Research

Bailey DB Jr, Hebbeler K, Spiker D, Scarborough A, Mallik S, Nelson L. Thirty-six-month outcomes for families of children who have disabilities and participated in early intervention. Pediatrics. 2005; 116(6): 1346-52.
This study assessed family outcomes at the end of early intervention (near the child’s third birthday). Results suggest that early intervention provides important supports for families of young children with disabilities.

Bear LM. Early identification of infants at risk for developmental disabilities. Pediatric Clinics of North America. 2004; 51(3): 685-701.
This article describes why early identification of infants at risk for developmental delay is of the utmost importance to initiate appropriate intervention. Although early detection can be a challenge, the primary care practitioner is in the ideal position to recognize and refer these children.

Blauw‐Hospers CH, Hadders‐Algra M. A systematic review of the effects of early intervention on motor development. Developmental Medicine & Child Neurology. 2005; 47.6: 421-432.
This systematic review studies the effect of early intervention, starting between birth and a corrected age of 18 months, on motor development in infants at high risk for, or with, developmental motor disorders. Authors concluded the type of intervention that might be beneficial for infants at preterm age differs from the type that is effective in infants who have reached at least term age. Preterm infants seem to benefit most from intervention that aims at mimicking the intrauterine environment, such as NIDCAP intervention. After term age, intervention by means of specific or general developmental programs has a positive effect on motor development.

Broomfield J, Dodd B. Is speech and language therapy effective for children with primary speech and language impairment? Report of a randomized control trial. International Journal of Language & Communication Disorders. 2011; 46.6: 628-640.
The study considered outcomes of treatment versus no treatment. The study found that an average of 6 hours of speech and language therapy in a 6-month period can produce significant improvement in performance, and it has been shown to be more effective than no treatment over the same 6-month period for children with primary speech and/or language impairment. Moreover, speech and language therapy intervention is demonstrated as being more effective than no intervention for children with primary speech and/or language impairment.

Edwards SL, Sarwark JF. Infant and Child Motor Development. Clinical Orthopaedics & Related Research. 2005; 434: 33-39.
An emphasis has been placed on early detection and referral for intervention, which has been shown to enhance the lives of the infant or child and his or her family. Appropriate recognition of delay is necessary for referral to early intervention services, which serve to help these children overcome or improve motor dysfunction and to help families grow more confident in caring for children with special needs.

Fucile S, Gisel EG. Sensorimotor interventions improve growth and motor function in preterm infants. Neonatal Network: The Journal of Neonatal Nursing. 2010; 29.6: 359-366.
This study assessed the effect of an oral, a tactile/kinesthetic, and a combined intervention on preterm infants’ weight gain and motor function and to determine whether the combined intervention has an additive/synergistic effect on outcomes. Authors concluded that single and combined interventions improved growth and motor function. The combined intervention, because of the shorter duration of each modality, did not lead to additive/synergistic effects, suggesting that the duration of the sensorimotor input is as important as its target in achieving defined outcomes.

Kirk MA, Rhodes RE. Motor skill interventions to improve fundamental movement skills of preschoolers with developmental delay. Adapt Phys Activ Q. 2011; 28(3):210-32.
The purpose of this review was to critically appraise the existing interventions to establish direction for future trials targeting preschoolers with a developmental delay. This review supports the utility of interventions to improve fundamental movement skills of preschoolers with developmental delay.

McManus BM, Kotelchuck M. The Effect of Aquatic Therapy on Functional Mobility of Infants and Toddlers in Early Intervention. Pediatric Physical Therapy. 2007; 19.4: 275-282.
The purpose of this study was to determine the effect of aquatic therapy (AT) as an adjunct to home-based early intervention (EI) on differences in children’s functional mobility. Authors concluded that AT is a useful adjunct to EI to improve children’s functional mobility.

Moeller MP. Early Intervention and Language Development in Children Who are Deaf and Hard of Hearing. Pediatrics. 2000; 106(3): 1-9.
This study examined the relationship between age of enrollment in intervention and language outcomes at 5 years of age in a group of deaf and hard-of-hearing children. Significantly better language scores were associated with early enrollment in intervention. High levels of family involvement correlated with positive language outcomes, and, conversely, limited family involvement was associated with significant child language delays at 5 years of age, especially when enrollment in intervention was late. The results suggest that success is achieved when early identification is paired with early interventions that actively involve families.

Petronic I, et al. Congenital muscular torticollis in children: distribution, treatment duration and outcome. European Journal of Physical and Rehabilitation Medicine. 2010; 46.2: 153.
This study evaluated the proportion of left and right congenital muscular torticollis (CMT) in both genders and age groups of the patients as well as to evaluate the duration of physical therapy and treatment outcome in observed population. Authors concluded that torticollis is frequent in both genders and age groups. Younger children have lower treatment duration and better treatment outcome.

Scherzer AL, et al. Global perspective on early diagnosis and intervention for children with developmental delays and disabilities. Developmental Medicine & Child Neurology. 2012; 54.12: 1079-1084.
This review finds that early diagnosis and intervention programs are essential to ameliorate developmental delays and disabilities, and are feasible in developing countries and organizations. The authors state the incorporation of early evaluation and intervention programs into routine pediatric care is likely to have the most impact on the quality of life of these children.

van Vlimmeren LA, et al. Effect of pediatric physical therapy on deformational plagiocephaly in children with positional preference: a randomized controlled trial. Archives of Pediatrics & Adolescent Medicine. 2008; 162.8: 712.
Findings from this study indicate a 4-month standardized pediatric physical therapy program to treat positional preference significantly reduced the prevalence of severe deformational plagiocephaly compared with usual care.

Williams J, Holmes CA. Improving the early detection of children with subtle developmental problems. J Child Health Care. 2004; 8(1): 34-46.
Findings from this review article indicate early identification is one of the challenges facing health visitors or child health nurses. Authors suggest that if they can utilize the knowledge and experience of parents, the opportunities for early identification and intervention would be dramatically improved.

Language Development in Typically Developing Infants and Children

Fagan MK. Mean length of utterance before words and grammar: longitudinal trends and developmental implications of infant vocalizations. J Child Lang. 2009; 36(3): 495-527.
In this study, researchers measured developmental changes in various types of infant utterances, and found that changes occur in predictable ways with regards to both age and language milestones. Results led to new perspectives on the processes underlying the transition from babbling to first words.

Iverson JM. Developing language in a developing body: the relationship between motor development and language development. J Child Lang. 2010; 37(2): 229-261. 
This review article contends that motor acquisitions provide infants with an opportunity to practice skills relevant for communication development and language acquisition before they are needed for that purpose.

Kuhl, Patricia. Early language acquisition: cracking the speech code. Nat Rev Neurosci. 2004; 5(11): 831-843.
Early language acquisition is constrained at the perceptual, computational, social, and neural levels. The author concludes that identifying the constraints and determining whether those constraints reflect innate language-specific or general knowledge will be the focus of future research on language learning.

Lyytinen, P., Laakso, M.-L., Poikkeus, A.-M. and Rita, N. The development and predictive relations of play and language across the second year. Scand J Psychol. 2008; 40(3): 177–186.
Results from this study show that vocabulary production and symbolic play at 14 months and language outcomes at 18 months are predictive of language and cognitive skills at 2 years.

Mayberry R, Nicoladis E. Gesture reflects language development: evidence from bilingual children. Psychol Sci. 2000; 9(6): 192-196.
This study explored the relationship between gesture and language development in French-English bilingual children from 2 to 3.5 years old. Researchers found that the onset of iconic and beat gestures coincided with the onset of sentence-like utterances separately in each of the children’s two languages, supporting the idea that gesturing is not independent from language development.

Nip IS, Green JR, Marx DB. Early speech motor development: cognitive and linguistic considerations. J Commun Disord. 2009; 42(4): 286-98.
The goal of this study was to examine the developmental trajectories of various orofacial movements during the early stages of language acquisition. Silent spontaneous movements were consistently slower than those for babble and words, suggesting that linguistic and cognitive processing demands affect speech-related movements.

Nip IS, Green JR, Marx DB. The co-emergence of cognition, language, and speech motor control in early development. J Commun Disord. 2011; 44(2): 149-60.
This article presents preliminary evidence of the interaction between cognition, language, and speech motor skills during early development. Further work is needed to identify and quantify causal relationships among co-emerging skills in these domains.

