40. Psychosocial Growth Chart for Children With Craniofacial Anomalies: A Prospective Longitudinal Study

PURPOSE: While improving quality of life has long been the ultimate goal in the care of children with congenital craniofacial anomalies, the intersection between surgery and psychosocial functioning has not been well understood. A major reason for this discrepancy is the lack of systematic, validated, and quantitative psychosocial assessments throughout the care pathway. While our group previously reported in a cross-sectional study that patients 8 to 10 years of age are at an increased risk for psychosocial dysfunction compared to their teenage counterparts, longitudinal outcomes have not yet been documented. Such longitudinal charting of quality of life could contribute to the development of a psychosocial growth chart that may be incorporated as a standard of care. Therefore, the current work is the culmination of our prospective, longitudinal assessment of quality of life for over eight years to develop a psychosocial growth chart for children with craniofacial anomalies. METHODS: Patients were prospectively assessed from ages 8 to 17 at the University of California, Los Angeles and the Orthopaedic Institute for Children from 2015 to 2024. Psychosocial functioning was evaluated using eight Pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) instruments either in person or by telephone. Linear mixed models were fitted for each PROMIS measure with either a linear or quadratic effect of time, depending on which effect better represented the distribution of outcomes over time. The models incorporated age as a fixed effect and random intercepts by patients. RESULTS: 217 children (mean age of 12.7±2.8 years) with craniofacial anomalies, such as cleft lip and palate, cleft palate, and craniofacial microsomia, were included in this study. Peer relationships, anxiety, and depressive symptoms demonstrated a quadratic change over time with worse outcomes throughout the initial years that improved during the early teenage years before tapering back during the later teenage years. Anger scores remained relatively constant over time but exhibited a similar yet nonsignificant quadratic trend over time. On the other hand, psychological stress experiences and global health demonstrated a linear worsening trend over time. Family relationships and cognitive function scores decreased linearly to a nonsignificant degree. Based on the predicted PROMIS scores from the mixed models analyses, psychosocial growth charts from ages 8 to 17 were constructed for each measure. CONCLUSIONS: Children with craniofacial anomalies demonstrate age-related variations in psychosocial functioning throughout the care pathway. While comparisons with the general adolescent population are unknown, incorporating psychosocial growth charts as a standard of care could contribute towards identifying patients who are at higher risk of psychosocial dysfunction.