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An Easy and Practical Tool to Detect the
Neurodevelopmental Status in the First
Two Years of Life
Magda Di Renzo1*, Elena Vanadia1, Paolo Pace2, Teresa Mazzone3, Lidia Racinaro1,
Monica Rea1 and Alberto Villani4
1Institute of Ortofonologia (IdO), Rome, Italy
2Child Neuropsychiatry ASP, Trapani, Italy
3Pediatric Primary Care, ASL, Rome, Italy
4University of Rome-Tor Vergata and Hospital Bambino Gesù, Rome, Italy
Introduction
The neurodevelopmental screening and monitoring form 0-2 years presented in this
research was constructed following some basic assumptions. Chief among these is the
importance of early detection of developmental disorders in order to establish therapy and/or
family support programs as soon as possible, so that children’s vulnerabilities or conditions of
altered environmental stimulation can be recognized and addressed in a broader perspective
of treatment, which also becomes a prevention for the onset of emotional-behavioral disorders,
two years of life represent one of the periods if not the main one-in which brain displays the
greatest plasticity; this is valid both in adaptive and maladaptive terms [1], whereas in this
second case a condition of hindered functional recovery or the development of an undesired
some questions relating to the so-called alarm bells for neurodevelopmental disorders, such
as language, movement and autism spectrum disorders but also neurosensory disorders and
as developmental disorders, which typically onset in childhood are very frequent because
they affect about 15-20% of the population between childhood and adolescence at different
Crimson Publishers
Wings to the Research Research Article
*Corresponding author: Magda Di
Renzo, Institute of Ortofonologia (IdO),
Rome, Italy
Submission: September 04, 2023
Published: September 25, 2023
Volume 8 - Issue 1
How to cite this article: Magda Di
Renzo*, Elena Vanadia, Paolo Pace, Teresa
Mazzone, Lidia Racinaro, Monica Rea and
Alberto Villani. An Easy and Practical Tool
to Detect the Neurodevelopmental Status
Neonatol. 8(1). RPN. 000677. 2023.
DOI: 10.31031/RPN.2023.08.000677
Copyright© Magda Di Renzo. This
article is distributed under the terms of
the Creative Commons Attribution 4.0
International License, which permits
unrestricted use and redistribution
provided that the original author and
source are credited.
ISSN: 2576-9200
Research in Pediatrics & Neonatology 688
Abstract
described in the pediatric literature. It is also well known that intercepting these situations early allows an
early intervention, in many cases fundamental, thanks to an early diagnosis and to obtain the best desired
results. In Italy all children have the right to free pediatric assistance thanks to the National Health System
(SSN). Periodic check-ups (health reports) are foreseen and regulated from birth to 14 years of age. In this
that is easy to compile and based on the well-known stages of neurodevelopment at the different ages in
which health assessments are usually carried out, allows situations of delay or defect to be highlighted,
identifying them and allowing those who test positive in screening to be referred to specialist centers.
different ages allows pediatricians to select the population that really needs a specialist evaluation, avoiding
overloading specialist centers. The results of this study on 1993 subjects aged between 1 and 24 months are
of situations worthy of further diagnostic investigation.
Keywords: Neurodevelopmental screening; Psychomotor development; Neurodevelopment delay;
Screening form; Pediatrician
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and biological factors [6,7]. However, a high percentage of them
Another important assumption relates to the concept of
development trajectories. Referring again to the brain plasticity
child’s development proceeds in an integrated and synactive
way [9], it is clear that some limitations or dysfunctions in the
early processes of maturation and regulation can interfere with
subsequent physiological acquisitions also in other domains of
development, but also that by intervening early on the dysfunctions
it is possible to positively modify the development trajectories.
of a single disorder, but which focuses attention on the main areas
of development ranging from physio-logical regulation (sleep,
nutrition, etc.) to motor development, from the modulation of
behavioral states to attention and intersubjectivity indices, from
a concrete and easy way to encourage punctual observation and
monitoring of children over time, from a global and developmental
perspective. This tool allows you to highlight the delay with respect
it is of fundamental importance to give parents and caregivers the
opportunity to better understand and respond to children’s needs
by directing care and treatment processes according to a correct
timing, which also means optimizing re-sources, acting for health
promotion and disease prevention, taking into account the bio-
psycho-social model which places the interaction of biological,
psychological and social factors at the center of health and disease
of 1993 forms com-piled by pediatricians, the domains in which
developmental delays or alterations are most frequently observed
in the various age groups in early childhood.
