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.