Harris Infant Neuromotor Test Research Articles

Cross-cultural validity of standardized motor development screening and assessment tools: a systematic review.

To investigate whether standardized motor development screening and assessment tools that are used to evaluate motor abilities of children aged 0 to 2 years are valid in cultures other than those in which the normative sample was established. This was a systematic review in which six databases were searched. Studies were selected based on inclusion/exclusion criteria and appraised for evidence level and quality. Study variables were extracted. Twenty-three studies representing six motor development screening and assessment tools in 16 cultural contexts met the inclusion criteria: Alberta Infant Motor Scale (n=7), Ages and Stages Questionnaire, 3rd edition (n=2), Bayley Scales of Infant and Toddler Development, 3rd edition (n=8), Denver Developmental Screening Test, 2nd edition (n=4), Harris Infant Neuromotor Test (n=1), and Peabody Developmental Motor Scales, 2nd edition (n=1). Thirteen studies found significant differences between the cultural context and normative sample. Two studies established reliability and/or validity of standardized motor development assessments in high-risk infants from different cultural contexts. Five studies established new population norms. Eight studies described the cross-cultural adaptation of a standardized motor development assessment. Standardized motor development assessments have limited validity in cultures other than that in which the normative sample was established. Their use can result in under- or over-referral for services.

Evaluation of neuromotor development by means of the Harris Infant Neuromotor Test

To investigate the neuromotor development of at-risk children between three and 12 months of life, administering the Brazilian version of the Harris Infant Neuromotor Test (HINT). A longitudinal study, with 78 children and 76 parents/guardians discharged from a neonatal intensive care unit in Fortaleza-CE/Brazil. Two instruments were administered: HINT and a socioeconomic questionnaire, between July/2009 to August/2010. Data from 55 preterm and 23 term children were analyzed. The final mean scores ranged from 14.6 to 25.2 and from 11.2 to 24.7, for preterm and term, respectively, showing that 91% of children demonstrated good neuromotor performance; seven premature infants showed alterations which led to the referral of three children to a specialized clinic for examination and diagnostics. The test allowed nurses to assess infant development, identify deviations early, and plan interventions.

Comparative predictive validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale

SIR–The paper by Harris et al.1 describes the Harris Infant Neuromotor Test (HINT), an assessment of infant motor function developed by the first author. The stated purpose of the HINT is ‘to differentiate atypical from typical motor development in infants aged 2.5 to 12.5 months.’ Hence, this first report of the predictive validity of the HINT deserves careful review. Unfortunately, the article lacks key information, so the reader is unable to evaluate the study procedures, or to determine the clinical validity of the HINT. Demographic and birth characteristics are presented for 144 infants, recruited as a convenience sample of 58-term and 86 at-risk infants. However, the authors report attrition of 21% prior to their primary outcome at 2 years and 50% prior to outcome at 3 years. This implies the predictive validity is actually based on outcome of 114 infants at 2 years and 72 infants at 3 years. But, these participants are not described and the numbers are ambiguous. Tables III and IV indicate that the predictive validity results are based on a sample of 144; the ROC curves in the online supplemental materials indicate 13 missing participants at 2-year outcome. The authors discuss attrition as a limitation but conclude that the ‘considerable’ attrition in their study was not a problem because the statistically significant findings indicate adequate power. However, they do not address attrition as a source of selection bias which can seriously undermine the validity of an epidemiological study. As stated in the resource cited by the authors,2 to address attrition in long-term follow-up studies researchers should, ‘provide clear, unambiguous information on the flow of subjects through the study/cohort at each stage.’ The article by Harris et al. does not clearly describe the evolution of the study sample, nor of the participants at each end-point. The reference cited further advises researchers to ‘provide baseline characteristics for those seen and not seen at follow-up for each intervention group.’2 Harris et al. do not compare the characteristics of participants who were evaluated to those who were lost to follow-up. This information is required because it is likely that accurate prediction of developmental outcome would be more challenging for those infants who were not maintained in the study, due to a higher prevalence of confounding influences. Indeed, in the discussion the authors note a differential rate of attrition between the typical and atypical infants. If this report of predictive validity of the HINT is based only on follow-up of the infants who represented greater developmental stability relative to the source population, this bias should be noted. The authors do not provide explicit information about the outcome status of the participants. Since the key predictive measures (sensitivity, specificity, predictive values) are based on the proportion of participants with normal or abnormal outcomes, it is necessary for readers to know the a priori operational definitions of outcome, as well as the actual developmental outcome of all participants. The authors do not define the outcome criteria in the Method section. The titles for Tables III and IV suggest two levels of outcome measures based on Bayley-II scores; however, the readers are never informed of the outcomes of the individual study participants. The authors note that ‘only two infants showed significant BSID-II motor delays at age 2.’ No report is given of the number of infants who exhibited mild delay at age 2 years, or of the outcome status at 3 years. Finally, the authors claim that their sample is ‘representative of … the US population in terms of ethnic origin’ (and ‘generalizeable’), based on reported 79% Caucasian infants in their sample deemed comparable to 77% white race in the United States. In studies of health outcomes in the US, it is not standard practice to categorize participants simply as ‘white’ or ‘non-white’ because these designations may comprise very different racial/ethnic groups (Hispanic, Asian, African-American, Native American). It is unlikely that a sample of infants in British Columbia is racially comparable to the demographics of the USA. The authors should simply provide the racial/ethnic identity of their participants (not given) and allow the reader to determine the generalizability of the findings. Harris et al. are to be commended for conducting a longitudinal study over a period of 3 years in an effort to demonstrate long-term predictive validity of the HINT. Inclusion of the information missing from this article regarding the study participants and procedures would enable the reader to accurately evaluate the predictive value of this new tool.

