Beyond the skull: Autism and social functioning in craniosynostosis

A 2025 study by Lara R. Ljubicic, Amanda J. Osborn, and Rachel M. Roberts published in the Journal of Pediatric Neuropsychology explores the critical but underexamined association among craniosynostosis, autism, and social functioning. Craniosynostosis is a congenital condition in which one or more cranial sutures fuse prematurely, potentially disrupting brain development. It affects approximately 1 in 10,000 live births, with global incidence rising (Shlobin et al., 2022). While craniosynostosis has been linked to neurodevelopmental challenges such as behavioral problems, its association with autism remains unclear (Osborn et al., 2023).

Through a comprehensive systematic review and meta-analysis, this study offers a clearer understanding of how nonsyndromic craniosynostosis may relate to autism symptoms and social-functioning difficulties. Drawing from 12 studies and 2,001 participants, the analysis includes research that reports formal autism spectrum disorder (ASD) diagnoses or uses validated autism and social-functioning assessments. Studies were sourced from Embase, APA PsycInfo, PubMed, and Scopus using strict inclusion criteria.

Key findings include the following:

• 4% of children with craniosynostosis had a formal ASD diagnosis,
• 14% showed clinically significant autism symptoms, and
• 12% had delays in social functioning.

These results suggest that many children with craniosynostosis experience notable social challenges, even without a formal autism diagnosis. This finding highlights the importance of proactive screening and early developmental assessments to identify at-risk children.

This research supports the integration of autism screening into routine evaluations for children with craniosynostosis. Early identification enables timely, targeted interventions and more personalized care. This study also underscores the need for interdisciplinary collaboration among clinicians, educators, and allied health professionals.

Currently, however, most available research is cross-sectional, offering only a snapshot of outcomes. Longitudinal studies are needed to track how autism symptoms and social functioning difficulties develop over time, especially during key transitions such as starting school or adolescence, when social demands increase. Understanding these developmental trajectories is crucial for tailoring long-term support strategies.

Beyond the clinical implications, managing both a craniofacial condition and neurodevelopmental concerns can create an emotional and logistical strain on families. A family-centered approach—providing anticipatory guidance, access to coordinated services, and caregiver support—is essential to improving outcomes for both children and their families.

The findings also have clear relevance for educators. Children with craniosynostosis may face subtle but meaningful social and communication challenges that impact learning and peer relationships. Educators should be aware of these potential difficulties and apply differentiated teaching strategies to better support social inclusion and academic success.

In addition, policymakers are encouraged to support integrated care models that bring together health, education, and social services. Investment in early, holistic intervention frameworks can ensure timely support and reduce long-term disparities for children with craniosynostosis and related neurodevelopmental needs.

This study provides a comprehensive synthesis of the relationship between nonsyndromic craniosynostosis and autism-related outcomes. It makes a strong case for embedding developmental screening into standard care and promoting cross-sector collaboration to improve early identification and intervention.

This article is in the Clinical Psychology topic area.

Ljubicic, L. R., Osborn, A. J., & Roberts, R. M. (2025). Autism and social functioning in individuals with nonsyndromic craniosynostosis: A systematic review and meta-analysis. Journal of Pediatric Neuropsychology, 11(1): 2–12. https://doi.org/10.1037/jpn0000003

Osborn, A. J., Roberts, R. M., Dorstyn, D. S., Grave, B. G., & David, D. J. (2023). Behavioural and psychological functioning of children and adults with sagittal synostosis. Journal of Pediatric Neuropsychology, 9(4): 183–199. https://doi.org/10.1007/s40817-023-00149-1  

Shlobin, N. A., Baticulon, R. E., Ortega, C. A., Liping, D., Bonfield, C. M., Wray, A., Forrest, C. R., & Dewan, M. C. (2022). Global epidemiology of craniosynostosis: A systematic review and meta-analysis. World Neurosurgery, 164: 413–423. https://doi.org/10.1016/j.wneu.2022.05.093opens in new window

Lara J. Ljubicic, BPsychSc(Hons), is a researcher in the School of Psychology, University of Adelaide. Her research interests include craniosynostosis, child development, and chronic pain.  

Amanda J. Osborn, PhD, is a research associate in the School of Psychology, University of Adelaide. Her research focuses on improving outcomes for families and individuals impacted by craniofacial conditions.  

Rachel M. Roberts, PhD, is a professor in the School of Psychology, University of Adelaide. She is a registered clinical psychologist, health psychologist, and clinical neuropsychologist. In addition to her extensive clinical work with individuals affected by craniofacial conditions, she is the principal investigator for the Craniosynostosis Outcomes Study, a long-term collaboration between the University of Adelaide and Craniofacial Australia. Contact Rachel M. Roberts.