!

SSESSMENTOFGROSSMOTORDEVELOPMENTINTHE7(/
-ULTICENTRE'ROWTH2EFERENCE3TUDY

4RUDY- ! 7IJNHOVEN -ERCEDESDE/NIS !DELHEID7 /NYANGO 4RACEY 7ANG

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!BSTRACT

SITES CONDUCTED REGULAR STANDARDIZATION SESSIONS $ATA

COLLECTION AND DATA QUALITY CONTROL TOOK PLACE SIMULTA
$ATAVERIFICATIONANDCLEANINGWERE PERFORMED
4HE OBJECTIVE OF THE -OTOR $EVELOPMENT 3TUDY WAS TO NEOUSLY
DESCRIBETHEACQUISITIONOF
SELECTEDGROSSMOTORMILESTONES UNTILALLQUERIESHADBEENSATISFACTORILYRESOLVED
AMONGAFFLUENTCHILDREN
GROWINGUPINDIFFERENTCULTURAL
SETTINGS 4HIS STUDY WAS CONDUCTED IN 'HANA )NDIA
.ORWAY /MAN ANDTHE5NITED3TATESASPART OF THELON +EYWORDS #HILD CHILDDEVELOPMENT INFANT LONGI
GITUDINALCOMPONENTOF THE7ORLD(EALTH/RGANIZATION
TUDINALSTUDY MOTORDEVELOPMENT MOTORSKILLS
7(/ -ULTICENTRE'ROWTH2EFERENCE3TUDY -'23
)NFANTSWERE FOLLOWEDFROMTHEAGEOF FOURMONTHSUNTIL THEY
COULD WALK INDEPENDENTLY
3IX MILESTONES THAT ARE )NTRODUCTION
FUNDAMENTAL TO ACQUIRING SELF SUFFICIENT ERECT LOCOMO TION
AND ARE SIMPLE TO EVALUATE WERE ASSESSED SITTING WITHOUT -OTOR BEHAVIOR IS AN ESSENTIAL ASPECT OF CHILD
SUPPORT HANDS AND KNEES CRAWLING
STANDING DEVELOPMENT 'IVENTHEUNIQUEOPPORTUNITYPROVIDED BY
WITHASSISTANCE WALKINGWITHASSISTANCE STANDINGALONE THE7ORLD(EALTH/RGANIZATION 7(/ -ULTICENTRE
ANDWALKINGALONE
4HEINFORMATIONWASCOLLECTEDBYBOTH 'ROWTH 2EFERENCE 3TUDY -'23
A COMPONENT TO
THECHILDREN S CAREGIVERSANDTRAINED-'23FIELDWORKERS
ASSESS GROSS MOTOR DEVELOPMENT WAS INCLUDED IN THE
4HECAREGIVERSASSESSEDANDRECORDEDTHEDATESWHEN
THE PROTOCOL -OTOR DEVELOPMENT IS USUALLY ASSESSED IN
MILESTONES WERE ACHIEVED FOR THE FIRST TIME ACCORDING TO TERMS OF AGE OF ACHIEVEMENT OF MOTOR MILESTONES
ESTABLISHED CRITERIA 5SING STANDARDIZED PROCEDURES THE ; = "ESIDES THE DETERMINATION OF AGE AT ATTAINMENT
FIELDWORKERSINDEPENDENTLYASSESSEDTHEMOTORPERFORM
LONGITUDINAL ASSESSMENT OF DIFFERENT TYPES OF MOTOR
ANCE OF THE CHILDREN AND CHECKED PARENTAL RECORDING AT SKILLSHASTHEADVANTAGEOF
PROVIDINGAPROFILEOF THEIR
HOMEVISITS 4OENSURE STANDARDIZEDDATACOLLECTION THE
SEQUENCE ANDTEMPO;
= (OWEVER FEWSTUDIESUSING A
LONGITUDINAL DESIGN HAVE BEEN DONE ON THE AGE OF
ACHIEVEMENTOF CERTAINMOTORMILESTONES; n = AND
4RUDY- ! 7IJNHOVEN -ERCEDESDE/NIS AND!DELHEID
ONLY TWO OF THEM ARE OF A MULTICOUNTRY NATURE ;
7 /NYANGOARE AFFILIATEDWITHTHE$EPARTMENTOF .UTRITION
=
7ORLD (EALTH /RGANIZATION 'ENEVA 3WITZERLAND 4RACEY
4O OURKNOWLEDGE
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7ANG IS AFFILIATED WITH THE $EPARTMENT OF .UTRITION
5NIVERSITYOF #ALIFORNIA $AVIS #ALIFORNIA 53! 'UNN %LIN
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THISGAPININFORMATIONBY
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4ELEPHONE
FAX
E MAIL
MOTOR
MILESTONES
IN
FIVE
OF
THE COUNTRIES PARTICIPAT
DEONISM WHO INT
INGINITSLONGITUDINALGROWTHANDDEVELOPMENTSTUDY
-EMBERS OF THE 7(/ -ULTICENTRE 'ROWTH 2EFERENCE
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3TUDY'ROUPAND!CKNOWLEDGMENTSARELISTEDATTHEENDOF
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5NDERTHEUMBRELLAOF THE-'23
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&OODAND.UTRITION"ULLETIN VOL NO SUPPLEMENT