The theoretical basis of the screening form
relationships lay the foundation for lifelong health and well-being.
this reason, dealing with the psychophysical development in early
childhood means having care of those parameters of physical
growth, both regulatory and relational, that have a strong impact on
neurological, adaptive and psychological development of the child
in later stages. The division of the questionnaire into 5 age groups,
was chosen on the basis of the timing with which in Italy pediatric
National Health system (SSN) guarantees free health care from 0
to 14 years. Pediatricians must carry out periodic check foreseen in
the following ages: 1 month, 2-3, 4-6, 7-9, 10-12, 15-18 months, 2-3
years. This ensures that all patients adhered to the study because
the questionnaires were administered and completed during the
An added value of the questionnaire is to be replicable and usable
each age and this allows both to monitor the changes with respect
to any criticalities that emerged from the previous balance, the
onset of symptoms or signs that must alert the pediatrician to the
child’s neuro-psycho-behavioral development. On the international
scene, there are several standardized scales and checklists used in
and allow the early detection of some pathological frameworks.
physical and neurological characteristics and estimates the baby’s
gestational age within 1-2 weeks of the true gestational age [12]; the
Prechtl’s [13] assessment of general movements for the functional
assessment of the young nervous system [13], the M-CHAT and
[14,15].
However, the scales described so far have the limit to evaluate
child development 3rd edition [16] and the Bayley [17] Scales of
Infant and Toddler Development 3rd edition [17], most often used in
an individual administration, which lasts at least an hour; therefore,
unlike the questionnaire that we present, are not suitable for use
available, including rating scale for caregivers, which detect any
deviations of the physiological trajectory of a child’s development,
for example the Milestones checklist [18]. However, these types of
checklists are more generic, as they are designed to be used by non-
professional people (especially parents) and therefore they are not
designed for medical/psychological supervision. The questionnaire
literature related to the different domains of development in the
age in which children acquire and show new abilities, usually
divided in 5 or 6 stages from 0 to 24 months [11]. Neurological
development: The brains’ many functions do not develop at the
same time. Although basic sensation and perception systems
are fully developed at about kindergarten age, systems such as
memory, decision making and emotion continue to develop well
into childhood [19]. The foundations of many of these abilities are
constructed during the early years. Infants and toddlers use their
sense and motor abilities to manipulate their surroundings and
learn about the environment. They understand a cause-and-effect
relationship and as the frontal lobe matures and memory develops,
children can imagine what may happen without physically causing
an effect. This is the emergence of thought and allows for the
planning of actions.
Sensory development
Development of the senses begins in early fetal life, initially
with structures and then in-utero stimulation initiates perception.
After birth, environment accelerates each sensory organ to nearly
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months of a baby’s life are full of sensory advancements. Sight,
eventually will follow past the midline. At about 12 months, depth
perception and distance judgements improve, it’s easy grabbing
of objects. There is an increase in smell preference and reaction.
Baby can recognize and react to songs and sounds; he is now able
to grasp handheld toys like rattles and tethers and enjoys a greater
variety of taste [21]. Motor development: At birth the child’s
unable to make voluntary movements and for this reason he reacts
with tears to a posture set by the adult which he perceives as unsafe
development is considered within stages of development according
to age groups, each of these stages collects functional skills that
the 3-6 month phase, in a sitting position he holds his head straight,
the spine is straight except at the lumbar level (kyphosis); between
6 and 9 months he maintains the sitting position and is able to
lean on his arms; between 9 and 12 months it crawls; in the 12-
18 month stage he begins to walk on his own; between 18 and 24
months autonomous walking is more rapid (greater balance and
stability, no longer brings hands forward for defense) [23].
Language development: there is more than one theory related
to linguistic development, from Skinner who believed that children
learn language through operant conditioning [24], to the Chomsky’s
one based on innate abilities to learn language (“language
Acquisition Device”) [25]. Bruner went beyond the previous
positions by theorizing the LASS (Language Acquisition Support
System) as a system that allows the LAD (language Acquisition
Device) to be made operational thanks to the interactions of the
child with the caregiver [26]. Jean Piaget’s theory of language
development suggests that children use both assimilation and
accommodation to learn language [27] and Vygotsky’s theory of
language development focused on social learning and the zone of
proximal development [28]. Camaioni studied communication in
its preverbal aspects, emphasizing the importance of gestures as
photosymbiotic forms [29]. With respect to linguistic acquisitions,
screams, cries, blows and responds with vocalizations; between 6
and 12 months he gradually passes from bubbling to single words,
to which he is attributing a precise meaning starting to use them
voluntarily. Between 12 and 18 months, he recognizes his name and
immediately turns away if he hears his name. He uses single words
and understands simple commands. Within 2 years the vocabulary
expands exponentially and from the word phrase passes to the
association of two or more words [29]. Psychological development:
balancing assimilation and accommodation. Assimilation consists
understood mental schemas. Accommodation means adapting
and revising a previously understood mental schema according to
the new information’s. Piaget divided child development into four
the time when children master causality and object permanence.
