Risk and Protective Factors at Age 10: Psychological Adjustment in Children with a Cleft Lip and/or Palate

Abstract

Objective To explore psychological functioning in children with a cleft at age 10 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and social adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable children were found across domains or whether risk was limited to specific areas of adjustment. Methods Retrospective chart review from psychological assessments at age 10 (N = 845). The effects of gender, cleft visibility, and the presence of an additional condition were investigated. Results were compared with large national samples. Measures Personality Inventory for Children, Child Experience Questionnaire, Strengths and Difficulties Questionnaire, Satisfaction With Appearance scale. Results The factor affecting psychological adjustment on most domains was the presence of an associated condition in addition to the cleft. As expected, no support was found for cleft visibility as a risk factor, while there were some gender differences related to emotional difficulties and attention. Correlation analyses of risk groups pointed to an association between social experiences and emotional adjustment and between social and behavioral adjustment; whereas, dissatisfaction with appearance was not related to any other domains of risk at age 10. Conclusions The results point to the importance of early screening and assessment of children born with a cleft to identify possible associated conditions and offer adapted and appropriate treatment and care. Future research should investigate how protective factors could counteract potential risk in children with a cleft.

Translation and pilot study of the Cleft Hearing Appearance and Speech Questionnaire (CHASQ)

“…Therefore, it is essential for a cleft team to include assessments of PRO and psychosocial outcome into standard practice of care [32]. To enable cleft teams to learn as much as possible from a wide variety of experience, it is desirable for cleft teams to use an internationally accepted outcome measure [1,7,17,33,34].…”

“…The same author, however, in a further study highlighted that self-reported psychosocial functioning in patients with CL/ P was worse than in non-cleft controls, when analysed in separate domains of depressive symptoms, behavioural problems and satisfaction with appearance and speech [11]. Further studies have suggested that self-reported psychosocial function significantly correlates with satisfaction with appearance [7,[12][13][14] and speech [4,[15][16][17]. Hearing difficulties have also been associated with social impairment [17].…”

“…SWA was designed by the Cleft Psychology Special Interest Group, Craniofacial Society of Great Britain and Ireland specifically for patients with facial disfigurement [27]. SWA and CHASQ have satisfactory internal validity, construct validity and overall adequate psychometric properties and have been used in clinical research in Europe [2,3,6,7,14,[28][29][30].…”

“…PRO results in patients with CL/P and clinician/objective rating Earlier research has demonstrated that the association is weak between professional or laymen rating and patient satisfaction with nasal appearance or QoL [2,3], speech [4,5] or the level of self-reported social adjustment, satisfaction with appearance or cleft type [6][7][8]. A surgeon's judgement of a result is not always synonymous with patient assessment [9].…”

Body Image and Quality of Life in Adolescents with Craniofacial Conditions

“…In recent years, body image has received increasingly more attention in medical populations, particularly those which impact physical appearance (Fauerbach et al, 2000; Bowe et al, 2011; Clarke et al, 2014; Auerbach et al, 2014; Sarwer, et al 2006). While condition-specific measures have been developed (e.g., Satisfaction with Appearance Scale; Emerson, et al, 2004), there is little consensus about which measures to use when assessing body image and psychosocial functioning among youth with visible differences (Feragen & Stock, in press; Roberts & Shute, 2011). Instruments developed for the general population may not be sensitive enough to identify specific concerns (e.g., concerns about facial features).…”