1
|
Stock NM, Crerand CE, Johns AL, McKinney CM, Koudstaal MJ, Drake AF, Heike CL. Establishing an International Interdisciplinary Research Network in Craniofacial Microsomia: The CARE Program. Cleft Palate Craniofac J 2024; 61:1470-1479. [PMID: 37248561 PMCID: PMC10984877 DOI: 10.1177/10556656231176904] [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: 05/31/2023] Open
Abstract
OBJECTIVE Craniofacial microsomia (CFM) is a broad clinical term used to describe a congenital condition most commonly involving the underdevelopment of the external ear, mandible, soft tissues, and facial nerve. Despite medical advances, understanding of the psychological health and healthcare experiences of individuals with CFM and their caregivers remains limited. This article describes a research program designed to address these knowledge gaps, and identify opportunities for psychosocial intervention and improved healthcare provision. DESIGN The Craniofacial microsomia: Accelerating Research and Education (CARE) research program aims to: 1) Conduct up to 160 narrative interviews with individuals and caregivers to validate a conceptual framework; 2) Administer an online international survey of up to 800 individuals with CFM and caregivers to identify predictors of psychological distress; 3) Perform up to 60 semi-structured interviews with healthcare providers and advocacy leaders to examine the extent to which current healthcare provisions address identified patient needs; and 4) Establish a participant registry to build a longitudinal database and develop an international community. RESULTS Teams in the USA and UK have been established, alongside an international, interdisciplinary Advisory Committee. Data analysis for Aim 1 is ongoing and informing the delivery of Aims 2-3. Aim 4 is also in development. A dedicated website serves as a recruitment tool, educational resource, and mechanism for engaging with the CFM community. CONCLUSIONS The CARE program provides a comprehensive approach to understanding the experiences of individuals with CFM and their caregivers. Challenges encountered and lessons learned are shared for the benefit of the community.
Collapse
Affiliation(s)
- Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Canice E. Crerand
- Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, USA 43205
| | - Alexis L. Johns
- Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, USA 90027
| | - Christy M. McKinney
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
| | - Maarten J. Koudstaal
- Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Amelia F. Drake
- University of North Carolina at Chapel School of Medicine, 170 Manning Drive, CB 7070, Chapel Hill, NC, USA 27599
| | - Carrie L. Heike
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
| |
Collapse
|
2
|
Parikh N, Hu KG, Allam O, Ihnat JM, Rancu AL, Boroumand S, Persing JA, Alperovich M. Sports participation after craniosynostosis repair: the critical role of post-operative guidance in parental decision-making. Childs Nerv Syst 2024; 40:2551-2556. [PMID: 38578479 DOI: 10.1007/s00381-024-06381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Despite previous research supporting patient safety in sports after craniosynostosis surgery, parental anxiety remains high. This study sought to evaluate the role of healthcare providers in guiding patients and families through the decision-making process. METHODS Parents of children with repaired craniosynostosis were asked to assess sports involvement and parental decision-making in children ages 6 and older. Questions were framed primarily on 5-point Likert scales. Sport categorizations were made in accordance with the American Academy of Pediatrics. Chi-squared, linear regression, and Pearson correlation tests were used to analyze associations between the questions. RESULTS Forty-three complete parental responses were recorded. Mean ages at surgery and time of sports entry were 7.93 ± 4.73 months and 4.76 ± 2.14 years, respectively. Eighty-two percent of patients participated in a contact sport. Discussions with the primary surgeon were more impactful on parental decisions about sports participation than those with other healthcare providers (4.04 ± 1.20 vs. 2.69 ± 1.32). Furthermore, children whose parents consulted with the primary surgeon began participating in sports at a younger age (4.0 ± 1.0 vs. 5.8 ± 2.7 years, p = 0.034). The mean comfort level with contact sports (2.8 ± 1.4) was lower than that with limited-contact (3.8 ± 1.1, p = 0.0001) or non-contact (4.4 ± 1.3, p < 0.0001) sports. CONCLUSION This study underscores the critical role that healthcare professionals, primarily surgeons, have in guiding families through the decision-making process regarding their children's participation in contact sports.
Collapse
Affiliation(s)
- Neil Parikh
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Kevin G Hu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Omar Allam
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Jacqueline M Ihnat
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Albert L Rancu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Sam Boroumand
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - John A Persing
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Michael Alperovich
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA.
| |
Collapse
|
3
|
Stock NM, Pearse L, Murfett L, Pearse K, Kearney A, Horton J, Hilton C, Wilkinson-Bell K. Surgery for Craniosynostosis: Developing a Psychosocial Booklet for Families. J Craniofac Surg 2024:00001665-990000000-01764. [PMID: 39012620 DOI: 10.1097/scs.0000000000010422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024] Open
Abstract
Parents of children with craniosynostosis may experience psychological distress, particularly during intensive periods of treatment. Yet, recent research indicates parents may not be accessing the support they need to cope with common challenges. The aim was to develop an evidence-based booklet to promote psychological health in families undergoing surgery and to assess the acceptability of the booklet among the craniosynostosis community. Researchers collaborated with UK charity Headlines Craniofacial Support, 5 parent representatives, and 2 specialist clinical psychologists to develop the booklet based on data obtained from online focus groups, individual interviews, and written accounts. The draft booklet was attached to an online acceptability survey and distributed to a broader group of parents and multidisciplinary craniofacial specialists for feedback. A total of 52 complete responses to the online acceptability survey were received, and acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents supported the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support families. It is hoped this booklet can begin to address the gap in psychological support for families affected by craniosynostosis.
Collapse
Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol
| | | | | | | | - Anna Kearney
- Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Jo Horton
- Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
| | | | | |
Collapse
|
4
|
Fladeboe KM, Stock NM, Heike CL, Evans KN, Junkins C, Stueckle L, O'Daffer A, Rosenberg AR, Yi-Frazier JP. Feasibility and Acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) Intervention for Caregivers of Children with Craniofacial Conditions. Cleft Palate Craniofac J 2024; 61:1125-1133. [PMID: 36802967 DOI: 10.1177/10556656231157449] [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: 02/23/2023] Open
Abstract
OBJECTIVES Few evidence-based psychosocial programs exist within craniofacial care. This study (a) assessed feasibility and acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) intervention among caregivers of children with craniofacial conditions and (b) described barriers and facilitators of caregiver resilience to inform program adaptation. DESIGN In this single-arm cohort study, participants completed a baseline demographic questionnaire, the PRISM-P program, and an exit interview. PARTICIPANTS Eligible individuals were English-speaking legal guardians of a child <12-years-old with a craniofacial condition. INTERVENTION PRISM-P included 4 modules (stress-management, goal-setting, cognitive-restructuring, meaning-making) delivered in 2 one-on-one phone or videoconference sessions 1-2 weeks apart. MAIN OUTCOME MEASURES Feasibility was defined as >70% program completion among enrolled participants; acceptability was defined as >70% willingness to recommend PRISM-P. Intervention feedback and caregiver-perceived barriers and facilitators of resilience were summarized qualitatively. RESULTS Twenty caregivers were approached and 12 (60%) enrolled. The majority were mothers (67%) of a child <1-year-old diagnosed with a cleft lip and/or palate (83%) or craniofacial microsomia (17%). Of these, 8 (67%) completed PRISM-P and 7 (58%) completed interviews; 4 (33%) were lost-to-follow-up before PRISM-P and 1 (8%) before the interview. Feedback was highly positive, with 100% willing to recommend PRISM-P. Perceived barriers to resilience included uncertainty about their child's health; facilitators included social support, parental identity, knowledge, and control. CONCLUSIONS PRISM-P was acceptable among caregivers of children with craniofacial conditions but not feasible based on program completion rates. Barriers and facilitators of resilience support the appropriateness of PRISM-P for this population and inform adaptation.
Collapse
Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Carrie L Heike
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Kelly N Evans
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Courtney Junkins
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Laura Stueckle
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Palliative Care, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| |
Collapse
|
5
|
Lloyd-White S, Samuel R, Edwards-Bailey L, Piggott K, Blighe S, Bassi A, Hotton M, Horton J, Johnson D, Parks C, Kearney A. The Craniofacial Collaboration UK: Developmental Outcomes in 7- and 10-Year-Old Children With Sagittal Synostosis. J Craniofac Surg 2024:00001665-990000000-01738. [PMID: 38949257 DOI: 10.1097/scs.0000000000010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/20/2024] [Indexed: 07/02/2024] Open
Abstract
The Craniofacial Collaboration UK (CC-UK) protocol is a shared agreement across the 4 UK Highly Specialist Craniofacial Centres (HSCCs) to conduct robust neurodevelopmental and psychosocial clinical screening for children with craniosynostosis. This agreement allows for the analysis of outcomes of a homogenous sample of children with single suture craniosynostosis (SSC), a frequent limitation of the existing research. The current study is the latest analysis of CC-UK data on behavioral, cognitive, and psychosocial outcomes. The focus of this analysis is 7- and 10-year-olds with nonsyndromic sagittal synostosis (SS) who have undergone primary corrective surgery and completed routine clinical screening at 1 of the 4 HSCCs since the introduction of the CC-UK protocol. Due to changes in clinical pathways, only data from 3 HSCCs is included to preserve homogeneity. Results show that the majority of children with SS fall within the average range across behavioral and neurodevelopmental domains. A notable exception was a task involving perceptual reasoning and visuomotor skills (Block Design). Although this difference was small and the mean score remained within the average range, it suggests some increased risk of subtle difficulty with such skills for children with SS. Across other measures, there was no consistent evidence of any significantly increased risk of poorer outcomes, in line with findings of previous CC-UK papers. Understanding the psychological phenotype of SS is a key research priority for parents and clinicians, and the current study is another step toward achieving this goal.
Collapse
Affiliation(s)
- Samuel Lloyd-White
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Rosanna Samuel
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | | | | | - Sabrina Blighe
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Amber Bassi
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Matthew Hotton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jo Horton
- Birmingham Women's and Children's Hospital, UK
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | | | - Anna Kearney
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, UK
| |
Collapse
|
6
|
Svalina A, Serlo W, Sinikumpu JJ, Salokorpi N. Experiences of surgical complications and reoperations in nonsyndromic sagittal synostosis patients in Oulu. Childs Nerv Syst 2024:10.1007/s00381-024-06519-0. [PMID: 38940955 DOI: 10.1007/s00381-024-06519-0] [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: 10/25/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The purpose of this study was to evaluate the surgical complications of patients treated for nonsyndromic sagittal craniosynostosis and the necessity for reoperations due to craniocerebral disproportion. MATERIALS AND METHODS The patient cohort of this study consisted of patients (N = 82) who were treated in the Oulu University Hospital using the open vault cranioplasty with a modified H-technique between the years 2008 to 2022. There were 69 males (84.1%) and 13 females (15.9%). The mean age at the primary operation was 6.1 months. Mean follow-up time was 9.0 years. RESULTS There were no major complications related to the procedures. Two patients (2.4%) had a minor dural lesion. There were no postoperative wound infections. Of the 82 patients, seven patients with primary craniosynostosis (13.0%) developed symptomatic craniocerebral disproportion requiring reoperation to increase intracranial volume. In all these patients, invasive intracranial pressure (ICP) monitoring was performed prior to decision-making. In the majority of cases, the aesthetical outcome was considered good or excellent. CONCLUSION The operative method used was feasible and safe. Thirteen percent of patients who were followed over 5 years required major surgery due to development of craniocerebral disproportion later in life.
