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I. Introduction

Very few people know what a cleft palate actually is. A cleft palate is one of the most

common birth deformities and is when the tissue of the roof of the mouth doesn’t fuse

together in fetus development. It can extend all the way to the lip which then is classified as a

cleft lip and can sometimes not fuse in two places and be classified as either a bilateral cleft

palate or lip. Many people don’t realize the struggles that come with having a cleft palate and

being someone who had cleft palate I want to bring to life how people like Cheryl who had a

cleft palate live differently.

It is said that when you have cleft palate you have speech issues. The indications are

that most of the words can’t be pronounced properly and that recognition of sounds is too

difficult. There are many of these people who used sign language to be understood. Others

have tried their best to utter such words in order to deliver the correct message.

Cleft lip and palate are birth defects of the mouth and lip, also known as oral-facial

clefts. A normal fetus has a split lip and palate, but early in pregnancy, the sides of the lip

and the roof of the mouth should fuse. Failure of fusion results in cleft lip and/or cleft palate.

Cleft lip is an abnormality in which the lip does not completely form during fetal

development. The degree of the cleft lip can vary greatly, from mild (notching of the lip) to

severe (large opening from the lip up through the nose), in which case the cleft can be very

noticeable. Cleft palate occurs when the roof of the mouth does not completely close during

fetal development, leaving an opening that can extend into the nasal cavity. The cleft may

involve either side of the palate. It can extend from the front of the mouth (hard palate) to the

throat (soft palate). Often the cleft will also include the lip. Cleft palate is not as noticeable as

cleft lip because it is inside the mouth. It may be the only abnormality in the child, or it may
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be associated with cleft lip or other syndromes. In many cases, other family members have

also had a cleft palate at birth. Children can also have a less noticeable form of cleft palate,

known as a submucous cleft palate. This is a cleft covered by the mucous membrane that

lines the roof of the mouth.

One in ten children (with or without a cleft!) have Speech, Language and

Communication Needs (SLCN), meaning around three children in every classroom will have

issues that make communicating with others difficult. This can include having trouble

knowing how to talk and listen to others, understanding words and instructions, or having

speech which is difficult to understand.

SLCN can sometimes be a hidden problem, because these children look just like

others and can be just as clever. But communication problems can affect children in a variety

of ways which may not be obvious at first. What is seen as ‘bad behaviour’ or problems with

socializing with other children could just be children attempting to communicate or

becoming frustrated at not being understood. Speech also helps us understand and develop

language, so problems with speech can mean children struggle to read and write.

These problems can often be missed or misdiagnosed, but thankfully the treatment

pathway for children with a cleft includes speech and language assessments to ensure that

any issues with speech are identified and managed early on. An estimated 10% to 20% of

school children have learning disabilities, the most common source of school-learning

problems today. Most people have heard the term “learning disability,” but few people really

understand what it means. Specific definitions of learning disabilities vary from region to

region. However, there are some basic principles which are common to most defini- tions. In
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general, learning disabilities are related to weaknesses in one or more of the psychological

processes which influence learning. These processes include: (1) language-expressive

(speaking), receptive (listening), and associa- tive reasoning (the ability to understand new

ideas or the relationships between ideas or objects); (2) memory (visual and/or auditory;

short-term and/or long-term recall); (3) visual perception skills (the ability to copy designs

and/or orient oneself in space); and/or (4) motor coordination. Studies have shown that some

specific learning problems do occur more frequently in children with clefts. These include

early developmental reading problems, short-term memory problems, and associative

language (comprehension) problems.

Some children with clefts have an increased risk for reading and learning problems

which are probably related to early speech and language delays. More specifically, an early

speech delay may affect beginning reading skills. In addition, children with clefts tend to

have more verbal/language problems than other children. Early identification and treatment

of these problems is important. If a child with a cleft is displaying any problems learning

color names, numbers, or the alphabet sounds once he or she has begun school, then a

thorough psycho-educational evaluation should be performed. Some children with clefts are

at a higher risk of having verbal/memory problems, which interfere with the child’s ability to

remember words, recall spelling lists, and memorize math facts. Early recognition of this

learning characteristic can result in treatment and teaching methods that can correct or avoid

many difficulties. If this memory problem is not recognized, parents and/ or teachers may

think that the child is not trying, is inattentive, or does not have the ability to learn. It is

important to have the child’s memory assessed if any of these symptoms occur. Memory can

be evaluated in several ways, including comparing verbal versus visual memory and memory
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for isolated facts versus memory for general information. There is increasing evidence that

some children with clefts experience a language problem which is more serious than just a

memory problem. This type of problem is called an “associative language” or

“comprehension” problem. Studies suggest that it may occur more frequently in children

with cleft palate only; however, children with cleft lip and palate may also have it. Children

with an associative-language problem have difficulty understanding verbal directions,

changing from one activity to another, and comprehending what they read, even when they

can read the individual words. If the problem is not identified and treated, these children may

be inappropriately labeled as slow learners, or even as mentally retarded. This condition

should be evaluat- ed by a professional trained and experienced in testing children with

speech, hearing, and/or oral and written language disorders. Often this professional is a

psychologist or neuropsychologist. Individuals with cleft lip and palate often demonstrate

multiple problems such as early feeding difficulties, nutritional issues, developmental delays,

abnormal speech and / or resonance, dentofacial and orthodontic abnormalities, hearing loss,

and possibly, psychosocial issues.

