Center of pressure and the projection of the time-course of sitting skill acquisition

A normal time-course for the acquisition of sitting is essential. A delay in sitting may affect other developmental milestones, resulting in deficiencies in overall skill. Therefore, our aim was to identify variables whose measures at the very beginning of sitting would allow for the projection of the evolution of the sitting skill. Center of pressure data were collected from the postural sway of twenty-six typically developing infants while sitting on a force platform with a beginning ability to sit upright. Spatial, temporal and frequency variables of postural sway were obtained from both the medial/lateral and anterior/posterior directions of sway. Discriminant function analysis was conducted to identify potential predictors of the duration between onset and fully independent sitting. Gender (p=0.025), Median Frequency (p=0.006), and Correlation Dimension (p=0.002) were identified to be predictive of grouping with 73.1% correct classification of the participating infants into short, mid, and long delay groups. In conclusion, measures taken at the earliest stage of sitting may allow the projection of the time-course to achieve independent sitting for typical infants. This approach may be useful for monitoring typical development

The development of a screening tool to evaluate infants who are HIV positive

HIV/AIDS continues to be one of the greatest health challenges which South Africa faces. The epidemic in children is closely linked to that in women, the prevalence of which continues to grow according to antenatal statistics from the South African Department of Health (DOH). HIV is known to invade the central nervous system at the time of infection, and causes widespead damage. In children, this leads to a well-researched condition known as HIV encephalopathy, which affects all areas of neurodevelopment. The effects of timely initiation of antiretroviral therapy on alleviating the impact of encephalopathy have been well described. Neurodevelopmental delay is a stage four disease indicator according to the World Health Organisation (WHO), and therefore is a criterion for initiation of Highly Active Antiretroviral Therapy (HAART). HAART is often only administered according to the virologic and immunologic status of a child, as standardised neurodevelopmental assessment tools are not widely available in South African clinics. When HAART initiation is dependent on immunologic status, it is often too late to prevent encephalopathy. To date, the only means of prevention of this condition is early initiation of HAART, which has not been widely available in South Africa. Stringent guidelines for the commencement of this therapy according to the WHO, and the South African Department of Health (DOH) have had to be followed, leading to late initiation of HAART, and widespread central nervous system encephalopathy. Studies which have been carried out in South African clinics have demonstrated the high prevalence of this condition. Once there is evidence of encephalopathy, children should be referred for assessments in all facets of development, and where necessary, for rehabilitation. A standardised developmental screening tool which is suitable for use in a developing country is therefore necessary in order to screen for neurodevelopmental delays to allow for further assessment and referral to rehabilitation services, as well as providing an additional assessment criterion for initiation of HAART. Paediatric HIV clinics in developing countries are understaffed, and children may be seen by junior staff or screened by nurses due to the high numbers of clinic attendees. This often results in neurodevelopment being inadequately assessed and children are therefore not referred for intervention services. A standardised screening tool, could be administered by clinic staff in order to ensure correct and timely referral of children for further assessment and intervention is therefore necessary. This is of importance both locally and internationally where a screening tool, which has been developed specifically for this purpose, does not exist. The aim of this study was therefore to evaluate the agreement between the Bayley-III Screening Test and the Bayley Scales of Infant Development (3rd version) in a population of HIV positive infants in order to evaluate its appropriateness for use in South Africa. The Bayley Scales of Infant Development have long been considered the ‘gold standard’ in infant developmental assessment, which is why this tool was chosen to evaluate the Bayley-III Screening Test against. The developmental scores in each facet (cognitive, motor or language) were evaluated to determine which should be included in an assessment tool for this population. Further objectives for the study were to adapt the screening