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Stock NM, Blaso D, White P, Shepherd L, Costa B, Edme K, Aspland R, Hotton M. Longitudinal psychological well-being in caregivers of young children with cleft lip and/or palate. J Pediatr Psychol 2025:jsaf029. [PMID: 40332945 DOI: 10.1093/jpepsy/jsaf029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Revised: 03/27/2025] [Accepted: 03/31/2025] [Indexed: 05/08/2025] Open
Abstract
OBJECTIVE Caregivers of children with chronic conditions can experience psychological distress and an impact on quality of life (QoL). Cleft lip and/or palate (CL/P) is one of the most common congenital conditions worldwide. Utilizing data extracted from The Cleft Collective cohort studies in the United Kingdom, this study investigated longitudinal psychological well-being in caregivers of young children with CL/P, to inform screening practices and early intervention. METHODS Baseline (post-diagnosis) and 5-year questionnaire data were extracted for 525 caregivers (342 biological mothers, 183 fathers/partners). Outcome measures included the PedsQL-Family Impact Module, the Perceived Stress Scale, and the Hospital Anxiety and Depression Scale. RESULTS QoL significantly improved from T1 (post-birth) to T2 (5 years) as reported by mothers and fathers/partners. At T2, scores on all measures were aligned with, or more favorable than, norms. A minority continued to report clinically significant levels of distress at 5 years. Predictors of poorer outcomes on all measures included a less positive life orientation, more negative appraisals of CL/P, less favorable baseline scores, lower healthcare satisfaction, and prior mental health conditions. Outcomes were also less favorable for caregivers of children with combined cleft lip and palate compared to other cleft types. Reductions in negative appraisals of CL/P were significantly associated with improved QoL over time. CONCLUSIONS QoL and psychological well-being in caregivers is generally positive at 5 years. A minority experienced poorer outcomes and routine assessment by a multidisciplinary team is therefore recommended. Targeting early negative appraisals may help to facilitate long-term caregiver adjustment.
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Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Debora Blaso
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Paul White
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Laura Shepherd
- Trent Cleft Network, City Hospital Campus, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Karine Edme
- Cleft NET East, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Richa Aspland
- Cleft NET East, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Matthew Hotton
- Oxford Institute of Clinical Psychology Training and Research, Oxford, United Kingdom
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Crerand CE, Conrad AL, Bellucci CC, Albert M, Heppner CE, Sheikh F, Woodard S, Udaipuria S, Kapp-Simon KA. Psychosocial Outcomes in Children with Cleft Lip and/or Palate: Associations of Demographic, Cleft Morphologic, and Treatment-Related Variables. Cleft Palate Craniofac J 2024; 61:1784-1802. [PMID: 37350106 DOI: 10.1177/10556656231181581] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To determine associations of demographic, morphologic, and treatment protocol parameters with quality of life (QoL), appearance/speech satisfaction, and psychological adjustment. DESIGN Observational study utilizing retrospective report of protocol variables and current outcome variables. SETTING Six North American cleft treatment clinics. PARTICIPANTS Children, ages 8.0-10.99 years, with Cleft Lip ± Alveolus, Cleft Palate, Cleft Lip and Palate, and parents (N = 284). OUTCOME MEASURES Pediatric QoL Inventory (PedsQL): Parent, Child, Family Impact Module (FIM); Patient Reported Outcome Measurement Information System (PROMIS); Child Behavior Checklist (CBCL); CLEFT-Q. RESULTS Outcome scores were average with few differences by cleft type. Multiple regression analyses yielded significant associations (Ps < .05) between socioeconomic status, race, and age at assessment and parent- and self-reported measures. Females had higher PROMIS Depression (β=.20) but lower CBCL Affective (β = -.16) and PROMIS Stigma scores (β= -.24). Incomplete cleft lip was associated with lower PROMIS Depression, and more positive ratings of CLEFT-Q: Nose, Nostril, Lip Scar; CBCL Competence scores, (βs = -.17 to .17). Younger Age at Lip Closure was associated with higher CBCL School Competence (β= -.18). Younger Age at Palate Closure was associated with higher Child PedsQL Total, Physical, Psychosocial QoL, and better CLEFT-Q Speech Function (βs = -.18 to -.15). Furlow Palatoplasty was associated with more CBCL Externalizing Problems (β = .17) higher CBCL Activities (β = .16). For all diagnoses, fewer Total Cleft-Related Surgeries was associated with lower PROMIS Stigma and higher CBCL Total Competence and Activities (βs = -.16 to .15). CONCLUSIONS Demographic characteristics, lip morphology, and treatment variables are related to later psychological functioning.
