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Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader STARTPlay intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.

Purpose: To evaluate the validity, reliability, and sensitivity of the novel Means-End Problem-Solving Assessment Tool (MEPSAT). Methods: Children with typical development and those with motor delay were assessed throughout the first 2 years of life using the MEPSAT. MEPSAT scores were validated against the cognitive and motor subscales of the Bayley Scales of Development. Intra- and interrater reliability, developmental trends, and differences among groups were evaluated. Results: Changes in MEPSAT scores positively related to changes in Bayley scores across time for both groups of children. Strong intra- and interrater reliability was observed for MEPSAT scoring across all children. The MEPSAT was sensitive to identify change across time and differences in problem-solving among children with varying levels of motor delay. Conclusions: The MEPSAT is supported by validity and reliability evidence and is a simple tool for screening early problem-solving delays and evaluating change across time in children with a range of developmental abilities. What this adds to the evidence: The novel MEPSAT is supported by validity and reliability evidence. It is sensitive to detect problem-solving differences among young children with varying motor ability and to capture changes in problem-solving across time. It requires minimal equipment and time to administer and score and, thus, is a promising tool for clinicians to screen for early problem-solving delays or to track intervention progress in young children with or at risk for problem-solving delays.

Fine motor skills enable children to make precise and coordinated movements with their hands and support their ability to engage in everyday activities and learning experiences. In a longitudinal study of 1,058 4-year-old children in rural Pakistan (n = 488 girls), we examined how prior and concurrent levels of home stimulation relate to change in fine motor skills from ages 2 to 4 while controlling for family wealth, maternal education, number of siblings at birth, prior and concurrent measures of children's physical growth and food insecurity, and prior motor skills at age 2. Moreover, we tested whether the association between early home stimulation and subsequent fine motor skills was mediated by physical growth, food insecurity, motor skills at age 2, and concurrent home stimulation. Results revealed that home stimulation at 18 months was positively associated with change in fine motor skills from ages 2 to 4, over and above family socioeconomic resources. This association was mediated by physical growth, food insecurity and motor skills at age 2. In contrast to home stimulation at 18 months, home stimulation at age 4 was positively associated with concurrent motor skills at age 4 when controlling for all antecedent family factors, as well as prior and concurrent measures of physical growth and food insecurity, and prior motor skills at age 2. Findings suggest that the preschool period may be an important window of time when physically and cognitively stimulating experiences at home uniquely relate to variability in fine motor development. [This article is published in "Developmental Psychology" (EJ1305482).]

Evidence-based treatments for young children with developmental language delays include caregiver-implemented naturalistic interventions. However, there is little research on culturally appropriate interventions for Spanish-speaking caregivers from low-socioeconomic status (SES) households and their young children with identified language delays. We compared interaction strategies of Latino Spanish-speaking caregivers from low-SES backgrounds and non-Latino English-speaking caregivers from high-SES backgrounds with their children with language delays. Caregivers' interactions were coded for (a) interaction characteristics, (b) use of naturalistic language support strategies, and (c) linguistic input. Results indicated Spanish-speaking Latino caregivers from low-SES backgrounds used a more directive, responsive, and warm interaction style than non-Latino caregivers. Non-Latino, English-speaking caregivers from high-SES backgrounds used more cognitively stimulating strategies, spent more time observing and narrating play, and used longer utterances and more lexical diversity. Findings provide directions for future research and guidance for clinicians working with Latino families from low-SES households.

Early identification of autism spectrum disorder (ASD) provides the best opportunity for children to receive evidence-based early intervention. Research indicates that accurate diagnosis can be made as early as the toddler period when an assessment is completed by experienced clinicians. Typical ASD evaluations involve an assessment of developmental skills, such as those measured with the "Bayley Scales of Infant and Toddler Development, Fourth Edition." There is limited research, however, on the use of the newest iteration, the Bayley-4, in discriminating between various developmental disorders and delays. This study compared the performance of three groups of toddlers on the Bayley-4: (1) ASD (n = 31), (2) developmental delay (n = 26) and (3) problems specific to language (n = 45). Results of a multivariate analysis of variance indicated mean differences existed between the ASD and language groups on the five Bayley-4 subtests that comprise the Cognitive Motor, and Language Scales; however, logistic regression analysis indicated group membership could not be predicted by performance on the subtests. Our findings suggest children who are identified with ASD at a very young age exhibit global developmental deficits, which may help distinguish them from other groups who exhibit more targeted delays.

Content validity describes the extent to which a measure represents, and is relevant to, the construct it aims to assess. The International Classification of Functioning, Disability and Health and derived Core/Code Sets (Sets) for autism, attention deficit-hyperactivity disorder, cerebral palsy and early developmental delay and disability are adequate to establish the content validity of measures aiming to assess functioning in young children with neurodevelopmental conditions (NDCs). This article aimed to assess the content validity of comprehensive assessments of functioning for young children with NDCs against these standards. Twenty-two common measures of functioning were evaluated for content validity against the International Classification of Functioning, Disability and Health at a domain level, with 10 measures analysed at the item-level and compared to the Sets relevant to young children with NDCs. Measures covered between 21% and 57% of the combined Set codes and 19% to 63% of codes from specific Sets. Much of this variation was between measures, with some variation due to differences between individual Sets. The percentages reflect that measures heavily focus on activities and participation areas, with environmental factors rarely assessed. These findings are useful for clinicians, policymakers, and researchers in identifying the most appropriate measures for assessing functioning in young children with neurodevelopmental conditions.

