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.

Intelligibility in 3- and 5-year-olds born with cleft lip and/or palate: Reference data on Intelligibility in Context Scale scores

The following paper has just been published. It was commenced during my Benjamin Meaker Visiting Distinguished Professorship at the University of Bristol.

Davies, A., McLeod, S. & Wren, Y. (2026). Intelligibility in 3- and 5-year-olds born with cleft lip and/or palate: Reference data on Intelligibility in Context Scale scores. The Cleft Palate Craniofacial Journal. https://doi.org/10.1177/10556656261456526

Here is the abstract:

Objective
(a) Provide reference data for the Intelligibility in Context Scale (ICS) for children born with cleft lip and/or palate and (b) compare ICS scores: between cleft types; with typically developing and normative samples; and across ages 3- and 5-year-old children.
Design
Longitudinal prospective cohort study.
Setting
Questionnaire data from the Cleft Collective.
Participants
Three-year-old (n = 928) and 5-year-old children (n = 795) born with cleft lip and/or palate.
Main Outcome Measure(s)
ICS – parent-reported measure using a 5-point Likert scale to indicate how intelligible their child is with seven different communication partners.
Results
Median scores for children born with cleft lip only were higher (4.14, 95% CI = 4.00–4.14 for 3-year-olds; 5.00, 95% CI = 4.29–5.00 for 5-year-olds) than those born with any form of cleft palate (3.71, 95% CI = 3.57–3.86 for 3-year-olds; 4.14, 95% CI = 4.14–4.29 for 5-year-olds). Scores for children born with cleft lip only aligned with studies comprising typically developing children and normative samples, whereas those born with any form of cleft palate did not. Children born with cleft palate and a diagnosed syndrome scored lower than those born with non-syndromic cleft palate. For children who had data at both ages, 75.4% showed improvement over time, 14.3% stayed the same and 10.3% scored lower at age 5.
Conclusion
Reference data are now available for children with the major cleft subtypes which can be used for comparison in clinical settings. These data show how children born with cleft compare with the non-cleft population and change over time.

Catch up with Prof Yvonne Wren

 There are so many projects and areas of overlap with Prof Yvonne Wren from University of Bristol and Cardiff that we needed a 2026 catchup tonight. Topics included

• The Oxford Handbook of Speech Development in Languages of the World (Yvonne co-authored the English English chapter and the Welsh chapter - and has colleagues who may be able to write chapters in the next edition of the book) 
• Two papers with Amy Davis about using the Intelligibility in Context Scale with the Cleft Collective Cohort
• MISLToe studies - now there are 3 manuals for replications in other countries and with other populations to consider: core outcomes, list of definitions, and diagnostic protocols.
• AMS grant with our colleagues from Brazil 

 

Invitation to speak at the UNICEF UK Child Rights Academic Research Network meeting

I have been invited to speak with Prof Yvonne Wren at the UNICEF UK Child Rights Academic Research Network meeting on June 18th at 1-3pm focusing on child/youth voice. Our talk is titled "Ensuring all children have a voice: Upholding a child’s right to communicate in the context of speech, language and communication needs"

Huong Le (UNICEF, UK) indicated that while the network primarily aims to focus on work being undertaken in the UK they welcome learning and research from other parts of the world as well.

The brief is to:

1.    Provide a brief overview of your research on child/youth voice
2.    What are the key findings?
3.    What are the implications of your research for those working in practice?
4.    (Optional fourth question) What are the implications of your research for promoting children's rights?