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Affiliation(s)
- Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amy L Conrad
- The Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa College of Medicine, Iowa City, IA, USA
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
| | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Celia E Heppner
- Fogelson Plastic and Craniofacial Surgery Center, Children's Health/Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Shivika Udaipuria
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
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3
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Osorio C, Persson M. Psychosocial Issues Related to Speech and Hearing in Patients With Clefts. J Craniofac Surg 2024:00001665-990000000-01979. [PMID: 39329524 DOI: 10.1097/scs.0000000000010707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/28/2024] [Indexed: 09/28/2024] Open
Abstract
INTRODUCTION Individuals with cleft lip and palate often face persistent challenges related to speech and hearing disorders, impacting various aspects of their lives. These challenges can lead to additional mental health issues such as attention-deficit/hyperactivity disorder, anxiety, and depression, as well as heightened psychosocial challenges, including appearance-related issues, bullying, workplace discrimination, and impaired social interactions. Children and adolescents with these disorders commonly experience loneliness, peer rejection, and challenges in forming friendships, particularly during adolescence, while voice disorders can diminish the quality of life in older individuals. CASE DESCRIPTION This case study focuses on a 17-year-old male with unilateral cleft lip and palate undergoing treatment in Medellin, Colombia, aiming to provide insights into the intricate psychosocial challenges linked to speech and hearing difficulties in individuals with cleft conditions. DISCUSSION AND EVALUATION Clinical evaluations identified significant challenges concerning speech difficulties and self-perception, influenced by the patient's cleft condition, which impacts his self-esteem, confidence, and social skills development. The interconnectedness between speech and hearing challenges underscores the necessity for comprehensive care to address the multifaceted psychosocial aspects experienced by individuals with cleft conditions. CONCLUSIONS This case study used as an example, indicates that speech difficulties and psychosocial challenges related to cleft conditions are experienced from childhood and may persist into adulthood. These challenges can have profound effects on various aspects of life, including school, social interactions, family dynamics, and even romantic relationships. Consequently, the lack of confidence, social isolation, and limited social skills may delay patients from reaching their fullest potential.
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Affiliation(s)
- Camila Osorio
- Fundación Clínica Noel Medellín, Antioquia, Colombia
| | - Martin Persson
- Kristianstad University Kristianstad, Sweden
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital Malmö, Sweden
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Larson JH, Ho KC, Lai H, Shaholli V, Smetona J, Vicari F, Naran S. Individuals with Cleft Lip and/or Palate Demonstrated Improved Self-Reported Psychosocial Functioning Following the Onset of the COVID-19 Pandemic. JPRAS Open 2024; 41:138-147. [PMID: 39027011 PMCID: PMC11255094 DOI: 10.1016/j.jpra.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 07/20/2024] Open
Abstract
Objective To evaluate the impact of the COVID-19 pandemic on the psychosocial functioning of individuals with cleft lip and/or palate (CL/P). Methods Patients with CL/P ≥ 6 years old were prospectively recruited from the Cleft and Craniofacial Clinic of a tertiary children's hospital. From July-October 2021, eligible patients (or their parent/guardian) were sent a survey regarding their psychosocial functioning before and after the start of the pandemic. Main Outcome Measure The difference between prepandemic and intrapandemic patient-reported outcome scores. Results Thirty-six patients (20 female, age: 15.9 ± 9.8 years) responded. Most had cleft lip and palate (77.8%), responded online (69.4%), interacted remotely via both voice- and video-conferencing (62.9%), and wore masks routinely (77.1%). Similar numbers of patients responded independently (27.8%), responded with the help of a parent/guardian (36.1%), or had a parent/guardian respond on their behalf (36.1%). General social-emotional well-being (p = 0.004, r rb = 0.659) and satisfaction with facial appearance (p = 0.044, r rb = 0.610) significantly improved after the start of the pandemic. Compared to their general intrapandemic social-emotional well-being scores, patients reported higher scores while wearing a mask (r rb = 0.827) and lower scores while interacting remotely (r rb = 0.605), although all were still significantly improved compared to their prepandemic scores (p ≤ 0.010). Patients also reported significant improvement in social functioning while wearing a mask (p = 0.036, r rb = 0.519), whereas they did not when considering their general intrapandemic feelings/experiences (p = 0.269, r rb = 0.211). Conclusion Patients with CL/P demonstrated significant improvement in overall social-emotional well-being, satisfaction with facial appearance, and social functioning after the start of the COVID-19 pandemic, particularly when wearing a mask.
