Matthew L Speltz

University of Washington Seattle, Seattle, Washington, United States

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Publications (108)267.56 Total impact

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    ABSTRACT: OBJECTIVE The language and memory functions of children with and without single-suture craniosynostosis (SSC) were compared at school age (mean 7.45 years, standard deviation [SD] 0.54 years). The children in this cohort were originally recruited in infancy and prior to cranial surgery for those with SSC. METHODS Individual evaluations of 179 school-aged children with SSC and 183 controls were conducted (70% of the original cohort) using standardized measures of language, learning, and memory. Parents participated in an interview about specialized education interventions and school progress. Parents and teachers completed questionnaires about language development. RESULTS Children with SSC (cases) obtained lower scores than controls on all measures. The adjusted differences in language, learning, and memory scores were modest, with SD ranging from 0.0 to -0.4 (p values ranged from 0.001 to 0.99). Censored normal regression was used to account for intervention services received prior to the school-age evaluation; this increased case-control differences (SD range 0.1 to -0.5, p value range 0.001 to 0.50). Mean scores for cases in each SSC diagnostic group were lower than those for controls, with the greatest differences observed among children with unilateral coronal craniosynostosis. CONCLUSIONS Children with SSC continue to show poorer performance than controls on language, learning, and memory tasks at early elementary school age, even when controlling for known confounders, although mean differences are small. Multidisciplinary care, including direct psychological assessment, for children with SSC should extend through school age with a specific focus on language and conceptual learning, as these are areas of potential risk. Future research is needed to investigate language, memory, and learning for this population during the middle to high school years.
    No preview · Article · Jan 2016 · Journal of Neurosurgery Pediatrics
  • Zakia Hammal · Jeffrey F. Cohn · Carrie Heike · Matthew L. Speltz
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    ABSTRACT: Previous work in automatic affect analysis (AAA) has emphasized static expressions to the neglect of the dynamics of facial movement and considered head movement only a nuisance variable to control. We investigated whether the dynamics of head and facial movements apart from specific facial expressions communicate affect in infants, an under-studied population in AAA. Age-appropriate tasks were used to elicit positive and negative affect in 31 ethnically diverse infants. 3D head and facial movements were tracked from 2D video. Head angles in the horizontal (pitch), vertical (yaw), and lateral (roll) directions were used to measure head movement; and the 3D coordinates of 49 facial points to measure facial movements. Strong effects were found for both head and facial movements. Angular velocity and angular acceleration of head pitch, yaw, and roll were higher during negative relative to positive affect. Amplitude, velocity, and acceleration of facial movement were higher as well during negative relative to positive affect. A linear discriminant analysis using head and facial movement achieved a mean classification rate of positive and negative affect equal to 65% (Kappa = 0.30). Head and facial movements individually and in combination were also strongly related to observer ratings of affect intensity. Our results suggest that the dynamics of head and facial movements communicate affect at ages as young as 13 months. These interdisciplinary findings from behavioral science and computer vision deepen our understanding of communication of affect and provide a basis for studying individual differences in emotion in socio-emotional development.
    No preview · Article · Dec 2015
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    ABSTRACT: Introduction: Single Suture Craniosynostosis (SSC) occurs in 1 in 2,500 live births and is the most common type of craniosynostosis treated in most centers. Surgical treatment has evolved over the past century and open techniques are tailored to the specific suture type. Additionally, the concept of multi-disciplinary team care has proliferated and is becoming the standard of care for SSC. The combination of these evolutions, we believe, has improved the safety of cranial vault surgery for SSC. Methods: A retrospective review of patients participating in the Infant Learning Project at Seattle Children's Hospital who underwent cranial vault surgery for treatment of SSC between 2002 and 2006 was performed. Pre-operative assessment, surgical techniques, anesthetic and intraoperative events and both intra-operative and post-operative adverse events were analyzed. Results: Eighty eight patients fulfilled the inclusion criteria (42 sagittal, 23 metopic, 19 unicoronal, 4 lambdoid). Length of procedure varied (FOA 5.2 hrs, modified pi 2.5 hrs, total vault 4.9 hrs and switch cranioplasty 4.6 hrs), as did transfusion amount (FOA 385 mL, modified pi 216 mL, total vault 600 mL, switch cranioplasty 207 mL) although 99% of patients received a transfusion of some sort. There were no deaths and no major intraoperative complications. Minor events include; ET tube malposition (1), desaturation (1), acidosis (1), hypothermia (9), coagulopathy (2), Hct < 25 (55). Average hospital stay was 3.4 days with no major post-operative complications. One patient was readmitted to the ICU and 1 had a scalp hematoma, but no patients returned to the operating room within 6 months after surgery. Discussion: The surgical treatment of SSC has evolved from lengthy, risky procedures to become almost routine at most craniofacial centers. Additionally, the care for patients with SSC has evolved from a single provider to a multidisciplinary team concept based around protocols for workup, delivery of anesthesia, streamlined surgical procedures and post-operative care and assessment. This evolution has given open cranial vault surgery for SSC an acceptable safety profile.