4HE5NITED.ATIONS5NIVERSITY

!SSESSMENTOFGROSSMOTORDEVELOPMENT

MENT 3TUDY PROVIDES A UNIQUE OPPORTUNITY TO ASSESS

GROUP AND INDIVIDUAL VARIABILITY IN THE ACQUISITION OF
KEYMOTORSKILLS
ASWELLASPROVIDINGANOPPORTUNITYTO
ANALYZETHERELATIONSHIPBETWEENPHYSICALGROWTHAND
GROSS MOTOR DEVELOPMENT AMONG GROUPS OF AFFLUENT
CHILDRENGROWINGUPINDIFFERENTCULTURALSETTINGS
4HISPAPEROUTLINESTHE-OTOR$EVELOPMENT3TUDY
PROTOCOLFORCOLLECTINGINFORMATIONONSIXMOTORMILE
STONES
THEMETHODSANDPROCEDURESOF DATACOLLECTION
ANDTHETRAININGANDSTANDARDIZATIONOFFIELDWORKERS

-ETHODS
3TUDYSUBJECTSANDSTUDYDESIGN

4HEMOTORDEVELOPMENTASSESSMENTSWERE
DONEFROM
THEAGEOF
FOURMONTHSONALLSUBJECTSENROLLEDINTHE
LONGITUDINALCOMPONENTOF THE-'23
$ETAILSOF THE
ENROLLMENTOF SUBJECTS THEINCLUSIONCRITERIA ANDTHE
-'23 STUDY DESIGN ARE EXPLAINED ELSEWHERE IN THIS
SUPPLEMENT ; = 4HE STUDY TOOK PLACE IN FIVE OF THE
SIXCOUNTRIESPARTICIPATINGINTHE-'23 'HANA )NDIA
.ORWAY /MAN
ANDTHE5NITED3TATES 4HEIMPLEMEN
TATIONOF THESTUDYPROTOCOLSINEACH OF THESECOUNTRIES IS
DESCRIBED IN SEPARATE PAPERS IN THIS SUPPLEMENT
; n = 4HE "RAZILIAN SITE WAS UNABLE TO PARTICIPATE
INTHE-OTOR$EVELOPMENT3TUDYBECAUSETHESITEHAD
INITIATED DATA COLLECTION BY THE TIME THE DECISION TO
ASSESSMOTORDEVELOPMENTWASTAKEN