The very purpose of this case study is to determine and analyze the effects of having

cleft lip and palate to the speaking ability of an individual. The way of speaking and the

effect to its literacy skill will also be touched by this study.

It is therefore imperative to provide substantial information about the issue and the

subject to be taken to give ideal recommendations and insights for everyone. This could also

be one of the ways to reflect and understand the situation of other people knowing their short

background and experience.

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II. Personal Information of the Subject

I do believe that best learning would take place if you are not always taught, but you

should be given the wish to learn. “Okay lang sir,” such a motivating phrase from Cheryl

who really wished to be interviewed by his teacher of how she overcomes her challenges in

life. Cheryl Sibuan is the daughter of Mr. Florenci and Mrs. Myrna Sibuan. She is now at her

Grade 10 and her parent told me that her child is really eager to learn something and enjoys

drawing, watching and playing outside together with her peers. She hates to sing but prefers

to dance along with her classmates especially hip hop.

Cheryl could not read well because of her inborn cleft lip and palate. She finds it hard

to recognize sounds out of printed symbols. She is fond of staying inside the house and

playing only with her brothers and sisters before and now with her neighborhood. Mrs.

Sibuan has seven children and only Cheryl has the difficulty in speaking which really affects

her reading skills.

According to her parent Cheryl could familiarize and recognize better the numbers

rather than letters. I could see the potential to her despite of the fact that her self- confidence

was not yet fully developed.

Cheryl graduated her elementary at Sinogbuhan Elementary School and planned to

proceed with her Senior High School at Sinogbuhan National High School. She is lucky to

have a humble and vibrant adviser Ms. Armie Escalona, Teacher II of the same school.

Cheryl dreams to become a professional chef someday and wished to have her own

restaurant. She believes that in God nothing is impossible. Cheryl is observed to be a

religious kind of student who in fact regularly goes to church together with her mother.
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Cheryl likes to work her outputs in a quiet environment and wants to be alone in preparing

her assignments.
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III. Family History

Cheryl is a student who came from a simple family with her mother who is a

housekeeper. She is the youngest daughter of Mrs. Sibuan and enjoys learning at her Junior

High School (Grade 10) under section Puti. According to her she doesn’t have any idea at all if

they have relatives who have the same situation with what she is actually experiencing right

now – learning disability (cleft lip and palate). She said that it was an inborn disability that

hinders her ability to speak clearly and loudly. Her brothers and sisters are now having their

family except for her one brother who is a product of Balik-Aral at his Grade 7. There were

two of her sisters who are now having their jobs at Manila and Guimbal, Iloilo. One of his

brothers is residing with her mother and is now under medication due to his injury. On the

other hand her brother Michael is the one who helps them with their education with the aid of

his business “Oring: Buy and Sell”.

At best, family relationships are challenging, and raising a child with learning

disability can create even more stress for a family. Concerns about a child with learning

disability may impact the parent interactions with that child as well as other children, and

sibling relationships. Simply put, what happens in the family affects each child, and what

happens with each child affects the family. I am happy that somehow the family of Cheryl is

a family with a strong relationship and understanding with one another exists.

Family history is very important to an individual. By knowing where one comes from,

one can have a better perspective of life. Having a clear understanding of the family

background allows everyone to better appreciate the things that she would normally take for

granted. A person’s roots and origin is one of the most important things to explore. It alone can

bring someone closer to self-discovery.

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IV. Developmental History

Cheryl’s development is sequential in terms of its physical, language, thought and

emotional changes that occur from her birth to adulthood. During this process Cheryl

progresses from dependency on her parents to increasing independence. Her development is

strongly influenced by genetic factors (genes passed on from her parents) and events during

prenatal life. It is also influenced by environmental facts and her learning capacity. Cheryl is

still fortunate for she was able to cover the full scope of skills that a child masters over her

life span including development in: Cognition – the ability to learn and problem solve; Social

interaction and emotional regulation – interacting with others and mastering self-control;

Speech and Language – understanding and using language, reading and communicating;

Physical skills – fine motor (finger) skills and gross motor (whole body) skills; Sensory

awareness – the registration of sensory information for use.

One of the things I have found out is that she has not yet fully developed her listening

skill. It is then observed that Cheryl has a minor problem in her hearing ability especially in

listening to instructions. The best thing is that it is not regularly observed to the subject

especially if she was in her full attention

In a general sense, Cheryl is able to develop her necessary skills that allows her to

enjoy playing team sports and join the dance activities every flag ceremony.
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V. Educational Development

It was a great challenge to her mother upon knowing that the child is experiencing

cleft lip and palate. At first she finds it very disappointing for Cheryl is always crying when

she was a baby until such time that she cannot even utter clearly the words “nanay” and

“tatay”.

