This article traces the historical foundations of the identification of language disorders in childhood through an international perspective. It describes the development of the profession of speech-language pathology, initially in Western Europe and later in North America. The roles played by key researchers in the area of child language are highlighted, with specific reference to significant periods of theoretical influence, using J. Duchan's (2006) labels for the periods as scientific, processing, linguistic, and pragmatic.

BACKGROUND:Language impairment and delayed language onset have been described, although not investigated in detail, in children with 22q11 deletion syndrome.AIMS:To investigate different areas of language: the ability to retell a narrative, phonology, syntax and receptive vocabulary in a group of 5-8-year-old children with 22q11 deletion syndrome regardless of whether or not they had a history of speech and language difficulties. Gender differences were also investigated.METHODS & PROCEDURES:Nineteen consecutively referred children with 22q11 deletion syndrome, ten girls and nine boys, between the ages of 5 and 8 years, participated in the study. The mean full-scale IQ of the group was 78. Six children had an autism spectrum disorder, attention deficit/hyperactivity disorder, or a combination of these. Three different language tests were used: (1) the Bus Story - a test of narrative speech and language; (2) an articulation test including all Swedish phonemes in different positions; and (3) the Peabody Picture Vocabulary Test - Revised (PPVT-R).OUTCOMES & RESULTS:All but two children had an information score in the retelling task of 1 SD below the population mean. A negative correlation between age and the information score implied that the older the children, the more severe the problems. One child had an average sentence length within the normal limits and five children had subordinate clauses within normal limits. A median of 4% of the utterances included grammatical errors. About 50% of the children had a complete consonant inventory. The phonological process analysis implied delayed rather than deviant development. The group had a moderately low score for receptive vocabulary.CONCLUSIONS:Language difficulties in all investigated areas of language were found. It is suggested that speech-language impairment is a common feature of 22q11 deletion syndrome. An implication of these results is that follow-ups of language skills are important not only for pre-school children, but also for school age children and adolescents with 22q11 deletion syndrome.

The object of this paper is to give an overview of the education and training programmes in logopedics offered in the Scandinavian/Nordic countries and to provide some information about the development of the programmes in Scandinavia since their foundation in the 1920s. In order to collect information about the various programmes, a questionnaire comprising 12 questions was sent to representatives for education programmes and national societies affiliated to the IALP. In the past all the countries used to provide possibilities for teachers to continue their education with courses in logopedics to become ‘special teachers’. These programmes no longer exist except in Norway. Degree programmes at bachelor’s and/or master’s level are now offered in all the Nordic countries. It can be concluded that the education and training in logopedics have developed into university degree programmes, with few exceptions, in the Nordic countries.

The purpose of this study was to investigate a consecutive series of 65 participants between 3 and 33 years of age (median age of 9 years and 4 months) with a confirmed 22q11.2 deletion, in order to ascertain the frequency and severity of articulation difficulties, velopharyngeal impairment (VPI), and the level of intelligibility. The majority had velopharyngeal impairment; over half of them to such a degree that surgery had been performed or was considered necessary. A high level of correct place and manner of consonants was only found in children with the 22q11 deletion syndrome from age 6. The most misarticulated consonants were stops and fricatives. Glottal articulation assessed in words and sentences was less frequent than expected according to earlier studies. A high prevalence of reduced intelligibility at different ages indicates an obvious communication limitation in younger children, and for some individuals even as teenagers and adults.Educational objectives: As a result of this activity, the participant will have knowledge about the frequency and severity of: (4) articulation difficulties; (2) velopharyngeal impairment; and (3) the level of intelligibility in patients with a 22q11.2 deletion. (C) 2002 Elsevier Science Inc. All rights reserved.

