Among complications associated with non-syndromic cleft lip and/or palate (NSCL/P) in school age children, conductive hearing loss has been thoroughly investigated because the symptoms are noticeable and the treatment is often easy to access. Research on central auditory processing disorder [(C)APD] has been rarely explored in this clinical population. However, children with NSCL/P have been reported to have delayed speech and language development, as well as poor academic performance in general compared to craniofacially normal peers, despite their peripheral hearing problems typically resolving with age. In order to investigate suspected (C)APD in children with NSCL/P, the present research program was initiated. The study aimed to utilize a comprehensive test battery to assess auditory status in children with NSCL/P, and to investigate whether they have a greater frequency of (C)APD compared to craniofacially normal children. 147 children with NSCL/P and 60 normal children were recruited. They were Mandarin speakers and attending regular schools. The children with NSCL/P did not have peripheral hearing problems at time of assessment. There were three types of assessment tools used in the present research program. Firstly, hearing health tests were conducted to evaluate peripheral hearing function. Case history and auditory questionnaire reports were completed by caregivers to obtain basic medical and developmental information (Chapter 3). Secondly, auditory behavioral tests of (C)APD functioning were administered, including a gap detection test and a speech in noise recognition test (Chapter 4). Thirdly, an auditory evoked potential (AEP) assessment was conducted as an objective evaluation of the central auditory nervous system (Chapter 5). Based on the results of this research program, it was concluded that, firstly, children with NSCL/P showed behaviors typically found in children with (C)APD when questionnaire results were considered. Children with cleft palate (CP) showed the most negative outcomes, and cleft lip (CL) group children showed results equivalent to craniofacially normal children. Secondly, behavioral assessment results showed that compared to control group children, maturation for temporal resolution abilities was delayed in children with NSCL/P. Also, the ability to use interaural timing and intensity cues for speech recognition in a noisy environment was poorer in children with CP and CLP. Finally, abnormal AEP findings in children with cleft suggested longer neural transmission times and delayed development of the auditory nervous system may occur in this population. In summary, the research program found that children with NSCL/P are at higher risk of auditory processing difficulties compared to craniofacially normal children. In addition, a comprehensive test battery is more appropriate for making an accurate diagnosis of (C)APD in this population than a single assessment protocol. The present research program has contributed to an enhanced awareness of potential (C)APD in children with NSCL/P, which had not been investigated using a comprehensive test battery for a large sample of children with cleft disorders in any previous studies. Since Chinese language specific assessment tools are limited, further studies to develop an appropriate, comprehensive test battery for the diagnosis of auditory processing disorder in Chinese children with oral cleft and to explore effective management of this disorder are required. / published_or_final_version / Speech and Hearing Sciences / Doctoral / Doctor of Philosophy

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The purpose of this study was to examine the validity of teacher ratings for screening childrens language skills. Teacher ratings were measured through the use of two tools, the Childrens Communication Checklist-2 (CCC-2; Bishop, 2006) and the Teacher Rating of Oral Language and Literacy (TROLL; Dickinson, McCabe, & Sprague, 2001). The data for this study were from 77 kindergarteners who lived in rural Louisiana and spoke a non-mainstream dialect of English; 51 were classified as typically developing and 26 as presenting with Specific Language Impairment. Convergent validity was examined by comparing the two teacher rating tools to each other and to three language and literacy screeners. Predictive validity was examined by comparing the teacher rating tools to the Diagnostic Evaluation of Language Variation: Norm Referenced (Seymour, Roeper, & de Villiers, 2005). Although some results supported the convergent and predictive validity of the teacher ratings as measured by the two tools, neither tool nor the other screeners accurately identified a sufficient number of children with SLI. When empirically-derived cut scores for each screener were utilized, accuracy of the teacher ratings improved, and a discriminant function analysis with empirically-derived cut scores selected the Peabody Picture Vocabulary Test 4 (PPVT-4; Dunn & Dunn, 2007) and TROLL as the best tools to utilize in combination for screening purposes. This combination of tools accounted for 73% of the variation in the childrens DELV-NR scores. However, the PPVT-4 by itself was just as accurate as the PPVT-4 and TROLL together, with 95% of the children accurately screened (Sensitivity = .88; Specificity = .98). For screening purposes, these findings support the use of teacher ratings as measured by the TROLL when empirically-derived cut scores are used and when the TROLL is combined with the PPVT-4.

The purpose of this study was to identify how SLP communication regarding language disorders was perceived by caregivers. Employing a qualitative methodology, the caregivers of 10 children, identified with a language-based reading impairment, participated in semi-structured interviews concerning their experiences communicating with SLPs. As a whole, the findings showed the value caregivers place on receiving clear, concrete, and timely diagnostic information, the variability and complexity associated with caregivers understanding of language disorders, and the reciprocal relationship between key SLP communication practices, caregiver knowledge, and effective collaboration. Some of the key themes emphasized in regard to SLP communication practices included: recognition of the importance of diagnostic labels to caregivers, recognition of the potentially different ways caregivers may interpret diagnostic labels, recognition of the need for initiating and following-up on communication opportunities with caregivers, recognition of the necessity of checking for caregiver understanding of messages, recognition of how caregiver roles and responsibilities influence caregiver collaboration, and recognition of the importance of providing caregivers with informational resources across time that increase their knowledge and understanding of the diagnostic and intervention process.

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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / abstract / toc / Psychiatry / Master / Master of Philosophy