Sit to Talk: Relation between Motor Skills and Language Development in Infancy

Cognitive, language and motor development of infants exposed to risk and protective factors

INTRODUCTION

Risk factors are biological or environmental characteristics increasing the likelihood of delays in child development. Meanwhile, protective factors are conditions that can minimize risks and favor the acquisition of skills. Infants with risk indicators for hearing loss (RIHL) tend to live in less stimulating environments which may lead to lower cognitive, language, and motor development.

OBJECTIVE

To compare the cognitive, language, and motor development of infants under the influence of risk and protective factors.

METHOD

A cross-sectional observational study in which 259 infants aged 8-10 months were assessed for cognitive, language, and motor development using the Bayley Scales of Infant and Toddler Development - Third Edition (BSITD-III). The groups were formed according to the presence or absence of RIHL and the quality of the resources, being: SG-AE (Study Group with Adequate Environment), SG-IE (Study Group with Inadequate Environment), CG-AE (Compared Group with Adequate Environment)) and CG-IE (Compared Group with Inadequate Environment). Affordances were assessed using the questionnaire Affordances in the Home Environment for the Motor Development - Infant Scale (AHEMD-IS). The groups were compared using the Chi-square test or the Kruskal-Wallis test, followed by Dunn's multiple comparison test. The level of significance adopted was 5%.

RESULTS

Infants from the CG-AE performed better than the other groups in cognition and motor skills. The CG-AE language was statistically superior to the SG-IE. SG-IE showed the highest frequency of delays in all domains. CG-IE and SG-AE showed a similar frequency of delays. Adequate environment associated with the absence of RIHL (CG-AE) leads to better cognitive, language, and motor performances.

CONCLUSION

Biological and environmental risk factors have a similar impact on development, but the accumulation of both tends to increase the risks of developmental delay. The absence of RIHL and quality environments worked as protective factors and favored the acquisition of skills.

The contribution of motor functions to academic achievement in primary school: State of the art and future directions

This review is intended to point out the role played by motor skills proficiency in the academic achievement of typically and atypically developing pupils who are attending primary school. First, the interplay between motor and cognitive development will be presented. Next, the cognitive phenotype, not yet deeply investigated, of a neurodevelopmental condition associated with the atypical development of motor functions (known as Developmental Coordination Disorder) will be illustrated. Thus, the contribution of motor functions to academic learning and the impact of motor difficulties for pupils attending primary school will be discussed. In addition, the importance of developing observational tools to be used in educational settings and the need for effective interventions designed to empower motor functioning and academic achievement of atypically developing pupils with motor deficits will be highlighted. Finally, future directions within the educational agencies for the early detection of the atypically developing motor trajectories and their treatment will be traced.

Motor Development Research: II. The First Two Decades of the 21st Century Shaping Our Future

In Part I of this series I, we looked back at the 20th century and re-examined the history of Motor Development research described in Clark & Whitall’s 1989 paper “What is Motor Development? The Lessons of History”. We now move to the 21st century, where the trajectories of developmental research have evolved in focus, branched in scope, and diverged into three new areas. These have progressed to be independent research areas, co-existing in time. We posit that the research focus on Dynamical Systems at the end of the 20th century has evolved into a Developmental Systems approach in the 21st century. Additionally, the focus on brain imaging and the neural basis of movement have resulted in a new approach, which we entitled Developmental Motor Neuroscience. Finally, as the world-wide obesity epidemic identified in the 1990s threatened to become a public health crisis, researchers in the field responded by examining the role of motor development in physical activity and health-related outcomes; we refer to this research area as the Developmental Health approach. The glue that holds these research areas together is their focus on movement behavior as it changes across the lifespan.

Motor skills and later communication development in early childhood: Results from a population-based study

BACKGROUND

Motor milestones in infancy are important developmental markers, not only for later motor skills but also for more widespread social, cognitive, and communication development. The aim of the current study was to investigate the relationships between fine and gross motor development in infants at 6 and 12 months of age and communication skills at 24 months of age.

METHODS

The Ages & Stages Questionnaire (ASQ-II) was used to measure gross motor, fine motor, and communication skills in a large population-based sample of 1,555 infants, recruited from well-baby clinics in five municipalities in South-Eastern Norway. Of these, 557 children had valid values of gross and fine motor scores at 6 and 12 months and for communication score at 24 months. The relationships between motor skills at 6 and 12 months and communication skills at 24 months were analysed using a linear regression analysis.

RESULTS

Gross motor skills at 6 months were positively associated with communication skills at 24 months (coefficients 0.09, p = 0.036) and fine motor skills at 12 months were positively associated with communication skills at 24 months (coefficient 0.23, p < 0.001). We did not find clear evidence for a relationship between gross motor skills at 12 months and communication skills at 24 months (coefficient 0.05, p = 0.126) or between fine motor skills at 6 months and communication skills at 24 months (coefficient 0.08, p = 0.098).

CONCLUSION

The present study supports previous research showing associations between early motor development and later communication development in infancy. Targeted intervention should be considered with at-risk infants.

Coincidence or cascade? The temporal relation between locomotor behaviors and the emergence of stranger anxiety

Two infant milestones, self-propelled locomotion and stranger anxiety, tend to emerge at a similar age in development. An adaptive relation may exist in which the onset of one influences the development of the other in individual children. We examine whether these milestones systematically co-occur and whether one reliably precedes the other. In the current study, 104 parents completed weekly online surveys between 6 and 12 months, noting milestones as they occurred. Onset ages for locomotor behaviors were correlated with onset of stranger anxiety over and above a milestone in a third domain, namely consonant-vowel babbling. These data suggest that infants' earliest locomotor behaviors may play a role in galvanizing the development of stranger anxiety.

