2 schools on the first day (Monday) - which is 2% of the research population. The children and staff were excellent. We have a fun few weeks ahead. Thanks everyone.

Tuesday update - we now have signed consent from 733/1203 (60.93%) students. I assessed another 12 students. Ally and Emma assessed more. 

Thursday update - 166 children had been assessed

Helen Blake, Ally Barrett, Sharynne, Felicity Laurence, Lisa Johnson

Sharynne  with Emma Scanlon after transcription reliability checking

Emma and Ally online

 

CeTasSSD data planning and collection is underway

We have begun data collection for our CeTasSSD study! Tonight 715 entries have been recorded from the caregivers of 4- to 5-year-olds. While some entries will not be analysed (a few parents entered twice, some did not give consent to be involved in the research etc.), we are going to have a large number of children to help us learn about children's speech, and the best screening pathway for the state. Thank you to Kate Crowe, Felicity Laurence and Lisa Johnson who have overseen this online data collection phase from parents.

Today we also met to work through the practicalities of the data collection phase that begins next week to talk with children to listen to their production of speech sounds and learn from them about what they think about their speech. It was a really productive day of problem solving and getting things in place. Thanks Helen Blake, Ally Barrett, and Emma Scanlon - plus our special helper :)

.

 

 

Tasmanian speech study - data analysis and preparation for 2026 data collection

This week I have spent a lot of time on our Tasmanian speech study (CeTasSSD). I have undertaken data analysis with Dr Nicola Ivory - which involved more data cleaning therefore beginning all of the analyses again (a very typical scenario in quantitative data analysis). I have hired a new research assistant, Emma Scanlon and worked on finalising the International Speech Screen with Helen Blake.

Emma Scanlon

Nicola Ivory

 

Thesis revisions

I had a lovely meeting with Cathie Matthews today finalising her thesis revisions after examination. One famous examiner from USA recommended no changes! Her thesis is titled "Supporting 2-year-olds’ communication: Collaborations between caregivers, early childhood educators, and health professionals in rural Australia". Congratulations Cathie - nearly there!

Our first data have arrived for our research with Catholic Education Tasmania

Today was an exciting day that we have worked for >1 year to achieve. We received the first set of data from Catholic Education Tasmania from 561 4-to-5-year-old children. Hooray! Now we can begin to analyse the data to co-create new pathways to support children with speech sound disorders.

 

Congratulations Cathie

This afternoon Cathie Matthews received great feedback from her MPhil examiners for her thesis titled "Supporting 2-year-olds’ communication: Collaborations between caregivers, early childhood educators, and health professionals in rural Australia". Congratulations Cathie! I hope you enjoy celebrating this weekend.

 

Population data - The importance of working with key data managers

Today I was able to meet with "Data Debbie" from Catholic Education Tasmania. She is overseeing our data entry once our project is signed off and ready to officially begin with CET. We discussed the importance of demographic data, understanding missing data, and also the possibility of scanning data into Excel straight from the ICS forms! Thanks Debbie, Lisa and Udari!

 

Speech and language therapists' insights into severity of speech sound disorders in children for developing the Speech Sound Disorder Severity Construct

Congratulations to Anniek Van Doornik, my PhD student at Utrecht University in The Netherlands, who has just had this paper from her PhD accepted for publication:

Van Doornik, A., Welbie, M., McLeod, S., & Gerrits, E., Terband, H. (2025, in press). Speech and language therapists' insights into severity of speech sound disorders in children for developing the Speech Sound Disorder Severity Construct. International Journal of Language and Communication Disorders.