Between 0 and 2 months infants actively seek stimuli and respond
more vigorously to changing ones; between 3 and 6 months children
engage in a purposeful sensory exploration of their bodies, and this
builds the concepts of cause and effect and self-understanding.
Between 7 and 12 months object permanence emerges, as the
toddler looks for objects. Between 13 and 18 months toys can be
explored, made to work and novel play skills emerge. Gestures
and sounds can be imitated. Egocentric pretend play emerges
too. Between 19 and 24 months new problem solving strategies
emerge even without rehearsal. Thoughts and imagination arise,
and there is the ability to plan actions. Object permanence is wholly
established, and objects can be searched for by anticipating where
they may be [30].
Socio-emotional and intersubjective development: Social
emotional development covers two important concepts of
development including the development of self or temperament
and relationship to others or attachment. Temperament is an
innate component that directs the child’s approach to the world
and his interaction with the environment; it includes activity level,
distractibility, intensity of emotions, regularity, sensory threshold,
tendency to approach versus withdrawing, adaptability, persistence,
mood quality [30]. In healthy children, social-emotional stages
develop on an expected trajectory, and monitoring these steps
is a fundamental part of preventative health supervision visits.
physiologically and needs easy routines. Around 4 months of age
turn taking conversation (vocalizations) begin. The infant learns
to manipulate his environment. Between 6 to 12 months, infants
establish attachment relationships with a responsive caregiver.
Around 8 months of age, joint attention skills develop. An infant
will look in the same direction as the caregiver and follow his gaze
and gradually becomes able to share experiences. Between 12 to 18
months, the infant learns to explore his environment with support
from a caregiver. Around 12 months of age, the child takes part in
interactive play (peekaboo) and around 18 months of age, the child
brings the object to show or give it to the caregiver. Between 18 and
30 months, autonomy, that is individuation, emerges so that child’s
temperament manifests itself more [31,32]. Trevarthen stressed
that the meanings of language and cognition are co-created thanks
to the exchange of the child with the caregiver on the basis of an
moments of life [33,34].
Regulatory development
which greater attention must be paid are physiological regulation
(neonatal vagal tone and sleep-wake cyclicity), emotion regulation
(response to stress at 3, 6, and 12 months) and attention regulation
by focused attention and delayed response (during the 2nd year).
showed stability across time, measure and levels, and also the
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coherence of the regulation construct and with neurobiological
models on self and consciousness [35]. Also [36] purposed a
theoretical model to understand and assess the individual infant
focus on the dynamic, continuous interplay of various subsystems
within the organism: The autonomic system, the motor system, the
state organizational system, the attention al interactive system, and
the self-regulatory system. The organism forges ahead negotiating
emerging developmental agenda while simultaneously seeking
to attain a new level of modulated, functional competence [36].
development and from the already existing standardized tools, we
have selected those items that the pediatrician can easily evaluate
within the health assessments or ask the parents and which,
correlated to each other on the basis of the presence/absence
and their evolution, can allow early detection not only of major
neurological or psychological disorders (e.g. infantile cerebral
minor cases or vulnerability of neurobehavioral development. We
have also considered some of the conditions that most frequently
interfere with physiological psychomotor acquisitions, for example
we think that for a pediatrician, being able to have a tool that also
contemplates the correlations between the different developmental
systems, can represent a valid aid to clinical practice in order to be
able to give the right advice to parents and to be able to direct any
investigations and referrals to other specialists.
Method and Materials
The screening form
13-18 months and 19-24 months. Each Module is calibrated for the
the others. Responses to items are organized on a 3-point Likert
scale, where 0 indicates the absence of problematic behaviors, 1
sum of the scores assigned to each item provides a total score
which will be compared with the cut-off (indicated at the footer)
on the basis of which implement the suggested operational choice
(typical= nothing to report; low risk=retest between 3 months;
high risk= retest in 1 month). Typical refers to a child who is able to
carry out what is foreseen for his/her age; Low risk refers to a child
age; High risk refers to the children who are not able to respect the
each Module there are “critical” items, highlighted in bold: if even
in only one of these items the child receives a score of “2”, an in
depth study would be appropriate. The administration time of the
questionnaire is about 5/10 minutes.
