Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts

Abstract

Objective: Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type. Method: A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n ¼ 7,842) was compared to a matched cohort (n ¼ 78,409) as well as to their unaffected siblings (n ¼ 9,637). The risk of psychiatric diagnoses, suicide attempts, and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models. Results: Children with cleft lip (CL) had a significantly higher risk of any psychiatric disorder, intellectual disability, and language disorders; children with cleft lip and palate (CLP) had, in addition, an increased risk of autism spectrum disorder (ASD). Children with cleft palate only (CPO) had risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and also for psychotic disorders, attention-deficit/ hyperactivity disorder (ADHD), and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD, or ADHD compared to their siblings with OFC. Conclusion: Children with nonsyndromic clefts had a significantly higher risk of neurodevelopmental disorders. This risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.

Parental and health care professional views on psychosocial and educational outcomes in patients with cleft lip and/or cleft palate

“…Statistically significant impairments in other domains of cognition were also found, but the data did not meet the criteria for study homogeneity and publication bias [15]. Two large Scandinavian population-based studies found that there was a higher risk of being diagnosed with a psychiatric disorder in nonsyndromic patients with clefts compared with individuals without clefts [30,31] and compared with the patients' siblings [31].…”

Assessing speech at three years of age in the cleft palate population: a scoping review of assessment practices

“…) and an increased risk of neurodevelopmental disorders (Tillman et al . ). This variability presents a challenge when designing assessment protocols, in particular the selection of speech samples and the parameters of speech which can be assessed reliably.…”

“…As such, 3-year-old children can be highly variable in how they present in these areas despite being within normal developmental limits. Furthermore, variability in presentation can also result from the known delay in expressive language and speech (Cavalheiro et al 2019) and an increased risk of neurodevelopmental disorders (Tillman et al 2018). This variability presents a challenge when designing assessment protocols, in particular the selection of speech samples and the parameters of speech which can be assessed reliably.…”

Efficacy and Safety in Combining Primary Palatoplasty and Myringotomy in Patients with Cleft Palate

“… 1 Patients with CLP have higher rates of health complications such as speech delays, behavioral disorders, failure to thrive, otitis, hearing loss, and dental anomalies, for which they undergo numerous surgical procedures. 2 – 4 Although operative treatment has been proven to be beneficial for these patients, there are increasing concerns about higher exposure to general anesthesia and its association with abnormal neurocognitive development. 5 …”