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Motor Delays

Short and long term motor delays associated with NAS can vary depending on the drug

or drugs the fetus is exposed to in-utero with the majority of motor delays occurring from the use

of opiates and methadone. The length of time and degree of fetal exposure to such drugs in-utero

can be the determining factors in whether or not motor abilities are affected. According to Logan

(2013), “Methadone-exposed infants have been found to exhibit increased motor rigidity,

dysregulated motor patterns and decreased activity by observation and maternal report on the

Bayley Infant Behavior Record”. The Bayley Infant Behavior Record (BSID-III) is used to

assess developmental functioning in infants and young children between the age of 1 month and

42 months of age with applications in cognition, language and motor development making this

scale an important assessment tool for NAS.

Logan’s (2013) study of 200 methadone and non-methadone participating families

found the following: At 9 months of age, 37.5 % of our sample of methadone exposed

infants showed clinically significant motor delays using the BSID-III compared to low

but typical development in the comparison group. Motor deficits were most prominent in

the milestones of sitting independently and crawling (pg 4).

The motor deficits found in the first study of methadone exposed infants are focused on gross

motor skills which are movements associated with large muscle groups and whole body

movement and develop in a head-to-toe order.

In the second study of opiate exposed infants the finding are pointed more toward

psychomotor delays. Psychomotor refers to the relationship between cognitive functions and

physical movement. Psychomotor skills are physical skills such as movement, coordination,
manipulation, dexterity, strength, and speed all of which demonstrate the fine motor skills. 133

infants from opiate dependent moms and 103 healthy infants were tested with psychomotor

deficits being evident among the opiate exposed infants compared to the control group of healthy

infants. According to Hunt (2007), “Despite no differences being detected in psychomotor

development at 18 months, there was a significantly lower score on the McCarthy Motor Scale at

3 years of age for opiate-exposed children”. Hunt also states that, “Many investigators have been

less than willing than us to attribute significance to their finding because the opiate-exposed

infants had psychometric scores that fell within range. We challenge this premise and argue that

despite the small numbers studied, there are still clear differences in development between

opiate-exposed infants and controls. To clarify, findings for this study were based on the

Psychomotor Development Index pertaining to the Bayley Scales which tested both groups on

their level of psychomotor development by age and although the opiate-exposed infants were

technically within range, their scores were significantly lower than those of the control group

leading the researchers to believe that opiate exposed infants in fact have these delays due to

their exposure in-utero.

As mentioned above, many past researchers have failed to find the link between motor

delays and NAS because not meeting the age appropriate developmental milestones in motor

coordination can also be contributed to other factors such as; environment, parental involvement,

and genetic influences. Another big factor is that children all have their own unique pattern of

meeting milestones within a certain time frame. All of this considered, it has made it hard for

researchers to pinpoint motor delays strictly to NAS because most NAS infants fall into the

normal range. This range however, has been significantly lower than that of the control groups.

According to Logan (2013), “Few studies have used both biological and clinical measures to
evaluate developmental delays”. This can very well be part of the reason why the majority of

other studies done on developmental delays of NAS have limited information on motor deficits.

Not to mention, that most of the studies performed have had a hard time keeping participation

levels high (as was the case for Hunt), leaving them with a consistently low number of

participants over 42 months of age to assess for motor delays, which in turn has lead to very

mixed findings. With all that being said, there is an extreme need for further research to

investigate short and long term motor delays seen with NAS as well as a need for more long term



Early Childhood Physical Development: Gross and Fine Motor Development. (n.d). Retrieved

March 3, 2017, from

early-3-7/article/12755 early-childhood-physical-development-gross-and-fine-motor-


Hunt, R. W., Tzioumi, D., Collins, E., &Jeffery, H.E. (2008). Adverse neurodevelopmental

outcome of infants exposed to opiate in-utero. Early Human Development, 84(1), 29-35.


Logan, B. A., Brown, M. S., & Hayes, M. J. (2013). Neonatal Abstinence Syndrome. Clinical
Obstetrics and Gynecology, 56(1), 186-192. doi:10.1097/grf.0b013e31827feea4