Toddlerhood is marked by advances in several lexico-semantic skills, including improvements in the size and structure of the lexicon and increased efficiency in lexical processing. This project seeks to delineate how early changes in vocabulary size and vocabulary structure support lexical processing (Experiment 1), and how these three skills together (vocabulary size, structure, and lexical processing) relate to later language outcomes at age 3 (Experiment 2). Experiment 1 explored how the size and semantic structure of toddlers' vocabulary from 18 to 24 months (N = 61) predicted performance on two lexical processing tasks (semantically related and semantically unrelated trials). Denser semantic connectivity (i.e., global level connectivity between near and far neighbors) positively associated with semantic interference during semantically related lexical processing, whereas denser category structure (i.e., lower-level connectivity between near neighbors) facilitated lexical processing in semantically unrelated trials. In Experiment 2, a subset of the same children (N = 49) returned at age 36 months and completed a comprehensive assessment of their language skills using the Clinical Evaluation of Language Fundamental, Preschool 2 (CELF-P2). Here, earlier measures of lexico-semantic connectivity and lexical processing best predicted age 3 language skill. The findings support accounts that early vocabulary structure and lexical processing skills promote continued growth in language.

Early exploratory behaviors have been proposed to facilitate children's learning, impacting motor, cognitive, language, and social development. This study related the performance of behaviors used to explore oneself to behaviors used to explore objects, and then related both types of exploratory behaviors to motor, language, and cognitive measures longitudinally from 3 through 24 months of age via secondary analysis of an existing dataset. Participants were 52 children (23 full-term, 29 preterm). Previously published results from this dataset documented delays for preterm relative to full-term infants in each assessment. The current results related performance among the assessments throughout the first 2 years of life. They showed that the developmental trajectories of behaviors children used for self-exploration closely related to the trajectories of behaviors they employed to explore objects. The trajectories of both self and object exploration behaviors significantly related to trajectories of children's motor, language, and cognitive development. Specifically, significant relations to global development were observed for self-exploratory head lifting, midline head and hand positioning, hand opening, and behavioral variability, as well as for object-oriented bimanual holding, mouthing, looking, banging, manipulating, transferring of objects, and behavioral intensity and variability. These results demonstrate continuity among the early exploratory behaviors infants perform with their bodies alone, exploratory behaviors with portable objects, and global development. The findings identify specific self- and object-exploration behaviors that may serve as early indicators of developmental delay and could be targeted by interventions to advance motor, language, and cognitive outcomes for infants at risk for delay.

Research in developed countries has found that paternal involvement has positive and significant effects on early childhood development (ECD). Less is known, however, about the state of paternal involvement and its influence on ECD in rural China. Using data collected in Southern China that included 1,460 children aged 6-42 months and their fathers (as well as their primary caregivers), this study examines the association between paternal involvement and ECD. Although the results demonstrate that the average level of paternal involvement is low in rural China, paternal involvement is related to a significant increase in three domains of ECD (cognition, language, and social-emotional skills). Older children benefit significantly more than do younger children from paternal involvement in all domains of ECD. The results also show that, if the mother is the primary caregiver, the mother's higher educational level and the family's higher socioeconomic status are positively associated with paternal involvement.

The aim was to evaluate the effects of a family-focused early intervention programme on the cognitive, motor, and language development of infants exposed to social and biological risks in the first year of life. Quasi-experimental randomized controlled trial (RBR-6ct969), with intervention (IG; n = 72) and control (CG; n = 170) groups. IG mothers participated in two individual Newborn Behavioral Observation sessions and six in-group sessions. Children's development was assessed at 4, 6, 9, and 12 months of age, using the Bayley-III scale. The results showed that IG children had higher receptive language scores (p = 0.02) and lower gross motor scores (p = 0.03) than CG. The chance of receptive language delay (OR = 0.61, CI 0.38-0.96, Cohen's d = 0.28) was reduced in IG, but no impact was observed on the other domains. The present intervention reduced the risk of receptive language delay, despite its low intensity and short duration.

Purpose: This study examines object permanence development in infants with motor delays (MD) compared with infants with typical development (TD) and in relation to sitting skill. Methods: Fifty-six infants with MD (mean age = 10 months) and 36 with TD (mean age = 5.7 months) were assessed at baseline and then at 1.5, 3, and 6 months postbaseline. A scale was developed to measure object permanence (Object Permanence Scale [OPS]), and the Gross Motor Function Measure sitting subsection (GMFM-SS), and the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) were administered. Results: Interrater reliability of the OPS was excellent and correlation between the OPS and Bayley-III cognitive scores was moderately positive. Compared with TD, infants with MD were delayed in development of object permanence but demonstrated increased understanding over time and as sitting skills improved. Conclusion: In children with MD, object permanence, as quantified by the OPS, emerges in conjunction with sitting skill.

Purpose: This case series documents developmental changes over time and in response to a novel intervention, Sitting Together and Reaching to Play (START-Play), in children with early-life seizures. Methods: Thirteen children with early-life seizures were included from a subset of participants in the START-Play multisite, randomized controlled trial. Seven received 3 months of twice weekly START-Play intervention; 6 continued with usual care early intervention. Bayley Scales of Infant Development-III (Cognitive Composite), Gross Motor Function Measure-66 Item Set, Assessment of Problem-Solving in Play, and reaching assessments were administered at baseline, 3, 6, and 12 months postbaseline. Change scores are reported at 3 and 12 months postbaseline. Results: Over time, plateau or decline was noted in standardized cognition measures; motor development improved or was stable. Children receiving START-Play showed positive trends in problem-solving (71.4%) and reaching behaviors (57.2%). Conclusions: Interventions such as START-Play that combine motor and cognitive constructs may benefit children with early-life seizures.