4 - ! 7IJNHOVENETAL

'ROSSMOTORMILESTONES DESCRIPTION CRITERIA AND

TESTINGPROCEDURE

3IX DISTINCT GROSS MOTOR MILESTONES WERE SELECTED FOR

STUDY SITTINGWITHOUTSUPPORT HANDS AND KNEESCRAWL ING
STANDINGWITHASSISTANCE WALKINGWITHASSISTANCE STANDING
ALONE AND WALKING ALONE 4HESE MILESTONES WERE
SELECTED BECAUSE THEY ARE CONSIDERED TO BE UNI VERSAL
FUNDAMENTALTO THEACQUISITIONOF
SELF SUFFICIENT
ERECTLOCOMOTION ANDSIMPLETOTESTANDEVALUATE
"EFORE THE ACHIEVEMENT OF ANY OF THE SIX MOTOR
SKILLS THE CHILD GOES THROUGH MANY PRECEDING INTER
MEDIATESTAGESOF DEVELOPMENT;
= %VALUATIONOF
AMILESTONEPERFORMANCECONSISTSINOBSERVINGNOTONLY
WHATACHILDDOES
BUTALSOHOWANDWITHWHATLEVELOF
DEVELOPMENTHEORSHEDOESIT; = 4HERE ISALSOANEED TO
INCLUDEINTHECRITERIAFORTESTINGWHETHERACHILDCAN
PERFORMAMILESTONEINDEPENDENTLYORPERFORMSITAFTER
HAVINGBEENPLACEDINTOPOSITION;
= 4HUS INORDERTO
MINIMIZEINTERPERSONALINTERPRETATIONDIFFERENCES
EACH
TESTITEMNEEDEDTOBECLEARLYDEFINEDWITHRESPECTTO THE
METHOD OF ADMINISTRATION AND THE INTERPRETATION
OFTHECHILD SPERFORMANCE; =
4HE DESCRIPTIONS OF THE SIX GROSS MOTOR SKILLS USED IN
THIS STUDY ORIGINATED FROM VARIOUS EXISTING DEVEL
OPMENTAL SCALES ;
n = 4HE SEQUENTIAL PRES
ENTATIONOFTHEMOTORMILESTONESFOLLOWEDTHEPATTERN
GENERALLY FOUND IN THE LITERATURE ; n = (OWEVER
OCCASIONALLY THE SUGGESTED SEQUENCE BETWEEN TWO OR
MORE MILESTONES MIGHT ACTUALLY BE REVERSED
AND
OBSERVED MILESTONES MIGHT BE INHIBITED LATER ; =
4HEREFORE NOFIXEDDEVELOPMENTALSEQUENCE OF ACHIEVE
MENTWASASSUMED
!LL MILESTONES WERE ASSESSED USING STANDARDIZED

4!",% -'23PERFORMANCECRITERIAFORSIXGROSSMOTORMILESTONES
'ROSSMOTORMILESTONE

-'23PERFORMANCECRITERIA

3ITTINGWITHOUTSUPPORT

#HILDSITSUPSTRAIGHTWITHTHEHEADERECTFORATLEAST SECONDS #HILDDOESNOTUSEARMS

ORHANDSTOBALANCEBODYORSUPPORTPOSITION
#HILDALTERNATELYMOVESFORWARDORBACKWARDONHANDSANDKNEES 4HESTOMACHDOESNOT
TOUCHTHESUPPORTINGSURFACE 4HEREARECONTINUOUSANDCONSECUTIVEMOVEMENTS ATLEAST
THREEINAROW
#HILDSTANDSINUPRIGHTPOSITIONONBOTHFEET HOLDINGONTOASTABLEOBJECT E G FURNITURE
WITHBOTHHANDSWITHOUTLEANINGONIT 4HEBODYDOESNOTTOUCHTHESTABLEOBJECT AND
THELEGSSUPPORTMOSTOFTHEBODYWEIGHT #HILDTHUSSTANDSWITHASSISTANCEFORATLEAST
SECONDS
#HILDISINUPRIGHTPOSITIONWITHTHEBACKSTRAIGHT #HILDMAKESSIDEWAYSORFORWARDSTEPS
BYHOLDINGONTOASTABLEOBJECT E G FURNITURE WITHONEORBOTHHANDS /NELEGMOVES
FORWARDWHILETHEOTHERSUPPORTSPARTOFTHEBODYWEIGHT #HILDTAKESATLEASTFIVESTEPS
INTHISMANNER
#HILDSTANDSINUPRIGHTPOSITIONONBOTHFEET NOTONTHETOES WITHTHEBACKSTRAIGHT 4HE
LEGSSUPPORT OFTHECHILD SWEIGHT 4HEREISNOCONTACTWITHAPERSONOROBJECT
#HILDSTANDSALONEFORATLEAST SECONDS
#HILDTAKESATLEASTFIVESTEPSINDEPENDENTLYINUPRIGHTPOSITIONWITHTHEBACKSTRAIGHT
/NELEGMOVESFORWARDWHILETHEOTHERSUPPORTSMOSTOFTHEBODYWEIGHT 4HEREISNO
CONTACTWITHAPERSONOROBJECT