Do Gross and Fine Motor Skills Differentially Contribute to Language Outcomes? A Systematic Review

Background: Changes in motor development provide children with new learning opportunities to interact with objects, their environment, and with caregivers. Previous research finds that both gross and fine motor skills are predictive of later language outcomes across early infancy and childhood. However, gross and fine motor skills afford different types of interactions. Thus, gross and fine motor skills may potentially differ in the developmental trajectories through which cascading changes in language may occur. The aim of the present study was to investigate whether there are differences in the predictive capacities of gross and fine motor skills toward language outcomes across infancy and early childhood in typical development. Method: A systematic review of existing literature on motor-language cascades was conducted in across studies measuring gross and/or fine motor and language development in children from 0 to 5 years old. Searches were conducted in PsycINFO, PubMed, and MEDLINE. Keywords used were a combination of "gross motor," "fine motor," "motor performance," "motor development," or "psychomotor development" along with "language," "language development," or "communication skills." Two independent reviewers screened abstracts and full texts based on inclusion and exclusion criteria. Results: A total of 23 articles were retained. Of these, seven studies measured only gross motor skills, four studies measured only fine motor skills, and 12 studies measured both gross and fine motor skills in the same study. Studies used a variety of measures to assess gross motor skills, fine motor skills, and language development (e.g., parent report, in lab observations, standardized assessment), and findings varied based on analyses used. Results demonstrated that both gross and fine motor skills are related to language outcomes, but due to a smaller amount of studies testing fine motor skills, conclusions regarding whether one is more important for language outcomes cannot be drawn. Conclusions: We conclude that both gross and fine motor skills help foster language development from infancy to early childhood. Limitations regarding current knowledge regarding the mechanisms that underlie motor-language cascades are discussed, as well as the need for more studies on fine motor skills.

Language growth in very young siblings at risk for autism spectrum disorder

BACKGROUND

Children with autism spectrum disorder (ASD) show substantial variability in their language development. Language problems are highly prevalent in these children. In addition, the quality of early language abilities contributes to the overall development of these children and is highly predictive of their adult outcome. Yet, little is known about language development in children at risk of ASD during the first years of life.

AIMS

To compare early receptive language (RL) and expressive language (EL) development in children at risk of ASD and determine predictors of language development.

METHODS & PROCEDURES

Developmental trajectories of RL and EL were investigated from 10 to 36 months of age in younger siblings of typically developing children (LR-sibs, N = 30) and in younger siblings of children with ASD (HR-sibs, N = 31) using the Mullen Scales of Early Learning. Furthermore, both child and demographic characteristics were examined as possible predictors of language development.

OUTCOMES & RESULTS

Both groups showed similar growth curves for RL and EL and the majority of the children showed average (within ±1.5 SD of the mean) or above-average language abilities. Nevertheless, the mean growth of EL was lower and the variation in growth of both RL and EL was higher in HR-sibs than in LR-sibs. Furthermore, early child characteristics were predictive of language development in both groups. Yet, some child characteristics seemed to be of more importance in HR-sibs than in LR-sibs. Consequently, lower non-verbal abilities at 10 months in both groups and a higher degree of ASD characteristics at 14 months in HR-sibs may be indicative of difficulties in language development.

CONCLUSIONS & IMPLICATIONS

HR-sibs show more variation in their language development than LR-sibs during the first 3 years of life. The majority of HR-sibs, however, did not present with below-average language abilities. Yet, early characteristics of ASD may be a red flag for difficulties in the language development of HR-sibs.

Walking, pointing, talking - the predictive value of early walking and pointing behavior for later language skills

Both walking abilities and pointing gestures in infants are associated with later language skills. Within this longitudinal study we investigate the relationship between walk onset and first observed index-finger points and their respectively predictive value for later language skills. We assume that pointing as a motor as well as a communicative skill is a stronger predictor of later language development than walk onset. Direct observations, parent questionnaires, and standardized tests were administered in 45 children at ages 1;0, 2;0, 3;0, and 4;0. Results show that both walk onset and early index-finger pointing predict language abilities at age 2;0, but only early index-finger pointing predicts language skills at ages 3;0 and 4;0. Walk onset seems to contribute to an initial increase in language acquisition without a sustained advantage. The predictive value of first observed index-finger points, however, is strong and lasts at least until age 4;0.

Twelve-Month-Old Infants Respond to Speech About Absent Inaccessible Objects

This article investigated the interplay of 12-month-old infants' perception of affordances for locomotion and their ability to respond to the mention of hidden objects. In Experiment I, a toy was hidden in an ottoman that was placed on a cabinet out of infants' reach. Infants were more likely to look at, point to or approach the ottoman when there were stairs leading to it than when there were none. The stairs did not help infants respond by highlighting the target corner of the room (Experiment II) or by boosting their engagement with the study events (Experiment III). This suggests that infants' perception of the accessibility of the hiding location influences their ability to respond to speech about absent things.

A home-video method to assess infant gross motor development: parent perspectives on feasibility

Background

Current use of smartphone cameras by parents create opportunities for longitudinal home-video-assessments to monitor infant development. We developed and validated a home-video method for parents, enabling Pediatric Physical Therapists to assess infants’ gross motor development with the Alberta Infant Motor Scale (AIMS). The objective of the present study was to investigate the feasibility of this home-video method from the parents’ perspective.

Methods

Parents of 59 typically developing infants (0–19 months) were recruited, 45 parents participated in the study. Information about dropout was collected. A sequential mixed methods design was used to examine feasibility, including questionnaires and semi-structured interviews. While the questionnaires inquired after the practical feasibility of the home-video method, the interviews also allowed parents to comment on their feelings and thoughts using the home-video method.

Results

Of 45 participating parents, 34 parents returned both questionnaires and eight parents agreed to an interview. Parent reported effort by the infants was very low: the home-video method is perceived as similar to the normal routine of playing. The parental effort level was acceptable. The main constraint parents reported was time planning. Parents noted it was sometimes difficult to find the right moment to record the infant’s motor behavior, that is, when parents were both at home and their baby was in the appropriate state. Technical problems with the web portal, reported by 28% of the parents were also experienced as a constraint. Positive factors mentioned by parents were: the belief that the home videos are valuable for family use, receiving feedback from a professional, the moments of one-on-one attention and interaction with their babies. Moreover, the process of recording the home videos resulted in an increased parental awareness of, and insight into, the gross motor development of their infant.

