Changes In Motor Development Research Articles

Dynamics of changes in motor development depending on the quality in the 3rd month of life.

The aim of the study was to show that the quantitative and qualitative motor development from the 3rd month of life is key to achieving milestones and that it may be an early warning signal in children at risk of cerebral palsy (CP). The study population included 93 children (69 born at term). Children were born at week 38 ± 4, the mean body weight was 3,102 ± 814 g. All children were evaluated after reaching the 3rd month of life (quantitative and qualitative assessment), and then the 4.5th, 7th, and 12th of life (quantitative assessment). In case of suspected CP, children were followed until the 18th month, when the diagnosis was confirmed. If at the age of 3 months, a child achieved a quadrangle of support and symmetrical support, then its development at the 4.5th month of life was correct, it would creep, and it would assume a crawl position, then in the final assessment (12th month of life), the child would start to walk. If a child failed to achieve a quadrangle of support and symmetrical support and the dynamics of its development were incorrect, the development would be delayed (12th month of life), or CP would develop. A correct qualitative assessment in the 3rd month of life with a high probability guarantees corrects quantitative development at the 4.5th, 7.5th, and 12th months of life. If the qualitative assessment in the 3rd month of life was very low the child would probably be diagnosed with CP at 18 months.

Reference centiles based on year-to-year changes for a longitudinal evaluation of motor performance in children and adolescents.

ObjectivesThe aim was to evaluate the longitudinal course of motor skills development in children with a view to improve the understanding of intra-individual variance. Previous publications have been based on cross-sectional data or analyzed longitudinal studies in a cross-sectional manner.DesignLongitudinal. Year-to-year change.MethodsThe present study is based on motor function data collected in the LIFE Child study (Germany). The participants (6 to 17 years) completed parts of the motor tests according to the standard of the German Motor Performance Test 6–18 (DMT). For a total of 1653 participants, 4616 motor tests with an annual interval in the period 2011 to 2019 were included in the evaluation.ResultsWe were able to produce gender and age-specific change centiles for the test items standing long jump, jumping sideways, push-ups, stand and reach and balancing walking backwards. Each set of centiles revealed a range of variability in motor development in children and adolescents, with distinct progressive patterns in the different test items and different genders. The supplied tables offer an indication of expected year-to-year change for each test item depending on age and gender. Depending on the test item and the mean age, a deterioration in test results after a one-year interval was observed, despite cross-sectional centiles showing an upward trend.ConclusionWe present a user-friendly tool as a way to assess individual dynamic changes in motor development of children and adolescents. In combination with the well-known cross-sectional centiles as baseline, this can be helpful for the scientific evaluation of motor skills tests and can also be used in school settings.

The Effects of tDCS with NDT on the Improvement of Motor Development in Cerebral Palsy

We investigated the effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) with neurodevelopmental treatment (NDT) on the improvement of motor development and reduction of spasticity in children with cerebral palsy (CP). Twenty-four children with CP were allocated to two groups: the tDCS + NDT group and the only NDT group, done 3 times per week for 5 weeks. The Gross Motor Function Measurement (GMFM-88) and Box and Block Test (BBT) were used to assess changes in motor development, and the Modified Ashworth Scale (MAS) was used to evaluate changes in spasticity. All measurements were carried out at 3 time points: baseline, post-intervention, and 1 month follow-up. We found improvements in the GMFM-88 total scores and in each individual GMFM-88 dimension scores, favoring the tDCS + NDT group over the only NDT group. The BBT scores improved only in the tDCS + NDT group. In addition, the MAS scores reduced in the hemibody with significant motor impairment only in the tDCS + NDT group. The present findings suggest that tDCS combined with NDT can be considered a promising intervention for children with CP, as it can enhance motor development and reduce spasticity in this population.

