SUMMARY The ages at attainment of 12 gross motor milestones were obtained prospectively during well‐baby visits in the first two years of life for 381 children. All had been born at term and were judged to be normal at one year. A longitudinal analysis, using an index summarising each chilďs progress for eight selected milestones, is reported for the 284 children for whom data were complete. A high percentage of parents were able to report the age at attaining milestones with an acceptable degree of variability. The children attained milestones at earlier ages than traditionally reported. There were only minor sex differences in age at attainment, but black children attained milestones earlier than white children. RÉSUMÉ Développement moteur fondamental normal: influence de la race, du sexe et de la classe socio‐économique Les ǎges oil sont atteints 12 réperes moteurs fondamentaux ont été obtenus prospectivement durant des visites de contrôle de bonne santé dans les deux premières années de la vie, chez 381 enfants. Tous étaient nés a terme et jugés normaux à I'ǎge ďun an. Une analyse longitudinale utilisant un index résumant les progrés de chaque enfant pour huit repéres séléctionnés est rapportée pour les 284 enfants, pour lesquels les données étaient complétes. Un pourcentage éléve de parents ont pu indiquer L'ǎge auquel les repèrés étaient atteints avec un degré acceptable de précision. Les enfants atteignaient les etapés à des ages plus précoces qu'il n'est traditionnellement rapporté. II n'a été rapporte que des différences minimes ďǎge de réussite selon le sexe mais les enfants noirs atteignaient les repéres plus tôt que les enfants blancs. ZUSAMMENFASSUNG Normale allgemein‐molorische Entwicklung: Beeinflussung durch Rasse, Geschlecht und gesellschafllichen Stand Bei 381 Kindern wurde prospektiv bei Kontrolluntersuchungen in den ersten zwei Lebensjahren bestimmt, in welchem Alter die 12 Meilensteine der motorischen Entwicklung erreicht wurden. Alle Kinder wurden zum Termin geboren und im Alter von einem Jahr füesund befunden. Für 284 Kinder, deren Daten vollstandig waren, wird eine Longituinalanalyse gegeben, bei der ein Index verwendet wurde, der den Fortschritt eines jeden Kindes für acht ausgewählte Meilensteine zusammenfaßte. Die meisten Eltern konnten das Alter, mit dem die Meilensteine erreicht wurden, mit nur geringen Abweichungen angeben. Die Kinder erreichten die Meilensteine früher als bisher beschrieben. Es fanden sich nur unwestetliche Geschlechtsunterschiede, aber die schwarzen Kinder erreichten die Meilensteine eher als die weißen. RESUMEN Desarrollo motor grosero normal: influencia de la raza, sexo y nivel socio‐económico Se obtuvieron prospectivamente 12 hitos de consecución de la motilidad no fina en el curso de visitas de puericultura realizadas en 381 niños en los primeros dos años de vida. Todos eran recién nacidos a término eran considerados normales al año de edad. Se muestra un estudio longitudinal, haciendo uso de un indice que resumía los progresos d...

Legislatively mandated programs for early intervention on behalf of handicapped infants often stipulate the inclusion of physical therapy as a major component of treatment for cerebral palsy. To evaluate the effects of physical therapy, we randomly assigned 48 infants (12 to 19 months of age) with mild to severe spastic diplegia to receive either 12 months of physical therapy (Group A) or 6 months of physical therapy preceded by 6 months of infant stimulation (Group B). The infant-stimulation program included motor, sensory, language, and cognitive activities of increasing complexity. Masked outcome assessment was performed after both 6 and 12 months of therapy to evaluate motor quotient, motor ability, and mental quotient. After six months, the infants in Group A had a lower mean motor quotient than those in Group B (49.1 vs. 58.1, P = 0.02) and were less likely to walk (12 vs. 35 percent, P = 0.07). These differences persisted after 12 months of therapy (47.9 vs. 63.3, P less than 0.01, and 36 vs. 73 percent, P = 0.01, respectively). We noted no significant differences between the groups in the incidence of contractures or the need for bracing or orthopedic surgery. Group A also had a lower mean mental quotient than Group B after six months of therapy (65.6 vs. 75.5, P = 0.05). The routine use of physical therapy in infants with spastic diplegia offered no short-term advantage over infant stimulation. Because of the limited scope of the trial, our conclusions favoring infant stimulation are preliminary. The results suggest that further study of the effects of both physical therapy and infant stimulation is indicated.

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This report describes quantitative standardization data on nine primitive reflexes for a cohort of 381 normal infants evaluated longitudinally at each visit between birth and two years of age. Normality was confirmed by the use of the Bayley Scales of Infant Development at one year of age. The standardization of this new examination technique complements the traditional infant neurological examination and may allow primitive reflexes to become a useful adjunct to the prediction of motor disability in early infancy.

Pediatric neuro-AIDS may be the first clinical manifestation of HIV infection in children born to HIV-infected mothers. As part of the neurodevelopmental examination of children, the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was investigated as a tool for pediatricians to use to monitor the development of children at risk for HIV infection. The CAT/CLAMS was found to detect neurodevelopmental differences between HIV-infected and uninfected children at 12 and 18 months of age. Good correlations were found between the CAT/CLAMS and concurrently administered Bayley Scales of Infant Development. These findings suggest that the CAT/CLAMS should be considered as a part of the neurodevelopmental examination of children at risk for pediatric neuro-AIDS.

