Systematic Screening of Communication Outcomes at Age 5 in Children Treated for Nonsyndromic Craniosynostosis.
Justin Weinfeld, Christina Havstam, Marizela Kljajić and 4 others
Most five-year-olds treated for nonsyndromic craniosynostosis score within the normal range on a parent-reported communication screen.
The diagnosis alone does not mean a speech or language disorder, though subtle weaknesses in speech sounds and grammar are slightly more common than average.
Key findings
1The overall communication score did not differ significantly between the NSC group and the normative sample. 15% of NSC children (24 of 157) scored below the clinical cutoff compared with 10% in the norm group (46 of 451), but the overall score distribution was not significantly different (p = 0.45).
2On the Speech and Syntax subscales, the NSC group scored significantly lower than the normative sample (mean differences of 1.58 and 1.57 points, moderate effect sizes). The most commonly flagged items were mispronunciation of /r/ and /s/ sounds and omission of verb endings.
3Among children with metopic craniosynostosis, those operated before 6 months had higher overall communication scores than those operated later (mean difference 13.8 points, p = 0.025). No other craniosynostosis type showed a significant timing effect.
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What it does not show
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.
Declared interests
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.
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