Accessible online at: www.karger.com/journals/fpl It is hard to believe that my 3-year term as IALP President is now completed, years that have comprised so much hard work, such a lot of fun, friendship and pleasure, but also some frustration. The frustration may not be as negative as it sounds, however, as it also contains a promise about the great potentials for the future of our Association. Let me come back to that later on. IALP is a fantastic organisation! Just imagine a world society that without discrimination with respect to race, gender, religion or cultural differences offers a platform for people all over the world to share knowledge and form networks based on professional needs and friendship. This is also a wonderful chance of finding out how much we really have in common regardless of linguistic and cultural differences in our common efforts to assist people with communication disorders. IALP is an old venerable association. In 1999, it celebrated its 75th anniversary with the Goteborg Composium, where many distinguished scholars were invited to present the state of the art within the various IALP domains. Just before the anniversary, the fourth edition of the IALP History was published thanks to the dedicated work of many IALP members. This is indeed interesting reading, where the growth of the Association can be followed from its foundation in 1924. The 2001 congress in Montreal will be the 25th one and with the next congress in Brisbane, Australia, all continents will have hosted at least one IALP congress, thereby stressing the globality of the Association. Serving in an established organisation in many ways means challenges. It goes without saying that many traditions that have developed over the years within IALP reflect different ways of looking at things and ways that are not very suitable for our modern world and our way of thinking. We certainly must take advantage of new techniques that in so many ways can improve and also certainly have improved our work in IALP, but we must be careful in our efforts to modernise, so that we do not cut the links to the past. I think we owe that to our predecessors. One of the challenges and also one of the frustrations is to make IALP better known. As it now is, IALP is both too big and too small. The organisation is too big to be run exclusively on a voluntary basis, if we want to live up to our ambitious plans. It is too small to afford projects that require a substantial financial support. We need to grow and to inform colleagues all over the world about

OBJECTIVE The purpose of the study was to study the speech outcome in a series of 5-year-old children born with an isolated cleft palate and compare the speech with that of noncleft children and to study the impact of cleft extent and additional malformation on the speech outcome. DESIGN A cross-sectional retrospective study. SETTING A university hospital serving a population of 1.5 million inhabitants. SUBJECTS Fifty-one patients with an isolated cleft palate; 22 of these had additional malformations. Thirteen noncleft children served as a reference group. INTERVENTIONS A primary soft palate repair at a mean of 8 months of age and a hard palate closure at a mean age of 4 years and 2 months if the cleft extended into the hard palate. MAIN OUTCOME MEASURES Perceptual judgment of seven speech variables assessed on a five-point scale by three experienced speech pathologists. RESULTS The cleft palate group had significantly higher frequency of speech symptoms related to velopharyngeal function than the reference group. There were, however, no significant differences in speech outcome between the subgroup with a nonsyndromic cleft and the reference group. Cleft extent had a significant impact on the variable retracted oral articulation while the presence of additional malformations had a significant impact on several variables related to velopharyngeal function and articulation errors. CONCLUSION Children with a cleft in the soft palate only, with no additional malformations, had satisfactory speech, while children with a cleft palate accompanied by additional malformations or as a part of a syndrome should be considered to be at risk for speech problems.

Babbling and speech in 21 children with cleft palate were compared at pre-speech level, 3, and 5 years of age. The aims were to study if misarticulations in pre-school speech appear to be articulatorily related to the sound productions in pre-speech, whether the feeding technique influenced the prevalence of anterior articulation, and if there was a relationship between speech and the size of the residual cleft at 3 and 5 years of age. All the children had the soft palate closed, whereas the cleft in the hard palate was left open to be closed later on. Perceptual judgement of speech revealed a high prevalence of hypernasality, nasal escape and retracted oral articulation of dental or alveolar plosives. The latter was correlated with the size of the residual cleft area. There was a tendency towards a relationship between absence of anterior sound productions in babbling and retracted oral articulation in speech. The feeding technique, however, appeared not to have had any influence on articulatory place.

