School results in single-suture craniosynostosis: what should we tell parents at the first consultation? - 17/09/26

Doi : 10.1016/j.neuchi.2026.101883

Luca Liberati ^a,⁎ , Federica Moriconi ^b, Angelica Marfoli ^b, Giovani Dall’Olio ^b, Daniela Pia Rosaria Chieffo ^b,^c,^d

^a Clinical Psychology Unit, Health Management, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, Rome, Italy

^b Clinical Psychology Unit, Health Management, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, Rome, Italy

^c Complex Operational Unit of Child Neuropsychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, Rome, Italy

^d Department of Women, Children and Public Health, Catholic University of the Sacred Heart, Rome, Italy

^⁎ Corresponding author.

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 17 September 2026

Highlights

•	Most children with nonsyndromic monosutural craniosynostosis achieve academic performance in the average range, but variability is increased and a meaningful subgroup benefits from educational supports.
•	Real-world educational data show that meeting grade-level standards can coexist with evolving special education needs across primary school.
•	Relative vulnerabilities are most consistently reported in mathematics, language-based learning processes, and attention/executive functioning-domains that shape classroom participation and homework load.
•	Evidence does not support a robust independent effect of surgical timing or surgical approach on later school outcomes once confounding is considered; monitoring and early intervention remain appropriate regardless of technique.
•	At first consultation, counselling should combine reassurance with a proactive plan: what to monitor, when to reassess, and how to collaborate with schools.

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Abstract

Background

Parents of children diagnosed with nonsyndromic single-suture craniosynostosis (SSC) frequently ask whether school difficulties should be expected and what type of monitoring is appropriate over time.

Objective

To synthesize evidence on school-related outcomes in SSC and translate it into counselling guidance for the first consultation.

Methods

We conducted a structured narrative review with a systematic literature search. PubMed/MEDLINE and Scopus were searched from database inception to January 2026 using terms related to craniosynostosis, single-suture disease, school achievement, learning, cognition, attention, executive function, behaviour, and educational supports. Reference lists of included studies and relevant reviews were hand-searched. Eligible sources included controlled cohorts, longitudinal studies, population or registry studies, systematic reviews/meta-analyses, and clinically relevant studies reporting academic, neuropsychological, behavioural, or educational service outcomes in children with nonsyndromic SSC. Results were narratively synthesized by school-relevant domains.

Results

Mean intellectual and academic scores in SSC generally fall within normative ranges, with modest group differences and substantial overlap with peers. However, variability is increased, and a clinically meaningful subgroup shows learning vulnerabilities or requires educational supports. Mathematics, language-based learning processes, attention/executive function, and behaviour regulation are recurrent areas of concern. Population-linked and registry studies suggest that many children meet grade-level standards, while educational needs may emerge or become more visible as academic demands increase. Evidence for independent effects of surgical timing or technique on school-age cognition remains mixed and confounded.

Conclusions

School outcomes in nonsyndromic SSC are generally favourable but heterogeneous. First-consultation counselling should combine realistic reassurance with anticipatory monitoring, attention to risk modifiers, and early collaboration with schools.

Le texte complet de cet article est disponible en PDF.

Keywords : single-suture craniosynostosis, school outcomes, academic achievement, educational supports, executive function, CBCL, counselling, structured narrative review.