(ANDS AND KNEESCRAWLING

3TANDINGWITHASSISTANCE

7ALKINGWITHASSISTANCE

3TANDINGALONE

7ALKINGALONE

!SSESSMENTOFGROSSMOTORDEVELOPMENT

&)'

3ITTINGWITHOUTSUPPORT

4 - ! 7IJNHOVENETAL

&)'

(ANDS AND KNEESCRAWLING

TESTING PROCEDURES 4ABLE DESCRIBES THE -'23 PER

FORMANCE CRITERIA FOR THE SIX MILESTONES ! MILESTONE WAS
CONSIDERED ACHIEVED ONLY IF ALL THE GIVEN CRITERIA
WEREMET
3ITTINGWITHOUTSUPPORT lG

$ESCRIPTION
4HECHILDISABLETO BALANCETHEWEIGHTOF
THETRUNKANDHEADWITHOUTANYEXTERNALSUPPORTORTHE USEOF
ARMSANDHANDS
4HECHILDSITSUPSTRAIGHTWITH
THEHEADERECT THATIS NOTLEANINGFORWARD
/NEOF THE
LOWERLIMBSISUSUALLYFLEXED

3TANDINGWITH
ASSISTANCE lG

&)'

3TANDINGWITHASSISTANCE

$ESCRIPTION 4HISIS
THE FIRST DIRECT STEP TOWARD ERECT BIPEDAL LOCOMOTION IN
WHICH THE CHILD IS FOR THE FIRST TIME CHALLENGED TO
MAINTAINSOMEBALANCEOF
THEWHOLEBODYWEIGHTSOTHAT
HEORSHECANMOVE
FORWARD 4HESALIENTCHARACTERISTICIS
WHETHERTHECHILDCANACTUALLYSUPPORT HISORHERWEIGHT IF
HEORSHEISHOLDINGONTO A STABLEOBJECT E G
A PIECE
OFFURNITURE
WITHBOTHHANDSWITHOUTLEANINGOVEROR
RESTINGTHEBODYONTHESTABLEOBJECT

#RITERIA
A 4HECHILD SHEADISERECT B THECHILDDOES
NOTUSETHEARMSORHANDSTO
BALANCEBODYORSUPPORT
POSITION
C THE CHILD SITS UP STRAIGHT FOR AT LEAST
SECONDS

