Social-emotional development of infants and young children with orofacial clefts

Children with orofacial clefts are believed to have distinctly elevated risk for a variety of adverse social-emotional outcomes including behavior problems, poor self-concept, and parent-child relationship difficulties. This assumption has been based primarily on theories of facial appearance and social bias, a handful of empirical studies, and clinical impressions. Studies of these children have been limited by methodological problems such as diagnostic heterogeneity, ascertainment bias, and absent or poorly matched control groups. In an attempt to address at least some of these methodological problems, the longitudinal research described in this article examined the developmental course of infants with unilateral cleft lip & palate (CLP) and cleft palate only (CPO). We followed these infants to age 7, with ongoing comparisons to a demographically matched group of typical children. Outcome measures targeted child attachment, maternal/child interaction during feeding and teaching tasks, parent satisfaction with surgical outcomes, parent and teacher behavior rating scales, and child self-concept and behavioral adaptation. Although our findings have provided limited support for the hypothesis that infants and young children with CLP/CPO are at greater risk for social-emotional problems than their peers, we have found that among infants with clefts, early assessment can predict subsequent social-emotional outcomes. In this article, we review theory and data in this area of study; summarize our longitudinal findings, describe our success and failures with respect to methodological rigor, and discuss emerging research and areas for further inquiry.