Comparative predictive validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale

We compared abilities of the Alberta Infant Motor Scale (AIMS) and the Harris Infant Neuromotor Test (HINT), during the infant's first year, in predicting scores on the Bayley Scales of Infant Development (BSID) at age 2 and 3 years. This prospective study involved 144 infants (71 females, 73 males), assessed with the HINT and AIMS at 4 to 6.5 and 10 to 12.5 months and with the BSID at 2 and 3 years. Inclusion criteria for typical infants (n=58) were the following: 38 to 42 weeks' gestation, birthweight at least 2500g, and no congenital anomaly, postnatal health concern, nor major prenatal or perinatal maternal risk factor. For at-risk infants (n=86), inclusion criteria were any of the following: less than 38 weeks' gestation, birthweight less than 2500g, maternal age older than 35 years or younger than 19 years at infant birth, maternal psychiatric/mental health concerns, prenatal drug/alcohol exposure, multiple births, or use of reproductive technology. For the overall sample, the early (4-6.5mo) HINT had higher predictive correlations than the AIMS for 2-year BSID-II motor outcomes (r=-0.36 vs 0.26), and 3-year BSID-III gross motor outcomes (r=-0.45 vs 0.31), as did the 10- to 12.5-month HINT (r=-0.55 vs 0.47). Correlations were identical for 10- to 12.5-month HINT and AIMS scores and 3-year BSID-III gross motor (r=-0.58 and 0.58) and fine motor (r=-0.35 and 0.35) subscales. When the sample was divided into typical and at-risk groups, predictive correlations were consistently stronger for the at-risk infants. Categorical predictive analyses were reasonably similar across both tests. Results suggest that the HINT has comparable predictive validity to the AIMS and should be considered for use in clinical and research settings.

Infant development and parents’ perceptions associated with use of the harris infant neuromotor test

This work aimed to identify the socio-economic, health, and educational profiles of parents, as well as their perceptions of their infants’ motor development in the first year of life. This descriptive study was carried out from November/2008 to February/2009. Participants in the study were 50 infants and 50 parents/guardians, in Fortaleza-Brazil. We used the Portuguese version of the Harris Infant Neuromotor Test (HINT) with infants ranging in age from 3 months to 11 months and 20 days. Twenty-six infants (52%) were boys. The mean age of the mothers was 24.5 years. Of the caregivers, 23 (46%) lived in stablemarital relationships, Sixteen (32%) had finished secondary education, and 27 (54%) of the families had incomes between R$ 464,72 (US$202.05) and R$ 929,44 (US$404.10). Participating caregivers were generally accurate in their own perceptions of their children’s development when compared to the numeric HINT scores assessed by nurses trained in infant development. DOI:https://doi.org/10.15253/2175-6783.2010011esp000014

Motor Development in Canadian Infants of Asian and European Ethnic Origins

Ethnic origin is one factor that may influence the rate or sequence of infant motor development, interpretation of screening test results, and decisions regarding early intervention. The primary purpose of this study is to compare motor development screening test scores from infants of Asian and European ethnic origins. Using a cross-sectional design, the authors analyzed Harris Infant Neuromotor Test (HINT) scores of 335 infants of Asian and European origins. Factorial ANOVA results indicated no significant differences in test scores between infants from these two groups. Although several limitations should be considered, results of this study indicate that practitioners can be relatively confident in using the HINT to screen infants of both origins for developmental delays.

Harris Infant Neuromotor Test: Comparison of US and Canadian Normative Data and Examination of Concurrent Validity With the Ages and Stages Questionnaire

The Harris Infant Neuromotor Test (HINT) was developed as a screening tool for potential motor and cognitive developmental disorders in infants. Scoring on the HINT has been shown to be reliable, and several studies have supported the validity of the HINT. Normative values for the tool have been developed using Canadian infants. The aims of this study were (1) to further evaluate the validity of the HINT by comparing data obtained on US infants who were developing typically with data previously acquired on Canadian infants and (2) to determine the concurrent validity of the HINT with the Ages and Stages Questionnaire (ASQ). Secondary analyses of HINT scores for US white and nonwhite infants and for US infants who had parents with lower levels of education and US infants who had parents with higher levels of education (as a proxy for socioeconomic status [SES]) were conducted. Cross-sectional exploratory and quasi-experimental comparative research designs were used to evaluate the validity of the HINT. Sixty-seven infants from the United States who were developing typically and who were aged 2.5 to 12.5 months were recruited via convenience sampling. Sixty-four of these infants were compared with Canadian infants matched for age, sex, ethnicity or race, and parental education. The HINT was administered by raters who had been trained to attain acceptable levels of interrater reliability, and parents completed the ASQ. The HINT scores for US white versus nonwhite infants (n=46) and infants who had parents with lower SES versus a higher SES (n=52) were compared. There were no significant differences between HINT total scores for US and Canadian infants or for US racial or ethnic groups and SES groups. There were high correlations (r=-.82 to -.84) between HINT and ASQ scores. The study used a small US sample with limited geographical diversity. Small sample numbers also did not allow for comparisons of specific racial or ethnic groups. The SES groups were created primarily using parental education as a proxy for SES. The results suggest that HINT screening in the United States is supported on the basis of Canadian norms and the validity of the HINT in screening for motor and cognitive delays. Although there is preliminary support for the HINT as an appropriate screening tool for US infants who are nonwhite or who have parents with a lower SES, more research is warranted.

Listening to Parents’ Concerns: Three Case Examples of Infants with Developmental Motor Delays

The primary purpose of this clinical report was to compare parents' concerns about their infants' suspected motor delays with scores on the Harris Infant Neuromotor Test (HINT) and the Bayley-II Motor Scale. The second purpose was to determine whether there was agreement in categorizing the delays on the 2 tests. Three female infants with parent-identified concerns of motor delay were assessed on the HINT and Bayley-II Motor Scale. All showed significant delays, corroborating parental concerns. On the HINT, all scored >2 SD above the mean, being categorized as significantly delayed. On the Bayley-II Motor Scale, all demonstrated significantly delayed motor performance, ie, >2 SD below the mean. Pediatric physical therapists should listen to parents' concerns about their infants with suspected motor delays and provide assessments to address these concerns. When appropriate, these infants should be referred for early intervention services.

Concurrent Validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale

We examined concurrent validity of scores for two infant motor screening tools, the Harris Infant Neuromotor Test (HINT) and the Alberta Infant Motor Scale, in 121 Canadian infants. Relationships between the two tests for the overall sample were as follows: r = -.83 at 4 to 6.5 months (n = 121; p < .01) and r = -.85 at 10 to 12.5 months (n = 109; p < .01), suggesting that the HINT, the newer of the two measures, is valid in determining motor delays. Each test has advantages and disadvantages, and practitioners should determine which one best meets their infant assessment needs.

Sleep Difficulties in Infants at Risk for Developmental Delays: A Longitudinal Study

We compared the sleep of infants at risk for neuromotor delays to that of infants without such risks, and examined the predictive validity of risk indicators to the development of sleep problems. Conveniently recruited infants (n = 142) were assessed for neuromotor achievements and sleep behaviors at 4-6 months and 10-12 months of age. Assessment tools were the Harris Infant Neuromotor Test and Morrell's Infant Sleep Questionnaire. Based on a cumulative risk index, three groups were defined: higher risk (n = 28), lower risk (n = 42), and no risk (n = 72). At both ages, the sleep scores were similar among the groups. In the no risk and lower risk group, sleep difficulties decreased with age, while for infants in the higher risk group, more difficulties were reported over time. Overall, the neuromotor attainments were not related to sleep fragmentation or settling difficulties. In a diverse sample of infants, with and without risks for developmental delays, overall, sleep patterns were similar. It appears that the neuromotor achievements are not associated with sleep-wake regulation, as measured by caregivers' report.

