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Teasing and bullying in children and young people with cleft lip and/or palate: A framework for formulation

Teasing and bullying in children and young people with cleft lip and/or palate: A framework for formulation

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Quick Overview

Orofacial clefts are the most common congenital condition, affecting around one in 650 babies. Others' reactions to a cleft, as well as problems with appearance, hearing and speech, can make a child more vulnerable to teasing or bullying at various life stages. The purpose of this paper is to link a range of theoretical frameworks to a lifespan formulation, and to provide a guide to enhancing clinical intervention where problems with teasing and bullying occur.

The main premise is that different frameworks come into focus at different stages in the life of the individual. Because of the nature of the condition, wider social and societal factors overlay the psychological impact, alongside the treatment pathway. These different elements are represented in a series of diagrams in the paper. The text provides a framework based on life stages. Each life stage considers the key events, alongside the psychosocial issues which need to be considered at that stage.



Executive summary

1. A framework for formulation



  • Bullying
  • Types of bullying
  • Who does it involve?
Introduction to the model
  • Age and UK cleft-care audit points
  • Major life events including treatment and tasks related to life stages
  • Theoretical issues
  • General theories
  • Theories related to developmental stages
  • Context
  • Interventions

2. Birth and early infancy

Antenatal diagnosis


  • Key issues and events
  • Primary psychological interventions
  • Key issues and events
  • Primary psychological interventions
  • Key issues and events
  • Primary psychological interventions

    Guidance box

3.    Pre-school and nursery/school entry
    Key issues and events

  • Nursery/school entry
  • Separation and attachment
  • Social skills and empathy
  • New friendships
  • Self-awareness

    Primary psychological interventions

  •  Supporting parents
  •  Choosing and informing schools
  •  Developmental assessment and Statementing
  •  Behaviour interventions
  •  Systemic factors within the family

     Guidance box

4.    Junior school and middle childhood
Key issues and events

  • Ongoing treatment
  • Cognitive development and education
  • Group identity and play
  • Friendships
  • Teasing
  • Transition to secondary school

Primary psychological interventions

  • Cognitive assessment
  • Information and empowerment
  • Cognitive behaviour therapy
  • Social skills training
  • 'Toolkit' of behaviour strategies
  • Transition groups
  • Empowering parents 
  • Supporting and advising schools 
Guidance box

5.    Adolescence
Key issues and events

  • Adolescent with a cleft lip and/or palate
  • Appearance
  • Relationships
  • Shame
  • Identity formation
  • Gaining independence
  • Resilience
  • Protective factors
  • Vulnerability factors

Primary psychological interventions

  • Working with school
  • Social skills
  • Individual psychological interventions
  • Cognitive behaviour therapy
  • Narrative therapy 
  • Guidance box

6. Transition to adulthood
Key issues and events

  • The challenge of transition
  • Graduating from treatment
  • Genetic implications for long-term relationships
  • Self-worth

Primary psychological interventions
Coping strategies/social skills

  • Information, CBT and challenging unhelpful beliefs
  • Longer term person-centred/psychotherapeutic work on self-worth

      Guidance box

7.  Guidelines for future research

8. Concluding comments

9. Appendices - Suggested checklists
        1    Birth and Infancy
        2    Preschool and school entry
        3    Junior school and middle childhood
        4    Adolescence
        5    Transition to adulthood

10.    References
Additional reading

Additional Information