Self-perception of children and adolescents with Möbius sequence.
Kids with Möbius sequence feel calmer than their frozen faces suggest—always check self-report plus caregiver report.
01Research in Context
What this study did
Briegel (2012) asked kids with Möbius sequence how anxious and sad they felt. The team also asked parents and teachers the same questions. They compared the two sets of answers.
Möbius sequence freezes facial muscles, so faces stay flat. The study wanted to know if flat faces hide real feelings.
What they found
The children rated their own anxiety and depression lower than test norms. Caregivers, however, ticked boxes for more social and emotional problems.
In short, the kids felt fine inside, but adults saw trouble.
How this fits with other research
Heald et al. (2020) saw the same split in youth with HFASD. Parents reported more depression, anxiety, and hyperactivity than the teens did. Together, the two papers show a pattern: when a child has a neurodevelopmental difference, adults often see more symptoms than the child reports.
Tang et al. (2025) used the same multi-informant trick with preterm children. Child, parent, and clinician scores did not line up. The 2025 study adds weight: always collect more than one point of view.
Root et al. (2017) found that kids with low-functioning ASD mis-read subtle angry faces. Wolfgang’s kids cannot make any face at all. Both papers warn that facial cues are weak data in these groups.
Why it matters
If you serve a child with Möbius, ASD, or any condition that dulls facial expression, do not trust what you see. Ask the child directly, then ask a parent, then ask a teacher. Use simple rating scales or mood charts. Triangulate before you write goals. One flat face can hide real feelings—or hide their absence.
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02At a glance
03Original abstract
Möbius sequence is a rare congenital disorder usually defined as a combination of facial weakness with impairment of ocular abduction. Some studies suggest that psychosocial and psychiatric problems might be increased among affected persons. So far, there have been no studies on the self-perception of children and adolescents with the sequence. Seventeen participants with Möbius sequence (9 male, 8 female) aged 9-15 (mean: 11.59) years were studied. None of the probands was mentally retarded or had a diagnosis of autism spectrum disorder. Participants filled out well standardized German questionnaires on depression (Depressionsinventar für Kinder und Jugendliche [DIKJ]), anxiety (Angstfragebogen für Schüler [AFS]) and personality aspects (Persönlichkeitsfragebogen für Kinder von 9-14 Jahren [PFK 9-14]). Additionally, their primary caregivers were asked to complete a special questionnaire to compile the probands' personal, somatic and psychosocial history as well as the German version of the Strengths and Difficulties Questionnaire, Parent Form [SDQ-Deu]. According to the participants' self-perception only one girl scored clinical (t-score ≥ 63) for manifest anxiety [AFS] and depression [DIKJ] (5.9% vs. 10% in the general population). Moreover, the whole sample reported significantly lower test anxiety (p=0.000) and manifest anxiety (p=0.005) [AFS] whereas general anxiety as a personality aspect [PFK 9-14] did not differ from the normative sample. Compared to normative data, subjects expressed significantly less depression (p=0.023) and impulsivity (p=0.042). One out of 17 subjects was rated abnormal for total problems on the SDQ-Deu (5.9% vs. 10% of the normative sample), five participants scored abnormal for social problems (29.4%) and three for emotional problems (17.6%). Social problems correlated significantly with the probands' age (rho=0.707; p=0.002). As Möbius patients have severe difficulties with facial expression of feelings, and others might therefore falsely recognize them as serious or even depressed, the subjects' self-perception is crucial for assessment and diagnosis, especially if it differs considerably from that of the primary caregivers.
Research in developmental disabilities, 2012 · doi:10.1016/j.ridd.2011.08.013