Quality of life of Malay-speaking school-aged children with cleft lip and palate: a cross-sectional study examining speech, language, and voice quality

Abstract

Children with cleft lip and palate (CLP) are reported to have a lower quality of life (QoL) than their typically developing peers. They showed a high risk of underachieving academic skills, particularly in reading and language, struggling with normal speech production, and may experience voice disorder. The QoL of local school-aged children with CLP was not comprehensively explored, while studies on their speech, language, and voice were limited. This study aims to explore the performance of participants on speech, language, voice, and QoL and determine factors associated with the performance. This is a cross-sectional study of 7- to 12-year-old Malay-speaking children with non-syndromic CLP. Participants completed CLEFT-Q, examining appearance, facial function, and health-related QoL. Speech samples, specifically speech intelligibility, resonance, and articulation, were judged by one expert SLP. Language skills were assessed using the Malay Preschool Language Assessment Tool (MPLAT) and the adapted Subway-School-age Language and Assessment Measures (SLAM). Perceptual voice assessment and acoustic measurement of fundamental frequency (F0), jitter, and shimmer were performed. Findings revealed that participants had comparable scores with the normative data on CLEFT-Q. However, they generally reported low satisfaction with facial appearance, particularly with teeth and nose-related features. Children from low-income families and those with less severe clefts, such as a cleft lip, may experience higher satisfaction with social or speech function. A significant proportion of the children failed to achieve normal speech outcomes in terms of resonance (38.5%), speech intelligibility (28.8%), and consonant production (84.6%). Attending speech therapy significantly improves children's speech intelligibility by 15 times compared to those who did not attend or defaulted on speech therapy. Fourteen (26.92%) participants demonstrated language deficits. They performed significantly poorer in reading comprehension (p = 0.031) and narration (p = 0.026). The prevalence of voice disorder was low, at 5.8%. Male children with CLP have significantly higher F0 on /a/ than peers but normal shimmer and jitter scores. Our findings revealed a relationship existed between QoL and speech or language performance. The results of this study presented new insights on the challenges faced by this population and highlighted the urgent need for multidisciplinary professionals to work in collaboration to improve their QoL