Motor performance of Indian preterm infants as compared to the US population on the Test of Infant Motor Performance (TIMP)

PURPOSE

The study aimed at scoring Indian preterm infants at three months corrected age on the TIMP and then comparing the scores to the United States age-based population scores.

METHODS

After obtaining Ethical clearance, participants meeting the inclusion criteria of 53 infants whose parents consented were screened and recruited (N = 47) at a tertiary care hospital. The TIMP was then administered at three months of corrected age.

RESULTS

Data obtained from 47 infants born preterm (Male = 33, Female = 14) at three months corrected age with mean gestational age (34.4 ± 2.36 weeks) and mean birth weight (1.93 ± 0.55 kgs) was analyzed. Indian infants born preterm scored a mean of (98.17 ± 20.90) compared to the US mean of (108 ± 19), suggesting an under-performance. The average scores were lower when comparing the mean of the study group with the US-based age-matched population.

CONCLUSION

Motor performance scores of Indian preterm infants were low when compared to their US counterparts. Since there exists a difference in the raw score obtained by Indian Preterm infants compared to the US-based population, it may not be appropriate to categorize the motor development of Indian infants based on the US population scores.

Early-life stress and current stress predict BMI and height growth trajectories in puberty

In cross-sectional analyses, early institutional care is associated with shorter stature but not obesity during puberty in children adopted into US families. We examined whether shorter stature and leaner body composition in youth adopted internationally from institutions would continue as puberty progressed. We also examined whether current psychosocial stress would moderate the association between early institutional deprivation and growth during adolescence. Using an accelerated longitudinal design and linear mixed-effects models, we examined the height and body mass index (BMI) of 132 previously institutionalized (PI) and 176 nonadopted (NA) youth. We examined youth aged 7-15 at the beginning of the study three times across 2 years. Nurses assessed anthropometrics and pubertal status. Current psychosocial stress was measured using the Youth Life Stress Interview. Our results indicated that PI youth remained shorter and leaner across three assessments than NA youth. However, age-and-sex-adjusted BMI increased faster in PI youth. Psychosocial stress during puberty predicted greater age-and-sex-adjusted BMI, but this effect did not differ by group. The gap in BMI but not height appears to close between PI and NA youth. Higher psychosocial stress was associated with higher BMI during puberty.

The development of phonological memory and language: A multiple groups approach

Pierce et al. (2017) have proposed that variations in the timing, quality and quantity of language input during the earliest stages of development are related to variations in the development of phonological working memory and, in turn, to later language learning outcomes. To examine this hypothesis, three groups of children who are at-risk for language learning were examined: children with cochlear implants (CI), children with developmental language disorder (DLD), and internationally-adopted (IA) children, Comparison groups of typically-developing monolingual (MON) children and second language (L2) learners were also included. All groups were acquiring French as a first or second language and were matched on age, gender, and socioeconomic status, as well as other group-specific factors; they were between 5;0-7;3 years of age at time of testing. The CI and DLD groups scored significantly more poorly on the memory measures than the other groups; while the IA and L2 groups did not differ from one another. While the IA group performed more poorly than the MON group, there was no difference between the L2 and MON groups. We also found differential developmental relationships between phonological memory and language among the groups of interest in comparison to the typically-developing MON and L2 groups supporting the hypothesis that language experiences early in life are consequential for language development because of their effects on the development of phonological memory.

The Nutritional Status of Individuals Adopted Internationally as Children: A Systematic Review

Since 1955, international adoption has been a way of finding homes for children who have been orphaned or abandoned. We aimed to describe the nutritional status of individuals adopted internationally and their long-term nutritional and health outcomes. We searched four databases for articles published from January 1995 to June 2020, which included information on anthropometric or micronutrient status of children adopted internationally (CAI). Mean Z-scores on arrival to adoptive country ranged from -2.04 to -0.31 for weight for age; -0.94 to 0.39 for weight for height; -0.7 to 0 for body mass index; -1.89 to -0.03 for height for age; -1.43 to 0.80 for head circumference for age. Older children, those adopted from institutionalized care or with underlying disability, were more likely to be malnourished. Though long-term data was scarce, mean Z-scores post-adoption ranged from -0.59 to 0.53 for weight for age; -0.31 to 1.04 for weight for height; 0.39 to 1.04 for body mass index; -1.09 to 0.58 for height for age; -0.06 to 1.23 for head circumference for age. We conclude that though CAI are at high risk of malnutrition at baseline, marked catch-up growth is possible, including for those older than two years of age on arrival. This has implications not only for CAI but for the wider population of malnourished children worldwide. Research on how to optimize catch-up growth is a priority.

