Considering the role of speech processing in cleft‐related speech sound disorders: Implications for causal pathways and classification systems

Background Classification systems in healthcare support shared understanding of conditions for clinical communication, service monitoring and development, and research. Children born with cleft palate with or without cleft lip (CP+/−L) are at high risk of developing cleft‐related speech sound disorder (SSD). The way cleft‐related SSD is represented and described in SSD classification systems varies. Reflecting on the potential causal pathways for different cleft‐related speech features, including the role of speech processing skills, may inform how cleft‐related SSD is represented in classification systems. Aim & Approach To explore and reflect on how cleft‐related SSD is represented in current SSD classification systems in the context of considering how speech processing skills and other factors may be involved in causal pathways of cleft speech characteristics (CSCs). Main Contribution Variation in the representation of cleft‐related SSD in classification systems is described. Potential causal pathways for passive cleft‐ related speech features and different active CSCs are explored. The factors involved in the development and/or persistence of different active CSCs may vary. Some factors may be specific to children born with CP+/−L, but if speech processing skills are also involved, this is an overlap with other SSD subtypes. Current evidence regarding relationships between different speech processing skills and active CSCs is limited. Implications for the representation of cleft‐related SSD in SSD classification systems are discussed. Conclusion There are different categories of cleft‐related speech features which are essential to understand and identify in children with cleft‐related SSD to ensure appropriate management. Representation of these feature categories in classification systems could support understanding of speech in this population. Speech processing skills could be involved in the development and/or persistence of different active CSCs in individual children. Reflection and discussion on how cleft‐related SSD is represented in classification systems in relation to other SSD subtypes may inform future iterations of these systems. Further work is needed to understand factors influencing the development and/or persistence of active CSCs, including speech processing skills. What this paper adds What is already known on the subject Cleft‐related speech sound disorder (SSD) is commonly described as being of known origin. The features of cleft‐