In this study, we investigate the association between family environment and early childhood development among children aged 6-24 months in rural counties in China. To do this, we used cross-sectional data from a large scale survey, including 1809 child-caregiver dyads across 22 nationally designated poverty counties. We found that 53.95% of children were at the risk of cognitive development delay, 60.26%, 36.27%, 40.69% of children were at the risk of language, motor, and social-emotional development delay respectively. Moreover, the good quality of family environment was significantly associated with the child's development. Rural family environments are providing insufficient stimulation for children, especially a low variety of developmental enriching materials and lacking play activities. Our study confirms the need for programmatic interventions that provide reliable ways to learn how to play with their children and build a stimulating environment to improve early childhood development in the region.

The Sustainable Development Goals mandate that by 2030, all children should have access to quality early child development opportunities, healthcare and pre-primary education. Yet validated measures of ECD in low and middle income countries (LMICs) are rare. To address this gap, a Systematic Review (SR) of measures available to profile the development of children between the ages of 0-5 years in LMICs was undertaken. Drawing on education, psychology and health databases, we identified reliable, valid or measures adapted for use in LMICs for either assessments of children's development or their learning environments. The inclusion criteria were (1) peer reviewed papers published between January 2009 and May 2019; (2) assessment tools used to measure cognitive/language development or the early years or home environment in at least one LMIC; (3) report of the psychometric properties (validity and reliability) of the tool, and/or description of the cultural adaptability/translation process undertaken before applying it to a LMIC. Two hundred and forty-nine available records published in the last decade in peer-review journals and nine relevant systematic literature reviews were identified. Fifty-seven records were qualitatively synthesised based on their psychometric properties and cultural adaptation. Forty-three tools were reviewed utilising 12 criteria. Five elements of analysis present in Tables 2 and 3 (study, population tested, validity, reliability and cultural adaptability/translation) focused on the tools' psychometric properties and previous application in LMICs. A further seven dimensions outlined in Tables 4 and 5 identified specific characteristics of the tools from target age, administration method, domains, battery, accessibility, language and country/institution. We suggest these 12 key considerations for the selection of measurement tools that are applicable to effectively assess ECD in LMICs.

Purpose: The purpose of this study was to investigate the relationship of the grunt vocalizations to cognitive and expressive language status in children with disabilities. Children with typical development produce communicative grunts at the onset of referential word production and comprehension at 14-16 months of age and continue to use this vocalization for communication as they develop language. Method: All grunt vocalizations produced by 26 children with disabilities (mental age: 3-56 months; communicative age: 47-69 months) were identified from video-recorded seminaturalistic play sessions. Grunts were identified as accompanying effort or attention or as communicative bids. Participants were grouped as prelinguistic, emergent, language delay, and language competent based on standardized assessments of cognitive and language level. The Mann--Whitney U test (1947) compared groups to determine the relationships between grunt production and cognitive and language status. Results: As hypothesized, participants in the language delay group produced significantly more communicative grunts than those in the language competent group (W = 39, p = 0.028 < 0.05). The children with a cognitive and language level lower than 9 months (prelinguistic group) failed to produce communicative grunts. Conclusions: The results document grunt production in children with disabilities in the same contexts as typical children and support the hypothesized relationship between assessed cognition and language and communicative grunt production. These results require replication. This vocalization, if recognized in treatment, may unlock verbal communication in many nonverbal children with disabilities. Future longitudinal research should include controlled intervention to determine the potential effectiveness of building broader communicative skills on this simple vocalization.

Recent studies of autism diagnosis in New Zealand have revealed inconsistent implementation of best practice standards in autism assessment and high rates of parental dissatisfaction with the diagnostic process. These findings have arisen despite the development and dissemination of the New Zealand Autism Spectrum Disorder Guideline (the Guideline). In this study, we investigated current diagnostic processes, and adherence to the Guideline in New Zealand, for an opportunity sample of 117 health professionals who practice across a wide range of diagnostic services, health professionals and geographic regions in New Zealand. The results show considerable variability in practice, and suggest specific areas for improvement. These include the robustness of diagnostic evaluations conducted in private settings, the provision of specialist assessment services for youth and adults presenting for autism diagnosis, and the uniformity of post-diagnostic supports and services. These findings have implications for further implementation of the Guideline in New Zealand.

Background: There is limited research examining the efficacy of early physical therapy on infants with neuromotor dysfunction. In addition, most early motor interventions have not been directly linked to learning, despite the clear association between motor activity and cognition during infancy. Objective: The aim of this project is to evaluate the efficacy of Sitting Together And Reaching To Play (START-Play), an intervention designed to target sitting, reaching, and motor-based problem solving to advance global development in infants with motor delays or neuromotor dysfunction. Design: This study is a longitudinal multisite randomized controlled trial. Infants in the START-Play group are compared to infants receiving usual care in early intervention (EI). Setting: The research takes place in homes in Pennsylvania, Delaware, Washington, and Virginia. Participants: There will be 140 infants with neuromotor dysfunction participating, beginning between 7 to 16 months of age. Infants will have motor delays and emerging sitting skill. Intervention: START-Play provides individualized twice-weekly home intervention for 12 weeks with families to enhance cognition through sitting, reaching, and problem-solving activities for infants. Ten interventionists provide the intervention, with each child assigned 1 therapist. Measurements: The primary outcome measure is the Bayley III Scales of Infant Development. Secondary measures include change in the Early Problem Solving Indicator, change in the Gross Motor Function Measure, and change in the type and duration of toy contacts during reaching. Additional measures include sitting posture control and parent-child interaction. Limitations: Limitations include variability in usual EI care and the lack of blinding for interventionists and families. Conclusions: This study describes usual care in EI across 4 US regions and compares outcomes of the START-Play intervention to usual care.

