Perceptions of stigmatization, attributional style and adjustment in adolescents with craniofacial conditions

This study investigated the relationships among demographic and condition variables, perceptions of stigmatization, attributional style, self-concept, and social and behavioral adjustment in adolescents with craniofacial conditions (CFC). Of particular interest was whether attributional style acts to mediate the relationship between perceived stigma and outcome variables.; Participants were 53 male and 30 female adolescent/parent dyads. Adolescents were between 13 and 18 years of age with a visible, congenital facial difference (cleft lip, cleft lip/palate, craniofacial syndrome, or other CFC such as hemangioma) and no developmental delay or profound physical disability. Independent variables were age, gender, number of functional impairments (hearing or speech problems, learning disability), self-rated appearance (Self-Description Questionnaire-II/SDQ-II) and perceived stigmatization. Outcome variables were self-concept (SDQ-II), social skills as measured by the Social Skills Rating System (SSRS-Student), extent of peer network (Peer Interaction Record-PIR), and externalizing and internalizing behavioral problems (SSRS-Parent).; Of the adolescents, 83% reported some experience of stigmatization in their social interactions; parents' and adolescents' perceptions were significantly correlated but adolescents reported significantly higher levels of stigmatization. Greater satisfaction with physical appearance and more optimistic attributional style were significantly and positively correlated with self-concept and social skills, and negatively correlated with behavioral problems. Higher perceived stigmatization was negatively correlated with self-concept and social skills and positively correlated with behavioral problems. Demographic (age, gender, SES) and condition-related variables (diagnosis, number of functional impairments) were generally not significantly predictive. However, learning disabilities were associated with fewer social skills, more internalizing problems, and a more pessimistic attributional style. Results show that a more positive attributional style mediated the relationship between perceptions of stigmatization and social skills, self-concept, and internalizing behavior problems; it had no effect on either extent of peer network or externalizing behavior problems. Both practical and theoretical implications of these results are addressed, as are directions for further research.