Behavioral adjustment of toddler and preschool-aged children with single-suture craniosynostosis
Related Experiment Video
Updated: May 19, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Kathleen A Kapp-Simon1, Brent R Collett, Michael A Barr-Schinzel
1Chicago, Ill.; Seattle, Wash.; St. Louis, Mo.; and Atlanta, Ga. From the Department of Surgery, Northwestern University; Departments of Psychology and Plastic Surgery, Shriners Hospital for Children; Psychiatry and Behavioral Medicine, Seattle Children's Hospital; Departments of Psychiatry and Behavioral Sciences and Epidemiology, University of Washington; Department of Psychology, The Chicago School of Professional Psychology; Department of Psychology, St. Louis Children's Hospital; Department of Pediatrics, Washington University School of Medicine; Craniofacial Team, Children's Healthcare of Atlanta.
Insights
Children with single-suture craniosynostosis generally exhibit typical behavioral development. While some small differences in attention and social adjustment were noted by parents, overall behavior was largely indistinguishable from peers.
Area of Science:
- Pediatric neurology
- Developmental psychology
- Behavioral science
Background:
- Single-suture craniosynostosis is a congenital condition affecting skull development.
- Previous reports suggested elevated behavior problems in affected children.
- Longitudinal studies with multiple informants are needed for confirmation.
Purpose of the Study:
- To confirm or refute reports of increased behavioral issues in children with single-suture craniosynostosis.
- To investigate specific areas of potential behavioral vulnerability, such as attention and social adjustment.
- To compare behavioral development between children with single-suture craniosynostosis and a control group.
Main Methods:
- Utilized the Child Behavior Checklist (CBCL) completed by mothers and fathers at two time points (19 and 37 months).
- Incorporated Caregiver-Teacher Report Form (CTRF) data for a subset of children.
- Employed longitudinal analysis and a control group for robust comparison.
Main Results:
- Overall behavior problem scores (externalizing, internalizing, total) were slightly higher in children with single-suture craniosynostosis, but most differences were not statistically significant.
- No significant behavioral differences were linked to the specific suture involved.
- Parents reported small to medium effect size differences in attention and social problems at the older age point.
Conclusions:
- Toddlers and preschoolers with single-suture craniosynostosis demonstrate behavioral development largely comparable to peers from similar socioeconomic backgrounds.
- Small group differences in attention and social adjustment warrant further investigation.
- A follow-up study at age 7 will assess the long-term predictive significance of these early behavioral observations.
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.
