[Factors involved in intelligent development of children with cleft lip and palate]

OBJECTIVE

The objective of this study was to investigate the possible factors involved in intelligent development of children with cleft Lip and palate.

METHODS

The intelligence quotient (IQ) and developmental quotient (DQ) of 152 children with cleft lip and palate under 14 years old were conducted, and the control group was made up of 80 healthy children. The considered factors included degrees of deformation, situation of perinatal period, way of feeding, psychological conditions of the children, general situation of their parents and education of these children. The data were statistically analyzed and compared.

RESULTS

The IQ value of these children generally was normal, but the mean value was still lower than that of the control group (P < 0.01). The mean IQ value of the group of children with only cleft lip or cleft palate was higher than that of the group with both cleft lip and cleft palate, and the mean IQ value of these children with II degree deformity was higher than that of children with III degree deformity. The mean IQ value of these children feed with mother's milk was higher than that of those feed with artificial milk. These children more than 5 years old were disturbed psychologically, and their parents were also with pressure.

CONCLUSION

The intelligent development of children with cleft lip and palate is affected by many factors, including types and degrees of deformity, feeding ways, illnesses and social psychological factors in different periods of development. Therefore, it is very important to take steps before 5 years old, including correctly feeding, repairing the deformity as early as possible, preventing the illnesses, necessary psychological treatment, improving social environment.

Spatial image of school environment in children with cleft lip and/or palate

To evaluate the adaptability of children with cleft lip and/or palate to school, their mental images of the school environment were investigated in a semantic differential method survey using 23 pairs of adjectives. The following eight places on and off the school grounds were chosen as environmental factors; classroom, gymnasium, school nurse's office, teachers' office, playground, hallway, road leading to school and road leading back home. 50 children with cleft lip and/or palate (ages 10-11 years) were enrolled in this study. These children had a feeling of liberation in the teachers' office and school nurse's office. However, they did not have an established feeling of relaxation or affinity in the classroom, gymnasium, playground, hallway, or on the road to and from school, the very locales that were the main areas of their school activity. This suggested that self-expression and adaptation were difficult for these children.

"Only skin deep": health, resilience, and craniofacial care

The literature on psychological and social responses to cleft palate and craniofacial conditions focuses on the challenges and limitations posed by biological factors, cognitive status, and social stigma. In spite of the various challenges experienced by persons with these conditions, many individuals have rich and satisfying lives. This paper develops a theoretical perspective to elucidate factors that account for health, life success, and resiliency in persons with craniofacial conditions. Three steps are proposed to change how craniofacial conditions are envisioned by clinicians and researchers: (1) creating optimism and positivity around the time of birth and diagnosis, (2) asking children and parents new and different questions, and (3) launching a new craniofacial social science model for research built around understanding resilience and health.

Social anxiety in Chinese adults with oral-facial clefts

OBJECTIVE

This study examined social anxiety and measures of psychosocial adjustment in Chinese adults with oral-facial clefts, their unaffected siblings, and age-matched controls.

DESIGN

This cross-sectional study utilized a matched case-control study design.

PARTICIPANTS

Eighty-five adult cleft lip and cleft palate (CL/CP) subjects and 85 unaffected siblings (one adult sibling of each CL/CP subject) were recruited in Shanghai, China, from a larger CL/CP study. Eighty-five unaffected controls, gender- and age-matched to the CL/CP subjects, were recruited from Shanghai work units including factories, universities, and other institutions.

OUTCOME MEASURES

Social Avoidance and Distress Scale, Fear of Negative Evaluation, Rosenberg Self-Esteem Scale, Interpersonal Support Evaluation List.

RESULTS

Affected adults reported significantly more social anxiety than unaffected siblings and controls. Affected adults also scored significantly lower on measures of self-esteem and social support than unaffected siblings and controls. Unaffected siblings and controls were not found to differ on any of these measures.

CONCLUSIONS

Findings suggest that individuals with oral-facial clefts may be more disadvantaged with respect to social affiliation and adaptation than unaffected adults. Cross-cultural research is essential in enabling us to determine whether similar trends exist across cultures.