Conclusion

The AIMS home-video method is feasible for parents of typically developing children. Most constraints are of a practical nature that can be addressed in future applications. Future research is needed to show whether the home-video method is also applicable for parents with an infant at risk of motor development problems.

Developmental divergence: motor trajectories in children with fragile X syndrome with and without co-occurring autism

BACKGROUND

Autism spectrum disorder (ASD) is highly prevalent in fragile X syndrome (FXS), affecting 50-70% of males. Motor impairments are a shared feature across autism and FXS that may help to better characterize autism in FXS. As motor skills provide a critical foundation for various language, cognitive, and social outcomes, they may serve an important mechanistic role for autism in FXS. As such, this study aimed to identify differences in motor trajectories across direct assessment and parent-report measures of fine and gross motor development between FXS with and without autism, and typical development, while controlling for cognitive functioning.

METHODS

This prospective longitudinal study included 42 children with FXS, 24 of whom also had ASD (FXS + ASD), as well as 40 typically developing children. The Mullen Scales of Early Learning provided a direct measure of fine and gross motor skills, and the Vineland Adaptive Behavior Scales provided a measure of parent-reported fine and gross motor skills. Random slopes and random intercepts multilevel models were tested to determine divergence in developmental motor trajectories between groups when controlling for cognitive level.

RESULTS

Model results indicated the children with FXS + ASD diverged from TD children by 9-months on all measures of gross and fine motor skills, even when controlling for cognitive level. Results also indicated an early divergence in motor trajectories of fine and gross motor skills between the FXS + ASD and FXS groups when controlling for cognitive level. This divergence was statistically significant by 18 months, with the FXS + ASD showing decelerated growth in motor skills across direct observation and parent-report measures.

CONCLUSIONS

This study is the first to examine longitudinal trends in motor development in children with FXS with and without comorbid ASD using both direct assessment and parent-report measures of fine and gross motor. Furthermore, it is among the first to account for nonverbal cognitive delays, a step towards elucidating the isolated role of motor impairments in FXS with and without ASD. Findings underscore the role of motor impairments as a possible signal representing greater underlying genetic liability, or as a potential catalyst or consequence, of co-occurring autism in FXS.

State Regulations Promoting Infant Physical Activity in Early Care and Education

BACKGROUND

State policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018.

METHODS

We reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemar's tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period.

RESULTS

From 2013 to 2018, we observed significant improvement in one recommendation for homes-to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; p = 0.006). We did not observe any other significant difference between 2013 and 2018 regulations.

CONCLUSIONS

Despite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.

The Interaction of Social, Physical and Nutritive Factors in Triggering Early Developmental Language Delay in a Sample of Egyptian Children

BACKGROUND:

Language acquisition and child development during the early years of life depend on multiple interacting factors.

AIM:

To explore potential factors that can impact language development in 2 groups of Egyptian children, one with normal language development and the second with delayed development. Also, to explore to what extent can the involvement of impaired motor development potentiate the risk of developmental language delay.

METHODS:

This cross-sectional case-control study involved Egyptian children belonging to the middle socioeconomic class between 18 and 36 months of age. Children were classified according to their performance on language domain of Bayley Scales of Infant and Toddler Development (Bayley-III) into two groups, infants with the average or above score (control group) and those having below-average scores (cases). Motor development was assessed on the same scale. Factors affecting language development were tested, including socio-demographic, obstetric, and maternal medical factors in addition to Infant Feeding Practices.

RESULTS:

The independent factors lowering the language scores were early introduction of complementary food, low family income, history of delivery problems, pregnancy-related diseases of the mother, and maternal education. Impaired motor development appears as a further highly significant risk factor to the previously mentioned factors

CONCLUSION:

In Egyptian children, delayed language development is severely affected by the interaction of medical, social and nutritional factors. Providing adequate maternal health care during pregnancy and childbirth, regular developmental monitoring at each child visit, and screening for such risk factors, can reduce size of the problem and promote child’s social and psychological development.

Vocal and locomotor coordination develops in association with the autonomic nervous system

In adult animals, movement and vocalizations are coordinated, sometimes facilitating, and at other times inhibiting, each other. What is missing is how these different domains of motor control become coordinated over the course of development. We investigated how postural-locomotor behaviors may influence vocal development, and the role played by physiological arousal during their interactions. Using infant marmoset monkeys, we densely sampled vocal, postural and locomotor behaviors and estimated arousal fluctuations from electrocardiographic measures of heart rate. We found that vocalizations matured sooner than postural and locomotor skills, and that vocal-locomotor coordination improved with age and during elevated arousal levels. These results suggest that postural-locomotor maturity is not required for vocal development to occur, and that infants gradually improve coordination between vocalizations and body movement through a process that may be facilitated by arousal level changes.

Sitting Matters! Differences Between Sitters and Nonsitters at 6 Months' Adjusted Age in Infants At-Risk and Born Preterm

PURPOSE

Sitting delays in infants born preterm compound cognitive and language deficits. This retrospective study examines differences in prematurity-related risk and compares developmental outcomes between sitters and nonsitters at 6 months' adjusted age.

METHODS

A total of 105 graduates of the neonatal intensive care unit met inclusion criteria. Infant demographic and medical risk profiles and 6-month Bayley Scales of Infant Development-3rd edition (BSID-III) cognitive and language scores were retrieved. Infants who sat with hands free greater than 60 seconds were classified as "sitters."

RESULTS

Sixty-nine percent of the sample were nonsitters and were born earlier, had lower birth weights, were chronologically older at follow-up, and spent more days with respiratory support. BSID-III scores were significantly higher in sitters but did not differ by gender, multiple birth, head ultrasound results, payment type, or race/ethnicity.

CONCLUSION

Sitting abilities at 6 months' adjusted age are associated with prematurity risk factors. Cognitive and language scores differ significantly between sitters and nonsitters.

