A Developmental Framework for Psychosocial Research on Young Children with Craniofacial Anomalies

  • Matthew L. Speltz
  • Holly Galbreath
  • Mark T. Greenberg


Young children with craniofacial anomalies (CFA) and their families undergo a succession of extremely stressful events through the first five years of life, beginning with the parents’ awareness of and coping with the infants’ disfigurement at birth, followed by extraordinary caregiving demands (e.g., feeding problems), multiple diagnostic procedures, and the initial reactions of friends and relatives to the babies’ appearance. Next come one or more surgeries with varying and uncertain degrees of restorative outcome and associated hospitalizations. Finally, the family must anticipate and prepare for the children’s inevitable exposure to possibly negative peer reactions in daycare or preschool. How do these children and their families react to and cope with these extreme and repeated stressors in early life? What influence do these early events have on the developing parent — child relationship and children’s internalization of the caregiving environment? Are such factors predictive of the children’s later resilience or vulnerability to negative social responses?


Cleft Palate Maternal Behavior Trained Observer Facial Appearance Typical Child 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Achenbach, T.M., & Edelbrock, CS. (1981). Behavioral problems and competencies reported by parents of normal and disturbed children aged four through sixteen. Monographs of the Society for Research in Child Development, 46, Serial No. 188.Google Scholar
  2. Adams, G. (1980). The effects of physical attractiveness on the socialization process. In G. Lucker, K. Ribbens, & J. McNamara (Eds.), Psychological aspects of facial form. Ann Arbor, MI: University of Michigan Press.Google Scholar
  3. Affleck, G., McGrade, B., Allen, D., & McQueeney, M. (1985). Mothers’ beliefs about behavioral causes for their developmentally disabled infant’s condition: What do they signify? Journal of Pediatric Psychology, 10, 293–303.PubMedCrossRefGoogle Scholar
  4. Ainsworth, M.D.S., Blehar, M.C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the Strange Situation. Hillsdale, NJ: Erlbaum.Google Scholar
  5. Barden, R., Ford, M., Jensen, A., Rogers-Salyer, M., & Salyer, K. (1989). Effects of craniofacial deformity in infancy on the quality of mother-infant interactions. Child Development, 60, 819–824.PubMedCrossRefGoogle Scholar
  6. Barnard, K., Hammond, M., Booth, C., Bee, H., Mitchell, S., & Spieker, S. (1988). Measurement and meaning of parent-child interactions. In F. Morrison, C. Lord, & D. Keating (Eds.), Applied developmental psychology. New York: Academic Press.Google Scholar
  7. Bates, J.E., & Bayles, K. (1988). Attachment and the development of behavior problems. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachment (pp. 235–239). Hillsdale, NJ: Erlbaum.Google Scholar
  8. Bates, J.E., Maslin, C.A., & Frankel, K.A. (1985). Attachment security, mother-child interaction, and temperament as predictors of behavior-problem ratings at age three years. In I. Bretherton & E. Waters (Eds.), Growing points in attachment theory and research. Monographs of the Society for Research in Child Development, 50, 167–193.Google Scholar
  9. Beckman, P.J. (1984). A transactional view of stress in families of handicapped children. In M. Lewis (Ed.), Beyond the dyad. New Brunswick NJ: Plenum.Google Scholar
  10. Belsky, J. (1984). The determinants of parenting: A process model. Child Development, 58, 83–96.CrossRefGoogle Scholar
  11. Belsky, J., & Isabella, R. (1988). Maternal, infant, and social-contextual determinants of attachment security. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachment (pp. 3–17). Hillsdale, NJ: Erlbaum.Google Scholar
  12. Belsky, J., Rovine, M., & Taylor, D. (1984). The Pennsylvania Infant and Family Development Project: III. The origins of individual differences in infant-mother attachment: Maternal and infant contributions. Child Development, 55, 718–728.PubMedCrossRefGoogle Scholar
  13. Bjornsson, A., & Agustsdottir, S. (1987). A psychosocial study of Icelandic individuals with cleft lip or cleft lip and palate. Cleft Lip Journal, 24, 152–157.Google Scholar
  14. Blacher, J., & Meyers, C.E. (1983). A review of attachment formation and disorder of handicapped children. American Journal of Mental Deficiency, 4, 359–371.Google Scholar