tool to the needs of the population, or to develop a new screening tool shouldthe Bayley-III Screening Test not prove suitable for use in this population. In order to meet the aims and objectives, a cross-sectional study was conducted where 112 HIV positive infants between the ages of six and eighteen months were assessed using the Bayley-III Screening Test and the Bayley Scales of Infant Development (3rd version) (BSID III). The infants were stratified into four age groups namely 6-8 months, 9-12 months, 13-16 months, and 17-18 months. Children were recruited from Harriet Shezi Children’s Clinic at Chris Hani Baragwanath Hospital in Soweto. The agreement between the Bayley-III Screening Test and the Bayley Scales of Infant Development (3rd version) was analysed using Kappa, for the overall group, and for each age group. Overall agreement between the tools was as follows: K=0.58 for the Cognitive facet, K=0.82 for the Expressive Communication facet, K=0.76 for the Receptive Communication facet, K=0.44 for the Fine Motor facet and K=0.57 for the Gross Motor facet. These values indicate that the Bayley-III Screening Test is therefore not acceptable for clinical use, as excellent agreement (k≥0.75) in all facets would be necessary for this purpose. A new screening tool therefore had to be developed. The infant’s developmental scores from the BSID III were analysed to determine which facets of development were most severely affected, and therefore which facets should be included in a new screening tool. Gross motor function was demonstrated to be the area which was most severely affected, followed by cognitive function. A gross motor screening tool would therefore be suitable for use in this population, as no equipment would be necessary. Gross motor development is the most universally similar aspect of development, which is not completely dependent on cultural or socioeconomic factors which often have an influence on language and cognitive development. Item selection from the BSID III was undertaken to determine which items should be included in a brief screening tool. In each of the four age groups, item selection occurred as follows: Two items which discriminated the At-Risk, from Emerging and Competent groups (less than 20% in the At-Risk group, and 100% in the other groups) were selected. Two items, which discriminated between children in the ‘Emerging’ and ‘Competent’ categories on the BSID III were selected (0-5% of children who were At-Risk obtained credit, 30-50% of the Emerging group obtained credit, and 100% of the Competent group obtained credit). Lastly, two items were selected which discriminated the Competent group from the other two groups (100% or as high as possible in the Competent group, and 0% in the other groups). The new gross motor screening tool was assembled using the selected items, scoring was allocated, and it was tested against the scores obtained on the Gross Motor facet of the BSID III for the initial 112 infants. Agreement between the tools was analysed using Kappa, and refinements were made according to the discrepancies. This was done three times, until the Kappa value revealed excellent agreement between the tools (k = 0.87). A panel of experts was then invited to examine the new gross motor screening tool, and to comment on it, and further adjustments were made accordingly. Preliminary concurrent validity testing of the new gross motor screening tool was then carried out against the Gross Motor facet of the BSID III on 60 children, who were recruited from the Harriet Shezi Children’s Clinic at Chris Hani Baragwanath Hospital in Soweto. Statistical analysis revealed that the agreement between the BSID III and the new screening tool was excellent (k=0.85). The diagnostic properties of the new gross motor screening tool were as follows: sensitivity 97.4%, specificity 85.7%, positive predictive value 92.7%, and negative predictive value 94.7%. These values indicate that the statistical properties of the tool are excellent, and the tool will not be predisposed to underreferrals or over-referrals. Preliminary reliability testing was carried out on 15 children for test-retest/intrarater reliability and 15 children for interrater reliability. Interrater, test-retest and intrarater reliability were excellent (r=1, r=0.98, r=0.98 respectively). Further testing of reliablity and validity should be undertaken in order to establish these properties, and standardisation should also be carried out on healthy children. Given the need for an assessment tool of this nature in South Africa and other developing countries, and the statistical properties thus far, the tool may be used clinically for the purposes for which it was developed

Early Movement Matters: Examining the Influence of Early Postnatal Caregiving Experiences of Term Infants on Motor and Head Shape Outcomes Across Infancy

