Abstract
The purpose of this study is to evaluate quantitative structural measures of the ventromedial prefrontal cortex (vmPFC) in boys with isolated clefts of the lip and/or palate (ICLP) relative to a comparison group and to associate measures of brain structure with quantitative measures of hyperactivity, impulsivity, and inattentiveness. A total of 50 boys with ICLP were compared to 60 healthy boys without clefts. Magnetic resonance imaging brain scans were used to evaluate vmPFC structure. Parents and teachers provided quantitative measures of hyperactivity, impulsivity, and inattentiveness using the Pediatric Behavior Scale. Boys with ICLP had significantly higher ratings of hyperactivity/impulsivity/inattention (HII) and significantly increased volume of the right vmPFC relative to the comparison group. There was a direct relationship between HII score and vmPFC volume in both the ICLP group and control group, but the relationship was in the opposite direction: in ICLP, the higher the vmPFC volume, the higher the HII score; for the comparison group, the lower the vmPFC volume, the greater the HII score. The vmPFC is a region of the brain that governs behaviors of hyperactivity, impulsivity and inattention (HII). In boys with ICLP, there are higher levels of HII compared to the controls and this is directly related to a significantly enlarged volume of the right vmPFC. Enlargement of this region of the brain is therefore considered to be pathological in the ICLP group and supports the notion that abnormal brain structure (from abnormal brain development) is the underlying etiology for the abnormal behaviors seen in this population.
Highlights
Orofacial clefts are the most common major birth defect in America, affecting over 6,800 births annually (Canfield et al 2006)
In a previous study from our lab, we investigated the neural underpinnings of externalizing behaviors and found that in a sample of healthy normal boys, the region of the brain that was directly related to behaviors of impulse control was the right ventromedial prefrontal cortex
The current study finds that boys with isolated clefts of the lip and/or palate (ICLP) have elevated levels of HII behaviors
Summary
Orofacial clefts are the most common major birth defect in America, affecting over 6,800 births annually (Canfield et al 2006). The cognitive deficits associated with ICLP are well documented and characterized with a lowering of overall intelligence quotient (IQ) (though not to mental retardation level) and specific deficits in language function (Richman and Eliason 2009; Richman and Eliason 2001). These deficits are severe enough that reading disabilities have been reported to be as common as 35% of children with ICLP (Richman et al 1988; Broder et al 1998)
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