Psychological and Peer Difficulties of Children with Cleft Lip and/or Palate: A Systematic Review and Meta-Analysis

Abstract

Objectives A systematic review and meta-analysis were conducted to determine if children born with cleft lip and/or palate are at increased risk of psychological and peer difficulties, and if so, which difficulties they develop. Methods EMBASE, MEDLINE, and PsycINFO were searched for English language studies published between January 2005 and January 2022 which investigated the psychological outcomes and peer function of children with nonsyndromic cleft lip and palate. Outcomes included internalizing problems, such as anxiety and depression, externalizing problems, such as hyperactivity, conduct disorders, self-concept including self-image and self-esteem, peer problems, resilience, coping, and overall psychological function. A risk of bias assessment was performed using the Newcastle-Ottawa Scale. Random effects models were used in the meta-analysis to compare the outcomes for children born with a cleft and those without. Results In total 41 studies met inclusion criteria, with 9 included in the meta-analysis. Children born with a cleft appear to have similar psychological outcomes compared to normative controls when using the strengths and difficulties questionnaire. There are some minor differences between self-report and parent report, with parents generally reporting that their child with a cleft has increased emotional, conduct, and hyperactivity problems. The small differences between the study cohort and control cohorts are unlikely to imply any differences on a clinical level. Conclusions Overall psychological outcomes appear to be similar between children born with a cleft and the nonaffected population, however, some symptoms such as anxiety and depression appear higher in children with cleft lip and/or palate.

The impact of COVID‐19 on the well‐being of Victorian children born with cleft lip and/or palate

“…Despite previous studies indicating minor differences in levels of well-being between groups based on age, gender and cleft visibility, 9,29,30 Mann-Whitney U tests did not reveal any within-group differences. This may be due to the small number of study participants.…”

“…A previous systematic review has indicated there is great variability in the incidence of psychological difficulties and well-being in children born with CL/P. 9 The current study suggests that children Institute and Victorian Infrastructure Operating Fund. We would also like to thank Ivy Hsieh for her assistance with data collection on this project.…”

“…9 This longitudinal study had a 6 months follow-up, with high retention rates between baseline and timepoint two, and utilized the SDQ, which has been used extensively in epidemiological studies investigating the impact being born with CL/P has on psychological functioning. 9 However, due to its inclusion in the wider COVID-Resilience project, and therefore the limitations regarding a short follow-up period, the generalizability of the results may be limited.…”

“…Due to an increased risk of bullying and social stigmatization as a result of their facial difference, challenges with communication and lower levels of self‐esteem and self‐acceptance, 7,8 it has been hypothesized that children with CL/P may present with lower levels of well‐being. Despite this, a recent systematic review and meta‐analysis indicated that overall children born with CL/P have similar levels of well‐being when compared with their typically developing peers; however, they may experience slightly increased levels of psychological symptoms, including depression and anxiety 9 …”

“…Despite this, a recent systematic review and metaanalysis indicated that overall children born with CL/P have similar levels of well-being when compared with their typically developing peers; however, they may experience slightly increased levels of psychological symptoms, including depression and anxiety. 9 On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic, recommending countries attempt to supress and control the spread of the virus. 10 As a result, policies were introduced worldwide to encourage a reduction in the spread of the disease, which included social distancing recommendations, such as stay-at-home orders or lockdowns.…”