The nurturing, handling and positioning exposures infants experience during daily caregiving contribute to their physical, motor, cognitive and social–emotional development. A relationship exists between infant sleep and wake-time positioning, the emergence of motor skills and the development of head shape deformities diagnosed as non-synostotic plagiocephaly (NSP). However, the underlying causal mechanism of the specific caregiving behaviours that may play a role remains unclear. The purpose of the study was to investigate the association between maternal caregiving behaviours and the developmental outcomes of ‘low-risk’ term infants in the first 10 months of life. The first phase of the research involved the establishment of an expert panel of experienced clinical practitioners and researchers to design, construct and validate an observational scale—the Infant Handling Measure—to measure the physical capabilities of an adult to move, lift, hold, position and play with a young infant (neonate to four months) during regular infant caregiving activities. The second phase was an exploratory prospective longitudinal birth cohort study. Data were collected over eight collection points (three home-based and five online telephone sessions) to explore the patterns and possible mechanisms by which early infant caregiving exposures may influence the developmental outcomes of healthy ‘low-risk’ term infants. Observations of infant motor and head shape outcomes were obtained at one, three and 10 months, and observations of maternal–infant handling were obtained at one and three months. Self-reported parenting measures were collected at the eight time points, and infant caregiving measures were collected at the seven postnatal time points. A final sample of 48 ‘low-risk’ term singleton infant (24 male; 27 firstborn)–mother dyads completed all observational measures. Mothers had the strongest influence on infant motor and head shape outcomes. Maternal knowledge about infant development and insufficient parenting instruction on infant handling, positioning and care practices were found to be important factors influencing caregiving abilities. The number of adverse perinatal health events, knowledge of infant development and mothers’ early infant handling skills contributed to infant motor development. Risk analysis confirmed maternal knowledge of infant development, the consistent provision of centred head and body positions and the vi adoption of rotational movements in infant care activities were protective and reduced the risk of delayed motor development. Three factors contributed to adverse infant head shape outcomes: insufficient parenting instruction on infant care practices, infants spending more than 17 hours per day in supine position during the first six months of life and the late adoption of rotational movements in daily infant care routines. Risk analysis confirmed that prior learning of handling techniques and adopting rotational movements in infant care activities were protective and reduced the risk of NSP. Early mastery of infant handling by mothers in the first months of life may be a salient mechanism of protection for infant motor and head shape development. Low maternal knowledge about infant development and insufficient parenting instruction on infant care practices highlight the gaps in current parenting strategies. A collaborative revision of early infant handling education, including consumers and stakeholders, is recommended

Peabody developmental motor scales, second edition : validação e normatização para crianças brasileiras

