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Stock NM, Costa B, Parnell J, Johns AL, Crerand CE, Billaud Feragen K, Stueckle LP, Mills A, Magee L, Hotton M, Tumblin M, Schefer A, Drake AF, Heike CL. A Conceptual Thematic Framework of Psychological Adjustment in Caregivers of Children with Craniofacial Microsomia. Cleft Palate Craniofac J 2024:10556656241245284. [PMID: 38584503 DOI: 10.1177/10556656241245284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE Children with craniofacial microsomia (CFM) have complex healthcare needs, resulting in evaluations and interventions from infancy onward. Yet, little is understood about families' treatment experiences or the impact of CFM on caregivers' well-being. To address this gap, the NIH-funded 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program sought to develop a conceptual thematic framework of caregiver adjustment to CFM. DESIGN Caregivers reported on their child's medical and surgical history. Narrative interviews were conducted with US caregivers (n = 62) of children aged 3-17 years with CFM. Transcripts were inductively coded and final themes and subthemes were identified. RESULTS Components of the framework included: 1) Diagnostic Experiences, including pregnancy and birth, initial emotional responses, communication about the diagnosis by healthcare providers, and information-seeking behaviors; 2) Child Health and Healthcare Experiences, including feeding, the child's physical health, burden of care, medical decision-making, surgical experiences, and the perceived quality of care; 3) Child Development, including cognition and behavior, educational provision, social experiences, and emotional well-being; and 4) Family Functioning, including parental well-being, relationships, coping strategies, and personal growth. Participants also identified a series of "high" and "low" points throughout their journey and shared their priorities for future research. CONCLUSIONS Narrative interviews provided rich insight into caregivers' experiences of having a child with CFM and enabled the development of a conceptual thematic framework to guide clinical care and future research. Information gathered from this study demonstrates the need to incorporate evidence-based psychological support for families into the CFM pathway from birth onward.
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Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jade Parnell
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Laura P Stueckle
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Mills
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leanne Magee
- Buerger Center for Advanced Pediatric Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Hotton
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, England
| | - Melissa Tumblin
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Schefer
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel School of Medicine, Chapel Hill, NC, USA
| | - Carrie L Heike
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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Kling J, Billaud Feragen K. Experiences of appearance conversations among young people living with a visible difference. Body Image 2024; 49:101699. [PMID: 38489964 DOI: 10.1016/j.bodyim.2024.101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024]
Abstract
Stigmatisation surrounding having a visible difference to the face or body may have a marked impact on how young people communicate about appearance. The aim of our study was therefore to explore the experiences of appearance conversations among young people living with a visible difference. Interviews were conducted with 32 young people (mean age 14.1 years; 67.7% girls), with a condition resulting in a visible difference (e.g., craniofacial condition or scarring). Using reflexive thematic analysis, we identified three themes. Importance of Safety and Understanding reflects the importance of feeling safe in order to be able to talk about appearance. Participants described appearance conversations as often originating in their need for emotional support or practical assistance when encountering difficulties (Conversations When in Need of Support), but appearance was also experienced as a sensitive topic that was difficult to talk about (Avoiding Appearance Conversations). Our results highlight the importance of creating spaces where young people with a visible difference feel safe to bring up the topic of appearance when in need of support. Elements that facilitate such conversations include others having knowledge about the condition and having one's feelings and experiences validated instead of minimised.
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Affiliation(s)
- Johanna Kling
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, Norway; Department of Psychology, University of Gothenburg, Sweden.
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Lindberg NE, Kynø NM, Feragen KB, Pripp AH, Tønseth KA. Parental Stress, Infant Feeding and Well-being in Families Affected by Cleft Lip and/or Cleft Palate: The Impact of Early Follow-up. Cleft Palate Craniofac J 2024:10556656241231524. [PMID: 38384126 DOI: 10.1177/10556656241231524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To document the impact of early follow-up by specialized cleft nurses (SCNs) provided to families affected by cleft lip and/or palate (CL/P) and the status of parental stress, infant feeding and well-being. DESIGN Prospective inclusion of a control group, which only received standard care, followed by an intervention group that also received early SCN follow-up. SETTING The cleft lip and palate team at Oslo University Hospital, Norway. PARTICIPANTS Seventy families (69 mothers and 57 fathers) distributed into an intervention group (n = 32) and a control group (n = 38). INTERVENTION SCNs provided a consultation at the maternity ward and a follow-up conversation by phone or face-to-face at scheduled times for six months. OUTCOME MEASURES Parental Stress Index (PSI), Perceived Stress Scale (PSS-14), feeding questionnaire, survey of infant diets, weight percentiles. RESULTS The mothers reported higher stress scores than the fathers, but in the control group only in the PSI parent domain at T2 and T3 (P = .007, P = .018). Infants in the intervention group used pacifiers less frequently than in the control group (55.2% vs. 81.1%, P = .023). Otherwise, no significant differences were found between the groups. Overall, the infants received less breast milk than norms. CONCLUSION Contextual strategies for early follow-up of families affected by clefts need to be developed, with an emphasis on involving fathers and those parents reporting elevated stress and/or feeding difficulties. There is a need for diagnosis-specific guidelines about the use of pacifiers as well as collaboration between the health professionals involved to increase breastmilk feeding.
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Affiliation(s)
- Nina Ellefsen Lindberg
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Margrethe Kynø
- Department of Nursing and Health Promotion, Acute and Critical illness, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Johns AL, McWilliams D, Costa B, Heike CL, Feragen KB, Hotton M, Crerand CE, Drake AF, Schefer A, Tumblin M, Stock NM. Early Experiences of Parents of Children With Craniofacial Microsomia. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00001-7. [PMID: 38320743 DOI: 10.1016/j.jogn.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/02/2024] [Accepted: 01/02/2023] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE To describe the early health care experiences of parents of children with craniofacial microsomia (CFM), a congenital diagnosis often identified at birth. DESIGN Qualitative descriptive. SETTING Homes of participants. PARTICIPANTS Parents of 28 children with CFM from across the United States. METHODS We interviewed participants (27 mothers individually and one mother and father together) via telephone or teleconference and used reflexive thematic analysis to derive themes that represented early health care experiences of parents of children with CFM. RESULTS Participants' narratives included detailed recounting of their birth and early care experiences. We identified two overarching themes. The first overarching theme, Stressors, included four subthemes that represented difficulties related to emotional reactions and negative experiences with health care providers. The second overarching theme, Finding Strength, included four subthemes that represented participants' positive adjustment to stressors through independent information seeking about CFM, adaptive coping, positive experiences with health care providers, and drawing on external supports. CONCLUSION Participants often described early experiences as challenging. Findings have implications for improving early care, including increasing open and supportive communication by health care professionals, expanding access to CFM information, screening for mental health concerns among parents, strengthening coping among parents, and linking families to resources such as reliable online CFM information and early intervention programs.
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Johns AL, Stock NM, Costa B, Feragen KB, Crerand CE. Psychosocial and Health-Related Experiences of Individuals With Microtia and Craniofacial Microsomia and Their Families: Narrative Review Over 2 Decades. Cleft Palate Craniofac J 2023; 60:1090-1112. [PMID: 35382590 PMCID: PMC10803131 DOI: 10.1177/10556656221091699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper describes 20 years of microtia and craniofacial microsomia (CFM) psychosocial and healthcare studies and suggests directions for clinical care and research. A narrative review of papers January 2000 to July 2021 related to psychosocial and healthcare experiences of individuals with microtia and CFM and their families. Studies (N = 64) were mainly cross-sectional (69%), included a range of standardized measures (64%), and were with European (31%), American (27%), or multinational (23%) samples. Data were generally collected from both patients and caregivers (38%) or patient self-report (35%). Sample sizes were 11 to 25 (21%), 26 to 50 (19%), 51 to 100 (22%), or over 100 (38%). Studies addressed 5 primary topics: (1) Healthcare Experiences, including Medical Care, Hearing Loss/Amplification, Diagnostic Experiences, and Information Preferences; (2) Psychosocial Experiences, including Teasing, Behavioral Adjustment, Psychosocial Support, and Public Perception; (3) Neurocognitive Functioning and Academic Assistance; (4) Pre- and Post-Operative Psychosocial Outcomes of Ear Reconstruction/Canaloplasty; and (5) Quality of Life and Patient Satisfaction. Care involved multiple specialties and was often experienced as stressful starting at diagnosis. Psychosocial and neurocognitive functioning were generally in the average range, with possible risk for social and language concerns. Coping and resiliency were described into adulthood. Satisfaction and positive benefit of ear reconstruction/canaloplasty were high. Care recommendations include increasing: hearing amplification use, microtia and CFM knowledge among providers, efficient treatment coordination, psychosocial support, academic assistance, and advances to minimize surgical scarring. This broad literature overview informs clinical practice and research to improve psychosocial outcomes.