An alternative management of older children with persisting communication problems

Speech and language deficits frequently implicate accompanying psychosocial problems (such as low self-esteem). An alternative management approach is described which adopts a holistic paradigm and provides a unique opportunity for intensive work on communication within a supportive environment. The residential programme for 8-14 year olds with persistent communication difficulties incorporated cognitive, emotional and psychosocial dimensions of communication, co-ordinated with work on speech features. Although the programmes were developed for children with cleft palate, they have potential for benefiting a wide range of communication impairments of different aetiologies. A forthcoming manual with resource material developed by the research team will be used in studies across these groups.

Are we ready to predict speech development from babble in cleft lip and palate children?

The speech development of nine children with cleft lip/palate was followed longitudinally from nine months to three years of age. The results indicate speech sound development closer to the non-cleft population than previous studies. Nasal fricatives previously not extensively described in the literature may be an experimental stage of developmental babble, which spontaneously reduce. The study has added to the evidence-base for practice in one cleft unit. It may be useful to channel resources at our centre to children who at nine months may be more at risk, i.e. children with bilateral clefts and known developmental delay.

Different cleft conditions, facial appearance, and speech: relationship to psychological variables

OBJECTIVE

The purpose of this investigation was to study the adjustment and learning characteristics of children with different types of clefts. The hypotheses were that there may be different relationships among cleft variables (speech and appearance) according to the cleft types.

DESIGN

The study compared three cleft groups on behavior rating, anxiety scales, depression scales, and self-perception (analyses of variance) and examined the influence of facial and speech ratings on self-perception (multiple regression analyses).

SETTING

All patients were treated at a university hospital cleft palate clinic.

PATIENTS

Sixty-five children aged 8 years to 17 years were selected based on nonsyndromic cleft (unilateral cleft lip and palate [ULP], bilateral cleft lip and palate [BLP], and cleft palate only [CPO]) and no significant neurological condition or hearing loss.

RESULTS

The findings indicated children with CPO showed greater problems with parent- and teacher-reported depression, anxiety, and learning related to speech than children with ULP or BLP. The later two groups showed fewer problems and a greater relationship of problem to facial appearance. The children with ULP self-reported lower levels of depression than the other two groups.

CONCLUSIONS

Children with cleft show relatively good overall adjustment, but some problems appear related to speech and facial appearance. Subgroups may need to be studied separately.

Psychological study of cleft palate children with or without cleft lip by kinetic family drawing

To clarify how cleft palate children with or without cleft lip perceive their family, we applied the Kinetic Family Drawing (KFD) technique to 60 cleft palate children (with or without cleft lip). The children were aged 7-9 years (in the 1-3 grade of elementary school) and attended the Department of Oral Surgery, Nagoya University Hospital, between 1990 and 1997. Controls consisted of 100 normal elementary school children of the same age. Major findings were: (1) Compared with normal children, cleft lip and palate boys and cleft palate only girls drew their self-images significantly more often in region D (lower right) and in region A (upper left), respectively. (2) Cleft palate children with or without cleft lip felt anxiety and fear toward their family, rarely viewing their homes as a restful place; this suggested insecurity. Uniquely dynamic relations were also suggested in their homes. (3) Cleft palate children with or without cleft lip often perceived their father or mother as persons easily acceptable in society. Rather remote psychological distance between parents and cleft palate children with or without cleft lip was suggested.

[Ethics and best practice in the consulting management of children with cleft lip and palate, and their parents]

Surgical treatment is only one part of the management of the child with cleft lip and palate. This paper exclusively focuses on other important aspects of this management. This includes the information and psychological supports of the parents, whether the cleft lip is diagnosed prenatally or at birth, the practical aspects of the consultation within the team of the different specialists involved (surgeon, anesthetist, dentist, orthodontist, speech therapist, otorhinolaryngologist, geneticist, child psychologist). The school teacher must also be concerned at the beginning of the first school year.

Provision of general dental care for children with cleft lip and palate--parental attitudes and experiences

OBJECTIVE

To evaluate the attitudes of parents of 4-8 year-old children with cleft lip and palate (CLP) towards the provision of paediatric dental care and to assess their experience of treatment within the General Dental Services.

DESIGN

Postal questionnaire distributed to all parents of 4-8 year-old children on the Birmingham CLP database.

RESULTS

The response rate was 77%. Ninety-nine (91%) children were registered with a dentist. Seventy-five (69%) had previously received preventive advice and 32 (29%) had experienced restorative intervention. The majority of parents (64%) expressed a wish for a dental check-up to be provided at the designated Cleft Centre, with 42 (39%) requesting preventive advice. Fifty-eight (67%) of the parents who requested a dental check-up were agreeable for treatment to be provided in the primary sector.

