Behavioral adjustment of toddler and preschool-aged children with single-suture craniosynostosis

Abstract

Background: The purpose of this study was to confirm initial reports of elevated behavior problems in children with single-suture craniosynostosis, using multiple informants, longitudinal analyses, and a control group. The authors hypothesized that children with single-suture craniosynostosis would have higher levels of maladjustment than comparison children, particularly at the older age and in selected areas of previously observed vulnerability: attention and social adjustment.

Methods: The Child Behavior Checklist was completed by 436 mothers (219 with single-suture craniosynostosis) and 371 fathers (177 with single-suture craniosynostosis) when children were aged approximately 19 months, and by 361 mothers (175 with single-suture craniosynostosis) and 303 fathers (142 with single-suture craniosynostosis) when children were aged approximately 37 months. A minimum of one caregiver/teacher report was available for 169 of these children (74 with single-suture craniosynostosis) using the Caregiver-Teacher Report Form.

Results: Average Child Behavior Checklist/Caregiver-Teacher Report Form externalizing, internalizing, and total scores for all informants were consistently higher (worse) for children with single-suture craniosynostosis than for control group children, but most differences were small and statistically nonsignificant. No differences associated with suture site were found. At the oldest age point, both mothers and fathers (but not teachers) generated higher average scores for patients than for controls on scales measuring attention and social problems, with small to medium effect sizes (0.20 to 0.32).

Conclusions: On average, toddlers/preschoolers with single-suture craniosynostosis show behavioral development that is largely indistinguishable from same-aged peers of similar socioeconomic background. The predictive significance of small group differences in attention and social adjustment will be assessed in a follow-up of this cohort at age 7.

Conflict of interest statement

Conflict of Interest:

The authors have no conflicts of interest to report.

Figures

Figure 1

Forest plot presenting adjusted mean differences and effect sizes with 95% confidence intervals (CI) for Child Behavior Checklist (CBCL) and Caregiver-Teacher Report Form (CTRF) syndrome and DSM scores at Time (T) 1 and T2. Analyses adjusted for study site, age (months), socioeconomic status (composite score from the Hollingshead, entered as a continuous score), sex, and race/ethnicity (white, non-Hispanic versus non-white or Hispanic)