Facial Expressions of Emotion in Children with Cleft Lip and Palate

Objective: To examine the facial movements children with cleft lip and palate (CLP) employ to express basic emotions. Ability of observers to interpret facial expressions of children with CLP was also considered. Design: Prospective case-control design. Setting: Outpatient craniofacial anomalies clinic. Patients: Twenty-five children with CLP (age 8 to 12) and 25 age/sex-matched controls. Outcome Measures: Children were video recorded making facial expressions representing anger, disgust, fear, happiness, sadness, and surprise. Magnitude of children's facial movements was quantified and compared using OpenFace. Subsequently, emotion videos were presented to 19 adults who were asked to identify the emotion conveyed in each facial expression. Accuracy of emotion recognition was compared across groups. Results: Compared with controls, children with CLP employed significantly (P < .05) smaller magnitude superior and lateral perioral movements to express disgust (Cohen's d = .50), happiness (Cohen's d = 1.1), and fear (Cohen's d = .93). For disgust and sadness, children with CLP employed significantly greater magnitude movements of the nose and chin, presumably to compensate for reduced perioral range of motion. For anger, happiness, and sadness, children with CLP employed smaller magnitude movements of the upper face when compared with controls. Observers identified disgust (OR = 1.26), and fear (OR = 2.44) significantly less accurately in children with CLP when compared with controls. Conclusions: Children with CLP employed different facial movements to express certain emotions. Observers less accurately identified some emotions conveyed by facial expressions in children with CLP when compared with controls, likely due in part to differences in facial movements. Future research should explore the implications of these differences for social communication.