OBJECTIVE:This study was conducted to evaluate the relationship between size of residual clefts in the hard palate and speech.SUBJECTS:Fifteen 7-year-old children born with complete cleft lip and palate were investigated.METHODS:All of the children were treated according to a surgical regimen involving early soft palate repair and delayed hard palate closure. Measures were taken of the area, length, and maximal width of the residual cleft in the hard palate about a year before its closure and correlated with a perceptual judgment of several speech variables.RESULTS:Significant positive correlations were obtained between the size of the cleft and two variables: weak pressure consonants and hypernasality. Nasal escape was very common among the patients, and almost half the children had retracted palatal or velar articulation of dental stop consonants. Neither of these two variables correlated with the size of the residual cleft.CONCLUSION:Perceived oral pressure and, perhaps, resonance seem to be related to size of the opening of the residual cleft, whereas audible nasal escape and articulatory compensations are not, at least not the latter once established.

The speech of 20 children with cleft in the hard palate that had not yet been repaired was evaluated and analysed at 7 years of age. The cleft in the hard palate was open in 14 patients and functionally closed in six. All children were born with cleft lip and palate and treated surgically according to a routine that included delayed closure of the hard palate until age 8-10 years. The soft palate was repaired at approximately 6-8 months of age. Tape recordings were used for perceptual analysis of the speech. Maxillary casts were used to assess approximate age for functional closure of the residual cleft. Speech results showed only mild hypernasality for both groups of subjects which indicates acceptable velopharyngeal function in the whole group. Children with open residual clefts had significantly more nasal escape and a higher prevalence of compensatory retracted articulation than children with functionally closed clefts. The functional closure seems to have occurred at about the age of 18-36 months. Factors which appear to facilitate narrowing of the residual cleft include the original width of the cleft, the amount of tissue in the alveolar and palatal processes, and anterior placement of a vomer flap.

The influence of an open residual cleft in the hard palate on speech was studied in nine children with cleft lip and palate at about 7 years of age. The subjects were treated by early repair of the velum (before 12 months of age), whereas the repair of the cleft in the hard palate was postponed until about 8 years of age. Speech and velopharyngeal function were assessed systematically with the residual cleft open and temporarily covered with an oral bandage. Listeners' judgments, the Nasal Oral RAtio Meter (NORAM), videofluoroscopy, and cephalometrics were used for the analyses. Four patients were also examined with a pressure-flow technique. Nasality registered by NORAM, nasal escape, and weak pressure consonants judged by listeners were common but decreased appreciably when the residual cleft was covered. Retracted articulation was found in four patients (44%) and glottal compensations in one (11%), with no improvement after covering.

Pre-speech in 35 children with clefts of the lip and palate or palate only were analyzed for place and manner of articulation. Transcriptions were made from tape recorded babbling sequences. Two children without clefts were used as reference. All of the children with clefts were treated according to a regimen of early surgical repair of the velum cleft and delayed closure of the cleft in the hard palate. The frequency of selected phonetic features was calculated. Correlations between phonetic/perceptual and functional and morphological factors were tested. Supraglottal articulation dominated among all the children indicating a sufficient velopharyngeal mechanism. The results also showed correlations between cleft type and place of articulation. Anteriorly placed sounds (i.e., bilabial, dental, and alveolar sounds) occurred frequently among the children with cleft palate only and in the noncleft children. In children with cleft lip and palate, posteriorly placed articulations predominated. It was postulated that early intervention may have a positive effect on articulatory development.

Speech was analyzed about 1 year postoperatively in 30 patients with cleft lip and palate who were the first ones to undergo late closure of the hard palate in Gothenburg, Sweden. Fourteen had bilateral and 16 had unilateral clefts. Soft palate closure had been performed at the mean age of 8 months, and the hard palate was closed at the mean age of 8 years with a range of 7-11 years. Imitated and spontaneous speech was analyzed at an average of 15 months after palatal repair. Six percent had moderate to severe hypernasal speech and 23% had retraction of dental consonants. No glottal articulation was found. Hoarseness and deviant s articulation were frequent. For 6 of the patients the same speech analysis was also made 1-3 months postoperatively. At this time there was no change in the speech of these 6 children compared with preoperative speech. Thus, the closure of the palate did not improve the speech directly. The improvement of the speech seems to be a gradual process.