Collapse
Affiliation(s)
- Anja Svalina
- Research Unit of Clinical Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.
- Medical Research Center, Oulu University Hospital, Oulu, Finland.
- Department of Neurosurgery, NeurocenterOulu University Hospital, PO Box 21, 90029, Oulu, OYS, Finland.
| | - Willy Serlo
- Research Unit of Clinical Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Skills Center for Children and Women, Oulu University Hospital, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- Research Unit of Clinical Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, Oulu, Finland
- Skills Center for Children and Women, Oulu University Hospital, Oulu, Finland
| | - Niina Salokorpi
- Research Unit of Clinical Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Neurosurgery, NeurocenterOulu University Hospital, PO Box 21, 90029, Oulu, OYS, Finland
| |
Collapse
|
7
|
Stock NM, Costa B, Parnell J, Johns AL, Crerand CE, Billaud Feragen K, Stueckle LP, Mills A, Magee L, Hotton M, Tumblin M, Schefer A, Drake AF, Heike CL. A Conceptual Thematic Framework of Psychological Adjustment in Caregivers of Children with Craniofacial Microsomia. Cleft Palate Craniofac J 2024:10556656241245284. [PMID: 38584503 DOI: 10.1177/10556656241245284] [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] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE Children with craniofacial microsomia (CFM) have complex healthcare needs, resulting in evaluations and interventions from infancy onward. Yet, little is understood about families' treatment experiences or the impact of CFM on caregivers' well-being. To address this gap, the NIH-funded 'Craniofacial microsomia: Accelerating Research and Education (CARE)' program sought to develop a conceptual thematic framework of caregiver adjustment to CFM. DESIGN Caregivers reported on their child's medical and surgical history. Narrative interviews were conducted with US caregivers (n = 62) of children aged 3-17 years with CFM. Transcripts were inductively coded and final themes and subthemes were identified. RESULTS Components of the framework included: 1) Diagnostic Experiences, including pregnancy and birth, initial emotional responses, communication about the diagnosis by healthcare providers, and information-seeking behaviors; 2) Child Health and Healthcare Experiences, including feeding, the child's physical health, burden of care, medical decision-making, surgical experiences, and the perceived quality of care; 3) Child Development, including cognition and behavior, educational provision, social experiences, and emotional well-being; and 4) Family Functioning, including parental well-being, relationships, coping strategies, and personal growth. Participants also identified a series of "high" and "low" points throughout their journey and shared their priorities for future research. CONCLUSIONS Narrative interviews provided rich insight into caregivers' experiences of having a child with CFM and enabled the development of a conceptual thematic framework to guide clinical care and future research. Information gathered from this study demonstrates the need to incorporate evidence-based psychological support for families into the CFM pathway from birth onward.
Collapse
Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jade Parnell
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | | | - Laura P Stueckle
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angela Mills
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Leanne Magee
- Buerger Center for Advanced Pediatric Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Hotton
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, England
| | - Melissa Tumblin
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amy Schefer
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel School of Medicine, Chapel Hill, NC, USA
| | - Carrie L Heike
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| |
Collapse
|
8
|
Ferraro JJ, Jeffe JS, Seu MY, Aminzada A, Tragos C. Is There a Role for Comfort Care in Neonates With Severe Craniofacial Anomalies? Case Report and Review of Quality-of-Life Literature. Cleft Palate Craniofac J 2024; 61:717-722. [PMID: 36384315 DOI: 10.1177/10556656221138884] [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: 02/17/2024] Open
Abstract
This article aims to determine how quality of life (QoL) is defined and assessed in cases of severe craniofacial anomalies, as well as the impact such considerations may have on the treatment of a neonate with these conditions with respect to palliative neonatal care. Our literature review found insufficient evidence to suggest that craniofacial anomalies result in consistently poor QoL. Based on these findings and in line with the current acceptable standards for the ethical care of neonates, with the exception of rare cases, resuscitative efforts should always be performed on patients with isolated craniofacial anomalies, as demonstrated in the management of this reported patient.
Collapse
Affiliation(s)
| | - Jill S Jeffe
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | |
Collapse
|
9
|
Pereira D, Machado V, Botelho J, Lemos C, Mendes JJ, Delgado AS. Vertical Dentofacial Skeletal Divergency Is Not Linked with Oral Health-Related Quality of Life. J Clin Med 2024; 13:665. [PMID: 38337358 PMCID: PMC10856730 DOI: 10.3390/jcm13030665] [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: 12/26/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
The aim of this study is to assess how vertical skeletal malocclusion affects oral health-related quality of life (OHRQoL) among a sample of individuals comprising adolescents, young adults, and adults seeking orthodontic treatment. From January 2019 to March 2020, participants were consecutively enrolled. The assessment of OHRQoL involved measurement using the oral health impact profile (OHIP-14). Lateral cephalograms were performed to measure the vertical skeletal divergency with four cephalometric measurements. Descriptive and inferential statistical analyses were performed. The Mann-Whitney test was applied to compare OHRQoL scores according to the vertical dimension category. The mean age of the participants ranged between 30.3 ± 14.9 and 29.9 ± 14.4 and there was a majority of female participants, between 64.1% and 65.9%. There were no statistically significant differences observed between hyperdivergent and normodivergent groups in either the total score or any domain of the OHIP-14 questionnaire. Individuals with hyperdivergent facial morphology did not show a reduced OHRQoL compared with a normodivergent facial type.
Collapse
Affiliation(s)
- Dinis Pereira
- Orthodontics Department, Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal;
- Clinical Research Unit (CRU), CiiEM, Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal; (V.M.); (J.B.); (J.J.M.)
| | - Vanessa Machado
- Clinical Research Unit (CRU), CiiEM, Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal; (V.M.); (J.B.); (J.J.M.)
| | - João Botelho
- Clinical Research Unit (CRU), CiiEM, Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal; (V.M.); (J.B.); (J.J.M.)
| | - Carolina Lemos
- Population Studies Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), UniGENe, Institute for Molecular and Cell Biology (IBMC), Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, 4050-313 Porto, Portugal;
- UniGENe, Institute for Molecular and Cell Biology (IBMC), University of Porto, 4050-313 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, 4050-313 Porto, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), CiiEM, Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal; (V.M.); (J.B.); (J.J.M.)
| | - Ana Sintra Delgado
- Orthodontics Department, Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal;
- Clinical Research Unit (CRU), CiiEM, Egas Moniz School of Health and Science, 2829-511 Caparica, Portugal; (V.M.); (J.B.); (J.J.M.)
| |
Collapse
|
10
|
Hermans MM, Schappin R, de Laat PCJ, Mendels EJ, Breur JMPJ, Langeveld HR, Raphael MF, de Graaf M, Breugem CC, de Wildt SN, Okkerse JME, Pasmans SGMA, Rietman AB. Mental Health of School-Aged Children Treated with Propranolol or Atenolol for Infantile Hemangioma and Their Parents. Dermatology 2024; 240:216-225. [PMID: 38228125 PMCID: PMC10997238 DOI: 10.1159/000536144] [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] [Received: 09/24/2022] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Infants with infantile hemangioma (IH) have been effectively treated with propranolol or atenolol. Concerns were raised about the mental health of these children at school age, due to central nervous system effects of propranolol and visible nature of IH. OBJECTIVE This study aimed to compare the mental health at school age of children treated with propranolol to children treated with atenolol for IHs and their parents. METHODS This two-centered cross-sectional study included children aged ≥6 years and treated with either propranolol or atenolol for IH during infancy. Children's outcomes were performance-based affect recognition (Dutch version of the Developmental Neuropsychological Assessment-II [NEPSY-II-NL]), parent-reported emotional and behavioral functioning (Child Behavioral Checklist [CBCL]), and health-related quality of life (KIDSCREEN-27). Parents' outcome was parenting stress (Parenting Stress Questionnaire [OBVL]). RESULTS Data of 105 children (36 propranolol, 69 atenolol; 6.0-11.8 years) were analyzed. Mental health outcomes did not differ between both β-blocker groups. Although overall functioning was in line with norms, children presented specific problems concerning affect recognition, parent-reported attention, and social quality of life. Parents showed increased physical symptoms, depressive symptoms, and parent-child relationship problems. CONCLUSION No difference in mental health at school age was found between children treated with propranolol or atenolol for IH. Although few overall mental health problems were found, specific problems require follow-up. Follow-up of children should be directed toward affect recognition, attention, and social functioning in daily life. Problems reported by parents could be ameliorated by mental health support during and after their infant's β-blocker treatment.
Collapse
Affiliation(s)
- Mireille M Hermans
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands,
| | - Renske Schappin
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Rotterdam, The Netherlands
| | - Peter C J de Laat
- Department of Pediatrics (-Hemato-oncology), Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Utrecht, The Netherlands
| | - Elodie J Mendels
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester R Langeveld
- Department of Intensive Care and Pediatric Surgery, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martine F Raphael
- Department of Dermatology, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic Surgery, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jolanda M E Okkerse
- Department of Child and Adolescent Psychology/Psychiatry, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Child and Adolescent Psychology/Psychiatry, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
11
|
Edwards-Bailey L, Piggott K, Dalton L, Horton J, Parks C, White S, Wright G, Kearney A. The Craniofacial Collaboration UK: Developmental Outcomes in 7- and 10-Year-Old Children With Metopic Synostosis. J Craniofac Surg 2024; 35:96-103. [PMID: 38294298 DOI: 10.1097/scs.0000000000009803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/26/2023] [Indexed: 02/01/2024] Open
Abstract
The Craniofacial Collaboration (CC-UK) is a shared initiative across the Psychology teams attached to 4 highly specialized craniofacial centers in the United Kingdom. The CC-UK aims to address key limitations in the existing craniofacial literature by analyzing data for homogenous samples of children with craniosynostosis. This article presents the fifth wave of CC-UK data collection, focused on 7- and 10-year olds who have undergone primary corrective surgery for metopic synostosis (MS). Data for children with sagittal synostosis and MS have previously been presented at 3 and 5 years. This paper continues to build on this with consideration to older age groups, presenting the first CC-UK analysis of cognitive assessment data using the Wechsler Abbreviated Scale of Intelligence-Second Edition. Results show that the majority of children with MS fall within the average ranges across behavioral and neurodevelopmental domains. However, several domains indicated a trend of heightened concern when compared with normative data, particularly for parent-reported outcomes, suggesting that there may be some subtle difficulties for children with MS. Consideration of how these findings compare with that of previous CC-UK analyses is explored. Further, implications for clinical practice and future research are considered, with the need for longitudinal analyses, as well as data from multiple perspectives (eg, school, parents, and self) at older age points to establish patterns over time. Through collaboration across the highly specialized craniofacial centers, the CC-UK hopes to work toward this goal moving forward.
