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Neurodevelopmental and Academic Outcomes in Children With Orofacial Clefts: A Systematic Review
Emily R Gallagher1,2,3,4, Brent R Collett1,3,4
1Seattle Children's Craniofacial Center and.
Insights
Children with orofacial clefts (OFCs) experience neurodevelopmental and academic challenges compared to peers. These deficits persist from infancy through adolescence, impacting cognition, language, and academic achievement.
Area of Science:
- Developmental Pediatrics
- Craniofacial Anomalies
- Neuroscience
Background:
- Orofacial clefts (OFCs) are associated with potential neurodevelopmental disparities.
- Existing research on neurodevelopmental outcomes in children with OFCs shows variability in methodologies and findings.
- Longitudinal trends in neurodevelopmental outcomes by age in this population remain underexplored.
Purpose of the Study:
- To systematically review and synthesize evidence on neurodevelopmental and academic outcomes in children and youth with OFCs.
- To explore age-related trends in neurodevelopmental outcomes for individuals with OFCs.
- To assess the overall strength of evidence regarding neurodevelopmental outcomes in OFCs.
Main Methods:
- A systematic review was conducted, encompassing studies published from 1980 to 2017.
- Eligibility criteria included studies on individuals under 25 years with OFCs and assessment of neurodevelopmental or academic outcomes.
- Thirty-one studies involving over 10,000 patients with OFCs and 2 million controls met the inclusion criteria.
Main Results:
- Patients with OFCs consistently demonstrated poorer performance on neurodevelopmental and academic measures compared to control groups.
- In infancy, significant differences were noted in cognition, motor skills, and language development.
- In later childhood and adolescence, deficits were evident in academic achievement, including special education needs, grades, and standardized test scores.
Conclusions:
- Children with OFCs exhibit significant neurodevelopmental and academic deficits relative to their unaffected peers.
- The nature of these deficits evolves across developmental stages, from infancy through adolescence.
- Ongoing monitoring and appropriate support for neurodevelopment are crucial for children with OFCs.
Context:
Children with orofacial clefts (OFCs) are reported to have worse neurodevelopmental outcomes than unaffected peers, although study methodologies and findings are highly variable and trends in outcomes by age remain unexplored.
Objective:
To examine the strength of the evidence and explore trends in neurodevelopment by age.
Data Sources:
A systematic review was conducted of studies published from January 1, 1980, through November 3, 2017.
Study Selection:
Studies were independently screened by the authors and included in the review if they met predetermined eligibility criteria: (1) children and/or youth (<25 years) with OFCs were studied, and (2) neurodevelopmental or academic outcomes were included.
Data Extraction:
The authors independently evaluated study quality and extracted outcome data.
Results:
Thirty-one studies involving 10 143 patients with OFCs and 2 017 360 controls met eligibility criteria. Although the quality of the studies varied, patients with OFCs consistently performed worse than their peers on neurodevelopmental and academic measures. In infancy, differences were observed on multiple developmental outcomes (eg, cognition, motor skills, and language), and in later childhood and adolescence, differences were manifest on several indicators of academic achievement (eg, use of special education services, grades, and scores on standardized measures).
Limitations:
Heterogeneity in study designs, methods, and outcomes prevented statistical pooling and modeling for meta-analysis.
Conclusions:
Children with OFCs exhibit neurodevelopmental and academic deficits compared with their unaffected peers. Although the nature of these deficits changes with development, differences are observed from infancy through adolescence. Clinicians should monitor neurodevelopment in children with OFCs and support them appropriately.
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