Progress and limitations in the psychological study of craniofacial anomalies.

The term "craniofacial anomalies" (CFAs) refers to a diverse group of congenital disorders including complex syndromes marked by multiple sutural fusions (e.g., Crouzan's, Treacher Collins, and Aperts syndromes), simple craniosynostoses involving single fusions (e.g., sagittal synostosis), hemifacial microsomia, clefts of the lip and/or palate, and isolated "birth marks" on the face and neck, such as benign vascular nevi (i.e., port-wine stains). Most children with these disorders experience one or more associated complications including feeding and growth difficulties, oral-dental problems, chronic ear infections, speech and language impairments, and multiple structural and cosmetic surgeries for both visible disfigurement and "invisible" dysmorphologies (e.g., cleft palate). Any or all of these factors may produce significant stress and conflict for the child and family. Various psychological risk factors have been identified that may compromise the child's psychological adjustment, such as parental guilt or overprotectiveness, stigmatizing social responses to speech impairment or facial disfigurement, and certain neuropsychological limitations (see Barden, 1990; Richman & Eliason, 1993, for reviews of this literature). Although the majority of children with CFA appear to show normal psychosocial development (Speltz, Galbreath,