Intrusive parenting has been traditionally considered a negative parenting style and includes actions that are overly directive and controlling of children's behavior. However, current research aims to contextualize this parenting behavior. This study examined the relation between intrusive parenting and early childhood behavior problems or emotion regulation, as well as the moderating role of race/ethnicity and developmental delay. Participants (n = 511; 47.4% male) were part of a larger, longitudinal Early Head Start study, entitled Baby FACES, with a racially and ethnically diverse sample (40.1% White, 18.7% Black, and 41.2% Hispanic). Behavior problems and developmental delay were assessed via parent report, while parent intrusiveness and emotion regulation were rated by observers. More use of intrusive parenting at age 2 was associated with greater behavior problems and less emotion regulation at age 3. However, this relation was moderated by race/ethnicity and developmental level. Greater intrusiveness was related to increased behavior problems and poorer emotion regulation for White and Hispanic/Latino families; they were unrelated in Black families. Similarly, although intrusive parenting and behavior problems were positively associated at all developmental levels, the relation was strongest for children with typical development. Further, fewer maternal risk factors, being female, and being Hispanic/Latino were associated with higher emotion regulation, and more risk factors were associated with more behavior problems. These findings highlight the importance of considering how a child's context and development interact with parenting style. Children may benefit from clinical assessment and intervention that considers this intersectionality.

Fine motor skills enable children to make precise and coordinated movements with their hands and support their ability to engage in everyday activities and learning experiences. In a longitudinal study of 1,058 4-year-old children in rural Pakistan (n = 488 girls), we examined how prior and concurrent levels of home stimulation relate to change in fine motor skills from ages 2 to 4 while controlling for family wealth, maternal education, number of siblings at birth, prior and concurrent measures of children's physical growth and food insecurity, and prior motor skills at age 2. Moreover, we tested whether the association between early home stimulation and subsequent fine motor skills was mediated by physical growth, food insecurity, motor skills at age 2, and concurrent home stimulation. Results revealed that home stimulation at 18 months was positively associated with change in fine motor skills from ages 2 to 4, over and above family socioeconomic resources. This association was mediated by physical growth, food insecurity and motor skills at age 2. In contrast to home stimulation at 18 months, home stimulation at age 4 was positively associated with concurrent motor skills at age 4 when controlling for all antecedent family factors, as well as prior and concurrent measures of physical growth and food insecurity, and prior motor skills at age 2. Findings suggest that the preschool period may be an important window of time when physically and cognitively stimulating experiences at home uniquely relate to variability in fine motor development.

Purpose: This study examined the efficacy of the Vocabulary Acquisition and Usage for Late Talkers (VAULT) treatment in a version that manipulated the length of clinician utterance in which a target word was presented (dose length). The study also explored ways to characterize treatment responders versus nonresponders. Method: Nineteen primarily English-speaking late-talking toddlers (aged 24-34 months at treatment onset) received VAULT and were quasirandomly assigned to have target words presented in grammatical utterances matching one of two lengths: brief (four words or fewer) or extended (five words or more). Children were measured on their pre- and posttreatment production of (a) target and control words specific to treatment and (b) words not specific to treatment. Classification and Regression Tree (CART) analysis was used to classify responders versus nonresponders. Results: VAULT was successful as a whole (i.e., treatment effect sizes of greater than 0), with no difference between the brief and extended conditions. Despite the overall significant treatment effect, the treatment was not successful for all participants. CART results (using participants from the current study and a previous iteration of VAULT) provided a dual-node decision tree for classifying treatment responders versus nonresponders. Conclusions: The input-based VAULT treatment protocol is efficacious and offers some flexibility in terms of utterance length. When VAULT works, it works well. The CART decision tree uses pretreatment vocabulary levels and performance in the first two treatment sessions to provide clinicians with promising guidelines for who is likely to be a nonresponder and thus might need a modified treatment plan.

Children with autism spectrum disorder have a high risk of vision problems yet little is known about their vision care. This cross-sectional survey study, therefore, examined vision care among 351 children with autism spectrum disorder ages 6-17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Vision care variables were vision tested with pictures, shapes, or letters in the past 2 years; vision tested by an eye care practitioner (e.g. ophthalmologist, optometrist) in the past 2 years; prescribed corrective eyeglasses; and wore eyeglasses as recommended. Covariates included sociodemographic, child functioning, and family functioning variables. Multivariable models were fit for each vision care variable. Though 78% of children with autism spectrum disorder had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism spectrum disorder prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Multivariable analysis results demonstrated statistically significant differences in vision care among children with autism spectrum disorder by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism spectrum disorder do not receive recommended vision care and highlight potentially modifiable disparities in vision care.

