Neurodevelopmental and Academic Outcomes in Children With Orofacial Clefts: A Systematic Review

Abstract

CONTEXT: Children with orofacial clefts (OFCs) are reported to have worse neurodevelopmental outcomes than unaffected peers, although study methodologies and findings are highly variable and trends in outcomes by age remain unexplored. OBJECTIVE: To examine the strength of the evidence and explore trends in neurodevelopment by age. DATA SOURCES: A systematic review was conducted of studies published from January 1, 1980, through November 3, 2017. STUDY SELECTION: Studies were independently screened by the authors and included in the review if they met predetermined eligibility criteria: (1) children and/or youth (<25 years) with OFCs were studied, and (2) neurodevelopmental or academic outcomes were included. DATA EXTRACTION: The authors independently evaluated study quality and extracted outcome data. RESULTS: Thirty-one studies involving 10 143 patients with OFCs and 2 017 360 controls met eligibility criteria. Although the quality of the studies varied, patients with OFCs consistently performed worse than their peers on neurodevelopmental and academic measures. In infancy, differences were observed on multiple developmental outcomes (eg, cognition, motor skills, and language), and in later childhood and adolescence, differences were manifest on several indicators of academic achievement (eg, use of special education services, grades, and scores on standardized measures). LIMITATIONS: Heterogeneity in study designs, methods, and outcomes prevented statistical pooling and modeling for meta-analysis. CONCLUSIONS: Children with OFCs exhibit neurodevelopmental and academic deficits compared with their unaffected peers. Although the nature of these deficits changes with development, differences are observed from infancy through adolescence. Clinicians should monitor neurodevelopment in children with OFCs and support them appropriately.

Retrospective Evaluation of Number of Surgeries and Parent Ratings of Academic and Behavioral Functioning Among Children With Isolated Oral Clefts

“…The above-to-above average ratings on the ABAS-FA scale suggest that children with iCL/P are performing at or above age-expected levels of independence related to school activities. This is in contrast to previous work that has identified academic underachievement in children with iCL/P (Persson et al, 2012; Wehby et al, 2014; Goodwin et al, 2017; Conrad, 2018; Persson et al, 2018; Gallagher & Collett, 2019). However, parent ratings are very different than actual measures of achievement.…”

School absence and achievement in children with isolated orofacial clefts

“…[1] A cleft can affect hearing, [2,3] language, [4,5] dental health, [6,7] psychosocial health, [8] neurodevelopmental health, [9] and academic outcomes. [9,10] Recently, we have shown that the presence of an isolated cleft (a cleft without additional anomalies or syndromes) negatively affects all areas of learning, especially when the cleft involves the palate (both CPO and CLP). [10] These findings reflect the 'educational attainment gap' in children born with an orofacial cleft, even when treated under modern conditions and supported by a co-ordinated multidisciplinary team approach.…”

Early Childhood General Anesthesia and Neurodevelopmental Outcomes in the Avon Longitudinal Study of Parents and Children Birth Cohort

“…In the present study, children with middle ear effusions who were referred for grommet insertion were at risk of delayed speech/language development, either because they may have prolonged bilateral hearing loss 43 or because they have craniofacial abnormalities associated with impaired neurodevelopment. 44 Children referred for adenotonsillectomy for obstructive sleep apnea are also at risk of impaired neurodevelopment. 45 This source of bias tends to cause false-positive findings, i.e.…”