The purpose of this study was to evaluate possible relationships between number of surgeries and parent ratings of academic functioning among children with isolated oral clefts.
Design:
Multicenter, retrospective cohort study including structured interviews, questionnaires, and chart reviews.
Setting:
Completion of questionnaires occurred during clinical visits at 6 different cleft centers across North America.
Participants:
Parents of 285 children with isolated clefts of the lip and/or palate, aged 8 to 10 years old, participated in structured interviews and completed questionnaires regarding the academic and behavioral functioning of their children.
Main Outcome Measures:
Parent interview and medical chart review of number of surgeries to date and parent ratings on the Adaptive Behavior Assessment System, Third Edition-Functional Academics Scale (ABAS-FA) and Child Behavior Checklist (CBCL) Total Competency Scale.
Results:
Parent ratings of ABAS-FA were at or above normative expectations, while ratings across CBCL Competency Scales were lower than normative expectations. Socioeconomic status (SES), age, and race were consistent predictors of parent ratings (higher SES, older age, and Caucasian race were associated with better functioning). Number of surgeries did not add significantly to academic ratings but did significantly contribute to ratings of social and activity participation. Patients with more surgeries were rated with lower functioning in these domains.
Conclusions:
Findings do not support a connection between number of surgeries and later ratings of academic functioning but do support a connection to social and activity involvement. Recommendations for conducting direct studies of the connection between surgeries and academic functioning as well as clinical considerations for surgeries and impact on social and activity involvement are discussed.
AchenbachTM. The Child Behavior Checklist and related instruments. Lawrence Erlbaum Associates Publishers; 1999.
2.
BoesADMurkoVWoodJLLangbehnDRCanadyJRichmanLNopoulosP. Social function in boys with cleft lip and palate: relationship to ventral frontal cortex morphology. Behav Brain Rses. 2007;181(2);224–231.
3.
BurchinalMMcCartneyKSteinbergLCrosnoeRFriedmanSLMcLoydVPiantaR, NICHD Early Child Care Research Network. Examining the black-white achievement gap among low-income children using the NICHD study of early child care and youth development. Child Dev. 2011;82(5):1404–1420. doi:10.1111/j.1467-8624.2011.01620.x
4.
ChapmanKL. The relationship between early reading skills and speech and language performance in young children with cleft lip and palate. Cleft Palate Craniofac J. 2011a;48(3):301–311. doi:10.1597/08-213
5.
ChapmanKL. The relationship between early reading skills and speech and language performance in young children with cleft lip and palate. Cleft Palate Craniofac J. 2011b;48(3):301–311. doi:10.1597/08-213
6.
ClausenNGPedersenDAPedersenJKMøllerSEGrosenDChristensenKHansenTGWehbyGL. Oral clefts and academic performance in adolescence: the impact of anesthesia-related neurotoxicity, timing of surgery, and type of oral clefts. Cleft Palate Craniofac J. 2016;54(4):371–380. doi:10.1597/15-185
7.
CollettBRStott-MillerMKapp-SimonKACunninghamMLSpeltzML. Reading in children with orofacial clefts versus controls. J Pediatr Psychol. 2010;35(2):199–208. doi:10.1093/jpepsy/jsp047
8.
CollettBRWehbyGLBarronSRomittiPAAnsleyTNSpeltzML. Academic achievement in children with oral clefts versus unaffected siblings. J Pediatr Psychol. 2014;39(7):743–751. doi:10.1093/jpepsy/jsu049
9.
ConradALDaileySRichmanLCanadyJKarnellMPAxelsonENopoulosP. Cerebellum structure differences and relationship to speech in boys and girls with nonsyndromic cleft of the lip and/or palate. Cleft Palate-Craniofacial J. 2010;47(5):469–475. doi:10.1597/08-228
10.
ConradALGoodwinJWChoiJBlockRINopoulosP. The relationship of exposure to anesthesia on outcomes in children with isolated oral clefts. J child Neurol. 2017;32(3):308–315. doi:10.1177/0883073816681257
11.
