Behavioral Adjustment of School-Age Children with and without Single-Suture Craniosynostosis.

BACKGROUND

Previous research has observed higher than average rates of behavior problems in school-age children with single-suture craniosynostosis. However, most studies used a single informant (mothers) and did not include comparison groups to control for sociodemographic factors.

METHODS

The authors gave standardized behavior checklists to the mothers, fathers, and teachers of 179 elementary school children with single-suture craniosynostosis and 183 controls. We used linear regression to compare children with and without single-suture craniosynostosis on continuous measures of adjustment, and logistic regression to compare the proportions of children who scored above a well-established clinical threshold based on the report of one or more informants. All analyses were adjusted for demographic confounds (age, sex, socioeconomic status, maternal intelligence quotient).

RESULTS

Cases received higher average behavior problem scores than controls from all informants. However, differences were small in magnitude (0.01 to 0.2 SD; p = 0.12 to p = 0.96). Thirty-three percent of children with single-suture craniosynostosis were rated above a clinical threshold by one or more informants, compared with 21 percent of controls (adjusted odds ratio, 1.67; p = 0.04). Among cases, children with metopic synostosis had the highest level of observed behavior problems (41 percent greater than threshold); those with sagittal synostosis had the lowest level (29 percent).

CONCLUSIONS

The authors observed little difference in average ratings of behavior problems between children with and without single-suture craniosynostosis. However, children with single-suture craniosynostosis were more likely to score above a clinical threshold than unaffected controls. No specific areas of maladjustment were associated with case status or location of suture fusion.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.