Cleft Speech Treatment Timeline

Working with a cleft-affected child? This is a general guide for speech therapy interventions in cleft-affected children. The overview helps breakdown the interventions required at different stages in development. The cleft speech treatment timeline may vary based on when surgeries occur. Early intervention and being knowledgable in cleft speech characteristics is essential while treating this population.

Cleft Speech Treatment Timeline

The first three years should emphasize building language skills. This includes expressive and receptive language, such as vocabulary and following directions. At three years of age, begin assessing and monitoring articulation, resonance, and voice.

Over half of cleft-affected children will need speech therapy at some point (Hardin-Jones & Jones, 2005). However, most will develop normal speech by age five if they receive appropriate team care and support.

Ages 0-3

concentrate on quantity of language
implement a home program with an emphasis on language
begin language therapy if indicated

Babies with cleft palate may babble later and have less variety of sounds, as well as a smaller vocabulary. The main goals in early intervention are to increase consonant inventory, increase vocabulary, and increase oral airflow.

Being proactive with early intervention is important to eliminate the possibility of future errors and improve speech intelligibility. Part of speech therapy is teaching correct motor movements and airflow patterns that can help eliminate the possibility of future errors. Research has shown that speech therapy can be helpful before errors develop.

Ages 3-4

assess the quality of speech and resonance
evaluate speech and velopharyngeal function and refer to a craniofacial specialist if needed
begin speech therapy or consider surgery as indicated

It is important to start therapy immediately to address any speech errors. It is much harder to treat established errors or delays. Developmental errors that persist to age five contribute to the likelihood of other delays.

Ages 5+

Typically therapy at this age is for articulation errors that are residual compensatory errors from velopharyngeal insufficiency, or errors related to dental malocclusion. These errors can be compensatory (learned errors) or obligatory (passive errors).

Speech therapy cannot fix obligatory errors. Read more about the difference between obligatory errors and compensatory errors.

Cleft Speech Frequency of Sessions

The more intensive treatment results, the more rapid the results. Ideally, speech therapy sessions should take place five days a week since research shows that the greater the frequency, the greater the results!

A study showed that a group of cleft-affected children treated 5 days/week for 60 minutes for a total of two weeks made greater progress compared to a group treated 1 day/week for 60 minutes for a total of ten weeks (Alighieri et al., 2021).

This type of model is difficult and not realistic for most settings. The minimum should be an hour a week, which may look like two 30-minute sessions a week.

Interested in a comprehensive resource for cleft speech?

The Cleft Palate Speech Guidebook is a comprehensive manual for evaluating and treating cleft speech, along with parent handouts. This unique cleft speech book has concise, easy-to-understand information for SLPs and SLPAs to assess and treat cleft-affected children. It contains over 100 pages of accessible information to feel confident in treating cleft speech!