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Affiliation(s)
- Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicola Marie Stock
- Center for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Center for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Canice E Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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Myhre A, Råbu M, Feragen KB. Are We Together in This? Relationship Experiences of Parents of Children with Craniofacial Anomalies. Cleft Palate Craniofac J 2023:10556656231180512. [PMID: 37282504 DOI: 10.1177/10556656231180512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE The birth of a child with a craniofacial anomaly (CFA) can have a profound psychological impact on the family and the parental relationship. The purpose of this study was to qualitatively investigate how a child's CFA condition affected parents' couple relationship. SETTING All patients with a CFA are followed-up by the National Unit for Craniofacial Surgery, a specialized and multidisciplinary team. Hence, participants were recruited within a centralized treatment setting. DESIGN We used a qualitative approach to explore the relationship experiences of parents of children with CFAs. The interviews were analysed using a hermeneutic-phenomenological approach. PARTICIPANTS The study included 13 parents, nine mothers and four fathers of children with a range of different CFAs. At the time of the interview, 10 participants were married, one was cohabiting, and two were divorced. RESULTS Most participants perceived their partners as committed and engaged in caring for their affected child and involved in the family's everyday life, and described a strengthened relationship to their partner after the child with a CFA was born. However, some participants struggled in their relationships with their partners, and did not receive the comfort and support they needed during this critical time, leading to feelings of distance and loneliness. CONCLUSIONS Craniofacial teams should be mindful of the importance of the environment surrounding the child, such as parental relationship and family function. Therefore, a comprehensive approach should be included in team-based care, and couples and families in need of extra support should be referred to relevant specialists.
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Affiliation(s)
- Anita Myhre
- Centre of Rare Disorders, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Marit Råbu
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Kristin Billaud Feragen
- Centre of Rare Disorders, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Lindberg NE, Kynø NM, Billaud Feragen K, Pripp AH, Tønseth KA. Early Follow-up of Parents by a Specialized Cleft Nurse After the Birth of an Infant with Cleft lip and/or Palate. Cleft Palate Craniofac J 2023:10556656231171750. [PMID: 37151047 DOI: 10.1177/10556656231171750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE To document the impact of early follow-up by specialized cleft nurses (SCNs) to families of infants with cleft lip and/or cleft palate (CL/P). DESIGN Prospective inclusion of a control group, which received standard care alone, followed by an intervention group, which in addition received early SCN follow-up. SETTING The cleft lip and palate team at a University hospital. PARTICIPANTS 70 families (69 mothers and 57 fathers); control group (n = 38); intervention group (n = 32). INTERVENTION SCNs offered a consultation at the maternity ward and follow-ups by phone or face-to-face at one, three, eight weeks and six months after birth. OUTCOME MEASURES Use of Internet-Questionnaire, Quality of discharge teaching scale (QDTS), Post discharge coping difficulty scale (PDCDS), Response on follow-up by health professionals. RESULTS Infants in the intervention group were admitted less frequently to a Neonatal Intensive Care unit (NICU); 21.9% vs 51.4%, P = .012. Parents in the intervention group used internet for cleft-related reasons less frequently (74.6% vs 85.9%), P = .112 and the mothers benefitted less from cleft-related activity on the internet (P = .013). The intervention group reported higher mean score for satisfaction with total cleft care (P = .001). There were no significant group differences regarding mean total score for discharge teaching (P = .315) and coping difficulties (P = .919). CONCLUSION Early follow-up by a SCN with expertise in cleft care is highly valued by parents. Closer cooperation between the cleft team and health professionals at birth hospitals and Child health centers is necessary for optimal follow-up.
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Affiliation(s)
- Nina Ellefsen Lindberg
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nina Margrete Kynø
- Department of Nursing and Health Promotion, Acute and Critical illness, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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von der Lippe C, Neteland I, Feragen KB. Children with a rare congenital genetic disorder: a systematic review of parent experiences. Orphanet J Rare Dis 2022; 17:375. [PMID: 36253830 PMCID: PMC9575260 DOI: 10.1186/s13023-022-02525-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for a child with a chronic disease may be demanding and stressful. When a child has a rare condition, the impact of care on parents is amplified due to the rarity of the diagnosis. In order to address the lack of generalized and synthesized knowledge regarding parents' experiences of having a child with a rare genetic disorder, and give a holistic picture of these experiences, a systematic review of the available qualitative research was conducted. METHODS We performed a systematic review, including qualitative studies on parents of children with rare genetic disorders, published between 2000 and 2020. RESULTS The review included 33 qualitative studies. Findings were synthesized and categorized according to three main themes: Parents' experiences with health care, Responsibilities and challenges, and Factors promoting positive experiences in parents. The findings demonstrate that parents of children with rare genetic disorders share many common challenges, despite evident differences across conditions. CONCLUSION Coordinated care, and a more holistic approach in the follow up of children with rare genetic disorders is needed. International collaboration on research, diagnostics, producing scientific correct and understandable information available for health care professionals and lay people should be prioritized.
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Affiliation(s)
- Charlotte von der Lippe
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, P.B. 4950, 0424, Nydalen, Oslo, Norway.
| | - Ingrid Neteland
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, P.B. 4950, 0424, Nydalen, Oslo, Norway
| | - Kristin Billaud Feragen
- Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, P.B. 4950, 0424, Nydalen, Oslo, Norway
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Daae E, Feragen KB, Sitek JC, von der Lippe C. It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis. Health Psychol Behav Med 2022; 10:335-356. [PMID: 35402085 PMCID: PMC8986293 DOI: 10.1080/21642850.2022.2053685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents. Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis. Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships. Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.
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Affiliation(s)
- Elisabeth Daae
- Center for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
| | | | - Jan C Sitek
- Department of Dermatology, Oslo University Hospital HF, Oslo, Norway
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Abstract
OBJECTIVE To compare school grades of adolescents in Norway born with isolated cleft with those of their unaffected peers. DESIGN Population-based cohort study. SETTING Norway. PATIENTS A total of 347 419 individuals born in Norway between 1986 and 1992, including 523 isolated cleft cases which were identified using data from Norway's two treatment centres. Individuals were followed from birth through compulsory school. MAIN OUTCOME MEASURES Grade point average (GPA) from middle school graduation (around the age of 16). Specific subject grades were also investigated. RESULTS Using a grade scale from 1-6, the observed mean GPA for the reference group was 3.99. Both cleft lip only (CLO) and cleft lip with cleft palate (CLP) had a mean GPA similar to the reference group (adjusted GPA differences from the reference with 95% CIs of 0.06 (-0.04 to 0.16) and -0.08 (-0.19 to 0.03), respectively). Cleft palate only (CPO) had a marginally lower GPA (adjusted GPA difference: -0.18 (-0.28 to -0.08)). These comparisons were consistent across specific subjects. Overall, the evidence suggests a larger difference in GPA between cases and controls in males compared with females. Females with CLO even had a higher estimated GPA than females in the reference group (adjusted GPA difference: 0.19 (0.013 to 0.36)). Grades were similar regardless of laterality of cleft lip (CLO or CLP). CONCLUSION In Norway, individuals born with isolated CLO or CLP did not have lower average school grades when graduating from middle school. Individuals born with isolated CPO had marginally lower grades.
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Affiliation(s)
- Miriam Gjerdevik
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Rolv Terje Lie
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Øystein Ariansen Haaland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Erik Berg
- Department of Plastic and Reconstructive Surgery, Southern Norway Hospital, Arendal, Norway
| | | | - Åse Sivertsen
- Department of Plastic Surgery and Norwegian Quality Registry of Cleft Lip and Palate, Haukeland University Hospital, Bergen, Norway
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Kjoelaas S, Tillerås KH, Feragen KB. The Ripple Effect: A Qualitative Overview of Challenges When Growing Up in Families Affected by Huntington's Disease. J Huntingtons Dis 2021; 9:129-141. [PMID: 32065801 PMCID: PMC7369039 DOI: 10.3233/jhd-190377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The average age for the onset of Huntington's disease (HD) is an age when many people have children and caretaking responsibilities; HD is therefore likely to impact the whole family, including children and adolescents. Despite an increased understanding of the challenges for young people of growing up in a family affected by HD, a continuing lack of available knowledge has led to inadequate youth-focused support in many countries. OBJECTIVE This study explored the risks of growing up in a family affected by HD, and provided a participant-generated overview of the main challenges the participants experienced, in order to enhance awareness and promote more youth-focused support. METHODS As part of a larger national study, this qualitative paper included 36 semi-structured interviews with young people and adults who had previous or current experiences of growing up in families affected by HD. The interviews were analysed using thematic analysis. RESULTS The participants described challenges relating to four main domains of everyday life: family functioning, emotions and reactions, social functioning, and public and care services. CONCLUSION This study contributes to an increased understanding of risk factors posed on young people by growing up with a parent with HD. The study highlighted challenges in several areas of life presenting a risk to the overall health and functioning of young people. We propose that this knowledge should be applied within a bioecological framework, to increase understanding and promote awareness of the possible risks posed, for young people, by HD.
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Affiliation(s)
- Siri Kjoelaas
- Centre for Rare Disorders, Oslo University Hospital HF, Rikshospitalet, Nydalen, Oslo, Norway
| | | | - Kristin Billaud Feragen
- Centre for Rare Disorders, Oslo University Hospital HF, Rikshospitalet, Nydalen, Oslo, Norway
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Sønsterud H, Halvorsen MS, Feragen KB, Kirmess M, Ward D. What works for whom? Multidimensional individualized stuttering therapy (MIST). J Commun Disord 2020; 88:106052. [PMID: 33080388 DOI: 10.1016/j.jcomdis.2020.106052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/17/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE This study reports outcomes from a stuttering therapy approach that combines value and awareness-based elements from Acceptance and Commitment Therapy (ACT) with those of stuttering and speech modification interventions. The approach, entitled Multidimensional Individualized Stuttering Therapy (MIST), includes a combined clinician and client selection of factors across five areas: 1) general breathing patterns and body tension, 2) breathing patterns during speech production, 3) vocal features in speech production, 4) value and mindfulness-based strategies, and 5) general communication and/or presentation skills. The aims of this study were to evaluate whether the MIST a) reduces the impact of stuttering and stuttering severity, and b) has a positive impact on speaking ability, confidence in communication, avoidance-behavior, and quality of life. METHOD Eighteen adults, age 21-61 years took part in an A-B-A multiple case study design. Participants underwent a pre-clinic assessment phase, followed by 10 h of therapy over four sessions administered by an experienced speech-language therapist. Outcome measures examined both psychosocial and behavioral aspects of therapy three-, six- and twelve-months post-therapy. RESULTS Most participants chose elements from at least four of the five areas of focus. There was a significant reduction in the impact of stuttering at both 6- and 12-months post-therapy, with moderate (d = .71) to very large (d = 1.06) effect sizes. A strong association was found between overall satisfaction with MIST and improved speaking abilities. Moderate to strong associations were also found between experienced speaking abilities, confidence in communication, reduction in avoidance behaviors and improved quality of life. DISCUSSION Findings indicate that MIST can be effective in managing adult stuttering. The findings highlight the importance of shared decision making and personal considerations using flexible therapy approaches that integrate stuttering and speech modification interventions with value and awareness-based skills. The nature of a multidimensional individualized approach, as shown in this study, highlights the importance of adjusting the relative weighting of different subcomponents according to each individual's needs and goals. CONCLUSION MIST was shown to be efficacious in clinical settings and effective in real life settings. Findings were promising, despite a relatively small sample, and replication by other SLPs and with larger samples is warranted.
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Affiliation(s)
- Hilda Sønsterud
- Department of Psychology, University of Oslo, Norway; Department of Speech and Language Disorders, Statped, Oslo, Norway.
| | | | | | - Melanie Kirmess
- Department of Special Needs Education, University of Oslo, Norway
| | - David Ward
- University of Reading, Department of Speech Research Laboratory, United Kingdom
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Sønsterud H, Feragen KB, Kirmess M, Halvorsen MS, Ward D. What do people search for in stuttering therapy: Personal goal-setting as a gold standard? J Commun Disord 2020; 85:105944. [PMID: 31607438 DOI: 10.1016/j.jcomdis.2019.105944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 09/03/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Stuttering affects people in individual ways, and there are multiple factors which may influence a person's goals when seeking therapy. Even though there is a common consensus that speech-language pathologists should discuss the individual's goals and expectations for stuttering therapy and outcomes, few studies have systematically investigated this issue. The aims of the present study were to investigate individual motivations and goal-setting related factors in stuttering therapy. The associations between self-reported impact of stuttering and the participants' perceptions of stuttering interference in communication, speaking abilities, and relationships with other people were also investigated. METHOD This study is part of a wider-ranging treatment study of individualized stuttering management tailored to the participants' personal goals and preferences. A mixed method, multiple single-case design was used to address the research questions. Twenty-one adults, age 21-61 years, took part in a pretherapy interview, which also included two quantitative measures: the Client Preferences for Stuttering Therapy-Extended version (CPST-E) and the Overall Assessment of Speakers' Experience of Stuttering-Adult version (OASES-A). Findings from the study sample was compared with a Norwegian reference group, in order to check for the representativeness of the study sample. RESULTS Quantitative data showed that most participants wanted to focus on both physical and psychological aspects of therapy, and that 95% considered 'to gain a sense of control over the stuttering' as important. Participants' perspectives on their speaking ability and stuttering interference in communication were identified as central factors, particularly in social and professional settings. These outcomes aligned well with the finding of avoidance behaviors, such as avoiding words and speaking situations. Qualitative data identified four main areas that the participants wanted to improve: speech fluency, emotional functioning, activity and participation, and understanding of their stuttering. CONCLUSION The study confirms that multiple and individual factors may influence the person's goals for therapy. Goals were mainly anchored in participants' wish of better coping in real world settings. A high degree of avoidance behavior was reported, suggesting that anxiety, and in particular linguistic-related anxiety needs to be taken into account when addressing social anxiety in fluency disorders.
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Affiliation(s)
- Hilda Sønsterud
- Department of Psychology, University of Oslo, Norway; Statped, Department of Speech and Language Disorders, Norway.
| | | | - Melanie Kirmess
- Department of Special Needs Education, University of Oslo, Norway; Sunnaas Rehabilitation Hospital, Norway
| | | | - David Ward
- University of Reading, Speech Research Laboratory, England, United Kingdom
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Daae E, Feragen KB, Waehre A, Nermoen I, Falhammar H. Sexual Orientation in Individuals With Congenital Adrenal Hyperplasia: A Systematic Review. Front Behav Neurosci 2020; 14:38. [PMID: 32231525 PMCID: PMC7082355 DOI: 10.3389/fnbeh.2020.00038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/21/2020] [Indexed: 12/12/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) is a genetic condition of the steroidogenic enzymes in the adrenal cortex normally leading to variable degrees of cortisol and aldosterone deficiency as well as androgen excess. Exposure to androgens prenatally might lead to ambiguous genitalia. The fetal brain develops in traditional male direction through a direct action of androgens on the developing nerve cells, or in the traditional female direction in the absence of androgens. This may indicate that sexual development, including sexual orientation, are programmed into our brain structures prenatally. The objective of this study was to perform a systematic review of the literature, investigating sexual orientation in individuals with CAH. The study also aimed at identifying which measures are used to define sexual orientation across studies. The review is based on articles identified through a comprehensive search of the OVIDMedline, PsycINFO, CINAHL, and Web of Science databases published up to May 2019. All peer-reviewed articles investigating sexual orientation in people with CAH were included. Quantitative, qualitative, and mixed methods were considered, as well as self-, parent-, and third-party reports, and no age or language restrictions were enforced on publications. The present review included 30 studies investigating sexual orientation in patients with CAH assigned female at birth (46, XX) (n = 927) or assigned male at birth (46, XY and 46, XX) (n = 274). Results indicate that assigned females at birth (46, XX) with CAH had a greater likelihood to not have an exclusively heterosexual orientation than females from the general population, whereas no assigned males at birth (46, XY or 46, XX) with CAH identified themselves as non-heterosexual. There was a wide diversity in measures used and a preference for unvalidated and self-constructed interviews. Hence, the results need to be interpreted with caution. Methodological weaknesses might have led to non-heterosexual orientation being overestimated or underestimated. The methodological challenges identified by this review should be further investigated in future studies.
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Affiliation(s)
| | | | | | - Ingrid Nermoen
- Oslo University, Oslo, Norway
- Akershus University Hospital, Lillestrøm, Norway
| | - Henrik Falhammar
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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15
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Feragen KB, Stock NM, Myhre A, Due-Tønnessen BJ. Medical Stress Reactions and Personal Growth in Parents of Children With a Rare Craniofacial Condition. Cleft Palate Craniofac J 2019; 57:228-237. [PMID: 31426676 DOI: 10.1177/1055665619869146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The birth of a child with a congenital craniofacial anomaly (CFA) can have a profound psychological impact on the family. Despite the complexity and variability in treatment for these rare conditions, few studies have been conducted into parents' emotional responses to health-care experiences. The aim of the present study was to investigate parents' subjective experiences of their child's condition and treatment using an in-depth qualitative approach. METHODS Individual semistructured interviews were conducted in person or over the telephone with 48 parents of children with a range of rare CFAs. Interviews were transcribed verbatim, translated into English, and analyzed using inductive thematic analysis. RESULTS Participants reported physical and psychological symptoms that could be indicative of medical traumatic stress in relation to their child's diagnosis and treatment. Participants described feelings of powerlessness and the weight of being responsible for their child's care. Yet, participants also reported that as a result of their experiences, their perspective on life had changed and they had grown in self-confidence. CONCLUSIONS The findings provide insight into the complex physical and psychological effects experienced by parents in response to their child's diagnosis and medical treatment, as well as an understanding of how these experiences may also result in personal growth over time. Implementation of trauma-informed evidence-based resources should be considered in craniofacial care and future research, particularly in regard to prevention and treatment of psychological distress.
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Affiliation(s)
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, England
| | - Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
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16
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Sønsterud H, Kirmess M, Howells K, Ward D, Feragen KB, Halvorsen MS. The working alliance in stuttering treatment: a neglected variable? Int J Lang Commun Disord 2019; 54:606-619. [PMID: 30866151 PMCID: PMC6617998 DOI: 10.1111/1460-6984.12465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/22/2018] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The 'working alliance' is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular. AIMS To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients' concept of motivation and treatment outcomes 6 months post-therapy. METHODS & PROCEDURES Eighteen adults (21-61 years) participated in this multiple single-case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory-Short Version Revised (WAI-SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST-E), the Overall Assessment of Speakers' Experience of Stuttering-Adult version (OASES-A), the Wright & Ayre Stuttering Self-Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS). OUTCOMES & RESULTS Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post-treatment. The association between client-led goals and therapy tasks appeared particularly important. CONCLUSIONS & IMPLICATIONS The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client-clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted.
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Affiliation(s)
- Hilda Sønsterud
- Department of PsychologyUniversity of OsloOsloNorway
- StatpedDepartment of Speech and Language DisordersOsloNorway
| | - Melanie Kirmess
- Department of Special Needs EducationUniversity of OsloOsloNorway
- Sunnaas Rehabilitation HospitalNorway
| | | | - David Ward
- University of ReadingSpeech Research LaboratoryReadingUK
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Billaud Feragen K, Myhre A, Stock NM. “Exposed and Vulnerable”: Parent Reports of Their Child’s Experience of Multidisciplinary Craniofacial Consultations. Cleft Palate Craniofac J 2019; 56:1230-1238. [PMID: 31142141 DOI: 10.1177/1055665619851650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Childhood is a period of extensive socioemotional development, which can be impacted by the presence of a congenital craniofacial anomaly (CFA). Complex multidisciplinary treatment and long-term follow-up are normally required, yet understanding of children’s treatment experiences is limited. The objective of this study was to investigate children’s experiences of multidisciplinary team (MDT) consultations from the perspective of their parents. Design: Thirty-eight parents of children with a rare CFA were interviewed in person or over the telephone. Interviews were transcribed verbatim, translated into English, and explored using thematic analysis. Results: Background factors influencing the child’s experience of the consultation included age, developmental stage, personality, and prior treatment experiences. Participants tried to prepare their child for meeting the MDT, but did not fully understand what to expect themselves. During consultations, participants were acutely focused on their child’s emotional state, making it difficult to balance their desire to protect the child from potentially negative experiences, and the need to engage in a constructive dialogue with health professionals. Participants believed that health professionals’ conduct could considerably influence the child’s well-being and subsequent treatment decisions. Finally, participants highlighted the need to debrief their child to help them adjust positively. Conclusions: The ultimate goal of craniofacial care is to help children develop into confident adults who are able to cope with the challenges associated with their condition. Multidisciplinary teams play a vital role in creating a safe and supportive environment in which children feel genuinely informed and involved in key aspects of their care.
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Affiliation(s)
| | - Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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18
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Myhre A, Agai M, Dundas I, Feragen KB. “All Eyes on Me”: A Qualitative Study of Parent and Patient Experiences of Multidisciplinary Care in Craniofacial Conditions. Cleft Palate Craniofac J 2019; 56:1187-1194. [DOI: 10.1177/1055665619842730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: The present study investigated how adults with congenital craniofacial anomalies (CFAs) and parents experience the long-term and complex treatment offered by a multidisciplinary team (MDT). Design: Exploratory-descriptive qualitative study based on individual semistructured interviews. Setting: Centralized national follow-up and treatment of CFAs by a multidisciplinary craniofacial team from which participants were systematically recruited. Participants: The sample included 48 parents of children with CFAs and 16 adults with CFAs (N = 64). Results: In general, participants reported to be satisfied with the follow-up and treatment they received from the MDT. Still, some aspects of treatment were experienced as demanding such as the large number of health professionals present during the consultation and being the object of their scrutinizing attention. Health professionals’ communication skills were described as central for participants’ involvement in, and satisfaction with, treatment. Participants also expressed a need for more treatment-related information regarding future treatment. Conclusions: Findings could have implications for the organization of care for parents and patients with rare CFAs. The many advantages of MDTs also create unique challenges for patients and parents that need to be addressed. Patients and families should be prepared for the first consultation with the MDT. Health professionals should be aware of their communication style when interacting with patients and be aware of individual differences and needs regarding treatment-related experiences and expectations.
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Affiliation(s)
- Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
| | - Mehri Agai
- The Educational and Psychological Counselling and Follow Up Service, Hordaland County Authority, OT/PPT, Hordaland fylkeskommune, Bergen, Norway
| | - Ingrid Dundas
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Særvold TK, Hide Ø, Feragen KB, Aukner R. Associations Between Hypernasality, Intelligibility, and Language and Reading Skills in 10-Year-Old Children With a Palatal Cleft. Cleft Palate Craniofac J 2019; 56:1044-1051. [DOI: 10.1177/1055665618824432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: This study investigated the associations between hypernasality and intelligibility, and language and reading skills in 10-year old children with a cleft palate ± lip. Design: Cross-sectional data collected during routine assessments of speech and language in a centralized treatment setting. Participants: Children aged 10, born with cleft palate ± lip from 4 birth cohorts (N = 123). Outcome Measures: Hypernasality and intelligibility: Swedish Articulation and Nasality Test-N; language: Language 6-16 (Sentence recall, Serial recall, Vocabulary); reading: word chain test and reading comprehension test. Results: A total of 71.3% of the children had no occurrence of hypernasality and 82.8% had intelligibility scores within the normal range. For all children with hypernasality and intelligibility within the normal range, reading and language scores were also within normal ranges. Children with presence of hypernasality had significantly lower language skills, with mean scores within the lower normal range. Children with reduced intelligibility had lower scores on reading comprehension. Conclusions: The findings highlight a possible association between hypernasality and language skills, and intelligibility and reading skills. Cleft teams should consider routine assessments of language and reading skills in children with speech impairment, in order to identify potential needs for intervention as early as possible.
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Affiliation(s)
- Tone Kristin Særvold
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
| | - Øydis Hide
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
| | | | - Ragnhild Aukner
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
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Daae E, Feragen KB, Nermoen I, Falhammar H. Psychological adjustment, quality of life, and self-perceptions of reproductive health in males with congenital adrenal hyperplasia: a systematic review. Endocrine 2018; 62:3-13. [PMID: 30128958 PMCID: PMC6153586 DOI: 10.1007/s12020-018-1723-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/12/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Congenital adrenal hyperplasia (CAH) has been shown to potentially affect psychological adjustment. However, most research has focused on females, and knowledge about psychological challenges in males remains sparse. The aim of this systematic review was therefore to assess these in males with CAH. METHODS We systematically searched the OVID Medline, PsycINFO, CINAHL, and Web of Science databases, for articles published up to April 20, 2018, investigating psychological adjustment in males with CAH. RESULTS Eleven studies were included in the review. Three main health domains were identified: psychological and psychiatric health, quality of life (QoL), and self-perceptions of reproductive health. Some studies covered more than one health domain. Seven studies explored psychological adjustment and/or the presence of psychiatric symptoms or disorders. Results indicated that males with CAH had more problems related to internalizing behaviors (negative behaviors directed toward the self) and more negative emotionality compared to reference groups. Six studies examined QoL, five of them reporting reduced QoL compared to reference groups. Three studies explored the impact of fertility and sexual health issues on psychological health with varying results from impaired to normal sexual well-being. CONCLUSIONS CAH seems to have an impact on males' psychological health. However, the number of identified studies was limited, included few participants, and revealed divergent findings, demonstrating the need for larger studies and highlighting a number of methodological challenges that should be addressed by future research.
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Affiliation(s)
- Elisabeth Daae
- Centre for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
| | | | - Ingrid Nermoen
- Department of Endocrinology, Akershus University Hospital HF, Lørenskog, Norway
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
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21
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Harcourt D, Hamlet C, Feragen KB, Garcia-Lopez LJ, Masnari O, Mendes J, Nobile F, Okkerse J, Pittermann A, Spillekom-van Koulil S, Stock NM, Williamson H. The provision of specialist psychosocial support for people with visible differences: A European survey. Body Image 2018; 25:35-39. [PMID: 29454284 DOI: 10.1016/j.bodyim.2018.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/05/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
A substantial body of research has demonstrated the challenges commonly facing people with visible differences (disfigurements) and explored the potential benefits offered by specialist psychosocial support and intervention for those who are negatively affected. However, little is known about the availability of such support in Europe for people whose appearance is in any way different to 'the norm'. This survey of 116 psychosocial specialists from 15 European countries, working with a range of patient groups, has shown a tendency for specialists to prioritise Cognitive-behavioural-based approaches, amongst a wide range of other approaches and interventional techniques. It indicates variations in the availability of support, and a perceived need for improved access to interventions, additional training, and greater awareness of the psychosocial issues associated with visible differences.
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Affiliation(s)
- Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK.