Bristol Benjamin Meaker Distinguished Visiting Professorship

I have just learned that I have been awarded a Bristol Benjamin Meaker Distinguished Visiting Professorship (BBMDVP) to visit the University of Bristol for 5 weeks in 2024. I will work with Dr Yvonne Wren and her team on a project titled "Children born with cleft palate: Intelligibility and participation". I had been awarded a BBMDVP in 2020, but had been unable to visit due to COVID-19 restrictions. I am looking forward to visiting in 2024. 

http://www.bristol.ac.uk/international-research-partnerships/visiting-researchers/

http://www.bristol.ac.uk/international-research-partnerships/visiting-researchers/visitors/

Oral presentation at the 14th International Cleft Congress, Edinburgh

I have been working with a team of researchers from Bristol University and the Speech and Language Therapy Reserach Unit in Bristol. We have had the following paper accepted for presentation at the 14th International Cleft Congress (Cleft 2022) (https://cleft2022.com/) which is taking place in Edinburgh from 11th-15th July 2022: 

Exploring the association between intelligibility and language skills in 3-year-old children born with a cleft palate +/- lip 

Authors: Miriam Seifert, Lucy Southby, Amy Davies, Yvonne Wren, Sharynne McLeod 

The full program is here: https://cleft2022.com/cleft-2022-programme/

Intelligibility in Context Scale: UK Cleft Collective Cohort Studies

I have been invited to collaborate with researchers in the UK who are part of the Cleft Collective Cohort Studies, including Yvonne Wren, Miriam Seifert, and Amy Davies & Sharynne McLeod They are using the Intelligibility in Context Scale as a measure of children's speech. We are presenting the following conference paper next week:

Seifert, M., Wren, Y., Davies, A. & McLeod, S. (2019, April). Parents’ ratings of intelligibility in 3-year-olds with cleft lip and/or palate using the Intelligibility in Context Scale: Findings from the Cleft Collective Cohort Studies. Craniofacial Society of Great Britain and Ireland Conference, London, UK.

Sound Start Study symposium at Speech Pathology Australia 2016

The Sound Start Study, our Australian Research Council Discovery Grant (DP1030102545) is coming to a close, so it was a privilege to present five papers within a symposium session to share some of our findings.

• 

  L-R: Elise Baker, Sarah Masso, Pam Enderby (keynote speaker at the conference),
  Kate Crowe, Charlotte Howland, Sharynne McLeod

Here is the abstract from the first paper in the symposium

Speech sound disorders (SSD) affect many Australian preschoolers and if it persists into the school years between 30% to 77% will have reading difficulties. Without support services, these children face increased risk of life-long social, educational, occupational limitations; however, demand for speech pathology services exceeds supply. The Sound Start Study was designed to determine if the Phoneme Factory Sound Sorter (PFSS) (Wren & Roulstone, 2013) computer software can be used enhance preschoolers' speech and pre-literacy skills. The Sound Start Study was conducted in 6 stages per year, repeated over 3 years. In stage 1, 1205 children were screened via parent and teacher questionnaire. In stage 2, children whose parents and teachers had concerns about speech were assessed (n = 275). In stage 3, children who had a phonological impairment with no known cause (n = 133) underwent additional assessment of their speech, pre-literacy and phonological processing skills. In stage 4, 123 children were eligible and randomized into a control group or intervention group. The intervention group received PFSS administered by preschool staff over 9 weeks. This innovative computer program was designed using a psycholinguistic framework to target children's perception and representations of their phonological patterns via phonemic awareness tasks. In stages 5 and 6, children were re-assessed by speech pathologists blinded to the first assessment and intervention condition. These immediate and 3-month post-intervention assessments were undertaken to determine whether the intervention improved the children’s speech and pre-literacy skills.  

Here are the titles of our presentations:

• Randomised controlled trial of software to enhance preschoolers' speech and pre-literacy skills (Presenter - Sharynne McLeod)
• Implementation of a computer-assisted intervention for children with speech sound disorders in Australian preschools (Presenter - Kate Crowe)
• The print knowledge of preschool children with speech sound disorders before and after intervention targetting speech and pre-literacy abilities (Presenter - Elise Baker)
• The relationship between polysyllable production and emergent literacy in preschool-aged children with speech sound disorders (Presenter - Sarah Masso) 
• Realization of grammatical morphemes by children with speech sound disorders (Presenter - Charlotte Howland)

We were very pleased with the large number of people in the audience and the number of people who have commented, asked questions, and contacted us about our work after the presentation. More information about all of our presentations at SPA 2016 is here and information about Charlotte's award is here.

