Exploring an integrative model of infant behavior: what is the relationship among temperament, sensory processing, and neurobehavioral measures?

Inter-hemispheric somatosensory coherence and parental stress in hypersensitivity at 8 months old: An electroencephalography study

OBJECTIVE

Infant hypersensitivity affects daily challenges and parental stress. Although the crucial role of tactile sensation in infants' brain function has been highlighted, hypersensitive infants and their families lack support. Electroencephalography may be useful for understanding hypersensitivity traits. We investigated the relationship between infant perceptual hypersensitivity and parental stress, somatosensory-evoked potential (SEP), and magnitude-squared coherence (MSC) in the general population.

METHODS

Infants aged 8 months (n = 63) were evaluated for hypersensitivity and parental stress using a questionnaire and for cortical activity using electroencephalography. Vibration stimuli were applied to the infant's left foot. SEP components that peaked around 150 ms (N2) and at 200 ms (P2) after stimulus onset were evaluated by amplitude and latency at the midline electrode (Cz) and MSC between the midline electrodes (C3-C4).

RESULTS

Parental stress was associated with infant hypersensitivity. The latency of Cz was delayed, and C3-C4 delta MSC was high in infants with hypersensitivity.

CONCLUSIONS

Increasing inter-hemispheric MSC synchrony in the stimulated condition in infants with hypersensitivity suggested atypical somatosensory cortical function.

SIGNIFICANCE

These findings contribute to identifying, understanding the mechanisms of, and developing effective coping strategies for early-stage hypersensitivity.

Prevalence Models to Support Participation: Sensory Patterns as a Feature of All Children’s Humanity

Purpose

Research about children tends to consider differences from expected patterns problematic, and associates differences with disabilities [e.g., Autism, attention deficit hyperactivity disorder (ADHD)]. When we focus on disabilities and consider differences automatically problematic, we miss the natural variability in the general population. The International Classification of Functioning, Disability and Health (ICF 11) acknowledges that the experience of disability results from interactions between “environmental” and “personal” factors which determine the person’s capacity to participate. The purpose of this study was to examine sensory patterns across a national sample of children in the general population and samples of children with disabilities to investigate the extent to which differences in sensory processing are representative of natural variability rather than automatically problematic or part of a disability.

Materials and Methods

We employed descriptive statistics and chi-square tests to examine sensory processing patterns in children in the general population and autistic children and children with ADHD. We used standardization and validity data from the Sensory Profile 2 to conduct analyses.

Results

Consistent sensory patterns exist across all groups. Children in all groups had different rates of certain patterns.

Conclusion

Since children in all groups have certain sensory patterns, we cannot associate differences with problematic behaviors. Children participating successfully with all sensory patterns might provide insights for universal design that supports participation of all children.

Exploring Perinatal Indicators of Infant Social-Emotional Development: A Review of the Replicated Evidence

The importance of infant social-emotional development for outcomes across the lifecourse has been amply demonstrated. Despite this, most screening measures of social-emotional development are designed for children 18 months of age and over, with a clear gap in earlier infancy. No systematic review has yet harvested the evidence for candidate indicators in the perinatal window. This paper examines modifiable risk and protective factors for two seminal early markers of social-emotional development: attachment security and behavioral regulation mid-infancy. We searched meta-analytic and longitudinal studies of developmental relationships between modifiable exposures in the perinatal window (pregnancy to 10 months postpartum) and attachment and behavioral regulation status measured between 12 and 18 months. Six electronic databases were used: ERIC, PsycINFO, Medline Complete, Informit, Embase, and Scopus. Twelve meta-analytic reviews and 38 original studies found replicated evidence for 12 indicators across infant, caregiving, and contextual domains predictive of infant behavioral regulation and attachment status between 12 and 18 months. Key among these were caregiving responsiveness, maternal mental health, couple relationship, and SES as a contextual factor. Perinatal factors most proximal to the infant had the strongest associations with social-emotional status. Beyond very low birthweight and medical risk, evidence for infant-specific factors was weaker. Risk and protective relationships were related but not always inverse. Findings from this review have the potential to inform the development of reliable tools for early screening of infant social-emotional development for application in primary care and population health contexts.