Procedure
Italian Regions, Liguria (16%), Abruzzo (24%), Lazio (55%) and
Campania (5%), and was completed by them during the periodic
routine check-up of 1993 children. The children (N= 1993) were
aged between 1 and 24 months, subdivided into age groups: 0-3
months (N=358); 4-6 months (N=408); 7-12 months (N=572); 13-
18 months (N=352) and 19-24 months (N=303). Half of them were
male (N=1059; 53%). The data were collected between January
2019 and June 2021. 19.2% of the data (N=382) were collected in
the post-lockdown period (i.e. after May 2020). Characteristics of
for typical developmental children; there was no known risk factor
for a neurodevelopmental disorder. The pregnancies were full-term
and normal.
Table 1: Characteristic of sample, divided by age group.
Gender (N, %
male)
Mean Gestational
Age (months)
Average Length
(cm) Weight (kg) Body Mass
Index
Cranial
Circumference (cm)
Range 0-3 months (N=358) 189(52.8%) 39±2 56.70± 4.47 5.07±1.43 15.73±2.48 38.89±3.45
Range 4-6 months (N=408) 218(53.4%) 39±2 65.18± 3.39 7.35±2.99 16.99±2.28 42.71±1.75
Range 7-12 months (N=572) 306(53.5%) 39±2 72.65± 4.04 10.07±8.07 17.58±3.08 45.66±1.65
Range13-18 months (N=352) 192(54.5%) 39±2 78.95± 4.27 10.65±1.48 16.94±2.55 47.34±1.89
Range 19-24 months (N=303) 154 (50.8%) 39±2 84.54± 4.14 12.78±7.57 16.96±3.78 48.25±1.84
Inclusion criteria
Children with the following characteristics were not included in
the research: (a) neurological disorders or focal neurologic signs;
severe birth injuries such as asphyxia, head trauma or epilepsy;
(d) preterm children (<36 weeks of pregnancy); (d) chronic
comorbidities and genetic syndromes. Pediatricians gave feedback
to families on screening outcome.
Data analysis
Inferential tests on the normal distribution of scores were
conducted, on the basis of which the raw scores corresponding to
the 5th percentile were calculated. In particular, the total raw scores
were transformed into z points and then into T points, whereby
scores between -1.5 and +1.5 standard deviations from the mean
and 2 standard deviations from the mean (i.e, T points between 61
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and 69) were considered Low Risk; scores greater than 2 standard
Risk. Descriptive analyzes of the items were also conducted to
Result
A preliminary analysis was conducted on the total raw scores
obtained in each age group from the total sample, to establish the
cut-off points beyond which the scores are indicative of a probable
Scores falling between the 25th and 100th
as Typical, scores between the 6th and 24th
as Low Risk, scores lower than or equal to the 5th percentile were
verify the effect of the variable “gender” on the total scores. The
cut off scores emerged are shown in Table 2. Table 3 shows the
numbers and percentages of children in the sample falling into the
three different risk probability ranges, divided by age group.
Table 2: Clinical cut-off by age groups.
Typical “Nothing to Report” Low Risk “Follow-up in 3 Months” High Risk “Follow-up in 1 Month”
Range 0-3 months 0-8 points 9-11 points
Range 4-6 months 0-4 points 5-7 points
Range 7-12 months 0-6 points 7-9 points
Range13-18 months 0-7 points 8-10 points
Range 19-24 months 0-9 points 10-13 points
Table 3: Numbers and percentages of children in the sample falling into the three different risk probability ranges,
divided by age group.
