Guide To Treatment Decision-Making

For Cleft-Type Speech

Adapted from Trost-Cardamone (2013)

Perceptual Speech Findings

• Hypernasality • Hypernasality
• Compensatory articulations • PSNE only
• Audible nasal emission • Reduced speech power
+/- hypernasality or audible
+/- developmental • Normal/age-appropriate nasal emission • Minimal to no hypernasality
articulation errors articulation

• Refer for cleft palate • Start speech therapy to

• Start speech therapy for • Start speech therapy to
team evaluation, VP target PSNE
developmental errors target compensatory errors
imaging study, and
consideration of surgical • If unsure of diagnosis or
• Refer for cleft palate team • Refer for cleft palate team
management if poor progress after a
evaluation, VP imaging evaluation and VP imaging
few sessions, refer to cleft
study, and consideration study, if there are any oral
• Speech therapy not palate team SLP to confirm
of surgical management pressure targets
indicated diagnosis

Note. PSNE=phoneme-specific nasal emission; VP=velopharyngeal

Trost-Cardamone, J. (2013). Cleft palate speech: A comprehensive 2-part set. Rockville, MD: American Speech-Language-Hearing Association.
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