Prevalence and Factors Associated with Behavioral Problems in 5-Year-Old Children Born with Cleft Lip and/or Palate from the Cleft Collective

Objectives To determine the UK prevalence of behavioral problems in 5-year-old children born with isolated or syndromic cleft lip and/or palate (CL/P) compared to the general population and identify potentially associated factors. Design Observational study using questionnaire data from the Cleft Collective 5-Year-Old Cohort study and three general population samples. Main Outcome Measure The Strengths and Difficulties Questionnaire (SDQ). Participants Mothers of children (age: 4.9-6.8 years) born with CL/P ( n = 325). UK general population cohorts for SDQ scores were: Millennium Cohort Study (MCS) ( n = 12 511), Office of National Statistics (ONS) normative school-age SDQ data ( n = 5855), and Avon Longitudinal Study of Parents and Children (ALSPAC) ( n = 9386). Results By maternal report, 14.2% of children born with CL/P were above clinical cut-off for behavioral problems, which was more likely than in general population samples: 7.5% of MCS (OR = 2.05 1.49-2.82, P < 0.001), 9.8% of ONS (OR = 1.52 1.10-2.09, P = 0.008), and 6.6% of ALSPAC (OR = 2.34 1.70-3.24, P < 0.001). Children in the Cleft Collective had higher odds for hyperactivity, emotional and peer problems, and less prosocial behaviors. Maternal stress, lower maternal health-related quality of life and family functioning, receiving government income support, and maternal smoking showed evidence of association (OR range: 4.41-10.13) with behavioral problems, along with maternal relationship status, younger age, and lower education (OR range: 2.34-3.73). Conclusions Findings suggest elevated levels of behavioral problems in children born with CL/P compared to the general population with several associated maternal factors similar to the general population.