Cleft Palate: A Psychologist's View

Children born with cleft palates share many unique but similar early life experiences. Among these are problems in feeding, repeated hospitalizations, early surgery, reactions of family to facial disfigurement, defective speech development, and some degree of hearing loss (Lencione, 1980). One would anticipate that there would be certain personality characteristics that would set these individuals off in a recognizable way. However, studies on the psychological effects of clefting have not demonstrated that, as a group, cleft palate children differ significantly in personality characteristics from noncleft palate children. A primary variable may be the continuing management of the child with a cleft palate. This article will emphasize the importance of management in the formation of the child's personality. Phipps (1965) reviewed the literature on psychological and social problems of cleft palate children. He found that the studies could be divided into those that 'logically" assessed the situation, and those based on controlled data. Though stated in many ways, the "logical" approach was always that people with cleft palate must suffer from severe social and psychological problems. On the other hand, controlled studies looked at the relationship between cleft palate and such variables as intelligence, adjustment, and personality. Phipps found that there was no conclusive evidence that cleft palate children differed from their noncleft peers in either personal or social adjustment. Phipps could not account for the discrepancy between the "logical" viewpoint and controlled research. One answer might be that the socalled "logical" view was derived from a theoretical orientation that minimizes the therapeutic strength of direct environmental influences. This author, as a behavior therapist who has worked with cleft palate patients for more than 20 years, takes a different position. Environmental influences affect what the child learns, and correct child management based on the laws of learning is the primary influence on the child's personality. Tisza et al., (1958) reported that the developmental history of children born with a cleft lip, cleft palate, or both was different from that of the noncleft child because of experiences peculiar to the cleft group. The majority of these infants experienced no sucking and frequently were not held while being fed. According to this study, many children underwent three or four surgical procedures, resulting in separation from home, anesthesia, pain in the oral region, and temporary restrictions of the arms and hands following surgery. The investigators reported that in their interview with mothers, the recurring theme was that the mothers felt some lack in themselves and tended to minimize or deny the existence and severity of the problem. Tisza and Gumpertz (1962) inter-