The adult patient. The adult patient.

Abstract

The stories told by these two individuals reflect considerable differences in background conditions, treatment protocol, career decisions, life experiences, and emotional perspectives. They represent a spectrum of variables found in caring for patients with clefts. The following conclusions can be drawn from the existing literature as well as from the patients interviewed: 1. Early intervention is critical; treatment should be completed as early as possible. 2. Adults with clefts who have speech problems during adolescence and even adulthood generally do not do as well as cleft patients who have not experienced major speech problems. 3. Despite well-trained social work and psychological support from the cleft palate team, patients really may not verbalize their innermost feelings about their condition. There may be self-imposed limitations of which SLPs are unaware. 4. Just because the patient has achieved satisfactory cosmetic, functional, and speech results does not necessarily mean the patient's emotional development has reached a satisfactory level of adjustment. 5. SLPs see patients only within the well-defined limits of the hospital or clinic setting. They are not seen in public, their job setting, or within the family constellation. 6. The effects of cultural biases and differences may not be readily apparent but may have considerable influence on patient adjustment, expectations, behavior, and overall ability to accept the condition. 7. Infancy and childhood provide a window of time during which all operations, dental procedures, and therapies should be accomplished. Many older children will reach a point at which they will choose to stop the process and refuse what we think are the final stages of treatment.