Background: Many South African learners seem unprepared for formal education, and a need for intervention during early childhood has been identified. Aim: The present study explored the effect of infant exposure to an early childhood development programme aimed at the sensory developmental stage of the infant's brain. Setting: Participants were recruited through local baby clinics and nursery schools in the Western Cape. Participants were from the middle-income sector and the sample consisted of 63 infants between the ages of 3 and 12 months--gender representation was approximately equal and 17% of the infants were of mixed race, 8% black and 75% white. Methods: A pretest-posttest design was used involving an intervention group (N = 29) and a control group (N = 34) of infants. There was no known bias in group allocation. Intervention was provided in the form of the Numbers in Nappies programme and cognitive performance was assessed with the BSID (III) before and after the intervention for both groups. Results: The intervention group showed theory expectant increases, most notably on the Cognitive Scale and the Social-Emotional Scale of the BSID (III). The performance of the intervention and the control group on the cognitive subscales (Cognitive, Language and Motor) was compared before and after the intervention. The only significant difference was on the Cognitive Scale after the intervention. Conclusion: The findings indicate that appropriate intervention taps into the cognitive processing potential of infants, thus increasing their cognitive ability and enhancing their social-emotional functioning. The stimulation provided by parents and primary caregivers is essential in enhancing this experience-dependent development and the Numbers in Nappies programme provides a cost-effective intervention suitable for a home environment.

Previous research has shown that the quality of mother-child interactions between pre-term children and their mothers tends to be poorer than that of full-term children and their mothers (Forcada-Guex, Pierrehumbert, Borghini, Moessinger & Muller-Nix, 2006). Mothers of pre-term children are less responsive and more intrusive in interactions with their children than mothers of full-term children (Forcada-Guex et al., 2006; Ionio, Lista, Mascheroni, Olivari, Confalonieri, Mastrangelo, Brazzoduro, Balestriero, Banfi, Bonanomi, Bova, Castoldi, Colombo, Introvini & Scelsa, 2017; Laing, McMahon, Ungerer, Taylor, Badawi & Spence, 2010). The current research explored differences between mothers of pre-term and full-term children in terms of interactive beliefs and style, and the potential for language development to be differentially predicted by maternal interactive beliefs and styles in pre-term versus full-term children. Independent t-tests were conducted to compare pre-term and full-term groups in relation to the measures of maternal interactive beliefs and styles. A series of multiple regression analyses were then performed separately for each group to examine the shared and unique contributions of maternal interactive beliefs and styles on full-term versus pre-term children's language development. The results showed that mothers of pre-term children were more intrusive-directive than mothers of full-term children; in contrast, mothers of full-term children were more responsive and supportive-directive in interactions with their children. Moreover, predictors of language development were different in full-term versus pre-term children; in full-term children, maternal supportive beliefs and responsiveness were significant predictors of language development evaluated by both the Bayley Scales of Infant and Toddler Development and the MacArthur Communicative Development Inventory; in the pre-term group, maternal supportive and directive beliefs, as well as supportive and intrusive directiveness, were significant predictors, with the latter being negatively associated with language development indicators. This research can shed light on how to prevent language delay in children and improve mother-child interactions that contribute to language development, which may in turn improve language development in vulnerable children, children born pre-term in particular.

Early diagnosis of autism spectrum disorder (ASD) facilitates access to interventions that improve outcomes for children and families. Understanding developmental and behavioral manifestations of symptoms and competencies improves early diagnosis. The authors illustrate the benefits of using the ZERO TO THREE "DC:0-5™: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood" (DC:0-5, 2016) multiaxial system for assessment of young children suspected of having a diagnosis of ASD. DC:0-5 provides a framework for forming rich conceptualizations that reflect the influence of the family system, physical health, psychosocial stressors, developmental competence and co-occurring mental health symptoms and disorders, to promote accurate early diagnosis and enhance treatment planning.

Findings are presented from a study examining the effects of the home-based intervention 'Growing: Birth to Three' (GBT) on children born prematurely at a regional hospital in Norway over a four-year period. Nineteen children received the intervention, while 17 children comprised the control group. Results indicate that GBT had a positive effect on development at 18 months, as measured by the Bayley Scale of Infant Development. However, by 36 months both the intervention and control groups were in the normal range on this measure. A post-test comparison of language performance at 36 months found significantly higher expressive language scores among children in the intervention group on the Reynell Developmental Language Scale. Parental anxiety at the end of the intervention was also measured. The benefits of implementing the GBT programme are discussed in relation to public health and the early childhood education and care systems in Norway.

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder whose symptoms may involve deficits across three domains: communication, socialization and atypical behaviors or interests. With a high prevalence across populations and a tendency to impact males more than females, early and accurate diagnosis appears critical. The most current literature on ASD provides a myriad of difficulties associated with diagnosis under the age of 3 years. The purpose of this study was to determine if a predictive relationship exists between a child's individual developmental domain standard deviation (SD) subscale scores (motor, language, cognitive, social-emotional and adaptive skills) on the Bayley-III assessment instrument and whether a diagnosis of ASD was applied. A retrospective file review of 151 children participating in Kentucky's early intervention program -- First Steps -- was completed. The children ranged in age from 18 to 35 months. Individual binary logistic regressions were used to assess the association between the Bayley-III subscale scores and whether or not an ASD diagnosis was applied following multidisciplinary evaluation. The results indicated that individual lower subscale scores in the cognitive, language, adaptive, and social-emotional domains on the Bayley-III were predictive of an autism diagnosis.

Interventions to enhance cognitive and executive function performance are essential for the child's performance in current and future occupations. Occupational therapy practitioners are critical members of early intervention, education, and healthcare teams. Practitioners are distinctly qualified to address cognitive functioning within the context of occupational performance by providing evidence-based interventions to children and their families as well as training caregivers and teams to enhance cognitive and executive functioning (EF) performance. The purpose of this review was to update the previous systematic review on this topic. The focused question guiding the selection of research studies was: "What is the evidence for the effectiveness for interventions within the scope of occupational therapy practice to promote cognitive development and prevent further delay for children 0-5 and their families?" Due to the breadth of the review, the results were divided into two articles. This article (Part 1) focuses on cognitive interventions for children birth to 5 years with known conditions while Part 2, also in this issue, will address findings on interventions for children at risk due to environmental factors and promoting cognitive development for children birth to 5 years. [For Part 2, see EJ1333259.]

