26. The Association of Age at Surgery and Behavioral Functioning in Children with Surgically Corrected Metopic Craniosynostosis

PURPOSE: Nonsyndromic craniosynostosis is associated with neurocognitive and behavioral deficits. We examined the association of age at surgery and long-term behavioral functioning at school age in children with surgically-corrected metopic synostosis. METHODS: Parents of children ages 6-18 years old with metopic synostosis completed the Child’s Behavioral Checklist (CBCL), Conners 3rd Edition (Conners-3), Social Responsiveness Scale 2nd Edition (SRS-2), and Behavior Rating Inventory of Executive Function 2nd Edition (BRIEF-2). The Conners-3 assesses features of ADHD, the SRS-2 assesses features of autism spectrum disorder, and the CBCL and BRIEF-2 broadly assess behavioral and emotional functioning. Multivariate linear regression was used to evaluate the association of behavioral scores with age at surgery while controlling for sociodemographic factors. RESULTS: The parents of 41 patients completed surveys. Average age at surgery was 8.46±5.34 months, and average age at assessment was 10.42±3.62 years. Average scores were greatest for the peer relations and inattention subscales of the Conners-3 with 22 (53.7%) and 20 (48.8%) patients scoring at or above borderline clinical levels, respectively. Greater age at surgery was associated with significantly higher scores on the inattention (B=1.40, p=0.02) and executive function (B=1.37, p=0.01) subscales of the Conners-3 and cognitive regulation index (B=1.01, p=0.03) and global executive composite (B=1.05, p=0.03) of the BRIEF-2. CONCLUSIONS: Nearly half of patients with surgically-corrected metopic synostosis reached borderline clinical scores for attention and peer relations. Greater age at surgery was associated with features of ADHD and worse executive function. Prompt surgical correction of metopic synostosis may benefit long-term emotional and behavioral function.