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Affiliation(s)
- Jordan H. Larson
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Kelly C. Ho
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Hillary Lai
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Vick Shaholli
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - John Smetona
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Frank Vicari
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
| | - Sanjay Naran
- Division of Pediatric Plastic Surgery, Advocate Children's Hospital, Chicago, IL, USA
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Materne G, Disler ER, Scott AR, Marston AP. Quality of Life and Psychosocial Outcomes Among Children With Cleft Differences. Cureus 2024; 16:e69176. [PMID: 39398658 PMCID: PMC11470974 DOI: 10.7759/cureus.69176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 10/15/2024] Open
Abstract
Introduction Velopharyngeal insufficiency (VPI) and craniofacial differences can lead to diminished speech and swallowing function resulting in communication and social challenges throughout childhood. To monitor changes in patients' psychosocial health and velopharyngeal function, the Pediatric Symptom Checklist (PSC) and Velopharyngeal Insufficiency Effects on Life Outcomes (VELO) survey tools can be utilized. This study aimed to investigate the relationship between VPI quality-of-life outcomes and psychosocial disturbances through a comparative analysis of PSC and VELO parental surveys among children followed by a craniofacial team. Methods A retrospective chart review was completed using data from a single, multidisciplinary cleft and craniofacial team. Previously completed parental survey responses between 2010 and 2022 were collated and results were analyzed using a Spearman's rank correlation test (rs). Results There were 89 subjects who completed both surveys on the same day (n = 148 survey pairs (s)). Patients aged three to five years old (s = 88) had a mean VELO of 17.9 (0-65) and a mean PSC of 7.9 (0-27), while patients aged six to eight years old (s = 60) had a mean VELO of 16.6 (0-74) and a mean PSC of 12.0 (0-37). The strongest correlation observed for both age groups was between the total PSC and VELO Speech Limitations sub-scores (three to five years old: rs = 0.537, p < 0.001; six to eight years old: rs = 0.330, p = 0.010). Similarly, children in the six- to eight-year-old group with cleft lip and palate showed a correlation between the total PSC and VELO Speech Limitations (rs = 0.583, p < 0.001). Conclusion This study suggests a relationship between PSC and VELO scores among children ages three to eight years old with cleft differences and demonstrates that specific domains within the VELO questionnaire should be considered as being associated with a higher risk for psychosocial impairment. Specifically, higher VELO Speech Limitations sub-scores may portend a greater risk for poor psychosocial outcomes supporting the importance of early interventions in this group.
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Affiliation(s)
- Grace Materne
- Otolaryngology - Head and Neck Surgery, Tufts University School of Medicine, Boston, USA
| | - Emily R Disler
- Otolaryngology - Head and Neck Surgery, Tufts University School of Medicine, Boston, USA
- General Surgery, Lahey Hospital & Medical Center, Burlington, USA
| | - Andrew R Scott
- Dr. Elie E. Rebeiz Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, USA
- Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, USA
- Otolaryngology - Head and Neck Surgery, Tufts University School of Medicine, Boston, USA
- Pediatric Facial Plastic and Craniofacial Surgery, Massachusetts Eye and Ear, Boston, USA
| | - Alexander P Marston
- Otolaryngology - Head and Neck Surgery, University of California Davis Health System, Sacramento, USA
- Dr. Elie E. Rebeiz Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, USA
- Otolaryngology - Head and Neck Surgery, Tufts University School of Medicine, Boston, USA
