Editing Cleft lip and cleft palate (section)

===Psychosocial issues===
There is research dedicated to the [[psychosocial development]] of individuals with cleft palate. A cleft palate/lip may impact an individual's [[self-esteem]], [[social skills]] and [[behavior]]. Self-concept may be adversely affected by the presence of a cleft lip or cleft palate, particularly among girls.<ref>{{cite journal | vauthors = Leonard BJ, Brust JD, Abrahams G, Sielaff B | title = Self-concept of children and adolescents with cleft lip and/or palate | journal = The Cleft Palate-Craniofacial Journal | volume = 28 | issue = 4 | pages = 347–353 | date = October 1991 | pmid = 1742302 | doi = 10.1597/1545-1569(1991)028<0347:SCOCAA>2.3.CO;2 }}</ref> Negative outcomes can also be associated with the long durations of hospitalization. Psychological issues could extend not just to the individual with CLP but also to their families, particularly their mothers, that experience varying levels of depression and anxiety.<ref>{{cite journal | vauthors = Al-Namankany A, Alhubaishi A | title = Effects of cleft lip and palate on children's psychological health: A systematic review | journal = Journal of Taibah University Medical Sciences | volume = 13 | issue = 4 | pages = 311–318 | date = August 2018 | pmid = 31435341 | pmc = 6694901 | doi = 10.1016/j.jtumed.2018.04.007 }}</ref><ref>{{cite journal | vauthors = Hunt O, Burden D, Hepper P, Johnston C | title = The psychosocial effects of cleft lip and palate: a systematic review | journal = European Journal of Orthodontics | volume = 27 | issue = 3 | pages = 274–285 | date = June 2005 | pmid = 15947228 | doi = 10.1093/ejo/cji004 | doi-access = free }}</ref>

Research has shown that during the early preschool years (ages 3–5), children with cleft lip or cleft palate tend to have a self-concept that is similar to their peers without a cleft. However, as they grow older and their social interactions increase, children with clefts tend to report more dissatisfaction with peer relationships and higher levels of [[social anxiety]]. Experts conclude that this is probably due to the associated stigma of visible deformities and possible [[speech impediment]]s. Children who are judged as attractive tend to be perceived as more intelligent, exhibit more positive social behaviors, and are treated more positively than children with cleft lip or cleft palate.<ref>{{cite journal | vauthors = Tobiasen JM | title = Psychosocial correlates of congenital facial clefts: a conceptualization and model | journal = The Cleft Palate Journal | volume = 21 | issue = 3 | pages = 131–139 | date = July 1984 | pmid = 6592056 }}</ref> Children with clefts tend to report feelings of anger, sadness, fear, and alienation from their peers, but these children were similar to their peers in regard to "how well they liked themselves."

The relationship between parental attitudes and a child's self-concept is crucial during the preschool years. It has been reported that elevated stress levels in mothers correlated with reduced social skills in their children.<ref>{{cite journal | vauthors = Pope AW, Ward J | title = Self-perceived facial appearance and psychosocial adjustment in preadolescents with craniofacial anomalies | journal = The Cleft Palate-Craniofacial Journal | volume = 34 | issue = 5 | pages = 396–401 | date = September 1997 | pmid = 9345606 | doi = 10.1597/1545-1569(1997)034<0396:SPFAAP>2.3.CO;2 }}</ref> Strong parent support networks may help to prevent the development of negative self-concept in children with cleft palate.<ref>{{harvnb|Bristow|Bristow|2007|pp=82–92}}</ref> In the later preschool and early elementary years, the development of social skills is no longer only impacted by parental attitudes but is beginning to be shaped by their peers. A cleft lip or cleft palate may affect the behavior of preschoolers. Experts suggest that parents discuss with their children ways to handle negative social situations related to their cleft lip or cleft palate. A child who is entering school should learn the proper (and age-appropriate) terms related to the cleft. The ability to confidently explain the condition to others may limit feelings of awkwardness and embarrassment and reduce negative social experiences.<ref>{{cite web|title=Cleft Palate Foundation|url=http://cleftline.org|url-status=live|archive-url=https://web.archive.org/web/20070701095458/http://www.cleftline.org/|archive-date=July 1, 2007|access-date=July 1, 2007}}</ref>

As children reach adolescence, the period of time between age 13 and 19, the dynamics of the parent-child relationship change as peer groups are now the focus of attention. An adolescent with cleft lip or cleft palate will deal with the typical challenges faced by most of their peers including issues related to self-esteem, dating and social acceptance.<ref>{{cite journal | vauthors = Snyder HT, Bilboul MJ, Pope AW | title = Psychosocial adjustment in adolescents with craniofacial anomalies: a comparison of parent and self-reports | journal = The Cleft Palate-Craniofacial Journal | volume = 42 | issue = 5 | pages = 548–555 | date = September 2005 | pmid = 16149838 | doi = 10.1597/04-078R.1 | s2cid = 37357550 | citeseerx = 10.1.1.624.1274 }}</ref><ref>{{cite journal | vauthors = Endriga MC, Kapp-Simon KA | title = Psychological issues in craniofacial care: state of the art | journal = The Cleft Palate-Craniofacial Journal | volume = 36 | issue = 1 | pages = 3–11 | date = January 1999 | pmid = 10067755 | doi = 10.1597/1545-1569(1999)036<0001:PIICCS>2.3.CO;2 }}</ref><ref name="PopeSynder">{{cite journal | vauthors = Pope AW, Snyder HT | title = Psychosocial adjustment in children and adolescents with a craniofacial anomaly: age and sex patterns | journal = The Cleft Palate-Craniofacial Journal | volume = 42 | issue = 4 | pages = 349–354 | date = July 2005 | pmid = 16001914 | doi = 10.1597/04-043R.1 | s2cid = 31313562 }}</ref> Adolescents, however, view appearance as the most important characteristic, above intelligence and humor.<ref>{{cite journal | vauthors = Prokhorov AV, Perry CL, Kelder SH, Klepp KI | title = Lifestyle values of adolescents: results from Minnesota Heart Health Youth Program | journal = Adolescence | volume = 28 | issue = 111 | pages = 637–647 | year = 1993 | pmid = 8237549 }}</ref> This being the case, adolescents are susceptible to additional problems because they cannot hide their facial differences from their peers. Adolescent boys typically deal with issues relating to withdrawal, attention, thought, and [[Internalization (psychology)|internalizing]] problems, and may possibly develop anxiousness-depression and aggressive behaviors.<ref name="PopeSynder" /> Adolescent girls are more likely to develop problems relating to self-concept and appearance. Individuals with cleft lip or cleft palate often deal with threats to their [[quality of life]] for multiple reasons including unsuccessful social relationships, deviance in social appearance, and multiple surgeries.