ConradALMcCoyTEDeVolderIRichmanLCNopoulosP. Reading in subjects with an oral cleft: speech, hearing and neuropsychological skills. Neuropsychology. 2014;28(3):415–422. doi:10.1037/neu0000024
12.
ConradALRichmanLNopoulosP. Reading achievement in boys with non-syndromic cleft palate only: relationship to neuropsychological skill and neurocircuitry. Dev Neuropsychol. 2015;40(7-8):395–406. doi:10.1080/87565641.2016.1142991
13.
ConradALWermkeKEisenmannMKuhlmannEBenavidesAKoscikTMagnottaV. Preliminary evaluation of pre-speech and neurodevelopmental measures in 7-11 week old infants with isolated oral clefts. Pediatr Res. Epub ahead of print2020:1–6.
14.
ConradAL. Are predictors of reading impairment in isolated cleft similar to those in idiopathic dyslexia?Ann Dyslexia. 2018;69(2):153–165. doi:10.1007/s11881-018-00166-2
15.
CrerandCEConradALAlbertMBellucciCCHeppnerCESheikhFWoodardSKapp-SimonKA. The Americleft psychosocial outcomes project: a multicenter approach to advancing psychosocial outcomes for youth with cleft lip and palate. Clin Pract Pediatr Psychol. 2017;5(1):65–76. doi:10.1037/cpp0000172
16.
CrerandCEKapaHMLitteralJPearsonGDEastmanKKirschnerRE. Identifying psychosocial risk factors among families of children with craniofacial conditions: validation of the psychosocial assessment tool-craniofacial version. Cleft Palate Craniofac J. 2018;55(4):536–545. doi:10.1177/1055665617748010
17.
DavidsonAJDismaNDe GraaffJCWithingtonDEDorrisLBellGStargattRBellingerDCSchusterTArnupSJ, et al.Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet. 2016;387(10015):239–250. doi:10.1016/S0140-6736(15)00608-X
18.
FeragenKBSærvoldTKAuknerRStockNM. Speech, language, and reading in 10-year-olds with cleft: associations with teasing, satisfaction with speech, and psychological adjustment. Cleft Palate Craniofac J. 2017;54(2):153–165. doi:10.1597/14-242
19.
FitzsimonsKJDeaconSACopleyLPParkMHMedinaJvan der MeulenJH. School absence and achievement in children with isolated orofacial clefts. Arch Dis Child. 2020. doi:10.1136/archdischild-2020-319123
20.
GallagherERCollettBR. Neurodevelopmental and academic outcomes in children with orofacial clefts: a systematic review. Pediatrics. 2019;144(1):e20184027. doi:10.1542/peds.2018-4027
21.
GoodwinJWConradALAnsleyTNopoulosP. Arithmetical calculation and related neuropsychological skills in subjects with isolated oral clefts. Neuropsychology. 2017;31(7):834–841. doi:10.1037/neu0000381
HentgesFHillJBishopDVGoodacreTMossTMurrayL. The effect of cleft lip on cognitive development in school-aged children: a paradigm for examining sensitive period effects. J Child Psychol Psychiatry. 2011;52(6):704–712. doi:10.1111/j.1469-7610.2011.02375.x
24.
HollingsheadAB. Four Factor Index of Social Status. Department of Sociology, Yale University; 1975.
25.
HuntOBurdenDHepperPJohnstonC. The psychosocial effects of cleft lip and palate: a systematic review. Eur J Orthodontics. 2005;27(3):274–285. doi:10.1093/ejo/cji004
26.
IsaacsJ. Starting School at a Disadvantage: The School Readiness of Poor Children. Brookings Institution; 2012.
27.
Jevtovic-TodorovicVHartmanREIzumiYBenshoffNDDikranianKZorumskiCFOlneyJWWozniakD. Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits. J Neurosci. 2003;23(3):876–882.
28.
LaubDRJrWilliamsRK. Neonatal anesthesia neurotoxicity: a review for cleft and craniofacial surgeons. Cleft Palate Craniofac J. 2015;52(4):494–498. doi:10.1597/14-126
29.