Stark RE, Rose SN, McLiagan M. Features of infant sounds: the first eight weeks of life. J Child Lang. 1975; 2: 205–221.
In this study, researchers recorded the vocalizations of two girls between one and eight weeks of age, and found particular features that appeared to be highly typical of cry and discomfort sounds, and others typical of vegetative sounds.

Tsao FM, Liu HM, Kuhl PK. Speech perception in infancy predicts language development in the second year of life: longitudinal study. Child Dev. 2004; 75(4): 1067-1084.
Results from this study demonstrate that speech perception performance at 6 months predicts receptive and expressive language skills at 2 years, supporting the idea that phonetic perception may play a key role in language acquisition.

Wetherby AM, Rodrigues GP. Measurement of communicative intentions in normally developing children during structured and unstructured contexts. J Speech Lang Hear Res. 1992; 35(1): 130-139.
The purpose of this study was to examine the effect of sampling context on measurements of expressive language by typically-developing children during various stages of linguistic development. Authors found that the production of requests and comments increased significantly from the prelinguistic stage to the multiword stage in both structured and unstructured contexts. Furthermore, significantly more requests were produced during the structured context.

Language Development in Atypically Developing Infants & Children

Eilers RE, Oller DK. Infant vocalizations and the early diagnosis of severe hearing impairment. J Pediatr. 1994; 124(2): 199-203.
Findings from this study indicate that infants with normal hearing produce canonical vocalizations before 11 months of age, while infants with severe to profound hearing loss do not produce these vocalizations until they are 11 months of age or older. Authors conclude that otherwise healthy infants who do not produce canonical babbling by 11 months of age are likely at risk for hearing impairment, and should promptly be referred for audiologic evaluation.

Kent RD, Osberger MJ, Netsell R, Hustedde C. Phonetic development in identical twins differing in auditory function. J Speech Lang Hear Res. 1987; 52: 64-75.
This study compared the vocal development of twin boys: one with normal hearing and the other with profound bilateral hearing loss. Researchers collected vocal samples at 8, 12, and 15 months, and found acoustic-phonetic differences between them at each age. Authors discuss the implications of this study for the early identification of infants at risk for communication disorders.

Laing, E., Butterworth, G., Ansari, D., Gsödl, M., Longhi, E., Panagiotaki, G., Paterson, S. and Karmiloff-Smith, A.  Atypical development of language and social communication in toddlers with Williams syndrome. Developmental Science. 2002; 5(2): 233–246. 
The purpose of this study was to examine the social and interactive precursors to language that may contribute to late language onset and atypical linguistic development in toddlers with Williams syndrome (WS). Researchers found that toddlers with WS were impaired in triadic interactions and the comprehension and production of referential pointing.

Lieberman, A, HAtrak M, Mayberry R. Learning to look for language: Development of joint attention in young deaf children. Language Learning and Development. 2013: 10(1); 19-35.
Study of four deaf children during interactions with their deaf mothers. Gaze patterns observed in deaf children were not observed in a control group of hearing children, indicating that modality-specific patterns of joint attention behaviors emerge when the language of parent-infant interaction occurs in the visual mode.

Levin K. Babbling in infants with cerebral palsy. Clin Linguistic Phon. 1999; 13(4): 249-267.
This report describes the development of babbling in eight 1-year-old infants with cerebral palsy. Most subjects showed a delay in the onset of canonical babbling, and all subjects had a limited phonetic repertoire and only produced monosyllabic utterances. Study investigators believe these findings challenge the idea of babbling as a robust phenomenon and justify early intervention.

Mitchell S, Brian J, Zwaigenbaum L, Roberts W, Szatmari P, Smith I, Bryson S. Early language and communication development of infants later diagnosed with autism spectrum disorder. J Dev Behav Pediatr. 2006; 27(2): S69-S78.
This study confirms that delays in communication and language development can be identified early in children with ASD. Authors suggest that developmental surveillance should include monitoring for delays in gesture production, which may be among the earliest signs of ASD.

Nathani S, Oller DK, Neal AR. On the robustness of vocal development: An examination of infants with moderate-to-severe hearing loss and additional risk factors. J Speech Lang Hear Res. 2007; 50(6): 1425-1444.
Researchers evaluated vocal development in four infants with moderate-to-severe hearing loss. Subjects showed some delay in the onset of babbling, though the delay was much less than that observed in infants with deafness. Authors suggest further investigation of the effects of varying degrees of hearing loss on vocal development.

Polisenska, K, Kapalkova S. Language profiles in children with Down Syndrome and children with Language Impairment: Implications for early intervention. Research in Developmental Disabilities. 2014: 35(2); 373-82.
This study compared early language profiles of children with Down Syndrome or Language Impairment to typically developing children. Findings suggest that language intervention should be tailored to specific etiologies rather than focus on general communication strategies.

Rvachew S, Creighton D, Feldman N, Sauve R. Vocal development of infants with very low birth weight. Clin Linguist Phon. 2005; 19(4): 275-294.
This article describes the vocal development of healthy infants, relatively healthy pre-term infants with very low birth weights (VLBW), and pre-term infants with VLBW and bronchopulmonary dysplasia (BPD). At 18 months, pre-term infants with BPD had significantly smaller expressive vocabulary sizes than healthier pre-term infants and healthy full-term infants.

Sauer E, Levine S, Goldin-Meadow S. Early gesture predicts language delay in children with pre- or perinatal brain lesions. Child Dev. 2010; 81(2): 528-539.
In this study, researchers examined language outcomes in 11 children with pre- or perinatal unilateral brain lesions (PL) who produced a varying range of gestures at 18 months. The study authors found that gesture production at 18 months was predictive of language outcomes at 30 months for children with PL, suggesting that gesture may be a promising diagnostic tool for persistent language delays.

St. Clair MC, Pickles A, Durkin K, Conti-Ramsden G. A longitudinal study of behavioral, emotional, and social difficulties in individuals with a history of specific language impairment (SLI).  J Commun Disord. 2011; 44(2): 186-199.
This report found that individuals with a history of SLI have poorer long-term social and emotional outcomes, while behavioral difficulties seem to decrease by adolescence. Reading skills and expressive language were linked to behavioral problems, while pragmatic skills were related to difficulties in all three domains.

Tek S, Mesite L, Fein D. Longitudinal analyses of expressive language development reveal two distinct language profiles among young children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders. 2014: 44; 75-89.
In this study, researchers found that children with ASD present two distinct language profiles. Children with ASD who had higher verbal skills were comparable to typically developing children on most language measures, while children with ASD who had low verbal skills had flatter trajectories in most language measures.

Thal D, Tobias S, Morrison D. Language and gesture in late talkers: A 1-year follow-up. J Speech Lang Hear Res. 1990; 34: 604-612.
This purpose of this study was to explore language performance in children identified as late talkers. Children who eventually displayed persistent language delays showed early delays in language comprehension, and performed worse on gesture-related tasks compared to late talkers who eventually caught up to their peers.

Facilitating Language Development in Infants & Children

Bernhardt BM, Kemp N, Werker JF. Early word-object associations and later language development. First Language. 2007; 27(4): 315-328.
This study found that word-object association performance at 17 or 20 months, measured by the Switch task, was related to scores on standardized tests of language comprehension and production up to two and a half years later. The authors believe these findings warrant further investigation of the Switch task as a tool for the early identification of language delays.

DeThorne LS, Johnson CJ. When “Simon Says” doesn’t work: Alternatives to imitation for facilitating early speech development. Am J Speech Lang Pathol. 2009;1 8: 133-145.
This article provides health professionals with six evidence-based strategies to facilitate early speech development in young children who are not readily imitating sounds.

Kidd C, White KS, Aslin RN. Toddlers use speech disfluencies to predict speakers’ referential intentions. Developmental Science. 2011; 14(4): 925-934.
In this study, researchers found that 2-year-old children were able to use speech disfluencies (i.e. filled pauses ‘uh’ and ‘um’) to determine a speaker’s intended referent.

Goodwyn SW, Acredolo LP, Brown CA. Impact of symbolic gesturing on early language development. J Nonverbal Behav. 2000; 24(2): 81-103.
This study assessed the effect of encouraging the production of symbolic gestures on verbal language development in hearing 11-month-old infants. Authors concluded that the use of symbolic gestures does not impede, and may in fact facilitate, verbal development.