Parental genetic contributions to neonatal temperament in a nonhuman primate (Macaca mulatta) model

Temperament is an individual's nature and is widely believed to have a heritable foundation. Few studies, however, have evaluated paternal and maternal contributions to the triadic dimensions of temperament. Rhesus monkeys are widely utilized to model genetic contributions to human development due to their close genetic-relatedness and common temperament structure, providing a powerful translational model for investigating paternal and maternal genetic influences on temperament. The temperament of rhesus monkey infants born to 19 different sires and 50 different dams was assessed during the first month of life by comparing the temperament of paternal or maternal half-siblings reared with their mothers in species-normative conditions or reared in a neonatal nursery. Factor scores from three dimensions of temperament were obtained (Orienting/Regulation, Negative Affectivity, and Surgency/Extraversion) and ANOVAs were used to assess genetic effects. For paternal half-siblings, results showed a statistically significant paternal contribution to Orienting/Regulation, Negative Affectivity, and Surgency/Extraversion factor scores. For maternal half-siblings, results showed a statistically significant contribution to Orienting/Regulation factor scores. When parsed by early rearing condition, results showed a paternal contribution Orienting/Regulation, Negative Affectivity, and Surgency/Extraversion scores for paternal half-siblings reared in the neonatal nursery, while there was only a paternal contribution to Surgency/Extraversion for paternal half-siblings reared by their mothers. There was only a maternal contribution to Orienting/Regulation for maternal half-siblings reared by their mothers. These results show that paternal and maternal contributions to temperament vary by environmental context, and that mothers may environmentally buffer their infants from paternal contributions to their temperament.

Evaluating the Involving Relationships between Temperament and Motor Coordination in Early Childhood: A Prognostic Measurement

The main aim of the present study was the evaluation of dynamic relationships between dimensions of temperament and motor coordination in 3–7-year-old children in Greece. More specifically, the main objectives of the current study were the test outcomes regarding the psychometric properties (structural validity and internal consistency) of the Greek versions of (a) the Child Behavior Questionnaire—very short format (CBQ—VSF), and (b) the Developmental Coordination Disorder Questionnaire (DCDQ). For the purposes of the present study, 231 parents (202 women and 29 men), aged 23–53 years (mean (M) = 36.7 and standard deviation (SD) = 5.4) completed the aforementioned questionnaires. The sample consisted of 231 children (110 girls and 121 boys) aged 3–7 years (M = 4.75 years and SD = 1.30). For the DCDQ, the confirmatory factor analysis revealed three factors consistent with the factors that emerged from the constructs, with strong internal consistency reliability. Furthermore, regarding the CBQ—VSF, which measures the dimensions of temperament, the implementation of the confirmatory factor analysis indicated three factors and satisfactory internal consistency reliability, as well. Finally, path analysis revealed that temperamental effortful control, which mirrors both inhibitory and self-regulatory capacity, has a positive effect on motor coordination.

Practitioner Review: Effective management of functional difficulties associated with sensory symptoms in children and adolescents

BACKGROUND

Sensory symptoms are defined as atypical behavioral responses to daily sensory stimuli that impact on the performance of everyday routines. Sensory symptoms have been observed in young people with and without developmental concerns. There is uncertainty, however, regarding the best way to identify and manage sensory symptoms. The aim of this paper is  to provide a review of current best evidence regarding measurement of and interventions for sensory symptoms.

METHODS

A narrative review methodology is adopted to address the aims of this paper. First, sensory symptoms are defined, and then, an overview of the evidence for the relationship between sensory symptoms and childhood function is provided. Second, commonly used sensory assessment tools are summarized and evaluated. Finally, an overview and critique of the evidence for sensory and nonsensory-based interventions addressing sensory symptoms are given.