The Signal in the Noise: The Visual Ecology of Parents' Object Naming

The uncertainty of reference has long been considered a key challenge for young word learners. Recent studies of head-camera wearing toddlers and their parents during object play have revealed that from toddlers' views the referents of parents' object naming are often visually quite clear. Although these studies have promising theoretical implications, they were all conducted in stripped-down laboratory contexts. The current study examines the visual referential clarity of parents' object naming during play in the home. Results revealed patterns of visual referential clarity that resembled previous laboratory studies. Furthermore, context analyses show that such clarity is largely a product of manual activity rather than the object-naming context. Implications for the mechanisms of early word learning are discussed.

The Development of Object Construction from Infancy through Toddlerhood

Early in development, children explore and combine objects in increasingly complex ways. One manual skill, object construction, represents a major shift in how objects are explored relative to other objects. Despite recent connections with cognitive functioning such as spatial skills, the development of object construction ability has rarely been studied and its trajectory has not been adequately described. The purpose of this study was to describe the development of three types of object construction (stacking, nesting, affixing) across 5 monthly infant visits and 7 monthly toddler visits using a longitudinal design and a large sample size. Infants (10-14 months, n=131) and toddlers drawn from the infant sample (18-24 months, n=65) were given sets of age-appropriate toys each of which elicited at least one type of constructive play. We described success at different construction tasks and identified trends for construction skill for infant and toddler development using multilevel modeling. We found that each of the three construction actions developed in unique ways across the 10-24-month period. Infant construction skill predicted the development of toddler skill, but toddler construction skill diverged from infant trajectories. We discuss the role of combination strategies in the development of object construction skill and how object construction could be related to other domains of development.

Changes in Posture and Interactive Behaviors as Infants Progress From Sitting to Walking: A Longitudinal Study

This longitudinal study assessed how infants and mothers used different postures and modulated their interactions with their surroundings as the infants progressed from sitting to walking. Thirteen infants and their mothers were observed biweekly throughout this developmental period during 10 min laboratory free-play sessions. For every session, we tracked the range of postures mothers and infants produced (e.g., sitting, kneeling, and standing), we assessed the type of interactions they naturally engaged in (no interactions, passive involvement, fine motor manipulation, or gross motor activity), and documented all target transitions. During the crawling transition period, when infants used sitting postures, they engaged mainly in fine motor manipulations of targets and often maintained their activity on the same target. As infants became mobile, their rate of fine motor manipulation declined during sitting but increased while kneeling/squatting. During the walking transition, their interactions with targets became more passive, particularly when sitting and standing, but they also engaged in greater gross motor activity while continuing to use squatting/kneeling postures for fine motor manipulations. The walking period was also marked by an increase in target changes and more frequent posture changes during object interactions. Throughout this developmental period, mothers produced mainly no or passive activity during sitting, kneeling/squatting, and standing. As expected, during this developmental span, infants used their body in increasingly varied ways to explore and interact with their environment, but more importantly, progression in posture variations significantly altered how infants manually interacted with their surrounding world.

Identifying patterns of motor performance, executive functioning, and verbal ability in preschool children: A latent profile analysis

BACKGROUND

A relationship between motor performance and cognitive functioning is increasingly being recognized. Yet, little is known about the precise nature of the relationship between both domains, especially in early childhood.

AIMS

To identify distinct constellations of motor performance, executive functioning (EF), and verbal ability in preschool aged children; and to explore how individual and contextual variables are related to profile membership.

METHODS AND PROCEDURES

The sample consisted of 119 3- to 4-year old children (62 boys; 52%). The home based assessments consisted of a standardized motor test (Movement Assessment Battery for Children - 2), five performance-based EF tasks measuring inhibition and working memory, and the Receptive Vocabulary subtest from the Wechsler Preschool and Primary Scale of Intelligence Third Edition. Parents filled out the Behavior Rating Inventory of Executive Function - Preschool version. Latent profile analysis (LPA) was used to delineate profiles of motor performance, EF, and verbal ability. Chi-square statistics and multinomial logistic regression analysis were used to examine whether profile membership was predicted by age, gender, risk of motor coordination difficulties, ADHD symptomatology, language problems, and socioeconomic status (SES).

OUTCOMES AND RESULTS

LPA yielded three profiles with qualitatively distinct response patterns of motor performance, EF, and verbal ability. Quantitatively, the profiles showed most pronounced differences with regard to parent ratings and performance-based tests of EF, as well as verbal ability. Risk of motor coordination difficulties and ADHD symptomatology were associated with profile membership, whereas age, gender, language problems, and SES were not.

CONCLUSIONS AND IMPLICATIONS

Our results indicate that there are distinct subpopulations of children who show differential relations with regard to motor performance, EF, and verbal ability. The fact that we found both quantitative as well as qualitative differences between the three patterns of profiles underscores the need for a person-centered approach with a focus on patterns of individual characteristics.

Visual and somatosensory contributions to infant sitting postural control

There are a limited number of studies that have investigated sitting posture during infancy and the contribution of the sensory systems. The goal of this study was to examine the effects of altered visual and somatosensory signals on infant sitting postural control. Thirteen infants (mean age ± SD, 259.69 ± 16.88 days) participated in the study. Initially, a single physical therapist performed the Peabody Developmental Motor Scale to determine typical motor development. Then the child was placed onto a force platform under four randomized conditions: (a) Control (C) - sat independently on the force plate, (b) Somatosensory (SS) - Sat independently on a foam pad (low density), (c) Visual (VS) - sat independently on the force plate while the lights were turned off creating dim lighting, and (d) Combination of b and c (NVSS). Center of pressure (COP) data from both the anterior-posterior (AP) and the medial-lateral (ML) directions were acquired through the Vicon software at 240 Hz. The lights off conditions, both VS and NVSS, lead to increased Root Mean Square (RMS) and Range values in the AP direction, as well as increased Lyapunov Exponent (LyE) values in the ML direction. Altered visual information lead to greater disturbances of sitting postural control in typically developing infants than altered somatosensory information. The lights off conditions (VS and NVSS), unveiled different control mechanisms for AP and ML direction during sitting. Thus, the present findings confirm the dominance of vision during the early acquisition of a new postural accomplishment.