Jones HA, Horn EM, Warren SF. The effects of motor skill acquisition on the development of intentional communication. J Early Interv. 1999; 22(1): 25-37.
Researchers evaluated the effect of motor skills intervention on communication development in four young children with neuromotor impairments. All four subjects increased communication behaviors after intervention, and maintained this trend during the follow-up period. Authors conclude that motor skills training has a stable effect on the development of communication skills.

Jones SS. Imitation or exploration? Young infants’ matching of adults’ oral gestures. Child Dev. 1996; 67(5): 1952-1969.
In this study, researchers explored the motivation behind infants’ tongue protrusions in response to adults’ tongue protrusions, a reaction often interpreted as imitation. Results indicate that this reaction may actually be a reflection of visual interest and oral exploration.

Lebedeva GC, Kuhl PK. Sing that tune: Infants’ perception of melody and lyrics and the facilitation of phonetic recognition in songs. Infant Behav Dev. 2010; 33(4): 419-430.
Researchers assessed 11-month-old infants’ perception of phonetic content and pitch content in songs, and found that phonetic information takes precedent over pitch. Furthermore, they found that exaggerated pitch patterns in songs may facilitate recognition of the phonetic information within them.

Legerstee M, Markova G. Variations in 10-month-old infant imitation of people and things. Infant Behav Dev. 2007; 31(1): 81-91.
This study evaluated 10-month-old infants’ abilities to imitate the actions of human and non-human agents (stuffed animal). Authors conclude that although infants are able to superficially mimic the actions of both humans and non-human agents, they only engage in intentional imitation with people.

Whitehurst GJ, Falco FL, Lonigan CJ, Fischel JE, DeBaryshe BD, Valdex-Maenchaca MC, Caulfield M. Accelerating language development through picture book reading. Dev Psychol. 1988; 24(4): 552-559.
In this study, a group of parents were instructed to change their picture book reading habits (i.e. asking more open-ended questions) with their child for one month. Children whose parents changed their reading routine accordingly scored higher on expressive language tests, and had a higher mean length of utterance, higher frequency of phrases, and lower frequency of single words compared to children in the control group. Differences between the two groups persisted after 9 months.

Early Identification & Intervention for Communication Delays & Disorders

Conner J, Kelly-Vance L, Ryalls B, Friehe M. A play and language intervention for two-year-old children: implications for improving play skills and language. Journal of Research in Childhood Education. 2014; 28(2): 221-37.
Results of this study show that typically-developing two-year-old children who received play and language intervention over a four-week period increased pretend play, comprehension skills, and expressive communication skills more than children in the control group.

Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, and Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics. 2006; 118(1): 405-420.
This article provides health professionals with a strategy for identifying infants and young children with developmental difficulties. The authors recommend incorporating developmental surveillance methods at every well-child visit, addressing concerns raised during surveillance with standardized developmental screening tests, and administering routine screening tests at the 9, 18, and 30 month visits.

Eadie AP, Ukoumunne O, Skeat J, Prior MR, Bavin E, Bretherton L, Reilly S. Assessing early communication behaviours: structure and validity of the Communication and Symbolic Behaviour Scales  – Developmental Profile (CSBS-CP) in 12-month-old infants. Int J Lang Commun Disord. 2010; 45(5): 572-595.
The purpose of this study was to investigate the validity of the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DP) in 12-month old infants. Authors concluded that the Infant-Toddler Checklist and Behavior Sample were valid clinical tools for measuring communication skills in this population.

Ellis EM, Thal DJ. Early language delay and risk for language impairment. Perspect Lang Learn Educ. 2008; 15(3): 93-100.
This review addresses the diagnostic challenge posed by late talkers, who may or may not eventually catch up to their peers.  Findings from this study suggest that children with a family history of language impairment, a delay in both vocabulary comprehension and production, and little to no use of non-verbal communication are at the greatest risk for continued language delay.

Fagan MK, Montgomery TR. Managing referrals for children with receptive language delay. Clin Pediatr. 2009; 48(1): 362-368.
Results from this study indicate that young children’s receptive language scores may predict cognitive performance. The authors recommend considering a referral for additional cognitive evaluation for children whose receptive language standard scores fall below 85.

Feldman HM. Evaluation and management of language and speech disorders in preschool children. Pediatr Rev. 2005; 26: 131-142.
Pediatric providers play a key role in the detection, evaluation, and management of children with language delays and disorders. For children with significant delays, the authors recommend a full audiologic assessment, a comprehensive developmental assessment for those with additional cognitive or social difficulties, or a speech-language evaluation for children who have no other difficulties.

Gulsrud A, Hellemann G, Freeman S, Kasari C. Two to ten years: developmental trajectories of joint attention in children with ASD who received targeted social communication interventions. Autism Research. 2014: 7(2); 207-15.
Study of 40 children in a randomized controlled early intervention trial from early childhood (2-5 years) to elementary school age (8-10 years). Children grouped by diagnosis at last follow-up. Results showed that joint attention skills increased over time, and pointing to shared interest increased over the first year measured and decreased thereafter. Study highlights longitudinal and developmental importance of measures of early core deficits in autism, and suggests that both treatment and ASD symptomatology may influence growth in these skills over time.

Herbert M, Kehayia E, Prelock P, Wood-Cauphinee S, Snider L. Does occupational therapy play a role for communication in children with autism spectrum disorders? International Journal of Speech-Language Pathology. 2014: (online only).
Study examines how occupational therapists can work with children with ASD to become better communicators. The research finds 3 roles of occupational therapy : developing non-verbal and verbal communication pre-requisites, adapting the setting, educating-partnering-advocating for the child, and providing occupation-based intervention.

Moeller MP. Early intervention and language development in children who are deaf and hard of hearing. Pediatrics. 2000; 106(3): 1-9.
This study examined the relationship between age of enrollment in intervention programs and language outcomes at 5 years of age in children with hearing loss. Findings suggest that both early enrollment in intervention and active family involvement are associated with better language scores in this population.

Nathani S, Ertmer DJ, Stark RE. Assessing vocal development in infants and toddlers. Clin Linguistic Phon. 2006; 20(5): 351-369.
The purpose of this study was to examine changes in vocal production in the first 20 months of life. The infant vocalizations were grouped into five levels using the Stark Assessment of Early Vocal Development-Revised (SAEVD-R), and the findings demonstrate that the SAEVD-R is a valuable tool for evaluating early vocal development.

Roberts M, Kaiser A. The effectiveness of parent-implemented language interventions: A meta-analysis. Am J Speech Lang Pathol. 2011; 20: 180-199.
This meta-analysis evaluated the effects of parent-implemented language interventions in language-impaired children between 18 and 60 months of age. Based on a review of 18 studies, authors found that parent-implemented interventions have a significant and positive impact on children’s receptive and expressive language skills.

Sachse S, Suchodoletz WV. Early identification of language delay by direct language assessment or parent report? J Dev Behav Pediatr. 2008; 29(1): 34-41.
The goal of this study was to compare the accuracy of parent reports and direct language assessments for the early identification of children with language delays. Findings from the study indicated that parent report measurements were comparable to those of direct language assessments, and there were no significant differences in accuracy concerning the prediction of language delays in children by age 3.

Webb, SJ, Jones EJ, Kelly J, Dawson G. The motivation for very early intervention for infants at high risk for autism spectrum disorders. International Journal of Speech-Language Pathology. 2014: 16(1); 36-42.
Researchers designed an intervention to promote early social development in order to steer brain development back toward the normal trajectory and remit or reduce the expression of ASD symptoms. Additional evidence is needed to evaluate treatment models. *when* to intervene is an unsolved issue in ASD research.

Zimmerman IL, Castilleja NF. The role of a language scale for infant and preschool assessment.  Ment Retard Dev Disabil Res Rev. 2005; 11: 238–246.
The Preschool Language Scale (PLS-4) is used to assess developmental language patterns in children from birth to 6 years 11 months. This study confirms that the PLS-4 is a valuable tool to 1) identify current receptive and expressive language skills and 2) measure changes in language skills over time.

Effectiveness of Sensory Integration Theory

Addison LR, Piazza CC, Patel MR, Bachmeyer MH, Rivas KM, Milnes SM, Oddo J. A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders. Journal of Applied Behavior Analysis. 2012; 45(3): 455-71.
This study about children with feeding issues concludes that behavioral and SI therapy used together can build the variety and amount of food the child will eat, while minimizing inappropriate behavior. Suggested behavioral therapy includes working around a child’s efforts to avoid eating (example: leaving a spoon on lips until food goes into child’s mouth) and periodically offering positive reinforcement.

