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To examine family functioning related to sociodemographic and clinical characteristics in youth with cleft lip and/or palate (CL/P).
Cross-sectional, multi-site investigation.
Six U.S. cleft centers.
A diverse sample of 1200 children with CL/P and their parents.
Parents completed the Family Environment Scale (FES), which assesses three domains of family functioning: cohesion (or closeness), expressiveness (open expression of feelings), and conflict. Demographic and clinical characteristics were also assessed including race, ethnicity, type of insurance, and surgical recommendations.
The FES scores for families seeking team evaluations for their youth with CL/P (mean age = 11.6 years) fall within the average range compared with normative samples. Families receiving surgical recommendations for their youth also had FES scores in the average range, yet families of children recommended for functional surgery reported greater cohesion, expressiveness, and less conflict compared with those recommended for aesthetic surgery (P < .05). For cohesion and expressiveness, significant main effects for race (P = .012, P < .0001, respectively) and ethnicity (P = .004, P < .0001, respectively) were found but not for their interaction. No significant differences were found on the conflict domain. Families with private insurance reported significantly greater cohesion (P < .001) and expressiveness (P < .001) than did families with public insurance.
Family functioning across domains was in the average range. However, observed differences by race, ethnicity, type of insurance, and surgical recommendation may warrant consideration in clinical management for patients and families.
Acknowledgments
We would like to thank the caregivers and their children who took part in this study as well as clinical personnel from the participating sites. We would also like to acknowledge Dr. Robert Norman for his assistance with statistical analyses.
Footnotes
Dr. Crerand is Assistant Professor of Pediatrics, Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital and Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, Ohio. Dr. Rosenberg is Assistant Professor of Clinical Psychology, Craniofacial Center, Departments of Surgery and Psychiatry, University of Illinois Medical Center at Chicago, Chicago, Illinois. Dr. Magee is Clinical Psychologist, Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Dr. Stein is Clinical Associate Professor, University of North Carolina Craniofacial Center & Department of Dental Ecology, Chapel Hill, North Carolina. Dr. Wilson-Genderson is Research Faculty, Department of Public Health, Temple University, Philadelphia, Pennsylvania. Dr. Broder is Professor of Cariology and Comprehensive Care, Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, New York.
This research was supported by the National Institutes of Health, National Institute of Dental and Craniofacial Research (grant DE018729 to H. Broder, principal investigator, and grant K23 DE020854 to C. Crerand, principal investigator).
This paper was originally presented at the 12th International Congress on Cleft Lip/Palate and Related Craniofacial Anomalies, Lake Buena Vista, Florida, May 9, 2013.