Early Motor and Communicative Development in Infants With an Older Sibling With Autism Spectrum Disorder

Purpose

A recent approach to identifying early markers of risk for autism spectrum disorder (ASD) has been to study infants who have an older sibling with ASD. These infants are at heightened risk (HR) for ASD and for other developmental difficulties, and even those who do not receive an eventual ASD diagnosis manifest a high degree of variability in trajectories of development. The primary goal of this review is to summarize findings from research on early motor and communicative development in these HR infants.

Method

This review focuses on 2 lines of inquiry. The first assesses whether delays and atypicalities in early motor abilities and in the development of early communication provide an index of eventual ASD diagnosis. The second asks whether such delays also influence infants' interactions with objects and people in ways that exert far-reaching, cascading effects on development.

Results

HR infants who do and who do not receive a diagnosis of ASD vary widely in motor and communicative development. In addition, variation in infant motor and communicative development appears to have cascading effects on development, both on the emergence of behavior in other domains and on the broader learning environment.

Conclusions

Advances in communicative and language development are supported by advances in motor skill. When these advances are slowed and/or when new skills are not consolidated and remain challenging for the infant, the enhanced potential for exploration afforded by new abilities and the concomitant increase in opportunities for learning are reduced. Improving our understanding of communicative delays of the sort observed in ASD and developing effective intervention methods requires going beyond the individual to consider the constant, complex interplay between developing communicators and their environments.

Presentation Video

https://doi.org/10.23641/asha.7299308.

The home handedness questionnaire: pilot data from preschoolers

While handedness questionnaires are widely used in adults, there is no comparable measure designed specifically for children. The current study developed the Home Handedness Questionnaire (HHQ), a new measure for preschoolers administered by parents using common household items. The HHQ has two scales that distinguish action types typically combined on other measures: actions performed with only the right or left hand (i.e., unimanual, such as holding a toothbrush), and actions performed with one hand holding the object for the other hand's action (i.e., role-differentiated bimanual manipulation or RDBM, such as unscrewing a lid from a jar). The HHQ was able to detect right preference, left preference, and no preference for unimanual and RDBM actions in a proof of concept study in 3-year-olds (N = 64). The HHQ identified a majority of children as right-handed, but was also sensitive to variability in direction across skill types. Approximately one-quarter of children in the sample had mixed preferences for the two types of manual skills, suggesting that for a subgroup of children, hand use patterns may still be undergoing change. Suggestions for refining the HHQ are discussed. Overall, the HHQ is a promising multidimensional parent-led tool for assessing preschool handedness.

Language delay aggregates in toddler siblings of children with autism spectrum disorder

BACKGROUND

Language delay is extremely common in children with autism spectrum disorder (ASD), yet it is unclear whether measurable variation in early language is associated with genetic liability for ASD. Assessment of language development in unaffected siblings of children with ASD can inform whether decreased early language ability aggregates with inherited risk for ASD and serves as an ASD endophenotype.

METHODS

We implemented two approaches: (1) a meta-analysis of studies comparing language delay, a categorical indicator of language function, and language scores, a continuous metric, in unaffected toddlers at high and low familial risk for ASD, and (2) a parallel analysis of 350 unaffected 24-month-olds in the Infant Brain Imaging Study (IBIS), a prospective study of infants at high and low familial risk for ASD. An advantage of the former was its detection of group differences from pooled data across unique samples; an advantage of the latter was its sensitivity in quantifying early manifestations of language delay while accounting for covariates within a single large sample.

RESULTS

Meta-analysis showed that high-risk siblings without ASD (HR-noASD) were three to four times more likely to exhibit language delay versus low-risk siblings without ASD (LR-noASD) and had lower mean receptive and expressive language scores. Analyses of IBIS data corroborated that language delay, specifically receptive language delay, was more frequent in the HR-noASD (n = 235) versus LR-noASD group (n = 115). IBIS language scores were continuously and unimodally distributed, with a pathological shift towards decreased language function in HR-noASD siblings. The elevated inherited risk for ASD was associated with lower receptive and expressive language scores when controlling for sociodemographic factors. For receptive but not expressive language, the effect of risk group remained significant even when controlling for nonverbal cognition.

CONCLUSIONS

Greater frequency of language delay and a lower distribution of language scores in high-risk, unaffected toddler-aged siblings support decreased early language ability as an endophenotype for ASD, with a more pronounced effect for receptive versus expressive language. Further characterization of language development is warranted to refine genetic investigations of ASD and to elucidate factors influencing the progression of core autistic traits and related symptoms.

Walking Ability is Associated with Social Communication Skills in Infants at High Risk for Autism Spectrum Disorder

Achievement of early motor milestones in infancy affords new opportunities for social interaction and communication. Research has shown that both motor and social deficits are observed in infants who later develop autism spectrum disorder (ASD). The current study examined associations between motor and social-communication skills in 12-month-old infant siblings of children with ASD who are at heightened risk for developmental delays (N=86) and low-risk, typically developing infants (N=113). Infants were classified into one of three groups based on their walking ability: walkers (walks independently), standers (stands independently), or pre-walkers (does not yet stand or walk independently). Social-communication and cognitive skills were assessed with two standardized assessments (Communication and Symbolic Behaviors Scales [CSBS] and Mullen Scales of Early Learning) and compared across the three walking groups. Results demonstrated that high-risk walkers showed superior social-communication skills, but commensurate cognitive skills, compared to high-risk pre-walkers. In contrast, social-communication and cognitive skills were largely comparable for low-risk infants, regardless of walking status. Findings suggest that for high-risk infants, who are already vulnerable to developmental delays and ASD, independent walking may facilitate the emergence of social-communication abilities. Pivotal motor milestones may serve as useful indicators of social-communication delays and targets for intervention.

Inability of infants to push up in the prone position and subsequent development

BACKGROUND

During routine health screening, some infants cannot maintain the prone position with extended arm support at 6 months. Little is known, however, about the development of full-term infants with this developmental deviation. We investigated the developmental course of infants with this characteristic.