American Occupational Therapy Association. Providing occupational therapy using sensory integration theory and methods in school-based practice. American Journal of Occupational Therapy. 2009; 63(6): 437-456.
This article states that when children demonstrate sensory related deficits impacting their ability to participate in general education curriculum, occupational therapy using an SI approach is appropriate at school.

Ayres AJ, Tickle LS. Hyper-responsivity to touch and vestibular stimuli as a predictor of positive response to sensory integration procedures by autistic children. American Journal of Occupational Therapy. 1980; 34(6): 375–381.
Results of this post SI therapy study of children with autism indicate that children who registered sensory input but could not adjust to it responded better to therapy than those who were under responsive to sensory input.

Ayres AJ. Effect of sensory integrative therapy on the coordination of children with choreoathetoid movements. American Journal of Occupational Therapy. 1977; 31(5): 291–293.
This study affirms that children with learning issues, SI deficits and choreoathetosis (involuntary movements) who received SI therapy developed better eye to hand coordination.

Horowitz LJ, Oosterveld WJ, Adrichem R. Effectiveness of sensory integration therapy on smooth pursuits and organization time in children. Pediatrie und Grenzgebiet. 1993; 31(5): 331–344.
After months of SI therapy focused on eye movement, tracking and learning time for children with SI issues, this study recorded significant reduction in impaired eye movement as well as time to complete organizational activities.

Kimball JG. Using the sensory integration and praxis tests to measure change: A pilot study. American Journal of Occupational Therapy. 1990; 44(7): 603–608.
In this study, boys age 6 to 8 were pretested and post tested with Sensory Integration and Praxis Tests (SIPT), before and after 6 months of occupational therapy. Most boys showed significant SI improvements. Author suggests that SIPT is useful for documenting client improvements based on SI therapy.

Lane SJ, Schaaf RC. Examining the neuroscience evidence for sensory-driven neuroplasticity: implications for sensory-based occupational therapy for children and adolescents. The American Journal of Occupational Therapy. 2010; 64.3: 375-390.
Authors determined there is sufficient evidence, based on review of science literature published from 1964 to 2005, to support Dr. A. Jean Ayres’ SI theory. Results reinforce neuroplasticity, which promotes exploration of how the brain can change throughout life.

Linderman TM, Stewart KB. Sensory integrative-based occupational therapy and functional outcomes in young children with pervasive developmental disorders: A single-subject study. American Journal of Occupational Therapy. 1999; 53(2): 207–213.
In this study, two boys age 3 with pervasive developmental disorders (PDD) which involves inability to socialize, communicate and use imagination, displayed significant post therapy improvements. These findings support SI based occupational therapy to help children with PDD.

May-Benson TA, Koomar JA.. Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. American Journal of Occupational Therapy. 2010; 64(3): 403-414.
Based on a review of 27 studies about SI intervention for children with difficulty processing and integrating sensory information, authors verify that SI approach can result in positive outcomes.

Miller LJ, Coll J, Schoen S. A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. American Journal of Occupational Therapy. 2007; 61(2): 228-38.
This pilot study suggests that occupational therapy with SI approach can improve skills of children with sensory modulation disorder (exaggerated or insufficient response to sensory environment, or constant sensory seeking).

Miller LJ, Kinnealey M. Researching the effectiveness of sensory integration. Sensory Integration Quarterly. 1993; 21: 2.
Authors note that the effectiveness of SI therapy cannot be answered in an isolated study, but will require collaborative, longitudinal studies with a variety of subjects.

Miller LJ, Schoen SA, James K, Schaaf RC. Lessons learned: A pilot study on occupational therapy effectiveness for children with sensory modulation disorder. American Journal of Occupational Therapy. 2007; 61(2): 161–169.
Multiple pilot studies are still needed to test the effectiveness of OT-SI in children with sensory processing disorders.

Paul S, Sinen P, Johnson J, Latshaw C, Newton J, Nelson A, et al. The effects of a sensory motor activities protocol based on the theory of sensory integration on children diagnosed with pre-primary impairments. Occupational Therapy in Health Care. 2003; 17(2): 19-33.
Researchers evaluated effectiveness of the Sensory Integrative Treatment Protocol (SITP) for children with early impairments. The results of this study indicate that SITP is effective in reducing SI issues and helping young children improve preschool performance.

Pfeiffer BA, et al.. Effectiveness of sensory integration interventions in children with autism spectrum disorders: A pilot study. The American Journal of Occupational Therapy. 2011; 65.1: 76-85.
To determine how to create trial research, identify outcome and address effectiveness of SI intervention for children with autism spectrum disorders (ASD), in this study children with ASD received fine motor or SI treatment which resulted in significant decrease in autistic mannerisms for children who received SI treatment.

Schaaf RC, Benevides TW, Kelly D, Mailloux-Maggio Z . Occupational therapy and sensory integration for children with autism: a feasibility, safety, acceptability and fidelity study. Autism. 2012; 16(3): 321-7.
For this study, children with autism spectrum disorder received occupational therapy using SI principles. The authors conclude that intervention is safe and feasible and it is acceptable to parents and therapists. Therapists were able to implement accurate and appropriate SI therapy procedures.

Schaaf RC, Nightlinger KM. Occupational therapy using a sensory integrative approach: a case study of effectiveness. American Journal of Occupational Therapy. 2007; 61(2): 239-46.
The findings from this case study provide preliminary evidence supporting sensory integration theory and the effectiveness of sensory integration therapy.

Smith SA, Press B, Koenig KP, Kinnealey M. Effects of sensory integration intervention on self-stimulating and self-injurious behaviors. American Journal of Occupational Therapy. 2005; 59(4): 418-425.
Involving individuals ages 8 to 19 with developmental delays and mental challenges, this study suggests that occupational therapy using SI approach helps reduce self stimulation behaviors, enabling inclusion in everyday activities.

Watling RL, Dietz J. Immediate effect of Ayres’s sensory integration-based occupational therapy intervention on children with autism spectrum disorders. American Journal of Occupational Therapy. 2007; 61(5):574-83.
This study concludes that positive outcomes of SI based occupational therapy for children with autism spectrum disorders are most evident during treatment sessions, and at home.

Wuang YP, Wang CC, Huang MH, & Su CY. Prospective study of the effect of sensory integration, neurodevelopmental treatment, and perceptual-motor therapy on the sensorimotor performance in children with mild mental retardation. American Journal of Occupational Therapy. 2009; 63(4): 441-52.
This study concludes that intervention involving SI therapy, neurodevelopmental treatment, and perceptual motor (PM) approach improves sensorimotor functions for children with mild mental challenges. (PM skills are movement related and largely responsible for an individual’s ability to engage in athletic activities and interact with his or her environment.)

Sensory Integration/Processing Effect on Learning

Ayres AJ. Effect of sensory integrative therapy on the coordination of children with choreoathetoid movements. American Journal of Occupational Therapy. 1977; 31(5): 291–293.
This study affirms that children with learning issues, SI deficits and choreoathetosis (involuntary movements) who received SI therapy developed better eye to hand coordination.

Ayres AJ. Improving academic scores through sensory integration. Journal of Learning Disabilities. 1972; 5(6):338–343.
This article explains how a group of children with learning issues improved academic test performance after involvement in an SI intervention program. Children with auditory language problems, and others with more generalized issues, made most significant gains.

Hoehn TP, Baumeister AA. A critique of the application of sensory integration therapy to children with learning disabilities. Journal of Learning Disabilities. 1994; 27(6): 338–350.
The present article critically examines the related issues of whether children with learning disabilities differentially exhibit concomitant problems in sensory integration, and whether such children are helped in any way by means specific to SI therapy.

Humphries T, Wright M, McDougall B, Vertes J. The efficacy of sensory integration therapy for children with learning disability. Physical and Occupational Therapy in Pediatrics. 1990; 10(3): 1–17.
This study identifies SI therapy as effective in providing significant gains for children with learning and SI issues, compared with perceptual motor training (a series of physical activities to help a child’s gaps get filled in their information processing system).

Humphries T, Wright M, Snider L, McDougall B. A comparison of the effectiveness of sensory integrative therapy and perceptual–motor training in treating children with learning disabilities. Developmental and Behavioral Pediatrics. 1992; 1: 31–40.
Perceptual motor training and sensory integration therapy were shown to be effective compared to no treatment in children with learning disabilities and sensory integrative dysfunction.

