Systematic Screening of Communication Outcomes at Age 5 in Children Treated for Nonsyndromic Craniosynostosis.

All data come from parent-completed questionnaires, not direct assessment by a speech-language pathologist, so subtle phonological, syntactic, or pragmatic difficulties may be missed. The unicoronal (n = 16) and miscellaneous (n = 12) subgroups are very small, making it impossible to draw reliable conclusions about those craniosynostosis types. The comparison is against previously published normative data, not a concurrently collected control group, so differences in testing conditions or time period could affect results. Some children may have already received speech-language therapy before age 5, which could mask or alter their scores. This is a single time-point assessment at age 5; it cannot tell us whether the subtle speech and grammar weaknesses persist, resolve, or evolve into literacy difficulties at school age. Single centre in Sweden using specific surgical techniques (spring-assisted osteotomy, distraction osteogenesis), so findings may not generalize to other surgical approaches or healthcare systems.

The authors declare no conflicts of interest. A version of the manuscript was presented at the European Society of Craniofacial Surgery Congress in Helsinki, Finland, in September 2024.

Do not read the slightly lower Speech and Syntax scores as evidence that every child with NSC has a speech or language disorder. The primary outcome, overall communication, did not differ significantly from the general population, and the specific items flagged (sounds like /r/ and /s/, verb endings) are still developing in typically speaking five-year-olds. The metopic surgery-timing finding is based on small subgroups and should not be generalized to other craniosynostosis types.