Yvonne Wren's visit to Bathurst

Yvonne Wren has spent almost a week visiting Bathurst as part of our ARC Discovery Grant (Sound Start Study). It has been a pleasure to share the sunshine and kangaroos - and to have so much time together to talk, plan, work, and write. One of the exciting moments of the visit was the team's submission of our Sound Start Study data to the statistician in the UK (Paul White).

We calculated we saw over 100 kangaroos behind the
Charles Sturt University campus (here are 17).

Sound Start Study visit to NSW Department of Education Rural and Distance Education Unit

Dr Yvonne Wren from the Bristol Speech and Language Therapy Research Unit and University of Bristol visited the NSW Department of Education Rural and Distance Education Unit on Thursday 26^th November. She demonstrated the Phoneme Factory software designed for teachers and assistants to support children with speech sound difficulties. Phoneme Factory consists of two programs:

1.     Phoneme Factory Phonology Screener provides teachers with a tool to individually assess children’s production of speech sounds and to determine if they need additional support (e.g., intervention using the Sound Sorter software, or further assessment and intervention by a speech pathologist)

2.     Phoneme Factory Sound Sorter provides games for children to play to support their speech and phonological awareness skills. The software enables teachers to individualise activities to a child’s particular needs.

The Phoneme Factory software was developed in the UK by Dr Wren and Professor Roulstone. The Phoneme Factory Sound Sorter has been adapted for the Australian context with support from the Rural and Distance Education Unit. It has been trialled in public and private preschools in NSW over the past 3 years in the Sound Start Study in association with researchers from Charles Sturt University (Professor Sharynne McLeod, A/Prof Jane McCormack, Dr Kate Crowe, Sarah Masso) and The University of Sydney (Dr Elise Baker).

Mike Tom, Kym Knight, David McLeod, Greg Alchin, and Yvonne Wren

Sound Start Study meeting

Today our Sound Start Study team met via Skype. We linked  7 people across 5 sites, 4 cities (Bristol, UK, Sydney, Albury, Bathurst) and 2 countries. This is the third and final year of the Sound Start Study - and by the end of the year we will learn whether the computerised intervention for children with speech sound disorders (Phoneme Factory Sound Sorter) has been successful. We have to continue to blind the data from our randomised controlled trial until the end of this year - so are looking forward to finding out the result.

Sound Start Study 2014

The Sound Start Study has had another extremely productive year.
During 2014 the team have seen 585 children, with more than 60 being involved in all six different stages of the study:

• Stage 1 = 585 children received screening assessments
• Stage 2 = 144 children received diagnostic assessments
• Stage 3 = 77 children received in-depth assessments
• Stage 4 = 69 children were randomised to either the intervention or control groups
• Stage 5 = 67 children received post-assessment 1
• Stage 6 = 65 children received post-assessment 2

Thank you to Kate Crowe and Sarah Masso who have completed these assessments with all of the children and Charlotte Howland, our research assistant who has assisted with data entry.
The Sound Start Study chief investigators and principle investigators are: Sharynne McLeod, Elise Baker, Jane McCormack, Yvonne Wren, Sue Roulstone and the research has been funded by an Australian Research Council Discovery Grant with support from the NSW Department of Education and Communities.

We have one more year of data collection to go, then can find out whether the Phoneme Factory Sound Sorter computer program is a successful intervention for children with phonologically-based speech sound disorders.

Sarah Masso, Mike Tom (Department of Education and Communities),
Kate Crowe, Charlotte Howland, Sharynne McLeod

Professor Sue Roulstone visits Australia (and Bathurst)

Professor Sue Roulstone, from the University of the West of England, Bristol, UK  is visiting Australia for a few weeks. She is an invited keynote speaker at the Speech Pathology Australia national conference. In addition, she is working with members of the Sound Start Study team (Sue is a co-investigator on the grant) and spending time at Charles Sturt University in Bathurst.