Cheryl graduated her Day Care at Sinogbuhan Day Care Center. When she was 5 her

mother sent her to pre-school where she already learned how to apply color and draw simple

shapes with the use of horizontal and vertical lines. Her mother enrolled her to Grade 1 at

Sinogbuhan Elementary School. This is the stage where she doesn’t mind to have playmates

for she is very dependent with her mother who always guides her to go to school. The

distance of Cheryl’s house to school is estimated 300 meters away from school. There is no

problem with the attendance of Cheryl when she was in her elementary for she is always

given attention by her mother. “Nabudlayan lang gid tana maghambal,” this is the statement

of the mother and one of the greatest challenges encountered by the pupil when she was in

her Grades 2 and 3 for she is now trying to memorize letters and numbers. “Malipatan gani ni

maam na nga di tana kabasa ti mayad, maduko lang gid ra ang bata.” This is the reason why

sometimes the mother also got depressed because of the poor development of her daughter in

terms of recognizing sounds and got very low scores in her spelling activity.

It can be noticed that as Cheryl grows old she finds it hard to be with her peers and

that she felt that she is always the subject of bullying in school. In her Grade 4 one of the

difficulties she had encountered in class is on how to read a selection knowing for the fact

that her classmates can do so. When she was in her Grade 5 and 6, Mr. Arvin Magbanua, her

Grade 6 adviser gave her series of reading tests using PHIL-IRI to determine her level and to
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identify the sounds that she finds it difficult to utter. It was observed that Cheryl could not

easily read even Basic Sight Words. It was with her teacher Arvin where she felt the comfort

and ease in learning word recognition. It was in her Grade 6 where she started to adjust to her

classmates.

The feeling of anxiety was minimized when Cheryl got enrolled in Grade 7 at

Sinogbuhan National High School. I am her remedial reading teacher under Special Reading

Class. At first, I never thought that Cheryl has difficulty in speaking due to her cleft lip and

palate. Her situation is not new to her classmates which make her environment so natural in

High School. The student is struggling until her High School especially reading long

sentences up to paragraph. Some of her classmates served as best interpreters of what Cheryl

tries to convey to the class especially that she volunteers once in a while to answer questions.

When Cheryl was in Grade 9 she in fact received the average of 83 in her progress

report card with 85 in English and Science. The reasons behind these are her active

involvement in every performance based assessment and her overwhelming attendance and

outputs where she still managed to pass them with the help of her classmates who served also

as her mentors.

Now that she is in her Grade 10, she portrays an image of a humble student with

natural ways in dealing with her classmates and vice versa. Cheryl is actually more serious

now and never forgets to show respect to her fellow that made her a respected student inside

the classroom. Every time she recites in class everything becomes normal and regular to her

teachers and classmate but still cannot be denied that teachers really need to pay attention to

the words that come out from her mouth to get the message she wants to deliver.
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VI. Social Development

“One of the things that really challenged me is overcoming my shyness in public,”

Cheryl mentioned when I interviewed her about how she gets along with other people. It is

very interesting that she now had her many friends and that they came from different aspects

of life may they be rich or poor.

Cheryl’s elementary years were only a silent and not everyone is really very willing

to communicate with her. She said that she was even neglected many times by her classmates

of play. It was only in her High School life that Cheryl was able to discover the beauty of

friendship and many friends are starting to be with her especially in making activities and

joining the group in a performance based assessment. I remember their group dancing,

singing and performing a verse choir with different disabilities considering the theme of the

chapter which is all about overcoming challenges.

Cheryl encounters different challenges throughout the course of her social

development. Both environmental and biological factors play a role, and can affect her

speech, academic performance, and behavior. The environmental impacts of cleft lip and/or

palate are rather transparent. Student like Cheryl with cleft can have facial differences and

speech problems that elicit a response from others, which can create issues of self-esteem and

emotional development. Some characteristics of cleft also have a biological basis, though.

Delayed speech and language development, reading deficits, memory problems, and learning

disabilities have been linked to clefting, seemingly related to the neuropsychological deficits

brought with cleft lip and palate. When Cheryl reaches her school age social skills, self-

control, and other behavioral regulation come into play.

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Cheryl’s parents and teachers have reported significantly higher behavior problems.

The occurrence of reading difficulties and learning disabilities is high. The increased

emphasis during adolescence on speech and appearance can bring a decrease in self-

confidence for Cheryl.

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VII. Psychological Development

It is evident that with various limitations that individuals with cleft lip and palate

experience, they are bound to encounter various psychological difficulties. Moreover, these

limitations build up over a period of time because of the psychological problems faced. For

example, communication disorders in individuals with cleft lip and palate seem not to result

from phonological defects but from psychological problems that may influence the entire

development of an affected child. Anxiety and depression have also been reported to be

twice as prevalent in adults with cleft lip and palate compared with normal controls.

Difficulties are also experienced in relation to behavioral problems and satisfaction with

facial appearances. Moreover, these psychological problems can be interrelated.