    No preview · Article · Oct 2015 · The Journal of craniofacial surgery
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    ABSTRACT: Children with single-suture craniosynostosis (SSC) have higher rates of learning disabilities and related neurocognitive problems than unaffected peers. Executive function (EF) and attention are thought to be areas of particular vulnerability, though studies to date have been limited by small sample sizes and a lack of control groups. We evaluated 179 school-aged children with SSC (cases) and 183 unaffected controls at an average age of 7 years using clinician-administered and parent and teacher report measures of EF and attention. Among children with SSC, we examined differences as a function of suture location (sagittal, metopic, unicoronal, or lambdoid) and age of corrective surgery. We used linear regression analyses, adjusted for potential confounders, to compare the two groups on all outcome measures. Cases scored lower than controls on most measures, though the magnitude of these differences was small and most were statistically insignificant. The largest relative deficit was on a measure of inhibitory control. Results changed little in sensitivity analyses adjusting for potential attrition bias and for the effects of developmental and academic interventions. Among cases, there were few differences in relation to the location of suture fusion or timing of surgery. Overall, we found limited evidence of broad deficits in EF or attention in children with SSC relative to unaffected controls. Neurocognitive development for children with SSC appears to be variable, across affected children and outcomes assessed. Further research is needed to understand the potential sources of this variability.
    No preview · Article · Sep 2015 · Child Neuropsychology
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    ABSTRACT: Parent-led toothbrushing effectively reduces early childhood caries. Research on the strategies that parents use to promote this behavior is, however, lacking. To examine associations between parent-child toothbrushing interactions and child oral health using a newly developed measure, the Toothbrushing Observation System (TBOS). One hundred children ages 18-60 months and their parents were video-recorded during toothbrushing interactions. Using these recordings, six raters coded parent and child behaviors and the duration of toothbrushing. We examined the reliability of the coding system and associations between observed parent and child behaviors and three indices of oral health: caries, gingival health, and history of dental procedures requiring general anesthesia. Reliabilities were moderate to strong for TBOS child and parent scores. Parent TBOS scores and longer duration of parent-led toothbrushing were associated with fewer decayed, missing or filled tooth surfaces and lower incidence of gingivitis and procedures requiring general anesthesia. Associations between child TBOS scores and dental outcomes were modest, suggesting the relative importance of parent versus child behaviors at this early age. Parents' child behavior management skills and the duration of parent-led toothbrushing were associated with better child oral health. These findings suggest that parenting skills are an important target for future behavioral oral health interventions. © 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    No preview · Article · Jul 2015 · International Journal of Paediatric Dentistry
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    ABSTRACT: Previous studies have indicated that infants and school-age children with single-suture craniosynostosis (SSC, cases) score modestly but consistently lower than unaffected children (controls) on neurodevelopmental tests. However, sex differences in these functions rarely have been examined, and it is unknown whether potential sex differences vary by case status (cases vs. controls) or location of suture fusion. We tested 182 cases and 183 demographically matched controls at a mean age of 7.4 years. We measured intellectual abilities with the Wechsler Scale of Intelligence for Children-Fourth Edition. We assessed reading, spelling, and math with a combination of the Wide Range Assessment Test-Fourth Edition, the Test of Word Reading Efficiency, and the Comprehensive Test of Phonological Processing. Among both cases and controls, males scored lower on all measures than females with standard score differences ranging from -1.2 to -7.8 for controls (p values from <0.001 to 0.55) and -2.3 to -8.5 for cases (p values from <0.001 to 0.33). For all but one measure, sex differences were slightly larger for cases than controls. Among cases, males were more likely than females to have learning problems (50 vs. 30 %, respectively), with the highest level observed among males with unicoronal synostosis (86 %). Sex differences in neurodevelopmental abilities among children with SSC are substantial, but not a unique correlate of this disorder as similar differences were observed among controls. Girls and those with sagittal synostosis have the lowest risk for academic problems. Boys with unicoronal synostosis warrant close developmental surveillance.