#RITERIA A 4HECHILDISINANUPRIGHTPOSITIONONBOTH FEET

B
THECHILDHOLDSONTOASTABLEOBJECTWITHBOTH
HANDSWITHOUTLEANINGONIT C THECHILD SBODYDOES NOT
TOUCH THE STABLE OBJECT D THE CHILD S LEGS SUP PORT
E THECHILDTHUS
4ESTING PROCEDURE &ACING THE CHILD AND SMILING THE MOSTOF THECHILD SBODYWEIGHT
FIELDWORKER PLACES THE CHILD IN A SITTING POSITION 4HE STANDSWITHASSISTANCEFORATLEAST SECONDS
FIELDWORKER THEN GIVES THE CHILD A TOY TO HANDLE WITH 4ESTING PROCEDURE 4HE FIELDWORKER PLACES THE CHILD IN
BOTHHANDSSOTHATHEORSHEISNOTABLETOUSETHEARMS
ASTANDINGPOSITIONSOTHATTHELEGS
SUPPORT THEBODY
TOSUPPORTHIMSELFORHERSELF
WEIGHT 4HE CHILD IS PLACED AT A DISTANCE FROM WHICH BOTH
HANDS BUT NOT THE BODY CAN REACH AND HOLD ONTO A
(ANDS AND KNEESCRAWLING lG
STABLE OBJECT 4HUS
MOST OF THE BODY WEIGHT IS
$ESCRIPTION 4HISISAPHASEOF A MOREORGANIZEDPRONE SUPPORTED BY THE CHILD S OWN FEET 4HE FIELDWORKER
MOVEMENTTHATREFERSTO THEPALM KNEEPOSITION
WITH SHOULD CHECK THAT THE CHILD IS NOT LEANING OVER OR
ALTERNATINGMOVEMENTSOF
THEUPPERANDLOWERLIMBS RESTINGHISORHERBODYONTHESTABLEOBJECT 4HEHEIGHT OF
THERIGHTARMANDLEFTLEGMOVE
FORWARDORBACKWARD THESTABLEOBJECTSHOULDBEATABOUTTHESAMELEVEL
SYNCHRONOUSLYANDVICE
VERSAINSIMILARLYORDEREDCON ASTHECHILD SSTOMACH
SECUTIVEMOVEMENTS
#RITERIA
A !LTERNATING MOVEMENT FORWARD OR BACK
WARDONHANDSANDKNEES
B THECHILD SSTOMACHDOES
NOTTOUCHTHESUPPORTINGSURFACE
C CONTINUOUSAND
CONSECUTIVEMOVEMENTS ATLEASTTHREEINAROW
4ESTING PROCEDURE 4HE FIELDWORKER PLACES THE CHILD IN
THEPRONEPOSITIONWITHTHEABDOMENABOVE
THESUP
PORTINGSURFACE 4HEFIELDWORKERPLACESHIMSELF ORHER SELF
INFRONTOF THECHILD ABOUT
TO
CMAWAY )F
THECHILDDOESNOTCRAWLSPONTANEOUSLY
THEFIELDWORKER
SHOWSTHECHILDATOYOROBJECTTHATATTRACTSTHECHILD
S
VISUALATTENTION
4HEFIELDWORKER SOMETIMESWITHTHE
HELP OF THE CAREGIVER THEN TRIES TO COAX THE CHILD TO
CRAWLTOWARDTHETOYANDGRABIT
&)'

7ALKINGWITHASSISTANCE

!SSESSMENTOFGROSSMOTORDEVELOPMENT

4 - ! 7IJNHOVENETAL

7ALKINGWITHASSISTANCE lG

$ESCRIPTION 4HISINVOLVESADELIBERATE ATTEMPTTOMAKE

STEPPINGMOVEMENTSANDTO
MAKEPOSTURALADJUSTMENTS
TOWARDTHISENDWHILEHOLDINGONTO A STABLEOBJECT E G
FURNITURE FORSUPPORT
#RITERIA
A 4HECHILDISINANUPRIGHTPOSITIONWITHTHE
BACKSTRAIGHT
B THECHILDMAKESSIDEWAYSORFORWARD
STEPSBYHOLDINGONTOASTABLEOBJECTWITHONEORBOTH HANDS
C ONELEGMOVESFORWARDWHILETHEOTHERSUP PORTSPARTOF
THEBODYWEIGHT
D
THECHILDTAKESATLEAST
FIVESTEPSINTHISMANNER
4ESTING PROCEDURE 4HE FIELDWORKER PLACES THE CHILD IN A
STANDING POSITION SO THAT THE LEGS SUPPORT MOST OF
THEBODYWEIGHT
4HECHILDISPLACEDATADISTANCEFROM
WHICHHEORSHECANREACH ANDHOLDONTO A STABLEOBJECT WITH
ONE OR BOTH HANDS )F THE CHILD DOES NOT MOVE
SPONTANEOUSLY THE FIELDWORKER SHOWS THE CHILD A TOY
OROBJECTTHATATTRACTSTHECHILD SVISUALATTENTION
4HE
FIELDWORKER SOMETIMESWITHTHEHELPOF THECAREGIVER
THENTRIESTOCOAXTHECHILDTOWALKTOWARDTHETOYAND GRAB IT
4HE HEIGHT OF
THE STABLE OBJECT SHOULD BE AT
ABOUTTHESAMELEVELASTHECHILD SSTOMACH