Typical Low Risk High Risk
Range 0-3 months(N=358) 88%(N=314) 8%(N=30) 4%(N=14)
Range 4-6 months(N=408) 86%(N=350) 10%(N=39) 4%(N=19)
Range 7-12 months(N=572) 85%(N=488) 9%(N=54) 5%(N=30)
Range 13-17 months(N=352) 84%(N=294) 10%(N=35) 6%(N=23)
Range 19-24 months(N=303) 86%(N=260) 9%(N=26) 5%(N=17)
Range 0-3 months
that 88% were within the Typical range (25th-75th percentile), 8%
of the children fell within the Low Risk range and 4% of children
were in the High Risk range. The items in which children with
High Risk most often had the score “2”, that is the score which
indicates the frequent presence of problematic behaviors, were:
the child does NOT adapt to being held (64%); the child does
NOT show attention to surroundings sounds (78%); the child is
not very attracted by colored objects (86%); the child does NOT
Range 4-6 months
In children of this age group (N= 408), emerged that 86%
were within the Typical range, 10% of children were in the Low
Risk group and 4% of children fell in the High Risk category. The
items in which children with High Risk most often had the score “2”
were: the child is NOT easy to dress/undress (37%) and the child’s
Range 7-12 months
In children of this age group (N= 572), emerged that 85% were
within the Typical category, 9% of children were in the Low Risk
group and 5% of the children were in the High Risk group. The
items in which children with High Risk most often had the score “2”
were: the child is NOT autonomous in his movements (40%), when
the child gets hurt a lot, he cries little (33%), the child sleeps too
much compared to other children ( 33%), the child does NOT repeat
child does NOT turn to pick up an object (33%), the child does NOT
imitate the other’s gestures (70%), the child’s sleep is irregular
(43%) and the child is NOT able to stand upright with support
Range 13-18 months
In children of this age group (N=352), emerged that 84% were
within the Typical range, 10% of children were in the Low Risk
group and 6% of the children in the High Risk group. The items in
which children with High Risk most often had the score “2” were:
the child tends to smell objects or people (30%), the child overreacts
to denial (35%), the child does NOT produce at least 5 words with
meaning (83%), the child’s sleep is irregular (43%), when he hurts
Range 19-24 months
In children of this age group (N=303), emerged that 86% were
in the Typical range, 9% of children were in the Low Risk group
and 5% of the children in the High Risk group. The items in which
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children with High Risk most often have the score “2” were: the child
tends to bring objects to the mouth and/or lick them (53%), the
child does NOT make sentences of 2 or more words (59%), the child
has eating problems (35%), the child does NOT complete a task
(65%), the child does not blow /suck (41%), does NOT produce at
least 20 meaningful words (88%) and the child overreacts to denial
Discussion
In the 0-3 months range, the main alarm bells revealed by
the screening form concern the child’s ability, while awake, to
pay attention to the world around her/him and to interact with
arms, to show attention to sounds and colors around her/him,
to imitate movements of the parent’s mouth and to breastfeed-
ing attachment. These aspects risk having an impact on the
development of self-regulation necessary for subsequent learning
trimester of life, we observe the eye gaze as well as the ability to
pay attention to objects, to look and respond to a familiar face,
until the appearance of the social smile [38-40]. Looking at the
adult’s mouth and imitating some facial movements represent the
precursors of preverbal communicative intentionality [41]. It is
interesting to note how the items in which the “High Risk” children
received high scores seem to indicate a vulnerability between
sensory-perceptive-motor development and early relational skills,
aspects which are very important to analyze within health check-
up and screening, in order to identify early vulnerability of the
mouth movements” may underlie a sensory-motor immaturity that
could have repercussions on the relationship sphere or, otherwise,
a social-affective vulnerability that limits the specialization of
motor functions (in this case oral) [35].
In the 4-6 month range, emerged alarm bells mainly related to
between a physiological transition phase (when sleep is the only
indicator and a spontaneous resolution is possible) and a disorder
that affects multiple subsystems, whereas specialist assessments
should be carried out and parents should be supported in
understanding child’s characteristics and environmental factors
that could represent “risk” or “protective” elements. In the 7-12
related to motor development (“the child is NOT autonomous in his
movements”; “while sitting or on all fours he does not turn around
to pick up an object”; “the child is not able to stand upright with
support”) and communicative-linguistic (“the child does not repeat
starting to move away (moving away from his parents or trying
to reach objects) stimulates the need to communicate more
acquisitions. But it should be emphasized that motor, linguistic
signals for autism spectrum disorders [47,48]. In our opinion, it is
therefore essential to pay attention to the quantity and quality of
the indicators, in order to early identify children at developmental
risk and to establish early and appropriate intervention and/or
monitoring programs.
In the 13-18 months range, alarm bells emerged concerning
tends to smell objects or people”; “the child overreacts to denial”;
“when he hurts a lot, he cries little”) but also remain those related
to linguistic and communicative development (“the child does not
through the pages of a book”) and the regularity of sleep. Compatibly
with developmental processes, at this age emotion regulation is
particularly “critical”, that is the individual ability to regulate own
emotions, both positive and negative, attenuating them, intensifying
them or simply maintaining them [49]. The processes through which
emotions can be regulated can be of intrinsic type, when the subject
acts by regulating himself (regulation in self), or of extrinsic type
(regulation in other), when someone acts to regulate the emotions
of the other [50,51]. Emotion regulation is initially mediated by
the caregiver, later in the course of development it appears as a
more autonomous and conscious modality [52-54]. This, more
than other areas of development, can easily be affected positively
or negatively by environmental conditions, including dysfunctional
family dynamics, parental psychopathologies, adverse, stressful
or traumatic events. It is also based on the temperament of each
child which, representing a constitutional characteristic, is the least
the environment to modulate the stimuli and favor a positive
regulation correlates, in terms of developmental trajectories, with
the risk of developing disorders of the emotional sphere, behavior
represent early risk indicators for detecting conditions at risk, in
particular behavioral and psychopathological.
