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Mental development and learning disorders in children with single suture craniosynostosis
1The Craniofacial Center, The University of Illinois at Chicago, 60612, USA.
Insights
Children with nonsyndromic craniosynostosis often show normal intellectual development in infancy. However, rates of mental retardation and learning disorders increase with age, regardless of surgical intervention.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Craniofacial Surgery
Background:
- Nonsyndromic craniosynostosis involves premature fusion of skull sutures.
- Intellectual development and learning disorders in affected children require further investigation.
- Surgical timing and its impact on neurodevelopment are not fully understood.
Purpose of the Study:
- To evaluate intellectual development in children with nonsyndromic metopic, sagittal, and unilateral coronal synostosis.
- To determine the prevalence of learning disorders and mental retardation.
- To assess the influence of early surgery, late surgery, or no surgery on developmental outcomes.
Main Methods:
- Longitudinal study design with assessments at initial evaluation, 1 year post-surgery/evaluation, and annually thereafter.
- Bayley Scales of Infant Development (Mental Development Index) and McCarthy Scales of Children's Abilities (General Cognitive Index) used for cognitive assessment.
- Learning disorders identified through school and clinical records.
Main Results:
- No statistical differences in development based on diagnosis or surgical status were found over time.
- While initial mental retardation rates were normal, they became 2-3 times higher than expected by T2 and T3.
- Learning disorders were identified in 47% of non-retarded school-age children, with no significant difference based on surgical status.
Conclusions:
- Most children with nonsyndromic craniosynostosis achieve normal infant development.
- The incidence of mental retardation may increase relative to normative expectations as children age.
- A significant proportion of these children develop learning disorders, warranting further research.
Objective:
This study examined the global intellectual development and presence/absence of learning disorders in children with nonsyndromic metopic, sagittal, and unilateral coronal synostosis who had early surgery (under 1 year of age), late surgery (over 1 year of age), or no surgery to correct the synostosis across three time periods.
Design:
The design was longitudinal. Children were assessed at initial team evaluation, 1 year after surgery or initial evaluation if surgery was not performed, and annually thereafter.
Participants:
Participants included 84 consecutively evaluated patients. Seventy-two children were evaluated at Time 1 (T1), 8 months; 57 at Time 2 (T2), 21 months; and 39 at Time 3 (T3), 50 months. Data on learning disorders or mental retardation were available on 34 children who were school age.
Main Outcome Measures:
The Mental Development Index from the Bayley Scales of Infant Development was the main outcome measure for T1 and T2. The General Cognitive Index from the McCarthy Scales of Children's Abilities was the main outcome measure for T3. Learning disorders were determined from school and clinical records.
Results:
Repeated measures analyses of variance found no statistical differences in the development of children based on diagnosis or surgical status across time. Base rate of mental retardation at T1 was consistent with normative data; however, the incidence of retardation was two to three times the expected rate at T2 and T3. Learning disorders were present in 47% of school-age children who were not retarded. Chi-square analysis showed no significant differences between rates of retardation or learning disorders based on surgical status.
Conclusions:
Most children with nonsyndromic craniosynostosis obtain developmental quotients within the normal range in infancy. Rates of retardation may increase relative to normative expectations as children mature. A high rate of learning disorders was identified. Results are preliminary due to sample size.