BACKGROUND AND AIMS: Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project.

METHOD: Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes.

RESULTS: Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years.

CONCLUSION: The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series.

TRIAL REGISTRATION: ISRCTN29932826.

Background and aim: Few studies have explored childrens emotional and behavioural reactions to cleft surgery and treatment-related stress. The objective was to investigate parents evaluations of appearance and treatment outcomes in their 5-year-old child with unilateral cleft lip and palate (UCLP), and their perceptions of how their child was coping with treatment, comparing this information with recorded postsurgical complications.Design: Three parallel group randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK.Methods: Three different surgical procedures for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. A total of 356 parents completed the Scandcleft Parent Questionnaire, and 346 parents completed the Cleft Evaluation Profile.Results: The results indicated that the majority of parents were satisfied with cleft-related features of their childs appearance. Further, most children coped well with treatment according to their parents. Nevertheless, 17.5% of the children showed minor or short-term reactions after treatment experiences, and 2% had major or lasting difficulties. There were no significant relationships between parent perceptions of treatment-related problems and the occurrence of post-surgical medical complications.Conclusions: Most parents reported satisfaction with their childs appearance. However, treatment-related problems were described in some children, urging cleft centres to be aware of potential negative emotional and behavioural reactions to treatment in some young children, with a view to preventing the development of more severe treatment-related anxiety.

Background and aim: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. Design: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. Methods: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children (136 girls, 255 boys) were available and perceptually analysed. The main outcome measures were VPC and hypernasality from blinded assessments. Results: There were no statistically significant differences between the prevalences in the arms in any of the trials. VPC: Trial 1, A: 58%, B: 61%; Trial 2, A: 57%, C: 54%; Trial 3, A: 35%, D: 51%. No hypernasality: Trial 1, A: 54%, B: 44%; Trial 2, A: 47%, C: 51%; Trial 3, A: 34%, D: 49%. Conclusions: No differences were found regarding VPC and hypernasality at age 5 years after different methods for primary palatal repair. The burden of care in terms of secondary pharyngeal surgeries, number of fistulae, and speech therapy visits differed.

Normative language-based data are important for comparing speech performances of clinical groups. The Swedish Articulation and Nasality Test (SVANTE) was developed to enable a detailed speech assessment. This studys aim was to present normative data on articulation and nasality in Swedish speakers. Single word production, sentence repetition and connected speech were collected using SVANTE in 443 individuals. Mean (SD) and prevalences in the groups of 3-, 5-, 7-, 10-, 16- and 19-year-olds were calculated from phonetic transcriptions or ordinal rating. For the 3- and 5-year-olds, a consonant inventory was also determined. The mean percent of oral consonants correct ranged from 77% at age 3 to 99% at age 19. At age 5, a mean of 96% was already reached, and the consonant inventory was established except for /s/, /r/, /?/. The norms on the SVANTE, also including a short version, will be useful in the interpretation of speech outcomes.

The last decades, speech and language pathology services have been subject to changes, and there has been a growing demand for intervention activities to be effective and evidence-based. The aim of the present study was to investigate if and how video recording can be used to assess the use of features targeted in phonological intervention, in everyday talk by children with LI. Three five-year-old girls with phonological problems participated in the study, and data consist of video recordings of intervention sessions and of interaction at home. Three different paths of development were identified: Some targeted speech sounds are displayed in everyday interaction; Targeted speech sound is present in intervention-like activity; No displays of targeted sounds. The results of the present study clearly demonstrate that the use of video recordings, transcriptions and analysis of interaction outside of the clinical setting contribute important information that may guide planning, goal-setting and evaluation of intervention.

Mastering spatial and temporal co-ordination in speech production is a challenge for children. Voice onset time (VOT) reflects timing in speech. The objective was to study VOT in Swedish children with a diagnosed phonological impairment and compare results with normative data. Thus 38 children, aged 4-11 years, in three age-groups were audio-recorded when producing minimal pairs with the plosives /p b t d k g/. Waveforms and spectrograms were analysed. Results show that children with phonological impairment produced plosives with deviant VOT values and greater variability compared to normative data. No developmental trend was seen with increasing age. Also, no relationship was found between VOT values and degree of impairment measured by percentage phonemes correct. Furthermore no relation was found between number of errors on auditory discrimination of nine minimal pairs with the different plosives and number of deviant VOT. Findings were interpreted as displaying motor co-ordination difficulties.