WHETHERTHECHILDCANMODIFYPOSTURE
ADJUSTTO THENEW
POSITION ANDSTANDALONEFORATLEAST SECONDS
7ALKINGALONE lG

$ESCRIPTION 4HE CHILD SHOWS THE CAPACITY TO BALANCE THE

BODY AND TO CONTROL HIS OR HER FORWARD STEPPING
MOVEMENTS 4HERE IS NO NEED FOR ASSISTANCE BECAUSE
BOTHTHEPOSTURALADJUSTMENTANDTHESTEPPINGMOVE
MENTSAREENGAGEDININDEPENDENTWALKING
!N IMPOR
TANTINDICATOROF THISPHASEOF ERECTLOCOMOTIONISTHAT
MOVEMENTOF THEENTIRE BODYDOESNOTACCOMPANYTHE
CHILD SSTEPPINGMOVEMENTS 4HISPHASEDOESNOTREFER TO
THECHILD SFIRSTINDEPENDENTSTEPSWHENTHECHILDIS ABLE TO
TAKE THREE OR FOUR UNCERTAIN STEPS TOWARD THE ADULT
SOUTSTRETCHEDHANDS
#RITERIA A 4HE CHILD IS IN AN UPRIGHT POSITION WITH
THEBACKSTRAIGHT
B ONELEGMOVESFORWARDWHILETHE
OTHERSUPPORTSMOSTOF THEBODYWEIGHT
C THERE ISNO
CONTACTWITHAPERSONORANOBJECT
D THECHILDTAKES
ATLEASTFIVESTEPSINDEPENDENTLY

4ESTING PROCEDURE 4HE FIELDWORKER PLACES THE CHILD IN AN

ERECT POSITION OUT OF THE REACH OF ANY SUPPORTING OBJECT
4HENTHEFIELDWORKERTAKESAPOSITIONABOUT TO
CM IN
3TANDINGALONE lG
FRONT OF THE CHILD AND CALLS THE CHILD TO MOVE
$ESCRIPTION
4HECHILDSHOWSTHECAPACITYFORBOTHEQUI TOWARDTHEFIELDWORKER
3OMETIMES
THECAREGIVER
LIBRATIONANDSUSTAININGBODYWEIGHTONTHEFEET
)N THIS NEEDSTOENCOURAGETHECHILD
POSITIONTHECHILD SLEGS SHOWNOFLEXION
ANDTHECHILD
ISSTANDINGONTHEFEET NOTONTHETOES WITHOUTLEANING OVER OR 4HECHILD SEMOTIONALSTATE
HOLDING ONTO AN OBJECT
4HE CHILD MAINTAINS
CONTINUOUSBALANCEINDEPENDENTLY
"ECAUSE EMOTIONAL AROUSAL CAN EITHER ENHANCE OR
UNDERMINEMOTORBEHAVIOR
THEFIELDWORKERRATEDTHE
#RITERIA
A 4HE CHILD IS IN AN UPRIGHT POSITION ON
OVERALLEMOTIONALSTATEOF THECHILDDURINGTHETESTING OF
BOTHFEET NOTONTHETOES WITHTHEBACKSTRAIGHT
B
ALLTHESIXGROSSMOTORMILESTONESACCORDINGTO TWO SCALES;
THECHILD SLEGS SUPPORT
OF THECHILD SWEIGHT C
= &IRST THESCALEOF CONSCIOUSNESSWASRATED EITHER AS
THERE ISNOCONTACTWITHAPERSONORANOBJECT
D THE
DROWSY OR AS AWAKE AND ALERT 3ECOND THE CHILD S
CHILDSTANDSALONEFORATLEAST SECONDS
IRRITABILITY WAS RATED AS BEING CALM FUSSY OR UPSET
4ESTING PROCEDURE 4HE FIELDWORKER PLACES THE CHILD CRYING
WITHBOTHFEETFLATONTHEFLOORANDSUPPORTSTHECHILD TO AN
)DEALLY THE CHILD SHOULD BE AWAKE ALERT AND CALM
ERECT POSITION 4HEN THE FIELDWORKER WITHDRAWS THE
DURING THE ASSESSMENTS OF MOTOR SKILLS $ROWSINESS
SUPPORT GRADUALLY AND TEMPORARILY TO DETERMINE
FUSSINESS ANDCRYINGWERE NOTREASONSFORNOTTESTINGIF
THECHILDWASSTILLABLETO DISPLAYTHEMILESTONEUNDER TESTING
(OWEVER IF THEYINTERFEREDWITHASSESSMENT
THECHILDWASRETESTEDWHENHEORSHEWASCALM )F A CHILD
WAS ASLEEP HE OR SHE WAS NOT WOKEN UP TO BE
TESTED
)N THE CONTEXT OF THE -'23 THE FIELDWORKERS
PREFERABLY TESTED THE CHILD ON THE MOTOR SKILLS AFTER
THECOMPLETIONOF
THEANTHROPOMETRICMEASUREMENTS
(OWEVER IF THECHILDWASKNOWN TOBECOMEUPSETBY
THEANTHROPOMETRICMEASUREMENTS
TESTINGONMOTOR
MILESTONES OCCURRED PRIOR TO THESE MEASUREMENTS
)F THE CAREGIVER AND OR THE CHILD WERE OBVIOUSLY
DISTRAUGHTORIF THECHILDWASSICKDURINGAFOLLOW UP VISIT
TESTINGDIDNOTOCCUR
&)'