Cheryl is one of those students who experienced depression and anxiety especially in

handling her emotions that result to loss of focus inside the classroom and neglect the value

of her parents sometimes.

Though several research studies have been carried out on various aspects of cleft lip

and palate they are insufficient in providing information. Many studies have shown other

environmental, confounding factors such as teasing, leading to poor psychological

functioning, more so than having a cleft lip and/or palate per se, thus providing conflicting

evidence when it comes to establishing whether children and adults with cleft lip and palate

experience psychological problems as a result of their cleft.

An individual's personality traits i.e. level of confidence and environmental factors

like upbringing, family background play a central role in influencing behavior. It appears that

research studies of the effects of cleft related conditions on behavior should examine both
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internalizing and externalizing dimensions of behavior and consider that there may be

subgroups of children showing these different kinds of behavior across different age levels.
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VIII. Home Environment

All children need love, encouragement, and support, and for student with learning

disability like Cheryl, such positive reinforcement can help ensure that she emerges with a

strong sense of self-worth, confidence, and the determination to keep going even when things

are tough.

The mother realized that her job as a parent is not to “cure” the learning disability, but

to give her child the social and emotional tools she needs to work through challenges. In the

long run, facing and overcoming a challenge such as a learning disability can help Cheryl

grow stronger and more resilient.

Cheryl is always guided by the statement of her sisters that the way she behaves and

responds to challenges has a big impact on her development. A good attitude won’t solve the

problems associated with a learning disability, but it can give her hope and confidence that

things can improve and that she will eventually succeed. Cheryl is very firm in answering my

question of how is the relationship of the parents before his father died. She said that “permi

sanda naga irinaway”. She cannot even understand why and all she knows is that her mother

wants his father to go home early. She can always hear her sisters crying especially if their

mother gets too emotional.

The ideal thing is that these problems are still considered minor and she believes also

that these are normal to a family. Cheryl explained that her mother is a positive mother for

she had not even heard from her words of discouragement especially in her schooling. She

has been told by her mother to “hindi kaw mag untat kag hindi kaw magmayha magpatudlo

kung hindi ikaw kamaan”.

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The house of the subject is located near the Brgy. Hall and it was 25 meters away

from the brgy. plaza. It cannot be denied that Cheryl is always out seeing her friends

especially if there are events in the plaza. When asked if what are the things she wants to do

at home, she said that watching movie, playing and helping the mother in doing household

chores are her enjoyed activities.

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IX. Neighbourhood and Peer Group

Today, people with learning disabilities live in the community and strive for

meaningful social inclusion. The attitudes of society to such individuals living in

communities continue to be the catalyst that will enable them to achieve genuine social

inclusion and integration.

Cheryl is very confident with her answers that she was not bullied by her neighbors

and that she live in a community where people don’t find her learning disability a big deal.

According to her it was maybe because many also of the children within their community

who suffer from different identified learning disabilities. Lordel, a seven year old child

enrolled in Special Education at San Joaquin South Central Elementary School is one of

those children with learning disability and considered to be the peer group of Cheryl together

with her sisters.

Cheryl acknowledges the help of her classmates like Merrian Jade and Angel who are

always there serving as the interpreters of Cheryl and her very good companion especially

when their teachers assigned them tasks on speaking. The student is lucky to be in a section

or even to a batch wherein peers do not bully her but gave her a quiet and relax environment.
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X. School Environment

Cheryl is lucky to be enrolled in a school where she can feel a sense of belonging,

trust others, and feel encouraged to tackle challenges, take risks, and ask questions. Her

school environment provides relevant content, clear learning goals and feedback,

opportunities to build social skills, and strategies to help students succeed.

School environment is one of the most important factors affecting student learning.

Simply put, students learn better when they view the learning environment as positive and

supportive (Dorman, Aldridge, & Fraser, 2006).

Ma. Fe Silfavan, OIC/Principal I of Sinogbuhan National High School is giving great

value on inclusive education which really centers on a child-friendly kind of school

environment. She is always reminding teachers to cater the needs of those students who have

special learning needs especially with their numeracy and literacy skills.

We all know the factors that can threaten a positive school environment: problems

that kids bring from home, lack of motivation among students whose love of learning has

been drilled right out of them, pressures from testing, and more. We can't control all these

factors, but what if we could implement some simple strategies to buffer against their

negative effects?

The good news is that Cheryl’s school environment is a child-friendly. She can foster

effective learning and transforms her experiences every day by harnessing the power of her

emotions. Having a positive school environment produces a powerful ripple effect that

continually enhances learning: when students can see the humor in their mistakes, celebrate

their successes, and feel empowered as change agents, they will actively engage in learning
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and, consequently, learn more effectively especially for students with learning disability like

Cheryl, Alford and Pearl Joy who are from the same school.
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XI. Actions Taken

Many parents of young children with learning disabilities ask what they can

do at home to help their youngsters. Generally, the first step is to try to understand the

child’s difficulties and to consider how these weaknesses might impact on self-help

skills, communication, discipline, play and independence; however, above all, we

encourage them to focus on the child’s strengths in order to build self-esteem and to

help them become an integral part of the family.