Abstract
Background: Children with speech sound disorders (SSD) are at higher risk of communication breakdown, but the impact of having an SSD may vary from child to child. Determining severity of SSD helps SLTs to recognise the extent of the problem and to identify and prioritise children who require intervention.
Aims: This study aimed to identify severity factors for SSD in order to develop a multifactorial Speech Sound Disorder Severity Construct (SSDSC) using speech-language therapists’ (SLTs’) views and the International Classification of Functioning, Disability and Health (ICF).
Method: In an explorative five-staged qualitative study, the research question was answered: “How do SLTs determine the severity of speech sound disorders in children?”. A total of 91 SLTs from the Netherlands participated in data collection and analysis. The iterative process included three different qualitative research methodologies (thematic analysis, constructivist grounded theory and content analysis) to ensure validation of the results by means of method triangulation.
Results: SLTs considered 9 themes: intelligibility, speech accuracy, persistence, the child’s perception, impact, communicative participation, concomitant factors, professional point of view, and environmental factors. The themes were summarised in three main severity factors: (I) Speech accuracy, (II) The child’s perception of the impact of their speech, and (III) Intelligibility in communication. Other severity factors were concomitant factors and impact. Expertise and support were identified as facilitators or barriers that may worsen or relieve the severity of SSD.
Conclusions: This study highlights the need for SLTs to rethink how they think about severity as a simplistic construct reflecting only speech accuracy. It is recommended that a broader holistic approach to measuring severity is adopted.

What this paper adds:
What is already known on the subject
Although there are several proposals aiming to define the severity of SSD, the extent to which these align with clinical practice is not well understood. In recent years, speech accuracy and other factors such as intelligibility have been suggested as possible indicators of SSD severity. Flipsen et al (2005) concluded that experienced clinicians evaluated the number, type and consistency of speech errors as well as intelligibility, considering articulatory competence at both the segmental and whole word level when determining severity. Enderby and John (2015) developed ICF-based Therapy Outcome Measures (TOMs), including a TOM for phonological disorder. Although there is evidence in the literature that multiple factors should be considered when determining severity, there is still no clear guidance on this. In this discussion, the perspective of SLTs is an important contribution to the development of a measure of severity, but is lacking in the known literature.  

What this paper adds to existing knowledge
As a first step, this study examines SLT’s perspectives on how they define and measure severity of SSD, and determines how those views align with the International Classification of Functioning, Disability and Health (ICF) in order to develop a severity construct that can be further tested and validated. Using the views of SLTs and the ICF, this qualitative study resulted in the multifactorial Speech Sound Disorder Severity Construct (SSDSC).

What are the potential or actual clinical implications of this work?
The practical experience of SLTs, combined with what is known from the literature, provides insight into the different factors that may contribute to severity of SSD. These factors may be considered in developing a measure of SSD severity in the future.

Catholic Education Tasmania - Prevalence and screening pathway project

This week A/Prof Sarah Verdon, Dr Nicola Ivory, A/Prof Kate Crowe and I are working on the ethics, and finalisation of the Catholic Education Tasmania - Prevalence and screening pathway project. It is a privilege to work on this to set up a robust screening pathway for Tasmania.

Monday - Sarah, Nicola and Sharynne at CSU

Monday evening-Kate C (in Iceland) and Sharynne

Tuesday - Sarah, Nicola and Sharynne at CSU

Tuesday afternoon - Lisa, Felicity at CET, Sharynne, Sarah, Nicola at CSU

Thursday afternoon - Felicity, Lisa, Sharyne, Nicola, Udari

Invited paper accepted for publication in Portuguese Journal of Speech and Language Therapy

We have just had the following invited paper accepted for publication in the Portuguese Journal of Speech and Language Therapy: 

McLeod, S., Blake, H. L. & Margetson, K. (2024, in press). Enhancing children’s speech using international evidence-based resources. RPTF - Revista Portuguesa de Terapia da Fala [Portuguese Journal of Speech and Language Therapy] https://www.aptf-rptf.com/

 It is wonderful to continue our collaborations with our colleagues in Portugal: https://speakingmylanguages.blogspot.com/search/label/Portuguese

 

Speech screening discussions with Catholic Education Tasmania

What a wonderful conversation today with Felicity Laurence and Lisa Johnson from Catholic Education Tasmania to continue our planning of a speech screener that would be able to be used for all children in Kindergarten (who attend 3 days/week) across Tasmania. I am very excited about finalising the brief for this project so we can begin working together.

