title: The Effect of Familiarity on Adult Responses to Infants with Atypical Facial Configurations.
Creators: name: Hunt, Benjamin
Publisher: name: University of Liverpool Repository
Year: 2026

description: The aim of this thesis was to investigate the effect of prior familiarity with infant cleft lip and/or palate (CLP) on adults’ perception of infants affected by this condition. CLP-affected infants are at risk of adverse outcomes due to how they are perceived by peers (e.g., teasing/bullying), related to their altered facial appearance. Research suggests prior familiarity with infant CLP may influence third-party observers’ perceptions of cleft-affected infants, which has implications for how these infants are perceived during interaction with caregivers and in social situations generally. This thesis contains three empirical studies investigating the effect of familiarity with infant CLP on the perception of cleft-affected infant faces, using three methods: subjective ratings, electroencephalography, and eye tracking combined with subjective ratings, in order to measure participants’ “cuteness” ratings, neural responses (N170 event related potentials typically seen in response to face stimuli), and the interaction between visual scanning of the face and “cuteness” ratings, respectively. 
To establish familiarity with CLP, a week-long training phase was purpose-designed for use in the studies. In each study, participants, approximately half of whom underwent the familiarisation training, were biologically female individuals who were shown images of typical and cleft-affected infants. 
In the first study, all participants rated cleft-affected infants as less “cute” than typical infants in a pre-training baseline assessment. However, familiarised participants provided significantly higher ratings of CLP-affected infants at post-test compared to baseline. Control participants did not show the same pattern of behaviour. 
In the second study, familiarised participants were expected to show greater N170 responses to CLP-affected infants compared to control participants. However, this was not observed. Notably, no difference in neural response was found between cleft and typical infant images, suggesting the cleft was not processed automatically by these groups of participants, contrary to findings from previous studies that have investigated the role of the cleft in the infant face processing literature. 
In the third study, no difference was observed between familiarised and control participants’ fixation time to the cleft-affected mouth region, however, for control participants only, the greater the fixation time to the mouth area of CLP images, the lower the “cuteness” ratings were. The same pattern of behaviour was not found for familiarised participants, suggesting the training abolished this effect in those who had undertaken it.
Taken collectively, the familiarisation training showed promise for modifying the third-party observer’s experience when interacting with CLP-affected infants. Findings may be used to inform interventions that seek to improve outcomes for cleft-affected infants by modifying observers’ perceptions of them. Findings may be valuable for public health literature aiming to inform parents about their cleft-affected child’s future social interactions with peers, and mechanisms whereby the latter can be encouraged to view the cleft positively.