The Family. Sending Cheryl to school is the ideal solution of the family and

giving her assistance in terms of her education. The mother registered Cheryl to be

one of the members of the Child. Inc., an incorporation which aims to give assistance

to poor but deserving children in San Joaquin by providing educational assistance, is

a big help to the family. It is noted that Cheryl has no medical record due to financial

constraints which hinders the family to visit specialists and other personalities who

can help address the problem of the student.

The School. The designated guidance advocate conducted student’s profiling

to assess and evaluate the status of Cheryl and further identify her learning needs

especially in learning core subjects. There are already students and teachers who

conducted a simple case study and Cheryl was chosen to be one of the respondents.

The principal is giving high value on inclusive education and making sure that

Sinogbuhan National High School is a child-friendly and a bully free campus. The

adviser secures personal information of the child and conducted home visitation to

assess the home environment of the student. Furthermore, the subject teachers are

always mindful of their teaching styles especially that there are presence of students
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who have learning difficulties and disabilities. The Division nurse with the school’s

initiative conducted counselling and monitors student’s physical condition to ensure

that every learner is normal.

The LGU. The Local Government Unit of the municipality of San Joaquin

conducted an activity that centers on students with learning difficulties and

disabilities especially on coping with their problems in school and even in their

family.

The community. The Barangay officials are giving priorities on students with

learning disabilities especially in terms of their security. Sustaining peace and order

in the community is observed to minimized distraction of classes and to get rid of

violent intruders that may disturbed the emotional aspect of the student.
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XII. Related Literature and Studies

Cleft lip and/or palate (CL/P) affects not just the child but also parents (Zeytinoglu

& Davey, 2012). Prior research has been cross-sectional, quantitative, and with mothers

(Stock & Rumsey, 2015). Fathers have been neglected despite their important role in

children’s development (Phares, Lopez, Fields, Karnboukos, & Duhig, 2005). Although a

prenatal diagnosis is more common because of improved technology (Maarse et al., 2010),

many babies are still diagnosed at or soon after birth (Jones, 2002).

Several studies have shown that children with isolated clefts have an increased

incidence of learning problems and academic underachievement. This work focused

primarily on reading and, although there are exceptions, most studies reported that affected

children score lower than expected compared with test norms and unaffected

controls. However, population-based investigations are rare, and most studies have included

small, clinic-based patient samples. The only 2 existing population-based studies relied on

indirect measures of academic performance, including classroom grades and graduation

rates from compulsory schools in Sweden and frequency of special education placement in

Atlanta, Georgia. Both studies suggested poor academic functioning among individuals with

clefts. However, the lack of direct testing limits the certainty of this conclusion, because

factors other than academic ability can influence grades and special education placement

(Wehby, 2013).

Leading scientists have identified an important gene that is associated with cleft lip

and palate. Experts say the discovery is a step closer to understanding how this birth defect

arises, and will help in the development of medical approaches to prevent the disfiguring

condition. An international team, led by Newcastle University, UK, and the University of
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Bonn in Germany, has found that variants near a gene called GREM1 (Gremlin1)

significantly increase the risk for cleft lip and palate. A cleft is a gap in the upper lip, the roof

of the mouth, or sometimes both. Each year, approximately 250,000 babies worldwide are

born with a cleft, equating to about two babies a day in the UK. Dr Heiko Peters, who works

at Newcastle University's Institute of Genetic Medicine, is senior author of the research paper

published in the journal, PLoS Genetics. He said: "The findings reveal a link between

GREM1 and specific clinical characteristics that arise in the formation of a cleft lip and

palate. "This is very important in this research area as it helps to decipher the complex

interplay between genes required for the different steps and in different tissues during lip and

palate development.

"A cleft lip can occur with or without a cleft palate and the genetic factors that

predispose to palate involvement are largely unknown." Although not life-threatening for

patients with access to postnatal surgery, cleft lip and palate requires additional

multidisciplinary care by specialists, including ear, nose and throat experts, orthodontists and

speech therapists. Children with the condition can have dental issues, speech problems and

are at increased risk of serious ear infections and hearing loss. To establish effective

prevention strategies scientists must identify genetic risk factors and understand how gene-

gene and gene-environment interactions interfere with lip and palate development.

Mother-of-five Joanne Brown knows first-hand the challenges faced by those with a

cleft lip and palate. The student nurse's daughter, Emily, seven, was born with the condition

and has had to undergo three operations so far with more expected in the years ahead. Emily

has coped well with her condition but having a cleft lip and palate has affected her speech

and confidence. Joanne, 33, of West Rainton, County Durham, who is married to David, 45,
 24

a joiner, welcomes the research into the condition. She said: "I found out at my 20 week

pregnancy scan that Emily had a cleft lip and palate. I was very upset as I didn't know

anything about the condition. "Speech is a huge problem for Emily and she is shy around

other children. She never used to look in the mirror and it has taken time for her to be able to

do this. "It's so important that research is carried out as the condition is a lifelong problem for

sufferers."This research is a significant step forward in understanding the condition. It would

be phenomenal if, in the future, the chance of a cleft lip and palate occurring could be

reduced."