Collapse
Affiliation(s)
| | - Katie Piggott
- Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Louise Dalton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Jo Horton
- Craniofacial Unit, Birmingham Women's and Children's Hospital, Birmingham
| | - Christopher Parks
- Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Samuel White
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Gillian Wright
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Anna Kearney
- Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| |
Collapse
|
12
|
Butterworth S, Fitzsimons KJ, Medina J, Britton L, Van Eeden S, Wahedally H, Park MH, van Der Muelen J, Russell CJH. Investigating the Impact of Patient-Related Factors on Speech Outcomes at 5 Years of Age in Children With a Cleft Palate. Cleft Palate Craniofac J 2023; 60:1578-1590. [PMID: 35733360 DOI: 10.1177/10556656221110094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To investigate the relationship between patient-related factors (sex, cleft type, cleft extent, and Robin Sequence [RS]) and speech outcome at 5 years of age for children born with a cleft palate ± lip (CP ± L). 3157 Children (1426 female:1731 male) with a nonsyndromic CP ± L, born between 2006 and 2014 in England, Wales, and Northern Ireland. Perceptual speech analysis utilized the Cleft Audit Protocol for Speech-Augmented (CAPS-A) rating and UK National Speech Outcome Standards: Speech Standard 1 (SS1)-speech within the normal range, SS2a-no structurally related speech difficulties or history of speech surgery, and SS3-speech without significant cleft-related articulation difficulties. Odds of achieving SS1 were lower among boys (aOR 0.771 [CI 0.660-0.901]), those with clefts involving the lip and palate (vs palate only) (UCLP-aOR 0.719 [CI 0.591-0.875]; BCLP-aOR 0.360 [CI 0.279-0.463]), and clefts involving the hard palate (incomplete-aOR 0.701 [CI 0.540-0.909]; complete-aOR 0.393 [CI 0.308-0.501]). Similar relationships with these patient factors were observed for SS3. SS2 was affected by the extent of hard palate involvement (complete; aOR 0.449 [CI 0.348-0.580]). Although those with CP and RS were less likely to meet all 3 standards than those without RS, odds ratios were not significant when adjusting for sex and cleft extent. Sex, cleft type, and extent of hard palate involvement have a significant impact on speech outcome at 5 years of age. Incorporating these factors into risk-adjustment models for service-level outcome reporting is recommended.
Collapse
Affiliation(s)
- Sophie Butterworth
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Kate J Fitzsimons
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Jibby Medina
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Lorraine Britton
- Trent Regional Cleft Network, Nottingham University Hospital NHS Trust, Nottingham, UK
| | | | | | - Min Hae Park
- London School of Hygiene and Tropical Medicine, London, UK
| | - Jan van Der Muelen
- Cleft Registry and Audit Network, Clinical Excellence Unit, The Royal College of Surgeons of England, London, UK
| | - Craig J H Russell
- Royal Hospital for Children, Queen Elisabeth University Hospital, Glasgow, UK
| |
Collapse
|
13
|
Costa B, Edwards W, Wilkinson-Bell K, Stock NM. Raising a Child with Craniosynostosis: Psychosocial Adjustment in Caregivers. Cleft Palate Craniofac J 2023; 60:1284-1297. [PMID: 35786018 DOI: 10.1177/10556656221102043] [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: 11/15/2022] Open
Abstract
OBJECTIVE While knowledge of the psychosocial impact of craniofacial conditions is growing, literature regarding the impact on parents remains limited. Parents of children born with a health condition may be at risk of experiencing a range of psychosocial challenges. This study conducted an initial investigation of psychosocial adjustment of parents of individuals with craniosynostosis to inform support provision for families. SETTING An online UK-wide mixed-methods survey was distributed to members of Headlines Craniofacial Support. DESIGN Quantitative data including standardized measures were analysed using descriptive statistics and independent samples t-tests, and inductive content analysis was used for open-ended questions. PARTICIPANTS Mothers (n = 109) and fathers (n = 9) of individuals ages 3 months to 49 years with single suture (63%) or syndromic (33%) craniosynostosis participated. RESULTS Compared to the general population, parents of individuals with craniosynostosis reported higher levels of stress, anxiety, and depression; lower levels of resilience and optimism. Qualitative responses provided insight into parents' experiences of birth, diagnosis, healthcare provision, familial wellbeing, and relationships. Parents reported several unmet information and support needs, alongside a range of positive outcomes. CONCLUSIONS This study illustrates the potential long-term psychosocial implications for parents raising children with craniosynostosis. There is a need for routine psychological screening for family members and provision of appropriate psychological support for those at risk for distress. Non-specialist health professionals may benefit from additional training about craniofacial conditions so they are better equipped to support and refer families.
Collapse
Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Wendy Edwards
- Headlines Craniofacial Support, St Albans, Hertfordshire, UK
| | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| |
Collapse
|
14
|
Netherton J, Horton J, Stock NM, Shaw R, Noons P, Evans MJ. Psychological Adjustment in Apert Syndrome: Parent and Young Person Perspectives. Cleft Palate Craniofac J 2023; 60:461-473. [PMID: 34967688 DOI: 10.1177/10556656211069817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To date, limited research has been carried out into the psychological impact of having a diagnosis of Apert syndrome (AS) and the life experiences of families living with this condition. The aim of the current study was to explore psychological adjustment to AS from the perspectives of young people, and their parents, with the broader goal of informing care, and support for this population. Four young people (2 male) aged 11 to 15 years and their mothers were interviewed in their homes using a semistructured interview guide and photo-elicitation methods. Transcripts were analyzed using Interpretive Phenomenological Analysis. Three superordinate themes were identified from the data: (1) Acceptance and Adjustment: A Cyclical Journey; (2) A Barrier to Adjustment: Navigating Treatment; and (3) Facilitating Adjustment: Social Support. Families described adjustment as a cyclical process, which was sensitive to change, particularly in the context of ongoing medical treatment. Families also utilized many resources, particularly in the form of social support, to adjust to the challenges of AS and build resilience. The findings of this study have important implications for the implementation of patient-centered care within designated craniofacial treatment centers, which should at a minimum include the provision of reliable information throughout the treatment pathway, additional support from health professionals at key times of transition, and the coordination of support across medical teams, and other key organizations in the child's life.
Collapse
Affiliation(s)
- Jennifer Netherton
- Health in Mind Team, 1729Birmingham Women's and Children's Hospital UK, Birmingham, United Kingdom
| | - Jo Horton
- Health in Mind Team, 1729Birmingham Women's and Children's Hospital UK, Birmingham, United Kingdom
| | - Nicola M Stock
- Centre for Appearance Research, University of the West of England UK, Bristol, United Kingdom
| | - Rachel Shaw
- School of Psychology, 14288Aston University UK, Birmingham, United Kingdom
| | - Peter Noons
- Craniofacial Team, 1729Birmingham Women's and Children's Hospital UK, Birmingham, United Kingdom
| | - Martin J Evans
- Craniofacial Team, 1729Birmingham Women's and Children's Hospital UK, Birmingham, United Kingdom
| |
Collapse
|
15
|
Stock NM, Costa B, Wilkinson-Bell K, Culshaw L, Kearney A, Edwards W. Psychological and Physical Health Outcomes in Adults With Craniosynostosis. Cleft Palate Craniofac J 2023; 60:257-267. [PMID: 34866454 PMCID: PMC9900192 DOI: 10.1177/10556656211059966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Within current research, little is known about the long-term outcomes of craniosynostosis. A priority-setting exercise by UK charity Headlines Craniofacial Support identified 2 key questions in this area: (1) What are the long-term physical and psychological effects for individuals with syndromic and non-syndromic craniosynostosis? and (2) Are individuals with craniosynostosis likely to suffer from mental health difficulties, or are they more resilient? The aim of the current study was to conduct an initial investigation of these priority questions. METHODS A comprehensive UK-wide survey consisting of 9 standardized psychological outcome measures and open-ended questions was distributed online. Thirty-six eligible adults (69.4% female) with a mean age of 30.8 years responded to the survey. Participants reported having single suture craniosynostosis (27.8%) or syndromic craniosynostosis (52.8%), with 19.4% being unsure of their diagnosis. Sample means were compared to published norms using independent samples t tests. Qualitative responses were analysed using inductive content analysis. RESULTS Compared to the general population, participants reported significantly less favorable scores related to appearance concerns, attachment in adult relationships, anxiety, optimism, and resilience. Self-worth, depression, and social anxiety scores were similar to norms. Qualitative responses provided additional insight into participants' satisfaction with appearance, physical health, medical treatment, employment, relationships, and recurrence risks. Few participants had accessed psychological support. DISCUSSION This preliminary study illustrates the potential long-term implications for individuals with craniosynostosis. Improved treatment protocols are needed to address physical health concerns in adulthood, while dedicated psychological resources are necessary to promote emotional well-being, social confidence, and resilience.
Collapse
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England,
Coldharbour Lane, Bristol, United Kingdom
- Nicola Marie Stock, Centre for Appearance
Research, University of the West of England, Bristol BS16 1QY, United Kingdom.
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England,
Coldharbour Lane, Bristol, United Kingdom
| | | | - Laura Culshaw
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
| | - Anna Kearney
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation
Trust, Liverpool, United Kingdom
| | - Wendy Edwards
- Headlines Craniofacial Support, St Albans, Hertfordshire, United
Kingdom
| |
Collapse
|
16
|
Millgård M, Feragen KB, Ullmann Miller J, Arfa S, Williamson H, Kling J. Adolescents and parents' perception of Young Person's Face IT: An online intervention for adolescents struggling with conditions affecting their appearance. Digit Health 2022; 8:20552076221147110. [PMID: 36601286 PMCID: PMC9806409 DOI: 10.1177/20552076221147110] [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] [Received: 06/17/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022] Open
Abstract
Objective A visible difference in appearance caused by a congenital or acquired condition can negatively affect adolescents' psychosocial well-being. Young Person's Face IT (YPF) is an online intervention based on cognitive behavioural therapy and social skills training, developed to help adolescents who struggle with adjusting to a visible difference. The objective of the present study was to explore adolescents' and parents' perceptions of the intervention's relevance and usefulness in supporting young people with appearance-related psychosocial concerns. Methods Participants were adolescents (N = 76, aged 11-18) and parents (N = 15), recruited in a larger randomised controlled trial aiming at evaluating YPF. This qualitative study with descriptive data includes adolescents' ratings on YPF's usefulness, and interview data from adolescents and parents on their experiences with YPF. The interviews were analysed using a thematic approach. Results Results indicated that YPF was experienced as useful and relevant. Interviews showed that adolescents felt validated through the programme's content, discovered that other young people had similar experiences and felt that YPF could contribute to changing self-perceptions for the better. However, results could not confirm whether perceived usefulness led to the development and use of new social skills in real-life situations. Conclusion This study offers new perspectives on the relevance and usefulness of YPF in supporting adolescents with appearance-related psychosocial concerns. Findings suggest that updates and modifications are required so that YPF stays relevant and useful for adolescents in need of support. Trial registration number NCT03165331.
