Behavioral pattern in Chinese school-aged children with cleft lip and palate

Psychological and Peer Difficulties of Children with Cleft Lip and/or Palate: A Systematic Review and Meta-Analysis

OBJECTIVES

A systematic review and meta-analysis were conducted to determine if children born with cleft lip and/or palate are at increased risk of psychological and peer difficulties, and if so, which difficulties they develop.

METHODS

EMBASE, MEDLINE, and PsycINFO were searched for English language studies published between January 2005 and January 2022 which investigated the psychological outcomes and peer function of children with nonsyndromic cleft lip and palate. Outcomes included internalizing problems, such as anxiety and depression, externalizing problems, such as hyperactivity, conduct disorders, self-concept including self-image and self-esteem, peer problems, resilience, coping, and overall psychological function. A risk of bias assessment was performed using the Newcastle-Ottawa Scale. Random effects models were used in the meta-analysis to compare the outcomes for children born with a cleft and those without.

RESULTS

In total 41 studies met inclusion criteria, with 9 included in the meta-analysis. Children born with a cleft appear to have similar psychological outcomes compared to normative controls when using the strengths and difficulties questionnaire. There are some minor differences between self-report and parent report, with parents generally reporting that their child with a cleft has increased emotional, conduct, and hyperactivity problems. The small differences between the study cohort and control cohorts are unlikely to imply any differences on a clinical level.

CONCLUSIONS

Overall psychological outcomes appear to be similar between children born with a cleft and the nonaffected population, however, some symptoms such as anxiety and depression appear higher in children with cleft lip and/or palate.

Salivary Cortisol and Sustained Auditory Attention in Children with and without Cleft Lip and Palate

Introduction Cortisol is a hormone involved in the response to stress. Attention is a function that can change due to exposure to stress.

Objectives To verify the correlation between the level of salivary cortisol and sustained auditory attention in children with cleft lip and palate, as well as to compare the results of the variables analyzed between female and male patients.

Methods In total, 103 children aged 6 to 11 years, were divided into 2 groups: those with cleft lip and palate (experimental group, EG; n = 69) and the control group (CG; n = 34). The Sustained Auditory Attention Ability Test (SAAAT) and salivary cortisol levels, measured by an enzyme immunoassay kit (Salimetrics, Stage College, PA, US), were calculated and compared regarding the two groups. The statistical tests used were the Mann-Whitney test and the Spearman correlation.

Results The median level of salivary cortisol was of 0.03615 µl/dL and 0.18000 µl/dL respectively for the EG and CG, with a significant difference between the groups (p = 0.000). Absence of statistical significance (total error score = 0.656; vigilance decrement = 0.051) was observed the for SAAAT among the EG (median total error score = 12.00; 25th percentile [25%] = 7.00; 75th percentile [75%] = 21.00; and vigilance decrement = 1.00; 25% = 0.00; 75% = 2.50) and the CG (median total error score = 12.00; 25% = 6.00; 75% = 24.00; and vigilance decrement = 0.00; 25% = -1.00; 75% = 2.00).

Conclusion All children had median levels of salivary cortisol and scores for sustained auditory attention within normal parameters. A significant correlation between the level of salivary cortisol and the ability to sustain auditory attention was observed in children without cleft lip and palate. There were no differences regarding the SAAAT and salivary cortisol between female and male patients.

Evaluating Psychosocial Problems in School-Age Children with Cleft Lip and Palate in Bandung, Indonesia Using CBCL/6-18

BACKGROUND

Cleft lip with or without palate (CL  ±  P) may impact children's eating, drinking, speaking, breathing, and hearing. We aim to evaluate psychosocial problems in Indonesian cleft center school-age patients identified after one or more surgical interventions.

METHODS

This is a cross-sectional study of parent report of patients with unilateral CL  ±  P who had cleft surgery from 2011 to 2016 in the Bandung Cleft Center using the Bahasa Indonesia version of CBCL/6-18 questionnaire. Descriptive statistics were completed based on measure norms and score ranges.

RESULTS

There were 104 participants (56.7% male) with a median age of 8 years old and 73.0% had unilateral cleft of lip, gum, and palate. We found that speech and appearance problems were not perceived by parents for 34.6% of participants after undergoing surgery. The majority of parents reported normal range scores for the Social scale (93.3%) and the School scale (92.3%). In contrast, largely due to the restrictions in the covid-19 pandemic, 78.8% of the patients had below normal range scores for the Activities scale. Borderline or Clinical range scores were reported for 6.7% of children on the Problem Items section and 15.4% of parents endorsed one or more Critical Items about their children, which indicate significant behavioral concerns.

CONCLUSION

In this study, we found 6.7% of the school-age children population with CL/P had psychosocial problems. The result of this study hopefully can shed some light in the long-term psychosocial conditions of the CL/P children post-operatively.

Problemas de Salud Mental en Niños con Fisura Labiopalatina

Los niños que padecen enfermedades genéticas son una población vulnerable para desarrollar problemas de salud mental. La fisura labiopalatina (FLAP) es una anomalía congénita de tipo estructural. Objetivo: Estudiar el impacto a nivel familiar del diagnóstico de FLAP. Metodología: Alcance descriptivo, de diseño mixto y corte transversal. Se construyó un cuestionario autoadministrado compuesto por un consentimiento informado, un cuestionario de datos sociodemográficos, el Child Behavior CheckList y preguntas abiertas. El muestreo fue intencional y la muestra fue de 42 casos. Resultados: El diagnóstico de una fisura labio palatina es una experiencia difícil en los padres, quienes viven este momento de manera negativa, con tristeza y miedo.  Los niños en edad preescolar con diagnóstico de fisura labiopalatina son una población en riesgo de desarrollar trastornos psicopatológicos, mayormente de tipo externalizantes.