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Conrad AL, Bellucci CC, Heppner CE, Albert M, Crerand CE, Woodard S, Sheikh F, Kapp-Simon KA. Screening for Academic Risk Among Students With Cleft Lip and/or Palate: Patterns of Risk and Qualities of Effective Tools. Cleft Palate Craniofac J 2024; 61:68-78. [PMID: 35892129 PMCID: PMC10176211 DOI: 10.1177/10556656221116008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the effectiveness of academic screening measures in relation to parent-reported diagnoses. Multicenter, retrospective cohort study including structured interviews, questionnaires, and chart reviews. Six North American cleft centers. Children (n = 391) with cleft lip and/or palate, ages 8 to 10 years of age (192 male) and their guardians were recruited during regular clinic visits. Parent and child ratings on the Pediatric Quality of Life Inventory (PedsQL) School Scale, child report on CleftQ School Scale, parent report on the Adaptive Behavior Assessment System-Third Edition Functional Academics (ABAS-FA) Scale and Child Behavior Checklist (CBCL) School Competency Scale, parent interview, and medical chart review. Risk for concerns ranged from 12% to 41%, with higher risk reflected on the CBCL-SC compared to other measures. Males with cleft palate were consistently at the highest risk. Only 9% of the sample had a parent-reported diagnosis of a learning or language disability. Ratings from the ABAS-FA and CBCL-SC had the highest utility in identifying those with language and/or learning concerns. As cleft teams work to develop standardized batteries for screening and monitoring of patients, it is important to evaluate the effectiveness of measures in identifying those at highest risk. When screening for language and learning disorders, questions related to potential academic struggles, such as increased school effort or increased school distress, are most useful. Referrals for follow-up evaluation are recommended for those identified at high risk.
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Affiliation(s)
- Amy L Conrad
- The Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago
| | - Celia E Heppner
- Department of Psychiatry at the University of Texas Southwestern Medical Center and Psychologist, Fogelson Plastic and Craniofacial Surgery Center, Children’s Health/Children’s Medical Center, Dallas, Texas
| | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Illinois, and Clinical Assistant Professor Craniofacial Center, Department of Surgery, University of Illinois at Chicago
| | - Canice E Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathleen A Kapp-Simon
- Craniofacial Center, Department of Surgery, University of Illinois at Chicago and Psychologist & Research Scientist, Cleft-Craniofacial Clinic, Departments of Research, Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Illinois
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7
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Heppner CE, Crerand CE, Crilly Bellucci C, Sheikh F, Woodard S, Albert M, Conrad AL, Kapp-Simon KA. A Multisite Study Investigating Child and Parent Proxy Reported Quality of Life in Children With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2023; 60:1474-1483. [PMID: 35675171 DOI: 10.1177/10556656221105766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This observational, multisite cohort study explored health-related quality of life (HRQoL) in children with cleft lip and/or palate (CL/P), including interrater agreement and ratings for this group relative to clinical cutoff scores and published means for healthy and chronically ill children. Participants (338 children ages 8-10 years, 45.9% male and their parents, 82.0% female) across 6 sites completed the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL). Intraclass correlation revealed poor interrater agreement for most HRQoL domains. Although ratings were generally higher than those expected for children with a chronic illness, child ratings were below healthy means for school functioning, and parent proxy ratings were below healthy means for all domains except physical functioning. Lower ratings consistent with chronic illness means were found for self-reported emotional and psychosocial functioning in children with cleft lip and palate (CLP), as well as parent proxy-reported emotional, school, and psychosocial functioning for children with cleft palate (CP). Scores were most likely to be in the clinical range for children with CP for social, school, and total functioning. Although parent proxy report provides important information about observed functioning, poor interrater agreement indicates that both child and parent proxy reported HRQoL should be included in outcomes assessment for CL/P. HRQoL ratings may be higher for children with CL/P compared to youth with other chronic illnesses, but psychosocial functioning may be negatively impacted when compared with healthy youth, particularly for emotional, social, and school functioning in children with CLP or CP.
