Stigmatization predicts psychological adjustment and quality of life in children and adolescents with a facial difference

J Pediatr Psychol. 2013 Mar;38(2):162-72. doi: 10.1093/jpepsy/jss106. Epub 2012 Nov 20.


Objectives: This cross-sectional study assessed psychological adjustment and health-related quality of life (HRQOL) in children and adolescents with congenital or acquired facial differences and identified potential predictors of adjustment.

Methods: Data were obtained from 88 children, ages 9 months to 16 years, by means of parent questionnaires (n = 86) and standardized interviews with children ≥7 years old (n = 31). Evaluation measures included the Child Behavior Checklist (CBCL), KIDSCREEN-27, TNO-AZL Preschool Quality of Life Questionnaire (TAPQOL), and Perceived Stigmatization Questionnaire.

Results: Psychological adjustment, as measured by the CBCL, was within norms. Parent-reported HRQOL was good in preschool children. Parent- and self-reported HRQOL of participants 7-16 years old was impaired in several dimensions, including psychological well-being. Psychological adjustment (especially internalizing behavior problems) and HRQOL were predicted primarily by perceived stigmatization.

Conclusions: Identification of stigma experiences and appropriate support may be crucial to enhancing psychological adjustment and quality of life in children with facial disfigurement.

MeSH terms

  • Adaptation, Psychological*
  • Adolescent
  • Burns / psychology
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Face
  • Female
  • Hemangioma, Capillary / psychology
  • Humans
  • Infant
  • Male
  • Nevus, Pigmented / congenital
  • Nevus, Pigmented / psychology
  • Parents / psychology
  • Port-Wine Stain / psychology
  • Quality of Life / psychology*
  • Skin Neoplasms / psychology
  • Social Adjustment*
  • Stereotyping*
  • Surveys and Questionnaires