Introdução: A identificação do nível de desenvolvimento motor em crianças devem ser conduzidos utilizando instrumentos confiáveis e válidos para que os resultados sejam confiáveis. Diversos instrumentos são utilizados na finalidade de avaliar o comportamento motor infantil no mundo todo, entretanto, verificase a necessidade de confirmar sobre o quão válidos são esses instrumentos para identificar e acompanhar o desenvolvimento motor desde o nascimento até a idade pré-escolar. Ainda mais, o quanto esses instrumentos são capazes de predizer os desempenhos futuros das crianças, bem como em um contexto cultural diferente da amostra normativa. Objetivos: O presente estudo teve os seguintes objetivos: artigo (1) investigar a validade de construto do Peabody Developmental Motor Scales-Second Edition (PDMS-2) para crianças brasileiras; artigo (2) verificar a validade de critério do PDMS-2 através da validade concorrente, validade preditiva e discriminante; artigo (3) investigar as propriedades de medida do PDMS-2 em crianças; artigo (4) avaliar e descrever as curvas de desempenho motor grosso e fino para a idade, comparar o desempenho motor das crianças brasileiras com a amostra original, e, estabelecer normas para a população brasileira. Métodos: Para contemplar cada um dos objetivos foram utilizados os seguintes métodos: artigo (1) para a validade de conteúdo, participaram do estudo 13 profissionais: quatro professores bilíngues, três professores universitários, dois profissionais de saúde para o processo de validade de face e quatro doutorandos em educação física. Para a validade de construto, uma amostra composta por 637 bebês e crianças (325 meninas e 312 meninos) com idade entre zero e 71 meses (n=399 0-23 meses; n=238 24-71 meses) foi avaliada com o PDMS-2; artigo (2) para a validade concorrente e discriminante, um grupo de 21,42% da amostra original (n=637) foi avaliado com o PDMS-2 e com outros testes com o mesmo construto ou um construto correlato. Para os bebês de zero à 18 meses (n=69) foi administrado o PDMS-2 e a AIMS; e para as crianças com idade entre 36 e 71 meses (n=67) foi administrado o PDMS-2 e o MABC-2 em um intervalo de tempo de no máximo cinco dias. Para a validade preditiva, 17% da amostra total fizeram parte dessa etapa, ou seja, 108 crianças com idade na 1º avaliação entre 0 e 71 meses foram acompanhadas longitudinalmente por quatro meses; artigo (3 e 4) para a análise de Rasch e avaliação das curvas de desempenho, participaram 637 crianças (51% meninas) com idades entre 0 a 71 meses (M= 21,7, DP = 18,6). Resultados: Os seguintes resultados foram encontrados: artigo (1) a versão brasileira do PDMS-2 (PDMS-2-BR) apresentou características psicométricas equivalentes à versão original; artigo (2) o coeficiente de correlação intraclasse com todas as subescalas da AIMS e PDMS-2 mostrou elevada correlação entre as baterias; diferentemente da análise de correlação entre PDMS-2 e MABC-2. A análise de regressão linear demonstrou efeito significativo da idade para todas as subescalas, indicando predição de desenvolvimento. A análise discriminante linear de Fisher indicou que a função com as subescalas reflexo, equilíbrio, locomoção, preensão e integração visuomotora foram capazes de discriminar de forma significativa as categorias da AIMS; o mesmo não foi observado para as categorias do MABC-2; artigo (3) a maioria dos itens do PDMS-2 nas subescalas avaliaram os construtos pretendidos e eram essencialmente unidimensionais. Na sua maioria, os itens que apresentaram desajuste foram em função de valores altos no outfit. Doze itens apresentaram desajuste; artigo (4) houve um aumento significativo nos desempenhos motores de acordo com a faixa etária em todas as subescalas. Foram observadas diferenças significativas no desempenho motor entre a amostra brasileira e amostra normativa americana nas médias da subescala PDMS-2, e portanto, normas para a população brasileira foram estabelecidas. Considerações Finais: Este estudo de validação assegurou que o PDMS-2 é capaz de mensurar as mudanças no desenvolvimento motor para crianças brasileiras. O PDMS-2 demonstrou compatibilidade com a AIMS, confiabilidade em predizer desempenhos futuros e capacidade discriminante, portanto, habilita-se para acompanhar o desenvolvimento infantil, principalmente durante a primeira infância. Os resultados demonstraram que o PDMS-2 apresentou resultados satisfatórios quanto à sua construção, apresentando-se assim como um instrumento confiável para administração em nossa população. Além disso, verificou-se que se trata de um instrumento confiável para avaliar o desenvolvimento motor em crianças, seja relacionado à idade em um determinado momento, ou ao longo do tempo, e de seu uso para mensurar o impacto interventivo.Introduction: The identification of motor competence and delays in children should be conducted using reliable and valid instruments for reliable results. Several instruments are used for purpose of assessing child motor behavior worldwide. However, there is a need to confirm how valid these instruments are to identify and monitor motor development from birth to preschool age. Moreover, how these instruments are capable of predicting the future performances of children, as well as in a cultural context different from the normative sample. Aims: The present study had the following objectives: article (1) investigate the construct validity of Peabody Developmental Motor