Are infants with orofacial clefts at risk for insecure mother-child attachments?

Objective. Several risk factors in the early lives of children with clefts are believed to interfere with their development of secure attachments to p arents; however, this possibility has rarely been studied empirically. This study compared 12- and 24-month attachment classifications of infants with cleft palate (CP), infants with cleft lip and palate (CLP), and a comparis on group of unimpaired infants (COMP). Method: Twenty-two CP infants, 24 CLP infants, and 61 matched COMP infants were assessed at 12 and 24 months of age in an urban children's hospital. A t both visits, mothers and infants participated in the Strange Situation, w hich was videotaped and subsequently coded for patterns of attachment behav ior. Results: CP infants displayed a lower rate of 12-month attachment security than infants in the CLP or COMP groups. By 24 months, no diagnostic group d ifferences in attachment classification were found. Stable 12- to 24-month attachment classifications were less likely in the CP group (36.3%) than in the COMP (62.3%) group. CP infants who were insecure at 12 months were mor e likely to become secure by 24 months than were CLP or COMP group infants. Conclusions: In contrast to previous theory and clinical speculation, the f acial appearance of infants with CLP does not appear to affect the early mo ther-infant relationship adversely. The infancy period is marked by attachm ent instability for infants with CP, who demonstrated lower-than-expected r ates of security at 12 months. However, these problems resolved in nearly a ll cases by 24 months of age. Most infants with clefts emerged from the fir st 2 years of life with secure maternal attachments.