Effectiveness of a home-based early cognitive-motor intervention provided in daycare, home care, and foster care settings: Changes in motor development and context affordances

BackgroundAppropriate opportunities within the context are crucial to affect the motor trajectory positively. ObjectiveTo investigate the effectiveness of professional-parental/caregivers' early motor-cognitive intervention on infants' motor development in Daycare (DC), Home Care (HC), and Foster Care (FC). Secondary objectives were to examine if parents and caregivers modified the context to meet the infants' needs and if making modifications was positively associated with infants' development. MethodsParticipants were 176 infants (DC = 48; HC = 58, FC = 70). Infants' were randomly assigned to intervention (IG) or comparison (CG) groups within each context. The Alberta Infant Motor Scale and Affordances in the Daycare and Home Environment for Motor Development were used. A cognitive-motor intervention was provided for infants in the intervention groups; and, a home-based support protocol for all caregivers and parents. ResultsIGs showed higher motor scores at post-test than CGs (p values from 0.018 to 0.026) and positive changes were observed from the pre-to-post intervention for all IGs (p ≤ .0001), and for two CGs (DC p ≤ .0001; HC p = .028). Maternal daily care and home opportunities improved for all infants. ConclusionsParents/caregivers' protocol combined with the cognitive-motor intervention lead to better motor outcomes and changes in the context for the IGs. Only the parent/caregivers' protocol was not strong to improve CGs motor outcomes, although changes in context were found. Intensive intervention is need for infants living in vulnerability.

Avaliação do desenvolvimento físico de lactentes no contexto da atenção primária à saúde

Objetivo: avaliar o desenvolvimento físico de lactentes no contexto do nível primário de atenção à saúde. Método: estudo transversal, descritivo e quantitativo, realizado em unidades de atenção primária à saúde de três cidades da região do Maciço de Baturité- CE: Acarape, Redenção e Itapiúna. A amostra foi constituída por lactentes acompanhados em unidades de saúde de acordo com a demanda apresentada. A coleta ocorreu entre março a abril de 2018 mediante dados sobre a caracterização geral e antropométrica do lactente, avaliação do desenvolvimento motor, com base no teste de desenvolvimento de Denver II e análise de reflexos primitivos. Os dados foram agrupados em planilhas Excel e compilados no software SPSS versão 20.0. Resultados: Participaram do estudo 75 crianças na fase de lactente. Um percentual de 60% dos lactentes era do sexo masculino, com média de 7,7 meses de idade. Na avaliação antropométrica dos escores z, a relação IMC/idade apresentou maior percentual de inadequação (66,7%), apresentando-se, na maioria, como acima do esperado. Na avaliação do desenvolvimento motor, houve risco de atraso em 13,3% dos lactentes (4% no motor fino e 9,3% no motor grosso). Na avaliação dos reflexos, em grande parte dos lactentes (85,3%) estavam presentes de acordo com o esperado para a idade Conclusões: nota-se um perfil de crianças com peso acima do adequado. Poucas alterações no desenvolvimento motor e nos reflexos foram constatadas, apontando para uma possível e adequada estimulação dos responsáveis e correta orientação dos profissionais de saúde.

Propuesta de una ficha de evaluación psicomotora de 0 a 5 años para el seguimiento al neurodesarrollo infantil

Children in development matters and requires professional supervision with contextualized tools to make the assessment of psychomotor progress infant from its earliest days, which is often underestimated in controlling the growth and development of children in some of our health centers means. The present study concerns the problem of psychomotor evaluation in children from birth to five years of life, although the health system considers controlling the development of the infant, evaluations of psychomotor development are made with several instruments not validated in context where they are employed, but for studies in neighboring countries or synthesis of various instruments without previous scientific studies. The study shows that monitoring of the psychomotor development in our environment is not a priority for the control of child growth, though no doubt the control of immunizations, weight and height, can not be neglected; nor should detract from the timely detection of changes in motor development, sensory and psychomotor tracking capabilities of the infant during the first six years of life. This study culminated in the presentation of an instrument for measuring psychomotor development based on a validation in 1000 children under standard tools systematised criteria employed by the different health centers, public, private and central parts of the Program for Support of Children; supplemented according to current trends on proposing an alternative validated in the population identified, submitted in physical form and electronics.

Motor development analysis of three-year-old children born preterm through the Motor Development Scale - Case Report

Introduction: Prematurity and low birth weight are conditions that may compromise the normal development of a child at different stages of development. Considering that these conditions may cause delay in the acquisition of motor skills, it is important to evaluate, detect and prevent possible changes in motor development.
 Objective: To investigate the influence of prematurity and low birth weight on the motor development of children of three years old relating chronological age to general motor age.
 Methods: This is an analysis of five cases of preterm children 32.1 (± 1.82) weeks and underweight 1704 (± 384.41) grams, mean chronological age of 43.2 (± 2.59) months, evaluated through the Motor Development Scale (MDS) in the Laboratory of Electromyography and Kinematics (LAELCIN) of the Federal University of Triângulo Mineiro (UFTM), considering general motor age (GMA) and chronological age (CA) as variables.
 Case: The five preterm and low birth weight children presented a difference between the mean general motor age (37.6 ± 7.40) months and the mean chronological age (43.2 ± 2.59) months, indicating delayed motor development.
 Conclusion: It was observed the absence of linearity of the variables, indicating delay in the motor development, thus justifying the necessity and importance of the longitudinal monitoring of this population for early detection and intervention.

