Term Paper: Speech Problems and Psychological Damage

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[. . .] Among these are excessive nasality of speech. Because those with cleft lips and palates lack the normal velopharyngeal (or soft palate-to-pharynx) closure, the voices of such individuals quite often acquire an abnormally nasal quality that is a direct result of the atypical resonance qualities of their nasal chambers. Generally, nasality alone does not render speech unintelligible, but it is generally considered to be an undesirable speech attribute and may make a child self-conscious enough about his or her speech to affect language acquisition. The lasting effects of such nasality may well among cultural and linguistic groups (Bebout and Arthur 1992).

Other specific speech problems that are associated with cleft lips and palates (and that can be alleviated through early surgical intervention of the problem) are problems in articulating the plosive sounds of a language (for example, the sound "p" as in "Peter"). Problems in this area of articulation arise because an individual with a cleft lip or palate cannot create sufficient pressure inside the mouth (which does not "seal" properly) to provide sufficient breath to create these particular sounds. As these sounds are common across the linguistic range, this is often highly problematic (Lewis and Freebairn 1992).

Other specific language problems that face the child with an unrepaired cleft lip or palate lie in the production of sibiliant sounds (for example "s" as in "sibilant" or "sh" as in "shiny"). This results from the fact that rather than escaping through the lips as is the case in an individual without a cleft, in an individual with a cleft the air needed to produce sibilant sounds tends to escape first through the nose and so is altered and does not result in the necessary (in terms of the language's phonological requirements) hissing sounds.

Children with unrepaired palates are aware of the fact that their speech does not sound like that of other children or adults, either because their speech is so different as to render them unintelligible to others or because they are mocked for their speech (or at least it receives more neutral comments) or simply because they themselves perceive it to be different.

As a result of their being aware that their speech is not "normal," children with unrepaired cleft lips and cleft palates try to compensate for their "deficiencies." They may try to constrict the flow of air through their nose either by "scrunching" up their face (the term may not be a formal one, but it is certainly evocative of the ways in which children with unrepaired clefts react) or they may even stop the flow of air through their nose by plugging their nose with their fingers to create the kind of pressure and closure that exists for other children naturally (Elbert and Cierut 1986).

Children with unrepaired cleft lips and palates also tend to shift the point of physical articulation of various sound down below the point of the cleft so that the pharynx and even the larynx become involved in the child's attempt to produce the plosive and sibilant sounds involved in the language being spoken. While this may be seen as a brave and ingenious attempt on the part of the child to reproduce "normal" speech, in fact such sub-palate speech is often unintelligible and the child's reliance on it may produce even more speech problems (Estrem and Broen 1989).

The above described problems in articulation are the direct result of what may be described as mechanical problems produced as the result of the lack of proper closure and sealing of the oral cavity. However, these direct problems are not the only ones that occur when clefts are not repaired surgically at as early an age as is possible.

Various aspects of language use are all affected by a retarded rate of speech acquisition, as occurs when a child is struggling to overcome the physical challenges presented by a cleft lip or palate. Reading ability, for example, may be affected by slow speech acquisition (Catts 1993). This is turn may lead to a series of other learning complications given the centrality of reading to every other learning activity in school. The child's total ability to learn may be affected; not only may the child in fact suffer from being behind his or her peers but he or she may come to regard himself or herself as "stupid" or "unteachable."

Also causing potential problems in overall language fluency for children - even those who have had clefts repaired surgically - is the ongoing high rate of ear infections. At the least, ongoing illness tends to isolate the child further from his or her peers and tends to reduce the time spent learning. In more serious cases, the repeated infections can lead to hearing loss, which of course also has negative effects on the child's ability to acquire language at a normative rate.


Because of the extensive and negative consequences that may occur when a child's language acquisition is substantially slowed and because of the direct and negative effect that a cleft palate or cleft lip has on language acquisition, medical and surgical intervention should be undertaken as soon as possible to ensure that the child suffers as few long-term consequences from this common birth defect as is possible.

In those cases in which surgical remedy is not considered feasible, other treatments must of course be considered. Among these are the use of a prosthetic plate called an obturator that in some ways resembles dentures and helps to seal the oral cavity. Whatever treatment is assayed, the child's ability to acquire language as naturally as possible must be considered.


Bebout, L., & Arthur, B. (1992). Cross-cultural attitudes toward speech disorders. Journal of Speech and Hearing Disorders, 35, 45-52.

Bernthal, J.E., & Bankson, N.W. (1993). Articulation and phonological disorders (3rd ed.). Englewood Cliffs, NJ: Prentice Hall.

Broen, P.A., Strange, W., Doyle, S.S., & Heller, J.H. (1983). Perception and production of approximant consonants by normal and articulation- delayed preschool children. Journal of Speech and Hearing Research, 26, 601-608.

Catts, H.W. (1993). The relationship between speech-language impairments and reading disabilities. Journal of Speech and Hearing Research, 36, 948-958.

Dinnsen, D.A., & Elbert, M. (1984). On the relationship between phonology and learning. In M. Elbert, D.A. Dinnsen, & G. Weismer (Eds.), Phonological theory and the misarticulating child (ASHA Monographs No. 22) (pp. 59-68). Rockville, MD: ASHA.

Elbert, M. (1984). The relationship between normal phonological acquisition and clinical intervention. In N.J. Lass (Ed.), Speech and language: Advances in basic research and practice (pp. 111-139). New York: Academic.

Elbert, M., & Cierut, J.A. (1986). Handbook of clinical phonology: Approaches to assessment and treatment. San Diego: College-Hill.

Estrem, T., & Broen, P.A. (1989). Early speech production of children with cleft palate. Journal of Speech and Hearing Research, 32, 949-958.

Freeby, N., & Madison, C.L. (1989). Children's perceptions of peers with articulation disorders. Child Study Journal, 19, 133-144.

Hodson, B.W., Chin, L., Redmond, B., & Simpson, R. (1983). Phonological evaluation and remediation of speech deviations of a child with a repaired cleft palate: A case study. Journal of Speech and Hearing Disorders, 48, 93-98.

Hodson, B.W., & Paden, E.P. (1983). Targeting intelligible speech. Boston: College-Hill.

Lewis, B.A., & Freebairn, L. (1992). Residual effects of preschool phonology disorders in grade school, adolescence, and adulthood. Journal of Speech and Hearing Research, 35, 819-831.

Locke, J.L. (1983). Phonological acquisition and change. New York: Academic.

Locke, J.L. (1993). The child's path to spoken language. Cambridge, MA:… [END OF PREVIEW]

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