Peer attitudes towards children with cleft lip and palate: An interaction of visual and auditory cues?

BACKGROUND AND AIMS: For children with speech disorders related to cleft palate with or without cleft lip (CP±L), effective communication presents significant challenges. Listeners often form judgments based on the speech signal, contributing to stigmatization and negative stereotyping. When a child also has a cleft lip, perceptions may be further influenced. Limited research has explored peer attitudes towards individuals with CP±L using audiovisual stimuli. This study aimed to examine peer attitudes of children towards children with CP±L, analyzing how these attitudes vary based on auditory, visual, and audiovisual cues and cleft type. Additionally, the relationship between speech intelligibility, speech acceptability, and social acceptance was evaluated.

METHOD: Audio samples, photographs, and audiovisual samples were collected from 11 Caucasian children: four with cleft palate (CP), four with cleft lip and palate (CLP) and three typically developing children without cleft. These stimuli were judged by 48 typically developing peers aged 7 to 12 (24 boys, 24 girls) based on three attitude components, i.e. cognitive, affective and behavioral. They also rated speech intelligibility and acceptability. Correlations were calculated between the attitude components and speech intelligibility/acceptability. The impact of the medium on peer attitudes per cleft type was verified.

RESULTS

Strong and significant positive correlations were found between all attitude dimensions and the mean speech intelligibility and speech acceptability scores given by peers, particularly with audio and audiovisual samples. Deviant speech (audio) negatively influenced all peer attitudes, whereas variations in facial appearance alone (photo) did not substantially impact peer attitudes. When speech and appearance were combined (audiovisual), deviant speech negatively influenced cognitive attitudes without substantial impact of variation in appearance. Affective and behavioral attitudes were negatively influenced when deviant speech was present in combination with a cleft lip.

CONCLUSION

This study underscores the importance of multidimensional approaches to understanding and improving peer attitudes towards children with CP±L. Addressing both auditory and visual aspects of cleft-related disorders can better support these children's social inclusion and well-being. Further research should explore the long-term impact of speech and psychological interventions and educational programs on peer attitudes and examine specific visual cues' roles in social perceptions.