Spontaneous movements in the first four months of life: An accelerometric study in moderate and late preterm infants.

Moderate preterm infants (MPI) and late preterm infants (LPI) account for the majority of children born preterm. Up to 5% of MPI and LPI are estimated to manifest neurodevelopmental impairments. However, information about normal early motor development in these patients is lacking. To find characteristic patterns for motor development in the first four months of life among MPI and LPI without risk factors for developmental impairment by using accelerometry of spontaneous movements. Prospective and observational study. Twenty-three MPI and LPI (9 female, 14 male) without known risk factors for neurodevelopmental impairment were included in this study. Spontaneous movements were measured by accelerometry at the time of hospital discharge (mean: 36.6wks postmenstrual age (PMA)) and at the corrected age of three months (mean: 53.0wks PMA). Motor development was described by analyzing 36 parameters calculated from the acceleration signal. Normal neurodevelopmental outcome was confirmed by Bayley Scales of Infant Development at the corrected age of two years. Statistically significant differences (p < 0.05) between the two measurements could be shown in 26 out of the 36 parameters. Striking changes in motor development were an increase in acceleration and variability of the spontaneous movements, the main criterion for analyzing spontaneous movements. Furthermore, the regularity of spontaneous movements increased significantly. Characteristic patterns of normal motor development in MPI and LPI can be identified and provide a basis for future investigations aiming at the early detection of abnormal motor development for this specific patient group.

Breastfeeding and motor development in term and preterm infants in a longitudinal US cohort

Background: The relation between breastfeeding and early motor development is difficult to characterize because of the problems in existing studies such as incomplete control for confounding, retrospective assessment of infant feeding, and even the assessment of some motor skills too early.Objective: We sought to estimate associations between infant feeding and time to achieve major motor milestones in a US cohort.Design: The Upstate New York Infant Development Screening Program (Upstate KIDS Study) enrolled mothers who delivered live births in New York (2008-2010). Mothers of 4270 infants (boys: 51.7%) reported infant motor development at 4, 8, 12, 18, and 24 mo postpartum; information on infant feeding was reported at 4 mo. Accelerated failure time models were used to compare times to standing or walking across feeding categories while adjusting for parental characteristics, daycare, region, and infant plurality, sex, rapid weight gain, and baseline neurodevelopmental test results. Main models were stratified by preterm birth status.Results: The prevalence of exclusive breastfeeding in preterm infants was lower than in term infants at 4 mo postpartum (8% compared with 19%). After adjustment for confounders, term infants who were fed solids in addition to breast milk at 4 mo postpartum achieved both standing [acceleration factor (AF): 0.93; 95% CI: 0.87, 0.99] and walking (AF: 0.93; 95% CI: 0.88, 0.98) 7% faster than did infants who were exclusively breastfed, but these findings did not remain statistically significant after correction for multiple testing. We did not identify feeding-associated differences in motor milestone achievement in preterm infants.Conclusion: Our results suggest that differences in feeding likely do not translate into large changes in motor development. The Upstate KIDS Study was registered at clinicaltrials.gov as NCT03106493.

What is Trained Develops! Theoretical Perspective on Skill Learning.