    Full-text · Article · Apr 2015 · Child s Nervous System
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    ABSTRACT: We compared the developmental status of school-age children with single-suture craniosynostosis (case group) and unaffected children (control group). Within the case group we compared the performance of children distinguished by location of suture fusion (sagittal, metopic, unicoronal, lambdoid). We administered standardized tests of intelligence, reading, spelling, and math to 182 case participants and 183 control participants. This sample represented 70% of those tested during infancy before case participants had corrective surgery. After adjustment for demographics, case participants' average scores were lower than those of control participants on all measures. The largest observed differences were in Full-Scale IQ and math computation, where case participants' adjusted mean scores were 2.5 to 4 points lower than those of control participants (Ps ranged from .002 to .09). Adjusted mean case-control differences on other measures of achievement were modest, although case deficits became more pronounced after adjustment for participation in developmental interventions. Among case participants, 58% had no discernible learning problem (score <25th percentile on a standardized achievement test). Children with metopic, unicoronal, and lambdoid synostosis tended to score lower on most measures than did children with sagittal fusions (Ps ranged from <.001 to .82). The developmental delays observed among infants with single-suture craniosynostosis are partially evident at school age, as manifested by lower average scores than those of control participants on measures of IQ and math. However, case participants' average scores were only slightly lower than those of control participants on reading and spelling measures, and the frequency of specific learning problems was comparable. Among case participants, those with unicoronal and lambdoid fusions appear to be the most neurodevelopmentally vulnerable. Copyright © 2015 by the American Academy of Pediatrics.
    No preview · Article · Feb 2015 · Pediatrics

  • No preview · Article · Feb 2015 · Plastic & Reconstructive Surgery
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    ABSTRACT: AimThe aim of this study was to determine whether neurobehavioral assessment before and after cranial vault surgery can improve prediction of developmental delay in children with single-suture craniosynostosis (SSC), after accounting for ‘baseline’ demographic and clinical variables (SSC diagnosis and surgery age).Method Children with SSC were referred by the treating surgeon or pediatrician before surgery. Neurobehavioral assessments were performed at ages of approximately 6, 18, and 36 months. Iterative models were developed to predict delay, as determined by one or more tests of cognitive, motor, and language skills at 36 months. We selected from groups of variables entered in order of timing (before or after corrective surgery), and source of information (parent questionnaire or psychometric testing).ResultsGood predictive accuracy as determined by area under the receiver operating characteristic curve (AUC), was obtained with the baseline model (AUC=0.66), which incorporated age at surgery, sex, and socio-economic status. However, predictive accuracy was improved by including pre- and post-surgery neurobehavioral assessments. Models incorporating post-surgery neurobehavioral testing (AUC=0.79), pre-surgery testing (AUC=0.74), or both pre- and post-surgery testing (AUC=0.79) performed similarly. However, the specifity of all models was considered to be moderate (≤0.62).InterpretationPrediction of delay was enhanced by assessment of neurobehavioral status. Findings provide tentative support for guidelines of care that call for routine testing of children with SSC.
