This presentation reviews the literature on the psychological implications of having a visible difference, focusing on Cleft Lip and Palate. This includes risk and resilience factors. It then reviews the validity of this within clinical practice using data collected from Cleft Centres around the UK, using the Child Hearing, Appearance and Speech Questionnaire for Children and Young People. This is a measure developed and validated by the Clinical Excellence Network for Psychologists working within Cleft Centres. The findings highlight that it is an individual’s perception of his/her difficulties and the subsequent coping strategies used that influences adjustment, rather than the cleft type per se.