Sue and Sharynne enjoying Bathurst's autumnal weather

Today, Thursday 8th May, Sue presented a seminar to speech pathologists from across the Central West of New South Wales. The audience had traveled for hours, coming from places including Parkes, Mudgee, Orange, Dubbo, Lithgow, Canowindra, and Cowra. Here is the title, abstract, and her biography:

Mapping research onto practice with preschool children with primary speech and language impairments

The session will provide an opportunity to compare speech-language pathology practice in Australia with that identified in the Child Talk research programme in England. The focus of Child Talk is on speech pathology-led interventions for preschool children with PSLI, examining the research evidence as it pertains to current practice, with the aim of developing an evidence-based framework. The session will present key findings from the research programme including a typology of therapy and the perspectives of children and parents on interventions.

Professor Sue Roulstone with speech pathologists from the Central West

 

Biography

Sue Roulstone is Emeritus Professor of Speech & Language Therapy at the University of the West of England, Bristol and a co-Dirctor of the Bristol Speech & Language Therapy Research Unit. Sue has worked as a speech and language therapist, a manager, a researcher and an educator and was Chair of the UK Royal College of Speech & Language Therapists from 2006-2009. Her research interests include child and family perspectives, professional judgement and evaluation of speech and language therapy. She was a core member of the national research programme commissioned by the UK government following the Bercow Review of Services for children and young people with speech, language and communication needs (the Better Communication Research Programme) and is currently completing work on a large research programme funded by the National Institute of Health Research to develop an evidence-based framework of interventions for preschool children.

Sound Start meeting in Turin, Italy

During the IALP conference, the Sound Start team met to finalise the intervention protocols. Six of the seven team members were present in Turin, and Elise Baker Skyped with us for 2.5 hours from Australia (until 11:30pm her time!). It was an extremely productive meeting, where theoretical and practical issues were discussed. We are looking forward to the final stage of testing the participants (next week), then beginning the intervention phase (in one month's time).

Sound Start in Italy: Sharynne, Kate, Yvonne, (Elise), Sarah, Sue, Jane

Yvonne and Sarah discuss implementation of the Phoneme Factory software

A productive week in Bristol, UK

The Sound Start team have had an extremely productive week visiting the Bristol Speech and Language Therapy Research Unit (SLTRU). We started the week sharing information about our research projects with the staff and students at SLTRU. The rest of the week we analyzed data, planned future data protocols, and had meetings with Paul White (University of the West of England statistician), Duncan Witham (busythings software developer), and Liz Dymond (North Bristol Trust innovations manager). Professor Sue Roulstone provided tutorials on randomized controlled trials and the history of Phoneme Factory Sound Sorter. In the evenings we continued our discussions as we explored Bristol and went on the Gromit trail in support of the Bristol Children's Hospital.

Staff and students at the Bristol Speech and Language Therapy Research Unit
with their Australian visitors

L to R: Sharynne McLeod, Sarah Masso, Jane McCormack,
Kate Crowe, Paul White (UWE), Sue Roulstone (UWE)

Five of the seven members of the Sound Start Team in Bristol
(will we ever manage a photo with all of us?)

The SLTRU is on the grounds of Frenchay Hospital -
a famous name for many speech pathologists

This Gromit was decorated to celebrate the Bristol (Brizzle) accent

Speaker of the House of Commons draws himself talking

The Speaker of the House of Commons, Rt Hon John Bercow MP, recently hosted an event for Afasic as they celebrated their 45^th birthday. Afasic is a national organisation that supports families of children with speech, language and communication needs (SCLN) in the UK. It was held at the Speakers House in the House of Commons, London.   
At the event Professor Sue Roulstone gave John Bercow a copy of our book “Listening to children and young people with speech languageand communication needs.” John Bercow had written the Foreword to the book, so was interested to see it. While he was looking at the book, a young woman from Afasic asked him to draw a cartoon. Sue opened our book at chapter based on our Children Draw Talking research and said to him perhaps he’d like to draw himself talking as we had asked the children to do. John drew the young lady a cartoon of himself talking which said something along the lines of ‘I can’t stop talking’.