3TANDINGALONE

&)'

7ALKINGALONE

!SSESSMENTOFGROSSMOTORDEVELOPMENT

4RAININGANDSTANDARDIZATIONOFlELDWORKERS
4RAINING

4HE -'23 FIELDWORKERS SELECTED TO CARRY OUT THE

MOTOR DEVELOPMENT ASSESSMENTS WERE TRAINED AT
THEIR OWN STUDY SITE BY AN EXTERNAL EXPERT PRIOR TO
THEINITIATIONOFDATACOLLECTION
4HETRAININGINVOLVED
LECTURES DISCUSSIONS OBSERVATIONS AND ASSESSMENTS
OF A GROUPOF ABOUT CHILDREN AGED n MONTHS
)T CONSISTEDOF TWODAYSOF INITIALTRAINING ONEDAYOF
EVALUATION OF THE TRAINEES AND TWO DAYS OF GUIDED
HOME VISITS $URING THE TWO DAY INITIAL TRAINING THE
ASSESSMENTSCARRIEDOUTBYTHETRAINEESWERE VIDEOTAPED AND
REVIEWED AFTERWARDS BY THE TRAINER AND TRAINEES
4HE EVALUATION SESSION WHICH WAS RECORDED AS WELL
ASSESSEDTHETRAINEES ABILITYTO SCORE THEACHIEVEMENT OF
THESIXMOTORMILESTONES 4HISSESSIONINVOLVEDBOTH TRAINER
AND TRAINEES
4HE TRAINER TESTED AND SCORED
APPROXIMATELY
TO
CHILDREN AGED n MONTHS
ANDDIDNOTGIVE ANY INDICATIONOF THECHILDREN S SCORES TO
THECAREGIVERSORTRAINEES
4HETRAINEESOBSERVEDTHE
CHILDBEINGTESTEDANDINDEPENDENTLYSCOREDTHECHILD
S
PERFORMANCEONEACHTESTEDSKILL !FTERTHEEVALUATION THE
TRAINEES SCORES WERE COMPARED WITH THE TRAINER S SCORES
AND IN CASE OF
DISAGREEMENTS
THESE WERE
DISCUSSEDBYLOOKINGATTHEVIDEOTAPEDSESSION
3TANDARDIZATION