METHODS

We enrolled 2,020 full-term infants who had been recruited at a regional center for the Japan Environment and Children's Study. Their development was measured using the Ages and Stages Questionnaire, third edition, at 0.5, 1, 1.5, 2, 2.5, and 3 years. The children were grouped according to their ability to stay prone on extended arms at 6 months, and their development was compared.

RESULTS

A total of 1,625 infants could stay prone on extended arms and 179 could not. We excluded 212 infants who could stay prone on extended arms only sometimes, and four who did not have a questionnaire response. In the gross motor domain, significant difference in questionnaire scores was observed between the "could" and "could-not" groups at 6 months (Hedges' g, 1.83) and persisted until 3 years (Hedges' g, 0.33). Significant differences were also observed in the communication, fine motor, problem solving, and personal-social domains at 6 months (Hedges' g, 0.20-0.58) and persisted until 1, 2, 2, and 1.5 years, respectively (Hedges' g, 0.21-0.25).

CONCLUSIONS

Infants who cannot maintain the prone position on extended arms lag behind those who can, although the effect sizes become relatively small after 1.5 years of age. Early intervention may be considered if delay is problematic or persistent.

Infant Motor Development in Autism Spectrum Disorder: A Synthesis and Meta-analysis

Studies of infant motor development in autism spectrum disorder (ASD) have increased in recent years. This article synthesized this literature through meta-analysis to assess (a) whether infant motor ability differs in ASD relative to neurotypical controls; and (b) whether motor ability and communication are related in infants with ASD. Study 1 aggregated data from 1,953 infants with ASD (ages 3.0-42.0 months), and Study 2 included 890 infants with ASD (age 6.0-42.9 months). Study 1 revealed that infant motor ability differed significantly in ASD compared with neurotypical infants-this difference was robust to variation in measurement and design. Furthermore, this group difference amplified as age increased. Study 2 indicated that within ASD, infant motor ability and communication are related.

Development of fine motor skills is associated with expressive language outcomes in infants at high and low risk for autism spectrum disorder

Background

A growing body of research suggests that fine motor abilities are associated with skills in a variety of domains in both typical and atypical development. In this study, we investigated developmental trajectories of fine motor skills between 6 and 24 months in relation to expressive language outcomes at 36 months in infants at high and low familial risk for autism spectrum disorder (ASD).

Methods

Participants included 71 high-risk infants without ASD diagnoses, 30 high-risk infants later diagnosed with ASD, and 69 low-risk infants without ASD diagnoses. As part of a prospective, longitudinal study, fine motor skills were assessed at 6, 12, 18, and 24 months of age and expressive language outcomes at 36 months using the Mullen Scales of Early Learning. Diagnosis of ASD was determined at the infant’s last visit to the lab (18, 24, or 36 months) using the Autism Diagnostic Observation Schedule.

Results

Hierarchical linear modeling revealed that high-risk infants who later developed ASD showed significantly slower growth in fine motor skills between 6 and 24 months, compared to their typically developing peers. In contrast to group differences in growth from age 6 months, cross-sectional group differences emerged only in the second year of life. Also, fine motor skills at 6 months predicted expressive language outcomes at 3 years of age.

Conclusions

These results highlight the importance of utilizing longitudinal approaches in measuring early fine motor skills to reveal subtle group differences in infancy between ASD high-risk and low-risk infant populations and to predict their subsequent language outcomes.

Electronic supplementary material

The online version of this article (10.1186/s11689-018-9231-3) contains supplementary material, which is available to authorized users.

Receptive language is associated with visual perception in typically developing children and sensorimotor skills in autism spectrum conditions

A number of studies have evidenced marked difficulties in language in autism spectrum conditions (ASC). Studies have also shown that language and word knowledge are associated with the same area of brain that is also responsible for visual perception in typically developing (TD) individuals. However, in ASC, research suggests word meaning is mapped differently, on to situational sensorimotor components within the brain. Furthermore, motor coordination is associated with communication skills. The current study explores whether motor coordination and visual perception are impaired in children with ASC, and whether difficulties in coordination and visual perception correlate with receptive language levels. 36 children took part: 18 with ASC and 18 TD children, matched on age and non-verbal reasoning. Both groups completed the Movement ABC, Beery-Buktenica Developmental Test of Visual-Motor Integration, British Picture Vocabulary Scale and Matrices (WASI). Results showed that ASC children scored significantly lower on receptive language, coordination and visual motor integration than the TD group. In the TD group receptive language significantly correlated with visual perception; in the ASC group receptive language significantly correlated with balance. These results imply that sensorimotor skills are associated with the understanding of language in ASC and thus the relationship between sensorimotor experiences and language warrants further investigation.

Motor Skills as Moderators of Core Symptoms in Autism Spectrum Disorders: Preliminary Data From an Exploratory Analysis With Artificial Neural Networks

Motor disturbances have been widely observed in children with autism spectrum disorder (ASD), and motor problems are currently reported as associated features supporting the diagnosis of ASD in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Studies on this issue reported disturbances in different motor domains, including both gross and fine motor areas as well as coordination, postural control, and standing balance. However, they failed to clearly state whether motor impairments are related to demographical and developmental features of ASD. Both the different methodological approaches assessing motor skills and the heterogeneity in clinical features of participants analyzed have been implicated as contributors to variance in findings. However, the non-linearity of the relationships between variables may account for the inability of the traditional analysis to grasp the core problem suggesting that the "single symptom approach analysis" should be overcome. Artificial neural networks (ANNs) are computational adaptive systems inspired by the functioning processes of the human brain particularly adapted to solving non-linear problems. This study aimed to apply the ANNs to reveal the entire spectrum of the relationship between motor skills and clinical variables. Thirty-two male children with ASD [mean age: 48.5 months (SD: 8.8); age range: 30-60 months] were recruited in a tertiary care university hospital. A multidisciplinary comprehensive diagnostic evaluation was associated with a standardized assessment battery for motor skills, the Peabody Developmental Motor Scale-Second Edition. Exploratory analyses were performed through the ANNs. The findings revealed that poor motor skills were a common clinical feature of preschoolers with ASD, relating both to the high level of repetitive behaviors and to the low level of expressive language. Moreover, unobvious trends among motor, cognitive and social skills have been detected. In conclusion, motor abnormalities in preschoolers with ASD were widespread, and the degree of impairment may inform clinicians about the severity of ASD core symptoms. Understanding motor disturbances in children with ASD may be relevant to clarify neurobiological basis and ultimately to guide the development of tailored treatments.

