What do we know about the relationship between family characteristics and infant gross motor development? Research findings and clinical implications
Keeping Current © Prepared by Stephanie Banh, Melanie Leung, and Doreen Bartlett, 2016
In this Keeping Current, we explore the relationship between selected family characteristics and infant gross motor development. Understanding these associations might assist with early identification and selection of interventions to address early motor delays. We present the findings from our research, summarize other research that has been done in this area, and propose recommendations for the direction of future research.
Why pay attention to early motor development?
Motor delays are frequently the first or most obvious sign of an underlying medical condition. (1) Parents typically keep a watchful eye on their children’s gross motor development, noting milestones such as holding the head and chest up when lying on their stomachs, sitting without support, crawling, and ultimately walking. These hallmarks of motor development tend to emerge in the same order in most infants, with infants gaining a new gross motor ability each week, on average. (2) These milestones provide a lens through which to assess the infant’s development. Ongoing or multiple delays in meeting these developmental milestones are often the first indication for parents to seek early intervention.
Why pay attention to family factors?
There are a number of models and frameworks that have been developed to help us understand health and development. One such model, developed by Bronfenbrenner (3) , proposes that environmental influences play a key role in shaping all aspects of human development. In the model, he placed the context of the family closest to the individual child and made the case that the family has a direct influence on child growth and development, particularly early in life. A more current framework that also focuses on the impact the environment plays on the development of an individual is the International Classification of Functioning, Disability and Health (ICF). (4) The ICF provides a conceptual framework for exploring the relationship between a person's health and disability in the context of personal and environmental factors. (4) The framework acknowledges the influence that the physical, social, and attitudinal environments have on a person’s ability to participate in everyday activities. For infants, families play a key role in shaping the environment, which may influence their motor development.
OUR STUDY
What data did we use?
The Alberta Infant Motor Scale (AIMS) (2) is a standardized norm-referenced observational measure to assess infant gross motor abilities from birth to 18 months of age, to identify infants at risk for gross motor delay. The original AIMS normative data set comprised scores of 2202 infants born in Alberta between March 1990 and June 1992. A study funded by the Canadian Institutes of Health Research was conducted between March 2010 and October 2012 to re-evaluate the norms. The study determined that the order and age of emergence of the AIMS items have remained stable in the last 2 decades. (5)
For this report, we used the AIMS scores that were collected between March 2010 and October 2012, as well as various family characteristics (highest level of education; household income; and information about other children and adults living in the same house). The data were collected in six provinces across Canada. In total, 650 infants, representing Canada’s ethnic diversity, were assessed between 7 days and 17 months of age. Ninety-one percent were full-term; 48% were female. Correlations were conducted between the AIMS percentile scores (which allowed us to control for age) and the four demographic factors. A p value of < 0.01 was used to determine statistical significance.
What did we find?
NS= non-significant
Although we found statistically significant negative relationships between infant motor development and both parental education and household income, the relationships were not clinically significant, because they accounted for less than 4% of motor development. This suggests that these family characteristics do not influence early gross motor development in a way that would make a difference in everyday life. These results are supported by other research in this area. Appendix A presents details from a literature review we conducted to analyze what is currently known about the relationships among these family characteristics and gross motor development. This literature review shows that the findings are mixed – some studies found a significant relationship between family characteristics and infant motor development and others did not. As such, there is no overwhelming consensus on the presence or absence of significant relationships between these variables.
What does this mean?
Based on our findings and the literature review presented in Appendix A, it is clear that the family characteristics in the table above do not provide guidance for service providers working with infants who have motor delays. To build on this work, we can go back to the ICF framework and propose other areas of examination that may provide more evidence to support clinical decision making.
What are some ideas for FUTURE research in this area?
The ICF framework acknowledges that the contexts in which people live their lives play a critical role in their function and participation. (4) Environmental factors include the physical, social, and attitudinal environments in which people live and conduct their lives. (4) These aspects of the environment and their relationships to infant motor development are presented below.
PHYSICAL ASPECTS
Equipment Use
- Statistically significant negative correlations between equipment use (e.g. exersaucer, high chair, infant seat) and infant motor development have been reported. (6)
- This suggests that infants who have high equipment use tend to score lower on infant motor development (and vice versa). It is unclear whether this is causative or whether families are responding to the slower development of their infants with higher equipment use.
Affordances in the home environment (that is, aspects of the home environment that support early motor development)
- The availability of stimulating objects (e.g. books, space, play materials, toys) in the home can be conducive to stimulating motor development in an infant, but the degree to which this influences motor development is unknown.
- The Affordances in the Home Environment and Motor Development (Self Report) measures how well home environments support movement and potentially promote motor development. It can be used to evaluate outside physical space, inside physical space, variety of stimulation, gross motor materials, and fine motor materials. (7)
Opportunities within the play space
- It is also important to examine the extent to which infants have opportunities to explore their environments through variability present in their physical spaces and sensory experiences. (8) For example, access to furniture permits exploration and provides opportunities for facilitating antigravity movement (e.g. sitting, standing, walking) potentially linking to positive motor outcomes.