CONCLUSION

The survey indicates there is parental support for paediatric dental assessment at cleft clinics with subsequent arrangement of treatment in the primary sector. The inclusion of paediatric dental support within the multidisciplinary cleft team should be considered as Regional Cleft Centres are established

Do psychosocial variables predict the physical growth of infants with orofacial clefts?

This study sought to determine whether psychosocial variables (parent-infant feeding interactions, infant temperament, maternal social support, family socioeconomic status) are important in predicting the physical growth of infants with orofacial clefts, after controlling for selected medical variables (infant health status, cleft diagnosis, and previous weight). Infant growth (weight-to-height zscores) was tracked for 2 years, and models were developed to predict growth at 3, 12, and 24 months. The authors also examined the growth trajectories of infants with different cleft types: cleft lip and palate (CLP) and cleft palate only (CPO). CPO infants showed some increase in their growth relative to the population mean over time, whereas the growth of CLP infants remained lower than the population mean at all time points. After controlling for medical variables, psychosocial variables collectively accounted for an additional 42% of the variance in infants' growth at 3 months of age, but they did not account for growth at 12 months and 24 months, largely due to the strong effect of previous growth. The authors tentatively conclude that psychosocial variables influence the early growth trajectory of infants with clefts, but subsequent growth becomes increasingly regulated by biological factors.

The impact of antenatal diagnosis on the effectiveness and timing of counselling for cleft lip and palate

Birth of a cleft child is emotionally distressing to the parents. The opportunity for forewarning the parents is now possible with antenatal ultrasound diagnosis of the cleft. This has opened up a new chapter of antenatal counselling. We present a retrospective postal study of 124 primary cleft lip and/or palate repairs operated over the last 5 years. In our study, 30% were diagnosed antenatally and received antenatal counselling. The rest received postnatal counselling. Of those who had an antenatal diagnosis 85% felt that the diagnosis prepared them psychologically for the birth of the cleft child. A total of 92% (n = 23) of parents who had antenatal as well as postnatal counselling, as compared with 71% (n = 46) of those counselled only postnatally, said the information given to them by the counselling cleft team was detailed and satisfactory. The majority of those who felt counselling was confusing had only postnatal counselling. Of those who had antenatal diagnosis 92% said that they had never contemplated termination of pregnancy. Only one parent had actually terminated her pregnancy due solely to the antenatal diagnosis of a bilateral cleft lip and palate. Our study has highlighted the importance of antenatal diagnosis of cleft and the importance of antenatal counselling for the delivery of a cleft child to be a positive experience.

Are infants with orofacial clefts at risk for insecure mother-child attachments?

OBJECTIVE

Several risk factors in the early lives of children with clefts are believed to interfere with their development of secure attachments to parents; however, this possibility has rarely been studied empirically. This study compared 12- and 24-month attachment classifications of infants with cleft palate (CP), infants with cleft lip and palate (CLP), and a comparison group of unimpaired infants (COMP).

METHOD

Twenty-two CP infants, 24 CLP infants, and 61 matched COMP infants were assessed at 12 and 24 months of age in an urban children's hospital. At both visits, mothers and infants participated in the Strange Situation, which was videotaped and subsequently coded for patterns of attachment behavior.

RESULTS

CP infants displayed a lower rate of 12-month attachment security than infants in the CLP or COMP groups. By 24 months, no diagnostic group differences in attachment classification were found. Stable 12- to 24-month attachment classifications were less likely in the CP group (36.3%) than in the COMP (62.3%) group. CP infants who were insecure at 12 months were more likely to become secure by 24 months than were CLP or COMP group infants.

CONCLUSIONS

In contrast to previous theory and clinical speculation, the facial appearance of infants with CLP does not appear to affect the early mother-infant relationship adversely. The infancy period is marked by attachment instability for infants with CP, who demonstrated lower-than-expected rates of security at 12 months. However, these problems resolved in nearly all cases by 24 months of age. Most infants with clefts emerged from the first 2 years of life with secure maternal attachments.

[Cleft lip and palate: the adolescent and his family]

Cleft lip or palate: The impact on adolescents and their families. Applying Bronfenbrenner's theory on human development (1979), this article aims to provide a better understanding of the family's impact on adolescents born with a cleft lip or palate. Results focusing on the family microsystem reveal that parents can be either a source of stress or a source of support for their teenager. A description of two teenagers' life experience, when faced with similar problems, highlights the disparity between their journeys. Data indicate the importance of family support in the development of individuals born with a malformation.

