Objective: Adjustment to cleft lip and/or palate (CL/P) is multifaceted, involving several domains of psychological and social functioning. A substantial increase in research in this area has been evident in recent years, along with a preliminary shift in how adjustment to CL/P is conceptualised and measured. An updated and comprehensive review of the literature is needed in light of the rapidly expanding and changing field.
Design: A narrative review of 148 quantitative and qualitative studies published between January 2004 and July 2015.
Main outcome measures: Findings are presented according to five key domains of adjustment: Developmental Trajectory, Behaviour, Emotional Well-being, Social Experiences and Satisfaction with Appearance and Treatment. Data pertaining to General Psychological Well-being were also examined.
Results: The overall impact of CL/P on psychological adjustment appears to be low. Nonetheless, the review demonstrates the complexity of findings both within and across domains, and highlights recurring methodological challenges.
Conclusions: Research findings from the last decade are considered to be largely inconclusive, although some areas of emerging consensus and improvements in the approaches used were identified. Efforts to collect data from large, representative and longitudinal samples, which are comparable across studies and encompassing of the patient perspective, should be doubled. 相似文献
The present study examined qualitative and quantitative differences in maternal interactive behaviour towards infants with and without cleft lip and palate (CLP). Thirty-three mother-child pairs with CLP and 34 pairs without CLP were videotaped at 3, 6, 9, and 12 months of age in two sorts of play situations at home. In addition, the mothers were questioned by letter about their ability to recognize and interpret the child's signals; their willingness to respond to such signals; and the duration of shared daily activities in the context of feeding and play. The results showed that mothers of CLP children are somewhat less sensitive than other mothers. In addition, it appeared that CLP children play less with other people. Longer feeding times for CLP children appeared to be restricted to the age of 3 months. It is suggested that mothers of CLP children may be comparatively directive and stimulating because of uncertainty about additional deficiencies. Furthermore, they may be inclined to keep their children away from the outside world. 相似文献
Having a facial anomaly is more than likely to cause some degree of psychological discomfort. Prior to establishing the most appropriate psychological intervention, there is a need to determine how having an atypical appearance manifests in day-to-day life. Counselling/psychotherapy provides people with the opportunity to talk about their experience - to tell their story. the aim of this heuristic investigation is to determine the lived experience of having a cleft lip and the potential need for counselling/psychotherapy. A heuristic approach was selected as the most appropriate method and one which would enable participants to talk about their experience. It also requires the researcher to have personal experience of the phenomenon. This study highlights the lack of opportunity to talk about how the presence of a facial disfigurement impacts upon life. Even within the family, it seems, the norm was that ‘it' was there, yet not spoken about. Counselling/psychotherapy could therefore provide a form of education. Provision of such a service would give people a choice. A discussion on the limitations of heuristics indicates the importance of the researchers' awareness, of their own experience, in relation to the phenomena being investigated. In conclusion, a counsellor/ therapist is considered to be an essential member of the multi-disciplinary cleft team, caring for persons with clefts from birth to maturity. 相似文献
Do the many feeding problems associated with isolated cleft palate (CP) and cleft lip and palate (CLP) adversely affect the emotional bond between mother and infant? This question was addressed by observing the feeding interactions of 126 mother-infant pairs (57 infants with CLP or CP) at 3 and 12 months of age. Infants with CLP were found to be less communicative during feeding at 3 month than comparison group infants. However, by 12 months, the CLP group had improved to a level indistinguishable from the CP and comparison groups. This change was unrelated to the timing of cleft palate surgery. Although maternal sensitivity during feeding at 3 months did not predict the attachment quality of infants with clefts, maternal sensitivity at 12 months was concurrently related to attachment. Change in maternal sensitivity between 3 and 12 months was also predictive of attachment in the cleft groups, with mothers of avoidant infants showing greater attenuation in maternal sensitivity than the mothers of secure infants. 相似文献
This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent–infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old—which can be considered marginally secure at that age—may reveal attachment vulnerabilities, which seem to be more apparent over the course of development. 相似文献
Objective: Many studies of individuals born with cleft lip and/or palate (CLP) address the psychological impact of CLP in terms of stigma and/or ‘resilience’. The present study challenges the usefulness of resilience in CLP research with the application of self-determination theory (SDT). It is proposed that SDT can serve to better understand how individuals born with CLP can achieve psychological growth and well-being.
Design: Interviews were conducted with 15 individuals born with CLP in the UK.
Results: A thematic analysis was conducted and four main themes emerged: (1) personal challenges, (2) support and strategies for social interaction, (3) experience of treatment and outcomes, and (4) personal development. The thematic analysis and the interpretation in the context of SDT leads to a greater understanding of the development of psychological growth and well-being in individuals born with CLP.
Conclusion: Interpreting the life experiences of individuals with CLP through the theoretical lens of SDT allows the conceptualisation of individuals with CLP as a positive psychological resource when faced with the exclusionary practice of stigma. This resourcefulness is primarily nurtured by a supportive family and social environment that leads to the development of positive psychological growth and well-being. A new direction in CLP research is proposed that seeks to inform and implement change in professional practice to support individuals with CLP and their families. 相似文献