Detecting developmental delays is essential for early intervention in low to middle-income countries. A cross-sectional, within-subject, comparative design was employed to determine the performance of the Parents Evaluation of Developmental status (PEDS) tools smartphone application and the Bayley Scales of Infant and Toddler Development III (BSID III) to detect developmental delays in 174 young children aged 3-18 months. Data were collected at a primary healthcare (PHC) clinic in an underserved high-risk community in South Africa. The PEDS tools identified 56% (n = 97), and the BSID-III 35% (n = 61) of the 158 children with possible developmental delays, with an overall agreement of 65% between tests. The PEDS tools referral rate was significantly higher (p = 0.004) than that of the BSID-III. The high-risk nature and age group may have contributed to poor agreement across tools. A combination of tools for screening and assessment in infants in a South African PHC context may be necessary.

This study examines the infant-father attachment in infants born preterm (

Background: Oppositional Defiant Disorder (ODD) appears more prevalent among children with intellectual disabilities (ID) as compared to children with typical development. However, it remains unclear what drives this difference. Methods: Data from 70 youth with typical development (TD) and 20 youth with ID were drawn from (The Collaborative Family Study). The relationships between child temperament and parent psychopathology (age 3), parenting behavior and child behavior problems (age 5), and ODD diagnosis (age 13) were explored via structural equation modeling. The predicted model was examined in the total sample, among children with and without ID separately, and with status (TD vs. ID) as a predictor. Conclusion: Many of the predicted relationships hold true for youth with and without ID. However, we found an unexpected relationship between negative-controlling parenting and child externalizing behavior problems for children with ID. The positive role of parental intrusiveness for children with ID is discussed, although limitations are noted due to the small sample size and preliminary nature of this study.

We investigated health-related quality of life in preterm children in association with birth weight, breastfeeding and maternal emotional state. A cross-sectional study was carried out involving 97 mothers of 2-year-old children born below 2500 g. Participants completed the Pediatric Quality of Life Inventory and a comprehensive psychological interview. Birth weight and chronic neonatal morbidities were not significant predictors of quality of life at 2 years. However, breastfeeding and positive maternal emotional state were important protective factors to the prospective quality of life of preterm children. Retrospectively, calm mothers reported their children more positively comparing to anxious mothers both during their pregnancy and after birth. As protective factors, the positive maternal emotional state before and after childbirth and breastfeeding are more crucial in the development of quality of life at 2 years than biological factors.

Infants born low birth weight (LBW) and preterm were evaluated in a high-risk follow-up clinic and compared with infants born full term. A multivariate linear model was used to examine the overall differences on Bayley Scales of Infant Toddler Development (BSID-III) among three groups: full term, heavy LBW (<2,500 g [greater than or equal to] 2,000 g), light LBW (<2,000 g). Results indicated no significant differences in BSID-III scores between the groups. The BSID-III was used to extrapolate indicators of executive function (EF) components. Dimensions of Mastery Motivation (DMQ 18) was correlated with the EF components. Findings showed that both LBW groups scored significantly lower than the full-term group on the EF components which include attention, plan/organize, working memory, and inhibit. Implications for research is discussed.

Purpose: Children with a cleft palate (± cleft lip; CP±L) can have difficulties communicating and participating in daily life, yet speech-language pathologists typically focus on speech production during routine assessments. The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY; World Health Organization, 2007) provides a framework for holistic assessment. This tutorial describes holistic assessment of children with CP±L illustrated by data collected from a nonclinical sample of seven 2- to 3-year-old children, 13 parents, and 12 significant others (e.g., educators and grandparents). Method: Data were collected during visits to participants' homes and early childhood education and care centers. Assessment tools applicable to domains of the ICF-CY were used to collect and analyze data. Child participants' Body Functions including speech, language, and cognitive development were assessed using screening and standardized assessments. Participants' Body Structures were assessed via oral motor examination, case history questionnaires, and observation. Participants' Activities and Participation as well as Environmental and Personal Factors were examined through case history questionnaires, interviews with significant others, parent report measures, and observations. Results: Valuable insights can be gained from undertaking holistic speech-language pathology assessments with children with CP±L. Using multiple tools allowed for triangulation of data and privileging different viewpoints, to better understand the children and their contexts. Several children demonstrated speech error patterns outside of what are considered cleft speech characteristics, which underscores the importance of a broader assessment. Conclusion: Speech-language pathologists can consider incorporating evaluation of all components and contextual factors of the ICF-CY when assessing and working with young children with CP±L to inform intervention and management practices.

Although 3-year-olds in the United States may attend prekindergarten prior to formal school entry in kindergarten, few investigations focus on the socioemotional foundations of classroom learning at age 3 and their relationship to later achievement. This study examined the relationship between age 3 readiness for group-based learning, modeled as the latent constructs, effortful control and social communication, and age 5 classroom adjustment and pre-academic outcomes. Data from the Early Head Start Research and Evaluation Project in the United States (n = 797) included observations, direct assessment, and examiner and teacher report. Children's effortful control predicted classroom adjustment and their social communication predicted pre-academic outcomes. Readiness for group-based learning provides a way to describe key constructs of early skill development and a framework to support children's classroom learning. Implications include promoting parents' and educators' capacities to support early developmental foundations for later adjustment and learning by fostering infants' and toddlers' effortful control and social communication. Efforts to support these skills simultaneously across diverse experiences in the home and classroom by focusing on children's individual needs may prove advantageous.