Known-Groups Analysis of the Harris Infant Neuromotor Test

The Harris Infant Neuromotor Test (HINT) is a screening tool designed to identify neuromotor or cognitive/behavioral concerns in infants who are healthy or at high risk between the ages of 3 and 12 months. The purpose of this study was to determine whether the HINT could distinguish between infants at high risk and infants at low risk for neuromotor delays. Following HINT administration by trained health care professionals, scores were compared for 54 high-risk infants and 412 low-risk infants with a t test. Mean HINT scores for infants at low risk were lower than mean scores for infants at high risk, as would be expected in that higher scores indicate higher risk. Significant differences were found at 4, 5, 7, and 8 months. At 6 months, there were no significant differences. There were not enough high-risk infants in other subgroups for reliable comparison. The HINT appears to discriminate effectively between infants who are at low risk and infants who are at high risk for neuromotor delays, supporting the use of the HINT as a screening tool for infants in the first year of life.

Is Maternal Education Related to Infant Motor Development?

Because results of previous studies were inconclusive, our purpose was to examine the relationship between maternal education and infant neuromotor development in infants who are healthy and born at term. Secondary analysis of normative data derived through administration of the Harris Infant Neuromotor Test (HINT) to 412 Canadian infants was conducted. Infants were recruited from community-based infant programs, childcare facilities, and homes in five Canadian provinces. Inclusion criteria included: term birth (38-42 weeks), birth weight > or =2500 g, and no history of major prenatal, perinatal, or postnatal medical complications or maternal complications. Infants encompassed Canadian ethnic diversity as well as equal gender distribution at each of 10 monthly age intervals. The analysis demonstrated that maternal education was only minimally associated with infant neuromotor development as measured by HINT total scores. Our results confirmed other researchers' findings of no association between maternal education and infant motor development.

Development and Standardization of the Harris Infant Neuromotor Test

Development and Standardization of the Harris Infant Neuromotor Test

Reliability and validity of the Harris Infant Neuromotor Test

Objective: To examine the reliability and validity of the Harris Infant Neuromotor Test (HINT), a screening tool that can be administered and scored in <30 minutes, with the goal of identifying neuromotor differences in infants aged 3 to 12 months. Study design: Infants, aged 3 to 12 months (n = 54), were assessed in 2 high-risk infant follow-up programs in Vancouver, British Columbia. Inter-rater, test-retest, and intra-rater reliability were examined. Concurrent and predictive validity of the HINT with the Bayley Scales of Infant Development-II (BSID-II) were evaluated by using the Pearson product-moment correlation. Results: Intraclass correlation coefficients for reliability for the Total HINT Score ranged from 0.98 to 0.99. Concurrent validity of the HINT with the BSID-II Mental Scale during the first year was r = –0.73 (P <.01), and with the BSID-II Motor Scale, r = –0.89 (P <.01). The predictive relationships between the HINT and the BSID-II at 17 to 22 months werer = –0.11 for the BSID-II Mental Scale and r = –0.49 (P <.01) for the BSID-II Motor Scale. Conclusions: The HINT is reliable for screening infant neuromotor performance and has strong concurrent validity with the Bayley-II Mental and Motor Scales. HINT scores during the first year accounted for 24% of the variance of Bayley-II Motor scores at 17 to 22 months. (J Pediatr 2001;139:249-53)

Content Validity of the Harris Infant Neuromotor Test

The purpose of this study was to assess the content validity of the Harris Infant Neuromotor Test (HINT), a new screening tool designed to detect early signs of cognitive and neuromotor delays in infants with known risk factors. A multidisciplinary panel of 26 international experts, including researchers and clinicians in physical therapy, occupational therapy, developmental pediatrics, child neurology, and psychology, was selected to assess, review, and suggest modifications to the HINT. A validity questionnaire that was keyed to the three parts of the HINT (background information, parent questionnaire, and infant assessment) and to individual items within each part was mailed to the selected content experts. Data were analyzed using descriptive statistics. Twenty experts completed the validity questionnaires, and the remaining 6 experts provided written comments. The experts generally agreed that the items on the initial development edition of the HINT were clearly worded and free of cultural bias. Based on written feedback, additional background information items were added, a fifth question was added to the parent questionnaire portion, and 20 of the 22 infant assessment items were modified. After receiving questionnaire responses and written comments from a panel of 26 experts, the original version of the HINT was modified and printed as development edition 2 in November 1993. This revised edition is currently being used to examine the reliability and validity of the HINT in assessing infants at risk.