Psychological issues in craniofacial care: State of the art

This article is an extensive review of the psychological literature on clef t lip and palate and other craniofacial anomalies. Issues of parental accep tance, social competence, self-concept, emotional adjustment, and cognitive functioning are examined. Cumulative research suggests that many children with craniofacial conditions develop in a typical manner and do not experie nce psychological problems. However, a significant number of children (30% to 40% in most studies) experience difficulties with internalizing and/or e xternalizing problems, learning disorders, and social competence. A multifa ctorial model for examining the domains that are related to both psychologi cal risk and protection is recommended. The need for multicenter studies th at are prospective and clinically relevant is emphasized.