Psychosocial Functioning and Sleep Patterns in Children and Adolescents With Cleft Lip and Palate (CLP) Compared With Healthy Controls Serge Brand, Ph.D., Anja Blechschmidt, M.Sc., Andreas Mu ¨ller, M.D., D.D.S., Robert Sader, M.D., D.D.S., Katja Schwenzer-Zimmerer, M.D., D.D.S., Hans-Florian Zeilhofer, M.D., D.D.S., Edith Holsboer-Trachsler, M.D. Objective: The aim of this study was twofold: to assess psychological functioning, interactional competencies, and sleep patterns in children and adolescents with cleft lip and palate (CLP), and to compare these results with those from age- and gender-matched controls. It was hypothesized that participants with CLP would exhibit greater difficulties in psychological functioning, more interactional difficulties, and poorer sleep patterns than those without CLP. Participants: Thirty-two children and adolescents with CLP and 34 controls were recruited. Ages ranged from 6 to 16 years. Main Outcome Measures: For psychosocial assessment, the Strength and Difficulties Questionnaire (SDQ) and a questionnaire on interactional compe- tencies (PIELCQ) were completed; for sleep assessment, a sleep log was completed for seven consecutive nights. Results: Participants with and without CLP did not differ with respect to emotional problems, conduct problems, or hyperactivity. With respect to interactional competencies, participants with CLP were six times more likely to report difficulties. Unfavorable sleep patterns were associated with psychosocial strain but not with the presence of CLP. Conclusions: Results indicate that children and adolescents with CLP may report that they have sleep irregularities as often as those without CLP. In adolescence, the presence of CLP may be associated with increased difficulties. Consequently, skill training to improve context-related social competencies may be appropriate. KEY WORDS: adolescents, children, cleft lip and palate, psychosocial function- ing, SDQ, sleep pattern Interest is growing regarding the psychosocial effects of cleft lip and palate (CLP) in children and adolescents. This interest stems from the assumption that facial appearance is important for healthy psychosocial development (Cole, 1998). As a consequence, it might be anticipated that children and adolescents with CLP would be at risk for psychosocial difficulties. However, results from a large body of research do not provide a coherent picture. On the one hand are findings of a negligible impact of CLP on an individual’s psychological well-being (Bressman et al., 1999; Gussy and Kilpatrick, 2006), supporting the conclu- sion that children and adolescents might not experience psychopathological difficulties (Hunt et al., 2005). On the other hand, specific psychological and sociocultural issues such as behavioral difficulties (Richman and Millard, 1997), stigma experiences (Strauss et al., 2007), and social problems (Peter and Chinsky, 1974; Snyder et al., 2005) have been reported. Moreover, symptoms of anxiety and depression (Ramstad et al., 1995), dissatisfaction with facial appearance (Marcusson et al., 2002; Patrick et al., 2007), withdrawal and internalization of problems (Pope and Snyder, 2005), and shyness (Boes et al., 2007) have been reported. In a cross-sectional study, Hunt et al. (2006) assessed the psychological functioning of patients with CLP by comparing 160 children and young adults with age- and gender-matched control groups. The research involved assessment of anxiety, depression, self-esteem, behavioral problems, and satisfaction with facial appearance and social functioning through the use of self-rating question- Dr. Brand is Research Psychologist, Psychiatric University Clinics, Depression Research Unit, Sleep Medicine and Neurophysiology, Basel, Switzerland. Ms. Blechschmidt is Lecturer, University of Applied Sciences Northwestern Switzerland, Basel. Dr. Sader is Head of the Cleft Centre– Clinic for Maxillofacial Surgery and Plastic Facial Surgery, Clinics of the Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. Dr. Mu ¨ ller is Assistant Physician, Dr. Schwenzer-Zimmerer is Primary Physician, and Dr. Zeilhofer is Head Physician and Head of the Clinics for Reconstructive Surgery, Division of Cranio-Maxillofacial Surgery, University Hospital Basel, Switzerland. Dr. Holsboer-Trachsler is Head, Psychiatric University Clinics, Depression Research Unit, Sleep Medicine and Neurophysiology, Basel, Switzerland. Submitted September 2007; Accepted June 2008. Address correspondence to: Serge Brand, Ph.D., Psychiatric University Clinics Basel, Depression Research Unit, Sleep Medicine and Neuro- physiology, Wilhelm Klein-Strasse 27, 4025 Basel, Switzerland. E-mail serge.brand@upkbs.ch. DOI: 10.1597/07-1651.1 124