Knowledge about developmental theories is important for experts or specialists working with children following normal development and children who have various kinds of dysfunction, in order to better understand what happens with processes associated with motor behavior. In this article, we have explored how theories of development and learning can be used to understand processes associated with motor behavior. A probabilistic perspective emphasizes that the changes taking place in the development is a result of interaction: structural changes in the nervous system leading to changes in function and behavior and opposite, functional changes resulting in changes in structure. This bidirectional interaction between biological and experiential aspects is a continuous process which cannot be reduced to either organism or environment. Dynamical systems theory (DST) emphasizes that it is the interaction between the person, the environment, and the task that changes how our movements are, also in terms of how we develop and learn new movements. The interplay between these factors will, over time, lead to changes in motor development. The importance of experience is central to Edelman's theory of neuronal group selection (NGST). Activation of the nervous system increases the connections between certain areas of the brain, and the selection processes in the brain are a result of enhancement of neural connections involved in a "successful" motion. The central nervous system adapts its structure and function in response to internal and external influences, and hence neural plasticity is a prerequisite for learning and development. We argue that Edelman´s approach supports the theory of specificity of learning. From the perspectives of probabilistic epigenesis, DST, and NGST, we can see that being physically active and having the opportunity to get different movement experiences are of great significance for promoting motor development and learning. A variation of purposeful or rewarding physical activity in a variety of contexts will provide individual opportunities for changes of behavior in terms of both quantitative and qualitative changes in motor development.

Changes in Motor Development During a 4-Year Follow-up on Children With Univentricular Heart Defects.

To compare changes in motor development from 1 to 5 years of age among 18 children with hypoplastic left heart syndrome and 12 with univentricular heart to 42 children without heart defect. Motor development was assessed with the Alberta Infant Motor Scale and Movement Assessment Battery for Children (Movement ABC). Children with hypoplastic left heart syndrome or univentricular heart had significantly lower scores on the Alberta Infant Motor Scale test at the age of 1 and on the Movement ABC test at the age of 5 years compared with controls. Children with clear abnormalities on brain magnetic resonance imaging had lower scores compared with those with normal images or mild changes, and their relative motor scores decreased during follow-up. Some children with univentricular heart defects may benefit from physiotherapeutic interventions to support their motor development.

Commentary on "Changes in Motor Development During a 4-Year Follow-up on Children With Univentricular Heart Defects".

Commentary on "Changes in Motor Development During a 4-Year Follow-up on Children With Univentricular Heart Defects".

Early life events and motor development in childhood and adolescence: a longitudinal study.

Few studies have reported on early life risk factors for motor development outcomes past childhood. Antenatal, perinatal and neonatal factors affecting motor development from late childhood to adolescence were explored. As sex differences in motor development have been previously reported, males and females were examined separately. Participants (n = 2868) were from the Western Australian Pregnancy Cohort Study. Obstetric and neonatal data were examined to determine factors related to motor development at 10 (n = 1622), 14 (n = 1584) and 17 (n = 1221) years. The Neuromuscular Development Index (NDI) of the McCarron Assessment of Motor Development determined offspring motor proficiency. Linear mixed models were developed to allow for changes in motor development over time. Maternal pre-eclampsia, Caesarean section and low income were negatively related to male and female motor outcomes. Lower percentage of optimal birthweight was related to a lower male NDI. Younger maternal age, smoking during early pregnancy and stress during later pregnancy were related to lower female NDIs. Events experienced during pregnancy were related to motor development into late adolescence. Males and females were influenced differently by antenatal and perinatal risk factors; this may be due to sex-specific developmental pathways.

Changes in motor development in infants participating in rehabilitation based on Vojta method

Changes in motor development in infants participating in rehabilitation based on Vojta method

Fatores associados ao atraso do desenvolvimento motor de crianças prematuras internadas em unidade de neonatologia

OBJETIVOS: verificar a frequência do atraso do desenvolvimento motor em crianças prematuras internadas em unidade neonatal e identificar os fatores associados. MÉTODOS: estudo descritivo e analítico, realizado na Unidade Neonatal de uma maternidade de alto risco em Recife, Brasil. Avaliou-se o desenvolvimento motor, através do Test of Infant Motor Performance, de 98 crianças nascidas pré-termo com idade pós-conceptual mínima de 34 semanas, durante a internação, entre janeiro e julho de 2009. Analisaram-se associações entre variáveis maternas, neonatais e assistenciais com desenvolvimento motor. RESULTADOS: a média de idade pós-conceptual na avaliação foi de 37 semanas e 39,8% das crianças apresentaram desenvolvimento motor alterado (atípico ou suspeito). Fatores significativamente associados ao desenvolvimento motor alterado foram: menor peso ao nascer; maior idade na avaliação; maior número de consultas pré-natais; ocorrência de hipóxia e displasia broncopulmonar; maior tempo de permanência na unidade de terapia intensiva e unidade neonatal. Houve tendência significante a um pior desenvolvimento motor com uso de oxigenoterapia e ventilação mecânica prolongadas. CONCLUSÕES: crianças prematuras internadas podem apresentar atraso precoce do desenvolvimento motor, de forma grave ou limítrofe. Peso ao nascer, morbidades neonatais e assistência recebida na unidade neonatal foram os fatores que mais influenciaram o desfecho. Esses resultados justificam o início de estratégias preventivas e estimulação ainda no período de internação.

