Incidence of Psychological and Neurodevelopmental Disorders in Craniosynostosis

Objective Craniosynostosis is associated with psychological and neurodevelopmental disorders (PNDD). Using a multi-center database, PNDD incidence in craniosynostosis was compared to controls and by suture. Design Retrospective analysis of TriNetX database (2015–2025). Participants Patients (<18 years) with craniosynostosis were identified using International Classification of Diseases, 10th revision code Q75 without excluding possible syndromes, and unmatched controls were identified without craniofacial diagnoses. Results Patients (N = 12,870) with sagittal (36.4%), coronal (35.5%), metopic (22.5%), lambdoid (2.1%), or multi-suture (3.5%) craniosynostosis were compared to controls (N = 22,401,930). Patients with craniosynostosis were significantly more likely to be younger, male, white, and non-Hispanic. Without controlling for sociodemographics, patients with craniosynostosis had higher rates of most PNDD. Speech disorders (14.5%–27.8% vs 4.9%) and motor disorders (5.6%–11.7% vs 1.2%) were frequent concerns. Except for the lambdoid group, patients with craniosynostosis had significantly higher incidence of intellectual disability (1.4%–7.1% vs 0.3%), autism spectrum disorder (3.4%–6.6% vs 2.1%), and scholastic disorder (1.6%–5.7% vs 1.0%). ADHD was significantly higher in the multi-suture (8.2%), metopic (6.3%), and sagittal (5.0%) craniosynostosis groups than in controls (3.6%), while conduct disorder was higher in the metopic (2.9%) and sagittal (1.7%) groups than in controls (1.1%). Only the multi-suture group (9.0%) had higher anxiety than controls (2.9%). All PNDD were higher in multiple-suture craniosynostosis than in single-suture craniosynostosis, with the metopic group having the highest PNDD (2.8%–21.5%). Conclusions The incidence of PNDD ranged from 1.1% to 27.8% in patients with craniosynostosis and varied by suture, underscoring the importance of multidisciplinary care and routine developmental surveillance.