Early Predictors of Attachment in Infants with Cleft Lip and/or Palate

Abstract

Previous studies have found that children with cleft lip and palate (CLP) and isolated cleft palate (CP) have elevated risk for a variety of psychosocial problems, but the origins of such problems are unclear. We expected that early medical and other stressors during infancy--including feeding problems and facial disfigurement--would have adverse effects on the infant, his or her caregivers, and the family environment, leading to a higher than expected rate of insecure attachments among infants with clefts. Twelve-month attachment classifications of CLP, CP, and comparison group infants were examined. No significant group differences in attachment status were found. When 3-month infant, maternal, and social/family characteristics were examined as potential predictors of insecure attachment, predictors interacted with diagnostic status. For the cleft group, infant and maternal characteristics, but not family characteristics, significantly predicted insecure attachment. For the comparison group, maternal and family characteristics, but not factors associated with the infant, were predictive. Infants with clefts, despite their special needs and caregiving requirements, seem not to have elevated risk for insecure attachments at the end of their first year. Contrary to social-psychological formulations, the facial appearance of infants with CLP had no adverse effect on the quality of their maternal attachment.

Social-Emotional Development of Infants and Young Children With Orofacial Clefts

“…As anticipated, infants with CLP were rated as least attractive, followed by infants with CPO, and control children. Contrary to our expectation, facial attractiveness ratings were not predictive of child attachment security at age 12 months (Speltz et al, 1997), a finding replicated with an independent group of attractiveness raters (Coy et al, 2002). In fact, securely attached infants were rated as less attractive than insecurely attached children.…”

“…Quality of mother-infant attachment was not affected by the presence or absence of cleft lip in children with cleft palate (Speltz, Endriga, Fisher, & Mason, 1997). However, the groups showed different patterns of change in attachment status over time.…”

“…Using a Q-sort procedure, a group of adults rated the facial attractiveness of infants in all groups (Coy, Speltz, & Jones, 2002;Speltz et al, 1997). As anticipated, infants with CLP were rated as least attractive, followed by infants with CPO, and control children.…”

Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae

“…Temperament assessments have been routinely included in many attachment studies, and examination of the pertinent data on 1,790 children revealed the absence of a correlation with disorganized attachment. Physical problems such äs cleft palate (Speltz et al, 1997) are also not related to attachment disorganization. Only neurological abnormalities may increase the likelihood of disorganized behavior, for example, in Downs syndrome children (Vaughn et al, 1994) or in autistic children (Capps et al, 1994;Willemsen et al, 1998).…”

Psychological Impact of Repair Surgery in Cleft Lip and Palate

“…Parenting quality also seemed to be better for those children with more severe facial disfigurements. Most evidence seems to suggest that there are no significant differences in attachment between those with CLP and control groups [27,[31][32][33][34] although there are some contrasting findings in which 12 month olds born with cleft palate (CP) had lower attachment security; however the differences then disappear by two years of age [33]. Timing of repair may be significant with one study indicating that those with a standard repair (between three and four months of age) show worse mental development scores at 18 months than those with a neonatal repair [35].…”