Infant Neuromotor Development and Childhood Problem Behavior

BACKGROUND

Research of adults and school-aged children suggest a neurodevelopmental basis for psychiatric disorders. We examined whether infant neuromotor development predicted internalizing and externalizing problems in young children.

METHODS

In Generation R, a population-based cohort in the Netherlands (2002-2006), trained research assistants evaluated the neuromotor development of 4006 infants aged 2 to 5 months by using an adapted version of Touwen's Neurodevelopmental Examination (tone, responses, and senses and other observations). We defined nonoptimal neuromotor development as scores in the highest tertile. Mothers and fathers rated their children's behavior at ages 1.5, 3, 6, and 10 years with the Child Behavior Checklist (n = 3474, response: 86.7%). The associations were tested with generalized linear mixed models.

RESULTS

Overall, neuromotor development predicted internalizing scores, but no association was observed with externalizing scores. Nonoptimal muscle tone was associated with higher internalizing scores (mothers' report: β = .07; 95% confidence interval [CI]: 0.01 to 0.13; fathers' report: β = .09, 95% CI: 0.00 to 0.16). In particular, nonoptimal low muscle tone was associated with higher internalizing scores (mothers' report: β = .11; 95% CI: 0.05 to 0.18; fathers' report: β = .13; 95% CI: 0.04 to 0.22). We also observed an association between senses and other observations with internalizing scores. There was no relationship between high muscle tone or reflexes and internalizing scores.

CONCLUSIONS

Common emotional problems in childhood have a neurodevelopmental basis in infancy. Neuromotor assessment in infancy may help identify vulnerability to early internalizing symptoms and offer the opportunity for targeted interventions.

Toddler hand preference trajectories predict 3-year language outcome

A growing body of work suggests that early motor experience affects development in unexpected domains. In the current study, children's hand preference for role-differentiated bimanual manipulation (RDBM) was measured at monthly intervals from 18 to 24 months of age (N = 90). At 3 years of age, children's language ability was assessed using the Preschool Language Scales 5th edition (PLS™-5). Three distinct RDBM hand preference trajectories were identified using latent class growth analysis: (1) children with a left hand preference but a moderate amount of right hand use; (2) children with a right hand preference but a moderate amount of left hand use; and (3) children with a right hand preference and only a mild amount of left hand use. Stability over time within all three trajectories indicated that children did not change hand use patterns from 18 to 24 months. Children with the greatest amount of preferred (i.e., right) hand use demonstrated higher expressive language scores compared to children in both trajectories with moderate levels of non-preferred hand use. Children with the greatest amount of right hand use also had higher scores for receptive language compared to children with a right hand preference but moderate left hand use. Results support that consistency in handedness as measured by the amount of preferred hand use is related to distal language outcomes in development.

Assessment of presentation patterns, clinical severity, and sensorial mechanism of tip-toe behavior in severe ASD subjects with intellectual disability: A cohort observational study

We assessed presentation patterns and characteristics of tip-toe behavior (TTB), more commonly known as toe walking, in a cohort of severe autism spectrum disorder (ASD) subjects with intellectual disability in two studies. The first study included 69 consecutive ASD subjects (57 males, mean age = 14 years-3.7 SD) under observation at our institute. A therapist assessed the presence of TTB during standing, walking, and running through direct observation and an interview with the subjects main caregiver. The prevalence of TTB was 32%. We found three clinical presentation patterns of TTB: (1) present when standing, walking and running (45.5%), (2) present when walking and running (18.4%), or (3) present only when running (36.4%). TTB subjects were more frequently nonverbal than those without TTB (72.7% vs. 44.6%-P = 0.03). On the other hand, no significant difference in ASD severity according to the ADOS scale was found between TTB and non-TTB subjects. In the second study, carried out in a subgroup of 14 ASD subjects (7 TTB and 7 non-TTB), we evidenced that a soft floor surface (foam mats) made a substantial difference in reducing the TTB phenomenon. TTB is frequently present in ASD individuals and may occur in three mutually exclusive modalities, which ultimately defines what is commonly known as toe walking. The presence of TTB seems correlated to the severity of language delay. Foot contact on soft surfaces reduces TTB both during static and/or dynamic tasks. Further evaluation is needed to clarify the potential pathophysiological implications of this phenomenon. Autism Res 2017, 10: 1547-1557. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Postural control strategies differ in normal weight and overweight infants

BACKGROUND

Evidence suggests obesity can have a negative influence on a child's motor development and postural control behavior. Little research has examined the impact of infant weight on gross motor behavior, particularly postural control at the onset of sitting.

OBJECTIVE

The purpose of this study was to determine whether normal weight and overweight infants differed in their postural control strategies at the onset of sitting and one-month post onset of sitting.

METHODS

29 infants (n=19 normal weight, n=10 overweight) were recruited to participate in this study. Infant's length and weight were measured at 3 months of age (visit 1). Infant's center of pressure (COP) was measured on an AMTI force platform at the onset of sitting (visit 2) and one-month post onset (visit 3). Data were analyzed using linear measures (range and RMS for the anterior/posterior (AP) and medial/lateral (ML) directions, sway path) and nonlinear measures (Sample Entropy in AP and ML directions).

RESULTS

Overweight infants had significantly greater RMS values in the ML direction at visit 2 and reduced Sway Path values in comparison to normal weight infants at visits 2 and 3. Further, there was a significant difference in Sample Entropy as overweight infants increased Sample Entropy from visit 2 to 3 while normal weight infants decreased Sample Entropy values during this time period.