Sensory and emotion reactivity (“the child tends to bring objects
to mouth and/or lick them”; “the child overreacts to denial”),
communication (“the child does not produce at least 20 meaningful
words”; “the child does not make sentences of 2 or more words”;
“the child does not blow/ suck”), nutrition (“the child has eating
problems”) and attention (“the child does not complete a task”).
At this age the child should imitate adults, discover language and
recognize the world of emotions, through play and social interaction
[29]. Usually, even when he still speaks little, he should be able to
communicate through gestures, point to ask, to show and to share.
This is also an age in which the expectations of the environment are
greater and the comparison with peers highlights the differences
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[57,58]. However, while on neurodevelopmental disorders, autism,
there is always greater attention to early detection, the delays or
atypia in areas such as language and emotional regulation are still
too often underestimated, depriving children of the possibility of
intervening in the most critical developmental window in which,
therefore, the system is more receptive. We believe that the results
here described highlight that there are areas and domains of
development in which, based on the age group and therefore on
the developmental stage, children may more frequently present
conditions of vulnerability; on the other hand, it is often precisely
disorders arise.
The goal is to look at development has a whole, rather than
going in search of a single pathognomonic indicator of a disorder,
so as not overlook conditions which although apparently less
serious could make the child more fragile even in the future and
example, while it is known that the absence of babbling and the
subsequent delay in language acquisition, as well as asymmetries
or other alterations in motor development could both represent the
we are still witnessing many delays in diagnosis and consequently
in therapy. Still too often, in fact, clinicians wait until the age of 3
year before carrying out a specialist evaluation for language delay,
perhaps also because not everyone knows the importance that
can have in determinism of future neuropsychological and social-
affective disorders, such as in the more well-known dyspraxia, but
also in sensory processing disorders [59] and in those of emotion,
attention and behavior regulation. There is another very important
factor in clinical practice with early childhood, which is gradually
entering the protocols of outpatient and hospital contexts; that
is, the impact of somatic dysfunctions (the most frequent is
plagiocephaly) on the adaptation of the child [60]. Many babies
develop plagiocephaly, so the incidence in the general population
[60-63]. These authors suggest clinicians to monitor infants with
plagiocephaly and to prompt referral to early intervention services,
who may identify infants with longer term developmental needs
[63].
Conclusion
The present research illustrates a large observational study of
life, deviations from the physiological developmental trajectories
occur. Most of the data correlate with those in the literature and
this supports us in thinking that the 0-2 neurodevelopmental
screening and monitoring form can represent for pediatricians
and childhood specialists an easy-to-use, repeatable and reliable
neurodevelopmental risk, but above all for the implementation
of differentiated care programs ranging from psycho-educational
indications to parents, to specialist consultancy and therapeutic,
habilitation/rehabilitation pathways, tailored to the needs and
global characteristics of each child, not just addressed at the disorder.
All the pediatricians who took part in the study appreciated the
possibility of having a tool which in just few minutes could allow
Promptly identifying those at risk and/or with problems allows
for early intervention, but also and above all, to refer only those
who really need them to specialist services, avoiding unnecessary
overloading of the competent structures for the diagnosis and
treatment of these disorders.
The future objectives will be: the comparison of the forms
administered to the same child, which will make it possible to better
the possible correlation between indicators of different domains,
the impact of the early activation of individualized diagnosis and
treatment pathways, the comparison of prevalence in the pre- and
post-pandemic period from Sars-CoV-2. This study shows that in
the population examined presents a delay or a lack of acquisition
of the fundamental stages of neurodevelopment. Epigenetics
conditions is essential in optimizing the interventions necessary to
prevent and/or limit damage which overtime acquires harmfulness
Author Contributions
Conceptualization, Magda Di Renzo, Paolo Pace and Elena
Vanadia; methodology, Monica Rea; writing original draft
preparation Lidia Racinaro; supervision Magda Di Renzo & Alberto
Villani. All authors have read and agreed to the published version
of the manuscript.”
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of
Helsinki. Ethical review and approval were waived because of the
use of secondary data.