Effects of early social deprivation on epigenetic statuses and adaptive behavior of young children: A study based on a cohort of institutionalized infants and toddlers

Early social deprivation (i.e., an insufficiency or lack of parental care) has been identified as a significant adverse early experience that may affect multiple facets of child development and cause long-term outcomes in physical and mental health, cognition and behavior. Current research provides growing evidence that epigenetic reprogramming may be a mechanism modulating these effects of early adversities. This work aimed to investigate the impact of early institutionalization—the immersion in an extreme socially depriving environment in humans—on the epigenome and adaptive behavior of young children up to 4 years of age. We conducted a cross-sectional study involving two comparison groups: 29 children raised in orphanages and 29 children raised in biological families. Genome-wide DNA methylation profiles of blood cells were obtained using the Illumina MethylationEPIC array; the level of child adaptive functioning was assessed using the Vineland Adaptive Behavior Scales-II. In comparison to children raised in families, children residing in orphanages had both statistically significant deficits in multiple adaptive behavior domains and statistically significant differences in DNA methylation states. Moreover, some of these methylation states may directly modulate the behavioral deficits; according to preliminary estimates, about 7–14% of the deviation of adaptive behavior between groups of children may be determined by their difference in DNA methylation profiles. The duration of institutionalization had a significant impact on both the adaptive level and DNA methylation status of institutionalized children.

A multi-group approach to examining language development in at-risk learners

A battery of standardized language tests and control measures was administered to three groups of at-risk language learners - internationally adopted children, deaf children with cochlear implants, and children with specific language impairment - and to groups of second-language learners and typically developing monolingual children. All children were acquiring French, were matched on age, gender, and socioeconomic status, and were between age 5;0 and 7;3 at the time of testing. Differences between the at-risk and not-at-risk groups were evident in all domains of language testing. The children with SLI or CIs scored significantly lower than the IA children and all three at-risk groups scored lower than the monolingual group; the L2 and IA groups scored similarly. The results suggest that children with limited access to, or ability to process, early language input are at greater risk than children with delayed input to an additional language but otherwise typical or relatively typical early input.

Growth recovery in newly arrived international adoptees in Italy: relation to parenting stress

BACKGROUND

Following initial adversities, most internationally adopted children arrive with significant growth delays. Postplacement recovery has been widely documented, but research about risk or protective factors is still limited. Even less is known about the relationship between growth recovery and the quality of the family environment.

METHODS

Twenty-eight children in 26 adoptive families were involved in this longitudinal study. A comprehensive evaluation (including anthropometry, cognitive assessment [using the Leiter International Performance Scale-Revised], and completion by both parents of the Parenting Stress Index - Short Form) was done at arrival of the child, and 1 year later.

RESULTS

Results evidenced that on arrival nearly half of children had growth measurements in the normal range. All the children showed a significant recovery in height and weight at 6 and 12 months postplacement. Initial and follow-up growth measurements correlated strongly. Growth recovery was related to the age of the child at adoption, the proportion of time the child had resided in institutional care, as well as parenting stress. Results suggested that the higher the parenting stress experienced the less improvements occurred in children: for mothers for height and weight, for fathers for all the growth indicators.

CONCLUSIONS

Results suggested the critical importance of family factor in influencing children's growth recovery.

Who wants to adopt and who wants to be adopted: a sample of American families and sub-Saharan African orphans

The debate between pro- and anti-international adoption advocates relies heavily on rhetoric and little on data analysis. To better understand the state of orphans and potential adopters in this debate, we utilize the National Survey of Family Growth (NSFG) and the Demographic and Health Surveys (DHS) to study who adopts internationally and the status of orphaned children in sub-Saharan Africa. According to NSFG data adopters are church going, highly educated, stable families aware of the challenges faced by international adoption, with high rates of infertility and rates of child abuse half the population average. According to the DHS data, orphans in sub-Saharan Africa suffer from significantly higher deprivation, reduced schooling and increased levels of stunting and underweight reported than their cohort. Using this data, we estimate conservatively that that 1 50 000 orphans from our sample of sub-Saharan African countries died from their 5-year birth cohort. Given the large number of families seeking to adopt and the high number of orphan deaths, it seems counterproductive to restrict international adoptions given the significantly lower risks faced by children in adopted families compared with remaining orphaned.

