{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T20:27:16Z","timestamp":1767990436935,"version":"3.49.0"},"reference-count":47,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T00:00:00Z","timestamp":1596067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Vocational Training Charitable Trust Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Facial palsy is often associated with impaired facial function and altered appearance. However, the literature with regards to the psychological adjustment of children and adolescents with facial palsy has not been systematically reviewed to date. This paper aimed to review all published research with regards to psychosocial adjustment for children and adolescents with facial palsy. Methods: MEDLINE, CINAHL, Embase, PsychInfo and AMED databases were searched and data was extracted with regards to participant characteristics, study methodology, outcome measures used, psychosocial adjustment and study quality. Results: Five studies were eligible for inclusion, all of which investigated psychosocial adjustment in participants with Moebius syndrome, a form of congenital facial palsy. Many parents reported their children to have greater social difficulties than general population norms, with difficulties potentially increasing with age. Other areas of psychosocial adjustment, including behaviour, anxiety and depression, were found to be more comparable to the general population. Discussion: Children and adolescents with Moebius syndrome may experience social difficulties. However, they also demonstrate areas of resilience. Further research including individuals with facial palsy of other aetiologies is required in order to determine the psychosocial adjustment of children and adolescents with facial palsy.<\/jats:p>","DOI":"10.3390\/ijerph17155528","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T04:15:31Z","timestamp":1596168931000},"page":"5528","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A Systematic Review of the Psychosocial Adjustment of Children and Adolescents with Facial Palsy: The Impact of Moebius Syndrome"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4400-0320","authenticated-orcid":false,"given":"Matthew","family":"Hotton","sequence":"first","affiliation":[{"name":"Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esme","family":"Huggons","sequence":"additional","affiliation":[{"name":"Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Hamlet","sequence":"additional","affiliation":[{"name":"Centre for Appearance Research, University of the West of England, Bristol BS16 1QY, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-5700","authenticated-orcid":false,"given":"Kathleen","family":"Bogart","sequence":"additional","affiliation":[{"name":"School of Psychological Science, Oregon State University, Corvallis, OR 97331, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Johnson","sequence":"additional","affiliation":[{"name":"Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan H.","family":"Norris","sequence":"additional","affiliation":[{"name":"Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Kilcoyne","sequence":"additional","affiliation":[{"name":"Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise","family":"Dalton","sequence":"additional","affiliation":[{"name":"Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1177\/0009922809347798","article-title":"Facial nerve palsy in the pediatric population","volume":"49","author":"Shargorodsky","year":"2010","journal-title":"Clin. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00006534-199001000-00001","article-title":"Facial nerve palsy in the newborn: Incidence and outcome","volume":"85","author":"Falco","year":"1990","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s13052-016-0256-5","article-title":"Moebius syndrome: Clinical features, diagnosis, management and early intervention","volume":"42","author":"Picciolini","year":"2016","journal-title":"Ital. J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ejpn.2010.11.004","article-title":"Facial palsy: Etiology, outcome and management in children","volume":"15","author":"Jenke","year":"2011","journal-title":"Eur. J. Peadiatr. Neuv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1037\/1528-3542.3.2.150","article-title":"What Do Facial Expression Convey: Feeling States, Behavioral Intentions, or Action Requests","volume":"3","author":"Horstmann","year":"2003","journal-title":"Emotion"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0163-6383(03)00017-1","article-title":"Father\u2013and mother\u2013infant face-to-face interactions: Differences in mind-related comments and infant attachment?","volume":"26","author":"Lundy","year":"2003","journal-title":"Infant. Behav. Dev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/S0272-7358(00)00056-8","article-title":"Adjusting to disfigurement: Processes involved in dealing with being visibly different","volume":"21","author":"Thompson","year":"2001","journal-title":"Clin. Psychol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1597\/08-257.1","article-title":"Living with Moebius syndrome: Adjustment, social competence, and satisfaction with life","volume":"47","author":"Bogart","year":"2010","journal-title":"Cleft Palate-Cran. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/j.bjps.2012.06.004","article-title":"Self-and parent-perceived stigmatisation in children and adolescents with congenital or acquired facial differences","volume":"65","author":"Masnari","year":"2012","journal-title":"J. Plast. Reconstr. Aes."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/13638490701217396","article-title":"Visible difference amongst children and adolescents: Issues and interventions","volume":"10","author":"Rumsey","year":"2007","journal-title":"Dev. Neurorehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1177\/1359105313517277","article-title":"People are all about appearances: A focus group of teenagers with Moebius syndrome","volume":"20","author":"Bogart","year":"2015","journal-title":"J. Health Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hotton, M., Hamlet, C., Kilcoyne, S., Johnson, D., Norris, J.H., Huggons, E., Shore, D., and Dalton, L. (2020). The Psychosocial Impact of Facial Palsy: A Systematic Review. Br. J. Health Psychol.","DOI":"10.1111\/bjhp.12440"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Int. Med."},{"key":"ref_14","unstructured":"National Institutes of Health (2020, June 02). Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies [National Heart, Blood, and Lung Institute], Available online: https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools."},{"key":"ref_15","first-page":"267","article-title":"Moebius sequence: Behaviour problems of preschool children and parental stress","volume":"18","author":"Briegel","year":"2007","journal-title":"Genet. Couns."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/j.1440-1754.2009.01652.x","article-title":"Behaviour problems of patients with Moebius sequence and parental stress","volume":"46","author":"Briegel","year":"2010","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.ridd.2016.02.005","article-title":"Quality of life and adjustment in children and adolescents with Moebius syndrome: Evidence for specific impairments in social functioning","volume":"53","author":"Strobel","year":"2016","journal-title":"Res. Dev. Disabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.ridd.2018.11.004","article-title":"Psychological adjustment of young subjects with M\u00f6bius sequence and their primary caregivers\u2019 strain and life satisfaction: First longitudinal data","volume":"85","author":"Briegel","year":"2019","journal-title":"Res. Dev. Disabil."},{"key":"ref_19","unstructured":"Achenbach, T.M., and Edelbrock, C.S. (1983). Manual for the Child Behavior Checklist and Revised Child Behaviour Profile, University of Vermont Department of Psychiatry."},{"key":"ref_20","first-page":"491","article-title":"German version of the Strength and Difficulties Questionnaire (SDQ-German)\u2014Overview and evaluation of initial validation and normative results","volume":"52","author":"Klasen","year":"2003","journal-title":"Prax. Kinderpsychol. Kinderpsychiatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ridd.2011.08.013","article-title":"Self-perception of children and adolescents with M\u00f6bius sequence","volume":"33","author":"Briegel","year":"2012","journal-title":"Res. Dev. Disabil."},{"key":"ref_22","unstructured":"Wieczerkowski, W., Nickel, H., Janowski, A., Fittkau, B., and Rauer, W. (1998). Angstfragebogen f\u00fcr Sch\u00fcler: (AFS); Handanweisung f\u00fcr die Durchf\u00fchrung, Auswertung und Interpretation, Hogrefe-Verlag."},{"key":"ref_23","unstructured":"Stiensmeier-Pelster, J., Sch\u00fcrmann, M., and Duda, K. (2000). Depressions-Inventar f\u00fcr Kinder und Jugendliche (DIKJ), Hogrefe-Verlag."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1023\/A:1008853819715","article-title":"Assessing health-related quality of life in chronically ill children with the German KINDL: First psychometric and content analytical results","volume":"7","author":"Bullinger","year":"1998","journal-title":"Qual. Life Res."},{"key":"ref_25","unstructured":"Seitz, W., and Rausche, A. (2004). Pers\u00f6nlichkeitsfragebogen f\u00fcr Kinder Zwischen 9 und 14 Jahren: PFK 9-14, Hogrefe-Verlag."},{"key":"ref_26","unstructured":"Krause, M.P., Petermann, F., and Petermann, F. (1997). Soziale Orientierungen von Eltern Behinderter Kinder (SOEBEK), Hogrefe-Verlag. Hogrefe Verlag f\u00fcr Psychologie."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1037\/a0035800","article-title":"The role of disability self-concept in adaptation to congenital or acquired disability","volume":"59","author":"Bogart","year":"2014","journal-title":"Rehabil. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.tics.2015.12.010","article-title":"Fashioning the face: Sensorimotor simulation contributes to facial expression recognition","volume":"20","author":"Wood","year":"2016","journal-title":"Trends Cogn. Sci."