    Full-text · Article · Nov 2014 · Developmental Medicine & Child Neurology
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    ABSTRACT: Background Nausea and vomiting during pregnancy (NVP) is the most common complication of pregnancy. NVP has been associated with improved fetal outcomes, but its association with childhood neurodevelopmental outcomes has rarely been studied.Methods Subjects were children aged 5–12 years (n = 560) who were controls in a previously conducted case–control study of prenatal risk factors for craniofacial malformations. Information on NVP, including trimester, duration, and treatment, was collected through a maternal interview conducted within 3 years of delivery. Neurocognition was assessed using the Peabody Picture Vocabulary Test (PPVT-III) and the Beery-Buktenica Test of Visual Motor Integration-Fifth Edition (VMI-5). Psychosocial outcomes, including internalising and externalising behaviour problems, were measured by maternal report, using the Child Behavior Checklist (CBCL), and teacher report, using the Teacher Report Form. Linear regression models were used to calculate adjusted mean (adjMD −3.04, 95% confidence interval (CI) −5.02, −1.06) differences (adjMD) and 95% confidence intervals [CI] on test scores for children exposed and unexposed to NVP in utero. Differences based on trimester, duration, and treatment were assessed.ResultsNVP was reported among 63% of women and was most common in early pregnancy. Children exposed to NVP performed worse on the VMI-5 [−3.04, 95% CI: −5.02, −1.06] but exhibited few other differences from unexposed children. Durations of NVP ≥4 months were associated with poorer scores on PPVT-III (adjMD −2.52), VMI-5 (adjMD −5.41), and CBCL [adjMD 3.38 (internalising) and adjMD 4.19 (externalising)].Conclusions Overall, there were few differences between children exposed and unexposed to NVP. NVP was associated with slightly worse visual motor performance, and prolonged NVP and NVP extending late into pregnancy were associated with poorer scores on several neurodevelopmental measures.
    No preview · Article · Nov 2014 · Paediatric and Perinatal Epidemiology
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    ABSTRACT: Craniosynostosis, a disorder in which one or more fibrous joints of the skull fuse prematurely, causes skull malformation and may be associated with increased intracranial pressure and developmental delays. In order to perform medical research studies that relate phenotypic abnormalities to outcomes such as cognitive ability or results of surgery, biomedical researchers need an automated methodology for quantifying the degree of abnormality of the disorder. This paper addresses that need by proposing a set of features derived from CT scans of the skull that can be used for this purpose. A thorough set of experiments is used to evaluate the features as compared to two human craniofacial experts in a ranking evaluation.
    No preview · Article · Aug 2014
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    ABSTRACT: Objective: To compare academic achievement in children with oral-facial clefts (OFC) with their unaffected siblings. Methods: 256 children with OFC were identified from the Iowa Registry for Congenital and Inherited Disorders, and 387 unaffected siblings were identified from birth certificates. These data were linked to Iowa Testing Programs achievement data. We compared academic achievement in children with OFC with their unaffected siblings using linear regression models, adjusted for potential confounders. In post hoc analyses, we explored modifiers of siblings' academic performance. Results: Achievement scores were similar between children with OFC and their siblings. Children with cleft palate only were significantly more likely to use special education than their unaffected siblings. Siblings' academic achievement was inversely related to distance in birth order and age from the affected child. Conclusion: Children with OFC and their siblings received similar achievement scores. Younger siblings, in particular, may share a vulnerability to poor academic outcomes.
    Preview · Article · Jul 2014 · Journal of Pediatric Psychology
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    ABSTRACT: Objective : To examine longitudinal differences in reported stress between parents of children with and without single-suture craniosynostosis and to compare the stress reports of mothers and fathers. Design : Multi-site, nonrandomized prospective study. Setting/Participants : Children with single-suture craniosynostosis (cases) were identified via referral of the treating surgeon or physician at the time of diagnosis, and those without single-suture craniosynostosis (controls) were recruited from pediatric practices, birthing centers, and announcements in print media. When children were aged 6, 18, and 36 months (on average), mothers and fathers of children with and without single-suture craniosynostosis completed the Parenting Stress Index. For cases, 247 mothers and 211 fathers completed the Parenting Stress Index at the first visit; corresponding numbers for controls were 254 and 220, respectively. Main Outcome Measures : The Parenting Stress Index Parent and Child Domains and subscales scores. Results : We found few differences between parents of infants with and without single-suture craniosynostosis, regardless of parent gender. Irrespective of case status, mothers consistently reported higher stress than fathers on the Parent Domain. Within the Parent Domain, mothers reported more stress than fathers on the Role Restriction and Spousal Support subscales. Conclusions : The parents of children with single-suture craniosynostosis reported levels of stress similar to those reported by parents of same-aged, unaffected children. Mothers reported greater stress than fathers, and these differences remained remarkably stable over time. This may reflect widely held perceptions of gender differences in parenting roles.