Collapse
Affiliation(s)
- Moa Millgård
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway,Moa Millgård, Centre for Rare Disorders,
Oslo University Hospital, PB 4950 Nydalen, 0424 Oslo, Norway.
| | | | | | - Shahrzad Arfa
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of
England, Bristol, UK
| | - Johanna Kling
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
17
|
Reducing social anxiety in adolescents distressed by a visible difference: Results from a randomised control trial of a web-based intervention. Body Image 2022; 40:295-309. [PMID: 35121566 DOI: 10.1016/j.bodyim.2022.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 01/28/2023]
Abstract
A visible difference to the face or body may challenge adolescents' adjustment and engagement in life activities, where some require psychosocial support. However, evidence is limited for whether existing interventions for this adolescent group reduce social or appearance-related distress. We therefore conducted a parallel-group, randomised control trial to evaluate the effectiveness of Young Person's Face IT, a self-guided web-based psychosocial intervention developed for adolescents with a visible difference who experience distress. Adolescents (N = 189, aged 11-18) from two countries (Norway and the Netherlands), were randomly allocated to an intervention group or care as usual (CAU). Outcomes were body esteem, social anxiety, perceived stigmatisation, and life disengagement. Compared with CAU, participants who completed Young Person's Face IT showed reductions in social anxiety symptoms (ηp2 = 0.06). No significant improvements were found for the other outcomes. This study endorses web-based psychosocial support in reducing social anxiety in adolescents distressed by a visible difference. Future studies are needed to confirm the effectiveness of Young Person's Face IT and to explore potential long-term effects.
Collapse
|
18
|
Fazel M, Afshari E, Jarrahi N. Dental management of tricho-dento-osseous syndrome in adolescent patients: Literature review and case presentation. Dent Res J (Isfahan) 2022; 18:98. [PMID: 35003563 PMCID: PMC8672132 DOI: 10.4103/1735-3327.330879] [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: 08/03/2020] [Revised: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 11/04/2022] Open
Abstract
Tricho-dento-osseous syndrome (TDO) is a rare autosomal dominant disorder with complete penetrance. Common clinical features include abnormalities of hair, teeth, and skull. Dental management of TDO patients is quite challenging in terms of existing dental and skeletal problems. The current article presents a 12-year-old girl suffering TDO, followed by a review on the published literature pertaining to the dental management of TDO patients. Patient history included, rejected corneal transplantation, stone-forming kidneys, and several previous dental treatments. She was noted to have signs of mandibular prognatia, frontal bossing of the skull, mild bilateral tibial bowing, microstomia, and labial fissures. Dental findings included severe generalized enamel defects, discolored teeth, microdontia, anterior open-bite, posterior cross-bite, deep periodontal pockets, hyperplastic inflamed gingiva, taurodontism of permanent molars, dental periapical radiolucencies, and missing teeth. She was the only child of healthy, nonconsanguineous parents with no familial history of similar congenital syndrome or dental abnormalities. A treatment plan was established based on medical/dental history and findings, using a team-based approach. This article emphasizes the importance of a multidisciplinary approach for the dental management of patients suffering TDO.
Collapse
Affiliation(s)
- Mojtaba Fazel
- Department of Emergency Medicine, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Elham Afshari
- Department of Pediatric Dentistry, School of Dentistry, Golestan university of Medical Sciences, Gorgan, Iran
| | - Neda Jarrahi
- Department of Prosthodontics, School of Dentistry, North Khorasan University of Medical Sciences, Bojnord, Iran
| |
Collapse
|
19
|
Feragen KJB, Myhre A, Stock NM. "Will You Still Feel Beautiful When You Find Out You Are Different?": Parents' Experiences, Reflections, and Appearance-Focused Conversations About Their Child's Visible Difference. QUALITATIVE HEALTH RESEARCH 2022; 32:3-15. [PMID: 34596475 PMCID: PMC8739583 DOI: 10.1177/10497323211039205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To investigate parents' reflections and experiences of having a child born with an appearance-altering condition, interviews with 33 parents of children born with rare craniofacial conditions were analyzed using inductive thematic analysis. Three themes emerged: "Managing emotions: A dynamic process," "Through another lens: External reminders of difference," and "Awareness of difference: Approaching the child." Findings suggest that although parents learned to accept and love their child's visible difference, external factors such as appearance-altering surgery and other people's reactions activated difficult emotions in parents. Parents struggled to decipher whether and when to raise appearance-related issues with their child, and how this could be done without distressing the child. Anticipatory guidance that facilitates positive appearance-focused conversations both within and outside the home seems to be needed. Parenting skills could also be strengthened by preparing parents for social reactions to the child's visible difference, and their child's changed appearance following surgery.
Collapse
|
20
|
Svalina A, Heikura E, Savolainen T, Serlo W, Sinikumpu JJ, Silvola AS, Salokorpi N. Appearance or attitude: what matters to craniosynostosis patients? Association of self-esteem, depressive symptoms, and facial aesthetics in patients with sagittal and metopic synostosis. Childs Nerv Syst 2022; 38:1929-1936. [PMID: 35732900 PMCID: PMC9522694 DOI: 10.1007/s00381-022-05587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE The aim of this study was to investigate the presence of depressive symptoms and self-esteem, and their association with facial asymmetry in adults who were operated on in early childhood due to metopic and sagittal craniosynostosis. METHODS The study population consisted of 49 non-syndromic patients of whom 41 had premature fusion of the sagittal and 8 of metopic suture. There were 64 controls from the Finnish National Register. Self-esteem, depressive symptoms, and subjective satisfaction with one's appearance were evaluated by using the Rosenberg self-esteem questionnaire (RSE), the short form of Beck Depression Inventory (R-BDI), and a purpose-designed questionnaire on satisfaction with facial and overall appearance. Aesthetic evaluation was done from standard photographs using panels. The facial symmetry was calculated by using 3D photogrammetric methods. RESULTS Patients did not have a lower self-esteem or experience significantly more moderate or severe depressive symptoms. However, 20% of the patients and 6% of the controls (p = 0.041) experienced mild depressive symptoms. There was no difference between self-assessed evaluation of appearance between the groups. Only weak correlation was found between facial asymmetry and RSE or R-BDI results (cc = 0.27-0.42, p < 0.05). The self-assessed evaluation of facial and overall appearance correlated strongly with the R-BDI results. CONCLUSION Non-syndromic craniosynostosis patients are as satisfied with their appearance in adulthood as the control group and do not experience a lower self-esteem or more depressive symptoms. Facial asymmetry does not correlate with low self-esteem or clinically significant depressive symptoms in adulthood. Subjective evaluation of one's appearance correlated with depressive symptoms. Age and gender do not influence the former results. Overall, patients are satisfied with their appearance.
Collapse
Affiliation(s)
- Anja Svalina
- Research Unit of Clinical Neuroscience, Oulu University Hospital and University of Oulu, Oulu, Finland. .,PEDEGO Research Group, University of Oulu, Oulu, Finland. .,Department of Neurosurgery, Oulu University Hospital, PO Box 21, 90029, Oulu, OYS, Finland.
| | - Emma Heikura
- grid.10858.340000 0001 0941 4873PEDEGO Research Group, University of Oulu, Oulu, Finland
| | - Tuula Savolainen
- grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Willy Serlo
- grid.10858.340000 0001 0941 4873PEDEGO Research Group, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital, Oulu, Finland ,grid.412326.00000 0004 4685 4917Department of Children and Adolescent, Oulu University Hospital, Oulu, Finland
| | - Juha-Jaakko Sinikumpu
- grid.10858.340000 0001 0941 4873PEDEGO Research Group, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital, Oulu, Finland ,grid.412326.00000 0004 4685 4917Department of Children and Adolescent, Oulu University Hospital, Oulu, Finland
| | - Anna-Sofia Silvola
- grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital, Oulu, Finland ,grid.10858.340000 0001 0941 4873Department of Orthodontics, Faculty of Medicine, Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Niina Salokorpi
- grid.412326.00000 0004 4685 4917Research Unit of Clinical Neuroscience, Oulu University Hospital and University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
21
|
The Craniofacial Collaboration UK: Developmental Outcomes in 3-Year-Old Children With Metopic Synostosis. J Craniofac Surg 2021; 33:112-116. [PMID: 34967518 DOI: 10.1097/scs.0000000000008045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The Craniofacial Collaboration UK (CC-UK) has been established across the 4 highly specialized craniofacial centers in the UK since 2015. This joint collective aims to address the current limitations within developmental craniofacial research, using robust clinical data from a homogenous sample of children. This paper presents the third wave of findings from the CC-UK, with consideration to developmental and behavioral parent-report measures. Whilst previous data for sagittal synostosis have been presented, this article summarizes the analysis of these outcomes for children with metopic synostosis (MS) at 3 years who have undergone primary corrective surgery. Results highlight similar patterns to that of earlier CC-UK work, with the majority of children falling within 1 standard deviation of the population normative means across all measures. However, statistically significant difficulties were found between group means for children with MS on various developmental and behavioral domains. Prosocial skills and peer difficulties were reported as the greatest areas of behavioral concern for parents, with prosocial skills found to be below the level expected for their chronological age. In order to further understand the developmental trajectory of children with MS, longitudinal examination of individual diagnostic and specific age groups with single-suture craniosynostosis is crucial. The continuation of the CC-UK provides an opportunity to attain this goal.
Collapse
|
22
|
A Booklet to Promote Psychological Health in New Families Affected by Craniosynostosis. J Craniofac Surg 2021; 33:1670-1673. [PMID: 34974462 DOI: 10.1097/scs.0000000000008454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Recent research indicates that parents of children with craniosynostosis may be at risk of emotional distress. Yet, parents may not be accessing the support they need to cope with common challenges. The aim of this project was to develop a research-informed booklet to promote psychological health in new families, and to assess acceptability of the booklet within the craniosynostosis community. The first draft was designed in close collaboration with leading UK charity Headlines Craniofacial Support 5 parent representatives, and 3 specialist clinical psychologists via online focus groups. The draft booklet, attached to an online acceptability survey, was distributed to a broader group of parents and multidisciplinary specialists working in craniofacial teams in England for feedback. A total of 44 complete responses to the online acceptability survey were received. Acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents reported they "agreed" or "strongly agreed" with the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support parents. It is hoped this booklet will begin to address the gap in psychological support for new families affected by craniosynostosis.
Collapse
|
23
|
Parental Reports of Intervention Services and Prevalence of Teasing in a Multinational Craniofacial Microsomia Pediatric Study. J Craniofac Surg 2021; 32:2687-2691. [PMID: 34727472 DOI: 10.1097/scs.0000000000007999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT Children with craniofacial microsomia (CFM) are at increased risk for educational and social concerns. This study describes intervention services and frequency of teasing in a multinational population of children with CFM. Caregivers of children with CFM ages 3 to 18 years in the US and South America were administered a questionnaire. Additional information was gathered from medical charts and photographs. Participants (N = 169) had an average age of 10.1 ± 6.2 years, were primarily male (60%), and from the US (46%) or Colombia (32%). Most participants had microtia and mandibular hypoplasia (70%). They often had unilateral (71%) or bilateral (19%) hearing loss and 53% used a hearing aid. In the US, special education services were provided for 48% of participants enrolled in school; however, similar services were rare (4%) in South America and reflect differences in education systems. Access to any intervention service was higher in the US (80%) than in South America (48%). Caregivers reported children showed diagnosis awareness by an average age of 4.4 ± 1.9 years. Current or past teasing was reported in 41% of the children, starting at a mean age of 6.0 ± 2.4 years, and most often took place at school (86%). As half of the US participants received developmental and academic interventions, providers should screen for needs and facilitate access to services. Given diagnosis awareness at age 4 and teasing at age 6, providers are encouraged to assess for psychosocial concerns and link to resources early in treatment.