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Affiliation(s)
- Celia E Heppner
- Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
- Fogelson Plastic and Craniofacial Surgery Center, Children's Health/Children's Medical Center, Dallas, TX, USA
| | - Canice E Crerand
- Department of Pediatrics, The Ohio State University College of Medicine and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Plastic Surgery, The Ohio State University College of Medicine and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA
| | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA
- Craniofacial Center, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Amy L Conrad
- Division of Developmental and Behavioral Pediatrics, The Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kathleen A Kapp-Simon
- Craniofacial Center, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
- Cleft-Craniofacial Clinic, Department of Research, Shriners Hospitals for Children-Chicago, Chicago, IL, USA
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8
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O'Gara M, Alcocer Alkureishi L, Alkureishi L, Barhight L. Interdisciplinary Team Care for Children with Facial Differences. Pediatr Ann 2023; 52:e18-e22. [PMID: 36625796 DOI: 10.3928/19382359-20221114-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Children who have cleft and craniofacial diagnoses require coordinated, interdisciplinary treatment planning from birth to young adulthood. Teams that adhere to the Parameters of Care and maintain annual review by the American Cleft Palate Craniofacial Association Commission on Approval of Teams are published at www.acpa-cpf.org to assist families in obtaining that care. The six critical components to this interdisciplinary care focus on the team's composition, the team's management and responsibilities, the inclusion of patient and family/caregiver communication, an ongoing commitment to cultural competence, the importance of psychosocial and social services provided for the child and family, and the dedication to outcomes assessment. Primary care physicians are in a unique position to help direct families to this online directory for the best possible outcomes. [Pediatr Ann. 2023;52(1):e18-e22.].
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Saikia A, Muthu M, Orenuga OO, Mossey P, Ousehal L, Yan S, Campodonico M, England R, Taylor S, Sheeran P. Systematic Review of Clinical Practice Guidelines for Oral Health in Children With Cleft Lip and Palate. Cleft Palate Craniofac J 2022; 59:800-814. [PMID: 34159833 PMCID: PMC9121521 DOI: 10.1177/10556656211025189] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) exist to present recommendations and policies aimed at optimizing the oral health of children and adolescents born with cleft lip and/or palate. The aim of this review is to identify and assess the scope, quality, adequacy, and consistency of CPGs related to oral health in children and adolescents with clefts, along with reporting any differences and shortcomings. METHODS A systematic review of the literature of CPGs following Preferred Reporting Items for Systematic Reviews guidelines was conducted. Assessment of selected CPGs was performed using the Appraisal of Guidelines for Research & Evaluation II methodological quality instrument. RESULTS Only 7 CPGs fulfilled the criteria. Of these, 4 were from the American Cleft Palate-Craniofacial Association, and 1 each from the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, and the American Academy of Pediatric Dentistry. The lowest overall mean scores were in the domain "Rigor of Development" (mean 29.58%, SD 17.11), revealing lower quality in methodology of the guideline. The domain "Clarity of Presentation" (mean 73.80%, SD 7.87) revealed the best score. CONCLUSIONS Our review results reveal a lack of integrated high-quality CPGs that can be used as universal guidelines by health workers in a range of disciplines for improving oral health in children and adolescents with cleft problems.
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Affiliation(s)
- Ankita Saikia
- Consulting Pediatric Dental Surgeon, Pedo Planet Children Dental
Centre, Porur, Chennai, Tamilnadu, India
| | - M.S. Muthu
- Centre for Early Childhood Caries Research (CECCRe), Faculty of
Dental Sciences, Department of Pediatric Dentistry, Sri Ramachandra Institute of
Higher Education and Research, Porur, Chennai, Tamilnadu, India
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman
University, United Arab Emirates
| | - Omolola O. Orenuga
- Department of Child Dental Health, College of Medicine University of
Lagos, University Teaching Hospital, Lagos, Nigeria
| | - Peter Mossey
- School of Dentistry, University of Dundee, Dundee, United
Kingdom
| | - Lahcen Ousehal
- Department of Orthodontics , University of Casablanca, Morocco
| | - Si Yan
- Department of Preventive Dentistry, Peking University, Beijing,
People’s Republic of China
| | | | | | - Sean Taylor
- FDI World Dental Federation, Geneva, Switzerland
| | - Pamela Sheeran
- Strategic Programs and Partnerships, Comprehensive Cleft Care,
Smile Train, NY, USA
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10
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Ruiz-Guillén A, Suso-Ribera C, Romero-Maroto M, Gallardo C, Peñacoba C. Adaptation of the Quality of Life Adolescent Cleft Questionnaire for Spanish children and adolescents with cleft lip and/or palate. Int J Paediatr Dent 2022; 32:157-168. [PMID: 33983656 DOI: 10.1111/ipd.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Quality of Life Adolescent Cleft Questionnaire is a measure of quality of life in cleft lip/palate (CL/P) and includes items on pre-treatment and post-treatment status. Items, however, were originally organized in a factor structure that prevents a formal pre-treatment to post-treatment comparison. Additionally, the questionnaire was tested in older patients. AIM We aimed to explore a factor structure that allows a comparison of pre- to post-treatment status in children and adolescents with CL/P. DESIGN The sample comprised 60 children and adolescents with CL/P. The scale was divided into two groups of items (24 comparing pre-treatment and post-treatment status and 26 measuring current quality of life). Two different exploratory and confirmatory analyses were conducted (one for each group of items). Sources of criterion validity were investigated with measures of self-esteem and self-efficacy. RESULTS The results supported a 6-factor structure for the pre-treatment and post-treatment items. In the second group of items, 9 items were removed due to inadequate functioning and a final 4-factor solution was obtained. The criterion validity of factors was good. CONCLUSION The proposed factor solution might be more useful to detect the perceived satisfaction in different areas and can be used in younger patients.
