Early Literacy Research Library (ELRL) - Article

Home Language Environment of Children with Orofacial Clefts as a Target for Intervention

Gallagher, E.R., Wallace, E., Thach, J., Kinter, S., Collett, B.R. (2021) Home Language Environment of Children with Orofacial Clefts as a Target for Intervention. Journal of Craniofacial Surgery, 32(2), 500-504.,

Access: Institutional Access

Publication year


study description

Feasibility study examining longitudinal trends.

core topic(s)

Reach Out and Read (ROR)

Population Characteristics

Infant/Newborn , Medical Conditions and Disabilities , Toddler/Preschool

Exposures, Outcomes, Other

Child Behaviors and Skills , Home Language/Literacy/Learning Environment , Language and Literacy Development , Parent Behaviors and Skills , Validity, Reliability, Feasibility, and Acceptability


To evaluate the home language environment (HLE) in children with orofacial clefts as a potential modifiable target for language and literacy intervention.


Reach Out and Read (ROR).

outcomes evaluated

Home language environment (HLE).


Tertiary care children's hospital.


Feasibility study examining longitudinal trends in HLE and responses to parent-focused literacy intervention...HLE data were collected for 38 children with orofacial clefts between ages 7 and 23 months. Twenty-seven participants received parent-focused literacy intervention...Reach Out and Read, a literacy intervention, was introduced during a clinic visit. To assess response, participants were randomized to age at intervention (9, 18, or 24 months).

sample size

n=38 (children)


Measure of Home Language Environment: analysis of adult word count, child vocalizations, and conversational turns based on in-home audio recordings using LENA (Language Environmental Analysis) systems.


Baseline (preintervention) results showed lower adult word count and conversational turns for caregivers and children with cleft lip and palate, as well as for those from lower socioeconomic groups. After the literacy intervention was introduced, this cohort showed increasing measures of child and caregiver vocalizations, particularly when introduced at 18 months.


Although these results are preliminary, findings suggest that HLE characteristics vary as a function of children's cleft type as well as family socioeconomic status. Further, our caregiver-focused literacy intervention was feasible and resulted in short-term improvements in HLE. This is the first study to document HLE as a target for intervention in children with oral clefts. These findings support further research on HLE and caregiver-focused intervention to improve language/literacy outcomes for children with oral clefts.


Most of our participants were middle to upper SES, limiting the generalizability of our findings. If anything, given the association between SES and HLE observed in previous research, we might expect larger intervention effects in lower SES families. Nonetheless, recruitment of low SES families should be a priority for future research. Our study did not include a noncleft control group for comparison in Study 1, nor did we enroll a nontreatment control group for comparison in Study 2. Instead, we prioritized enrollment of children with oral clefts to establish feasibility of HLE recording in this population and used a multiple- baseline design that allowed us to offer the intervention to all participating families. Further, our relatively small sample size limits the generalizability of our results and precluded some subgroup comparisons of interest (eg, analysis of treatment response as a function of cleft type and demographic characteristics). Future research documenting trends in HLE among children with clefts relative to unaffected controls, and intervention studies powered to explore heterogeneity in outcomes and factors associated with treatment response are needed.