Koenig KP, Rudney SG. Performance challenges for children and adolescents with difficulty processing and integrating sensory information: A systematic review. American Journal of Occupational Therapy. 2010; 64(3): 430-442.
Results suggest that children and adolescents with sensory integration difficulties exhibit functional performance difficulties in key areas of occupation. However, further study is needed to tie difficulties to specific sensory and motor issues.

Mangeot SD, Miller LJ, McIntosh DN, Mc-Grath-Clarke J, Simon J, Hagerman RJ, Goldson E. Sensory modulation dysfunction in children with attention-deficit-hyperactivity disorder. Developmental Medicine and Child Neurology. 2001; 43: 399-406.
This study investigates presence of sensory modulation dysfunction (intense sensation seeking or sensory avoidance to harmless sensory input) in children with ADHD. Study findings underline the importance of considering sensory processing abilities in children with ADHD.

Marco EJ, Khatibi K, Hill SS, Siegel B, Arroyo MS, Dowling AF, Neuhaus JM, Sherr EH, Hinkley, LNB, Nagarajan, SS . Children with autism show reduced somatosensory response: An MEG study. Autism Research. 2012; 5: 340-351.
This study examines the somatosensory cortical responses in children with autism and suggests that early differences in somatosensory processing will affect later stages of cortical activity from integration to motor response.

Polatajko HJ, Law M, Miller J, Schaffer R, Macnab J. The effect of a sensory integration program on academic achievement, motor performance, and self-esteem in children identified as learning disabled: Results of a clinical trial. Occupational Therapy Journal of Research. 1991; 11(3): 155–176.
A study assigned children aged 6-8 with sensory integration (SI) dysfunction to 3 groups: 35 used sensory modalities, 32 received psychomotor (PM) training, and 13 no intervention. SI and PM administered one hour per week for six months proved equally effective in improving academic and motor performance but had little effect on self-esteem.

Sanger TD, Chen D, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Definition and classification of negative motor signs in childhood. Pediatrics. 2006; 118(5): 2159-2167.
The purpose of the meeting was to establish terminology and definitions for 4 aspects of motor disorders that occur in children: weakness, reduced selective motor control, ataxia, and deficits of praxis. The purpose of the definitions is to assist communication between clinicians, select homogeneous groups of children for clinical research trials, facilitate the development of rating scales to assess improvement or deterioration with time, and eventually to better match individual children with specific therapies.

Stonefelt LL, Stein F. Sensory integration techniques applied to children with learning disabilities: An outcome study. Occupational Therapy International. 1998; 5(4): 252–272.
This article shares survey results among parents and teachers of children with learning challenges associated with SI issues, and occupational therapists. Authors point out that SI treatment is effective for addressing learning issues – especially when combined with other relevant treatment methods.

Wilson B, Kaplan K, Fellowes S, Gruchy C, Faris P. The efficacy of sensory integration treatment compared to tutoring. Physical and Occupational Therapy in Pediatrics. 1992; 12(1):1-36.
This study points out that SI treatment can be as effective as academic tutoring for children with motor and learning difficulties.

Parent Perspective on Sensory Integration

Ahn RR, Miller LJ, Milberger S, et al. Prevalence of parents’ perceptions of sensory processing disorders among kindergarten children. American Journal of Occupational Therapy. 2004; 58(3): 287–293.
This article shares results of a parent survey indicating that approximately 5.3% of incoming kindergartners in one suburb’s schools met criteria for sensory processing issues based on parental perceptions – consistent with overall percentage estimates of children with sensory issues. Authors say the findings justify continued studies of SI disorders.

Cohn E. Parent perspectives of occupational therapy using a sensory integration approach. American Journal of Occupational Therapy. 2001; 55(3): 285-94.
Based on parent interviews, this study identifies abilities, activities, and reconstruction of self worth as the major benefits of occupational therapy using SI approaches for their children. Authors share parents’ feelings about being able to better support and advocate for their children as a result.

Cohn E, Miller LJ, Tickle-Degnen L. Parental hopes for therapy outcomes: children with sensory modulation disorders. American Journal of Occupational Therapy. 2000; 54(1): 36-43.
Because parents’ therapy goals for children are essential to family centered care, authors interviewed parents to discover that their goals included boosting their children’s social participation, self regulation and competence. Parents also hoped to learn strategies for supporting their children and feeling validated.

Cohn ES, Cermak SA. Including the family perspective in sensory integration outcomes research. American Journal of Occupational Therapy. 1998; 52(7): 540–546.
Authors outline useful means for measuring intervention outcomes of children’s occupational therapy, including suggestions for potential research methods and assessments to ensure that family perspective are included in outcome studies.

Elbasan B, Kayıhan H, Duzgun I. Sensory integration and activities of daily living in children with developmental coordination disorder. Italian Journal of Pediatrics. 2012; 38(1):14-14.
Based on a study comparing children with or without developmental coordination disorders (DCD):  Children with DCD were more challenged by comprehension, expression, social communication, problem solving and memory skills. SI therapy, including motor skill activities, can help build independence in the daily lives of children with DCD.

Jaegermann N, Klein PS . Enhancing mothers’ interactions with toddlers who have sensory‐processing disorders. Infant Mental Health Journal. 2010; 31(3): 291-311.
This study reinforces the assumption that quality caregiver interaction with children helps moderate potential negative effects of sensory processing issues. Mothers involved in the study’s Mediational Intervention for Sensitizing Caregivers group showed the most sensitive behavior, supported toddlers’ communication behavior, and used teaching behaviors most appropriately.

Lane AE, et al.  Sensory processing subtypes in autism: Association with adaptive behavior. Journal of Autism and Developmental Disorders. 2010; 40(1): 112-122.
Children with autism often have sensory related issues such as low sound tolerance and food preferences, high pain reaction, rocking, flapping hands and noisemaking. This sensory processing study supports sensory based intervention to address communication and behavioral difficulties.

Oliveira CB, Medeiros ÍR, Greters MG, Frota NA, Lucato LT, Scaff M, Conforto AB . Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke. Clinics (Sao Paulo). 2011; 66(12): 2043-8.
Based on a study of SI and related test scores of patients with hemiparesis (weakness on one side of body) who have suffered strokes, balance control is a significant challenge and an important factor for planning effective rehabilitation interventions.

Siaperas P, et al.. Atypical movement performance and sensory integration in Asperger’s syndrome. Journal of Autism and Developmental Disorders. 2012; 42(5): 718-725.
Based on a study comparing boys with and without Asperger’s syndrome (AS), Children with AS have significant impairment of movement as well as proprioceptive and vestibular processing. Building understanding of motor and sensory impairment could have important AS treatment implications.

Sensory Processing and Cerebral Palsy

Bumin G, Kayihan H.. Effectiveness of two different sensory integration programs for children with spastic diplegic cerebral palsy. Disability and Rehabilitation. 2001; 23(9): 394-399.
An investigation of approaches to sensory perceptual motor (SPM) training for children with spastic diplegic CP (abnormal leg and possible arm stiffness), this study determines it is effective for group and individual treatment.

Cooper J, Majnemer A, Rosenblatt B, Birnbaum R. The determination of sensory deficits in children with hemiplegic cerebral palsy. Journal of Child Neurology. 1995; 10(4): 300-309.
Authors point out that treatment for children with CP tends to focus on motor deficits, with potential sensory deficits often overlooked. Study results show that significant bilateral sensory deficits were identified in hemiplegic children using a formal clinical sensory battery assessment. Recommendation: clinical sensory evaluation should be part of assessments of children with CP to maximize their functional potential.

Hoon AH, Stashinko EE, Nagaw LM, et al. Sensory and motor deficits in children with cerebral palsy born preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Developmental Medicine and Child Neurology. 2009; 51(9): 697-704.
Study results indicate that participants with CP born preterm had periventricular white matter injury. There was more severe injury in the posterior thalamic radiation pathways than in descending corticospinal tracts. Posterior thalamic radiation injury correlated with reduced contralateral touch threshold, proprioception, and motor severity.

Lesny I, Stehlik A, Tomasek J, Tomankova A, Havlicek I. Sensory disorders in cerebral palsy: Two-point discrimination. Developmental Medicine and Child Neurology. 1993; 35(5): 402-405.
Study adds further evidence to authors’ previous observations that sensory issues are an integral part of the clinical picture of CP.