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Affiliation(s)
- Ana Ruiz-Guillén
- Department of Nursing and Dentistry, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain.,Paediatric Dentist in Private Clinic, Madrid, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Universidad Jaume I, Castellón, Spain
| | | | - Carmen Gallardo
- Department of Medical Specialties and Public Health, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain
| | - Cecilia Peñacoba
- Department of Psychology, Universidad Rey Juan Carlos, Alcorcón (Madrid), Spain
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11
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Liu S, Wang YS, Zhang Q, Zhou Q, Cao LZ, Jiang C, Zhang Z, Yang N, Dong Q, Zuo XN. Chinese Color Nest Project : An accelerated longitudinal brain-mind cohort. Dev Cogn Neurosci 2021; 52:101020. [PMID: 34653938 PMCID: PMC8517840 DOI: 10.1016/j.dcn.2021.101020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 10/02/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022] Open
Abstract
The ongoing Chinese Color Nest Project (CCNP) was established to create normative charts for brain structure and function across the human lifespan, and link age-related changes in brain imaging measures to psychological assessments of behavior, cognition, and emotion using an accelerated longitudinal design. In the initial stage, CCNP aims to recruit 1520 healthy individuals (6-90 years), which comprises three phases: developing (devCCNP: 6-18 years, N = 480), maturing (matCCNP: 20-60 years, N = 560) and aging (ageCCNP: 60-84 years, N = 480). In this paper, we present an overview of the devCCNP, including study design, participants, data collection and preliminary findings. The devCCNP has acquired data with three repeated measurements from 2013 to 2017 in Southwest University, Chongqing, China (CCNP-SWU, N = 201). It has been accumulating baseline data since July 2018 and the second wave data since September 2020 in Chinese Academy of Sciences, Beijing, China (CCNP-CAS, N = 168). Each participant in devCCNP was followed up for 2.5 years at 1.25-year intervals. The devCCNP obtained longitudinal neuroimaging, biophysical, social, behavioral and cognitive data via MRI, parent- and self-reported questionnaires, behavioral assessments, and computer tasks. Additionally, data were collected on children's learning, daily life and emotional states during the COVID-19 pandemic in 2020. We address data harmonization across the two sites and demonstrated its promise of characterizing the growth curves for the overall brain morphometry using multi-center longitudinal data. CCNP data will be shared via the National Science Data Bank and requests for further information on collaboration and data sharing are encouraged.
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Affiliation(s)
- Siman Liu
- Research Center for Lifespan Development of Mind and Brain, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yin-Shan Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Developmental Population Neuroscience Research Center, International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Qing Zhang
- Research Center for Lifespan Development of Mind and Brain, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Quan Zhou
- Research Center for Lifespan Development of Mind and Brain, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Li-Zhi Cao
- Research Center for Lifespan Development of Mind and Brain, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chao Jiang
- School of Psychology, Capital Normal University, Beijing 100048, China
| | - Zhe Zhang
- Department of Psychology, College of Education, Hebei Normal University, Shijiazhuang 05024, Hebei, China
| | - Ning Yang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Developmental Population Neuroscience Research Center, International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Qi Dong
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Xi-Nian Zuo
- Research Center for Lifespan Development of Mind and Brain, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China; State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Developmental Population Neuroscience Research Center, International Data Group/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.
