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Behavioral Adjustment of Preschool Children With and Without Craniofacial Microsomia
Alexis L Johns1, Erin R Wallace2, Brent R Collett3
1Division of Plastic and Maxillofacial Surgery, 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.
Insights
Preschoolers with craniofacial microsomia (CFM) show similar overall behavior to peers. However, parents report more internalizing behaviors like anxiety, suggesting a need for targeted screening and interventions for children with CFM.
Area of Science:
- Pediatric Psychology
- Developmental Pediatrics
- Genetics and Rare Diseases
Background:
- Craniofacial microsomia (CFM) is a congenital condition affecting facial development.
- Behavioral and emotional adjustment in children with CFM requires further investigation.
Purpose of the Study:
- To assess and compare the behavioral adjustment of preschool children with and without craniofacial microsomia (CFM).
Main Methods:
- A multisite cohort study involving 161 preschoolers, with 89 diagnosed with CFM (cases) and 72 without (controls).
- Parental responses on the Child Behavior Checklist (CBCL 1.5-5) were analyzed using linear regressions.
- Standardized effect sizes (ES) were calculated, adjusted for sociodemographic factors.
Main Results:
- Overall behavioral adjustment scores were comparable between children with and without CFM.
- Parents of children with CFM reported higher scores for Anxious/Depressed, Stress Problems, and Anxiety Problems.
- Autism Spectrum Problems scores were higher in the CFM group, primarily reflecting speech concerns.
Conclusions:
- Preschoolers with CFM exhibit comparable overall behavioral adjustment to their peers.
- Increased parental concern for internalizing behaviors in children with CFM highlights the need for anxiety screening and interventions.
- More complex CFM presentations and extracranial anomalies correlate with increased behavioral concerns; speech issues in CFM require careful differentiation from psychosocial symptoms.
Objective:
The study aim was to assess behavioral adjustment in preschool children with and without craniofacial microsomia (CFM).
Design:
Multisite cohort study of preschoolers with CFM ("cases") or without CFM ("controls").
Participants:
Mothers (89%), fathers (9%), and other caregivers (2%) of 161 preschoolers.
Outcome Measure:
Child Behavior Check List (CBCL 1.5-5); linear regressions with standardized effect sizes (ES) adjusted for sociodemographic confounds.
Results:
Child Behavior Check Lists for 89 cases and 72 controls (average age 38.3 ± 1.9 months). Children were male (54%), white (69%), and of Latino ethnicity (47%). Cases had microtia with mandibular hypoplasia (52%), microtia only (30%), or other CFM-associated features (18%). Nearly 20% of cases had extracranial anomalies. Composite CBCL scores were in the average range compared to test norms and similar for cases and controls. On the subscales, cases' parents reported higher Anxious/Depressed scores (ES = 0.35, P = .04), Stress Problems (ES = 0.40, P = .04), Anxiety Problems (ES = 0.34, P = .04), and Autism Spectrum Problems (ES = 0.41, P = .02); however, the autism subscale primarily reflected speech concerns. Among cases, more problems were reported for children with extracranial anomalies and certain phenotypic categories with small ES.
Conclusions:
Behavioral adjustment of preschoolers with CFM was comparable to peers. However, parental reports reflected greater concern for internalizing behaviors; thus, anxiety screening and interventions may benefit children with CFM. Among cases, more problems were reported for those with more complex presentations of CFM. Craniofacial microsomia-related speech problems should be distinguished from associated psychosocial symptoms during developmental evaluations.