Commentary on “GMFM in Infancy

“How could I apply this information?” The authors suggest adaptations to the Gross Motor Function Measure (GMFM-88 and GMFM-66) to assess motor development in children younger than 2 years. In the literature and in practice, these instruments are used to measure change in motor development over time in children with cerebral palsy, but lack application to the infant population. In comparison, the Alberta Infant Motor Scale (AIMS), the Bayley Scales of Infant Development II (BSID II) (now III), and the Infant Motor Profile are used as scales for detecting infants who are “at risk” as well as to determine their developmental age. The suggestions for adaptation meet a clinical need for assessing younger infants who present with signs of cerebral palsy. Crediting skills that are no longer observed because the infant is capable of higher-level motor function is a valid suggestion, just as the AIMS and the BSID-II credit previous items of function below the baseline. This adaptation is practical since the goal of assessment and intervention in these children is to capture typical performance, and the “loss” of lower-level skills is expected in the trajectory of typical development. “What should I be mindful about in applying this information?” This study would be strengthened by using the percentiles or scaled scores of the AIMS and BSID III for comparison with the Gross Motor Function Measure scores, since the raw scores are the least reliable indicators for either test. The suggestion for arbitrary assignment of a score for a dimension negates the foundation of standardized testing and may not result in accurate results when used in a larger, more variable population. Stronger clinical relevance would be achieved by using the AIMS and BSID III, which are designed specifically for the infant population with valid and reliable results. However, the authors increase awareness of the lack of specific testing in younger infants at risk for cerebral palsy. The bias of the adapted tool should also be considered, since removing items and scoring unobserved items are likely to skew the test toward improvement, regardless of patient performance. Amber Richards, MPT, PCS Children's Hospital Los Angeles Los Angeles, California Linda Fetters, PT, PhD, FAPTA University of Southern California Los Angeles

Polimicrogiria perisilviana bilaterale

Bilateral perisylvian polymicrogyria is among the cortical abnormalities caused by late neuronal migration due to both genetic and environmental factors. It is associated with variable changes in motor development and facio-pharyngoglosso-masticatory diplegia with varying language disorders. Epilepsy is more common in lesions extending posteriorly. We describe two cases of non-familial bilteral perisylvian polymicrogyria with different clinical features but sharing signs of severe neonatal encephalopathy mimicking an anoxic-ischaemic lesion. MR studies were done at nine and 20 months in the first patient and at two weeks and three months in the second.

Behavioral consequences of marginal iron deficiency during development in a murine model.

Marginal iron deficiency is a common nutritional disorder in human populations world-wide; however, the neurobehavioral effects of chronic marginal iron (Fe) intakes during development are poorly characterized in animals. For this reason, we investigated whether mice reared on marginal Fe diets during pre- and postnatal development would experience neurobehavioral deficits. Swiss-Webster mice reared on either control (75 ppm Fe) or marginal iron (12.5 ppm) diets were assessed for changes in behavior on postnatal days 30, 40, and 50 using a neurobehavioral test battery. Because alterations in tissue mineral status can lead to an oxidative stress, markers of both protein (glutamine synthetase) and lipid oxidation (TBARS) were measured. Marginal iron animals exhibited a 20-55% reduction in grip strength. Although both marginal iron males and females demonstrated persistent lowering of body weights, statistical analysis using weight as the covariate demonstrated that the grip strength reductions were independent of body weight changes. This reduction in grip strength occurred in conjunction with a 25-45% lowering of brain iron in the marginal iron animals. Despite dramatic reductions in both brain and liver iron, hematocrits were unaffected by dietary iron reductions. Oxidative stress was indicated by an elevation in noniron-stimulated TBARS in the cerebellum of marginal iron animals. These data suggest that a chronic marginal Fe deficiency during critical periods of growth can result in functional changes in motor development even in the absence of iron deficiency anemia; furthermore, alterations in mineral status and oxidative stress may be mechanisms contributing to these observed changes.