CONCLUSIONS

These findings suggest that overweight infants adopt a different postural control strategy. This altered strategy may limit exploration early in development. More research is needed to determine if longitudinal differences continue to emerge.

Infant muscle tone and childhood autistic traits: A longitudinal study in the general population

In a longitudinal population-based study of 2,905 children, we investigated if infants' neuromotor development was associated with autistic traits in childhood. Overall motor development and muscle tone were examined by trained research assistants with an adapted version of Touwen's Neurodevelopmental Examination between ages 2 and 5 months. Tone was assessed in several positions and items were scored as normal, low, or high tone. Parents rated their children's autistic traits with the Social Responsiveness Scale (SRS) and the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist at 6 years. We defined clinical PDP if scores were >98th percentile of the norm population. Diagnosis of autism spectrum disorder (ASD) was clinically confirmed in 30 children. We observed a modest association between overall neuromotor development in infants and autistic traits. Low muscle tone in infancy predicted autistic traits measured by SRS (adjusted beta = 0.05, 95% CI for B: 0.00-0.02, P = 0.01), and PDP (adjusted beta = 0.08, 95% CI for B: 0.04-0.10, P < 0.001). Similar results emerged for the association of low muscle tone and clinical PDP (adjusted OR = 1.36, 95% CI: 1.08-1.72, P = 0.01) at age 6 years. Results remained unchanged if adjusted for child intelligence. There was no association between high muscle tone and SRS or PDP. Exclusion of children with ASD diagnosis did not change the association. This large study showed a prospective association of infant muscle tone with autistic traits in childhood. Our findings suggest that early detection of low muscle tone might be a gateway to improve early diagnosis of ASD. Autism Res 2017, 10: 757-768. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Pre-linguistic Vocal Trajectories at 6-18 Months of Age As Early Markers of Autism

This study explores pre-linguistic vocal trajectories in infants with autism spectrum disorder (ASD) during caregiver-infant interaction. Home videos were obtained from 10 infants with ASD and 10 typically developing infants (TD), covering three time periods: 0–6 months (T1, 47 video sequences), 6–12 months (T2, 47 video sequences), and 12–18 months (T3, 48 video sequences). In total 142 video sequences were analyzed. Vocalizations, long reduplicated babbling, 2-syllable babbling, and first words were investigated longitudinally. Face-gazing was also analyzed, to evaluate the social quality of vocal behaviors. Results show a lower rate of vocalizations in the ASD group at T2, and a lower rate of first words at T3, compared to the TD group. However, the prevalence of non-social babbling, appeared higher in the ASD group. The implications of these findings for screening programs are discussed.

First Steps into Language? Examining the Specific Longitudinal Relations between Walking, Exploration and Linguistic Skills

Recent empirical evidence demonstrates relationships between motor and language development that are partially mediated by exploration. This is in line with the embodied cognition approach to development that views language as grounded in real-life sensorimotor interactions with the environment. This view implies that the relations between motor and linguistic skills should be specific. Moreover, as motor development initially changes the possibilities children have to explore the environment, initial relations between motor and linguistic skills should become weaker over time. Empirical evidence pertaining to the duration and specificity of these relations is still lacking. The current study investigated longitudinal relations between attainment of walking and the development of several linguistic skills, and tested whether exploration through self-locomotion mediated these relations. Linguistic skills were measured at age 43 months, which is later than the age used in previous studies. Three hypotheses were tested: (1) the relations between walking and language found at younger ages will decrease over time (2) exploration through self-locomotion will remain an important predictor of spatial language (3) no relation will be found between walking, exploration and the use of grammatical and lexical categories and between exploration and general vocabulary. Thirty-one Dutch children took part in a longitudinal study. Parents reported about age of attainment of walking. Exploration through self-locomotion was measured using observations of play with a standard set of toys at age 20 months. Receptive vocabulary, spatial language and use of grammatical and lexical categories were measured at age 43 months using (standard) tests. Results reveal that age of walking does not directly predict spatial language at age 43 months. Exploration through self-locomotion does significantly and completely mediate the indirect effect of age of walking on spatial language. Moreover, neither age of walking nor exploration predict general vocabulary and the use of grammatical and lexical categories. Results support the idea that the initial relations between motor development and linguistic skills decrease over time and that these relations are specific and intrinsically dependent on the information children pick up through the execution of specific motor activities.

Why We Move: Social Mobility Behaviors of Non-Disabled and Disabled Children across Childcare Contexts

BACKGROUND

Social mobility is defined as the co-occurrence of self-directed locomotion and direct peer interaction. Social mobility is a product of dynamic child-environment interactions and thus likely to vary across contexts (e.g., classroom, gymnasium, and playground).

PURPOSE

The purpose of this present study was to examine differences in children's social mobility: (1) across contexts by age and (2) between non-disabled and disabled children.

METHOD

Participants (n = 55 non-disabled and three disabled children; Mage = 3.1 years, SD = 1.4) were video recorded within a university-based early learning center. Children were recorded for 20 min in each context: classroom, gymnasium, and playground. A 15-s momentary time sampling method was used to code social mobility, the simultaneous occurrence of self-directed locomotion, and direct peer interaction. This variable was calculated as percent time within each context.

RESULTS

A planned Friedman's rank ANOVA (n = 55), stratified by age, indicated that older children (3-5 years old) differed across contexts in their social mobility [χ2(2) ~ 7.3-10.5, p < 0.025], whereas younger children (1-2 years old) were similar across contexts. Social mobility was significantly lower in the classroom compared with the playground and gymnasium (with no difference between the latter contexts) for older children. Visual analysis confirmed that disabled children (n = 3) engaged in substantially less time in social mobility (average 0-1%), compared with non-disabled, age-similar peers (2-3 years old average 1-12%) across all contexts.

CONCLUSION

A substantial gap exists between non-disabled and disabled children for social mobility. There is an increase in magnitude and variability of social mobility around age three that suggests the gap between non-disabled and disabled children will continue to widen.