Date of Award

January 2014

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

John A. Persing

Subject Area(s)



The prevalence of deformational plagiocephaly has risen dramatically in recent years, now affecting 15% or more of infants. Prior research using existing developmental scales suggests that these children may be at elevated risk for developmental delays. However, the low positive predictive value of these instruments in identifying long-term impairment, coupled with their poor reliability in infants, warrants using different methods to more precisely measure brain function in craniofacial patients. Event-related potentials (ERPs) offer a direct measure of cortical activity that is highly applicable to young populations and has been implemented in other disorders to predict long-term cognitive functioning. The current study used ERPs to contrast neural correlates of auditory perception in infants with deformational plagiocephaly, typically developing children, and infants with head shape deformity due to craniosynostosis. We hypothesized that infants with deformational plagiocephaly would show normative patterns of speech sound processing, indicating intact development of these neurologic systems.

We examined speech sound processing through two experiments. In the first, ERPs were recorded while 16 infants with deformational plagiocephaly and 18 non-affected controls passively listened to speech sounds. Given prior research suggesting their association with subsequent intellectual functioning, analyses focused on the P150 and N450 ERP components.

In a second experiment, ERPs were recorded in 12 infants with deformational plagiocephaly, 7 typically developing control, and 10 infants with metopic craniosynostosis. Analyses focused on the hemispheric specialization of language processing.

Through both experiments, deformational plagiocephaly patients exhibited normative cortical responses to speech sounds.

Our study shows that children with deformational plagiocephaly demonstrate neural responses to language that are consistent with normative expectations and comparable to typical children. These results indicate that head shape deformity secondary to supine sleep is not associated with impairments in auditory processing. The applicability of the current methods in early infancy suggests that electrophysiological brain recordings represent a promising method to monitor brain development in children with cranial disorders.


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