Facial Appearance and Attachment in Infants with Orofacial Clefts: A Replication

Abstract

Objective The current study sought to replicate an unexpected finding reported by Speltz et al. (1997): relatively unattractive infants at age 3 months were more likely than attractive infants to show secure maternal attachment at age 12 months, a finding unaffected by the diagnosis of cleft lip and palate (CLP), cleft palate only (CPO), or the absence of a cleft condition. Design We evaluated the effects of diagnosis (CLP, CPO, or no diagnosis) and age (3, 12, and 24 months) on facial attractiveness ratings derived from a modified Q-sort method. Setting Craniofacial clinic in an urban children's hospital. Participants Infants with CLP and CPO and typically developing infants without clefts (n = 126) and their mothers. Ratings were made by 13 adults unfamiliar with cleft conditions. Main outcome Measures Facial attractiveness ratings. Results Infants with CLP were rated as the least attractive at all time points. At ages 12 and 24 months, infants in the CPO group were rated as less attractive than typical infants but more attractive than infants in the CLP group. Typical infants and those with CLP—utnot CPO—received higher attractiveness ratings with age. As hypothesized, less attractive infants, regardless of diagnosis, were more likely to show secure attachment than were more attractive infants. Conclusions We tentatively conclude that the perceived vulnerability of young infants, as indexed by atypical or unattractive facial characteristics, engenders extraordinary protectiveness and responsiveness in some mothers, leading to a higher probability of secure attachment. A test of this hypothesis with a new sample of infants is recommended.