Neurodevelopmental disorders in children with cleft lip and palate: a systematic review

Individuals with orofacial clefts (OFCs) may be at an increased risk of developing autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). This systematic review provides a summary of the most recent data regarding the prevalence of ASD and ADHD in the OFC population and compares this to the general paediatric population. Multiple databases were searched including PubMed/Medline and Embase in July 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and was registered in PROSPERO (CRD42024565219). 1025 papers were identified for screening, of which nine were included in the report. Percentage prevalence was calculated and compared to global prevalence or control populations where available. Overall, ASD prevalence among children with a cleft ranged from 0 to 50% (Mean = 2.87%; SD = 5.40) compared to ~ 1% globally (WHO) and ADHD prevalence ranged from 2.34 to 31.71% (Mean = 3.63%; SD = 4.30) compared to ~ 5% globally (NICE). Matched control populations showed larger differences. Isolated cleft palate was associated with higher rates than isolated cleft lip or combined cleft lip and palate. Prevalence in individuals with syndromic clefts appeared greater still (Mean = 14.80%; SD = 16.58) although populations were small. Children with OFCs demonstrate increased prevalence of ASD compared to the average paediatric population. Evidence for increased prevalence of ADHD is less clear, with varying rates across studies. Children with isolated cleft palate or cleft associated with genetic syndromes appear most at risk, although further research is needed.