Collapse
|
24
|
Pediatric Cranial Defects: What Size Warrants Repair? J Craniofac Surg 2021; 33:517-520. [PMID: 34643599 DOI: 10.1097/scs.0000000000008284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Identifying which cranial defects among children warrant surgical repair is integral to providing adequate protection of the skull whereas minimizing exposure to surgical complications. This review examines the available evidence regarding the role of defect size in determining the appropriateness of nonsurgical versus surgical management. METHODS An electronic literature review was performed using PubMed and Google Scholar to identify publications that provided rationales for nonsurgical management of cranial defects in the pediatric population based on size. Titles and abstracts were reviewed by the authors to determine eligibility for full-text analysis. Ineligible studies were categorized and relevant data from fully analyzed texts were recorded. RESULTS Of the 523 articles that were reviewed, 500 were ineligible for full-text analysis due to the following most common reasons: no cranial defect described (227, 45%), did not discuss management of cranial defects (68, 14%), or surgery was performed on all defects in evaluation of a technique or protocol (86, 17%). Ten publications provided relevant data. The suggested size below which surgery was not recommended varied widely between articles. Beyond the age of 1 to 2 years, no general agreement on recommended management in children was found. Craniofacial surgeons had divergent views on the minimum diameter for a "critical" defect and the size for which surgical repair is necessary. CONCLUSIONS Little guidance or consensus exists regarding the indications for surgical correction of cranial defects based on the size of the defect. Objective data is needed to classify "clinically critical defects" in the pediatric population.
Collapse
|
25
|
Myhre A, Råbu M, Feragen KJB. The need to belong: Subjective experiences of living with craniofacial conditions and undergoing appearance-altering surgery. Body Image 2021; 38:334-345. [PMID: 34087543 DOI: 10.1016/j.bodyim.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/08/2021] [Accepted: 05/20/2021] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to better understand how individuals with craniofacial conditions experience living with visible differences and make sense of appearance-altering surgery. We conducted semi-structured qualitative interviews with 11 adults with Goldenhar or Crouzon syndrome. Interviews were analysed using a hermeneutic-phenomenological approach to thematic analysis. Our analysis revealed the following overarching theme, To see myself as other people see me, which encompassed three main themes: a) Striving to fit in, b) Altering the way I look and c) Support from family and friends. The participants' sense of their own appearance seemed to be connected to how they perceived others to evaluate their appearance. All had experienced negative reactions from others. They experienced themselves as different and had a desire to belong. All participants had undergone appearance-altering surgery, hoping that by changing appearance, they would reduce negative reactions and feel more connected to and accepted by other people. The process of undergoing appearance-changing surgery was experienced as challenging, and participants wished for a dialogue with surgeons which included psychological and emotional aspects of changing appearance. A better understanding of how to strengthen positive identity processes and feelings of belongingness should be a key focus of future research.
Collapse
Affiliation(s)
- Anita Myhre
- Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.
| | - Marit Råbu
- University of Oslo, Department of Psychology, Postboks 1094 Blindern, 0317, Oslo, Norway.
| | - Kristin J B Feragen
- Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.
| |
Collapse
|
26
|
van Dalen M, Hermans MM, Leemreis WH, Kraaij V, De Laat PCJ, Pasmans SGMA, Versnel SL, Koudstaal MJ, Hillegers MHJ, Utens EMWJ, Okkerse JME. Emotional and Behavioral Problems in Children With a Cleft Lip With or Without Palate or an Infantile Hemangioma. Cleft Palate Craniofac J 2021; 59:S74-S83. [PMID: 34293942 DOI: 10.1177/10556656211031411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Life can be challenging for children with a visible difference due to a medical condition, and they might be at risk for emotional and behavioral problems. This study examines emotional and behavioral problems in children with a cleft lip with or without palate (CL ± P) or an infantile hemangioma (IH) in relation to the visibility of the condition, the presence of additional condition-related problems, and parental affect. SETTING This cross-sectional study took place in an academic medical hospital in the Erasmus MC Sophia Children's Hospital, the Netherlands. PARTICIPANTS A total of 309 parents (mean age = 40.34, 44.00% male) of 182 children with CL ± P and 48 parents (mean age = 39.21, 37.50% male) of 33 children with an IH completed questionnaires. Children were 1.5 to 12 years old. RESULTS Parents reported fewer child emotional and behavioral problems compared to normative data. Problems reported were mainly related to learning difficulties and parent gender, while visibility of the condition had no significant influence. Parental negative affect was related to child internalizing problems. Parental positive affect was not related to any of the outcome measures. CONCLUSIONS Parents reported fewer problems for their children compared to normative data. This is inconsistent with previous research, showing similar or worse scores for these children compared to peers. Our findings may be explained by a protective parenting style, a response shift in parents, or problems developing at a later point in life.
Collapse
Affiliation(s)
- Marije van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Mireille M Hermans
- Department of Dermatology, Centre of Pediatric Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Willem H Leemreis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Vivian Kraaij
- Clinical Psychology, Leiden University, the Netherlands
| | - Peter C J De Laat
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Sarah L Versnel
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, the Netherlands.,Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Jolanda M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| |
Collapse
|
27
|
Good Outcome for an Individual with Severe Facial Anomalies and Hypogonadotropic Hypogonadism: A Consequence of His Cognitive Function, Pragmatic Approach, and Temperament. Case Rep Pediatr 2021; 2021:9957218. [PMID: 34194860 PMCID: PMC8214474 DOI: 10.1155/2021/9957218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 11/18/2022] Open
Abstract
The multiple factors that determine outcomes for individuals with visible developmental errors and/or atypical development of the reproductive system are not fully understood. This case report of an individual with Bosma arhinia microphthalmia syndrome causing severe facial anomalies and hypogonadotropic hypogonadism is used to highlight factors that impacted his adjustment from childhood through adulthood. Key factors include his temperament, intact cognitive ability, and pragmatic approach for controlling his physical and social environment. His successful adjustment even in the face of significant early life challenges demonstrates that positive outcomes are attainable for individuals with significant developmental errors. His story and experiences with the health-care system offer insight into some factors that may be pertinent to resilience and lifelong adjustment for patients with similar conditions and the importance of continually seeking the patient's perspective to tailor treatment across the lifespan.
Collapse
|
28
|
Klassen AF, Rae C, Wong Riff KW, Bulstrode N, Denadai R, Goldstein J, Hol ML, Murray DJ, Bracken S, Courtemanche DJ, O'Hara J, Butler D, Tassi A, Malic CC, Ganske IM, Phua YS, Marucci DD, Johnson D, Swan MC, Breuning EE, Goodacre TE, Pusic AL, Cano S. FACE-Q Craniofacial Module: Part 1 validation of CLEFT-Q scales for use in children and young adults with facial conditions. J Plast Reconstr Aesthet Surg 2021; 74:2319-2329. [PMID: 34274246 DOI: 10.1016/j.bjps.2021.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/09/2021] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The CLEFT-Q includes 12 independently functioning scales that measure appearance (face, nose, nostrils, teeth, lips, jaws), health-related quality of life (psychological, social, school, speech distress), and speech function, and an eating/drinking checklist. Previous qualitative research revealed that the CLEFT-Q has content validity in noncleft craniofacial conditions. This study aimed to examine the psychometric performance of the CLEFT-Q in an international sample of patients with a broad range of facial conditions. METHODS Data were collected between October 2016 and December 2019 from 2132 patients aged 8 to 29 years with noncleft facial conditions. Rasch measurement theory (RMT) analysis was used to examine Differential Item Function (DIF) by comparing the original CLEFT-Q sample and the new FACE-Q craniofacial sample. Reliability and validity of the scales in a combined cleft and craniofacial sample (n=4743) were examined. RESULTS DIF was found for 23 CLEFT-Q items when the datasets for the two samples were compared. When items with DIF were split by sample, correlations between the original and split person locations showed that DIF had negligible impact on scale scoring (correlations ≥0.995). In the combined sample, RMT analysis led to the retention of original content for ten CLEFT-Q scales, modification of the Teeth scale, and the addition of an Eating/Drinking scale. Data obtained fit with the Rasch model for 11 scales (exception School, p=0.04). Person Separation Index and Cronbach alpha values met the criteria. CONCLUSION The scales described in this study can be used to measure outcomes in children and young adults with cleft and noncleft craniofacial conditions.
Collapse
Affiliation(s)
- Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Karen Wy Wong Riff
- Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Neil Bulstrode
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Sao Paulo , Brazil.
| | - Jesse Goldstein
- Department of Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Marinka Lf Hol
- Department of Otolaryngocoloy and Head and Neck Surgery, University Medical Center Utrecht, Prinses Maxima Center for Childhood oncology, Utrecht, The Netherlands.
| | - Dylan J Murray
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | - Shirley Bracken
- National Paediatric Craniofacial Centre, Children's Health Ireland at Temple Street, Dublin, Ireland.
| | | | - Justine O'Hara
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Daniel Butler
- Division of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, UK.
| | - Ali Tassi
- Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Claudia C Malic
- Department of Surgery, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada.
| | - Ingrid M Ganske
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
| | - Yun S Phua
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, Brisbane, Australia.
| | - Damian D Marucci
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia.
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Marc C Swan
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Eleonore E Breuning
- Department of Plastic Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom.
| | - Tim Ee Goodacre
- Spires Cleft Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Stefan Cano
- Modus Outcomes, Letchworth Garden City, United Kingdom.
| |
Collapse
|
29
|
Kennedy-Williams P, Care H, Dalton L, Horton J, Kearney A, Rooney N, Hotton M, Pinckston M, Huggons E, Culshaw L, Kilcoyne S, Johnson D, Wilkie AOM, Wall S. Neurodevelopmental, Cognitive, and Psychosocial Outcomes for Individuals With Pathogenic Variants in the TCF12 Gene and Associated Craniosynostosis. J Craniofac Surg 2021; 32:1263-1268. [PMID: 33904513 DOI: 10.1097/scs.0000000000007535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Heterozygous mutations in the TCF12 gene were discovered in 2013 as a cause of craniosynostosis (CS). However, limited information regarding the behavioral phenotypic profile is available. Here the authors provide the first detailed study of the neurodevelopmental, cognitive, and psychosocial outcomes for patients with a pathogenic TCF12 variant and associated CS.A clinical casenote audit was conducted at the 4 UK highly specialized craniofacial centers. A total of 35 patients aged 18 months to 10 years with an identified TCF12 pathogenic variant and CS (bicoronal CS = 45.7%, unicoronal CS = 40.0%, multisuture = 14.3%) were included. Standardized screening and/or assessment of full-scale intelligence quotient, social communication, development, behavior, and self-concept were conducted.In the majority of cases, outcomes were consistent with age-related expectations. About 75% of patients demonstrated no delay across any early developmental domain, while 84.6% demonstrated full-scale intelligence quotient scores within 1 standard deviation of the population mean. Significant behavioral difficulties were demonstrated by parent reporters in 26.3% to 42.1% of cases (dependent upon domain). Clinically elevated social communication profiles were present in (41.7%) of parent-reported cases. Levels of self-concept (at age 10) were consistent with age-related normative data.Most patients with a TCF12 pathogenic variant had a mild behavioral and cognitive phenotype, although they may be at a slightly increased risk of social communication difficulties and psychosocial issues. Although not measured statistically, there were no clear associations between surgical history and cognitive, behavioral, or psychosocial outcomes. This paper highlights the need for robust integrated developmental assessment of all CS patients, particularly those with an identified syndrome.
