The purpose of this study was to evaluate the effects of parent training in the Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) intervention program, using telepractice, on parent strategy use and child speech and language outcomes for children with repaired cleft palate with or without lip (CP/L). Four parent child dyads participated in the study. Child participants ranged in age from 28 to 53 months at the beginning of intervention and all had a diagnosis of nonsyndromic CP/L. Participants received two-to-three parent training sessions and twice weekly telepractice intervention sessions. Parents increased their use of EMT+PE strategies throughout intervention with the Modeling and Expansion and Prompting and Recasting strategies resulting in significant intervention effects. Moreover, parents maintained increased strategy use following the conclusion of direct intervention. A positive improvement in child speech and language outcomes was seen across intervention. This study showed that telepractice is an effective service delivery model for parent training and subsequent intervention session in EMT+PE strategy use to support the speech and language development for children with CP/L.

Children with cleft palate with or without cleft lip (CP+/-L) often demonstrate disordered speech. Clinicians and researchers have a goal for children with CP+/-L to demonstrate typical speech when entering kindergarten; however, this benchmark is not routinely met. There is a large body of previous research examining speech articulation skills in this clinical population; however, there are continued questions regarding the severity of articulation deficits in children with CP+/-L, especially for the age range of children entering school. This dissertation aimed to provide additional information on speech accuracy and speech error usage in children with CP+/-L between the ages of four and seven years. Additionally, it explored individual and treatment characteristics that may influence articulation skills. Finally, it examined the relationship between speech accuracy during a sentence repetition task versus during a single-word naming task.

Children with CP+/-L presented with speech accuracy that differed according to manner of production. Speech accuracy for fricative phonemes was influenced by severity of hypernasality, although age and status of secondary surgery did not influence speech accuracy for fricatives. For place of articulation, children with CP+/-L demonstrated strongest accuracy of production for bilabial and velar phonemes, while alveolar and palatal phonemes were produced with lower accuracy. Children with clefting that involved the lip and alveolus demonstrated reduced speech accuracy for alveolar phonemes compared to children with clefts involving the hard and soft palate only.

Participants used a variety of speech error types, with developmental/phonological errors, anterior oral cleft speech characteristics, and compensatory errors occurring most frequently across the sample. Several factors impacted the type of speech errors used, including cleft type, severity of hypernasality, and age.

The results from this dissertation project support previous research findings and provide additional information regarding the severity of speech articulation deficits according to manner and place of consonant production and according to different speech error categories. This study adds information on individual and treatment characteristics that influenced speech accuracy and speech error usage.