A prerequisite for natural speech production is the regular structure and coordinated

function of the speech organs. In cleft lip and palate, many articulation problems can be

found due to the involvement of speech organs. In Delphi's study in Ahvaz (2013), the score

of speech skills and lingual expression was lower in children (of all age ranges) with cleft lip

and palate in comparison with normal children.

Children with cleft lip are known to be at raised risk for socio-emotional difficulties,

but the nature of these problems and their causes are incompletely understood; longitudinal

studies are required that include comprehensive assessment of child functioning, and

consideration of developmental mechanisms. Children with clefts had raised rates of teacher-

reported social problems, and anxious and withdrawn-depressed behavior; direct

observations and child representations also revealed difficulties in social relationships. Child

communication problems largely accounted for these effects, especially in children with cleft

palate as well as cleft lip. Insecure attachment contributed to risk in both index and control

groups, and a poorer current parenting environment exacerbated the difficulties of those with

clefts. (Murray, 2010). Children with clefts are at raised risk for socio-emotional difficulties
 25

in the school years; clinical interventions should focus on communication problems and

supporting parenting; specific interventions around the transition to school may be required.

More generally, the findings reflect the importance of communication skills for children's

peer relations (Hill, 2010).

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XIII. Analysis and Interpretation

A cleft palate can affect speech and communication abilities in different ways. There

is a huge variation in how children with a cleft develop in terms of speech, and the severity

of their cleft is not always a good indication. Often, it won’t be clear how a child will be

affected until they start to speak.

“I thought that Cheryl will have only his difficulty in reading and speaking, but it

does not limit there because she suffered also in her eating activity.” This is the statement of

the mother as I interviewed her also of the situation of her child.

To deal to a child with cleft palate is not an easy task for one must learn to adjust to

her way of speaking. Cheryl hardly pronounced sounds of any words particularly “sshh”

sound and phonemes like /s/, /h/, /z/, /l/ and /r/. These are just few of the sounds that Cheryl

can’t properly utter. Another thing is that the level of comprehension of the child in

understanding what she is reading is somehow affected may be due also to her poor word

recognition.

In spite of the difficulties encountered by Cheryl I can still see the enthusiasm in her

for she is not that very ashamed to talk to people in that she wants someone to understand her

talk. Cheryl has also experienced bullying especially when she gets along with her playmates

and classmates at school and that she is always comforted by her mother. Mrs. Sibuan finally

realized that Cheryl needs companion and that she always wants to be with her best friend

Angel who always accompanied her in class.

I’ve found out that a child who has a cleft palate used to chop words and arrive into a

sentence until she could deliver the whole thought. There are moments according to her
 27

mother that they let Cheryl repeat what she had said for them to clearly understand her

message. “The challenge is not only in understanding her speech but also in following

instructions every time she was told by somebody,” added by her mother.

Children with a cleft that affects their soft palate (the part towards the back of the

throat) may have problems with speech that include sounding nasal. This is caused by the

soft palate not being able to properly close off the mouth from the nose while speaking and

therefore letting air escape through the nose. This is known as velopharyngeal impairment

(VPI). Additionally, if there are still holes (fistulas) in the palate, this makes it difficult to

make some consonant sounds such as /s/, /z/, /sh/ which require placing the tongue there to

make the sound. If teeth are missing or not in the right place, some dental sounds such

as /f/ and /v/ may be more difficult to articulate.

Children will start to learn how to make different sounds as they grow up. Speech

issues may be something that parents only notice as their child grows up. It could be that

while you can understand your child just fine, others have more difficulty. This isn’t such an

issue when they are still very young, but it needs to be treated if they are to start school and

interact with others confidently.

Sometimes, a child’s speech problem can be made worse by (or be the result of)

hearing issues, as they can’t hear themselves speak, or hear other people modeling the correct

pronunciation of the words, and so can’t work to fix the problems themselves.

Around half of all children with a cleft palate will need Speech and Language

Therapy (SLT) at some point, and any speech issues your child has should be picked up and

managed by the Cleft Team early on. Your child will have an assessment at around 18-24
 28

months old, and another one at 3 years. In both cases, treatment will be recommended if they

think it is necessary.

It’s much less likely for children with a cleft lip to have problems with their speech,

but if this is something you are concerned about then do talk to your Cleft Team about it. The

aim is for children to have good quality, intelligible (understandable) speech by age 5-6 so

that they can enter school able to participate fully in class and communicate with their peers.

Many children will only need SLT when they are younger, but some will need

support into their teenage years. How much, and how this is delivered, will depend on the

needs of the child in question – talk to your Speech and Language Therapist if you have

concerns.