Informed Consent Statement
Informed consent was obtained from all pediatricians involved
in the study.
Data Availability Statement
Data available on request due to restrictions (privacy). The
data presented in this study are available on request from the
corresponding author. The data are not publicly available due to
because they are collected by pediatricians in their private practices.
Acknowledgment
We thank all the pediatricians and family who participated in
this research.
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Res Pediatr Neonatol
Copyright © Magda Di Renzo
RPN.000677. 8(1).2023
Conicts of Interest
References
1. Cioni G, D’Acunto G, Guzzetta A (2011) Perinatal brain damage in
children: neuroplasticity, early intervention and molecular mechanisms
of recovery. Progress in Brain Research 189: 139-154.
2. Robins DL, Casagrande K, Barton M, Chen CMA, Dumont MT, et al. (2014)
3. Zubler JM, Wiggins LD, Macias MM, Whitaker TM, Shaw JS, et al. (2022)
Evidence-informed milestones for developmental surveillance tools.
Pediatrics 149(3): e2021052138.
4.
T.U.L.I.P. Protocol (TCE, UOI, Leiter-R as indicators of predictivity) for
the assessment of the developmental potential in children with autism
spectrum disorders. Autism Open Access 6(4): 188: 1-7.
5.
Sensory processing and repetitive behaviors in clinical assessment of
preschool children with autism spectrum disorder. Journal of Child and
Adolescent Behavior 5(2): 1-8.
6. Parenti I, Rabaneda LG, Schoen H, Novarino G (2020)
Trends in Neurosciences 43(8): 608-621.
7.
Multifactorial origin of neurodevelopmental disorders: Approaches to
understanding complex etiologies. Toxics 3(1): 89-129.
8.
9. Als H (1982) Toward a synactive theory of development: Promise for
the assessment and support of infant individuality. Infant Mental Health
Journal 3(4): 229-243.
10.
World Health Organization.
11. Kliegman RM, Behrman RE, Jenson HB, Stanton BM (2007) Nelson
textbook of pediatrics e-book. Elsevier Health Sciences.
12. Dubowitz LM, Dubowitz V, Goldberg C (1970) Clinical assessment of
gestational age in the newborn infant. The Journal of Pediatrics 77(1):
1-10.
13.
movements: A diagnostic tool for the functional assessment of the young
nervous system. Mental Retardation And Developmental Disabilities
Research Reviews 11(1): 61-67.
14.
Mental Retardation And Developmental Disabilities Research Reviews
11(3): 253-262.
15. Coelho MME, Bronstein J, Aedo K, Pereira JA, Arraño, et al. (2019)
with autism spectrum disorder. Rev Chil Pediatr 90(5): 492-499.
16.
scales of child development. (3rd edn), Hogrefe Ltd.: Oxford, UK.
17. Bayley N (2006) Bayley scales of infant and toddler development. (3rd
edn), San Antonio: NCS Pearson, USA.
18. Zubler J, Whitaker T (2022) CDC’s revised developmental milestone
19. Tierney AL, Nelson CA (2009) Brain development and the role of
experience in the early years. Zero Three 30(2): 9-13.
20. Clark GMB, Clark DA (2015) Sensory development. Pediatric Clinics
North Am 62(2): 367-384.
21. Bremner AJ, Lewkowicz DJ, Spence C (2012) Multisensory development.
Oxford University Press.
22.
development in healthy children (2-24 months). J Am Coll Nutr 21(2):
88-96.
23. WHO Multi centre Growth Reference Study Group (2006) WHO motor
development study: Windows of achievement for six gross motor
development milestones. Acta Paediatr Suppl 450: 86-95.
24.
USA.
25. Chomsky N (2011) How the world works.
26. Bruner J (1985) Child’s talk: Learning to use language. Child Language
Teaching and Therapy 1(1): 111-114.
27. Piaget J, Inhelder B, Cecchini M (1971) Mental imagery in the child: A
study of the development of imaginal representation. London: Routledge
and Kega Paul Ltd, UK.
28. Vygotsky LS (2012) Thought and language. MIT press, Cambridge, UK.
29. Camaioni L (2017) The development of intentional communication: A
re-analysis. In New perspectives in early communicative development.
Routledge, London, UK, pp. 82-96.
30.
31.
Pearls Publishing.
32. Tronick E (2007) The neurobehavioral and social-emotional
33. Trevarthen C (2012) Embodied human intersubjectivity: Imaginative
agency, to share meaning. Cognitive Semiotics 4(1): 6-56.