Nashner LM, Shumway-Cook A, Matin O. Stance posture control in select groups of children with cerebral palsy: Deficits in sensory organization and muscular coordination. Experimental Brain Research. 1983; 49(3): 393-409.
A majority of children with CP in this study displayed sensory, organizational, or muscular coordination dysfunctions. Results provided suggested methods for developing a more systematic understanding of movement control abnormalities.

Sanger TD, Kukke SN. Abnormalities of tactile sensory function in children with dystonic and diplegic cerebral palsy. Journal of Child Neurology. 2007; 22(3): 289-293.
Study results indicate that children with secondary dystonia and diplegia due to CP have deficits of tactile sensation similar to deficits seen in adults with focal dystonia. These results are the first to test the spatial discrimination threshold using Johnson, Van Boven, Phillips domes in children with CP.

Shamsiddini A. Comparison between the effect of neurodevelopmental treatment and sensory Integration therapy on gross motor function in children with cerebral palsy. Iranian Journal of Child Neurology. 2010; 4(1): 31-38.
Based on this study of children with CP (half with diplegia, half with quadriplegia) neurodevelopmental treatment and sensory integration therapy can improve these gross motor functions: lying and rolling, sitting, crawling and kneeling, standing.

Wingert JR, Burton H, Sinclair RJ, Brunstrom JE, Damiano DL. Tactile sensory abilities in cerebral palsy: Deficits in roughness and object discrimination. Developmental Medicine and Child Neurology. 2008; 50(11): 832-838.
Children with CP and diplegia or hemiplegia in this study displayed mild motor deficits but demonstrated widespread tactile deficits.

Infant Motor Development & Tummy Time

Abbott AL, Bartlett DJ. Infant motor development and equipment use in the home. Child: Care Health & Development. 2001; 27: 295–306.
This study concluded “parental education with respect to moderate use of equipment and provision with adequate floor time (tummy time) to practice and experiment with motor abilities might be required to enhance motor outcomes of vulnerable infants.”

American Physical Therapy Association. Lack of time on tummy shown to hinder achievement of developmental milestones, say physical therapists. News Release. 2008; August 6, 2008.
In the national survey of 400 pediatric physical and occupational therapists, two-thirds of those surveyed say they’ve seen an increase in early motor delays in infants over the past six years. Those physical therapists who saw an increase in motor delays said that the lack of “tummy time”, or the amount of time infants spend lying on their stomachs while awake, is the number one contributor to the escalation in cases.

Bartlett DJ, Kneale Fanning JE. Relationships of equipment use and play positions to motor development at eight months corrected age of infants born preterm. Pediatric Physical Therapy. 2003; 15: 8–15.
In this study, researchers examined the relationships between the use of infant equipment, play positions, and motor development in high risk, premature infants. Through parent reports the researchers determine that therapists should consider the use of infant equipment and specific play positions to enhance motor development and discuss ways to develop early motor skills with parents.

Berger SE, Nuzzo K. Older siblings influence younger siblings’ motor development. Infant & Child Development. 2008; 17(6): 607-615.
In one of the first attempts to study the effects of older siblings on the onset of motor milestones, this study begins to document the interaction between social and motor development and introduces a new set of questions. It is noted that parents set aside special ‘tummy time’ so that infants have the opportunity to get used to being on the floor and to strengthen the muscles they will need to crawl.

Davis BE, Moon RY, Sachs HC, Ottolini MC . Effects of sleep position on infant motor development. Pediatrics. 1998; 102(5): 1135-1140.
The purpose of this study was to determine the relationship between sleep position and the age of achieving specific motor milestones in the first year of life. Results of the study indicated that the average ages of attaining rolling from tummy to back, sitting supported, crawling, and pulling to stand were significantly earlier in the infants who slept on their tummy than infants who slept on their back.

Hotelling BA. Tools for teaching – newborn capabilities: parent teaching is a necessity. The Journal of Perinatal Education. 2004; 13(4): 43-49.
This column states that infants need tummy time for general upper body strengthening. Parents learn that the best time for tummy time is when the infant is awake and supervised.

Jantz JW, Blosser CD, Fruechuting LA. A motor milestone change noted with a change in sleep position. Archive of Pediatric and Adolescent Medicine. 1997; 151: 565-568.
This was the first study to investigate the relationship between change of sleep position and early motor development. At 4 and 6 months of age, 257 infants were studied to determine whether the recommended change in sleep position was having an impact on their motor development. Their results indicated that the 4 month old infants who slept on their back or side were less likely to roll over than tummy sleepers.

Majnemer A, Barr RG. Association between sleep position and early motor development. The Journal of Pediatrics. 2006; 149: 623-29.
To compare motor development among infants using different sleep positions, Canadian researchers studied 4 and 6 month olds who had been sleeping on their backs or on their tummy. Researchers found that at 4 months, motor scores were lower in the group that slept on their backs, and by 6 months, the differences increased, with motor delays documented in 22% of babies sleeping on their backs. At 15 months, the back sleep position continued to be linked to delayed motor performance. Researchers concluded that the rate at which an infant develops motor skills seems to be influenced by factors such as the positions they adopt during sleep and awake time. While sleeping on their backs may somewhat delay the rate at which infants reach certain milestones, daily tummy time while the infant is awake tends to overcome some of the delays linked to sleeping on their back.

Monson RM, Deitz J, Kartin D. The relationship between awake positioning and motor performance among infants who slept supine. Pediatric Physical Therapy. 2003; 15: 196–203.
The purpose of this study was to examine the relationship between gross motor development and whether an infant was placed on their tummy during awake time at 6 months of age in infants who slept on their backs. This study specifically examined the relationship between gross motor development and whether an infant was placed on their tummy during awake time instead of on their back. The study makes a final point that physical and occupational therapists should educate parents about the need for supervised tummy time in early infancy.

Msall ME. Measuring outcomes after extreme prematurity with the Bayley-III Scales of infant and toddler development: a cautionary tale from Australia. Archive of Pediatric and Adolescent Medicine. 2010; 164(4): 391-393.

Pin T, Eldridge B and Galea MP. A review of the effects of sleep position, play position and equipment use on motor development of infants. Development Medicine and Child Neurology. 2007; 49: 858-867.
The review concluded that healthy infants, born at term, who spent time on their tummy when awake, achieved developmental milestones significantly earlier than those who did not or who spent limited time in prone when awake in the first 6 months of life.

Ratliff-Schaub K, Hunt CE, Crowell D, Golub H, Smok-Pearsall S, Palmer P, Schafer S, Bak S, Canteu-Kiser J, O’Bell R; CHIME Study Group. Relationship between infant sleep position and motor development in preterm infants. Journal of Developmental & Behavioral Pediatrics. 2001; 22: 293–299.
This study examined whether motor development varies among sleep position preferences in premature infants. The results of this study revealed that preterm infants whose sleep position was on their back had better performance on the item tested while the infant was on their back (rolling from supine to side), but fewer percentages of these infants received credit on the items tested while they were on their tummy (such as maintaining head at certain degree and lower head with control).

Salls, JS, Silverman LN, Gatty CM. The relationship of infant sleep and play positioning to motor milestone achievement. American Journal of Occupational Therapy. 2002; 56: 577-580.
This study included 22 full-term infants recruited from well-baby visits at 2, 4, and 6 months of age. A questionnaire was given to the caregivers to gather information about demographic, primary sleep position, and estimated amount of awake time on baby’s tummy every day. The results of this study found that infants spent very little time on their tummy during the wakeful hours before 4 months of age. Some delay in the development of antigravity neck extension was found at 2 months of age, but no differences were found at later ages.

Sarwark JF, Aubin CE. Growth considerations of the immature spine. The Journal of Bone and Joint Surgery. 2007; 89: 8-13.
Discussion on the development of the spine.

Stein MT. Infants need daily “tummy time” for early motor development. Journal Watch Pediatrics and Adolescent Medicine. 2007.
Researchers in Canada compared motor skills in healthy white infants at either 4 or 6 months of age. Two standardized tests were used to evaluate infant motor function, and parents recorded infant positioning while awake. At 4 months, infants in the back sleeping group had lower motor scores and were significantly less likely than tummy sleepers to achieve prone extension on their arms. At 6 months, differences in motor development between the back and tummy sleeping infants increased significantly; 22% of infants sleeping on their backs had gross motor delays and also were less likely than tummy sleepers to sit and roll. Among back sleepers, more time spent on the tummy while awake was positively correlated with better motor performance.