The acquisition of accusative object clitics by IA children from China: evidence of early age effects?

The present study compared the performance of twenty-seven French-speaking internationally adopted (IA) children from China to that of twenty-seven monolingual non-adopted French-speaking children (CTL) matched for age, gender, and socioeconomic status on a Clitic Elicitation task. The IA children omitted significantly more accusative object clitics and made significantly more agreement errors using clitics than the CTL children. No other significant differences were found between the groups. The findings suggest that the adoptees may experience difficulties in morphosyntactic development possibly as a result of their delayed exposure to the adopted language.

Language and memory abilities of internationally adopted children from China: evidence for early age effects

The goal of the present study was to examine if internationally adopted (IA) children from China (M = 10;8) adopted by French-speaking families exhibit lags in verbal memory in addition to lags in verbal abilities documented in previous studies (Gauthier & Genesee, 2011). Tests assessing verbal and non-verbal memory, language, non-verbal cognitive ability, and socio-emotional development were administered to thirty adoptees. Their results were compared to those of thirty non-adopted monolingual French-speaking children matched on age, gender, and socioeconomic status. The IA children scored significantly lower than the controls on language, verbal short-term memory, verbal working memory, and verbal long-term memory. No group differences were found on non-verbal memory, non-verbal cognitive ability, and socio-emotional development, suggesting language-specific difficulties. Despite extended exposure to French, adoptees may experience language difficulties due to limitations in verbal memory, possibly as a result of their delayed exposure to that language and/or attrition of the birth language.

Motor outcomes in children exposed to early psychosocial deprivation

OBJECTIVES

To determine the effect of psychosocial deprivation early in life on motor development, assess the impact of a foster care intervention on improving motor development, and assess the association between motor and cognitive outcomes in children with a history of institutional care.

STUDY DESIGN

In a randomized controlled trial, children living in Romanian institutions were randomly assigned to care as usual in the institution or placed in family-centered foster care as part of the Bucharest Early Intervention Project. The average age at placement into foster care was 23 months. At age 8 years, the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, Short Form (BOT2-SF) was applied to assess the motor proficiency of children in both groups, as well as a never-institutionalized group from the Romanian community.

RESULTS

Children in the never-institutionalized group did significantly better on the BOT2-SF than children who had ever been institutionalized (P < .001). There was no significant difference in performance between children in the care as usual group and the foster care group. This finding also held true for all individual items on the BOT2-SF except sit-ups. Regression analyses revealed that the between-group and within-group differences in BOT2-SF scores were largely mediated by IQ.

CONCLUSION

Early deprivation had a negative effect on motor development that was not resolved by placement in foster care. This effect was predominantly mediated by IQ. This study highlights the importance of monitoring for and addressing motor delays in children with a history of institutionalization, particularly those children with low IQ.

Pre-adoption adversity and self-reported behavior problems in 7 year-old international adoptees

To further investigate the long-term impact of pre-adoption adversity on international adoptees, externalizing and internalizing symptoms were assessed using a self-report measure at school-age in addition to mothers' reports. The sample consisted of 95 adopted children and their mothers. Children's health and developmental status were assessed soon after arrival in their adoptive family. At age 7, the Dominic Interactive, a self-report measure, was used to evaluate externalizing and internalizing symptoms while mothers completed the CBCL. Children's self-reports were compared to their non-adopted peers'. Adopted children reported more symptoms of specific phobia than their peers. A significant correlation was found between mothers' and children's reports but only for externalizing symptoms. Self-reported symptoms were related to indices of nutritional and psychosocial deprivation at arrival, such as low height/age and weight/height ratios. Our results emphasize the importance of considering international adoptees' perception of their psychological adjustment and the long-term impact of early risk factors.