(Photos courtesy of Afasic)

• Here is the post from 2010 when I attended the same event. http://www.speakingmylanguages.blogspot.com.au/2010/07/invitation-to-house-of-commons-london.html

Speech characteristics of 8-year-old children with speech difficulties

The following manuscript has just been accepted for publication:

Wren, Y., McLeod, S., White, P., Miller, L. & Roulstone, S. (2012, in press August). Speech characteristics of 8-year-old children with speech difficulties: Findings from a prospective population study. Journal of Communication Disorders.

ABSTRACT
Speech disorder that continues into middle childhood is rarely studied compared with speech disorder in the early years. Speech production in single words, connected speech and nonword repetition was assessed for 7,390 8-year-old children within the Avon Longitudinal Study of Parents and Children (ALSPAC). The majority (n=6,399) had typical speech and 50 of these children served as controls. The remainder were categorised as using common clinical distortions only (CCD, n=582) or speech difficulties (SDiff, n=409).  The samples from the CCD children were not analysed further. Speech samples from the SDiff and the control children were transcribed and analysed in terms of percentage consonants correct, error type and syllable structure. Findings were compared with those from children in the Shriberg et al. (1997) lifespan database (n=25). The 8-year-old children from ALSPAC in the SDiff and control groups achieved similar speech accuracy scores to the 8-year-old children in the lifespan database. The SDiff group had consistently lower scores than the ALSPAC control group, with the following measures most clearly differentiating the groups: single word task (percentage of substitutions and distortions), connected speech task (percentage of vowels correct PVC, percentage of omission of singletons and entire clusters, and stress pattern matches), nonword repetition task (PVC, percentage of entire clusters omitted, percentage of distortions, and percentage of stress pattern matches). Connected speech and nonword samples provide useful supplementary data for identifying older children with atypical speech.

Listening Conference in Bristol

On 20^th June the University of the West of England hosted a 1 day conference titled: Listening to Children and Young People with Speech, Language and Communication Needs. The conference was attended by over 50 speech and language therapists, teachers, psychologists, parents and students. During the conference our Children Draw Talking art exhibition was displayed. I was invited to present the keynote address titled: The importance and challenges of listening to children and young people with speech, language and communication needs

The other presenters were:

• Rena Lyons: Exploring identity in children with speech and/or language impairments
• Ros Merrick: Picture Me: Using illustrations in conversation with children
• Graham Daniel and Sharynne McLeod: Listening to children with speech and language impairment: Implications for teachers of young children  (presented by Graham via video conference from Australia!)
• Mary Wickenden:  See me, not just the chair: Aspects of identity for disabled teenagers who use Augmentative and Alternative Communication
• Helen Hambly: One voice among many – contrasting children’s experiences of their primary language impairment (PLI) with the experiences of their parents, peers and the professionals who support them
• Sue Roulstone: Children’s perspectives from the Better Communication Research Programme
• Linda Lascelles: Chief Executive, Afasic: Tuning in to children and young people with speech and language difficulties.
  

  

  Sharynne presenting the keynote address

  
  

  

  Rachael and Jim, Ros Merrick, Helen Hambly, Sharynne, Sue Roulstone, Linda Lascelles, Mary Wickenden, Rena Lyons

  
  

  

  Year 3 students from Cardiff University with their copies of the Listening book

  
  

  

  Graham Daniel presenting his paper from Australia

  
  

  

  Rosemary Hayhow, and Anna Blackwell

  
  

  

  Jim and Rachael from J&R Press