Speech results were surveyed in 110 adolescent patients with clefts: 53 with unilateral cleft lip and palate, 46 with bilateral cleft lip and palate, and 11 with isolated clefts of the secondary palate. Only 12 of the 110 teenagers had received consistent team care from infancy. The early physical management was impossible to reliably determine in the remaining 98. Speech was normal in 22.7%, characterized by a variety of problems in approximately 66%, and a complete habilitative failure in 10.9%. Cleft palate and craniofacial teams who first encounter incompletely managed cases in the teenage years are faced with complex and interrelated challenges of providing appropriate physical management, speech habilitation, and psychosocial support, including determination of that approach which will be most likely to assure future compliance with treatment recommendations to each child and family.