[Nutrition of children with cleft lip and cleft palate, a bibliographic study]

The present study aimed at describing the children with congenital lip-palate malformation, emphasizing their alimentation, such as the difficulties and alternative methods to feed these children and nursing care in this process. The bibliographic review showed that there are many aspects in the alimentation care to fissured children, involving complex affective, social, economic and cultural relations that influence in mother-child relationship, in social discrimination of the fissured children and in mothers' difficulty to feed and give care to the child. Authors found the need to implement breast feeding, pointing out the physiological, psychological and social limitations that involve the child and the family as well as the importance of alimentation to physical and emotional development, favouring the surgical correction of lips and/or palate fissures as well as the rehabilitation process.

Cognitive and psychomotor development of infants with orofacial clefts

OBJECTIVE

To compare at ages 3, 12, and 24 months the cognitive and psychomotor development of 29 infants with cleft lip and palate (CLP), 28 infants with cleft palate only (CPO), and a demographically matched comparison (COMP) group of 69 infants; to examine predictors of cognitive status at age 24 months in the cleft group.

METHODS

Infants were administered the Bayley Scales of Infant Development (BSID), mother-infant interactions were observed, and medical records were reviewed.

RESULTS

CLP and CPO groups scored lower than the COMP group on the BSID, but did not differ from one another. Cleft group infants scored lower than COMP group infants on BSID items assessing nonverbal and expressive language skills. Quality of maternal interaction predicted the 2-year Mental Development Index (MDI) scores of infants with clefts.

CONCLUSIONS

Infants with clefts show relative deficits in cognitive and psychomotor development. Cognitive deficits are apparent in nonverbal as well as verbal areas of performance.

Social support and life adjustment for teenagers with cleft lip and palate in Taiwan

BACKGROUND

The teenage years (13-19 years) are a critical period for psychosocial development. Therefore, social support and life adjustment for teenagers with cleft lip/palate were chosen for investigation.

METHODS

The sample survey included 101 cleft patients randomly selected from the Chang Gung Craniofacial Center, and 101 non-cleft controls selected from local middle and high schools for comparison. Questionnaires were used to evaluate the social support and life adjustment scales. Items of social support were subdivided into social activities, social service, and psychological support. Items of life adjustment were subdivided into social, psychological, and physical adjustments.

RESULTS

The coefficients of alpha reliability were high at 0.9294 for social support, and 0.9389 for life adjustment. The results show that personal factors, family factors, and treatment status do not influence social support or life adjustment in either group; however, gender does. In the control group, non-cleft males had better social support and life adjustment than did females. Such a difference was not observed in the cleft group. Both groups received the same social support. The cleft teenagers have a significantly lower level of life adjustment. The association between the social support and life adjustment is high in both groups.

CONCLUSION

The cleft group has a lower level of life adjustment. There is a positive relationship between social support and life adjustment. More social support is required for the cleft group in order to improve their level of life adjustment.

Experience of teenagers born with cleft lip and/or palate and interventions of the health nurse

The objective of this study was to describe and understand the experiences of teenagers with cleft lip and/or palate. The human ecology approach of Bronfenbrenner (1979) was chosen as a basis for this study. From this perspective, the living environment of teenagers with cleft lip and/or palate was considered, and as such, qualitative research from an ethnographic standpoint was conducted. The data were collected by semistructured interviews and recorded on magnetic tape. Ten teenagers, between 15 and 17 years of age, were chosen and consulted while undergoing therapeutic treatment and surgery in a cleft lip and/or palate clinic. The results of this study indicate that teenagers born with this congenital malformation experience various physical, functional, or interactional problems throughout their development. To improve this situation, nursing care has been developed to enable the nurse to act within the multidisciplinary team treating cleft lip and/or palate cases, thereby allowing the teenager to develop in an environment that offers a better quality of life.

