**Abstract**

The psychosocial functioning of children and adolescents with cleft lip and/or palate (CL/P) and their mothers was evaluated using a cross-sectional survey. The quality of life, depression, and self-esteem questionnaires were administered to CL/P patients and their mothers. The study included 69 individuals with CL/P between the ages of 6 and 18 and their mothers. According to the patient's age, CL/P patients and their mothers were divided into two groups: the infant group (6–12 years) and the adolescent group (13–18 years). Patients and mothers were requested to complete the questionnaires about life quality, self-esteem, and depression. According to the norm values of the Coopersmith Self-Esteem Scale, both child and adolescent groups have low self-esteem. However, adolescents' self-esteem levels were substantially lower than those of children (p < 0.05). There were no significant disparities between mothers of children and adolescents in terms of quality of life and self-esteem. The Beck depression scale scores of mothers of children were found to be greater than those of pubescent mothers (p < 0.05). Patients with CL/P tend to have lower self-esteem as they age; adolescents tend to have lower self-esteem than toddlers. In contrast, mothers of children with CL/P are less susceptible to melancholy than mothers of children.

**Keywords:** cleft lip/palate, psychosocial functioning, quality of life, depression, self-esteem

### **1. Introduction**

Cleft lip and palate (CL/P) is a common congenital deformity causing upper lip, nose and alveolar malformation, esthetic and dental problems and functional disorders [1]. Modern interdisciplinary care for CL/P individuals aims at physical, functional and psychological rehabilitation [2]. Facial appearance has important effects on psychological well-being and communication skills [3].

Age is a crucial factor in the psychosocial development of individuals with cleft lip and palate (CL/P) and their mothers. Several studies suggest that the age of the patient may have an impact on their self-esteem, learning abilities and emotional well-being. For instance, Sischo et al. [4] found that older children with CL/P tend to have lower self-esteem than younger children, while Marques et al. [5]reported that mothers of younger children with CL/P experience higher levels of anxiety and depression compared to mothers of older children.

Speech-language problems and facial differences in CL/P patients can cause social reactions [6, 7], mocking and stigmatization [8] which may result in negative behavioral responses [9], low self-esteem, self-confidence and low quality of social interactions [3, 10, 11]. Age factor may affect the psychological development process in patients with CL/P. It was reported that adolescents with CL/P tend to have higher levels of self-esteem and lower levels of social anxiety and distress than adults [12]. Children and young adults with CL/P had greater behavioral problems and increased depression symptoms compared to healthy ones [13].

Cleft type also affects self-perception. The self-esteem of the individuals with cleft lip and palate (87%) was more affected than those with only cleft palate (75%), as the deformity in individuals with only cleft palate cannot be seen by others [14]. Despite some contradictory findings, the literature suggests that the relationship between age and psychosocial functioning in CL/P patients and their families is complex and multifaceted, influenced by factors such as the severity of the cleft, the timing of surgical interventions, and the presence of comorbidities. Nonetheless, to date, there have been limited studies investigating the psychosocial status of both individuals with CL/P and their mothers in a large-scale and multidimensional manner. Therefore, it is important to conduct further research to better understand the role of age in the psychosocial development of individuals with CL/P and their families.