4HE SITES CONDUCTED REGULAR HALF DAY STANDARDIZATION

SESSIONSTO DETERMINETHEINTEROBSERVERRELIABILITYRATES OF
FIELDWORKERS $URINGEACH SESSION ONEMEMBEROF THE
FIELDWORKERS TEAM TESTED AND SCORED A GROUP OF ABOUT
CHILDREN AGED
n
MONTHS FOR THE SIX MOTOR
MILESTONES 4HE ASSESSMENT AND PERFORMANCE OF THE
CHILDREN WERE VIDEOTAPED FOR SUBSEQUENT SCOR INGBY
THEOTHERFIELDWORKERSATTHESAMESITE !TEACH SESSION THE
FIELDWORKER DOING THE ACTUAL TESTING WAS ROTATED SO THAT A
DIFFERENT PERSON WAS THE TESTER
4HE CHILD
SCAREGIVERWASPRESENTBUTWASREQUESTEDNOTTO
INTERFEREWITHTHEASSESSMENTS
(OWEVER WHENNEEDED
THETESTERASKEDFORTHECAREGIVER S ASSISTANCE 4HETESTER DID
NOT GIVE ANY INDICATION OF THE CHILD S SCORES AND WROTE
THEM ON A STANDARDIZATION RECORD FORM
-ILE
STONEPERFORMANCECOULDBERATEDASINABILITY
REFUSAL
ABILITY OR UNABLE TO TEST ACCORDING TO THE ESTABLISHED
CRITERIA SEE BELOW 4HE OTHER FIELDWORKERS WATCHED THE
VIDEOTAPED SESSION AND INDEPENDENTLY SCORED THE
PERFORMANCE OF THE SAME CHILDREN ON EACH OF THE SIX
MILESTONES
!FTERTHECONDUCTOF EACHSESSION THEVIDEOTAPEOF
THESESSIONANDTHEFIELDWORKERS SCORESWERE SENTTO THE
#OORDINATING#ENTRE OF THE-'23AT7(/IN'ENEVA
4HE -OTOR $EVELOPMENT 3TUDY COORDINATOR ON THE
#OORDINATING#ENTRE TEAMVIEWEDTHETAPEANDSCORED THE
PERFORMANCE OF THE CHILDREN 4HE SCORES GIVEN BY THE
COORDINATOR WERE CONSIDERED TO BE THE STANDARD
TRUE SCORES )NTEROBSERVER RELIABILITY RATES PERCENT

4 - ! 7IJNHOVENETAL

AGES OF AGREEMENT WERE GENERATED BY CALCULATING A

CORRELATIONBETWEENTHESTANDARDSCOREANDTHESCORES
OBTAINEDBYTHETESTERANDTHEOBSERVERSINASITE
4HE RESULTS OF THE SESSIONS AND COMMENTS ON THE
OBSERVED DISAGREEMENT BETWEEN THE STANDARD SCORE AND
A FIELDWORKER S SCORE
AS WELL AS ON THE TESTER S
PERFORMANCEOF THEASSESSMENTS WERESENTASFEEDBACK TO
THESITE ! CUTOFF POINTOF
AGREEMENTWASSETTO
DETERMINEWHETHERFURTHERTRAININGWASREQUIRED
3TANDARDIZATIONOFCONDITIONSFORTESTING

)TISWELLDOCUMENTEDTHATCHILDREARINGPRACTICES;
=
ANDENCOURAGEMENTBY TRAININGANDPRACTICE ;
=
ACCOUNTFORPARTOF THEVARIABILITYINTHEACHIEVEMENT OF
MOTORMILESTONES $ATACOLLECTIONINTHESTUDYTOOK PLACE
ATTHECHILDREN S HOMESSOTHATTHESTANDARDIZA TION OF THE
ENVIRONMENT WAS LIMITED /NE SOURCE OF VARIABILITY
HOWEVER
THAT COULD BE CONTROLLED FOR WAS
THESOCIALANDPHYSICALCONTEXTINWHICHTHECHILDWAS TESTED
AND THE NATURE OF THE OBJECTS USED FOR TESTING
)F PHYSICALLY POSSIBLE AND CULTURALLY APPROPRIATE THE
NUMBEROF PERSONSPRESENTDURINGTESTINGWASLIMITED TO
THREE FIELDWORKER CAREGIVER ANDCHILD )F LIMITATION OF
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THECHILD
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TO
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AFTERANILL CAREGIVER HAD ACTUALLY TESTED AND RECORDED THE DATE OR
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4ESTITEMS

)DENTIlCATION
A &ORMCODE

- $3
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B 3TUDYNUMBER

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C 3ITENUMBER
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MOTOR DEVELOPMENT IN ONE INTERNATIONAL REFERENCE
4HESAMEPROTOCOLWASUSEDINTHEFIVE
COUNTRIESTHAT
PARTICIPATEDINTHESTUDY
ANDTHEMOTORDEVELOPMENT
ASSESSMENTS WERE
PERFORMED BY STANDARDIZED
FIELDWORKERS
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4 - ! 7IJNHOVENETAL

SAMETIME HAVINGCAREGIVERRECORDSOF THEEXACTDATES OF

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MILESTONESWERE ACQUIRED 4HEAVAILABILITYINTHE-'23
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ASSOCIATIONSBETWEEN
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SOCIOECONOMICANDDEMOGRAPHICPROFILESFOUNDINTHE
-'23
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