K ennedy-Williams and colleagues have collaborated in exploring the implications of TCF12 genetic abnormalities and coronal synostosis on intellect and behavior. They note that TCF12 genetic abnormalities, on their own, tend to have more limited effects on functional behavior than other genetic disorders, such as FGFR2 &3, TWIST 1, SMAD 6. Genetic influences in this study were, by design evaluated specifically in syndromic cases. Genetic influences, now in addition, are also are being recognized in nonsyndromic disorders. 1 Genetic influence may be associated with either or both biologic parents, 2 and may take the form of craniosynostosis structural maldevelopment and reduced intellect. 3 In the present report, the authors have limited their analysis, specifically, to only those with TCF12 abnormalities associated with unilateral or bilateral coronal synostosis. Thirty-five patients were operated upon, 29 with a fronto orbital advancement procedure, and the remaining 6 with a myriad of techniques. Of note is, the mean age of primary transcranial surgery was 17 months, (range of 5-123 months). Questions arise as to what neurologic and behavioral sequelae are related to, or influenced by, the timing of surgery, versus those that are related to the genetic abnormality. A breakdown of the patients operated at a younger age, for example, less than 12, or even 6 months of age, versus later, would help clarify the extent of these influences. Although the limited deficits in patients neurologic outcomes are somewhat reassuring, detail would be useful. Conclusions related to eventual neurologic outcomes, also, may be defined as a function of the timing and type of analyses performed. It is known that the earlier assessments of cognition and the behavioral impacts are often less accurate when compared with those at a later age (typically at, at least 6 years or later). The authors have adjusted their timing of analyses, as much as is possible, to address this, but some questions still remain. Due to limitations in the number of patients available in both parent reported outcomes and standardized testing, longer term outcomes could be discerned more accurately at later age. In a condition as uncommon as is seen in the current study, limitations must remain until larger scale and optimally at a later age should be considered.The reader is somewhat reassured that in the longest analysis times show relatively little negative effect on intellect, however, issues related to emotional, hyperactivity, conduct, peer difficulty, and overall stress domains, may limit achievement without significant reductions in IQ. In sum, however, the authors are to be commended for this pioneering study.