The purpose of the study was to evaluate the effects of a system of least prompts procedure and use of a graphic organizer to teach the academic literacy standard of comparing characters in text for elementary students with moderate and severe intellectual disability. A multiple probe across participants design was used to evaluate the results. The results indicated the system of least prompts and graphic organizer intervention was effective in teaching the skill to one student. The intervention, with modifications, was effective for two additional students. All participants maintained and generalized the skill. Directions for future research and practical implications are discussed.

In children with a hearing loss who receive cochlear implants (CIs) under the age of 2, regular assessments are conducted to monitor auditory and linguistic progress. However, the collection of authentic, representative, and reliable expressive language data on young children with CIs remains a challenge. The purpose of the study was to determine whether data from parental report, language diary, and spontaneous language sample are equally representative of the development of expressive vocabulary over the first 12 months of CI use. Nine French-speaking children and their families participated in the study. We collected data at 3, 6, 9, and 12 months post-implantation, and we measured parental satisfaction regarding the use of a language diary. All three methods showed a progression in the total number of different words expressed over time and captured grammatical diversity. The findings suggest that when vocabulary size is still small, the diary might provide a more comprehensive picture of development than a vocabulary checklist.

The purpose of this study is to understand the common accommodations used during standardized motor assessment of children on the autism spectrum. This study was completed in three parts: (1) a narrative review of the literature; (2) an open-ended survey sent to the first authors of the identified articles; and (3) a descriptive analysis of responses. Results revealed that 56.7% of the identified articles did not report enough information of assessment procedures, 18.9% followed the assessment manual, 16.9% provided accommodations on a needs basis, and 7.5% used a consistent modified protocol. Individual responses showed that extra demonstrations (n = 5) were the most frequent accommodation, followed by extra breaks (n = 3), picture cards (n = 2), and hand-over-hand assistance (n = 1); some respondents stated that they did not provide accommodations. The findings indicate that a clear set of accommodation for motor skill assessments does not exist, though some commonalities were reported. Further research is necessary to understand the impact of accommodations in the assessment process, as well as which accommodations are needed and/or effective.

We sought to determine whether pediatric primary care interventions targeting positive parenting among low socioeconomic status mothers resulted in reduced referrals to the New York City Early Intervention Program (NYC-EIP). Participants in Building Blocks (BB) and the Video Interaction Project (VIP) were linked with the NYC-EIP administrative dataset to determine referrals. In all, 139 of 422 study participants (31.4%) meeting inclusion criteria were referred to the NYC-EIP. Although referrals did not differ overall by group (VIP 29.8%; BB 33.8%; control 35.3%), differences were found for mothers with education/literacy of seventh grade or higher (interaction p = 0.02). In that subgroup, VIP was associated with reduced referrals by age 3 years (22.4%; adjusted odds ratio 0.53; 95% confidence interval [0.29, 0.97]), compared with BB (35.0%) and controls (34.3%), with survival analysis showing reduced cumulative risk (p = 0.04). We conclude that VIP resulted in reduced referrals for early intervention evaluation among children of mothers with seventh-grade education or higher.

Prenatal folate and vitamin B[subscript 12] status have been linked to child neuropsychological development, but less is known about maternal genetic influences on this association. We conducted an exploratory longitudinal study of 181 mother--child pairs to assess whether maternal MTHFR 677C>T genotype modifies the association between maternal plasma folate and vitamin B[subscript 12] in the first trimester of pregnancy and child neuropsychological development. Maternal plasma folate and vitamin B[subscript 12] were determined by radioimmunoassay, and MTHFR 677C>T genotypes by PCR. We evaluated child neuropsychological development at 1, 3, 6, 12, 18, 24, and 30 month old using the Bayley Scales of Infant Development II. We analyzed the data using mixed-effects multivariate linear regression. The MTHFR 677C>T genotype distribution among the mothers was 18.2% CC, 49.8% CT, and 32.0% TT. The Mental Development Index (MDI) was inversely associated with maternal plasma folate among offspring of MTHFR 677CC mothers ([Beta] = -2.18 per twofold increase, 95% CI -4.07; -0.30, corrected P value = 0.02); no significant associations were observed among children born to women of other genotypes. The Motor Development Index (PDI) was not significantly associated with maternal plasma folate in any maternal MTHFR 677C>T genotype group, nor were MDI or PDI significantly associated with maternal plasma vitamin B[subscript 12] in any maternal MTHFR 677C>T genotype group. This study suggests that maternal MTHFR 677CC genotype interacts with first-trimester plasma folate to influence offspring mental development.

The primary objective of this study was to describe cognitive and pre-academic skills of children born preterm (< 30 weeks gestational age) at preschool age. A secondary objective was to relate cognitive functioning at preschool age to developmental scores obtained using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley III) administered at 18-28 months chronological age. Participants were 21 children born preterm who participated in an initial study and returned for follow-up assessment at 42-66 months. Measures administered at the preschool-age visit included the Differential Abilities Scale-2nd Edition (DAS-II) and the myIGDIs Early Literacy and Early Numeracy measures. Most children fell below benchmark standards for early literacy and numeracy skills on the myIGDIs at preschool age. Frequency of skill levels below benchmark varied from 65 to 95% for early literacy and 70-95% for early numeracy tasks. A subset of the children (n = 16) had Bayley III scores available from a research visit at 18-28 months corrected age. Among those, cognitive composite scores were associated with verbal, but not nonverbal reasoning on the DAS-II at preschool age, and only for those with significant delays on the Bayley III. Results indicated that at preschool age, children's average cognitive scores on the DAS-II were > 1 SD below the mean across verbal (SS = 82.67; SD = 23.76) and nonverbal (SS = 80.20; SD = 23.65) domains. Practical implications of early screening for specific academic skill difficulties in early childhood settings for children born preterm are presented.