Back to Sleep Campaign & Tummy Time

American Academy of Pediatrics Policy Statement. Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005; 116(5): 1245-55.
The American Academy of Pediatrics’ (AAP) policy statement encourages tummy time when the infant is awake and observed as a means to enhance motor development. Additionally, the AAP includes a recommendation to avoid having the infant spend too much time in car-seat carriers and ‘bouncers,’ in which pressure is applied to the occiput.

American Academy of Pediatrics: Task Force on Infant Positioning and SIDS. Positioning and sudden infant death syndrome (SIDS): Update. Pediatrics. 1996; 98(6): 1216-1218.
This American Academy of Pediatrics update states: “A certain amount of “tummy time,” while the infant is awake and observed, is recommended for developmental reasons and to help prevent flat spots on the occiput.”

American Academy of Pediatrics: Task Force on Infant Sleep Position and SIDS. Changing concepts of sudden infant death syndrome: Implications for infant sleeping environment and sleep position. Pediatrics. 2000; 105(3): 650-656.
The American Academy of Pediatrics recognized “A certain amount of tummy time while the infant is awake and observed is recommended for developmental reasons…”

Davis BE, Moon RY, Sachs HC, Ottolini MC . Effects of sleep position on infant motor development.Pediatrics. 1998; 102(5): 1135-1140.
The purpose of this study was to determine the relationship between sleep position and the age of achieving specific motor milestones in the first year of life. Results of the study indicated that the average ages of attaining rolling from tummy to back, sitting supported, crawling, and pulling to stand were significantly earlier in the infants who slept on their tummy than infants who slept on their back.

Dewey C, Fleming P, Golding J. Does the supine sleeping position have any adverse effects on the child?: II. Development in the first 18 months. Pediatrics. 1998; 101: e5-12.
Evidence in this study suggests that putting infants to sleep on their backs results in a reduced developmental score at 6 months of age. However, this disadvantage appears to be short-term. Weighing this against the adverse health effects demonstrated with the back sleeping position, researchers in this study concluded that the results should not change the message of the Back to Sleep Campaign.

Koren A, Reece SM, Kahn-D’angelo L, Medeiros D. Parental information and behaviors and provider practices related to tummy time and back to sleep. Journal of Pediatric Health Care. 2010; 24(4): 222-30.
Outcomes of this study suggest that with the implementation of Back to Sleep guidelines there has been a lack of clarity and education for both parents and providers about the importance of tummy time when young infants are awake. 90% of the mothers in this study reported receiving information about positioning the infant while asleep. However, only 55% mothers postpartum and 26% at 2 months after birth received information regarding infant positioning during awake time. Providers reported barriers such as lack of time and confusing guidelines to tummy time education.

Madhavan S, Campbell SK, Campise-Luther R, Gaebler-Spira D, Zawacki L, Clark A, Boynewicz K, Kale D, Bulanda M, Yu J, Sui Y, Zhou XJ. Correlation between fractional anisotropy and motor outcomes in one-year-old infants with periventricular brain injury. Journal of Magnetic Resonance Imaging. 2014; 39(4): 949-57.
This study seeks to determine whether motor outcomes of an exercise intervention beginning at 2 months corrected age (CA) in children with periventricular brain injury (PBI) are correlated with fractional anisotropy (FA) measures derived from diffusion tensor imaging (DTI) at 12 months CA.

Ottenbacher KJ, Msall ME, Lyon N, Duffy LC, Ziviani J, Granger CV, Braun S. Functional assessment and care of children with neurodevelopmental disabilities. American Journal of Physical Medicine and Rehabilitation. 2000; 72(2): 114-123.
This study found that the Functional Independence Measure for Children (WeeFIM instrument) and severity of disability were the best predictors of amount of assistance ratings provided by parents and teachers.

Radecki RT, Gaebler-Spira D. Deep vein thrombosis in the disabled pediatric population. Arch of Phys Med and Rehabil. 1994; 75(3): 248-250.
This study seeks to study the incidence of deep vein thrombosis (DVT) in the disabled pediatric population and examines  the incidence in patients younger than 18 years of age who were in a rehabilitation center.

Younes M, Aubrin CE, Robitaille M, Sarwark JF, Labelle H. SYounes M, Aubrin CE, Robitaille M, Sarwark JF, Labelle H. Scoliosis correction objectives in adolescent idiopathic scoliosis. Journal of Pediatric Orthopaedics. 2007; 27(7):775-781.s. Journal of Pediatric Orthopaedics. 2007; 27(7): 775-781.
This study is presented to document and analyze 3-dimensional (3-D) surgical correction goals for AIS as determined by a sample of experienced spine surgeons.

Plagiocephaly, Torticollis & Tummy Time

Girolami G, Shiratori T, Aruin A. Anticipatory postural adjustments in children with typical motor development. Experimental Brain Research. 2010; 205:1 53-165.
This study seeks to examine anticipatory postural adjustments (APAs)  role in the performance of activities requiring the maintenance of vertical posture and how children utilize APAs during self-induced postural perturbations.

Horowitz LJ, Oosterveld WJ, Adrichem R. Effectiveness of sensory integration therapy on smooth pursuits and organization time in children. Pediatrie und Grenzgebiet. 1993; 31(5): 331–344.
After months of SI therapy focused on eye movement, tracking and learning time for children with SI issues, this study recorded significant reduction in impaired eye movement as well as time to complete organizational activities.

Hurley DS, Sukal-Moulton T, Msall ME, Gaebler-Spira D, Krosschell KJ, Dewald JP. The cerebral palsy research registry: Development and progress toward national collaboration in the United States. J Child Neurol. 2011; 26(12): 1534-1541.
This article describes the development of an expandable cerebral palsy research registry, its current status, and the potential it has to affect families and persons with cerebral palsy in the United States and abroad.

Hutchison L, Thompson J, Mitchell E. Determinants of nonsynostotic plagiocephaly: A case-control study. Pediatrics. 2003; 112(4): 316-322.
This study concluded that early identification of a favored head orientation, which may indicate the presence of neck muscle dysfunction, may help prevent the development or further development of nonsynostotic plagiocephaly in infants. The study also notes that plagiocephaly may be prevented by varying the head position when putting the infant down to sleep and by giving supervised tummy time when awake.

Kane AA, Mitchell LE, Craven KP, Marsh JL. Observations on a recent increase in plagiocephaly without synostosis. Pediatrics. 1996; 97: 877-885.
As a result of the recent increase in reported cases of plagiocephaly without synostosis (PWS), researchers in this study compared patterns of PWS referrals and referrals for another head deformity called synostotic plagiocephaly over a 16-year study period at a center specializing in head and facial deformities.

Kennedy E, Majnemer A, Farmer JP, Barr RG, Platt RW. Motor development of infants with positional plagiocephaly. Physical & Occupational Therapy in Pediatrics. 2009; 29(3): 222-35.
The purpose of this study was to compare motor development between infants with positional plagiocephaly and matched peers without positional plagiocephaly. Also, researchers examined differences in infant positioning practices when asleep and awake between the two groups. The study found that motor development was associated with amount of time spent on the tummy while awake for both groups of infants. Infants with positional plagiocephaly who spent less time on their tummies while awake had lower motor scores when compared with their matched pairs.

Persing J, James H, Swanson J, Kattwinkel J. Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery & Section on Neurological Surgery. Prevention and management of positional skull deformities in infants. Pediatrics. 2003; 112(1): 199-202.
This report provides guidelines for the prevention, diagnosis, and management of positional plagiocephaly in healthy infants. Pediatricians are advised to properly diagnose skull deformities, educate parents on methods of positional plagiocephaly prevention such as tummy time, initiate appropriate management, and make referrals to a therapist when necessary.

Renske M van Wijk, Leo A van Vlimmeren, Catharina G M Groothuis-Oudshoorn, Catharina P B Van der Ploeg, Maarten J IJzerman. Helmet therapy in infants with positional skull deformation: randomised controlled trial. BMJ. 2014; 348: g2741
The objective of the study was to determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5-6 months. The change score for both plagiocephaly and brachycephaly was equal between the helmet therapy and natural course groups. Full recovery was achieved in 10 of 39 (26%) participants in the helmet therapy group and 9 of 40 (23%) participants in the natural course group. All parents reported one or more side effects. The study concluded that based on the equal effectiveness of helmet therapy and skull deformation following its natural course, high prevalence of side effects, and high costs associated with helmet therapy, the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformation is not recommended.

van Vlimmeren L, van der Graaf Y, Boere-Boonekamp M, L’Hoir M, Helders P, Engelbert R. Effect of pediatric physical therapy on deformational plagiocephaly in children with positional preference: A randomized controlled trial. Archive of Pediatric and Adolescent Medicine. 2008; 162: 712-718.
After studying the effect of pediatric physical therapy on positional and deformational plagiocephaly, researchers found that a 4-month standardized pediatric physical therapy program to treat positional plagiocephaly significantly reduced the prevalence of severe deformational plagiocephaly compared with usual care.