Infants' responsiveness, attachment, and indiscriminate friendliness after international adoption from institutions or foster care in China: application of Emotional Availability Scales to adoptive families

In a short-term longitudinal design we investigated maternal sensitivity, child responsiveness, attachment, and indiscriminate friendliness in families with children internationally adopted from institutions or foster care in China. Ninety-two families with 50 postinstitutionalized and 42 formerly fostered girls, aged 11-16 months on arrival, were studied 2 and 6 months after adoption. Maternal sensitivity and child responsiveness were observed with the Emotional Availability Scales, attachment was assessed with the Strange Situation procedure, and mothers reported on children's indiscriminate friendliness. The postinstitutionalized children showed less secure attachment, whereas the former foster children did not differ from the normative distribution of attachment security. However, at both assessments the two groups of adopted children showed more disorganized attachments compared to normative data. Adoptive mothers of postinstitutionalized and former foster children were equally sensitive and their sensitivity did not change over time. Postinstitutionalized and former foster children did not differ on indiscriminate friendliness, but children with more sensitive adoptive mothers showed less indiscriminate friendliness. The former foster children showed a larger increase in responsiveness over time than the postinstitutionalized children, suggesting that children's responsiveness is more sensitive to change than attachment, and that preadoption foster care is more beneficial for the development of children's responsiveness after adoptive placement than preadoption institutional care.

Gross motor development in children adopted from orphanage settings

AIM

This study sought to examine the effect of environmental enrichment on the motor skills of children adopted from orphanage settings. We investigated balance and bilateral coordination skills in 33 internationally adopted postinstitutionalized children (16 males, 17 females; age range 8 y 5 mo-15 y 10 mo; mean age 10 y 9 mo; SD 2 y 2 mo) and compared them with 34 non-institutionalized children (21 males, 13 females; age range 8 y 3 mo-14 y 10 mo; mean age 11 y 2 mo; SD 2 y 1 mo) being raised in their birth families.

METHOD

The children were individually administered the balance and bilateral coordination subtests of the Bruininks-Oseretsky Test of Motor Proficiency in a research laboratory. Parents completed questionnaires about developmental history, family environment, and orphanage care.

RESULTS

Postinstitutionalized children showed motor system delays compared with the non-institutionalized comparison children (postinstitutionalized balance mean 9.44, SD 5.92, comparison children balance mean 14.12, SD 4.39; postinstitutionalized bilateral coordination mean 11.97, SD 5.43, comparison children mean 19.97, SD 3.97). The length of time that children remained institutionalized before adoption predicted balance delays (b=-1.57, t=-2.33, p=0.027) and the severity of caregiving deprivation the children experienced correlated with bilateral coordination (r=-0.44, p=0.013).

INTERPRETATION

These findings suggest that institutionalized settings do not provide the early life experiences needed for the development of age-level motor skills later in childhood and that simple environmental enrichment following adoption is not enough to remediate skills. Children who have experienced early institutional care may benefit from early identification and targeted intervention.

Developmental Outcomes of Internationally Adopted Children

This study followed the development of a sample of 106 (67 girls) internationally adopted children over a period of 18 months. Children were adopted from five birth regions, including China, Korea, Latin America, Eastern Europe, and other Asian countries. Mean age at adoption was 11 months. Mothers completed the Ages and Stages Questionnaire (ASQ) at 6, 12, and 24 months post-adoption, assessing children's gross and fine motor, communicative, personal-social, and problem solving skills. Results revealed that the sample as a whole demonstrated linear improvement over time in most developmental domains, but children with initially low scores remained significantly lower than other children at the 18-month follow-up. At the first time point, communication was the domain where children most commonly experienced delays. Children with medical problems had significantly lower developmental scores than those without medical diagnoses. ASQ scores were unrelated to age at adoption, but significant differences by birth country region were found. Across most domains, children adopted from Eastern Europe showed generally lower scores than children adopted from other birth regions.

Research, Practice, and Policy Perspectives on Issues of Children without Permanent Parental Care

This chapter presents conclusions, trends, conceptual analyses, hypotheses, and speculations regarding some fundamental issues of research, practice, and policy that are largely unsettled or controversial. As such, the chapter is not a summary of Chapters 1-8, but rather contains interpretations and opinions of the author intended to elevate the priority of certain issues, suggest hypotheses to be studied, and propose practice and policy steps to be considered.

Growth and development in internationally adopted children: extent and timing of recovery after early adversity

BACKGROUND

Following initial adversity, internationally adopted children arrive with significant growth and developmental delays. Post-placement recovery has been widely documented, but little has been known about its extent and timing several years after placement and in children with diverse pre-adoptive experiences.