Maxillary morphology and dental occlusion were studied from infancy to age 10 years in 32 patients born with isolated cleft palate. Wardill-Kilner push back repair of the palate had been done at a mean age of 7.5 months. Measurements obtained from casts of the jaws showed that the average maxillary dimensions before as well as after operation were less than those reported for children without clefts. The mean reduction was similar whether the cleft reached into the hard palate or affected the soft palate only. Preoperative anterior maxillary arch width in particular, and also distance from scar line to selected teeth seemed to influence postoperative development of the maxillary dental arch in individual patients.

During the period 1958-1985, 230 patients with cleft palate were operated on in the Department of Plastic Surgery, University of Göteborg, Sweden. A modified push-back technique according to Wardill and Kilner was used. The children were operated on at a mean age of 13 months. They were divided into two groups, the first in which the cleft affected the velum only (n = 121) and the other in which it also affected the hard palate (n = 109). Postoperative dehiscences and fistulas occurred in 19 (8%) patients, of which 16 (15%) belonged to the group in which the cleft affected the hard palate. Only three (2%) of the 121 patients with a cleft in the soft palate only developed dehiscences. The total number of patients who had to be reoperated on because of dehiscences were 10 (4%) and palatopharyngeal flaps had to be performed in 25 patients (11%) because of speech problems.

The speech of 31 consecutive patients with isolated cleft palate was evaluated when they were between 10 and 14 years of age. All the children had Wardill-Kilner push-back repairs at a mean age of 7.9 months. Several speech variables were assessed by two trained listeners. In addition, an overall evaluation of the quality of the patients' speech was made by the listeners and by the patients themselves. The patients had some remaining speech problems, mainly hypernasality which was moderate or severe in 7 (23%). The prevalence of compensatory articulations was low. however (n = 4, 13%), and most patients thought that their own speech was normal or relatively normal.

Since 1975, children with cleft lip and palate living in the western part of Sweden have been treated according to a regimen of early repair of the soft palate (at the age of 6-8 months) and late hard palate closure (at about 8-9 years of age). The present paper is a longitudinal study of 15 consecutive patients whose speech development was analysed at the mean ages (years:months) of 5:3, 7:0, 8:5, and 9:7 years. Hypernasality gradually decreased over the years whereas nasal escape almost completely ceased after closure of the residual cleft. There was no glottal articulation at any age. Despite the fact that retraction of apicodental consonants decreased in frequency with age and presumably with speech therapy, it was the main problem throughout the observation period. It was presumably caused by the residual cleft in the hard palate compensating for subnormal pressure in front of the opening to the nasal cavity.

Speech and maxillary development were analysed in two groups of patients with unilateral cleft lip and palate; both groups had early jaw orthopaedic treatment and a surgical regimen that included two-stage lip surgery (mean ages of 2 and 19 months) and soft palate repair (8 months). Closure of the hard palate was postponed until the children were 8 to 10 years of age. The first group comprised 10 consecutive patients who were analysed at 5 and 7 years of age, and the second group seven patients who were studied at the age of 5. Both groups were thus investigated before the repair of the cleft in the hard palate. In addition to surgical and jaw orthopaedic treatment, the second group of patients received early stimulation of lip and tongue tip movements. Our results indicated that hypernasality was less a problem than was retracted palatal or velar articulation of dental consonants. These deviations tended to be reduced, however, after early stimulation. There seemed to be no clear association between the size of the residual cleft in the hard palate and the extent of speech development. The average size of the residual cleft in our patients was comparatively small, and decreased further during follow up. We conclude that preschool children with unilateral cleft lip and palate may develop good speech, in spite of the residual cleft, if they use an intraoral plate and are given extra lip and tongue tip stimulation, together with early speech therapy if necessary.