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A preliminary examination of expressive writing in boys with isolated orofacial clefts



Children with isolated cleft of the lip and/or palate (iCL/P) are at a higher risk for language and reading issues. The current pilot study evaluated concurrent writing skills of children with iCL/P compared to unaffected participants with average (uAR) and impaired (uIR) reading. It was hypothesized that children with iCL/P would perform lower than age-expectations.


Twenty-three males, aged 8–11 years old, were recruited through clinics, local advertisements, and state dyslexia groups (iCL/P = 7, uAR = 8, uIR = 8). Group differences on measures of cognitive processes and writing were evaluated using ANCOVA. Relationships between these measures were compared for each group through Pearson correlations.


Participants with iCL/P performed within the average range across all measures; group differences were only found for the uIR group. For those with iCL/P, writing was correlated to global cognitive skills rather than more specific skills.


While this small sample of children with iCL/P demonstrated average writing skills, patterns suggest performance is related to global cognitive reasoning rather than specific cognitive processes as found in unaffected children with impaired reading. Further research is needed to better understand writing in iCL/P and the relationship to reading and cognitive processes.


  • Research in children with isolated cleft of the lip and/or palate (iCL/P) has demonstrated higher rates of language and reading disorders.

  • No work has assessed written expression in children with iCL/P in over 40 years.

  • This study is the first to evaluate elements of written expression and associated cognitive processes among children with iCL/P in comparison to unaffected children with either average or impaired reading skills.

  • Measures of writing were within the average range for children with iCL/P and demonstrated correlation to global cognitive reasoning rather than to specific cognitive processes as found in unaffected children with impaired reading.

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The authors would like to express gratitude to Emily Kuhlmann, BA for her assistance with data collection. Additional thanks are owed to the chapter leaders at Decoding Dyslexia and the International Dyslexia Association for facilitating successful recruitment. Lastly, thank you to the families who participated in this study. This study was supported by grants from the National Institute of Dental and Craniofacial Research (DE024511; to A.L.C.) and the National Center for Advancing Translational Sciences (UL1TR002537).

Author information




J.W.G.: contributed to design of the work, analysis and interpretation of data, and revision and final approval of the manuscript. A.L.C.: contributed to design of the work; acquisition, analysis, and interpretation of data; and revision and final approval of the manuscript.

Corresponding author

Correspondence to Jon W. Goodwin.

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The authors declare no competing interests.

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Parents/guardians provided written consent and children provided verbal and/or written assent to participate.

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Goodwin, J.W., Conrad, A.L. A preliminary examination of expressive writing in boys with isolated orofacial clefts. Pediatr Res (2021).

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