Collapse
Affiliation(s)
| | - Helen Care
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Louise Dalton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Jo Horton
- Birmingham Children's Hospital Craniofacial Unit, Birmingham Women's and Children's Hospital, Birmingham
| | - Anna Kearney
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Natasha Rooney
- Great Ormond Street Hospital for Children Craniofacial Unit, Great Ormond Street NHS Foundation Trust, London, United Kingdom
| | - Matthew Hotton
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Molly Pinckston
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Esme Huggons
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Laura Culshaw
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Sarah Kilcoyne
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| | - Andrew O M Wilkie
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
- MRC Weatherall Institute of Molecular Medicine, Oxford
| | - Steven Wall
- Oxford Craniofacial Unit, Oxford University Hospitals NHS Foundation Trust
| |
Collapse
|
30
|
Kamran R, Longmire NM, Rae C, Riff KWYW, Forrest CR, O’Hara J, Bulstrode N, Klassen AF. Concepts Important to Patients With Facial Differences: A Qualitative Study Informing a New Module of the FACE-Q for Children and Young Adults. Cleft Palate Craniofac J 2020; 58:1020-1031. [DOI: 10.1177/1055665620969589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The concepts important to children and young adults who undergo treatments for facial differences are not well-defined. Measurement of treatment outcomes from the patient’s perspective is necessary to ensure goals of treatment are met. We aimed to identify concepts important to children and young adults with facial differences through a qualitative study. Design: An interpretive description qualitative approach was followed. Semistructured interviews were conducted, transcribed verbatim, and coded using a line-by-line approach. Qualitative analysis led to the development of a conceptual framework of outcomes important to patients. Setting: Interviews were conducted in Canada and the United Kingdom at home, by telephone, or in the hospital. Participants: Participants (N = 72) were recruited between May and June 2014 from craniofacial clinics at the Hospital for Sick Children (Toronto) and Great Ormond Street Hospital (London). Participants included anyone with a visible and/or functional facial difference aged 8 to 29 years and fluent in English, excluding patients with a cleft. The sample included 38 females and 34 males, with a mean age of 13.9 years, and included 28 facial conditions (11 facial paralysis, 18 ear anomalies, 26 skeletal conditions, and 17 soft tissue conditions). Results: Analysis led to identification of important concepts within 4 overarching domains: facial appearance, facial function, adverse effects of treatment, and health-related quality of life (psychological, social, and school function). Conclusions: Our study provides an understanding of concepts important to children and young adults with facial differences.
Collapse
Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Karen W. Y. Wong Riff
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R. Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Ontario, Canada
| | - Justine O’Hara
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Neil Bulstrode
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
31
|
Schwartz DD, Fein RH, Carvalho CMB, Sutton VR, Mazzeu JF, Axelrad ME. Neurocognitive, adaptive, and psychosocial functioning in individuals with Robinow syndrome. Am J Med Genet A 2020; 185:3576-3583. [PMID: 32954672 DOI: 10.1002/ajmg.a.61854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 08/14/2020] [Indexed: 11/12/2022]
Abstract
It has been estimated that 10-15% of people with Robinow syndrome (RS) show delayed development, but no studies have formally assessed developmental domains. The objective of this study is to provide the first description of cognitive, adaptive, and psychological functioning in RS. Thirteen participants (10 males) aged 4-51 years were seen for neuropsychological screening. Eight had autosomal-dominant RS (DVL1, n = 5; WNT5A, n = 3), four had autosomal-recessive RS (NXN, n = 2; ROR2, n = 2), and one had a mutation on an RS candidate gene (GPC4). Participants completed measures of intellectual, fine-motor, adaptive, executive, and psychological functioning. Findings indicated generally average intellectual functioning and low-average visuomotor skills. Adaptive functioning was average in autosomal-recessive RS (RRS) but low average in autosomal-dominant RS (DRS). Parent-report indicated executive dysfunction and attention problems in 4/8 children, 3/4 of whom had a DVL1 variant; adult self-report did not indicate similar difficulties. Learning disabilities were also reported in 4/8 individuals with DRS, 3/4 of whom had a DVL1 variant. Peer problems were reported for a majority of participants, many of whom also reported emotional concerns. Altogether, the findings indicate average neurocognitive functioning in RRS. In contrast, DRS, especially DVL1 pathogenic alleles, may confer specific risk for neurodevelopmental disability.
Collapse
Affiliation(s)
- David D Schwartz
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rachel H Fein
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Claudia M B Carvalho
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Marni E Axelrad
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
32
|
Craniofacial Collaboration UK: Developmental Outcomes in 5-Year-Old Children With Sagittal Synostosis. J Craniofac Surg 2020; 32:51-54. [DOI: 10.1097/scs.0000000000006973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
33
|
Johns AL, Wallace ER, Collett BR, Kapp-Simon KA, Drake AF, Heike CL, Kinter SL, Luquetti DV, Magee L, Norton S, Sie K, Speltz ML. Behavioral Adjustment of Preschool Children With and Without Craniofacial Microsomia. Cleft Palate Craniofac J 2020; 58:42-53. [PMID: 32783465 DOI: 10.1177/1055665620947987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The study aim was to assess behavioral adjustment in preschool children with and without craniofacial microsomia (CFM). DESIGN Multisite cohort study of preschoolers with CFM ("cases") or without CFM ("controls"). PARTICIPANTS Mothers (89%), fathers (9%), and other caregivers (2%) of 161 preschoolers. OUTCOME MEASURE Child Behavior Check List (CBCL 1.5-5); linear regressions with standardized effect sizes (ES) adjusted for sociodemographic confounds. RESULTS Child Behavior Check Lists for 89 cases and 72 controls (average age 38.3 ± 1.9 months). Children were male (54%), white (69%), and of Latino ethnicity (47%). Cases had microtia with mandibular hypoplasia (52%), microtia only (30%), or other CFM-associated features (18%). Nearly 20% of cases had extracranial anomalies. Composite CBCL scores were in the average range compared to test norms and similar for cases and controls. On the subscales, cases' parents reported higher Anxious/Depressed scores (ES = 0.35, P = .04), Stress Problems (ES = 0.40, P = .04), Anxiety Problems (ES = 0.34, P = .04), and Autism Spectrum Problems (ES = 0.41, P = .02); however, the autism subscale primarily reflected speech concerns. Among cases, more problems were reported for children with extracranial anomalies and certain phenotypic categories with small ES. CONCLUSIONS Behavioral adjustment of preschoolers with CFM was comparable to peers. However, parental reports reflected greater concern for internalizing behaviors; thus, anxiety screening and interventions may benefit children with CFM. Among cases, more problems were reported for those with more complex presentations of CFM. Craniofacial microsomia-related speech problems should be distinguished from associated psychosocial symptoms during developmental evaluations.
Collapse
Affiliation(s)
- Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, 5150Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.,24183Shriners Hospitals for Children, Chicago, IL, USA
| | - Amelia F Drake
- Otolaryngology, 2331University of North Carolina, Chapel Hill, NC, USA
| | - Carrie L Heike
- Craniofacial Center, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Sara L Kinter
- Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Kathleen Sie
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| |
Collapse
|
34
|
Saydam SZ, Çüçülayef D, Doğan TN, Crerand CE, Özek M. Social Experiences of Turkish Parents Raising a Child With Apert Syndrome: A Qualitative Study. Cleft Palate Craniofac J 2020; 58:354-361. [PMID: 32744062 DOI: 10.1177/1055665620944761] [Citation(s) in RCA: 3] [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 Apert syndrome is a rare and understudied craniofacial condition with regard to its psychosocial impact on children and their parents. Due to the lack of studies focusing solely on the social experiences of children and families with Apert syndrome, it is difficult to develop interventions and strategies to support well-being and positive adjustment for this particular population. This study addressed this gap by assessing the unique social experiences of parents who are raising their children with Apert syndrome including difficulties they face and strategies they use to cope with challenges. DESIGN Descriptive qualitative study using thematic analysis. PARTICIPANTS Participants included 21 parents of 12 children (aged 1-12 years) with Apert syndrome (9 couples, 2 fathers, and 1 mother) who were recruited from a pediatric neurosurgery unit in Turkey. RESULTS The qualitative analysis yielded four main themes describing the experiences of parents including (1) social challenges; (2) coping with negative reactions; (3) promoting socialization and independence; and (4) sources of strength. CONCLUSIONS Parents reported several challenges, including social stigmatization, and utilized a range of strategies to support both their own and their child's positive adaptation and resiliency, including the use of religion and reliance on their spouses for support. Results offer clinically relevant insights about the strengths and challenges of families coping with Apert syndrome.
Collapse
Affiliation(s)
| | | | | | - Canice E Crerand
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, USA.,Department of Plastic Surgery, The Ohio State University School of Medicine, Columbus, OH, USA.,The Center for Biobehavioral Health, The Abigail Wexner Research Institute at 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Memet Özek
- Division of Pediatric Neurosurgery, Department of Neurosurgery, 162328Acıbadem University, Altunizade Mahallesi, Yurtcan Sokağı, Üsküdar/İstanbul, Turkey
| |
Collapse
|
35
|
Crerand CE, Rumsey N, Kazak A, Clarke A, Rausch J, Sarwer DB. Sex differences in perceived stigmatization, body image disturbance, and satisfaction with facial appearance and speech among adolescents with craniofacial conditions. Body Image 2020; 32:190-198. [PMID: 32006855 PMCID: PMC8930279 DOI: 10.1016/j.bodyim.2020.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/01/2023]
Abstract
Youth with craniofacial conditions often have appearance and speech differences and are vulnerable to social stigmatization and body image disturbances. Given sociocultural pressures for female attractiveness, adolescent girls with craniofacial conditions may be especially vulnerable to body dissatisfaction and appearance-related social stigmatization, though such sex differences have been infrequently studied in this population. This study aimed to: (1) examine sex differences in body image disturbance, satisfaction with speech and facial appearance, and perceived stigmatization among adolescents with craniofacial conditions; and (2) evaluate whether stigmatization perceptions are predictive of body image disturbance and satisfaction with facial appearance and speech. Using a cross-sectional design, 110 adolescents from two craniofacial centers completed measures of body image disturbance, satisfaction with speech and facial appearance, and perceived stigmatization. Females reported significantly greater levels of body image disturbance and lower satisfaction with facial appearance compared to males. There were no significant sex differences for satisfaction with speech or perceived stigmatization. Perceived stigmatization was a significant predictor of body image disturbance, and satisfaction with facial appearance and speech while controlling for sex, body mass index, and age. Interventions to prevent and/or address body image and stigmatization concerns are clinically indicated for both sexes.
