Cognitive characteristics of children treated for deformational plagiocephaly and parental perception of the therapy

Deformational plagiocephaly (DP) is a common acquired skull deformity, with the highest incidence at the age of 4 months (19.7%). As it is considered benign, good cosmetic outcome is the primary aim of treatment, which includes either repositioning therapy (RT) with or without physiotherapy or molding helmet therapy (MHT). However, the issue of possible developmental delays in this group has been investigated.

Children aged 2-7 years previously treated with RT or MHT for DP were eligible for the study. Patients were examined by a psychologist using Stanford-Binet 5 Scale (SB5), while parents filled in a questionnaire, investigating their perception of the therapy and child's cognitive performance.

Twenty-one patients were found to be eligible and agreed to participate in the study. Subgroups consisting of 11 RT (eight males; median age 4 years [range 2-7 years]) and 10 MHT (seven males; median age 4 years [range 2-6 years]) patients were analyzed. Mean and median SB5 scores in whole group were within normal range and no significant differences were found between them in RT and MHT groups. In MHT group, children with left-sided asymmetry scored significantly higher in working memory (WM). Overall parental satisfaction with therapy had no relation to SB5 scores in whole analyzed group, but in RT group a rate of 5 was more common among parents whose children scored better in visual-spatial processing (VSP, P=0.042). Therapy safety was more likely to be rated as 5 in patients who scored higher in QR (P=0.023) and WM (P=0.005); in RT group this relationship was found only in WM (P=0.011).

Our results suggest that, in absence of medical conditions affecting cognitive performance, cognitive abilities of children aged 2-7 years treated for DP either by MHT or RT are undisturbed. Although majority of parents are satisfied with chosen therapy, those whose children have better cognitive performance are more likely to rate therapy higher.