  15. Bowlby, J. (1969). Attachment and loss. Vol 1: Attachment. New York: Basic Books.Google Scholar
  16. Brantley, H.T., & Clifford, E. (1979). Maternal and child locus of control and field-dependence in cleft palate children. Cleft Palate Journal, 16, 183–187.PubMedGoogle Scholar
  17. Brazelton, B.T., Koslowski, B., & Main, M. (1974). The origins of reciprocity: The early mother-infant interaction. In M. Lewis & L.A. Rosenblum (Eds.), The effect of the infant on its caregiver (pp. 49–76). New York: John Wiley & Sons.Google Scholar
  18. Bull, R., & Rumsey, N. (1988). The social psychology of facial appearance. New York. Springer-Verlag.Google Scholar
  19. Cicchetti, D., & Schneider-Rosen, K. (1986). An organizational approach to childhood depression. In M. Rutter, C. Izard, & P. Read (Eds.), Depression in young people: Clinical and developmental perspectives (pp. 71–134). New York: Guilford.Google Scholar
  20. Clifford, E. (1969). Parental ratings of cleft palate infants. Cleft Palate Journal, 6, 235–244.PubMedGoogle Scholar
  21. Clifford, E. (1983). Why are they so normal? Cleft Palate Journal, 20, 83–84.PubMedGoogle Scholar
  22. Crnic, K.A., Friedrich, W.N., & Greenberg, M.T. (1983). Adaptation of families with mentally retarded children: A model of stress, coping, and family ecology. American Journal of Mental Deficiency, 88, 125–138.PubMedGoogle Scholar
  23. Crnic, K.A., Greenberg, M.T., Ragozin, A.S., Robinson, N.M., & Basham, R.B. (1983). Effects of stress and social support on mothers and premature and full-term infants. Child Development, 54, 209–217.PubMedCrossRefGoogle Scholar
  24. Egeland, B., & Farber, E.A. (1984). Infant-mother attachment: Factors related to its development and changes over time. Child Development, 55, 753–771.PubMedCrossRefGoogle Scholar
  25. Emde, R.N., & Brown, C. (1978). Adaptation to the birth of a Down’s Syndrome infant: Grieving and maternal attachment. Journal of the American Academy of Child Psychiatry, 17, 299–323.PubMedCrossRefGoogle Scholar
  26. Erickson, M.F., Sroufe, L.A., & Egeland, B. (1985). The relationship between quality of attachment and behavior problems in preschool in a high-risk sample. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50, 147–166.Google Scholar
  27. Erickson, M.F., & Farber, E.A. (1983). Infancy to preschool: Continuity of adaptation in high-risk children. Paper presented at the Society for Research in Child Development, Detroit, MI.Google Scholar
  28. Eyberg, S.M., & Robinson, E.A. (1981). Dyadic parent-child interaction coding system: A manual (3rd rev.). Unpublished manuscript, Oregon Health Sciences University, Portland, OR.Google Scholar
  29. Field, T.M., & Vega-Lahr, N. (1984). Early interactions between infants with craniofacial anomalies and their mothers. Infant Behavior and Development, 7, 527–530.CrossRefGoogle Scholar
  30. Fox, D., Lynch, J., & Brookshire, B. (1978). Selected developmental factors of cleft palate children between two and thirty-three months of age. Cleft Palate Journal, 15, 239–245.PubMedGoogle Scholar
  31. Gluck, M.R., McWilliams, B.F., Wylie, H.L., & Conkwright, E.A. (1965). A comparison of clinical characteristics of children with cleft palates and children in a child guidance clinic. Perceptual and Motor Skills, 21, 806.PubMedCrossRefGoogle Scholar
  32. Greenberg, M.T., & Kusche, K.C. (1989). Cognitive, personal and social development in deaf children and adolescents. In M.C. Wang, H.J. Walberg, & M.C. Reynolds (Eds.), The handbook of special education: Research and practice (1–3). Oxford, England: Pergamon Press.Google Scholar
  33. Greenberg, M.T., & Speltz, M.L. (1988). Attachment and the ontogeny of conduct problems. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachment (pp. 177–218). Hillsdale, NJ: Erlbaum.Google Scholar
  34. Greenspan, S.I., & Greenspan, N.T. (1985). First feelings: Milestones in the emotional development of your baby and child. New York: Viking.Google Scholar
  35. Grossmann, K., Grossmann, K.E., Spangler, G., Suess, G., & Unzner, L. (1985). Maternal sensitivity and newborns’ orientation responses as related to quality of attachment in Northern Germany. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50, (1–2, Serial No. 209), 233–256.Google Scholar