},{"key":"ref_29","first-page":"27","article-title":"Peripheral facial palsy: Speech, communication and oral motor function","volume":"134","author":"Lohmander","year":"2017","journal-title":"Eur. Ann. Otorhinolary"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/j.1651-2227.1989.tb11076.x","article-title":"Autistic behaviour in Moebius syndrome","volume":"78","author":"Gillberg","year":"1989","journal-title":"Acta Paediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.ridd.2010.06.012","article-title":"Moebius sequence and autism spectrum disorders\u2014Less frequently associated than formerly thought","volume":"31","author":"Briegel","year":"2010","journal-title":"Res. Dev. Disabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1753-2000-7-16","article-title":"The face of appearance-related social pressure: Gender, age and body mass variations in peer and parental pressure during adolescence","volume":"7","author":"Helfert","year":"2013","journal-title":"Child. Adolesc. Psychiatry Ment. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4825","DOI":"10.1200\/JCO.2009.22.5474","article-title":"Sex, drugs, and rock \u2018n\u2019roll: Caring for adolescents and young adults with cancer","volume":"28","author":"Morgan","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1258\/jrsm.2011.110221","article-title":"Development of the social brain in adolescence","volume":"105","author":"Blakemore","year":"2012","journal-title":"J. R. Soc. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1597\/1545-1569_2001_038_0231_rasiaw_2.0.co_2","article-title":"Resiliency and success in adults with Moebius syndrome","volume":"38","author":"Meyerson","year":"2001","journal-title":"Cleft Palate-Cran. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1037\/hea0000838","article-title":"Socioemotional functioning with facial paralysis: Is there a congenital or acquired advantage?","volume":"39","author":"Bogart","year":"2019","journal-title":"Health Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1177\/1359105311432491","article-title":"Social interaction experiences of adults with Moebius syndrome: A focus group","volume":"17","author":"Bogart","year":"2012","journal-title":"J. Health Psychol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1007\/s00787-018-1169-1","article-title":"Childhood aggression and the co-occurrence of behavioural and emotional problems: Results across ages 3\u201316 years from multiple raters in six cohorts in the EU-ACTION project","volume":"27","author":"Bartels","year":"2018","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"ref_39","unstructured":"Darras, B.T., Jones, H.R., Ryan, M.M., and De Vivo, D.C. (2015). Congenital and acquired facial palsies. Neuromuscular Disorders of Infancy, Childhood, and Adolescence, Academic Press."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/icd.578","article-title":"Relationships among parenting practices, parental stress, child behaviour, and children\u2019s social-cognitive development","volume":"18","author":"Guajardo","year":"2009","journal-title":"Infant. Child. Dev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1080\/1366825021000008657","article-title":"Parental stress and behaviour problems of children with developmental disability","volume":"27","author":"Hastings","year":"2002","journal-title":"J. Intell. Dev. Disabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"213","DOI":"10.3389\/fneur.2015.00213","article-title":"Training in compensatory strategies enhances rapport in interactions involving people with M\u00f6bius syndrome","volume":"6","author":"Michael","year":"2015","journal-title":"Front. Neurol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/j.bjps.2019.02.019","article-title":"Addressing the physical and psychosocial needs of young people with facial palsy: Facilitation of a single session group intervention","volume":"72","author":"Hotton","year":"2019","journal-title":"J. Plast. Reconstr. Aes. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/jpc.12497","article-title":"CHARGE syndrome: A review","volume":"50","author":"Hsu","year":"2014","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1002\/ajmg.c.31588","article-title":"Behavior in CHARGE syndrome","volume":"175","author":"Hartshorne","year":"2017","journal-title":"Am. J. Med. Genet. C"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1597\/08-093.1","article-title":"Coping with a cleft: Psychosocial adjustment of adolescents with a cleft lip and palate and their parents","volume":"46","author":"Berger","year":"2009","journal-title":"Cleft Palate-Cran. J."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1469-7610.2009.02186.x","article-title":"The effect of cleft lip on socio-emotional functioning in school-aged children","volume":"51","author":"Murray","year":"2010","journal-title":"J. Child. Psychol. Psychiatry"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/15\/5528\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:53:08Z","timestamp":1760176388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/15\/5528"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,30]]},"references-count":47,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["ijerph17155528"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17155528","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,30]]}}}