Scales-Second Edition (PDMS-2) for Brazilian children; article (2) verify the PDMS-2 criterion validity through concurrent validity, predictive and discriminant validity; article (3) to investigate the measurement properties of PDMS-2 in children; article (4) evaluate and describe performance curves for age-related gross and fine motor development, to compare the motor performance of Brazilian children with original sample and establish norms for the Brazilian population. Methods: In order to contemplate each of the objectives, the following methods were used: article (1) for the content validity, 13 professionals participated in the study: four bilingual teachers, three university professors, two health professionals for the face validity process and four doctoral students in physical education. For construct validity, a sample composed of 637 infants (325 girls and 312 boys) aged 0-71 months (n = 399 0-23 months, n = 238 24-71 months) was evaluated with PDMS-2; article (2) for concurrent and discriminant validity, a group of 21.42% of the original sample (n = 637) was evaluated with PDMS-2 and other tests with the same construct or a correlate construct. For infants from zero to 18 months (n = 69), PDMS-2 and AIMS were administered; and for children aged 36-71 months (n = 67) PDMS-2 and MABC-2 were given within a maximum of five days. For predictive validity, 17% of the total sample were part of this stage, that is, 108 children with age in the 1st evaluation between 0 and 71 months were followed longitudinally for four months; article (3 and 4) for Rasch analysis and evaluation of performance curves, 637 children (51% girls) aged 0-71 months (M = 21.7, SD = 18.6) participated. Results: The following results were found: article (1) the Brazilian version of the PDMS-2 (PDMS-2-BR) presented psychometric characteristics equivalent to the original version; article (2) the intraclass correlation coefficient with all AIMS and PDMS-2 subscales showed high correlation between the batteries; unlike the correlation analysis between PDMS-2 and MABC-2. Linear regression analysis showed significant age effect for all subscales, indicating prediction of development. Fisher's linear discriminant analysis indicated that the function with the reflex, balance, locomotion, gripping and visuomotor integration subscales were able to discriminate significantly the AIMS categories; the same was not observed for the MABC-2 categories; article (3) most PDMS-2 items in the subscales evaluated the intended constructs and were essentially onedimensional. For the most part, the items that presented mismatch were due to high values in the outfit. Twelve items presented misalignment; article (4) there was a significant increase in motor performances according to age in all 12 subscales. Significant differences were observed in motor performances between the Brazilian sample and the American normative sample in the averages of the subscale PDMS-2, and therefore, new norms for the population were established. Final considerations: This validation study ensured that the PDMS-2 can actually measure what it is intended to measure and that the results of the evaluation are statistically related to the performance data. PDMS-2 demonstrated compatibility with AIMS, reliability in predicting future performance and discriminant capacity, thus being able to monitor infant development, especially during early childhood. The results demonstrated that PDMS-2 presented satisfactory results in its construction, thus presenting itself as a reliable instrument for administration in our population. In addition, it has been found that this is a reliable instrument for assessing motor development in children that is age-related at any given time or over time

Assessment and diagnosis of autism spectrum disorder in Latino children

There is an increase in the number of children who are diagnosed with autism spectrum disorder. However, significant racial and ethnic disparities exist in the diagnosis and treatment of the disorder. Based on the literature, Latino children appear to be under diagnosed or misdiagnosed with other psychological disorders rather than autism spectrum disorder. In addition, Latino children are typically diagnosed at a later age than their White peers. There is almost no research devoted to the assessment of autism spectrum disorder with young Latino children and there is insufficient research related to cultural perceptions of symptoms which can influence parental report. There is an increasing need to provide culturally appropriate Spanish language assessment to Latino children and their families. Therefore, this dissertation provides a critical review of those tests that are frequently cited in the literature or available in Spanish for use in the neuropsychological assessment of young Latino children suspected of having autism spectrum disorder within the following domains: Social Communication and Social Interaction; Speech, Language and Communication; Restricted, Repetitive Behaviors, Interests or Activities; Sensory Processing/Sensory Integration and; Developmental and Adaptive Functioning. Tests used to aid in the differential diagnosis of autism spectrum disorder and other emotional and behavioral disorders in Latino children are also included. A few select tools are recommended for use with this population to be used as a resource for those clinicians serving this population