Developmental approach to the psychology of craniofacial anomalies

This article outlines a developmental perspective on psychosocial maladjustment and its implications for the psychological study and treatment of individuals with craniofacial anomalies. A developmental theory of attachment is described and used to formulate hypotheses about the developing parent-child relationship during the first 5 years of life and its influence on the child's subsequent social and emotional growth. Preliminary research involving infants with clefts and other craniofacial anomalies is reviewed with respect to hypothesized points of vulnerability in the attachment process. Two major points are made: (1) developmental theory provides a framework for the early identification of children in this population with elevated risk of subsequent psychosocial problems, and (2) among the multiple child and family variables associated with elevated risk, a craniofacial anomaly is unlikely to produce maladjustment in the absence of one or more other risk conditions such as family adversity, insecure attachment, or compromised child characteristics.