- The Environmental Opportunities Questionnaire is a measure that addresses the opportunities that infants might have within the play space, as a result of the physical layout of furniture, clothing restrictions, or parental restrictions. (8)
Sensory variety
- Exposure to a variety of stimuli (e.g. sensory materials, toys, different floor textures) and opportunities to interact and play with toys challenges an infant’s movement and encourages adaptation and motor development (8), but again we do not know the full degree to which this has an impact on the infant’s motor development.
In summary, further research is required on: the use of equipment within the home environment and introducing floor time to allow infants to experiment with new motor abilities; (6) and assessing the home environment and providing resources or recommendations to enhance its potential in maximizing infant motor development. (7,8)
SOCIAL ASPECTS
Social aspects of the infant’s environment that might contribute to infant motor development include parental interactions with the infant, which could either promote or limit infant motor development.
- Mothers’ use of formal handling practices that include challenging infants to hold themselves upright against gravity has been found to be associated with greater parental involvement in their infants overall care and more access to appropriate play materials for the infants, (9) which in turn might facilitate motor development.
- The Daily Activities of Infants Scale (DAIS) is a parent-reported quantitative measure of the daily activities parents do with their infants that help support the development of movement exploration and anti-gravity postural control. (10) Knowledge gained about the role of these daily activities might contribute to intervention programs for high-risk infants that promote physical activity and motor development and ensure that vulnerable infants are exposed early to opportunities for activities and exercise to facilitate motor development. (10)
- The Environmental Opportunities Questionnaire, described above, also contains items regarding parent knowledge and the extent to which parents change their interaction with their infant to match or challenge motor function. Motor development may be facilitated by increased parental encouragement and awareness of environmental impacts. (8)
All of these areas require further research.
ATTITUDINAL ASPECTS
Parental expectations
Research findings suggest that more supportive and stimulating home environments, mediated by parental attitudes, are associated with higher infant motor development scores.
- Expectations serve as standards by which parents evaluate the developmental progress of their children. In infancy, specific handling techniques and care-giving practices that expose infants to postural challenges, along with high parental expectations, have been shown to be associated with the earlier onset of target behaviours and motor development. (11)
- In another study, a group of mothers had high expectations of eight-month old babies’ motor performance and both the mothers and the infants scored higher than the normative sample on aspects of the home environment and infant motor development. (12)
- Cross-cultural studies have also demonstrated that parental expectations of children, which varies significantly across cultures and among individuals, appear to have an effect on motor development, either facilitating or inhibiting. (13)
Similar to the physical and social aspects of the environment, further research into attitudinal aspects will also shed more light on areas of potential parental education and clinical intervention to support optimal early motor development.
SUMMARY AND CLINICAL IMPLICATIONS
In our research study, we did not find a clinically significant relationship between family characteristics, such as household income and parental education, and infant motor development. To better understand potential influences on infant motor development, we reviewed other research that focuses on the physical, social, and attitudinal aspects of the environment. Recognizing that the family acts as an influential and important unit to facilitate and support change for the infant suggests that further research is required to study infant motor development and its relationship to different aspects of the home environment. Information from this type of research can then be used clinically in the course of planning and delivering interventions collaboratively with families. The relationship between these environmental characteristics and infant motor development need to be further clarified before clinical strategies can be implemented.
Acknowledgements
We would like to thank Anqi Gao and Michelle Wong for their contributions in the development and research of the study. This work was conducted in the partial fulfillment of the MPT degree for Banh, Leung and Wong.
For more information, please contact Doreen Bartlett at canchild@mcmaster.ca
References
Piper MC, Darrah J. Motor Assessment of the Developing Infant. Philadelphia, PA: W. B. Saunders; 1994.
Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MASS: Harvard University Press; 1979.
World Health Organization. Towards a Common Language for Functioning, Disability and Health: ICF The International Classification of Functioning, Disability and Health 2002. www.who.int/classifications/icf/training/icfbeginnersguide.pdf. Accessed October 13, 2013.
Darrah J, Bartlett D, O Maguire T, Avison WR, Lacaze-Masmonteil T. Have infant gross motor abilities changed in twenty years? A re-evaluation of the Alberta Infant Motor Scale normative values. Developmental Medicine and Child Neurology. Open Access. DOI: 10.1111/dmcn.12452; 2014.
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Doralp S, Bartlett DJ. Environmental Opportunities Questionnaire: development of a measure of the environment supporting early motor development in the first year of life. Disability and Rehabilitation. 2013;35:1692-1697.
Hopkins B, Westra T. Maternal handling and motor development: an intracultural study. Psychology Monographs. 1988;114:377-408.
Bartlett DJ, Fanning JK, Miller L, Conti-Becker A, Doralp S. Development of the Daily Activities of Infants Scale: A measure supporting early motor development. Developmental Medicine and Child Neurology. 2008;50:613-617.
Hopkins B, Westra T. Maternal expectations of their infants ‘development: some cultural differences. Developmental Medicine and Child Neurology. 1989;31:384-390.
Abbott A, Bartlett D. The relationship between the home environment and early motor development. Physical and Occupational Therapy in Pediatrics. 1999;19:43-57.
Cintas, HL. Cross-cultural similarities and differences in development and the impact of parental expectations on motor behavior. Pediatric Physical Therapy. 1995;7:103-111.
Noritz GH, Murphy NA, Hagan JF, et al. Motor delays: Early identification and evaluation. Pediatrics. 2013;131:e2016-e2027.
APPENDIX A