Validity of the Peabody Developmental Gross Motor Scale as an Evaluative Measure of Infants Receiving Physical Therapy

The purpose of this study was to examine the validity of the Peabody Developmental Gross Motor Scale (PDMS-GM) as an evaluative measure of infants receiving physical therapy. Infants who attended an early intervention program (N = 124) were grouped by diagnosis: cerebral palsy, Down syndrome, hydrocephalus, preterm with developmental delay, full term with developmental delay, and other. The PDMS-GM was administered to each infant three times over a 6-month period by a therapist who did not provide treatment. Mean scaled scores and age-equivalent scores increased for each group. Individual change was examined using the reliable change index. The results indicated that the change in total raw score for 62% of the infants was greater than what could be attributed to measurement error. When minimal clinically important change was defined as 10 scaled score points, the index of responsiveness was equal to 0.5. This finding indicates that a sample size of 68 subjects per group would be needed when the PDMS-GM is used as an outcome measure in research. The mean change scores for each group support the use of the PDMS-GM as an evaluative measure. For many infants, particularly infants with cerebral palsy, the PDMS-GM was not responsive to change over a 6-month period. The index of responsiveness suggests that the PDMS-GM should be used only as an outcome measure in large clinical trials. The PDMS-GM is not recommended for evaluating the direct effects of physical therapy but is recommended for providing a global measure of change in motor development as part of a multidimensional assessment.

A Randomized Clinical Trial of Home Intervention for Children With Failure to Thrive

To evaluate the efficacy of a home-based intervention on the growth and development of children with nonorganic failure to thrive (NOFTT). Randomized clinical trial. The NOFTT sample included 130 children (mean age, 12.7 months; SD, 6.4) recruited from urban pediatric primary care clinics serving low income families. All children were younger than 25 months with weight for age below the fifth percentile. Eligibility criteria included gestational age of at least 36 weeks, birth weight appropriate for gestational age, and no significant history of perinatal complications, congenital disorders, chronic illnesses, or developmental disabilities. Children were randomized into two groups: clinic plus home intervention (HI) (n = 64) or clinic only (n = 66). There were no group differences in children's age, gender, race, or growth parameters, or on any of the family background variables. Most children were raised by single, African-American mothers who received public assistance. Eighty-nine percent of the families (116 of 130) completed the 1-year evaluation. All children received services in a multidisciplinary growth and nutrition clinic. A community-based agency provided the home intervention. Families in the HI group were scheduled to receive weekly home visits for 1 year by lay home visitors, supervised by a community health nurse. The intervention provided maternal support and promoted parenting, child development, use of informal and formal resources, and parent advocacy. Growth was measured by standard procedures and converted to z scores for weight for height and height for age to assess wasting and stunting. Cognitive and motor development were measured with the Bayley Scales of Infant Development, and language development was measured by the Receptive/Expressive Emergent Language Scale. Both scales were administered at recruitment and at the 12-month follow-up. Parent-child interaction was measured by observing mothers and children during feeding at recruitment and at the 12-month follow-up, and the quality of the home was measured by the Home Observation Measure of the Environment 18 months after recruitment. Repeated-measures multivariate analyses of covariance were used to examine changes in children's growth and development and parent-child interaction. Analyses of covariance were used to examine the quality of the home. Independent variables were intervention status and age at recruitment (1.0 to 12.0 vs 12.1 to 24.9 months). Maternal education was a covariate in all analyses. When changes in developmental status and parent-child interaction were examined, weight for height and height for age at recruitment were included as covariates. Children's weight for age, weight for height, and height for age improved significantly during the 12-month study period, regardless of intervention status. Children in the HI group had better receptive language over time and more child-oriented home environments than children in the clinic-only group. The impact of intervention status on cognitive development varied as a function of children's ages at recruitment, with younger children showing beneficial effects of home intervention. There were no changes in motor development associated with intervention status. During the study period, children gained skills in interactive competence during feeding, and their parents became more controlling during feeding, but differences were not associated with intervention status. Findings support a cautious optimism regarding home intervention during the first year of life provided by trained lay home visitors. Early home intervention can promote a nurturant home environment effectively and can reduce the developmental delays often experienced by low income, urban infants with NOFTT: Subsequent investigations of home intervention should consider alternative options for toddlers with NOFTT: