Presurgical anxiety treated with cognitive behavioral therapy in a 13-year-old female with cleft lip and palate: a psychological case report.

This case report describes presurgical anxiety in a 13-year-old female with complete cleft lip and palate, treatment of the anxiety with cognitive-behavioral therapy and progressive relaxation with biofeedback prior to a septorhinoplasty, and the treatment outcome.

Facial Impairment Scales for Clefts.

The purpose of this paper is to present the Facial Impairment Scales for Clefts. The Facial Impairment Scales for Clefts consist of four, 24-photograph, empirically derived scales of severity of cleft impairment. They were developed (1) to serve as research tools in single and multicenter studies of the surgical, psychosocial, and integrated treatment outcomes of facial clefts and (2) to assist in clinical assessment staging of the aesthetic severity of cleft impairment. Study 1 was conducted to extend the generalizability of the Facial Impairment Scales for Clefts to other groups of raters, including plastic surgeons. Reliability of scale ratings between children (n = 54) and plastic surgeons (n = 23) was examined. Rank orders of photographic subjects by severity of cleft impairment by children were highly correlated with ranks given by plastic surgeons. Study 2 in this series was conducted to assess if new photographs could be reliably fitted to scales. One-hundred and thirty-four medical student raters were able to scale new photographs reliably to the standard measures. These findings suggest that the Facial Impairment Scales for Clefts have sufficient reliability and validity for use in studies of severity of facial impairment.

Clefting and psychosocial adjustment. Influence of facial aesthetics.

This article briefly reviewed the research literature on the psychosocial correlates of facial clefts and described a program of research to study the relationship between severity of cleft impairment and psychosocial adjustment. In the past 40 years, there has been increasing recognition and research literature on the psychologic implications of facial clefts to patients and their families. Advances in both the knowledge base and the science of the psychologic correlates of facial clefts have been made. Children with clefts are not at greater risk for psychopathology than are individuals without clefts; however, they are at significant risk for social competence problems relating to development of friendships, progress in school, and participation in organizations. Problems with social competence have a negative effect on development. The ability of all children to make friends and to be liked by others is considered by most parents, teachers, and child development specialists to be a major developmental milestone. Not having friends and social withdrawal can cause parents or teachers to refer noncleft children to mental health professionals and is a predictor of impaired adult social competence and mental health. Studies of adults with clefts are consistent with studies of adults without clefts. Adults with repaired clefts are less likely to marry than are their noncleft siblings, and they have more problems with social withdrawal. Because facial attractiveness is well-known to affect peer acceptance, we hypothesized that the severity of the cleft deformity may have a significant impact on social competence. Consequently, we undertook a program of research to examine this question.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined effects of severity of cleft impairment and facial attractiveness on social perception: an experimental study.

Children and adolescents provided their impressions of stimulus faces that systematically varied in attractiveness and severity of cleft impairment. The results indicated that facial attractiveness is a consistent characteristic of cleft-impaired faces. However, facial attractiveness did not moderate the negative impact of cleft impairment on social perception. Reduced severity of impairment did moderate the negativity of social perception. The implications of these findings for our understanding of the effects of cleft impairment on social perceptions are discussed.

Development of scales of severity of facial cleft impairment.

The reliability and validity of human judgments in rating the severity of cleft-related facial impairment were examined in this series of studies. The goal of the research was to develop scales for rating the severity of facial cleft impairment using psychophysical methods for measuring human judgment. The principle findings were: (1) Four photographic categorized scales with high inter-group reliability and satisfactory content and construct validity were developed; (2) Raters used objective stimulus characteristics of the face to scale impairment; (3) Ratings of facial attractiveness decreased as the severity of impairment increases; (4) Full face ratings of the severity of impairment correlated highly with ratings of the same photographs cropped below the eyes. The implications of these findings for clinical and research application are discussed.

Scaling facial impairment.

A major goal of the treatment of cleft lip and palate is to improve the esthetic acceptability of the face. It is assumed that an improved esthetic appearance is associated with significant psychosocial benefits, but there is almost no empiric support for this assumption. Researchers have been hindered in the study of this problem because scales to measure severity of facial impairment of clefts have not been available; however, standard scales of facial impairment have been developed for occlusal traits, orthognathic structure, and facial attractiveness. The purpose of this paper is to describe selected theoretic and methodologic approaches to scaling the esthetic acceptability of various facial characteristics and to discuss how these methods have been applied to the study of relationships between facial morphology and psychosocial variables. It is argued that these approaches may be useful, as models for the development of scales of severity of cleft impairment, to clinicians and researchers who are interested in the treatment of facial clefts.

