Challenges of Cleft Lip and Palate

Children with cleft lip and/or palate encounter different challenges throughout the course of their development. Both environmental and biological factors play a role, and can affect speech, academic performance, and behavior. Research has shown varying influences, including the type of cleft, gender, and age, affecting outcomes. The Cleft Pal­ate-Craniofacial Journal (July 2012) reviews findings about individuals with cleft in 3 age groups: infancy/early development, school age, and adolescence/young adulthood. Be­havioral, neuropsychosocial, and learning/achieve­ment out­comes are examined. The environmental impacts of cleft lip and/or palate are ra­ther transparent. Children with clefts can have facial differences and speech problems that elicit a response from others, which can create is­sues of self-esteem and emotional development for the child with cleft. However, some characteristics of clefts also have a biological basis.

In recent years, patterns of specific strengths and weaknesses have been found to be associated with clefts. De­layed speech and language development, reading de­fi­cits, memory problems, and learning disabilities have been linked to clefting, seemingly related to the neuropsychological defi­cits brought with cleft lip and palate. Each stage of development has its unique biological and psychological im­pacts. The early years of de­velopment for a child with cleft include surgical repair of the cleft lip or palate, orthodontic treatment, and assessment of speech along with other issues that might re­quire in­tervention. Parent-child interactions and attachments can be affected, both positively and negatively, by the emotional stresses of these events. When a child reaches school age, social skills, self-control, and other behavioral regulation come into play. Parents and teachers have reported significantly higher behavior problems in children with clefts. The oc­currence of reading difficulties and learning disabilities is high. The in­creased emphasis during adolescence on speech and ap­pear­­ance can bring a de­­crease in self-confidence for the child with cleft. Rates of learning disabilities decline during this age, however. Studies show that children with a realistic self-as­sessment who actively develop social skills fare better. Even after the physical as­pects of a cleft lip and/or palate have been re­solved, the neuro­psycho­log­ical deficits can persist, something that has only recently become ac­cepted. Related academic and so­cial-emo­tional problems are still present, and speech and language difficulties can persist into adulthood.


(Source: Cleft Pal­ate-Craniofa­cial Jour­nal, July 2012, Vol­ume 49, Number 4)