SPEECH OUTCOME FOLLOWING PALATOPLASTY IN PRIMARY-SCHOOL CHILDREN - DOLAY PEER OBSERVERS AGREE WITH SPEECH PATHOLOGISTS

The aim of this study was twofold: (1) to test the ability of normal c hildren to discriminate the speech of children with repaired cleft pal ate from the speech of unaffected peers and (2) to compare these naive assessments of speech acceptability with the sophisticated assessment s of speech pathologists. The study group (subjects) was composed of 2 1 children of school age (aged 8 to 12 years) who had undergone palato plasty at a single cleft center and 16 matched controls. The listening team (student raters) was composed of 20 children who were matched to the subjects for age, sex, and other variables. Randomized master aud iotape recordings of the children who had undergone palatoplasty were presented in blinded fashion and random order to student raters who we re inexperienced in the evaluation of patients with speech dysfunction . The same sound recordings were evaluated by an experienced panel of extramural speech pathologists whose intrarater and interrater reliabi lities were known; they were not direct care providers. Additionally, the master tape was presented in blinded fashion and random order to t he velopharyngeal staff at the cleft center for intramural assessment. Comparison of these assessment methodologies forms the basis of this report. Naive raters were insensitive to speech differences in the con trol and cleft palate groups. Differences in the mean scores for the g roups never approached statistical significance, and there was adequat e power to discern a difference of 0.75 on a 7-point scale. Expert rat ers were sensitive to differences in resonance and intelligibility in the control and cleft palate groups but not to other aspects of speech . The expert raters recommended further evaluation of cleft palate pat ients more often than control patients. Speech pathologists discern di fferences that the laity does not. Consideration should be given to th e utilization of untrained listeners to add real-life significance to clinical speech assessments. Peer group evaluations of speech acceptab ility may define the morbidity of cleft palate speech in terms that ar e most relevant to the patients themselves and may safeguard against t he possibility of offering treatment that may be unnecessary.