Development and Testing of the West Midlands Assessment of Speech-Preschool (WAS-P) for 3-Year-Olds With Cleft Palate ± Cleft Lip

Abstract

Background

In the United Kingdom, cleft care is provided across 14 regional NHS cleft units. Although all units assess speech at age 3, no speech assessments have been designed specifically for 3-year-old children with cleft palate ± cleft lip (CP ± L). Existing speech samples for older children are often too complex for this age group, while generalised samples may contain an excessive number of nasal consonants, influencing listener judgements of resonance and nasal airflow. The lack of a standardised assessment for 3-year-olds prevents meaningful comparisons of speech outcomes across UK cleft units before age5.

Aims

This paper describes the first stage in developing a valid and reliable speech assessment protocol for 3-year-old children with non-syndromic CP±L. This stage involved creating and piloting the West Midlands Assessment of Speech–Preschool (WAS-P) speech samples with 3-year-olds both with and without CP±L. The study aimed to: (1) design age-appropriate speech samples that assess speech parameters associated with CP±L, suitable for both routine clinical assessment and the evaluation of speech outcomes. (2) evaluate the completion rates and clinical usability of these speech samples, including the views of speech and language therapists (SLTs).

Methods and Procedures

Two English-language speech samples were developed, considering linguistic, lexical, and practical factors. Sample A combined spontaneous speech with single-word picture naming (59 words, including a cross-linguistic sample), while Sample B involved the repetition of 24 short sentences. The speech samples were piloted with 20 children with non-syndromic CP±L and five children without CP±L. Completion rates and completion times were recorded. Seven cleft-specialist SLTs analysed video recordings of the sessions and provided feedback on acceptability and usability.

Outcomes and Results

All children without CP±L completed both speech samples, compared to a 70% completion rate among children with CP±L. More children with CP±L attempted the single-word picture-naming task than the sentence-repetition task, even if they did not complete it fully. The duration of the sentence-repetition sample was completed in significantly less time than the spontaneous speech and single-word naming sample. SLTs reported that the 3-year-olds were generally well engaged and indicated that both samples would be suitable for clinical practice.

Conclusions and Implications

The first stage of developing the WAS-P speech samples demonstrates the feasibility of standardising speech assessments for 3-year-old children in the UK. Both samples were considered appropriate for use with 3-year-old children with non-syndromic CP±L, balancing ease of administration with clinical usefulness. These speech samples have now been incorporated into a further research study to establish a standardised protocol for evaluating speech outcomes at age three in the UK.

WHAT THIS PAPER ADDS

What is already known on this subject

• Although all UK NHS cleft units assess speech at age 3, there is no single standardised speech sample used, and no speech sample has been specifically designed for 3-year-olds with CP±L in the UK. The development of tailored speech samples for this population would facilitate cross-unit comparisons of speech outcomes in UK cleft units.

What this paper adds to the existing knowledge

• This study introduces the West Midlands Assessment of Speech-Preschool (WAS-P), comprised of two newly developed speech samples specifically designed to assess speech in 3-year-olds with CP±L. It demonstrates the integration of existing speech samples—originally intended for cross-linguistic assessments—into these newly designed samples, thereby enhancing the capacity for speech outcome comparisons across different languages. Additionally, the study underscores the critical role of linguistic, lexical, and practical/pragmatic factors, alongside feedback from SLTs, in informing the development of effective speech samples for this age group.

What are the potential or actual clinical implications of this work?

• The development and piloting of the WAS-P for 3-year-olds with CP±L offers a significant advancement in the standardisation of speech assessments across UK cleft units. These new speech samples could facilitate consistent speech assessments at age 3, enabling the comparison of speech outcomes across different clinical settings. Additionally, the inclusion of a restricted word list for cross-linguistic assessments opens the possibility for international comparisons of speech outcomes.