RESULTS

The terminology used to describe sensory symptoms varies by discipline, and several conceptual taxonomies including sensory subtypes have been proposed. There is ample evidence to support the association of sensory symptoms with childhood function including social engagement, repetitive behaviors, anxiety, and participation in self-care routines. Measurement of sensory symptoms is dominated by proxy-report instruments, and few single instruments assess the entire domain of sensory symptomatology. The evidence for interventions for sensory symptoms is emerging but still limited by low quantity and methodological concerns.

CONCLUSIONS

Effective management of sensory symptoms may mitigate the burden of neurodevelopmental disability and mental illness in young people. Identification of sensory symptoms should be conducted by a skilled practitioner utilizing multiple measurement methods. Intervention protocols for sensory symptoms should be informed by current best evidence which is strongest for Ayres Sensory Integration^® , Qigong massage, the Alert Program^® , and Social Stories. To make significant progress in this field, however, new intervention studies must address the question of 'what intervention works for whom?'.

Two-step actions in infancy-the TWAIN model

In this paper, we propose a novel model—the TWAIN model—to describe the durations of two-step actions in a reach-to-place task in human infants. Previous research demonstrates that infants and adults plan their actions across multiple steps. They adjust, for instance, the velocity of a reaching action depending on what they intend to do with the object once it is grasped. Despite these findings and irrespective of the larger context in which the action occurs, current models (e.g., Fitts’ law) target single, isolated actions, as, for example, pointing to a goal. In the current paper, we develop and empirically test a more ecologically valid model of two-step action planning. More specifically, 61 18-month olds took part in a reach-to-place task and their reaching and placing durations were measured with a motion-capture system. Our model explained the highest amount of variance in placing duration and outperformed six previously suggested models, when using model comparison. We show that including parameters of the first action step, here the duration of the reaching action, can improve the description of the second action step, here the duration of the placing action. This move towards more ecologically valid models of action planning contributes knowledge as well as a framework for assessing human machine interactions. The TWAIN model provides an updated way to quantify motor learning by the time these abilities develop, which might help to assess performance in typically developing human children.

Intergenerational transmission of emotion dysregulation: Part II. Developmental origins of newborn neurobehavior

We investigated whether neurobehavioral markers of risk for emotion dysregulation were evident among newborns, as well as whether the identified markers were associated with prenatal exposure to maternal emotion dysregulation. Pregnant women (N = 162) reported on their emotion dysregulation prior to a laboratory assessment. The women were then invited to the laboratory to assess baseline respiratory sinus arrhythmia (RSA) and RSA in response to an infant cry. Newborns were assessed after birth via the NICU Network Neurobehavioral Scale. We identified two newborn neurobehavioral factors-arousal and attention-via exploratory factor analysis. Low arousal was characterized by less irritability, excitability, and motor agitation, while low attention was related to a lower threshold for auditory and visual stimulation, less sustained attention, and poorer visual tracking abilities. Pregnant women who reported higher levels of emotion dysregulation had newborns with low arousal levels and less attention. Larger decreases in maternal RSA in response to cry were also related to lower newborn arousal. We provide the first evidence that a woman's emotion dysregulation while pregnant is associated with risks for dysregulation in her newborn. Implications for intergenerational transmission of emotion dysregulation are discussed.

Early Identification of Sensory Processing Difficulties in High-Risk Infants

OBJECTIVE. Our objective was to determine the extent to which young children at high risk for sensory processing difficulties differed from those who were at low risk.

METHOD. We compared high- versus low-risk young children using standardized measures. High-risk participants had older siblings identified as having sensory processing difficulties after a comprehensive occupational therapy evaluation (n = 13); low-risk participants (n = 16) had typically developing siblings and no family history of sensory or other neurological disorders.

RESULTS. High-risk infants scored significantly lower on the Language and Cognitive scales of the Bayley Scales of Infant and Toddler Development–Third Edition. The high-risk group presented with more atypical positions on the Toddler and Infant Motor Evaluation and fewer sensation-seeking behaviors on the Toddler Sensory Profile–2.