    No preview · Article · May 2014 · The Cleft Palate-Craniofacial Journal
  • Irma Lam · Michael Cunningham · Matthew Speltz · Linda Shapiro
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    ABSTRACT: Craniosynostosis, a disorder in which one or more fibrous joints of the skull fuse prematurely, causes skull deformity and is associated with increased intracranial pressure and developmental delays. Although clinicians can easily diagnose craniosynostosis and can classify its type, being able to quantify the condition is an important problem in craniofacial research. While several papers have attempted this quantification through statistical models, the methods have not been intuitive to biomedical researchers and clinicians who want to use them. The goal of this work was to develop a general platform upon which new quantification measures could be developed and tested. The features reported in this paper were developed as basic shape measures, both single-valued and vector-valued, that are extracted from a single plane projection of the 3D skull. This technique allows us to process images that would otherwise be eliminated in previous systems due to poor resolution, noise or imperfections on their CT scans. We test our new features on classification tasks and also compare their performance to previous research. In spite of its simplicity, the classification accuracy of our new features is significantly higher than previous results on head CT scan data from the same research studies.
    No preview · Article · May 2014 · Proceedings of the IEEE Symposium on Computer-Based Medical Systems
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    ABSTRACT: Previous studies of academic achievement of children with oral clefts have mostly relied on small, clinic-based samples prone to ascertainment bias. In the first study in the United States to use a population-based sample with direct assessment, we evaluated the academic achievement of children with oral clefts relative to their classmates. Children born with isolated oral clefts in Iowa from 1983 to 2003 were identified from the Iowa Registry for Congenital and Inherited Disorders and matched to unaffected classmates by gender, school/school district, and month and year of birth. Academic achievement was assessed by using standardized tests of academic progress developed by the Iowa Testing Programs. Iowa Testing Programs data were linked to birth certificates for all children. Regression models controlled for household demographic and socioeconomic factors. The analytical sample included 588 children with clefts contributing 3735 child-grade observations and 1874 classmates contributing 13 159 child-grade observations. Children with oral clefts had lower scores than their classmates across all domains and school levels, with a 5-percentile difference in the overall composite score. Children with clefts were approximately one-half grade level behind their classmates and had higher rates of academic underachievement and use of special education services by 8 percentage points. Group differences were slightly lower but remained large and significant after adjusting for many background characteristics. Children with oral clefts underperformed across all academic areas and grade levels compared with their classmates. The results support a model of early testing and intervention among affected children to identify and reduce academic deficits.
    No preview · Article · Apr 2014 · PEDIATRICS
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    Mary A Khetani · Brent R Collett · Matthew L Speltz · Martha M Werler
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    ABSTRACT: To compare health-related quality of life (HRQOL) among children with and without hemifacial microsomia (HFM) as assessed by parents and the children themselves during the elementary school years. One hundred thirty-six children with HFM (49 females, mean age = 6 years, 11.9 months, SD = 1.004) were compared with 568 matched controls (285 females, mean age = 6 years, 10.2 months, SD = 0.998) for parent and child responses on the PedsQL Version 4.0. After adjustment for sociodemographic factors, parent-reported summary scores were worse for affected children than control group children for physical (effect sizes [ES] = 0.26, p = .004), social (ES = 0.34, p = .001), and school (ES = 0.32, p = .001) functioning. There were no significant mean differences in summary scores based on children's self-reported functioning. Case-control mean differences in HRQOL were more apparent based on parent report, but not child self-report. Summary score findings suggest that case parents have concerns about their child's HRQOL, particularly with respect to their child's physical, social, and school functioning. Additionally, our findings highlight the potential differences between child and parent perspectives and the importance of collecting data from multiple reporters.
    Full-text · Article · Nov 2013 · Journal of developmental and behavioral pediatrics: JDBP
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    ABSTRACT: Discrepancies between observers are common in studies of child behavior problems that rely on behavior ratings. Although modest concordance between informants is well-documented, little is known about characteristics that predict discrepancies. In 477 children aged 5 to 12 years, maternal age and indicators of socioeconomic status (SES; maternal education, family income) were evaluated in relation to score discrepancies between the Child Behavior Checklist and Teacher Report Form for Total, Externalizing and Internalizing Problems. Family income <$35,000 was independently associated with discrepancies in which mothers rated more clinically significant child behavior problems than teachers for Total, Externalizing and Internalizing Problems [odds ratio (OR) = 3.26, 95% confidence interval (CI ), 1.19-8.96, OR = 2.76, 95% CI 1.03-7.34 and OR = 3.07, 95% CI 1.30-7.26, respectively]. Maternal education was not associated with discrepancies, but younger mothers were less likely to rate child's behavior in the clinical range for Externalizing Problems than teachers (OR per year of age = 0.88, 95% CI 0.81-0.96). These results suggest that studies that utilize only maternal or teacher report of child behavior may have misclassification of outcomes that is dependent on SES and could produce biased results.