General Impact of Music Therapy for Premature Infants

Haslbeck F. Music Therapy with preterm infants – Theoretical approach and first practical experience. Music Therapy Today, 2004;5(4): 1-16.
This thesis discusses why preemies need music therapy due to the continuous over-stimulation they receive in NICU. The environment causes stress, disturbs sleep and rest periods so that preemies lack proper sleep-wake rhythm.

Haslbeck F. Research strategies to achieve a deeper understanding of active music therapy in neonatal care. Music and Medicine. 2012; 4(4): 205–214.
This article proposes a flexible methodology that achieves a deep understanding of the therapeutic process of active music therapy in premature infants and their parents.

Hui-Ling Lai HL, Chen C, Peng J. T. C., Chang, F. M., Hsiao, Y. H, Chang, C. Randomized controlled trial of music during kangaroo care on maternal state anxiety and preterm infants’ responses. International Journal of Nursing Studies. 2006; 43(2): 139–146.
Infants in the music therapy treatment group in this study experienced more quiet sleep states and less crying. Music during kangaroo care also resulted in significantly lower maternal anxiety in the treatment group. Authors conclude there is evidence for the use of music during kangaroo care as an empirically-based intervention.

Neal DO, Lindeke LL. Music as a Nursing Intervention for Preterm Infants in the NICU. Neonatal Network. 2008; 27(5): 319-327.
This article presents evidence supporting use of music with preterm infants. Recommendations for music interventions with preterm infants are also discussed.

Standley JM. A meta-analysis of the efficacy of music therapy for premature infants. Journal of Pediatric Nursing. 2002;  17: 107–113.
This meta-analysis showed that music has statistically significant and clinically important benefits for premature infants in the NICU.

Philbin M. Planning the acoustic environment of a neonatal intensive care unit. Clin Perinatol. 2004; 31: 331–352.

This article addresses general principles of designing a quiet NICU including basic aspects of room acoustics. Includes the effects of various nursery designs on infants, parents, clinicians.

Stewart, K. PATTERNS—A model for evaluating trauma in NICU music therapy: Part 1—Theory and design. Music and Medicine. 2009; 1: 29–40.
This article discusses PATTERNS (Preventive Approach to Traumatic Experience by Resourcing the Nervous System), a preventive music therapy treatment model based on latent human resiliency and trauma renegotiation principles.

Effectiveness of Music Therapy to Maintain/Improve Premature Infants’ Health

Arnon S, Shapsa A, Forman L, Regev R, Bauer S, Litmanovitz L. Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth. 2006; 33: 131–136.
Compared with recorded music or no music therapy, authors conclude that live music therapy is associated with a reduced heart rate and a deeper sleep 30 minutes after therapy in stable preterm infants.
Cervasco A, Grant R. Effects of the pacifier activated lullaby on weight gain of premature infants. Journal of Music Therapy. 2005; 42(2): 123–139.
This study evaluates the effects of Pacifier Activated Lullaby (PAL)* trials on the weight gain of premature infants. Findings lead the authors to conclude it was beneficial for premature infants to participate in PAL 30 minutes prior to feeding.

Chou LL, Wang RH, Chen SJ. Effects of music therapy on oxygen saturation in premature infants receiving endotracheal suctioning. Journal of Nursing Research. 2003;11(3):209–216.
Study results show that premature infants receiving music therapy with endotracheal suctioning had a significantly higher SPO(2) than that when not receiving music therapy. The level of oxygen saturation returned to the baseline level faster than when they did not receive music therapy.

Courtnage A, Chawla H. Loewy J, Nolan P. Effects of live, infant-directed singing on oxygen saturation, heart rates and respiratory rates of infants in the neonatal intensive care unit. Pediatric Research. 2002; 2346(51): 403A.
Findings from this study suggest that this method of music therapy can infants’ address health stimulation needs that may go unmet in the NICU.

Loewy J, Stewart K, Dassler AM, Telsey A, Homel P. The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants. Pediatrics. 2013 [Epub ahead of print].
Authors conclude that informed, intentional therapeutic use of live sound and parent-preferred lullabies applied by a certified music therapist can influence cardiac and respiratory function.

Lubetzky R, Mimouni FB, Dollberg S, Reifen R, Ashbel G, Mandel D. Effect of Music by Mozart on Energy Expenditure in Growing Preterm Infants. Pediatrics. 2010; 125(1): 24–28.
This study found exposure to Mozart music significantly lowers resting energy expenditure (REE) in preterm infants. Authors speculate that this music on REE might explain, in part, the improved weight gain that results from this “Mozart effect.”

Olischar M, Shoemark H, Holton T, Weniger W, Hunt R. The influence of music on a EEG activity in neurologically healthy newborns 32 weeks’ gestational age. Acta Paediatr. 2011;100(5): 670–675.
Authors conclude that more mature sleep wake cycles in infants exposed to music, suggesting that there might be a small effect of music on quiet sleep in newborns.

Yildiz A, Arikan D. The effects of giving pacifiers to premature infants and making them listen to lullabies on their transition period for total oral feeding and sucking success. Journal of Clinical Nursing. 2012; 21(5–6): 644–656.
Giving pacifiers* to premature infants and making them listen to lullabies was found to have a positive effect on their transition period to oral feeding, their sucking success and vital signs (peak heart rate and oxygen saturation). NICU nurses are advises to give premature infants pacifiers and make them listen to lullabies during gavage feeding. *Pacifier-activated lullaby (PAL) is used with preemies having difficulty feeding. This device helps teach the suck, swallow and breathe reflex needed for bottle-feeding using music as a reward each time the baby sucks. As a result, the baby gains weight and is able to leave the hospital faster.

Use of Music Therapy to Support Premature Infants’ Initial Development

Shenfield T, Trainor LJ, Nakata T. Maternal singing modulates infant arousal. Psychology of Music. 2003; 31(4): 365–375.
This study analyzed saliva samples of infants to reveal that infants with lower baseline levels exhibited modest cortisol increases in response to maternal singing; those with higher baseline levels exhibited modest reductions. These findings are consistent with the view that maternal singing modulates the arousal of prelinguistic infants.

Trainor LJ, Wu L, Tsang CD. Long-term memory for music: infants remember tempo and timbre. Developmental Science. 2004; 7(3): 289-296.
Study results show that infants’ long-term memory representations for melodies are not just reduced to the structural features of relative pitches and durations, but contain surface or performance tempo- and timbre-specific information.

Tramo M, Lense M, Van Ness C, Kagan J. Settle, M, Cronin, J. Effects of music on physiological and behavioral indices of acute pain and stress in premature infants: clinical trial and literature review. Music and Medicine. 2011; 3(2): 72–83.
This study examined the controlled use of recorded vocal music to attenuate physiological and behavioral responses to heel stick in 13 premature infants via an experimental design. Finds indicate controlled music stimulation to be a safe and effective way to ameliorate pain and stress in premature infants following heel sticks.

Tsang CD, Conrad NJ. Does the message matter? The effect of song type on infants’ pitch preferences for lullabies and playsongs. Infant Behav Dev. 2009; 33(1): 96–100.
Study results suggest that the overall pitch of a song is communicative to infants and that the affective nature of music can have an effect on infants’ pitch preferences. Moreover, infants’ preferences for pitch are context-dependent.

Application of Music Therapy to Enhance Parent-Infant Relationship

De l’Etoile SK. Infant-directed singing: a theory for clinical intervention. Music Therapy Perspectives. 2006; 24:22–29.
This literature review supports the idea that infant-directed singing may have therapeutic value for at-risk mother/infant pairs.

Nakata T, Trehub SE. Infants’ responsiveness to maternal speech and singing. Infant Behavior and Development. 2004; 27: 455–456.
Authors in this study conclude that the stereotype and repetitiveness of maternal singing may promote moderate arousal levels, which sustain infant attention, in contrast to the greater variability of speech, which may result in cycles of heightened arousal, gaze aversion, and re-engagement. The regular pulse of music can also enhance emotional coordination between mother and infant.