The present study examined the dyadic nature of fathers' and mothers' reported frequency of storybook reading by testing (1) the longitudinal association in parents' frequency of storybook reading when their children were 10.47 months old and 52.95 months old, (2) the interdependence between both parents' reported frequency of storybook reading, (3) whether children's word use would be a potential mediator, and (4) potential moderators (e.g., education levels, language skills). The analytical sample consisted of 8,400 two-parent households from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B). The actor-partner interdependence mediation model was conducted. Findings showed a significant effect for the continuity in mothers' storybook reading, but not fathers. Mothers' reported storybook reading when their children were 10.47 months old significantly predicted fathers' reported storybook reading when their children were 52.95 months old. Children's word use was not a significant mediator. Implications and future research are discussed.

Introduction: Youth with intellectual disabilities (ID) demonstrate higher rates of disruptive behavior disorders (DBDs) than youth with typical development (TD). DBDs such as oppositional defiant disorder (ODD) predict higher rates of delinquency during adolescence. Yet, few studies have examined risk-taking and delinquency among youth with ID. Methods: We used a self-report measure to determine whether 13-year-old youth with ID (n = 23) reported higher rates of risk-taking and delinquent behavior than their TD peers (n = 77). We also examined whether or not youth had a previous diagnosis of ODD. Results: Our results suggest that youth with ID reported fewer rule-breaking and risk-taking behaviors than their TD peers. In contrast, youth with a previous diagnosis of ODD reported more of these behaviors. Conclusion: Our results appear discrepant from previous studies, which find higher rates of risk-taking and delinquency among youth with ID. As such, we discuss the factors that may explain our discrepant results, including our definition and assessment of ID, and the age of our participants.

The aim of this research was to assess global and socio-emotional development and infant's language of caregivers by means of the third edition of Bayley Scales of Infant and Toddler Development. Literature points peculiarities on the institutional setting and that presence or absence of mother can impact infant's development in several forms. Fourteen babies from zero to one year old that live at female prison and shelter -- seven of each institution -- took part of this research as participants. The subscales of Bayley: Cognitive, Motor, Language, Socio-emotional and Adaptive behaviour had been applicate based on caregiver and mother's knowledgement. It was found that babies in prison setting presented higher indices in subscales than babies in shelter setting, which had a satisfactory performance only in cognition. The data indicate the maternal presence seems essential for the healthy development. Longitudinal surveys and larger samples are suggested for statistical analysis.

Research on sources of individual difference in parental Infant-Directed Speech (IDS) is limited and there is a particular lack of research on fathers' compared to mothers' speech. This study examined the predictive relations between infant characteristics and variability in paternal lexical diversity (LD) in dyadic free play with two-year-olds (M = 24.1 months, SD = 1.39, 35 girls). Ten minutes of interaction for sixty-four father-infant dyads were transcribed and multiple regression analyses were performed to examine the effects of a set of distal and proximal sources of infant influence on paternal LD. Fathers' LD was predicted only by infant language, both standardised language scores and dynamic language measures, and was not predicted by infant age, gender, executive function, or temperament. Findings are discussed in the light of the complex interplay of factors contributing to variability in IDS and the infant's linguistic environment.

'High functioning autism' is a term often used for individuals with autism spectrum disorder without an intellectual disability. Over time, this term has become synonymous with expectations of greater functional skills and better long-term outcomes, despite contradictory clinical observations. This study investigated the relationship between adaptive behaviour, cognitive estimates (intelligence quotient) and age at diagnosis in autism spectrum disorder. Participants (n = 2225, 1-18 years of age) were notified at diagnosis to a prospective register and grouped by presence (n = 1041) or absence (n = 1184) of intellectual disability. Functional abilities were reported using the Vineland Adaptive Behaviour Scales. Regression models suggested that intelligence quotient was a weak predictor of Vineland Adaptive Behaviour Scales after controlling for sex. Whereas the intellectual disability group's adaptive behaviour estimates were close to reported intelligence quotients, Vineland Adaptive Behaviour Scales scores fell significantly below intelligence quotients for children without intellectual disability. The gap between intelligence quotient and Vineland Adaptive Behaviour Scales scores remained large with increasing age at diagnosis for all children. These data indicate that estimates from intelligence quotient alone are an imprecise proxy for functional abilities when diagnosing autism spectrum disorder, particularly for those without intellectual disability. We argue that 'high functioning autism' is an inaccurate clinical descriptor when based solely on intelligence quotient demarcations and this term should be abandoned in research and clinical practice.

We examined the relationship between maternal perinatal depression trajectories and infant development considering various ecological risk factors in the environment and employing growth mixture modelling. Participants were 717 mother-child dyads in rural Malawi. The mothers were interviewed three times: during pregnancy, 1-year postpartum, and 2-year postpartum. Their children were administered the Bayley test. First, because of the latent class growth model, a two-class solution was adopted: a 'depression mitigated group' (90.2%) and a 'depression aggravated group' (9.8%). Second, mothers' depression intensified and was maintained by risk factors that were not only intrapersonal but also contextual. Finally, infants in the 'depression aggravated group' scored significantly lower in cognitive and motor development than did infants in the 'depression mitigated group', suggesting the need for various support programmes including psychosocial interventions (e.g. women's empowerment and parenting education) beyond merely providing individual, basic treatment to support the healthy development of mothers and children.