Toddlerhood is a critical window for developmental interventions. But up to 75 percent of children born with cleft or lip palate don't receive the speech-language support they may need until grade school. This lag puts them at risk of challenges with communication, social relationships and academic performance. With a new $586,000 National Institutes of Health award, Vanderbilt researchers Ann Kaiser, Dr. Susan Gray Endowed Professor and professor of special education, and Tatiana Peredo, research assistant professor of special education, aim to change the status quo for these kids.
Their study, "Caregiver-implemented early speech and language intervention for toddlers with cleft palate," will pair speech-language pathologists with caregivers of young children who have cleft palate with or without cleft lip. Via remote training, caregivers will learn how to implement naturalistic speech and language teaching strategies with their two-year-old children. Based on several of their earlier studies-among children both with and without cleft palate-the researchers anticipate that this caregiver-provided intervention will improve outcomes for children with cleft palate.
Cleft palate is a common congenital anomaly that occurs when tissue in the lip and/or roof of the mouth does not fully connect, leaving a "cleft." Surgical procedures performed during infancy can typically address physical concerns, but for many kids, delays in speech and language persist.
"Early care for kids with cleft palate has been really focused on medical and surgical interventions. Those things have come so far and are really important," said Peredo. "But we want to see the landscape shift to incorporate speech-language therapy earlier via caregiver-implemented approaches."
"Developmentally catching up is not the same thing as having been on the same developmental trajectory," said Kaiser. "Children with cleft palate have different life experiences when they begin to use language and speak clearly later than expected. They haven't had the same access to learning opportunities as typical children. Socially, to not be a clear-speaking child until you're 8 years old is not a good experience in the world with peers, friends or family. Earlier is not only better-it might be essential," she said.
"Socially, to not be a clear-speaking child until you're 8 years old is not a good experience in the world with peers, friends or family. Earlier is not only better-it might be essential." - Ann Kaiser
In addition to narrowing the gap between the timing of surgical and therapeutical interventions, the researchers want to expand access to more children with cleft palate. "There's very little cleft-specialized care outside of major urban medical centers," said Peredo. "Our teletherapy, caregiver-coaching approach makes interventions accessible to kids who are in remote and rural areas."
The study will include toddlers from across the social-economic spectrum, both English- and Spanish-speaking, many of whom may not have access to expert cleft care in their communities. "I think we'll learn a lot about access and about whether this approach fills that gap for families," said Kaiser. The approach also aims to be sustainable by offering a lower-cost alternative to traditional, in-person therapy with a speech-language pathologist.
Kaiser and Peredo are co-principal investigators alongside Nancy Scherer, a leading cleft specialist and professor of speech and hearing science at Arizona State University. Their studies will take place in Nashville and Phoenix, providing caregivers with a series of 24 weekly coaching sessions that last about 45 minutes each. The initial funding is for the first two years, which are dedicated to planning and currently underway; there will be an additional five years to conduct the study.
Key collaborators include Kelly Cordero and Elizabeth Alvarez-Montoya with Phoenix Children's Hospital, along with Peabody's Jessica Logan, associate professor of special education, and Michael Golinko, Mellissa Henry and Lauren DeVries with Vanderbilt University Medical Center.
ABOUT ANN KAISER
Kaiser is a field leader in research and interventions for children with speech and language challenges, focusing on early intervention, language intervention and acquisition, environmental designs for dependent populations, and policy. She runs the KidTalk Kaiser Lab, which studies language growth in young children with disabilities.
Kaiser brings that expertise to her work on improving outcomes for children with cleft palate. "The study builds on a couple of decades of research in our lab around these strategies, this age of children, and telehealth-based intervention delivery. We've also done a lot of research on how to systematically teach caregivers to support their children's language development," she said.
ABOUT TATIANA PEREDO
Since early in her career, Peredo has worked with children facing language delays, focusing her research on adapting interventions to be culturally and linguistically appropriate. While pursuing a Fulbright U.S. Scholar Award, she connected with a professor at the University of São Paulo in Brazil, where she hoped to continue her line of research. But the professor told her that there was a huge need for cleft palate speech support in the area, urging her to turn her attention to that population.
"So, I got the fellowship working with Dr. Ana Paula Fukushiro and ran a pilot study coaching parents of toddlers with cleft palate at the hospital in Brazil. It's the only place like it in the world, in that they're very specialized in cleft palate and other craniofacial anomalies, across the lifespan, treating medical and psychosocial needs prenatally through adulthood," said Peredo. Her work in that hospital sparked the idea of a deeper study into supporting these families.
Kaiser and Peredo serve as faculty in the top-ranked Peabody College Department of Special Education, where professors not only teach, but are also actively involved in research that improves the lives of those with developmental disabilities. Learn more about all it has to offer here.