CONCLUSION. Results suggest that sensory, motor, cognitive, and language dimensions may be associated with sensory processing difficulties. Implications exist for the design of future studies and for early intervention.

NICU Network Neurobehavioral Scale: 1-month normative data and variation from birth to 1 month

BackgroundThe Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) is a standardized method for infant neurobehavioral assessment. Normative values are available for newborns, but the NNNS is not always feasible at birth. Unfortunately, 1-month NNNS normative data are lacking.AimsTo provide normative data for the NNNS examination at 1 month and to assess birth-to-one-month changes in NNNS summary scores.Study designThe NNNS was administered at birth and at 1 month within a longitudinal prospective study design.SubjectsA cohort of 99 clinically healthy full-term infants were recruited from a well-child nursery.Outcome measuresBirth-to-1-month NNNS variations were evaluated and the association of neonatal and sociodemographic variables with the rate of change of NNNS summary scores were investigated.Results and conclusionsNNNS scores from the 10th to the 90th percentile represent a range of normative performance at 1 month. A complex pattern of stability and change emerged comparing NNNS summary scores from birth to 1 month. Orienting, Regulation, and Quality of movements significantly increased, whereas Lethargy and Hypotonicity significantly decreased. Birth-to-1-month changes in NNNS performance suggest improvements in neurobehavioral organization. These data are useful for research purposes and for clinical evaluation of neurobehavioral performance in both healthy and at-risk 1-month-old infants.

Sensory Processing in the General Population: Adaptability, Resiliency, and Challenging Behavior

Sensory processing is a personal trait that can contribute to challenging behavior. Protective factors, such as resiliency, can support children in managing their behavior, yet little research has addressed the contribution of sensory processing to protective factors. Therefore, in this cross-sectional study we aimed to determine the contribution of sensory processing (using the Sensory Profile–2) to challenging behavior and protective factors (using the Behavior Assessment System for Children, 2nd ed., Parent Rating Scales) in a sample of 51 children ages 6–11 yr from the general U.S. population. The results indicated that sensory avoiding predicts externalizing behaviors, depression, resiliency, and adaptability. In addition, sensory seeking is related to depression and resiliency, whereas sensory sensitivity is related to externalizing behaviors. Implications for occupational therapy research and practice are discussed.

The State of the Science on Sensory Factors and Their Impact on Daily Life for Children: A Scoping Review

The objective of this study was to identify and synthesize research about how sensory factors affect daily life of children. We designed a conceptual model to guide a scoping review of research published from 2005 to October 2014 (10 years). We searched MEDLINE, CINAHL, and PsycINFO and included studies about sensory perception/processing; children, adolescents/young adults; and participation. We excluded studies about animals, adults, and review articles. Our process resulted in 261 articles meeting criteria. Research shows that children with conditions process sensory input differently than peers. Neuroscience evidence supports the relationship between sensory-related behaviors and brain activity. Studies suggest that sensory processing is linked to social participation, cognition, temperament, and participation. Intervention research illustrates the importance of contextually relevant practices. Future work can examine the developmental course of sensory processing aspects of behavior across the general population and focus on interventions that support children's sensory processing as they participate in their daily lives.

Assessment: The Newborn

Neonatal neurobehavioral assessment has become a standardized component of clinical care provided to newborn infants, guiding neonatal clinical care and subsequent access to early interventions and services. Links between neonatal assessment and neurosensory and motor impairments in high-risk infants have been relatively well established. In contrast, the extent to which newborn neurobehavioral assessment might also facilitate the early identification of infants susceptible to socioemotional impairments in early childhood is less well documented. This review examines longitudinal links between the neonatal neurobehavioral assessment, temperament, and socioemotional outcomes in early childhood.