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
| | | | - Luis-Joaquin Garcia-Lopez
- Department of Psychology, Division of Clinical Psychology, University of Jaen, Building C5, 23071, Jaen, Spain
| | - Ornella Masnari
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jose Mendes
- INTELECTO - Psychology & Research, Rua do Monte, 52B, R/C Esquerdo Nascente, 9500-451, Ponta Delgada, Açores, Portugal
| | | | - Jolanda Okkerse
- Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Anna Pittermann
- General Hospital of Vienna, Medical University, Department of Plastic and Reconstructive Surgery, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK; Cleft Collective, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, UK
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Stock NM, Feragen KB. Assessing Psychological Adjustment to Congenital Craniofacial Anomalies: An Illustration of Methodological Challenges. Cleft Palate Craniofac J 2018; 56:64-73. [DOI: 10.1177/1055665618769661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Recognition of the challenges inherent in psychology research related to cleft lip and/or palate (CL/P) and other craniofacial anomalies (CFAs) is far from novel; yet these challenges continue to limit progress within the field. The aim of the present article was to illustrate these challenges by utilizing data extracted from 2 recent literature reviews pertaining to psychological adjustment within CL/P and CFA research. Design: Data relating to 148 CL/P and 41 CFA studies were extracted, summarized, and compared, using percentages, figures, and χ2 calculations. Results: Comparable patterns were observed in both populations in relation to small sample sizes, wide age ranges, a reliance on data collection from single sites, and limited global coverage. Similarly, only one-third of all studies had used a comparison group, 42% of studies did not include the patient perspective, and fewer than 10% of studies had collected data longitudinally. Qualitative research was lacking across both populations, but particularly in relation to CFA. A higher proportion of CFA studies utilized validated measures and were less likely to exclude patients with additional anomalies. CFA studies most frequently focused on behavior and overall quality of life, while CL/P studies tended to investigate emotional well-being and social experiences. Conclusions: Findings illustrate the variability in research approaches, sampling, measurement, and analysis across both populations. There is a pressing need to address key methodological issues within craniofacial research and to examine the possible similarities and condition-specific differences between CL/P and other congenital craniofacial anomalies.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
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Stock NM, Feragen KB. Comparing Psychological Adjustment Across Cleft and Other Craniofacial Conditions: Implications for Outcome Measurement and Intervention. Cleft Palate Craniofac J 2018; 56:766-772. [PMID: 29652532 DOI: 10.1177/1055665618770183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
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Feragen KB, Stock NM. Factors affecting subjective appearance evaluations among patients with congenital craniofacial conditions: An application of Cash's cognitive-behavioural model of body image development. Body Image 2018; 24:124-136. [PMID: 29414145 DOI: 10.1016/j.bodyim.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
Satisfaction with appearance is of central importance for psychological well-being and health. For individuals with an unusual appearance, such as congenital craniofacial anomalies (CFA), appearance evaluations could be especially important. However, few, if any papers have presented a comprehensive synthesis of the factors found to affect subjective satisfaction with appearance among children, adolescents, and adults born with a CFA. Further, only a handful of craniofacial studies have applied psychological theories or models to their findings, resulting in an overall lack of guidance for researchers in the field. This paper summarises the literature pertaining to satisfaction with appearance among those affected by CFAs, and examines the extent to which Cash's cognitive-behavioural model of body image development (2012) fits with this literature. Given the overlap between factors of interest in the field of CFAs, and in the area of body image more broadly, a closer collaboration between the two research fields is suggested.
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Affiliation(s)
| | - Nicola Marie Stock
- 'Scar Free Foundation Research Fellow' at the 'Centre for Appearance Research and The Cleft Collective', University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom.
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Stock NM, Feragen KB, Rumsey N. Adults’ Narratives of Growing up with a Cleft Lip and/or Palate: Factors Associated with Psychological Adjustment. Cleft Palate Craniofac J 2018; 53:222-39. [DOI: 10.1597/14-269] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Growing up with a cleft lip and/or palate presents a number of challenges for those affected and their families. Understanding why some individuals cope well while others struggle is key to psychological research in this field. A better appreciation of the factors and processes that contribute to psychological adjustment to cleft lip and/or palate (CL/P) from the patient perspective would be of value to both researchers and clinicians. Design Qualitative data elicited from individual interviews with 52 adults born with CL/P. Result Inductive thematic analysis identified three main themes: “background” factors (age, gender, sexual orientation, culture, additional conditions, socioeconomic status, and adoption), “external” factors (treatment autonomy, familial coping and support, salience, public understanding, psychological input, and peer support), and “internal” psychological factors (perceptions of difference, noticeability and teasing, social confidence, internalization of beauty ideals, valence, expectations of treatment, responding to challenges, social comparisons, acceptance, faith, dispositional style, and recognition of strengths and positive growth). Conclusions The number and breadth of factors identified in this study are testament to the importance of psychology in the field of CL/P and may offer guidance in relation to developing and assessing the value of psychological interventions. There is a clear role for psychologists in tackling appearance-related concerns, designing materials, supporting patient decision making, and improving social interaction, as well as providing specialist psychological support. The findings illustrate the potential degree of individual variation in perspectives and offer insight into the conflicting results found within current literature.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Stock NM. Risk and Protective Factors at Age 10: Psychological Adjustment in Children with a Cleft Lip and/or Palate. Cleft Palate Craniofac J 2018; 53:161-79. [DOI: 10.1597/14-062] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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. Result 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.
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Affiliation(s)
- Kristin Billaud Feragen
- Department of Speech and Language Disorders, Bredtvet Resource Centre, Statped sørøst, Oslo, Norway
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Filip C, Feragen KB, Lemvik JS, Lindberg N, Andersson EM, Rashidi M, Matzen M, Høgevold HE. Multidisciplinary Aspects of 104 Patients with Pierre Robin Sequence. Cleft Palate Craniofac J 2018; 52:732-42. [DOI: 10.1597/14-161] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe Pierre Robin sequence patients with a cleft palate from a multidisciplinary perspective. Patients A total of 104 individuals with Pierre Robin sequence and cleft palate, born between 1980 and 2010. Method Data were collected retrospectively and compared with large control groups. Results Of 104 patients, 19 (18.3%) were treated with a nasopharyngeal or oropharyngeal tube, continuous positive airway pressure, and/or a tracheotomy. The mean weight percentile for newborns with Pierre Robin sequence was 30.9. It decreased to 29.9 at the time of cleft palate repair (mean age, 13.7 months) ( P = .78). Of 87 patients, 30 (34.5%) developed normal speech after cleft palate repair. Of 93 nonsyndromic Pierre Robin sequence patients, 31 (33.3%) had or are having surgery for velopharyngeal insufficiency, a rate that is significantly higher when compared with a control group of cleft palate–only patients (19.4%; P = .004). Of 31 patients, 25 (80.6%) developed normal resonance after surgery for velopharyngeal insufficiency. There was no significant difference in the rate of syndromes between the Pierre Robin sequence patients and a control group of cleft palate patients without Pierre Robin sequence ( P = .25). Seven of 39 boys (17.9%) with Pierre Robin sequence had a diagnosis of autism spectrum disorder. Conclusion Even though the mean weight percentile for newborns with Pierre Robin sequence was low, the patients did not show a growth spurt during the first year of life. The high rate of velopharyngeal insufficiency after cleft palate repair in patients with Pierre Robin sequence needs further investigation. Also, the high rate of autism spectrum disorder among boys with Pierre Robin sequence prompts further investigation.
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Affiliation(s)
- Charles Filip
- Cleft Lip and Palate Unit, Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet
| | | | | | - Nina Lindberg
- Cleft Lip and Palate Unit, Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet
| | - Els-Marie Andersson
- Cleft Lip and Palate Unit, Department of Odontology, Oslo University Hospital, Rikshospitalet
| | - Mitra Rashidi
- Cleft Lip and Palate Unit, Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet
| | - Michael Matzen
- Cleft Lip and Palate Unit, Department of Odontology, Oslo University Hospital, Rikshospitalet
| | - Hans Erik Høgevold
- Cleft Lip and Palate Unit, Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Semb G, Enemark H, Friede H, Paulin G, Lilja J, Rautio J, Andersen M, Åbyholm F, Lohmander A, Shaw W, Mølsted K, Heliövaara A, Bolund S, Hukki J, Vindenes H, Davenport P, Arctander K, Larson O, Berggren A, Whitby D, Leonard A, Neovius E, Elander A, Willadsen E, Bannister RP, Bradbury E, Henningsson G, Persson C, Eyres P, Emborg B, Kisling-Møller M, Küseler A, Granhof Black B, Schöps A, Bau A, Boers M, Andersen HS, Jeppesen K, Marxen D, Paaso M, Hölttä E, Alaluusua S, Turunen L, Humerinta K, Elfving-Little U, Tørdal IB, Kjøll L, Aukner R, Hide Ø, Feragen KB, Rønning E, Skaare P, Brinck E, Semmingsen AM, Lindberg N, Bowden M, Davies J, Mooney J, Bellardie H, Schofield N, Nyberg J, Lundberg M, Karsten ALA, Larson M, Holmefjord A, Reisæter S, Pedersen NH, Rasmussen T, Tindlund R, Sæle P, Blomhoff R, Jacobsen G, Havstam C, Rizell S, Enocson L, Hagberg C, Najar Chalien M, Paganini A, Lundeborg I, Marcusson A, Mjönes AB, Gustavsson A, Hayden C, McAleer E, Slevan E, Gregg T, Worthington H. A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management. J Plast Surg Hand Surg 2017; 51:2-13. [PMID: 28218559 DOI: 10.1080/2000656x.2016.1263202] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. METHOD Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes. RESULTS Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years. CONCLUSION The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series. TRIAL REGISTRATION ISRCTN29932826.