The aforementioned researches and relevant information struck me most and that I

reflected that these ideas can really help parents especially those who have children with

learning difficulties and problems. It is observed that the role of parents in raising Cheryl is

really a big factor to the total development of their child. A parent who can give the learning

needs of her child is a parent who has love and passion to do everything just to let her child a

confident one and can find meaning to the society she is in. Motivation is very necessary and

a great help to Cheryl. The reason why she is now in her Junior High School is her strong

motivation to go to school despite of the bullies she had experienced with her community.

Cheryl finds it hard to answer critical thinking type of questions and cannot

comprehend well especially if she was given a particular situation to answer. Although her

favorite subject is English, it cannot be denied that Cheryl is struggling with her reading

skills and comprehension that hinders her to get high scores in the said subject. Three to four
 29

syllable words are the hardest words that Cheryl cannot easily utter. I realized that open

communication between the student and the teacher is very important to listen to the voice of

the learners.

Others may think that Cheryl is such an unlucky person because though she’s alive

but she’s suffering. But they’re wrong for based on my observation to her, if she could only

speak well maybe she will shout to the world how thankful she is, how blessed she is because

in billions of people who’s in great illness God gave him a chance to live and see the world

he creates for us.

Student who has a learning disability like Cheryl needs more attention,

understanding, patience and most of all love. I should not judge her instead learn to accept

for who she is because after all we’re all the same, not in physical look but we’re all the same

in terms of life, we all experience happiness and pain. If one knows how to understand

student like Cheryl there’s no judgmental taught in mind. She also wants to live a normal life,

to be accepted by everyone, love, and understand by the other people.

 30

XIV. Recommendations

Cleft palate is one of the most common birth defects, affecting about one out of every

600 individuals. Despite this fact, children and families affected by clefts may feel alone and

isolated.

Cheryl is one of those students with cleft palate who can reach her maximum

potential when care is provided by a team of specialists from a variety of healthcare fields.

This is because children with clefts are at higher risk than others for differences in facial

growth, dental abnormalities, speech problems, ear infections and hearing loss, and some

types of learning disabilities.

Treatment of cleft lip and/or palate varies with each child, because no two children

have exactly the same needs. For example, some children may require one or two operations,

while others may require more. Speech therapy is needed by some children and not by others.

Because each child is unique, treatment must be individualized for each child.

Families already affected by clefting should request a consultation with a geneticist (a

specialist in genetic factors) to estimate the chance that future children, their affected child’s

children, and the offspring of their affected children may also have clefts.

The teachers would have better and profound picture of the effects of cleft palate to

speech and its negative effects on the development of language in the modern day culture as

primary way of communicating with family, friends and even office colleagues and also will

be helped in managing the classroom well having students with special needs.

The students will be more aware of their role that everyone needs respect and that

understanding one another is necessary to help others overcome the challenge they

encountered. They will be guided of the R.A. 10627 or an act requiring all elementary and
 31

secondary schools to adopt policies to prevent and address the acts of bullying inside the

school campus. Students will be more observant of their peers and they will be curious of the

cause of such issue that will lead them to conduct researches and be enlightened of the ideal

things to do in the future.

The researchers would be able to think of the many interventions on how to

overcome cleft palate in a normal way after the surgery of a child if possible. A number of

analysis can be made in order to really point out the root cause of such speech difficulty.

The community should learn to reflect to individual differences and will serve as

inspiration to children with difficulties. It would be less hassle for them to analyze the speech

of the subject if they learn to listen and adjust to the situation. The barangay can provide

more opportunities for students with learning disabilities especially with their benefits and

finding ways on how the family can be a good example to the community.
 32

XV. References

Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate:

understanding genetic and environmental influences. Nat Rev Genet

Durning P, Chestnutt IG, Morgan MZ, Lester NJ. (2007). The relationship

between orofacial clefts and material deprivation in wales. Cleft Palate Craniofac.

Mossey PA, Little J. (2002). Epidemiology of oral clefts: an international

perspective. In Cleft Lip and Palate: From Origin to Treatment. Oxford University

Press. Oxford.

Centers for Disease Control and Prevention (CDC). (2006). Improved

national prevalence estimates for 18 selected major birth defects--United States,

1999–2001. MMWR Morb Mortal Wkly Rep.

Gregg T, Boyd D, Richardson A (1994). The incidence of cleft lip and palate

in Northern Ireland from 1980-1990. Br J Orthod.

Amaratunga NA. (1989). A study of etiologic factors for cleft lip and palate

in Sri Lanka. J Oral Maxillofac Surg

Marazita, ML. (1992). Segregation analysis. In Cleft Lip and Palate: From

Origin to Treatment. Wyszynski DF, ed. Oxford University Press.

Murray, JC. (2002). Gene/environment causes of cleft lip and/or palate.

Stoll C, Alembik Y, Dott B, Roth MP. (2000). Associated malformations in

cases with oral clefts. Cleft Palate Craniofac J

Gorlin RJ, Cohen MMJ, Levin LS. (2001). Syndromes of the Head and Neck.

Oxford: Oxford University Press

Bergland O, Borchgrevink H, Semb G, Åbyholm F. (1986). The Oslo team-

 33

approach to the rehabilitation of cleft anomalies. In Early Treatment of Cleft Lip and

Palate. Hotz .

