Tips for families about timing of speech therapy
Early intervention is often beneficial with the right approach! Knowing what sounds to target and how to target them is important to later speech success. If your child’s palate is not yet repaired, some early intervention teams will provide home-based speech therapy to facilitate vocabulary and receptive language development. Prior to a palate repair your child’s speech sounds will be limited to primarily /m/, /n/ and vowels. Many children like to produce and experience grunting and growling sounds at this stage as well.
Emphasis on other sounds too early (sounds that require a completed palate surgery) can produce compensatory sound errors due to the limits of the palate; targeting these other sounds can create cleft palate speech errors that have to be corrected later. Fortunately, there are many therapeutic activities including sound play and verbal cues that can be helpful and introduced in very early speech therapy. Many children do not receive early intervention services until the palate is repaired. At that time specific sound play goals can facilitate speech in the context of play.
On our team we like to evaluate the development of sounds approximately 3 months after the palate repair to determine the time to initiate speech therapy. Speech therapy is recommended if the child is not developing what are considered “high pressure” sounds. These are sounds that require that the palate seal off the nose from any air loss during production of these sounds, a function not possible until the palate is repaired! These include sounds like “b, p, t, d, k, g, sh, f”. Sound development is also driven by age, so the lack of an ‘f’ for example would not alone indicate poor palate function in a 2 year old. However, if that 16 month old or 2 year old is only producing nasal sounds (m, n, ng) and vowels, this would indicate a need for early speech therapy.
Speech therapy for young children is presented in the context of play! Since play is the strategy of speech therapy for toddlers to preschool, it is important to make note that although it appears the child and speech therapist are simply playing together, specific goals and strategies should be obvious to you as the parent. If goals are not explained or do not lead to increased sound play or expressive language, be sure and discuss further with your child’s speech therapist or on the team the examples of progress you are looking for.
Speech therapy ultimately determines the need for what is considered secondary palatal management which is a surgery to improve the function of the palate for speech. If a child’s palate is too short, too immobile (doesn’t move well) or the gap between the palate and the back wall of the throat is too large, additional surgery may be necessary. However, speech therapy is the first intervention, often, throughout the toddler-to-preschool years. In the past, five-years-of-age was the most common age for a second a second surgery to address the function of the palate. Now, with improved technology to help assess the function of the palate, some teams and surgeons are recommending them as early as 3 ½ years though again, most commonly only after a period of direct speech therapy.
The child’s ability to fully participate in speech therapy is significant by age 3 and beyond. Targeting, for example, the sound being produced too far back in the throat or all out the nose (sound errors both common with cleft palate) requires that the child’s cognitive development allows him or her to understand the changes being targeted. Determining that a non-cooperative 2 year old leaks air out the nose because of the structure of the palate may be premature conclusion! For success at school, most teams like to see that by 5 years, or prior to kindergarten, the child’s speech is understandable to his peers. If your child’s speech quality suggests a surgical procedure may be needed, it is important to have the full participation of the cleft treatment team to help with making this decision.
Finally, some children do require a break during the time they are preparing for bone graft or during orthodontic expansion. Some of our older patients (teenagers) may have some errors on sounds like /s, z, sh/ due to the position of their jaw or tooth eruption. If these sounds will change with a change in structure, it is often recommended they follow up after any additional procedures. A short-term period of speech therapy might be recommended at that time.
Miss earlier posts in this series?
Part 1– Speech with the Team, Speech at School here.
Part 2–Building the Relationship Between Parents, Team and School here.
Part 3–Timing and Need for Speech Therapy here.
Part 4–Why Aren’t we Done Yet? here.
Part 5–Surgery and Speech Therapy here.
About this series: We recently asked Theresa M Snelling, M.A.,CCC-SLP, to help us learn more about speech development and support for the school-aged child. We are so pleased to share her response with you in this special eight-part, One From the Team series, Speech Therapy and the School-Aged Child.
Teresa is clinical coordinator for the Cleft Palate and Craniofacial Center at Rose Medical Center, Denver, CO and has been working with patients and families affected by clefts for more than 30 years. If you need assistance locating a team or a cleft-specializing speech therapist, please, drop us a line or give us a call! 1.800.242.5338 or firstname.lastname@example.org.