METHODS

A total of 289 children adopted from six countries into Spanish families were studied. Growth and psychological development were considered on arrival and after an average of over 3 years.

RESULTS

Growth and developmental initial delays affected a substantial percentage of the children. Post-adoption recovery seemed quicker and more complete in weight and height than in head circumference and psychological development. Initial and later values were correlated, but growth-development relation on arrival subsequently lost significance. Most of the catch-up happened in the first three post-adoption years.

CONCLUSION

Adoption offers an impressive opportunity for recovery after previous adversity, although continuity between past and present persists. The improvement is more marked in some areas than in others and more substantial in the first post-adoption years.

Two-Year Follow-up of Girls Adopted from China: Continuity and Change in Behavioural Adjustment

BACKGROUND

  To determine the developmental course of behavioural adjustment in 842 girls adopted from China.

METHOD

  Longitudinal data were collected with the Child Behaviour Checklist (CBCL/1.5-5 or CBCL/6-18) from the same parent with a two-year interval. In data analysis, the entire sample was first treated as a whole, then was divided into three age cohorts, including (1) children who were in preschool ages in both phases (Preschool Cohort) (n = 417, M_age  = 2.5 years in Phase I), (2) children who crossed from preschool ages over to school ages (Transition Cohort) (n = 174, M_age  = 4.8 years in Phase I), and (3) children who were in school ages in both phases (School-age Cohort) (n = 251, M_age  = 8.5 years in Phase I).

RESULTS

  The data revealed a strong behavioural continuity (rs = .57-.75) from Phase I to Phase II. The whole sample experienced a significant increase in both average score and rate of suboptimal adjustment on the CBCL Internalising and Total Problem scale. For children with suboptimal adjustment in Phase I, the odds for them to remain in suboptimal range in Phase II were very high. Repeated measures ANOVA revealed that the three cohorts changed differently over 2 years.

Social-emotional adjustment and attachment in children adopted from China: Processes and predictors of change

This study examined the processes and predictors of change in maternal ratings of internalizing and externalizing symptoms and attachment security in 70 infant girls adopted from China at a mean age of 13.5 months. These children’s mental and language development were also directly assessed. The adopted children were assessed within the first month of adoption and again six, 12 and 24 months later. Comparisons were made with 43 girls of similar age and family background. Results indicated that from six months postadoption onward, adopted children exhibited a rapid increase in internalizing symptoms, especially in emotion reactivity. Adopted children initially formed attachment rapidly. Growth in attachment gradually slowed down over time. Individual differences that emerged in the rate of attachment growth from six months postadoption were related to mental ability in both groups. The results point to the effects of potential risk factors on the processes of change, at least in the two years following adoption.

Communication Development and Differences in Children Adopted From China and Eastern Europe

Purpose

The communication development of children adopted from China and Eastern Europe was compared by region of origin at 6 and 12 months after adoption.

Method

Twenty children, recruited before or immediately following their adoption, participated in the study. Measures were collected between 2 and 6 months after adoption (Time 1) and between 12 and 14 months after adoption (Time 2). The children’s ages ranged between 11–22 months and 22–34 months, respectively. Parent-reported vocabulary comprehension and expression and behavioral communication assessments were administered.

Results

No significant differences between region of origin were found at Time 1. At Time 2, significant group differences in expressive language performance were found, with children adopted from China and Eastern Europe demonstrating different patterns of English language development.

Conclusion

Early prelinguistic measures may provide prognostic indicators for later English language development. Children adopted from different countries where they are initially exposed to different birth languages may acquire English differently.

Infants' physical and cognitive development after international adoption from foster care or institutions in China

OBJECTIVE

To compare the physical, cognitive, and motor development of infants adopted from foster care with infants adopted from institutions.

METHOD

Forty-two formerly fostered and 50 post-institutionalized girls adopted from China, aged between 11 and 16 months on arrival, were visited 2 and 6 months after adoption. Children's height, weight, and head circumference were measured. Stress regulation was assessed by diurnal salivary cortisol levels, and cognitive and motor development were assessed using the Bayley Scales of Infant Development-second edition.

RESULTS

At both assessments, the (modest) physical growth delays were similar for formerly fostered and post-institutionalized children. For weight and head circumference (but not for height) a catch-up over time was found, with a significant interaction between time and age at arrival, showing a more rapid catch-up for earlier adopted children. The daily cortisol curves of the formerly fostered and post-institutionalized children were similar and did not change over time. At both assessments, the former foster children outperformed the post-institutionalized children on mental and motor skills. Both groups showed a similar catch-up for mental development. For motor development, no catch-up was found.