Chaotic home environment is associated with reduced infant processing speed under high task demands

Early adversity has profound long-term consequences for child development across domains. The effects of early adversity on structural and functional brain development were shown for infants under 12 months of life. However, the causal mechanisms of these effects remain relatively unexplored. Using a visual habituation task we investigated whether chaotic home environment may affect processing speed in 5.5 month-old infants (n=71). We found detrimental effects of chaos on processing speed for complex but not for simple visual stimuli. No effects of socio-economic status on infant processing speed were found although the sample was predominantly middle class. Our results indicate that chaotic early environment may adversely affect processing speed in early infancy, but only when greater cognitive resources need to be deployed. The study highlights an attractive avenue for research on the mechanisms linking home environment with the development of attention control.

Relationship between early motor milestones and severity of restricted and repetitive behaviors in children and adolescents with autism spectrum disorder

This study explored the relationships between the later age of achievement of early motor milestones, current motor atypicalities (toe walking), and the severity of restricted and repetitive behaviors (RRBs) in individuals with autism spectrum disorder (ASD). Parents of 147 children and adolescents with ASD (M_age  = 8.09 years, SD = 4.28; 119 males) completed an early developmental milestones questionnaire and the Social Responsiveness Scale as a measure of Insistence on Sameness (IS) and Repetitive Mannerisms (RM). Two hierarchical regression analyses were conducted to test whether RM and IS behaviors were predicted by early motor milestones, or current toe walking. The final model predicting RM accounted for 15% of the variance (F = 3.02, p = .009), with toe walking as a unique and independent predictor of RM scores (t = 3.568, p = .001). The final model predicting IS accounted for 19.1% of variance in IS scores (F = 4.045, p = .001), with chronological age (CA) (t = 2.92, p = .004), age when first standing (t = 2.09, p = .038), and toe walking (t = 2.53, p = .013) as unique independent predictors. Toe walking (t = 2.4, p = .018) and age when first sitting (t = 2.08, p = .04) predicted the severity of RRBs on the Autism Diagnostic Observation Schedule (F = 2.334, p = .036). Our study replicates previous findings on the relationship between concurrent motor impairments and RRBs, and provides the first evidence for the association between RRBs and age of attainment of early motor milestones. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1163-1168. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Sensory over responsivity and obsessive compulsive symptoms: A cluster analysis

BACKGROUND

Several studies have examined the sensory component in Obsesseive Compulsive Disorder (OCD) and described an OCD subtype which has a unique profile, and that Sensory Phenomena (SP) is a significant component of this subtype. SP has some commonalities with Sensory Over Responsivity (SOR) and might be in part a characteristic of this subtype. Although there are some studies that have examined SOR and its relation to Obsessive Compulsive Symptoms (OCS), literature lacks sufficient data on this interplay.

OBJECTIVES

First to further examine the correlations between OCS and SOR, and to explore the correlations between SOR modalities (i.e. smell, touch, etc.) and OCS subscales (i.e. washing, ordering, etc.). Second, to investigate the cluster analysis of SOR and OCS dimensions in adults, that is, to classify the sample using the sensory scores to find whether a sensory OCD subtype can be specified. Our third goal was to explore the psychometric features of a new sensory questionnaire: the Sensory Perception Quotient (SPQ).

METHOD

A sample of non clinical adults (n=350) was recruited via e-mail, social media and social networks. Participants completed questionnaires for measuring SOR, OCS, and anxiety.

RESULTS

SOR and OCI-F scores were moderately significantly correlated (n=274), significant correlations between all SOR modalities and OCS subscales were found with no specific higher correlation between one modality to one OCS subscale. Cluster analysis revealed four distinct clusters: (1) No OC and SOR symptoms (NONE; n=100), (2) High OC and SOR symptoms (BOTH; n=28), (3) Moderate OC symptoms (OCS; n=63), (4) Moderate SOR symptoms (SOR; n=83). The BOTH cluster had significantly higher anxiety levels than the other clusters, and shared OC subscales scores with the OCS cluster. The BOTH cluster also reported higher SOR scores across tactile, vision, taste and olfactory modalities. The SPQ was found reliable and suitable to detect SOR, the sample SPQ scores was normally distributed (n=350).