The study investigates factors in problem-based learning tutorial groups which promote or inhibit learning. The informants were tutors and students from speech-language pathology and physiotherapy programmes. Semi-structured focus-group interviews and individual interviews were used. Results revealed three themes: Responsibility, Time and Support. Under responsibility, the delicate balance between individual and institutional responsibility and control was shown. Time included short and long-term perspectives on learning. Under support, supporting documents, activities and personnel resources were mentioned. In summary, an increased control by the program and tutors decreases students motivation to assume responsibility for learning. Support in tutorial groups needs to adapt to student progression and to be well aligned to tutorial work to have the intended effect. A lifelong learning perspective may help students develop a meta-awareness regarding learning that could make tutorial work more meaningful.

När ett barn med misstänkta tal‐ och språkavvikelser kommer till logoped för bedömning är det viktigt att samtliga aspekter av tal och språk beaktas. Under de år som svensk logopedi har vuxit fram, har ett flertal instrument för bedömning av barn tal‐ och språk tagits fram. Ett av dessa, Stora fonemtestet, som skapades i mitten av 1980‐talet, har länge varit det enda vitt spridda testet av barns fonologi i landet. Testet fanns under flera år inte att beställa på förlag, vilket var ett av motiven till arbetet med att ta fram ett nytt fonologiskt bedömningsmaterial. Ett annat var att Enheten för logopedi vid Linköpings universitet sedan 2010 ingår i en större multicenterstudie av avvikande fonologi i olika språk. Inom ramen för detta projekt och genom några magisterarbeten i logopedi har ett nytt fonologiskt bedömningsmaterial, LINUS, skapats. Vår förhoppning är att materialet skall vara ett användbart verktyg för att samla in data vid utredning av tal‐ och språkförmåga hos barn.

Background: Oral senorimotor development is the basis for several vital functions for the child, hence orofacial dysfunction may be severely disabling. Recently, a comprehensive screening instrument assessing different aspects of orofacial function in adults and children age three and up was developed, the Nordic Orofacial Test-Screening (NOT-S). The aim of the present study was to establish developmental profiles of orofacial function for children 3 to 7:11 years old using NOT-S methods: A total of 231  typically developing children 3:0 to 7:11 years old were included. Data were compiled from previous investigations. Comparisons across ages and gender were made.

Results: The total NOT-S score was below two for 58% (133) of all children in the study.There was a clear trend of lower total NOT-S score with  increased age according to a best linear fit regression, R2= .81, p = .014. The number of children without any score on NOT-S increases dramatically for the seven-year-old children, 44% compared to 20% or lower for the other age groups. Boys had statistically significant higher scores than girls on the total NOT-S score and also for the clinical examination according to a Mann-Whitney U-test, p<.000 for both cases.

Objectives: To study the long-term effect of tonsillotomy and tonsillectomy in young children after two years in comparison to the results after six months. Method: Children, age 4-5 with Sleep Disordered Breathing (SDB) and tonsil hyperplasia, were randomized to TE (32) or TT (35). TT was performed ad modum Hultcrantz with radiofrequency technique (Ellman). An adenoidectomy with cold steel was performed in the same session for 80% of cases. The patients were assessed prior to surgery, at six and 24 months postoperatively. Effects of surgery were evaluated clinically, through questionnaire (general health/snoring/ENT-infections), Quality of Life (QoL), survey of pediatric obstructive sleep apnea with OSA-18, and childrens behavior with the Child Behavior Checklist. Results: After two years there was still no difference between the groups with respect to snoring and frequency or severity of upper airway infections. Both TT and TE had resulted in large improvement in short and long term QoL and behavior. Three TT-children and one TE child had been re-operated due to recurrence of obstructive problems, the TE-child and one of the TT-children with adenoidectomy and two of the TT-children with tonsillectomy. Three of the TT-children had tonsil tissue protruding slightly out of the tonsil pouch and twelve TE-children had small tonsil remnants within the tonsil pouches, but with no need for surgery. Conclusion: Younger children have a small risk of symptom-recurrence requiring re-surgery within two years after TT. For the majority, the positive effect on snoring, infections, behavior and quality of life remain and is similar to TE.