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Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Sex differences in the neurodevelopment of school-age children with and without single-suture craniosynostosis
Mary Michaeleen Cradock1, Kristen E Gray, Kathleen A Kapp-Simon
1Department of Psychology, St Louis Children's Hospital; Department of Pediatrics, Washington University School of Medicine, One Children's Place 3N-14, 63110, St Louis, MO, USA, mmc0646@bjc.org.
Insights
Boys with single-suture craniosynostosis (SSC) show significant neurodevelopmental differences compared to girls, with higher risks for learning problems, especially those with unicoronal SSC. Girls and children with sagittal SSC have better academic outcomes.
Area of Science:
- Pediatric neurodevelopment
- Craniofacial anomalies
- Developmental psychology
Background:
- Single-suture craniosynostosis (SSC) is associated with modest neurodevelopmental deficits in affected children compared to controls.
- Sex differences in neurodevelopmental outcomes for children with SSC have been understudied.
- Understanding these differences is crucial for targeted interventions and support.
Purpose of the Study:
- To investigate sex differences in neurodevelopmental abilities among children with single-suture craniosynostosis (SSC).
- To determine if sex differences vary based on SSC status (cases vs. controls) or the specific suture fused.
- To identify specific subgroups of children with SSC who may be at higher risk for learning difficulties.
Main Methods:
- A cohort of 182 children with SSC (cases) and 183 controls were assessed at a mean age of 7.4 years.
- Intellectual abilities were measured using the Wechsler Scale of Intelligence for Children-Fourth Edition.
- Academic skills in reading, spelling, and math were evaluated using multiple standardized assessments.
Main Results:
- Males consistently scored lower than females on all neurodevelopmental measures, both in cases and controls.
- Sex differences in performance were generally slightly larger in children with SSC compared to controls.
- Among children with SSC, males had a higher prevalence of learning problems (50% vs. 30%), with the highest rates in males with unicoronal SSC (86%).
Conclusions:
- Substantial sex differences in neurodevelopmental abilities exist in children with SSC, though similar patterns are observed in typically developing children.
- Girls and children with sagittal SSC demonstrate the lowest risk for academic challenges.
- Boys with unicoronal SSC require vigilant developmental monitoring due to elevated risks for learning problems.
Purpose:
Previous studies have indicated that infants and school-age children with single-suture craniosynostosis (SSC, cases) score modestly but consistently lower than unaffected children (controls) on neurodevelopmental tests. However, sex differences in these functions rarely have been examined, and it is unknown whether potential sex differences vary by case status (cases vs. controls) or location of suture fusion.
Methods:
We tested 182 cases and 183 demographically matched controls at a mean age of 7.4 years. We measured intellectual abilities with the Wechsler Scale of Intelligence for Children-Fourth Edition. We assessed reading, spelling, and math with a combination of the Wide Range Assessment Test-Fourth Edition, the Test of Word Reading Efficiency, and the Comprehensive Test of Phonological Processing.
Results:
Among both cases and controls, males scored lower on all measures than females with standard score differences ranging from -1.2 to -7.8 for controls (p values from <0.001 to 0.55) and -2.3 to -8.5 for cases (p values from <0.001 to 0.33). For all but one measure, sex differences were slightly larger for cases than controls. Among cases, males were more likely than females to have learning problems (50 vs. 30%, respectively), with the highest level observed among males with unicoronal synostosis (86%).
Conclusions:
Sex differences in neurodevelopmental abilities among children with SSC are substantial, but not a unique correlate of this disorder as similar differences were observed among controls. Girls and those with sagittal synostosis have the lowest risk for academic problems. Boys with unicoronal synostosis warrant close developmental surveillance.
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