CONCLUSIONS

SOR is a dimensional feature that can influence the severity of OCS and may characterize a unique sensory OCD subtype.

Infant patterns of reactivity to tactile stimulation during parent-child interaction

Touch is the primary modality infants use to engage with the world; atypical responses to tactile stimuli may indicate risk for disordered outcomes. The current study examined infants' responses to tactile stimulation within parent-child interaction, adding to prior knowledge based on parent report. Nine-month-old infants (N=497) were observed while parents painted and pressed infants' hands and feet to paper to make designs. Positive and negative affect and gazing away, exploring, and resistance behaviors were coded. Latent Class Analysis of observed behaviors yielded four tactile response patterns partially consistent with current nosology for sensory processing patterns: Low Reactive, Sensory Overreactive, Sensory Seeking, and Mixed Over/Underreactive. To evaluate whether patterns made valid distinctions among infants, latent classes were examined in relation to parent-reported temperament. Infants in the Mixed Over/Underreactive class were rated higher in distress to limitations and activity level than other infants. Sensory processing patterns observed in parent-child interaction are consistent with those identified by parent-report and may be used in future research to elucidate relations with temperament and typical and atypical development.

Relations between Temperament, Sensory Processing, and Motor Coordination in 3-Year-Old Children

Poor motor skills and differences in sensory processing have been noted as behavioral markers of common neurodevelopmental disorders. A total of 171 healthy children (81 girls, 90 boys) were investigated at age 3 to examine relations between temperament, sensory processing, and motor coordination. Using the Japanese versions of the Children's Behavior Questionnaire (CBQ), the Sensory Profile (SP-J), and the Little Developmental Coordination Disorder Questionnaire (LDCDQ), this study examines an expanded model based on Rothbart's three-factor temperamental theory (surgency, negative affect, effortful control) through covariance structure analysis. The results indicate that effortful control affects both sensory processing and motor coordination. The subscale of the LDCDQ, control during movement, is also influenced by surgency, while temperamental negative affect and surgency each have an effect on subscales of the SP-J.

Sensory processing disorder in children ages birth-3 years born prematurely: a systematic review

This systematic review of multidisciplinary literature synthesizes evidence of the prevalence and patterns of sensory processing disorder (SPD) in children ages birth-3 yr born preterm. Forty-five articles including physiological, behavioral, temperament, and SPD research met the inclusion criteria and provided 295 findings related to SPD-130 (44%) positive (evidence of SPD) and 165 (56%) negative (no evidence of SPD). The majority of findings related to sensory modulation disorder (SMD; 43% positive). The most prevalent subcategory of SMD was sensory overresponsivity (82% of findings positive). Evidence of sensory underresponsivity and sensory-seeking SMD, sensory discrimination disorder, and sensory-based motor disorder was limited. This study supports the education of neonatologists, pediatricians, and caregivers about the symptoms and potential consequences of SPD and helps justify the need for follow-up screening for SPD in children ages birth-3 yr born preterm. Research using measures based on sensory processing theory is needed.

Correlational Research to Examine the Relation Between Attachment and Sensory Modulation in Young Children

This study investigated whether a relation exists between attachment and sensory modulation in young children. Participants were 68 children ages 3-6 yr recruited through the local community. Caregivers were asked to complete a standardized behavioral inventory of sensory modulation patterns, and parent-child interactions were observed in their home. The evaluator categorized these interactions on the basis of items related to attachment security and dependency. Results revealed modest correlations between attachment and sensory modulation: rs(66)=.28, p=.02. The capacity to predict sensory modulation function by attachment characteristics and the capacity to predict attachment characteristics by sensory modulation function was significant but small (p<.05). These findings supporting a relation between attachment and sensory modulation should be considered when assessing and planning treatment of children with problems in one or both of these areas.