  36. Harper, D., Richman, L., & Snider, B. (1980). School adjustment and degree of physical impairment. Journal of Pediatric Psychology, 5(4), 377–383.PubMedCrossRefGoogle Scholar
  37. Heller, A., Tidmarsh, W., & Pless, I. (1981). The psychosocial functioning of young adults born with cleft lip or palate. Clinical Pediatrics, 20, 459–465.PubMedCrossRefGoogle Scholar
  38. Horan, M.L. (1982). Parental reaction to the birth of an infant with a defect: An attributional approach. Advances in Nursing Science, 5, 57–68.PubMedGoogle Scholar
  39. Kapp, K. (1979). Self-concept of the cleft lip or palate child. Cleft Palate Journal, 16, 171–176.PubMedGoogle Scholar
  40. Kapp-Simon, K. (1986). Self-concept of primary-school-age children with cleft lip, cleft palate, or both. Cleft Palate Journal, 23, 24–27.PubMedGoogle Scholar
  41. Kazak, A.E., & Marvin, R.S. (1984). Differences, difficulties and adaptation: Stress and social networks in families with a handicapped child. Family Relations: Journal of Applied Family and Child Studies, 33, 67–77.Google Scholar
  42. Langlois, J., & Stephan, C. (1981). Beauty and the beast: The role of physical attractiveness in the development of peer relations and social behavior. In S. Brehm, S. Kassin, & F. Gibbons (Eds.), Developmental social psychology: Theory and research. New York: Oxford University Press.Google Scholar
  43. Lansdown, R. (1981). Cleft lip and palate: A prediction of psychological disfigurement? British Journal of Orthodontics, 8, 83–88.PubMedGoogle Scholar
  44. Lewis, M., Feiring, C., McGuffog, C., & Jaskir, J. (1984). Predicting psychopathology in six-year-olds from early social relations. Child Development, 55, 123–136.PubMedCrossRefGoogle Scholar
  45. Long, N.V., & Dalston, R.M. (1982). Gestural communication in twelve-month-old cleft lip and palate children. Cleft Palate Journal, 19, 57–61.PubMedGoogle Scholar
  46. Mahoney, G. (1988). Maternal communication style with mentally retarded children. American Journal on Mental Retardation, 92, 352–359.PubMedGoogle Scholar
  47. MacGregor, F.C., Abel, T.M., Brut, A., Lauer, E., & Weissman, S. (1953). Facial deformities and plastic surgery: A psychosocial study. Springfield, IL: Charles C. Thomas.Google Scholar
  48. Matas, L., Arend, R.A., & Sroufe, L.A. (1978). Continuity of adaptation in the second year: The relationship between quality of attachment and later competence. Child Development, 49, 547–556.CrossRefGoogle Scholar
  49. McWilliams, B.J., & Paradise, L.P. (1973). Educational, occupational and marital status of cleft palate adults. Cleft Palate Journal, 10, 223–229.PubMedGoogle Scholar
  50. Quay, H.C. (1979). Classification. In H.C. Quay & J.S. Werry (Eds.), Psychopathological disorders of childhood (2nd ed.). New York: Wiley.Google Scholar
  51. Quay, H., & Petersen, D. (1967). Manual for the behavior problem checklist. Champaign, IL: University of Illinois Press.Google Scholar
  52. Ramey, CT., Bryant, D.M., Sparling, J.J., & Lasik, B.H. (1984). A biosocial systems perspective on environmental interventions for low birth weight infants. Clinical Obstetrics and Gynecology, 27, 672–692.PubMedCrossRefGoogle Scholar
  53. Richman, L.C. (1976). Behavior and achievement of cleft palate children. Cleft Palate Journal, 13, 4–10.PubMedGoogle Scholar
  54. Richman, L.C (1978). The effects of facial disfigurement on teachers’ perception of ability in cleft palate children. Cleft Palate Journal, 15, 155–160.Google Scholar
  55. Richman, L.C., & Eliason, M. (1982). Psychological characteristics of children with cleft lip and palate: Intellectual, achievement, behavioral, and personality variables. Cleft Palate Journal, 19, 249–257.PubMedGoogle Scholar
  56. Richman, L.C., & Harper, D.C. (1978). Observable stigmata and perceived maternal behaviors. Cleft Palate Journal, 15, 215–219.PubMedGoogle Scholar
  57. Richman, L.C., & Harper, D.C (1979). Self-identified personality patterns of children with facial or orthopedic disfigurement. Cleft Palate Journal, 16, 257–261.PubMedGoogle Scholar
  58. Sameroff, A.J., & Chandler, M.J. (1975). Reproductive risk and the continuum of caretaking casualty. In F.D. Horowitz (Ed.), Review of child development research (Vol. 4) (pp. 187–244). Chicago: University of Chicago Press.Google Scholar
  59. Simonds, J.F., & Heimburger, R.E. (1978). Psychiatric evaluation of youth with cleft lip-palate matched with a control group. Cleft Palate Journal, 15, 193–201.PubMedGoogle Scholar