E, Baciliero U, Gombos F, Laino G, Rullo R, Cenzi R, Carls F, Tognon M.

(2003). Recent developments in orofacial cleft genetics. J Craniofac Surg.

 34

XVI. Appendices

Appendix A

Department of Education
Region VI – Western Visayas
Schools Division of Iloilo
SINOGBUHAN NATIONAL HIGH SCHOOL
Sinogbuhan, San Joaquin, Iloilo

July 2, 2019

Dear Mrs. Sibuan:

Panamyaw!

Ako naga conduct kang Case Study nahanungod sa mga bata nga nagakinahanglan
kang bulig kag pag agubay angot sa iya pagtuon nga may kaangtanan sa akon subject sa EDD
407 - Maximizing Teaching Strategies.

Angot sini, akon ikaw ginapaman-an nga ang imo bata nga si Cheryl Sibuan sang
Grade 10 Puti napili-an ko bilang mangin akon respondente sa amo nga pagtuon.

Kabay nga makabulig ini nga tikang sa imo bata kag sa iya pagtuon.

Salamat guid.

Ang matinahuron,

ROLLY S. CAMPANO
English Teacher
 35

Appendix B

Instrument of the Study

PART I. PERSONAL INFORMATION

Directions: Check the appropriate box and fill out the necessary information needed.

Name: __________________________________________________________ Sex: _______

(Surname) (First Name) (Middle Name)
Address: __________________________________________________ Age: ______
Date of birth: _______________________Place of Birth: ___________________________
Religious Affiliation: ___________________________Birth Order: _____________________
School Last Attended:________________________________________________________
Grade & Section: ___________General Average: ________Contact Number:_____________

PART II. QUESTIONS

Statements Agree Disagree

A. Sound System

1. I leave out sounds/sounds which are hard to produce.

2. I am not understood by others.
B. Resonance

1. I am producing a hyper sound.

2. I am producing a hyper nasal sound.
C. Language

1. I can easily understand the gestures/intonation of others.

2. I can communicate in English language
D. Medical History

1. I have undergone surgery.

2. I have ear infection.
E. Developmental History

1. I can manage to move well doing household chores.

2. I can communicate to others with confidence.
F. Feeding Skills

1. I have difficulty sucking and chewing.

2. I have a normal weight.
 36

Statements Yes No
1. Medical Concern
I have undergone any medical treatment before.
2. Articulation
I find it hard to produce /b/p/s /m/, and /l/.
3. Language
It is easy for me to speak in English.
4. Family
I am fully accepted by my family.
5. Community
I am never bullied by my neighborhood.
6. School
I am always motivated to go to school.
7. Academic
I have good grades in almost all subject areas.
8. Sports
I join in sports activities.
9. Personal
I always want relax and quiet environment.
10. Social
I always want to be with my friends.

PART III. INTERVIEW QUESTIONS

1. Tell me the story of how you struggle your speech.

___________________________________________________________________________
___________________________________________________________________________
 37

___________________________________________________________________________
___________________________________________________________________________

2. What were your concerns then? What are your concerns now?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

3. How do you motivate yourself to overcome these challenges?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

4. Describe your (thoughts) feelings during your first day in school.

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

5. Has this experience of having CLP been stressful for you? Why or why not?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

6. If you were talking to someone as a student with speech difficulty, what would you advise
them? What did you learn from your experience that was most helpful to you?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

7. What was the biggest challenge for you in this process?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

EVA S. SEGUNLA CLAUDINE MAE P. SEBIO

Designated Guidance Advocate Designated Guidance Advocate

XVII. Curriculum Vitae

Attach your updated CV with recent picture.

 38

I. PERSONAL CIRCUMSTANCES

Name : Rolly S. Campano

Date of Birth : November 27, 1993

Place of Birth : Brgy. Igbangcal San Joaquin, Iloilo

Permanent Address : Brgy. Igbangcal San Joaquin, Iloilo

II. EDUCATIONAL ATTAINMENT:

 Tertiary Level

Bachelor of Secondary Education

Major in English
Southern Iloilo Polytechnic College
Western Visayas College of Science and Technology
Miagao Campus, Miagao, Iloilo
Cum Laude Batch 2015

 Secondary Level

San Joaquin School of Fisheries

Baybay, San Joaquin, Iloilo
Salutatorian Batch 2011

 Elementary Level

Igbangcal Elementary School

Igbangcal, San Joaquin, Iloilo
First Honors Batch 2007

 Position Held

Teacher I
Sinogbuhan National High School
Sinogbuhan, San Joaquin, Iloilo
2016- Present

 Eligibility and Awards

Outstanding Teacher Sinogbuhan National High School – 2018

 39

Radio Broadcasting held at Punta Villa Resort - 2017

(2nd Placer)

Outstanding Teacher in English Schools Division of Iloilo - 2017

(5th Placer )

Proficiency Award in Student Teaching of SIPC- WVCST

Miagao Campus – 2015

Outstanding in Journalism of SIPC- WVCST

Miagao Campus – 2015