Early speech and language development in children with velocardiofacial syndrome

Speech-language impairment is one of the most common clinical features in velocardiofacial syndrome (VCFS). This report describes the speech and language development of four children with VCFS studied longitudinally from 6 to 30 months of age and compares their performance with three groups of children: (1) normally developing children, (2) children with cleft lip and palate, and (3) children with isolated cleft palate. The data show that young children with VCFS show a receptive-expressive language impairment from the onset of language. Further, speech and expressive language development were severely delayed beyond a level predicted by their other developmental or receptive language performance. The children with VCFS showed severe limitations in speech sound inventories and early vocabulary development that far exceeded those shown by the children with cleft lip and palate and children with isolated cleft palate. This study indicates that young children with VCFS emerge from a critical speech and language learning period with severe limitations in their communicative abilities. Further studies are required to describe the later course of these early speech and language impairments and to explore the relationship to learning disabilities described for older children with VCFS. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:714-723, 1999.

Appraisal and coping in adults with cleft lip: associations with well-being and social anxiety

The appraisal patterns and coping strategies of adults born with a cleft lip or cleft lip and palate were assessed in relation to measures of psychological well-being and social anxiety. A sample of 51 adults was recruited via the Cleft Lip and Palate Association. Data were collated using a questionnaire incorporating open questions and standardized measures. The focus was upon appraisal of the cleft, perceptions of consequences--both positive and negative--on personal and social dimensions, together with measurements of sense of coherence, psychological well-being, satisfaction with life and coping responses utilized in stressful situations. There was wide variability in the participants' reports of negative affect as a component of psychological well-being, suggesting that there may be small numbers of individuals with quite extreme responses. Seventy-five per cent reported difficulties which they attributed to their cleft. Perceiving positive gains as a result of the cleft and having a positive appraisal of facial appearance was associated with well-being. Patterns in coping strategies were also associated with emotional adjustment. Personal appraisals of both having a cleft and facial appearance may be more important in determining emotional well-being than the current medical emphasis on the aesthetics of surgical outcomes.

Asymmetry of left versus right unilateral cleft impairments: an experimental study of face perception

OBJECTIVE

Previous psychosocial studies of adults born with cleft lip and palate have provided circumstantial evidence that surgically repaired right-sided unilateral clefts may be more disfiguring than left-sided clefts. The present study asked if such asymmetries are physiognomic asymmetries or arise "in the eye of the beholder," representing perceptual processes in face recognition.

DESIGN

Color slides of 160 children (6 years of age) and young teenagers (16 years of age) were rated by subjects for perceived disfigurement. Sixty of the subjects had unilateral complete cleft lip and palate (30 had a right-sided cleft and 30 had a left-sided cleft), 60 had unilateral cleft lip/alveolus (30 right-sided and 30 left-sided clefts), 32 children had bilateral cleft lip and palate, and 8 children had cleft palate only. Faces were shown in normal and in mirror-reversed versions; the order in which faces were shown was randomized, as were other stimulus factors such as cleft type, age, and gender.

SETTING

The study was conducted as a classroom-type experiment at the Vision Laboratory, Department of Psychology, Oslo, Norway.

PARTICIPANTS

Thirty-seven students of psychology at the University of Oslo, who were ignorant of the purpose of the study, acted as subjects.

MAIN OUTCOME MEASURE

Subjects rated perceived disfigurement using a visual analog scale.

RESULTS

Modest but highly consistent hemifacial asymmetries in judged disfigurement were found, with left-sided unilateral clefts rated as less disfiguring than right-sided unilateral clefts. Unilateral clefts were judged as being less disfiguring than the bilateral clefts, and cleft lip/alveolus was judged as being less disfiguring than cleft lip and palate. The patterns of facial judgments were almost identical in the normal and reversed-slides conditions.

CONCLUSIONS

Asymmetries between left- and right-sided clefts reside in physiognomic factors rather than in hemispheric asymmetries controlling the perceptual process of face judgment.

Babbling of an infant with a repaired cleft lip: a case study

The infant born with a cleft lip is faced with risk factors that threaten the development of speech-language skills. The earlier the age of identification and management of the developmental delay, the better the outcome. The attainment of the mature syllable is considered to be a critical measure of babbling competency. This single case study aimed to determine whether the formedness of the syllable in babbling would be affected by the cleft lip repaired prior to the onset of meaningful speech. Three samples of babbling in a naturalistic environment were video-recorded. Data was analysed following the principles of infraphonology, employing a perceptually-based method. A profile of infraphonological features was obtained. Results showed that the development of the mature syllable was attained. The results support the theories that babbling is a robust phenomenon. Clinical and research implications are discussed.