  60. Speltz, M.L., Armsden, G., & Clarren, S. (1990). Effects of craniofacial birth defects on maternal functioning post-infancy. Journal of Pediatric Psychology, 15, 177–196.PubMedCrossRefGoogle Scholar
  61. Speltz, M.L., Goodell, E.W., Endriga, M.C., & Clarren, S.K. (1994). Quality of early feeding interaction between infants with craniofacial anomalies and their mothers. Infant Behavior and Development, 17, 131–139.CrossRefGoogle Scholar
  62. Speltz, M.L., Greenberg, M.T., Endriga, M.C., & Galbreath, H. (1994). Developmental approach to the psychology of craniofacial anomalies. Cleft Palate-Craniofacial Journal, 31, 61–67.PubMedCrossRefGoogle Scholar
  63. Speltz, M.L., Morton, K., Goodell, E.W., & Clarren, S.K. (1993). Psychological functioning of children with craniofacial anomalies and their mothers: Follow-up from late infancy to school entry. Cleft Palate-Craniofacial Journal, 30, 482–489.PubMedCrossRefGoogle Scholar
  64. Spieker, S.J., & Booth, C.L. (1988). Maternal antecedents of attachment quality. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachment (pp. 95–135). Hillsdale, NJ: Erlbaum.Google Scholar
  65. Spriesterbach, D. (1963). Psychosocial factors of cleft lip and palate rehabilitation. In B. Rogers (Ed.), Facial disfigurement: A rehabilitation problem. Washington, D.C: Vocational Rehabilitation Administration.Google Scholar
  66. Sroufe, L.A. (1979). The coherence of individual development: Early care, attachment, and subsequent developmental issues. American Psychologist, 34, 834–841.CrossRefGoogle Scholar
  67. Sroufe, L.A. (1988). The role of infant-caregiver attachment in development. In J. Belsky & T. Nezworski (Eds.), Clinical implications of attachment (pp. 18–38). Hillsdale, NJ: Erlbaum.Google Scholar
  68. Sroufe, L.A., & Fleeson, J. (1986). Attachment and the construction of relationships. In W. Hartup & Z. Rubin (Eds.), Relationships and development. Hillsdale, NJ: Erlbaum.Google Scholar
  69. Sroufe, L.A., Fox, N.E., & Pancake, V.R. (1983). Attachment and dependency in developmental perspective. Child Development, 54, 1615–1627.CrossRefGoogle Scholar
  70. Sroufe, L.A., & Rutter, M. (1984). The domain of developmental psychopathology. Child Development, 55, 17–29.PubMedCrossRefGoogle Scholar
  71. Starr, P. (1978). Self-esteem and behavioral functioning of teenagers with oral facial clefts. Rehabilitation Literature, 39, 233–235.PubMedGoogle Scholar
  72. Starr, P. (1980). Facial attractiveness and behavior of patients with cleft lip and/or palate. Psychology Reports, 46, 579–582.CrossRefGoogle Scholar
  73. Starr, P., Chinsky, R., Canter, H., & Meier, J. (1977). Mental, motor and social behavior of infants with cleft lip and/or palate. Cleft Palate Journal, 14, 140–147.PubMedGoogle Scholar
  74. Tisza, V.B., & Gumpertz, E. (1962). The parents’ reaction to the birth and early care of children with cleft palate. Pediatrics, 30, 86–90.PubMedGoogle Scholar
  75. Tobiasen, J. (1984). Psychosocial correlates of congenital facial clefts: Conceptualization and model. Cleft Palate Journal, 21, 131–139.PubMedGoogle Scholar
  76. Tobiasen, J.M., & Hiebert, J.M. (1984). Parents’ tolerance for the conduct problems of the child with cleft lip and palate. Cleft Palate Journal, 21, 82–85.PubMedGoogle Scholar
  77. Ullmann, L.P., & Krasner, L. (1975). A psychological approach to abnormal behavior. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  78. Vietze, P., & Coates, D. (1986). Research with families of handicapped persons. Lessons from the past, plans for the future. In J. Gallagher & P. Vietze (Eds.), Families of handicapped persons. Baltimore, MD: Brookes.Google Scholar
  79. Wallander, J.C., & Hubert, N.C. (1987). Peer social dysfunction in children with developmental disabilities: Empirical basis and a conceptual model. Clinical Psychology Review, 7, 205–221.CrossRefGoogle Scholar
  80. Ware, J., Johnston, S., Davies-Avery, A., & Brook, R. (1979). Conceptualization and measurement of health for adults: Vol 3. Mental Health (R-1987/3-HEW). Washington, D.C.: U.S. Government Printing Office.Google Scholar

Copyright information

© Springer-Verlag New York, Inc. 1995

Authors and Affiliations

  • Matthew L. Speltz
  • Holly Galbreath
  • Mark T. Greenberg

There are no affiliations available

Personalised recommendations