Academic journal article The Journal of Rehabilitation

Psychosocial Problems and Referrals among Oral-Facial Team Patients

Academic journal article The Journal of Rehabilitation

Psychosocial Problems and Referrals among Oral-Facial Team Patients

Article excerpt

This study examined the Psychosocial status and referral needs among 104 patients with oral-facial defects. The patients had (1) cleft lip and palate, (2) cleft palate (3) cleft lip, (4) speech disorder with no structural defect, or (5) facial deformities. The subjects were between 11 months and 18 years old. Based on interview data and results from standardized tests, the subjects' cognitive, emotional, and behavioral and family functioning were determined. Using descriptive statistics, approximately 56% of the patients had problems warranting psychosocial referrals. A stepwise regression model revealed that gender, intelligibility, and diagnostic category of speech disorder and facial disfigurement were significantly associated with patients' psychosocial status. implications for rehabilitation centers treating patients with oral-facial defects are discussed.

The literature regarding psychosocial status among patients with oral-facial defects has identified areas of psychosocial risks in this population. Typically, the research assesses and studies one dimension of psychosocial function. Such research has revealed that patients with clefts may have significant psychosocial needs and problems in the areas of cognitive, emotional, behavioral and family functioning.

Recent studies of self-concept (Broder et al., 1989), (KappSimon, 1986), psychoeducational development (Richman, 1989), social perception by peers (Tobiason, 1987), parents and teachers (Schneiderman and Aver, 1984) and the public (Middleton et al., 1986) identify the psychosocial risks among school-age children with clefts. Studies of adolescents with cleft lip and palate establish that appearance and speech may remain problematic (Richman, 1983) even in patients who have had extensive surgical and team-based care (Strauss et al., 1988). Studies of parental tolerance of conduct problems and school experience with children who have clefts suggest that there is an association between speech difficulties and facial disfigurement and the increased reporting of conduct problems at home and behavioral and learning problems at school (Tobiason and Hiebert, 1984), (Richman, 1989). Studies of cognitive function and intellectual status within the cleft population report lower verbal IQ scores and language deficiencies, and lower mean IQ scores, than nonnative data (Richman and Eliason, 1982). Children with isolated cleft palate sometimes demonstrate more severe reading disabilities (Richman et al., 1988). These children tend to underachieve relative to their intellectual ability and teachers tend to underestimate the intellectual ability of children with more severe, cleft-related facial deformities (Richman and Harper, 1978). Self concept of children with clefts appear to be lower than noncleft cohorts (Broder, 1989). Subjects with facial clefts are reported more concerned about their physical self concepts (Tobiasen et al., 1987). Children with facial clefts and intelligibility problems may be at higher risk for poor self concept. Additional congenital malformations increase the likelihood of school and home behavior problems. Inhibition and shyness are observed more frequently among individuals with clefts (Tobiasen and Hiebert, 1984). Adjustment and achievement problems are noted among adolescents with clefts (Richman, 1989). Adults with clefts report less dating experiences and marry later in life (Peters and Chinsky, 1974).

These psychological studies have not examined the patients' psychosocial problems and referrals concomitantly nor from a team perspective. If the ultimate goal of rehabilitation for patients evaluated by cleft/craniofacial teams is to improve the quality of their lives and to help them realize their potential, then assessing the patient's psychosocial status is essential.

Psychosocial status is defined as the patients' cognitive, social, and behavior skills and their family stability. The goals of this study include:

(1) identifying the incidence and type of psychosocial problems/referrals by a cleft/craniofacial treatment team in the study sample,

(2) examining whether patients who require psychosocial referrals are more likely to have multiple psychosocial problems and

(3) determining if there are significant independent variables associated with psychosocial problems warranting referrals in the sample. …

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