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Affiliation(s)
- Gunvor Semb
- a Division of Dentistry, University of Manchester , Manchester , UK.,b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway.,c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | | | - Hans Friede
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Gunnar Paulin
- f Department of Dentofacial Orthopedics , University Hospital , Linköping , Sweden
| | - Jan Lilja
- g Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Jorma Rautio
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Mikael Andersen
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Frank Åbyholm
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Anette Lohmander
- j Division of Speech and Language Pathology , Karolinska Institute, and Karolinska University Hospital , Stockholm , Sweden
| | - William Shaw
- a Division of Dentistry, University of Manchester , Manchester , UK
| | - Kirsten Mølsted
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Arja Heliövaara
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Stig Bolund
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Jyri Hukki
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Hallvard Vindenes
- k Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway
| | - Peter Davenport
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Kjartan Arctander
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Ola Larson
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Anders Berggren
- n Department of Plastic Surgery , University Hospital , Linköping , Sweden
| | - David Whitby
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Alan Leonard
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
| | - Erik Neovius
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Anna Elander
- g Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Elisabeth Willadsen
- p Department of Nordic Studies and Linguistics , University of Copenhagen , Denmark
| | - R Patricia Bannister
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | | | - Gunilla Henningsson
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Christina Persson
- r Institute of Neuroscience and Physiology, Speech and Language Pathology Unit , Sahlgrenska Academy, University of Gothenburg , Sweden.,s Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Philip Eyres
- a Division of Dentistry, University of Manchester , Manchester , UK
| | | | | | - Annelise Küseler
- a Division of Dentistry, University of Manchester , Manchester , UK
| | | | - Antje Schöps
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Anja Bau
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Maria Boers
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | | | - Karin Jeppesen
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Dorte Marxen
- i Copenhagen Cleft Palate Center, University Hospital of Copenhagen , Denmark
| | - Marjukka Paaso
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Elina Hölttä
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Suvi Alaluusua
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Leena Turunen
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Kirsti Humerinta
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Ulla Elfving-Little
- h Cleft Palate and Craniofacial Center, Helsinki University Central Hospital , Helsinki , Finland
| | - Inger Beate Tørdal
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Lillian Kjøll
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Ragnhild Aukner
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | - Øydis Hide
- c Department of Speech and Language Disorders , Statped sørøst , Oslo , Norway
| | | | - Elisabeth Rønning
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Pål Skaare
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Eli Brinck
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Ann-Magritt Semmingsen
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Nina Lindberg
- b Department of Plastic and Reconstructive Surgery , Oslo University Hospital Rikshospitalet , Oslo , Norway
| | - Melanie Bowden
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Julie Davies
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Jeanette Mooney
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Haydn Bellardie
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Nina Schofield
- l Greater Manchester Cleft Lip and Palate Unit , Royal Manchester Childrens' Hospital , Manchester , UK
| | - Jill Nyberg
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | - Maria Lundberg
- m Stockholm Craniofacial Team , Karolinska University Hospital , Stockholm , Sweden
| | | | - Margareta Larson
- u Eastman Institute, Stockholms Läns Landsting , Stockholm , Sweden
| | | | | | | | | | - Rolf Tindlund
- w Dental School, University of Bergen , Bergen , Norway
| | - Paul Sæle
- x Oral Health Center of Expertise/Western Norway , Bergen , Norway
| | - Reidunn Blomhoff
- k Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway
| | - Gry Jacobsen
- k Centre for Cleft Lip and Palate, Bergen University Hospital Haukeland , Bergen , Norway
| | - Christina Havstam
- s Division for Speech and Language Pathology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Sara Rizell
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Lars Enocson
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Catharina Hagberg
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Midia Najar Chalien
- e Department of Orthodontics , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Anna Paganini
- g Department of Plastic Surgery , Sahlgrenska Academy, University of Gothenburg , Sweden
| | - Inger Lundeborg
- y Division of Speech and Language Pathology , Linköping University , Linköping , Sweden
| | - Agneta Marcusson
- f Department of Dentofacial Orthopedics , University Hospital , Linköping , Sweden
| | - Anna-Britta Mjönes
- n Department of Plastic Surgery , University Hospital , Linköping , Sweden
| | - Annica Gustavsson
- f Department of Dentofacial Orthopedics , University Hospital , Linköping , Sweden
| | | | - Eilish McAleer
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
| | - Emma Slevan
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
| | - Terry Gregg
- o The Royal Hospital for Sick Children , Belfast , N. Ireland
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Abstract
Objective: Informant discrepancies on psychological measures may affect the assessment, classification, and treatment of children’s mental health. Concordance between different informants has been shown to be low to moderately correlated. The present study examined the agreement between children with cleft lip and/or palate (CL/P) and their parents. Design: Cross-sectional data from 7 consecutive birth cohorts based on routine psychological assessments at age 10 with comparisons to national reference groups. Setting: Centralized and multidisciplinary treatment setting. Participants: 323 children age 10, born with CL/P and their parents (participation rate: 89%). Outcome measures: Strengths and Difficulties Questionnaire (SDQ). Results: Children born with CL/P and their parents tend to follow similar patterns of disagreement on the SDQ as reported in the general population, with children reporting more symptoms than their parents, and boys having more problems than girls on most subscales. Child and parent reports were low to moderately correlated, and not affected by the child’s gender or the presence of conditions additional to the cleft. Conclusions: Differences between informants on the SDQ reflect different perspectives of the child’s adjustment, and both informants are important in the assessment of mental health. Children with CL/P and their parents do not significantly differ from children and parents in the general population on their agreement of the child’s psychological adjustment. As with the general population, clinical assessments should be based on a mixture of both informants’ reports.
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Affiliation(s)
- Susanna Memmen Bjerke
- Department of Psychology, UiT—The Arctic University of Norway, Tromsø, Norway
- Department of Speech and Language Disorders, Statped Sørøst, Oslo, Norway
| | | | - Svein Bergvik
- Department of Psychology, UiT—The Arctic University of Norway, Tromsø, Norway
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Abstract
Objective: To date, research investigating the psychological impact of craniofacial conditions has produced variability across outcomes. The aims of this article were to summarize the challenges that may contribute to this variability, and to offer alternative perspectives and approaches to guide future research and practice. Design: A comprehensive evaluation of papers exploring adjustment to congenital craniofacial conditions was conducted. Methodological approaches and underlying conceptual issues were identified and summarized. Results: The conceptual limitations identified include inherent challenges pertaining to the multifactorial and fluctuating nature of adjustment, a lack of consensus regarding the primary constituents of a positive outcome, scant use of appropriate models and theories, and a predominant focus on “deficits” over “strengths.” The methodological shortcomings identified include a lack of representative samples, biomedical inclusion/exclusion criteria, inconsistency in measurement, a relative absence of the patient perspective, variability in approaches to data analysis and interpretation, and the failure to draw on knowledge from other disciplines and related fields of health research. Findings are believed to be relevant to all disciplines involved in craniofacial research and practice. Conclusions: Existing literature remains markedly affected by a range of conceptual and methodological challenges, despite these challenges being identified 25 years ago. The present article proposes that a shift in the way we conceptualize and study craniofacial conditions is needed, in order to construct a comprehensive understanding of adjustment to craniofacial conditions, and to address the key unanswered questions important to all stakeholders.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Tim P. Moss
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Særvold TK, Aukner R, Stock NM. Speech, Language, and Reading in 10-Year-Olds with Cleft: Associations with Teasing, Satisfaction with Speech, and Psychological Adjustment. Cleft Palate Craniofac J 2017; 54:153-165. [DOI: 10.1597/14-242] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Despite the use of multidisciplinary services, little research has addressed issues involved in the care of those with cleft lip and/or palate across disciplines. The aim was to investigate associations between speech, language, reading, and reports of teasing, subjective satisfaction with speech, and psychological adjustment. Design Cross-sectional data collected during routine, multidisciplinary assessments in a centralized treatment setting, including speech and language therapists and clinical psychologists. Participants Children with cleft with palatal involvement aged 10 years from three birth cohorts (N = 170) and their parents. Outcome Measures Speech: SVANTE-N. Language: Language 6-16 (sentence recall, serial recall, vocabulary, and phonological awareness). Reading: Word Chain Test and Reading Comprehension Test. Psychological measures: Strengths and Difficulties Questionnaire and extracts from the Satisfaction With Appearance Scale and Child Experience Questionnaire. Results Reading skills were associated with self- and parent-reported psychological adjustment in the child. Subjective satisfaction with speech was associated with psychological adjustment, while not being consistently associated with speech therapists’ assessments. Parent-reported teasing was found to be associated with lower levels of reading skills. Having a medical and/or psychological condition in addition to the cleft was found to affect speech, language, and reading significantly. Conclusions Cleft teams need to be aware of speech, language, and/or reading problems as potential indicators of psychological risk in children with cleft. This study highlights the importance of multiple reports (self, parent, and specialist) and a multidisciplinary approach to cleft care and research.
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Affiliation(s)
| | | | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Aukner R, Særvold TK, Hide Ø. Speech, language, and reading skills in 10-year-old children with palatal clefts: The impact of additional conditions. J Commun Disord 2017; 66:1-12. [PMID: 28292606 DOI: 10.1016/j.jcomdis.2017.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 01/19/2017] [Accepted: 03/06/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study examined speech (hypernasality and intelligibility), language, and reading skills in children with a cleft palate, specifically investigating additional conditions to the cleft, in order to differentiate challenges related to a cleft only, and challenges associated with an additional condition. DESIGN Cross-sectional data collected during routine assessments of speech and language in a centralised treatment setting. PARTICIPANTS Children born with cleft with palatal involvement from four birth cohorts (n=184), aged 10. OUTCOME MEASURES Speech: SVANTE-N; Language: Language 6-16; Reading: Word Chain Test and Reading Comprehension Test. RESULTS Descriptive analyses revealed that 123 of the children had a cleft only (66.8%), while 61 children (33.2%) had a cleft that was associated with an additional condition (syndrome, developmental difficulty, attentional difficulties). Due to close associations with the outcome variables, children with specific language impairments and dyslexia were excluded from the sample (n=14). In the total cleft sample, 33.1% had mild to severe hypernasality, and 27.9% had mild to severe intelligibility deviances. Most children with intelligibility and hypernasality scores within the normal range had a cleft without any other condition. A high number of children with developmental difficulties (63.2%) or AD/HD (45.5%) had problems with intelligibility. Hypernasality scores were also associated with developmental difficulties (58.8%), whereas most children with AD/HD had normal hypernasality scores (83.3%). As could be expected, results demonstrated that children with a cleft and an additional condition had language and reading scores below average. Children with a cleft only had language and reading scores within the normal range. Among the children with scores below average, 33.3-44.7% had no other conditions explaining difficulties with language and reading. CONCLUSIONS The findings highlight the need for routine assessments of language and reading skills, in addition to assessments of speech, in children with a cleft, in order to identify potential problems as early as possible. Study designs need to take additional difficulties into account, so that potential problems with language and reading are not ascribed the cleft diagnosis, and can be followed by appropriate treatment and interventions.