34. Trevarthen C (2014) Modes of perceiving and modes of acting. In Modes
of perceiving and processing information. Psychology Press, London, pp.
99-136.
35.
to 5 years: Insights from premature infants. Child Development 80(2):
544-561.
36.
development of infants with positional plagiocephaly. Physical &
Occupational Therapy In Pediatrics 29(3): 222-235.
37. Baldwin DA (1991) Infants’ contribution to the achievement of joint
reference. Child development 62(5): 875-890.
38. Batki A, Baron CS, Wheelwright S, Connellan J, Ahluwalia J (2000) Is
there an innate gaze module? Evidence from human neonates. Infant
Behavior and Development 23(2): 223-229.
39. Parsons JP, Bedford R, Jones EJ, Charman T, Johnson MH, et al. (2019)
Gaze following and attention to objects in infants at familial risk for ASD.
40. Benson JB, Haith MM (2009) Social and emotional development in
infancy and early childhood. Academic Press.
41. Horta BL, Loret DMC, Victora CG (2015) Breastfeeding and intelligence:
A systematic review and meta-analysis. Acta paediatr 104(467): 14-19.
42. Zheng W, Chotipanvithayakul R, Ingviya T, Xia X, Xie L, et al. (2022)
Sensory stimulation program improves developments of preterm
Psychology 13: 867529.
43.
children and adolescents with neurodevelopmental disorders: A
696
Res Pediatr Neonatol
Copyright © Magda Di Renzo
RPN.000677. 8(1).2023
practical guide for clinicians. World Journal of Clinical Pediatrics 11(3):
239-252.
44.
processing that enables the developing human brain to discriminate
touch from pain. Current Biology 21(18): 1552-1558.
45.
biological and microsocial behavioral processes in the study of parenting.
Parenting 12(2-3): 154-164.
46. Deliens G, Leproult R, Schmitz R, Destrebecqz A, Peigneux P (2015)
Sleep disturbances in autism spectrum disorders. Review Journal of
Autism and Developmental Disorders 2: 343-356.
47. Guinchat V, Chamak B, Bonniau B, Bodeau N, Perisse D, et al. (2012) Very
early signs of autism reported by parents include many concerns not
589-601.
48. Gross JJ (2013) Handbook of emotion regulation. Guilford publications.
49. Gulsrud AC, Jahromi LB, Kasari C (2010) The co-regulation of emotions
between mothers and their children with autism. Journal of Autism and
Developmental disorders 40(2): 227-237.
50.
relationships. Monogr Soc Res Child Dev 59(2-3): 228-249.
51. Winnicott DW (2012) The family and individual development. Routledge,
London, UK.
52. Winnicott DW (2018) The maturational processes and the facilitating
environment: Studies in the theory of emotional development by D. W.
Winnicott. International Journal of Group Psychotherapy 16(4).
53.
parent-infant psychotherapy. Routledge, London, UK.
54. Cole PM, Dennis TA, Smith SKE, Cohen LH (2009) Preschoolers’ emotion
regulation strategy understanding: Relations with emotion socialization
and child self-regulation. Social development 18(2): 324-352.
55. Thompson RA (1994) The development of emotion regulation: Biological
and behavioral considerations. Monographs of the society for research
in child development 59(2-3): 25-52.
56. Marco EM, Macrì S, Laviola G (2011) Critical age windows for
neurodevelopmental psychiatric disorders: Evidence from animal
models. Neurotoxicity Research 19(2): 286-307.
57.
neurobiology 35: 27-34.
58. Zeanah CH, Carter AS, Cohen J, Egger H, Gleason MM, et al. (2016)
of infancy and early childhood dc: 0-5: Selective reviews from a new
nosology for early childhood psychopathology. Infant mental health
journal 37(5): 471-475.
59.
Osteopathic evaluation and positional plagiocephaly: A descriptive study
on a population of children with ASD. American Journal of Pediatrics
8(2): 104-110.
60. Santiago GS, Santiago CN, Chwa ES, Purnell CA (2023) Positional
plagiocephaly and craniosynostosis. Pediatric Annals 52(1): e10-e17.
61.
and developmental delay: A systematic review. Journal of Developmental
& Behavioral Pediatrics 38(1): 67-78.
62. Ballardini E, Sisti M, Basaglia N, Benedetto M, Baldan A, et al. (2018)
Prevalence and characteristics of positional plagiocephaly in healthy
full-term infants at 8-12 weeks of life. Eur J Pediatr 177(10): 1547-1554.
63.
problems. Pediatrics in review 21(8): 272-279.