MurrayLHentgesFHillJKarpfJMistryBKreutzMWoodallPMossTGoodacreT, Cleft Lip and Palate Study Team. The effect of cleft lip and palate, and the timing of lip repair on mother-infant interactions and infant development. J Child Psychol Psychiatry. 2008;49(2):115–123. doi:10.1111/j.1469-7610.2007.01833.x
30.
NopoulosPBoesADJabinesAConradALCanadyJRichmanLDawsonJD. Hyperactivity, impulsivity, and inattention in boys with cleft lip and palate: relationship to ventromedial prefrontal cortex morphology. J Neurodeve Disord. 2010;2(4):235–242. doi:10.1007/s11689-010-9060-5
31.
NopoulosPRichmanLMurrayJCanadyJ. Cleft palate and craniofacial conditions. Cleft Palate-Craniofac J. 2002;39(1):123–124. doi:10.1597/1545-1569(2002)039<0123: LTTE>2.0.CO;2
32.
PerssonMBeckerMConradALSvenssonH. Female and male differences in academic achievement in individuals with cleft: a population-based register study. Cleft Palate Craniofac J. 2018;55(2):196–203. doi:10.1177/1055665617726990
33.
PerssonMBeckerMSvenssonH. Academic achievement in individuals with cleft: a population-based register study. Cleft Palate Craniofac J. 2012;49(2):153–159. doi:10.1597/09-047
34.
PinckstonMDaltonLFarrarSHottonMT. The psychosocial adjustment of children born with a cleft lip and/or palate: cross-sectional and longitudinal analyses. Cleft Palate Craniofac J. 2020;57(11):1280–1290. doi:10.1177/1055665620921669
35.
RichmanLCEliasonMJLindgrenSD. Reading disability in children with clefts. Cleft Palate J. 1988;25(1):21–25.
36.
RichmanLCWilgenbuschTHallT. Spontaneous verbal labeling: visual memory and reading ability in children with cleft. Cleft Palate Craniofac J. 2005;42(5):565–569.
37.
SærvoldTKHideOFeragenKBAuknerR. Associations between hypernasality, intelligibility, and language and reading skills in 10-year-old children with a palatal cleft. Cleft Palate Craniofac J. 2019;56(8):1044–1051. doi:10.1177/1055665618824432
38.
ShriverASCanadyJRichmanLAndreasenNCNopoulosP. Structure and function of the superior temporal plane in adult males with cleft lip and palate: pathologic enlargement with no relationship to childhood hearing deficits. J Child Psychol Psychiatry. 2006;47(10):994–1002.
39.
SunLSLiGMillerTLSalorioCByrneMWBellingerDCIngCParkRRadcliffeJHaysSR, et al.Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. Jama. 2016;315(21):2312–2320. doi:10.1001/jama.2016.6967
40.
VutskitsLCulleyDJ. GAS, PANDA, and MASK: no evidence of clinical anesthetic neurotoxicity!Anesthesiology. 2019;131(4):762–764. doi:10.1097/ALN.0000000000002863
41.
WarnerDOZaccarielloMJKatusicSKSchroederDRHansonACSchultePJBuenvenidaSLGleichSJWilderRTSprungJ, et al.Neuropsychological and behavioral outcomes after exposure of young children to procedures requiring general anesthesia: the mayo anesthesia safety in kids (MASK) study. Anesthesiology. 2018;129(1):89–105. doi:10.1097/ALN.0000000000002232
42.
WehbyGLColletBBarronSRomittiPAAnsleyTNSpeltzM. Academic achievement of children and adolescents with oral clefts. Pediatrics. 2014;133(5):785–792. doi:10.1542/peds.2013-3072
43.
WehbyGLCollettBRBarronSRomittiPAnsleyT. Children with oral clefts are at greater risk for persistent low achievement in school than classmates. Arch Dis Child. 2015;100(12):1148–1154. doi:10.1136/archdischild-2015-308358
44.
WolodigerEDPopeAW. Associations between parenting stress at school entry and later psychosocial adjustment: a longitudinal study of children with congenital craniofacial anomalies. Cleft Palate Craniofac J. 2019;56(4):487–494. doi:10.1177/1055665618781371