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12
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Kara İ, Dumbak AB, Kayıkcı MEK. Perceptions Regarding the Academic and Cognitive Performance of Individuals With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2021; 59:32-39. [PMID: 33622048 DOI: 10.1177/1055665621995308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Factors such as teachers' appropriate support and social interactions have an impact on the academic performance of children with cleft lip and/or palate (CL/P). This study was designed to investigate the perceptions of the teachers and the general public about the academic and cognitive performance of individuals with CL/P. METHODS This study was included 360 (male/female = 102/258) teachers and 640 (male/female = 259/381) participants that represent the general public. Anonymized web-based and paper-and-pencil self-administered questionnaire that included multiple-choice and yes/no questions were administered. Within-group differences and intergroup differences were analyzed in terms of academic and cognitive performance. RESULTS Most of the teachers and the general public indicated that the academic and cognitive performance of individuals with CL/P is the same as their unaffected peers. A significantly higher proportion of the teachers indicated that the academic performance of children with CL/P is the same as their unaffected peers than the general public. CONCLUSION Considering that the general public's attitudes and appropriate teacher support are crucial to prevent adverse impacts on the lives of individuals with CL/P, it is important to support teachers with the appropriate information and to encourage the public to recognize that everybody with a facial difference should be treated as an individual rather than a disability.
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Affiliation(s)
- İlkem Kara
- Speech and Language Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Aydan Baştuğ Dumbak
- Speech and Language Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Maviş Emel Kulak Kayıkcı
- Speech and Language Therapy Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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13
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Conrad AL, Albert M, Crerand CE, Crilly Bellucci C, Heppner CE, Sheikh F, Woodard S, Kapp-Simon KA. Retrospective Evaluation of Number of Surgeries and Parent Ratings of Academic and Behavioral Functioning Among Children With Isolated Oral Clefts. Cleft Palate Craniofac J 2020; 58:1294-1303. [PMID: 33380226 DOI: 10.1177/1055665620982807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate possible relationships between number of surgeries and parent ratings of academic functioning among children with isolated oral clefts. DESIGN Multicenter, retrospective cohort study including structured interviews, questionnaires, and chart reviews. SETTING Completion of questionnaires occurred during clinical visits at 6 different cleft centers across North America. PARTICIPANTS Parents of 285 children with isolated clefts of the lip and/or palate, aged 8 to 10 years old, participated in structured interviews and completed questionnaires regarding the academic and behavioral functioning of their children. MAIN OUTCOME MEASURES Parent interview and medical chart review of number of surgeries to date and parent ratings on the Adaptive Behavior Assessment System, Third Edition-Functional Academics Scale (ABAS-FA) and Child Behavior Checklist (CBCL) Total Competency Scale. RESULTS Parent ratings of ABAS-FA were at or above normative expectations, while ratings across CBCL Competency Scales were lower than normative expectations. Socioeconomic status (SES), age, and race were consistent predictors of parent ratings (higher SES, older age, and Caucasian race were associated with better functioning). Number of surgeries did not add significantly to academic ratings but did significantly contribute to ratings of social and activity participation. Patients with more surgeries were rated with lower functioning in these domains. CONCLUSIONS Findings do not support a connection between number of surgeries and later ratings of academic functioning but do support a connection to social and activity involvement. Recommendations for conducting direct studies of the connection between surgeries and academic functioning as well as clinical considerations for surgeries and impact on social and activity involvement are discussed.
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Affiliation(s)
- Amy L Conrad
- Division of Developmental and Behavioral Pediatrics, The Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA.,Craniofacial Center, Department of Surgery, University of Illinois at Chicago, IL,USA
| | - Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, OH, USA
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA
| | - Celia E Heppner
- Fogelson Plastic and Craniofacial Surgery Center, Children's Health/Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA.,Craniofacial Center, Department of Surgery, University of Illinois at Chicago, IL, USA
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14
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Guillén AR, Olmo MJG, Puente CP, Maroto MR. Personality and Cognitive-Emotional Variables in Spanish Children and Adolescents With and Without Cleft Lip and/or Palate. Cleft Palate Craniofac J 2020; 58:872-880. [PMID: 34128404 DOI: 10.1177/1055665620965114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To analyze personality (Big Five Model) and cognitive-emotional variables in children and adolescents with a cleft lip/palate (s) in comparison to an equivalent peer sample without an orofacial cleft. DESIGN Cross-sectional study with data collected using self-reported questionnaires over 2 years. SETTING Data were collected during visits to health center dental clinics. PATIENTS Children and adolescents (aged 8-18 years) with nonsyndromic CL/P (n = 60) and without a cleft (n = 60). METHOD Patients completed questionnaires with assistance as needed from a member of the research team. MAIN OUTCOME MEASURES Children's Perceived Self-Efficacy, Cognitive Emotion Regulation Questionnaire (child version), Big Five Questionnaire for Children, and Alexithymia Questionnaire for Children. RESULTS When accounting for age, children with CL/P had normative self-efficacy and cognitive-emotional regulation strategies, with the protective factor of significantly lower rumination than peers. Children with CL/P were significantly lower on the Big Five personality areas of conscientiousness, openness to experience, extraversion, and agreeableness along with significantly higher neuroticism. They were similarly significantly higher than peers for alexithymia. CONCLUSION Children with CL/P showed strengths in self-efficacy typical of peers and less use of some maladaptive coping strategies; however, they also had higher levels of alexithymia and risk factors associated with the Big Five Model of personality. Strategies may be clinically useful that maximize areas of strength to support children with CL/P in expressing their emotions to reduce alexithymia, coping with of negative affect, and building assertiveness.
