Psychosocial Adjustment in Twin Pairs with and without Hemifacial Microsomia

Abstract

Objective To compare the psychosocial adjustment of children with and without hemifacial microsomia (HFM). Design This cross-sectional pilot study investigated psychosocial adjustment of twin pairs in which one twin was affected with HFM and the other was unimpaired. Data were analyzed using paired t tests. Setting The dental medicine clinic of a large urban children's hospital, serving a multistats area. Participants Participants were six twin pairs aged 9 to 15 years and their parents. Data were also collected from classroom teachers. Main outcome Measures Outcome measures included: the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Coopersmith Self-Esteem Inventory (SEI), and a structured self-concept interview (the Self-Interview). Results Children with HFM had significantly higher CBCL and TRF total behavior problem scores and lower SEI general self-esteem scores than their unimpaired twins. No differences were found in CBCL competence scores. Interview data revealed concerns among the HFM group related to appearance, negative social responses, and fear of hospital procedures. Children also reported positive aspects of coping with HFM. Conclusions The results of this study suggest that, similar to other craniofacial conditions, HFM is associated with an elevated risk for childhood psychosocial difficulties. Replication of specific findings with a larger sample is needed. Multicenter, collaborative studies are a crucial next step for this field.