{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:00:20Z","timestamp":1781236820272,"version":"3.54.1"},"reference-count":53,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp;amp; Comm Disor"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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+\/\u2212L) are at high risk of developing cleft\u2010related speech sound disorder (SSD). The way cleft\u2010related SSD is represented and described in SSD classification systems varies. Reflecting on the potential causal pathways for different cleft\u2010related speech features, including the role of speech processing skills, may inform how cleft\u2010related SSD is represented in classification systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim &amp; Approach<\/jats:title><jats:p>To explore and reflect on how cleft\u2010related 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Contribution<\/jats:title><jats:p>Variation in the representation of cleft\u2010related SSD in classification systems is described. Potential causal pathways for passive cleft\u2010 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+\/\u2212L, 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\u2010related SSD in SSD classification systems are discussed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There are different categories of cleft\u2010related speech features which are essential to understand and identify in children with cleft\u2010related 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\u2010related 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:sec><jats:title>What is already known on the subject<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Cleft\u2010related speech sound disorder (SSD) is commonly described as being of known origin. The features of cleft\u2010related SSD have been described extensively and several authors have also examined factors which may contribute to speech development and outcomes in children born with cleft palate +\/\u2212 lip. There is limited evidence regarding the role of speech processing in the development and persistence of cleft\u2010related SSD.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What this study adds<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This paper reflects on how cleft\u2010related SSD is represented in SSD classification systems in relation to key feature categories of cleft\u2010related SSD and possible causal pathways for passive features and active cleft speech characteristics (CSCs). The role of cognitive speech processing skills is specifically considered alongside other factors that may contribute to the development of active CSCs.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:sec><jats:sec><jats:title>What are the clinical implications of this work?<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Causal pathways for different features of cleft\u2010related SSD may vary, particularly between passive and active features, abut also between different active CSCs. Speech and language therapists (SLTs) need to differentially diagnose passive speech features and active CSCs. Consideration of the role of different speech processing skills and interactions with other potentially influencing factors in relation to active CSCs may inform clinical hypotheses and speech and language therapy (SLT) intervention. Representing key features of cleft\u2010related SSD in classification systems may support understanding of cleft\u2010related SSD in relation to other SSD subtypes.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec><\/jats:sec>","DOI":"10.1111\/1460-6984.12993","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T15:45:05Z","timestamp":1704987905000},"page":"2197-2207","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Considering the role of speech processing in cleft\u2010related speech sound disorders: Implications for causal pathways and classification systems"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3990-9951","authenticated-orcid":false,"given":"Lucy","family":"Southby","sequence":"first","affiliation":[{"name":"Speech, Hearing and Communication Research Group, Cardiff School of Sport and Health Sciences Cardiff Metropolitan University  Cardiff UK"},{"name":"Bristol Speech and Language Therapy Research Unit, Pines and Steps, Southmead Hospital North Bristol NHS Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1044\/2020_JSLHR-20-00129"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1460-6984.12853"},{"key":"e_1_2_13_4_1","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2021.110820"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118785065.ch2"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/1055665620918799"},{"key":"e_1_2_13_8_1","volume-title":"Differential diagnosis and treatment of children with speech disorder","author":"Dodd B.","year":"2005"},{"key":"e_1_2_13_9_1","volume-title":"Differential diagnosis and treatment of children with speech disorder","author":"Dodd B.","year":"1995"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2009.07.015"},{"key":"e_1_2_13_11_1","volume-title":"Linguistics in clinical practice","author":"Grundy K.","year":"1995"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/026565908800400205"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-6984.1995.tb01679.x"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/13682829609031326"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/136828298247776"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1044\/2019_JSLHR-S-18-0519"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/136828298247811"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699209308985569"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699200410001720827"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118785065.part1"},{"issue":"2","key":"e_1_2_13_21_1","first-page":"126","article-title":"Strategies in cleft palate speech\u2013with special reference to Danish","volume":"24","author":"Hutters B.","year":"1987","journal-title":"The Cleft Palate Journal"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.34.177.444"},{"key":"e_1_2_13_23_1","unstructured":"International Classification of Diseases Eleventh Revision (ICD\u201011) World Health Organization (WHO)(2019\/2021)https:\/\/icd.who.int\/browse11. 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