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An 8-year, 2-month-old African-American boy was infected with HIV through vertical transmission. Regular monitoring of the patient's neurodevelopmental status has been conducted as part of his participation in longitudinal research protocols. For the first 51/2 years of life, his neurodevelopmental status was normal, with cognitive functioning as measured by standardized psychometric tools solidly in the average range. Speech and language skills were age-appropriate. Tests of gross and fine motor functioning as well as evaluation of overall neurodevelopmental status suggested normal development. Magnetic resonance imaging (MRI) of the brain was consistently normal. His family reported that adaptive functioning, peer and family relationships, and behavior were all within normal limits. School reports indicated consistently that the patient was performing at age and grade level, with respect to both academic achievement and behavior. Initial concerns regarding the patient's development were expressed by both his family and school at age 6 years, 6 months. These concerns included difficulty with classroom work, decreased attention, word-finding problems, fatigue, staring spells, and loss of strength. His family and school reported a marked loss of skills acquired previously. Results of formal psychological and speech and language evaluation reflected statistically significant drops in test scores from baseline, with both delayed and atypical skills evident. The patient's condition worsened rapidly. Within a few months, he was no longer able to use sentences to communicate. Cognitive testing was attempted, but he was unable to participate because of significant fatigue, limited attention, and inability to communicate verbally. His family described periods of disorientation and confusion, lethargy, and disinterest in age-appropriate activities. He became agitated and overstimulated easily both in small group settings and in crowds. He demonstrated both fine and gross motor impairments. When frustrated, he displayed infantile and autistic-like behavior. MRI with contrast showed diffuse atrophy as well as mild prominence of the ventricles and sulcii compared with baseline assessment. In addition to fatigue and neurologic symptoms, wasting syndrome was diagnosed, with loss of percentiles in both weight and height by age 71/2 years. Low-grade elevation of liver function tests and amylase was noted. Blood cultures for mycobacteria were negative, as were serologic tests for hepatitis. (ABSTRACT TRUN

SUMMARY At each well‐child examination between birth and two years, parents of 448 infants were questioned about their child's age at attainment of 25 linguistic and auditory milestones. Parental reports were compared with the results of independently administered Bayley Mental Developmental Index (MDI) at one year of age. Parental recall of information was high, ranging from 70 to 99 per cent for 21 of the 25 milestones. The milestone performance of infants with normal MDI scores showed an orderly, sequential progression of expressive and receptive language. Across the entire population studied, the correlation between milestone attainment and MDI was statistically significant for 24 of the 25 milestones, and later attainment of milestones correlated with lower MDI. As a group, ‘delayed’ infants (MDI <68) attained milestones significantly later than ‘average’ infants (MDI 85 to 116) for 20 of 25 items. Attention to linguistic and auditory milestones early in infancy can contribute to the early detection and diagnosis of mental retardation and disorders of communication. RÉSUMÉ Echelle de compétence linguistique clinique et auditive: prédiction du niveau de connaissance durant la première enfance A chaque examen systématique d'enfants depuis la naissance jusqu'à l'âge de deux ans, les parents de 448 nourrissons ont été interrogés sur l'âge auquel étaient apparus 25 repères de developpement linguistique et auditif. Les dires des parents ont été comparés aux résultats d'un Index de Développement Mental de Bayley (MDI) administré indépendamment a l'âge d'un an. Le rappel d'informations chez les parents était élevé allant de 70 à 99 pour cent pour 21 des 25 repères. La réalisation des repères chez les nourrissons présentant des scores MDI normaux révélait une progression ordonnée, séquentielle du langage dans ses aspects d'expression et de compréhension. Sur la population totale étudiée, la corrélation entre l'âge de réalisation des repères et le MDI était statistiquement significative pour 24 des 25 repères et une atteinte plus tardive des repères était corrélèe avec un MDI plus bas. En tant que groupe, les enfants ‘retardés' (MDI plus petit que 68) atteignaient les repères significativement plus tard que les enfants ‘moyens' (MDI de 85 à 116) pour 20 des 25 items. Une attention apportée aux repères linguistique et auditif précocément durant la première enfance peut contribuer au dépistage précoce et au diagnostic de retard mental et de troubles de la communication. ZUSAMMENFASSUNG Sprachliche und akustische Entwicklungsstufen: prognostische Aussage zur Wahrnehmung im Kindesalter Bei jeder Vorsorgeuntersuchung von der Geburt bis zum zweiten Lebensjahr wurden die Eltern von 448 Kindern befragt, wann ihr Kind die 25 sprachlichen und akustischen Entwicklungsstufen erreicht hatte. Die elterlichen Angaben wurden mit dem unabhängig davon bestimmten Bayley Mental Developmental Index (MDI) im Alter von einem Jahr verglichen. Das Erinnerungsvermögen der Eltern für diese Informationen war hoch, im Durchschnitt 70 bis 99 Proze...