    No preview · Article · Sep 2013 · Journal of Psychopathology and Behavioral Assessment
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    Mark T. Greenberg · Matthew L. Speltz · Michelle Deklyen

    Full-text · Dataset · Jul 2013
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    ABSTRACT: Single-suture craniosynostosis (SSC) results in head shape anomalies that likely affect social perceptions of appearance. The purpose of this study was to evaluate laypersons' ratings of attractiveness in children with and without SSC. Among cases, we also examined differences by suture fused and age at surgery. We collected photographs of 196 children with SSC and 186 children without SSC as infants (before surgery, for cases) and at ages 18 and 36 months. Photographs were rated by 8 raters, who were blinded to the population being studied. We used linear regression to compare appearance ratings for the 2 groups at each visit and to evaluate changes over time. Regression analyses were used to examine the association between age at surgery and appearance ratings. Children with SSC received lower appearance ratings than unaffected controls at each visit (all P < 0.001). Appearance ratings decreased over time, with a similar trajectory for children with and without SSC. Among cases, those with unicoronal and lambdoid synostosis had the lowest ratings and those with sagittal synostosis had the highest. Age at surgery was inversely associated with appearance ratings. Children with SSC received lower appearance ratings than unaffected controls, with minimal change after surgery. Better outcomes were associated with earlier surgery. These findings do not indicate that children with SSC failed to benefit from surgery, as without surgical intervention, asymmetrical head shape would likely have worsened over time. However, our data suggest that appearance does not fully "normalize."
    No preview · Article · Jul 2013 · The Journal of craniofacial surgery
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    ABSTRACT: Objectives: Infants and toddlers with deformational plagiocephaly (DP) have been shown to score lower on developmental measures than unaffected children. To determine whether these differences persist, we examined development in 36-month-old children with and without a history of DP. Methods: Participants included 224 children with DP and 231 children without diagnosed DP, all of who had been followed in a longitudinal study since infancy. To confirm the presence or absence of DP, pediatricians blinded to children's case status rated 3-dimensional cranial images taken when children were 7 months old on average. The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) was administered as a measure of child development. Results: Children with DP scored lower on all scales of the BSID-III than children without DP. Differences were largest in cognition, language, and parent-reported adaptive behavior (adjusted differences = -2.9 to -4.4 standard score points) and smallest in motor development (adjusted difference = -2.7). Children in the control group who did not have previously diagnosed DP but who were later rated by pediatricians to have at least mild cranial deformation also scored lower on the BSID-III than unaffected controls. Conclusions: Preschool-aged children with a history of DP continue to receive lower developmental scores than unaffected controls. These findings do not imply that DP causes developmental problems, but DP may nonetheless serve as a marker of developmental risk. We encourage clinicians to screen children with DP for developmental concerns to facilitate early identification and intervention.
    Full-text · Article · Dec 2012 · PEDIATRICS

Publication Stats

3k Citations
267.56 Total Impact Points


  • 1990-2015
    • University of Washington Seattle
      • Department of Psychiatry and Behavioral Sciences
      Seattle, Washington, United States
  • 2014
    • Seattle Children’s Research Institute
      Seattle, Washington, United States
  • 2013
    • Boston University
      Boston, Massachusetts, United States
  • 2005-2012
    • Northwestern University
      • Department of Surgery
      Evanston, IL, United States
  • 2011
    • University of Illinois at Chicago
      Chicago, Illinois, United States
    • Washington University in St. Louis
      San Luis, Missouri, United States
  • 1997-2009
    • Seattle Children's Hospital
      • • Children's Hospital and Regional Medical Center
      • • Children's Hospital and Medical Center
      Seattle, Washington, United States
  • 2001
    • Pennsylvania State University
      University Park, Maryland, United States
  • 2000
    • California State University, Sacramento
      • Department of Psychology
      Sacramento, California, United States
  • 1983
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States