Reliability of esthetic ratings of cleft impairment.

The decision to seek secondary treatment for facial clefts is often the result of concerns about the esthetic acceptability of appearance. There are no standard techniques to assess cleft impairment for esthetic acceptability. Therefore, it is not possible to evaluate objectively either the need for or the benefits of treatment. If it could be shown that people agree closely on how they rate the esthetic appearance of cleft impairments that vary in severity, then esthetic measures of cleft impairment could be developed with human judgment as the yardstick. The goals of this study were: (1) to examine the reliability with which children express their preferences for cleft impairments that vary in severity, (2) to determine if other facial characteristics influence the reliability of children's preferences for cleft impairments, and (3) to evaluate if age and gender of children influence preferences for cleft impairments. Based on preratings, eight types of photographic slides were created that varied in severity of cleft impairment and global facial attractiveness. A second sample of subjects then rated the slides on the esthetic acceptability of appearance. Children ranked the photographic types consistently. They least preferred the photographic types depicting severe impairment or low facial attractiveness, or both, and most preferred faces with no impairment or moderate attractiveness, or both. There were also developmental effects in that younger children tended to have less consensus in their ratings of appearance than older children. Finally, boys displayed greater consensus than girls.

Social judgments of facial deformity.

The purpose of this study was to examine age- and gender-related personality and ability judgments associated with facial deformity. Four age groups (range = 8 to 16 years) were shown either photographically corrected versions of children with congenital facial clefts or uncorrected versions. Subjects' ratings of photographs of children with facial deformity were consistently negative. Neither age nor gender of subject were significantly related to judgments of facial deformity. Pictures of girls with facial deformities were judged more negatively than pictures of boys. The implications of these findings for future research were discussed.

Type of facial cleft, associated congenital malformations, and parents' ratings of school and conduct problems.

Parents' ratings of conduct and school problems were evaluated in 79 subjects with palatal clefts. Subjects were divided into four groups consisting of: (1) unilateral complete clefts of the lip and palate (UC Group); (2) unilateral complete clefts of the lip and palate with associated congenital malformations (UC-C Group); (3) cleft palate only (CPO Group); and (4) cleft palate only with associated congenital malformations (CPO-C Group). Comparisons between groups suggested that subjects with associated congenital malformations, whether or not they had UC or CPO, tended to have more serious school and conduct problems when compared to children with clefts and no associated congenital malformations. The association of congenital malformations with a cleft lip and palate increased the risk of reported conduct problems at home and behavioral and learning problems at school.

Burns and adjustment to injury: do psychological coping strategies help?

The effects of teaching patients strategies for coping with the pain of an acute burn injury and its treatment were investigated. Twenty patients with comparable burn injuries and admitted to a Burn Center were randomly assigned to either a control or experimental group. Experimental patients received systematic instruction on how to cope with the pain and stress of burn injury; control patients received standard information and social support only. Results showed that experimental patients reported less pain and greater sense of psychological well-being and control over the outcome of their injuries than did control patients. Moreover, experimental patients went home, on the average, more than 1 week sooner than did control patients. The implications of these findings for the improved care of patients with burn injuries and the economics of burn care are discussed.

Psychosocial correlates of congenital facial clefts: a conceptualization and model.

In recent years, there have been an increasing number of empirical investigations of the psychosocial correlates of congenital facial clefts. The inconsistencies between these studies, and their lack of a theoretical focus has made interpretation of findings difficult. The present paper presents a social developmental conceptualization of facial deformity. This conceptualization is applied to an integrative analysis and reinterpretation of existing psychosocial findings related to cleft lip and cleft palate defects and to the development of a model for future research.

Parents' tolerance for the conduct problems of the child with cleft lip and palate.

A standardized questionnaire was used to record parents' ratings of the frequency of conduct problems and their tolerance of the problems. According to parent report, children without facial clefts and children with facial clefts displayed conduct problems with about the same frequency. However, parents of children with facial clefts were significantly more tolerant of problems in their offspring. These data suggest that the social learning environments in the homes may be different for the two groups of children.