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Affiliation(s)
- Kristin Billaud Feragen
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway.
| | - Ragnhild Aukner
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway
| | - Tone K Særvold
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway
| | - Øydis Hide
- Statped sørøst, Department of Speech and Language Disorders, Bredtvetveien 4, 0950 Oslo, Norway
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Feragen KB, Semb G, Heliövaara A, Lohmander A, Johannessen EC, Boysen BM, Havstam C, Lundeborg I, Nyberg J, Pedersen NH, Bogh-Nielsen J, Eyres P, Bradbury E, Rumsey N. Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 10. Parental perceptions of appearance and treatment outcomes in their 5-year-old child. J Plast Surg Hand Surg 2017; 51:81-87. [DOI: 10.1080/2000656x.2016.1254642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristin Billaud Feragen
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
- Department of Speech and Language Disorders, Statped Sørøst, Oslo, Norway
| | - Gunvor Semb
- Dental School, University of Manchester, Manchester, UK
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Centre, Helsinki University Central Hospital, Helsinki, Finland
| | - Anette Lohmander
- Division of Speech and Language Pathology, Karolinska Institutet, Karolinska University Hospital, Sweden
| | | | - Betty Marie Boysen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Denmark
| | - Christina Havstam
- Division of Speech and Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Lundeborg
- Division of Speech and Language Pathology, Linköping University, Linköping, Sweden
| | - Jill Nyberg
- Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Philip Eyres
- Dental School, University of Manchester, Manchester, UK
| | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Feragen KB, Rumsey N, Heliövaara A, Boysen BM, Johannessen EC, Havstam C, Marcusson A, Nyberg J, Pedersen NH, Bogh-Nielsen J, Eyres P, Bradbury E, Semb G. Scandcleft randomised trials of primary surgery for unilateral cleft lip and Palate: 9. Parental report of social and emotional experiences related to their 5-year-old child's cleft diagnosis. J Plast Surg Hand Surg 2017; 51:73-80. [DOI: 10.1080/2000656x.2016.1254643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Arja Heliövaara
- Department of Plastic Surgery, Cleft Palate and Craniofacial Centre, Helsinki University Central Hospital, Helsinki, Finland
| | - Betty Marie Boysen
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Denmark
| | | | - Christina Havstam
- Division of Speech and Language Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agneta Marcusson
- Department of Dentofacial Orthopedics, Maxillofacial Unit, University Hospital Linköping, Linkjöping, Sweden
| | - Jill Nyberg
- Division of Speech and Language Pathology, Stockholm Craniofacial Team, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Philip Eyres
- Dental School, University of Manchester, Manchester, UK
| | | | - Gunvor Semb
- Dental School, University of Manchester, Manchester, UK
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Abstract
OBJECTIVE A congenital craniofacial anomaly (CFA) is expected to impact upon several domains of psychological, emotional and social functioning, yet no recent reviews have comprehensively summarised the available literature. Further, existing reviews tend to draw upon literature in the field of cleft lip and palate, and do not give substantive attention to other types of CFAs. DESIGN A review of 41 papers published between January 2000 and March 2016 pertaining to psychological adjustment to CFAs. MAIN OUTCOME MEASURES Findings are presented according to key psychological domains: General Psychological Well-being, Quality of Life, Behaviour, Emotional Well-being, Social Experiences, Appearance, and Treatment-Related Experiences. RESULTS Current literature offers a contradictory picture of adjustment to CFAs. Psychological adjustment appeared to be comparable to norms and reference groups in approximately half of the papers related to non-syndromic CFAs, while more variation was found across domains among samples with syndromic CFAs. Associations were found between adjustment, physical health and cognitive function in several papers. The review identified a number of gaps in the literature, such as the inclusion of a wide range of diagnoses within research samples. CONCLUSIONS This review demonstrates the complexity of findings, both within and across domains, and highlights a number of methodological challenges.
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Affiliation(s)
| | - Nicola Marie Stock
- b Centre for Appearance Research , University of the West of England , Bristol , UK
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Solberg O, Feragen KB. I13 Can I be old with huntington’s disease (HD)? J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-314597.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Feragen KB, Stock NM, Sharratt ND, Kvalem IL. Self-perceptions of romantic appeal in adolescents with a cleft lip and/or palate. Body Image 2016; 18:143-52. [PMID: 27459395 DOI: 10.1016/j.bodyim.2016.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
During adolescence, romantic relationships are a key developmental milestone. Coupled with the increasing salience of appearance and social acceptance, adolescents with an appearance-altering condition may feel particularly vulnerable when it comes to romantic relationships. This study aimed to explore the prevalence of romantic experiences among adolescents with a cleft lip and/or palate (CL/P), and to investigate how these experiences could be related to depressive symptoms and global self-worth. The study included 661 Norwegian adolescents with CL/P, who were compared to a large national sample. The prevalence of romantic relationships was lower among adolescents with CL/P compared to the reference group, although the overall impact on depressive symptoms and global self-worth appeared to be low. This study is one of few to explore the impact of a congenital visible condition on experiences of romantic relationships and provides preliminary insight into a significant, yet complex topic.
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Affiliation(s)
- Kristin Billaud Feragen
- Statped sørøst, Oslo, Norway; Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway.
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK.
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Abstract
There is a need for a better understanding of psychological processes when appearance is changed dramatically through surgery. The aim of this article is to shed light on how complex the process of changing appearance can be, and highlight the importance of including a psychological perspective to the treatment offered to children and adolescents with a visible condition affecting appearance. In order to illustrate some psychological aspects involved in a change of appearance, the case study of a young woman born with a cleft palate is presented. Through orthognathic surgery, an operation that changes the relationship and position of the upper and lower jaw, this young woman experienced a dramatic change in appearance. As a result of a new attractive appearance, she experienced new and different social interactions, which challenged her in surprising ways. Unexpectedly, an unknown past of childhood sexual abuse was triggered by romantic experiences due to her new appearance, and she developed signs of post-traumatic stress disorder (PTSD) and depression. This article presents central themes from the therapy and clinical interventions, which were mainly based on a solution-oriented and cognitive framework, and considers how the change of appearance affected the way this young woman behaved, felt and thought about herself after the surgery. Clinical implications of the case are discussed and their relevance to another research field - dramatic weight loss among those suffering from obesity - is suggested.
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Feragen KB, Stock NM, Kvalem IL. Risk and Protective Factors at Age 16: Psychological Adjustment in Children with a Cleft Lip and/or Palate. Cleft Palate Craniofac J 2015; 52:555-73. [DOI: 10.1597/14-063] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Explore psychological functioning in adolescents with a cleft at age 16 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and psychosocial adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable adolescents were found across domains or whether risk was limited to specific areas of adjustment. Methods Cross-sectional data based on psychological assessments at age 16 (N = 857). The effect of gender, cleft visibility, and the presence of an additional condition were investigated on all outcome variables. Results were compared with large national samples. Measures Hopkins Symptom Checklist, Harter Self-Perception Scale for Adolescents, Child Experience Questionnaire, and Satisfaction With Appearance scale. Results The main factor influencing psychological adjustment across domains was gender, with girls in general reporting more psychological problems, as seen in reference groups. The presence of an additional condition also negatively affected some of the measures. No support was found for cleft visibility as a risk factor except for dissatisfaction with appearance. Correlation analyses of risk groups seem to point to an association between social and emotional risk and between social risk and dissatisfaction with appearance. Associations between other domains were found to be weak. Conclusions The results point to areas of both risk and strength in adolescents born with a cleft lip and/or palate. Future research should investigate how protective factors could counteract potential risk in adolescents with a cleft.
