An investigation into the perceptions of non-professionals in rating cleft speech versus Speech and Language Therapists according to national auditing standards for speech outcomes

Abstract

Background: Speech and Language Therapists (SLTs) working with children with Cleft Lip and/or Palate (CLP) are specially trained to identify subtle differences in resonance, nasal airflow and articulation errors in speech. Their assessment determines the level of treatment received in terms of speech therapy or surgery. Whilst this is important in ensuring a consistent basis for delivering intervention, very little research has examined non-professional perceptions of what constitutes as requiring intervention, not to mention in the context of national standards for cleft speech outcomes. This information can have implications for treatment and contribute to research in determining whether untrained listeners and SLTs make similar or different judgements of cleft speech, regarding aspects such as noticeability, acceptability and need for intervention. By studying untrained listeners we can also gain a deeper insight into how cleft speech is perceived in everyday interactions and how far this may be a hindrance to the speaker. Aims: To compare ratings for cleft speech by untrained listeners to national auditing standards for speech outcomes used by SLTs. To examine possible discrepancies in ratings for male and female participants, and first year SLT students against untrained listeners of other professional backgrounds. Methods & Procedures: A rating scale was developed for the participants based on the structure and content of the Cleft Audit Protocol for Speech - Augmented (CAPS-A) (Harding, Harland and Razzell, 2007). 28 non-professionals rated samples of cleft speech. The ratings were subject to quantitative analysis and compared directly to the national auditing standards for treatment by SLTs using the CAPS-A format. Outcomes & Results: It was found that the untrained listeners were less consistent in their ability to pick up on resonance and more prominent nasal airflow features than SLTs according to the CAPS-A. Hypernasality was underestimated in terms of severity and need for intervention, however participants were more consistent with CAPS-A clinical implications in judging more prominent resonance, nasal airflow and CSC errors in speech as requiring intervention, despite being less sensitive to such errors. Intelligibility was a considerable factor in the treatment decisions for participants, who rated moderate-severe Cleft Speech Characteristics as the most noticeable and having the most need for intervention. Conclusions & Implications: The results of participants’ ratings in this study, in the main, correspond with the CAPS-A framework and show that cleft palate speech disorders may have an impact on the everyday life of the speaker. Despite being less sensitive to the nature of certain cleft speech errors, communication partners of individuals with CLP are likely to make similar judgements of speech as experts, forming a good basis for decisions regarding intervention.