CONCLUSIONS

The influence of pre-adoption foster versus institutional rearing seems more pronounced for cognitive and motor development than for physical development and hormonal stress regulation. Our outcomes suggest that pre-adoption foster care is less detrimental to children's cognitive and motor development than institutional rearing.

Associations between intensity of child welfare involvement and child development among young children in child welfare

OBJECTIVE

To examine developmental and behavioral status of children in child welfare (CW) over time, by intensity of CW involvement using a national probability sample.

METHODS

As part of the National Survey of Child and Adolescent Well-being (NSCAW), data were collected on 1,049 children 12-47 months old investigated by CW agencies for possible abuse or neglect. Analyses used descriptive statistics to characterize developmental and behavioral status across four domains (developmental/cognitive, language, adaptive functioning, and behavior) by intensity of CW involvement (in-home with CW services, in-home with no CW services or out-of-home care) over time. Multivariate analyses were used to examine the relationship between independent variables (age, gender, home environment, race/ethnicity, maltreatment history, intensity of CW involvement) and follow-up domain scores.

RESULTS

On average, children improved in developmental/cognitive, communication/language status over time, but these improvements did not differ by intensity of CW involvement. Analyses revealed a positive relationship between the home environment and change in language and adaptive behavior standard scores over time, and few predictors of change in behavioral status. An interaction between intensity of CW involvement and initial developmental/cognitive status was present.

CONCLUSIONS

Across domains, intensity of CW involvement does not appear to have a significant effect on change in developmental and behavioral status, although out-of-home care does have differential relationships with children's developmental/cognitive status for those with very low initial cognitive/developmental status. Facilitating development in children in CW may require supportive, enriched care environments both for children remaining at home and those in foster care.

PRACTICE IMPLICATIONS

Toddler and preschool age children known to child welfare are likely to have difficulties with development whether they are removed from their homes or not. It would be helpful if child welfare workers were trained to screen for developmental, language, adaptive behavior and behavioral difficulties in children in foster care, and those remaining at home. Additional support for biological, foster, and kinship caregivers in encouraging development is important for the attainment of critical developmental skills, especially for children with developmental difficulties.

Outcomes of children adopted from Eastern Europe

Behavioral problems are frequent among post-institutionalized Eastern European adoptees. However, risk factors related to outcomes have not been fully delineated. We evaluated 50 Eastern European adoptees, age 8—10 years, with their adoptive families for more than five years. Cognitive and behavioral outcomes and parenting stress were evaluated in relation to pre-adoptive risk factors, including arrival age, growth, and facial phenotype related to prenatal alcohol exposure. At follow-up, IQ and achievement scores were ≥ average in most children (≥74%). Behavioral and school problems were common (externalizing 44%, internalizing 18%, behavioral symptoms 50%, attention deficit hyperactivity disorder (ADHD) 46%, learning disabilities 40%, mental health disorders 28%); 38% had multiple problems. Behavioral problems correlated inversely with IQ. Parent stress was high and correlated with child externalizing behaviors and inversely to child full scale IQ. Children with “severe behavioral disturbances” (24%) were more likely to have had smaller head circumferences at arrival. Child's age at adoption related inversely to parent stress, possibly due to the longer duration of time that children resided with their families. “High/intermediate risk” phenotypic facial scores for prenatal alcohol exposure (58%) correlated with head circumference z scores at arrival and follow-up. Otherwise, arrival age, growth, and facial phenotype did not correlate with these specific outcome measures.

Gross motor development of Asian and European children on four motor assessments: a literature review

PURPOSE

The purpose of this article is to review the evidence surrounding similarities and differences in motor development in children of Asian and European ethnic backgrounds to ensure the appropriateness of mixed ethnicity normative comparison data.

SUMMARY OF KEY POINTS

A review of published studies indicates variability in rate and possibly sequence of motor development in children of European and Asian origins.

STATEMENT OF CONCLUSIONS AND RECOMMENDATIONS FOR CLINICAL PRACTICE

Assessment tools used to discriminate motor development in children of different ethnic backgrounds should be interpreted with caution until there is sufficient information regarding the appropriateness of comparisons among children of different ethnic origins.