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Affiliation(s)
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Stock NM, Feragen KB, Rumsey N. “It Doesn't All Just Stop at 18”: Psychological Adjustment and Support Needs of Adults Born with Cleft Lip and/or Palate. Cleft Palate Craniofac J 2015; 52:543-54. [DOI: 10.1597/14-178] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Cleft in the lip and/or the palate (CL/P) is considered to be a lifelong condition, yet relatively little is known about the long-term outcomes for patients. Existing literature is largely outdated and conflicted, with an almost exclusive focus on medical aspects and deficits. Objective To explore the psychological adjustment and possible support needs of a large number of adults born with CL/P from their own perspective. Design Fifty-two individual telephone interviews eliciting qualitative data. Results Qualitative analysis identified five themes. Participants reported a range of challenges in relation to discharge from the service, additional surgery as an adult, social and romantic relationships, higher education, vocational achievement, and access to psychological support. The findings imply that most adults with a cleft adjust well to these challenges and report many positive outcomes. For a minority of patients, issues attributed to the cleft may continue to cause distress in adulthood. Conclusions Adults with CL/P may require psychological support, information about the heritability of cleft, signposting and referrals from nonspecialists, support regarding further treatment, and opportunities to take part in research and activities. New issues arising in adulthood, such as entering the workplace, forming long-term relationships, and starting a family, may warrant both further investigation and additional support. Further work is needed to identify the factors that contribute to psychological distress and resilience, as well as the timing of particular points of risk and opportunity for personal growth.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Andersson EM, Feragen KB, Mikalsen D, Kaul J, Holla TM, Filip C. Bilateral Hypodontia in Adolescents with Pierre Robin Sequence. Cleft Palate Craniofac J 2015; 52:452-7. [DOI: 10.1597/aaid-joi-d-11-00190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe the frequency of hypodontia and left-right symmetry of hypodontia in the permanent dentition of children with Pierre Robin sequence (PRS). Patients and Method The sample consisted of 78 children born with PRS between 1980 and 2006 and referred to the Oslo Cleft Lip and Palate Team (OCLPT). Data were collected retrospectively from the archives of the OCLPT. Panoramic radiographs were evaluated to document hypodontia; third molars were excluded. Results Of the 78 children with PRS, hypodontia was found in 33 (42%). Of the 33 children with hypodontia, 27 (82%) showed hypodontia in the micrognathic lower arch, 24 (73%) were missing two or more permanent teeth, and 2 (6%) had oligodontia. The teeth most often missing were the mandibular second premolar (72%), followed by the maxillar second premolar (29%). Most cases of hypodontia 21 (64%) occurred bilaterally. Bilateral hypodontia of the mandibular second premolar occurred in 27 (73%) of the patients. Conclusion Hypodontia was found in 33 (42%) of the children with PRS, which is seven times higher than the prevalence among children without PRS (6%). Unlike in the general population, bilateral hypodontia was more common than unilateral hypodontia in the micrognathic mandible of children with PRS.
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Affiliation(s)
- Els-Marie Andersson
- Department of Orthodontics, Dental Faculty, and Orthodontist, Cleft Lip and Palate Team, University of Oslo, Oslo, Norway
| | | | | | | | | | - Charles Filip
- Department of Plastic Surgery, Oslo University Hospital, HF Rikshospitalet, Oslo, Norway
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Feragen KB, Stock NM, Rumsey N. Toward a Reconsideration of Inclusion and Exclusion Criteria in Cleft Lip and Palate: Implications for Psychological Research. Cleft Palate Craniofac J 2014; 51:569-78. [DOI: 10.1597/12-326] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background This article investigates the prevalence of conditions that affect cognitive and/or psychosocial functioning in 10-year-old children born with a cleft lip and/or palate (CL/P) and explores how the presence of such additional difficulties may affect the reporting of outcomes in psychological research. Design Cross-sectional data derived from routine psychological assessments. Setting Centralized treatment, Norway. Participants Data on cleft type and additional conditions were collected for 754 children with CL/P from 11 consecutive birth cohorts. Data on psychological adjustment were collected for three consecutive birth cohorts (n = 169). Main Outcome Measures The Strengths and Difficulties Questionnaire (SDQ), completed by children and parents. Results A total of 240 children (32%) in the sample had an additional condition, such as developmental delay, attention deficit/hyperactivity disorder, or a specific language impairment or dyslexia. Analysis of SDQ scores using conventional exclusion criteria (approach 1) was compared with a second method (approach 2), which included all children and categorized them according to the presence or absence of additional conditions. Significant variation in profiles of psychosocial adjustment was found depending on the approach to exclusion. Conclusions The presence of additional conditions in a sample may affect results and subsequently the conclusions drawn in relation to the psychosocial adjustment of children born with CL/P. The present study emphasizes the importance of careful assessments and reporting of all associated conditions, in order to improve the understanding of the impact of a cleft and the consequences of associated conditions in this population.
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Affiliation(s)
| | - Nicola Marie Stock
- Centre for Appearance Research, Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Feragen KB, Stock NM. When there is more than a cleft: psychological adjustment when a cleft is associated with an additional condition. Cleft Palate Craniofac J 2013; 51:5-14. [PMID: 23621662 DOI: 10.1597/12-328] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In spite of studies reporting a relatively high frequency of additional conditions in children with a cleft lip and/or cleft palate (CL/P), almost no research has focused on this clinically important subgroup. The objective of this study was to compare psychosocial adjustment in children with CL/P with and without an additional condition. DESIGN Cross-sectional data based on routine psychological assessments at age 10 years, with comparisons to national reference groups. SETTING Centralized treatment, Norway. PARTICIPANTS Two hundred five children with CL/P (participation rate: 80.1%) from three consecutive birth cohorts. OUTCOME MEASURES The Strengths and Difficulties Questionnaire (self-report and parent report) and the Child Experience Questionnaire (self-report). RESULTS Eighty-one children (39.5%) were identified as having at least one condition in addition to the cleft. These children reported significantly more psychosocial difficulties than children with a cleft alone. Differences between specific conditions were minor. Children with a cleft alone (n = 124) reported mean scores that were comparable to those reported by the reference group. There were no differences in adjustment between children with a visible versus a non-visible cleft. CONCLUSIONS The present study highlights the need for research to be conducted in children with CL/P who have additional conditions to provide better knowledge and clinical care for a potentially vulnerable subgroup of children and their parents.
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Feragen KB, Kvalem IL, Rumsey N, Borge AIH. Adolescents with and without a facial difference: The role of friendships and social acceptance in perceptions of appearance and emotional resilience. Body Image 2010; 7:271-9. [PMID: 20541483 DOI: 10.1016/j.bodyim.2010.05.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 05/06/2010] [Accepted: 05/13/2010] [Indexed: 11/28/2022]
Abstract
This study investigated the role of friendships and social acceptance in self-perceptions of appearance and depressive symptoms, comparing adolescents with and without a facial difference. Adolescents with a visible cleft (n=196) were compared with adolescents with a non-visible cleft (n=93), and with a comparison group (n=1832). Boys with a visible difference reported significantly more positive perceptions of friendships and less depressive symptoms than the comparison group. These results were interpreted in the context of indicators of emotional resilience. The objective measure of facial difference did not explain levels of depressive symptoms, while subjective measures did. Subjective ratings of appearance mediated the association between social acceptance and depressive symptoms in all samples. Gender did not contribute in explaining the paths between friendships, appearance, and depressive symptoms. The associations between perceptions of social acceptance, appearance, and emotional distress, support the possible utility of strengthening social experiences in preventing and treating appearance-concerns.
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Feragen KB, Borge AIH. Peer harassment and satisfaction with appearance in children with and without a facial difference. Body Image 2010; 7:97-105. [PMID: 20089466 DOI: 10.1016/j.bodyim.2009.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 12/07/2009] [Accepted: 12/08/2009] [Indexed: 11/19/2022]
Abstract
This study investigated associations between perceived peer harassment and satisfaction with appearance in the presence or absence of a facial difference. A cross-sectional sample of 661 children aged 10 or 16, with a cleft lip and/or palate, completed measures of satisfaction with appearance and peer harassment. Results indicated that the presence of a visible versus a nonvisible cleft was not associated with appearance dissatisfaction or higher levels of peer harassment for children aged 10 or for adolescent boys. Peer harassment was related to dissatisfaction with appearance in both age groups. In the adolescent group, there was an interaction between cleft visibility and gender, girls with a visible cleft being least satisfied with appearance. However, the association between cleft visibility and satisfaction with appearance was fully mediated by experiences of peer harassment. The results highlight the need to further explore the role of social interactions for subjective perceptions of appearance.
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Feragen KB, Borge AIH, Rumsey N. Social Experience in 10-Year-Old Children Born with a Cleft: Exploring Psychosocial Resilience. Cleft Palate Craniofac J 2009; 46:65-74. [DOI: 10.1597/07-124.1] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: The purposes of this study were to investigate self-reported social experience in 10-year-old children born with a cleft lip and/or palate and to gain a better understanding of variables implicated in psychosocial resilience. Design: Cross-sectional study of 10-year-old children from five consecutive birth cohorts, born from 1992 to 1997. Participants: A total of 268 children treated by the Oslo cleft team (Norway) participated in the study. The children's cleft conditions included cleft lip and palate, cleft lip alveolus, cleft palate, and submucous cleft palate. Outcome Measures: Psychosocial resilience was measured with the Child Experience Questionnaire (CEQ). Other variables were obtained during a clinical interview with the child. Cognitive, emotional, and psychosocial functioning was measured with the Personality Inventory for Children (PIC). Satisfaction with appearance was assessed through the use of the Satisfaction with Appearance Scales (SWA). Informants were both children and parents. Results: Cleft types differed significantly with respect to subtype and frequency of additional difficulties. Psychosocial resilience was associated with adequate emotional functioning, high satisfaction with appearance, and a lower frequency of reported teasing. Child characteristics such as visibility of cleft, gender, and additional diagnosis did not contribute to explain psychosocial resilience. Conclusions: Results reported here emphasise the importance of assessing the child's subjective report of satisfaction with appearance and psychosocial experience.
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Affiliation(s)
| | | | - Nichola Rumsey
- Centre of Appearance Research (CAR) at the University of West of England, Bristol, United Kingdom
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