Lisa, Sharynne and Felicity

Speech Pathology Australia National Conference

Our team is in Perth this week for the Speech Pathology Australia National Conference. Here are our presentations:

1. How can I assess children’s speech in a language I do not speak? Insights from VietSpeech research - Kate Margetson and Sharynne McLeod
2. Assessing the language skills of multilingual Vietnamese-Australian children - Sarah Faulks, Sarah Verdon and Sharynne McLeod
3. Caregivers’ insights into supporting late talkers using Target Word™ Hanen Program® for parents  - Sarah Bartlett and Sharynne McLeod
4. Supporting 2-yearold’s communication: Collaborations between rural health professionals and early childhood education services - Cathie Matthews, Sharynne McLeod, et al.
5. Children Draw Talking: Insights from 200 children from 24 countries - Sharynne McLeod, Carolyn Gregoric, Jessamy Davies, Lysa Dealtry, Laura Delli-Pizzi, Belinda Downey, Sheena Elwick, Suzanne C. Hopf, Nicola Ivory, Holly McAlister, Elizabeth Murray, Azizur Rahman, Shukla Sikder, Van H. Tran, Cherie Zischke, Julian Grant
6. International Association of Communication Sciences and Disorders (IALP): Making global and professional connections - Brian B. Shulman, Sharynne McLeod and Emily Hunt
   

Sharynne presenting Cathie Matthews' research

SLM team at SPA2024 - Sarah F, Kate M, Sharynne, Sarah B, Emily-Jane

Sarah Faulks presenting her honours research

Sarah Bartlett

Kate Margetson introducing the SACHL

Some attendees at the IALP session

IALP president Brian Shulman, Emily Hunt, Sharynne McLeod

Kate Margetson

Sharynne presenting about the Children Draw Talking research

University of Bristol Health Sciences Faculty invited lecture

My final presentation as Bristol Benjamin Meaker Visiting Distinguished Professor was held today https://www.bristol.ac.uk/international-research-development/diary/2024/health-sciences-talk-by-professor-sharynne-mcleod.html It was presented to University of Bristol Health Sciences Faculty. 

The title was: Multilingual Children’s Speech 

Here is the abstract: 

Many children and families are multilingual; whereas, many speech and language therapists in the UK (and other countries around the world) are monolingual English speakers. An evidence-based protocol has been developed for monolingual speech and language therapists to assess and analyse the speech of children who speak different languages. This protocol has been tested with Vietnamese-English children and adults during the VietSpeech Australian Research Council Discovery Grant. Free resources have been developed for working with Vietnamese children and families (https://www.csu.edu.au/research/vietspeech/info) as well as for speakers in over 100 languages on the Multilingual Children’s Speech website (https://www.csu.edu.au/research/multilingual-speech). Multilingualism has been described as a superpower (https://www.youtube.com/watch?v=wBrXmRW7lwg) and this presentation will encourage attendees to support young superheros during their speech and language therapy.

Abhaya Vadlamudi was thanked for being a
multilingual superhero who speaks Telugu and English

Invited lecture at Bristol Dental School: Speech, Language and Communication: An Overview for Dentists

Today, as part of my role as the Bristol Benjamin Meaker Visiting Distinguished Professor, I presented a guest lecture to the School of Dentistry titled "Speech, Language and Communication: An Overview for Dentists" https://www.bristol.ac.uk/international-research-development/diary/2024/dental-school-talk-by-professor-sharynne-mcleod.html. The lecture was held at the Bristol Dental School, Temple Quay Room

Here is the abstract: 

Most speech, language and communication is produced using the mouth. Dentists are frequently asked about the association between oral structures and communication. This presentation will describe how speech is produced using ultrasound and electropalatography images and will demonstrate the impact of oral structural alterations (e.g., tongue tie and cleft palate) on speech. Recent evidence-based techniques will be described to enable dentists to be better equipped to work with individuals with speech, language and communication needs.

Prof Sharynne McLeod and Prof Yvonne Wren