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Affiliation(s)
- Ana Ruiz Guillén
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Nursing and Dentistry, 16776Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - María José González Olmo
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Nursing and Dentistry, 16776Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Cecilia Peñacoba Puente
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Nursing and Dentistry, 16776Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Martín Romero Maroto
- Department of Medicine and Surgery, Public Health, Psychology and Immunology and Medical Microbiology, Nursing and Dentistry, 16776Rey Juan Carlos University, Alcorcón, Madrid, Spain.,Orthodontic Department, 16776Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Abstract
The challenges of cleft reconstruction have been present for centuries. However, understanding of the cleft nasal tip and the evolution of techniques decidedly began in the 20th century and refinement continues into the present day. Although a multitude of technical descriptions and case series have been published, a compendium of seminal techniques, which have shaped modern thought, has not been compiled in the literature. In this review, we discuss the anatomical disturbances in the cleft nasal tip anomaly, the timing and strategy of tip correction, and the major classic techniques for management of the cleft nasal tip. In addition, we have categorized the classic techniques into concepts that they embody.
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Crerand CE, Kapa HM, Litteral J, Pearson GD, Eastman K, Kirschner RE. Identifying Psychosocial Risk Factors Among Families of Children With Craniofacial Conditions: Validation of the Psychosocial Assessment Tool-Craniofacial Version. Cleft Palate Craniofac J 2018; 55:536-545. [PMID: 29315004 DOI: 10.1177/1055665617748010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of the Psychosocial Assessment Tool-Craniofacial Version (PAT-CV), a screening instrument for psychosocial risk in families of children with craniofacial conditions, and to examine risk classification of patients in a craniofacial population. DESIGN Prospective, cross-sectional, single-center study. SETTING Interdisciplinary cleft lip and palate/craniofacial center at a US children's hospital. PARTICIPANTS Parents/caregivers (n = 242) of 217 children ages 1 month to 17 years being treated for a congenital syndromic or nonsyndromic craniofacial condition completed the PAT-CV and validating measures from July 2015 to July 2016. The PAT-CV was completed by 121 caregivers a second time to assess test-retest reliability. MAIN OUTCOME MEASURES PAT-CV, Child Behavior Checklist, Adult Self-Report, Pediatric Quality of Life Inventory, Craniofacial Experiences Questionnaire, and Family Environment Scale. RESULTS Construct validity of the PAT-CV was supported by significant correlations ( P < .001) between PAT-CV total and subscale scores and the validated measures. PAT-CV total scores categorized 59.9% of families within the universal risk group, 32.3% within the targeted risk group, and 7.8% within the clinical range. Good criterion validity was indicated by significantly higher scores ( P < .0001) obtained on the validated measures for those in the targeted and clinical risk groups. Internal consistency (Cronbach's α = 0.86) and test-retest reliability for the PAT-CV total score ( r = 0.77, P < .0001) were acceptable. CONCLUSIONS The PAT-CV appears to be a reliable and valid screening instrument for psychosocial risk. Accurate identification of risk and implementation of appropriate interventions may contribute to improvements in medical and psychosocial outcomes.
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Affiliation(s)
- Canice E Crerand
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- 2 Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hillary M Kapa
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory D Pearson
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Katherine Eastman
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard E Kirschner
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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