Effects of infant and maternal sensory processing on infant fussing, crying, and sleep

This study investigated the effects of infant and maternal sensory processing on sleep, fussing, and crying in a sample of 55 firstborn, 4- to 7-month-old infants and their mothers. Mothers completed self-report questionnaires to assess maternal and infant sensory processing styles and a 4-day diary of infant behavior, including sleep, fussing, and crying. Higher levels of infant Sensation Avoiding were associated with less sleep, more fussing, and more crying whereas higher levels of Sensory Sensitivity were associated with less sleep and more fussing. The positive association between infant Sensation Avoiding and crying was strengthened by lower levels of Low Registration in mothers. The effect of infant Sensory Sensitivity on reducing total sleep also was strengthened by lower levels of maternal Low Registration. Assessment of infant sensory processing as well as the moderating effect of maternal sensory processing on the relationship between infant sensory processing and infant regulatory capacities need to be considered when assessing and designing interventions for families in which infant regulation is problematic.

Assessment and evaluation of the high risk neonate: the NICU Network Neurobehavioral Scale

There has been a long-standing interest in the assessment of the neurobehavioral integrity of the newborn infant. The NICU Network Neurobehavioral Scale (NNNS) was developed as an assessment for the at-risk infant. These are infants who are at increased risk for poor developmental outcome because of insults during prenatal development, such as substance exposure or prematurity or factors such as poverty, poor nutrition or lack of prenatal care that can have adverse effects on the intrauterine environment and affect the developing fetus. The NNNS assesses the full range of infant neurobehavioral performance including neurological integrity, behavioral functioning, and signs of stress/abstinence. The NNNS is a noninvasive neonatal assessment tool with demonstrated validity as a predictor, not only of medical outcomes such as cerebral palsy diagnosis, neurological abnormalities, and diseases with risks to the brain, but also of developmental outcomes such as mental and motor functioning, behavior problems, school readiness, and IQ. The NNNS can identify infants at high risk for abnormal developmental outcome and is an important clinical tool that enables medical researchers and health practitioners to identify these infants and develop intervention programs to optimize the development of these infants as early as possible. The video shows the NNNS procedures, shows examples of normal and abnormal performance and the various clinical populations in which the exam can be used.

Grandchild of the NBAS: the NICU network neurobehavioral scale (NNNS): a review of the research using the NNNS

A review of the research on the NICU Network Neurobehavioral Scale (NNNS) is presented. The NNNS has good psychometric properties and reliability. Standardized norms are available for it. It was found to be sensitive to a wide variety of medical, exposure, and demographic variables and has robust predictive validity. It will be useful for nurses for detecting neurobehavioral problems and management of the young infant.

Early motor developmental milestones and level of neuroticism in young adulthood: a 23-year follow-up study of the Copenhagen Perinatal Cohort

BACKGROUND

Studies investigating early developmental factors in relation to psychopathology have mainly focused on schizophrenia. The personality dimension of neuroticism seems to be a general risk factor for psychopathology, but evidence on associations between early developmental precursors and personality traits is almost non-existent. This study is therefore the first to investigate associations between early motor developmental milestones and neuroticism in adulthood. Method Mothers of 9125 children of the Copenhagen Perinatal Cohort recorded 12 developmental milestones during the child's first year of life. A subsample of the cohort comprising 1182 individuals participated in a follow-up when they were aged 20-34 years and were administered the Eysenck Personality Questionnaire (EPQ). Associations between motor developmental milestones and level of neuroticism, extraversion and psychoticism were analysed by multiple linear regression adjusting for for sex, single-mother status, parity, mother's age, father's age, parental social status and birth weight.

RESULTS

Among the 1182 participants with information on the EPQ, information on milestones was available for 968 participants. Infants who developed high levels of neuroticism as adults tended to sit without support, crawl, and walk with and without support significantly later than individuals with low levels of neuroticism (p values <0.05). These results remained significant after adjustment for the included covariates and for adult intelligence.

CONCLUSIONS

The findings are the first of their kind and suggest that delays in early motor development may not only characterize psychopathological disorders such as schizophrenia, but may also be associated with the personality dimension of neuroticism in adulthood.