Collapse
Affiliation(s)
- Canice E. Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital (700 Children’s Drive, Columbus, OH 43205) and Department of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine (370 W. 9th Avenue, Columbus, OH 43210)
| | - Nichola Rumsey
- Center for Appearance Research, Department of Psychology, University of the West of England (Coldharbour Lane, Bristol, BS16 1QY, United Kingdom)
| | - Anne Kazak
- Nemours Children’s Health System (1600 Rockland Road, Wilmington, DE 19803) and Sidney Kimmel Medical College of Thomas Jefferson University (1025 Walnut Street #100, Philadelphia, PA, 19107)
| | - Alexandra Clarke
- Center for Appearance Research, Department of Psychology, University of the West of England (Coldharbour Lane, Bristol, BS16 1QY, United Kingdom)
| | - Joseph Rausch
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital (700 Children’s Drive, Columbus, OH 43205)
| | - David B. Sarwer
- College of Public Health, Temple University (3223 N. Broad Street, Suite 175, Philadelphia, PA 19140)
| |
Collapse
|
36
|
Shi P, Huang Y, Kou H, Wang T, Chen H. Risk Factors for Facial Appearance Dissatisfaction Among Orthognathic Patients: Comparing Patients to a Non-Surgical Sample. Front Psychol 2019; 10:2775. [PMID: 31920824 PMCID: PMC6917591 DOI: 10.3389/fpsyg.2019.02775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/25/2019] [Indexed: 11/13/2022] Open
Abstract
This study conducted a cross-sectional investigation of facial appearance dissatisfaction between patients before undergoing orthognathic surgery and a non-surgical sample to evaluate the potential influencing factors of facial appearance dissatisfaction. A sample of 354 participants completed a set of questionnaires concerning facial appearance dissatisfaction, interpersonal pressure, media pressure, and fear of negative appearance evaluation (112 patients, 242 controls). The patients reported higher facial appearance dissatisfaction, more media pressure, more interpersonal pressure, and a greater fear of negative appearance evaluation among others than the control group. Moreover, regression analyses identified interpersonal pressure and fear of negative appearance evaluation as the main predictors of facial appearance dissatisfaction whether in the orthognathic patients or the control groups. The associations between the perceptions of interpersonal pressure, fear of negative appearance evaluation, and facial appearance dissatisfaction support the possible utility of strengthening social experiences and psychological intervention in preventing and treating these appearance-concerns, especially for the orthognathic patients.
Collapse
Affiliation(s)
- Pan Shi
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Yufei Huang
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Hui Kou
- Faculty of Psychology, Southwest University, Chongqing, China
- School of Management, Zunyi Medical University, Guizhou, China
| | - Tao Wang
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- *Correspondence: Tao Wang,
| | - Hong Chen
- Faculty of Psychology, Southwest University, Chongqing, China
- Key Laboratory of Cognition and Personality, Southwest University, Ministry of Education, Chongqing, China
- Hong Chen,
| |
Collapse
|
37
|
Bous RM, Hazen RA, Baus I, Palomo JM, Kumar A, Valiathan M. Psychosocial Adjustments Among Adolescents With Craniofacial Conditions and the Influence of Social Factors: A Multi-Informant Study. Cleft Palate Craniofac J 2019; 57:624-636. [PMID: 31769310 DOI: 10.1177/1055665619888308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies have investigated psychosocial adjustments among adolescents with cleft lip and/or palate (CL/P), but our understanding of other craniofacial conditions remains limited. The objective of this study is to compare psychosocial adjustments among 3 groups of adolescents: craniofacial conditions other than cleft lip and/or palate (craniofacial anomaly [CFA]), CL/P, and controls (CON). Our secondary objective is to examine how social factors may predict the adjustments levels. DESIGN Cross-sectional, multi-informant, controlled survey study. PARTICIPANTS Aged 11- to 17-year olds. Craniofacial anomaly (n = 49), isolated CL/P (n = 42), and 55 CON. Total = 146. OUTCOME MEASURES The Strengths and Difficulties Questionnaire (self-report, parent report, and teacher report). RESULTS All 3 informant groups displayed similar patterns, where CFA reported the highest difficulties, followed by CL/P, while CON scored the lowest. Parent reports demonstrated significant differences among the 3 groups for most subscales and were emphasized for peer problems. Self-reports showed significant differences between CFA and CON for total scores and peer problems, while teacher reports showed significant differences for peer problems only. Craniofacial anomaly displayed the highest frequency of abnormal psychosocial adjustments, followed by CL/P. Experiencing bullying or teasing predicted increased difficulties, while having a good friend predicted decreased difficulties. CONCLUSIONS Adolescents with CFA, and to a lesser extent CL/P, may be at a higher risk of having psychosocial problems. Peer problems may constitute the biggest challenge that CFA and CL/P confront. Social factors, especially being bullied or having a good friend, may predict the psychosocial well-being of adolescents with craniofacial conditions.
Collapse
Affiliation(s)
- Rany M Bous
- Craniofacial, Surgical and Special Care Orthodontics Fellowship Program, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rebecca A Hazen
- Departments of Pediatrics and Psychology, Case Western Reserve University School of Medicine.,Division of Developmental/Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, University Hospital's Cleveland Medical Center, Cleveland, OH, USA
| | - Irene Baus
- Cleft and Craniofacial Center, Rainbow Babies and Children's Hospital, University Hospital's Cleveland Medical Center, Cleveland, OH, USA
| | - J Martin Palomo
- Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Anand Kumar
- Department of Pediatric Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Plastic Surgery, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Manish Valiathan
- Craniofacial, Surgical and Special Care Orthodontics Fellowship Program, Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
38
|
Stock NM, Costa B. Provision of Care for Families Affected by Craniofacial Conditions: The Views of Nonspecialist Health Professionals. Cleft Palate Craniofac J 2019; 57:470-476. [PMID: 31665891 DOI: 10.1177/1055665619883151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE A diagnosis of a congenital craniofacial condition can have a significant impact on the psychological well-being of the affected family. As the first health professionals likely to come into contact with families, nonspecialists, such as diagnostic sonographers, midwives, and health visitors play a crucial role in facilitating familial adjustment. Yet, previous research has demonstrated parental dissatisfaction with the care delivered by nonspecialists. The aim of this study was to investigate the provision of care for families affected by craniofacial conditions from the perspective of nonspecialist health professionals, with a view to informing the development of educational materials. DESIGN Individual semistructured telephone interviews (n = 14) were conducted with 3 diagnostic sonographers, 2 fetal medicine consultants, 3 midwives, 4 health visitors, and 2 children's nurses. RESULTS Participants identified a range of barriers to the delivery of optimal care, including dealing with parental reactions, time pressure, hospital protocols and resources, a lack of contact with specialist craniofacial teams, and the emotional impact of delivering a diagnosis. Most participants had received no prior training in the area of congenital craniofacial conditions, while those who had felt current training materials were insufficient. All participants expressed a desire for further training and provided guidance regarding preferred content and format. CONCLUSIONS This study provides insight into the challenges faced by nonspecialists, as well as a range of information and training needs that could improve their knowledge and confidence. Suggestions for the development of educational materials for nonspecialist health professionals are made.
Collapse
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
| | -
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
| |
Collapse
|
39
|
Riklin E, Calandrillo D, Blitz A, Zuckerberg D, Annunziato RA. Examining the Psychosocial Needs of Adolescents With Craniofacial Conditions: A Mixed-Methods Approach. Cleft Palate Craniofac J 2019; 57:177-185. [DOI: 10.1177/1055665619870621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To determine, for intervention development, the psychosocial needs of adolescents diagnosed with a craniofacial condition who attended focus group sessions. Design: A mixed-methods design combining qualitative focus groups with quantitative measures. Setting: An outpatient clinic at a major medical center in Manhattan, New York. Participants: Fourteen adolescents, aged 14 to 18, with craniofacial conditions. Main Measures: Participants completed measures assessing a range of psychological constructs. Average scores were compared to clinical cutoff scores and normative data for adolescents. The 2 focus groups were coded using an inductive approach to assess pertinent themes. Additionally, the acceptability and feasibility of a proposed intervention was measured. Results: Adolescents with craniofacial conditions were within normal ranges for quality of life, self-esteem, and body image and they reported higher resiliency. They were above cutoff scores for perceived stress and post-traumatic stress disorder symptoms and below cutoff scores for mindfulness. When compared to normative samples, they displayed higher perceived social support, but lower coping. Based on qualitative analyses, 6 themes emerged: stress, bullying, coping, resiliency, mindfulness, and social support. Both qualitative and quantitative analyses revealed most participants were supportive of a future intervention for this population. Conclusions: The present study identified several factors associated with psychological well-being of adolescents with craniofacial diagnoses and demonstrates the importance of creating interventions to target specific psychosocial needs. Findings from this study may guide researchers in developing and refining a specific program for this population and provide information to help those with craniofacial conditions who are experiencing psychosocial challenges.
Collapse
Affiliation(s)
- Eric Riklin
- Department of Psychology, Fordham University, Bronx, NY, USA
| | | | - Aileen Blitz
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Dina Zuckerberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Rachel A. Annunziato
- Department of Psychology, Fordham University, Bronx, NY, USA
- Department of Psychiatry, The Mount Sinai School of Medicine, New York, NY, USA
| |
Collapse
|
40
|
Stock NM, Marik P, Magee L, Aspinall CL, Garcia L, Crerand C, Johns A. Facilitating Positive Psychosocial Outcomes in Craniofacial Team Care: Strategies for Medical Providers. Cleft Palate Craniofac J 2019; 57:333-343. [PMID: 31446785 DOI: 10.1177/1055665619868052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Psychosocial issues associated with craniofacial diagnoses and the ongoing burden of care can impact the quality of life of patients and families, as well as treatment adherence and outcomes. Utilizing available literature and clinical expertise across 6 centers, the present article summarizes key psychosocial issues for the benefit of nonmental health medical providers and offers suggestions as to how all members of craniofacial teams can promote positive psychosocial outcomes. Results: Family adjustment across developmental phases is outlined, with strategies to support adaptive parental coping. Teasing is a common concern in craniofacial populations and medical providers can promote coping and social skills, as well as link families to mental health services when needed. Academic issues are described, alongside suggestions for medical providers to assist families with school advocacy and ensure access to appropriate services within the school setting. Medical providers are key in preparing patients and families for surgery, including consideration of medical, social, and logistical supports and barriers. As craniofacial care spans infancy to adulthood, medical providers are instrumental in assisting patients and families to navigate treatment transition periods. In addition to ongoing clinical team assessments, medical providers may utilize screening measures to identify and track patient and family adjustment in multiple areas of team care. Conclusions: Multidisciplinary providers play an important role in supporting positive adjustment in patients affected by craniofacial conditions and their families.
Collapse
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Patricia Marik
- Children’s Hospital of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Leanne Magee
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Laura Garcia
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Canice Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Alexis Johns
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of South California, Los Angeles, CA, USA
| |
Collapse
|
41
|
Feragen KB, Stock NM, Myhre A, Due-Tønnessen BJ. Medical Stress Reactions and Personal Growth in Parents of Children With a Rare Craniofacial Condition. Cleft Palate Craniofac J 2019; 57:228-237. [PMID: 31426676 DOI: 10.1177/1055665619869146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The birth of a child with a congenital craniofacial anomaly (CFA) can have a profound psychological impact on the family. Despite the complexity and variability in treatment for these rare conditions, few studies have been conducted into parents' emotional responses to health-care experiences. The aim of the present study was to investigate parents' subjective experiences of their child's condition and treatment using an in-depth qualitative approach. METHODS Individual semistructured interviews were conducted in person or over the telephone with 48 parents of children with a range of rare CFAs. Interviews were transcribed verbatim, translated into English, and analyzed using inductive thematic analysis. RESULTS Participants reported physical and psychological symptoms that could be indicative of medical traumatic stress in relation to their child's diagnosis and treatment. Participants described feelings of powerlessness and the weight of being responsible for their child's care. Yet, participants also reported that as a result of their experiences, their perspective on life had changed and they had grown in self-confidence. CONCLUSIONS The findings provide insight into the complex physical and psychological effects experienced by parents in response to their child's diagnosis and medical treatment, as well as an understanding of how these experiences may also result in personal growth over time. Implementation of trauma-informed evidence-based resources should be considered in craniofacial care and future research, particularly in regard to prevention and treatment of psychological distress.
Collapse
Affiliation(s)
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, England
| | - Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
| | | |
Collapse
|
42
|
Preliminary Analysis From the Craniofacial Collaboration United Kingdom Developmental Outcomes in Children With Sagittal Synostosis. J Craniofac Surg 2019; 30:1740-1744. [PMID: 31403506 DOI: 10.1097/scs.0000000000005575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Craniofacial Collaboration United Kingdom (CC-UK) was established across the 4 Highly Specialized Craniofacial Centres (HSCCs) in the UK in 2015. This is the first wave of data to be analyzed, looking at 3-year-old children with sagittal synostosis who have had primary corrective surgery. This is a comprehensive, homogenous dataset, looking at parental measures of development and behavior. The results indicate that the majority of children are rated by their parents as falling within one standard deviation of the mean for both developmental and behavioral measures. However, there was a trend across the age groups within the sample which, although not statistically significant, indicates that more developmental difficulties may become apparent as children get older. Behavior was rated as more problematic, and the areas of greatest parental concern were Conduct (challenging or confrontational behavior) and Hyperactivity domains, where 24% of children were rated as within the clinically significant range. Although the majority of children were rated as falling within the average range, the difference in the mean between the sagittal and the normative group was significant in 5 of the 6 behavioral domains. Further research is required to examine whether these findings are stable over time and to look at the mechanism which might be driving these changes. It is anticipated that future CC-UK analysis will elucidate this more clearly.
Collapse
|
43
|
Billaud Feragen K, Myhre A, Stock NM. “Exposed and Vulnerable”: Parent Reports of Their Child’s Experience of Multidisciplinary Craniofacial Consultations. Cleft Palate Craniofac J 2019; 56:1230-1238. [PMID: 31142141 DOI: 10.1177/1055665619851650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Childhood is a period of extensive socioemotional development, which can be impacted by the presence of a congenital craniofacial anomaly (CFA). Complex multidisciplinary treatment and long-term follow-up are normally required, yet understanding of children’s treatment experiences is limited. The objective of this study was to investigate children’s experiences of multidisciplinary team (MDT) consultations from the perspective of their parents. Design: Thirty-eight parents of children with a rare CFA were interviewed in person or over the telephone. Interviews were transcribed verbatim, translated into English, and explored using thematic analysis. Results: Background factors influencing the child’s experience of the consultation included age, developmental stage, personality, and prior treatment experiences. Participants tried to prepare their child for meeting the MDT, but did not fully understand what to expect themselves. During consultations, participants were acutely focused on their child’s emotional state, making it difficult to balance their desire to protect the child from potentially negative experiences, and the need to engage in a constructive dialogue with health professionals. Participants believed that health professionals’ conduct could considerably influence the child’s well-being and subsequent treatment decisions. Finally, participants highlighted the need to debrief their child to help them adjust positively. Conclusions: The ultimate goal of craniofacial care is to help children develop into confident adults who are able to cope with the challenges associated with their condition. Multidisciplinary teams play a vital role in creating a safe and supportive environment in which children feel genuinely informed and involved in key aspects of their care.
Collapse
Affiliation(s)
| | - Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| |
Collapse
|
44
|
Epidemiology, prevention, diagnosis, treatment, and outcomes for psychosocial problems in patients and families affected by non-intellectually impairing craniofacial malformation conditions: a systematic review protocol of qualitative data. Syst Rev 2019; 8:127. [PMID: 31133050 PMCID: PMC6537209 DOI: 10.1186/s13643-019-1045-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 05/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical attractiveness or unattractiveness wields a tremendous impact on the social and psychological components of life. Many individuals with facial deformities are treated more negatively than normal individuals, which may affect their self-image, quality of life, self-esteem, interpersonal encounters, and ultimately, success in life. Malformations that do not create physiological problems and whose major health impact is to degrade physical attractiveness and engender psychosocial consequences are insufficiently understood and not considered functional problems by medical insurance companies. METHODS/DESIGN As part of a clinical practice guideline development process for psychosocial concerns in Freeman-Burian syndrome, manuscripts describing psychosocial considerations related to the presence of non-intellectually impairing craniofacial malformation conditions or associated clinical activities are sought, especially focusing on epidemiology, prevention, symptoms, diagnoses, severity, timing, treatment, consequences, and outcomes. All published papers on this topic are considered in searching PubMed, OVID MEDLINE, and CINAHL Complete and again before final analyses. The results will be written descriptively to be practically useful and structured around the type or timing of psychosocial problems or consequences described or target population characteristics. No meta-analysis is planned. DISCUSSION Because the quality of research on psychosocial problems in craniofacial malformation conditions is known to be fraught with methodological problems, inconsistencies, and considerable knowledge gaps, we anticipate difficulties, which may limit the review questions able to be answered. We hope to produce a survey relevant to all non-intellectually impaired craniofacially deformed patients and their families and outline knowledge gaps and prioritise areas for clinical investigation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018093021: UNIVERSAL TRIAL NUMBER: U1111-1211-8153.
Collapse
|
45
|
Myhre A, Agai M, Dundas I, Feragen KB. “All Eyes on Me”: A Qualitative Study of Parent and Patient Experiences of Multidisciplinary Care in Craniofacial Conditions. Cleft Palate Craniofac J 2019; 56:1187-1194. [DOI: 10.1177/1055665619842730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: The present study investigated how adults with congenital craniofacial anomalies (CFAs) and parents experience the long-term and complex treatment offered by a multidisciplinary team (MDT). Design: Exploratory-descriptive qualitative study based on individual semistructured interviews. Setting: Centralized national follow-up and treatment of CFAs by a multidisciplinary craniofacial team from which participants were systematically recruited. Participants: The sample included 48 parents of children with CFAs and 16 adults with CFAs (N = 64). Results: In general, participants reported to be satisfied with the follow-up and treatment they received from the MDT. Still, some aspects of treatment were experienced as demanding such as the large number of health professionals present during the consultation and being the object of their scrutinizing attention. Health professionals’ communication skills were described as central for participants’ involvement in, and satisfaction with, treatment. Participants also expressed a need for more treatment-related information regarding future treatment. Conclusions: Findings could have implications for the organization of care for parents and patients with rare CFAs. The many advantages of MDTs also create unique challenges for patients and parents that need to be addressed. Patients and families should be prepared for the first consultation with the MDT. Health professionals should be aware of their communication style when interacting with patients and be aware of individual differences and needs regarding treatment-related experiences and expectations.
Collapse
Affiliation(s)
- Anita Myhre
- Centre for Rare Disorders, Oslo University Hospital (Rikshospitalet), Oslo, Norway
| | - Mehri Agai
- The Educational and Psychological Counselling and Follow Up Service, Hordaland County Authority, OT/PPT, Hordaland fylkeskommune, Bergen, Norway
| | - Ingrid Dundas
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | |
Collapse
|
46
|
The effects of society on the psychosocial functioning of those with a facial difference. HEALTH PSYCHOLOGY REPORT 2019. [DOI: 10.5114/hpr.2019.85657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
47
|
|
48
|
Johns AL, Luquetti DV, Brajcich MR, Heike CL, Stock NM. In Their Own Words: Caregiver and Patient Perspectives on Stressors, Resources, and Recommendations in Craniofacial Microsomia Care. J Craniofac Surg 2018; 29:2198-2205. [PMID: 30334912 PMCID: PMC6224304 DOI: 10.1097/scs.0000000000004867] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study describes stressors, resources, and recommendations related to craniofacial microsomia (CFM) care from the perspective of caregivers of children with CFM and adults with CFM to inform improved quality of healthcare delivery. A mixed method design was used with fixed-response and open-ended questions from an online survey in English. The survey included demographics, CFM phenotypic information, and items about CFM-related experiences across settings. Themes were identified by qualitative analysis of responses to open-ended questions. Respondents (n = 51) included caregivers (n = 42; 90% mothers) and adults with CFM (n = 9; 78% female), who had a mean age of 45 ± 6 years. Most children were male (71%) with an average age of 7 ± 4 years. Respondents were primarily white (80%), non-Hispanic (89%), from the United States (82%), had a college degree (80%), and had private health insurance (80%). Reflecting the high rate of microtia (84%) in the sample, themes centered on the impact of hearing difficulties across settings with related language concerns. Negative social experiences were frequently described and school needs outlined. Multiple medical stressors were identified and corresponding suggestions included: providers need to be better informed about CFM, treatment coordination among specialists, and preference for a family-centered approach with reassurance, empathy, and clear communication. Advice offered to others with CFM included positive coping strategies. Overall, caregivers' and patients' responses reflected the complexity of CFM treatment. Incorporating these perspectives into routine CFM care has the potential to reduce family distress while improving their healthcare.
Collapse
Affiliation(s)
- Alexis L. Johns
- Division of Plastic and Maxillofacial Surgery; Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Daniela V. Luquetti
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | | | - Carrie L. Heike
- Seattle Children’s Hospital, Craniofacial Center; Seattle Children’s Research Institute; University of Washington, Department of Pediatrics, Seattle, WA, USA
| | - Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| |
Collapse
|
49
|
Stock NM, Feragen KB. Assessing Psychological Adjustment to Congenital Craniofacial Anomalies: An Illustration of Methodological Challenges. Cleft Palate Craniofac J 2018; 56:64-73. [DOI: 10.1177/1055665618769661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Recognition of the challenges inherent in psychology research related to cleft lip and/or palate (CL/P) and other craniofacial anomalies (CFAs) is far from novel; yet these challenges continue to limit progress within the field. The aim of the present article was to illustrate these challenges by utilizing data extracted from 2 recent literature reviews pertaining to psychological adjustment within CL/P and CFA research. Design: Data relating to 148 CL/P and 41 CFA studies were extracted, summarized, and compared, using percentages, figures, and χ2 calculations. Results: Comparable patterns were observed in both populations in relation to small sample sizes, wide age ranges, a reliance on data collection from single sites, and limited global coverage. Similarly, only one-third of all studies had used a comparison group, 42% of studies did not include the patient perspective, and fewer than 10% of studies had collected data longitudinally. Qualitative research was lacking across both populations, but particularly in relation to CFA. A higher proportion of CFA studies utilized validated measures and were less likely to exclude patients with additional anomalies. CFA studies most frequently focused on behavior and overall quality of life, while CL/P studies tended to investigate emotional well-being and social experiences. Conclusions: Findings illustrate the variability in research approaches, sampling, measurement, and analysis across both populations. There is a pressing need to address key methodological issues within craniofacial research and to examine the possible similarities and condition-specific differences between CL/P and other congenital craniofacial anomalies.
Collapse
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | | |
Collapse
|
50
|
Stock NM, Feragen KB. Comparing Psychological Adjustment Across Cleft and Other Craniofacial Conditions: Implications for Outcome Measurement and Intervention. Cleft Palate Craniofac J 2018; 56:766-772. [PMID: 29652532 DOI: 10.1177/1055665618770183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | | |
Collapse
|