Course:KIN366/ConceptLibrary/FineMotorSkillDevelopment

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
Email: shannon.bredin@ubc.ca
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Fine motor skills, or dexterity, are the refined and controlled use of small muscles located in the hand, fingers, and thumb in coordination with the maturation of the central nervous system [1]. Particularly, fine motor movements require an integrated, and highly efficient brain network to send sensory information from multiple sensory cortices to the motor complex at a rapid pace [2] The small muscle movements that occur in the hand are usually synchronized with muscle movements in the eyes. The development of fine motor skills is crucial to a child’s ability to become familiar with and learn about the world, and thus plays a central role in the development of intelligence. Various tasks that emerge from the development of fine motor skills include holding a pencil, writing, putting clothes on, picking up small objects, drawing, and many more [3].


Typical Development

Though fine motor skills develop in a specific, predetermined order, every child will develop at his/her own pace. This uneven pace is characterized by rapid spurts, and delays, both viewed as harmless [4].

Infancy (birth - walking)

The main milestone that newborn babies, to the average person, appear to have is the ability to grip [5]. This is commonly thought because when an infants palm is touched, it will make a very tight fist. Conversely, what appears to be a conscious action is actually an unconscious reflex called the Darwinian reflex. This reflex is commonly observed when an object is placed in an infant’s hand, and it grasps the object. After a few seconds or minutes, the infant’s muscles will relax and, consequently, the object is dropped. When an infant does this, it is completely unaware that it is doing so. This reflex will disappear within two to three months after birth [6].

Additional fine motor milestones:

Two weeks: Flailing arms at objects that are of interest to them, but cannot yet grasp the object. [7].

Eight weeks: Begin to discover, recognize, and play with their hands. They begin with touch, and at three months progress to using sight as well. Infants still cannot deliberately grasp objects [8].

Two to four months: Infant instigates a trail-and-error practice of sighting objects, followed by attempting to grab at them. This action is the beginning of hand-eye coordination development [9].

Four to five months: Infants have some success at actively grasping objects within reach. The telling feature of the grasp that signifies that the infant is consciously grabbing for a specific object is that it will only look at the object and not their hands reaching for it. Another term for this reach is “top-level reaching,” and it is a key achievement in fine motor development [10].

Six months: Infant becomes increasingly fascinated with grabbing small objects. Due to this, the infant gains the ability to briefly hold small objects. An infant might also bang objects, and place them in their mouths once they have grasped them. An can also be observed trying to grasp things that cannot be grasped, such as pictures in a book [11].

Eight to ten months: The original “palmar grasp,” where an infant holds an object with all four fingers, and its thumb, wrapped around the same side. This grasp makes it difficult to manipulate the object, and is the primary, or least advanced, version of the grip. As time passes, the “finger grasp” begins to emerge. This is when an infant only grips an object with all four fingers, pushing it against its thumb [12].

Ten to twelve months: Begin to explore and test out objects before grasping by touching them with entire hand or poking it with the index finger [13].

Twelve to fifteen months: Development of the advanced grip, the “pincer grip” begins. This is a significant motor accomplishment during infancy. The infant is now able to hold an object between the thumb and index finger. This grip allows infants to have more control and manipulation of the object, and provides the ability to deliberately drop the object [14].

One year: Infant can deliberately drop object into receptacle, hold an object in both hands and compare them, and stack objects on top of each other [15].

Toddlerhood (walking – two years)

The major milestone of this developmental stage is the increased ability deliberately control objects with a high level of sophistication[16]. This high level of sophistication leads to not only the manipulation of multiple different objects, but also to being able to name the objects they are manipulating. Toddlers at this stage are able to twist dials, pull strings, push levers, turn book pages, and use writing utensils to produce basic scribbles. These scribbles can become more advanced within this age period. Toddlers can be observed drawing different patterns, such as shapes. As well, they can draw abstract designs without going off the paper provided. [17]. Toddler’s manipulation of blocks becomes more advanced and purposeful as they gain the ability to stack [18]. Other tasks they are able to accomplish are stringing large beads, manipulate snap toys, play with clay, unwrap small objects, and pound pegs. If a child cannot pick up a crayon, or picks it up and uses it to teeth, he/she might be behind in fine motor skills development. Lastly, the right/left hand dominance usually emerges during this developmental stage [19].

Preschool (three – four years)

There is difficulty listing major milestones in this developmental stage because of the high variability in brain development, patience levels, and energy levels of each individual child [20].. The central nervous system maturation is still ongoing in this stage. This maturation process is long because there needs to be a sufficient amount of development in order to send complex messages from the brain to a child’s small muscles. Small muscles also tire more easily than larger muscles (used for gross motor movements). Preschoolers short, stubby fingers make small and complicated tasks more difficult than larger, less complex tasks. Lastly, unlike gross motor skills that require high energy levels, fine motor skills require high levels of patience, which preschoolers tend to have short supply of. The tasks that become more complicated due to the factors stated above are handling cutlery, tying shoelaces, and opening packages [21].

Additional fine motor milestones:

Three years: have adequate control over writing utensils. Preschoolers can draw primitive circles, copy model of horizontal and vertical lines, and draw basic stick-figure people [22].

Four years: Preschoolers gain the ability to use scissors, copy geometric shapes and letters, button large buttons, and form clay shapes with an average of two or three parts. The drawing of a human figure becomes more complex. The figure usually appears as a head with legs coming out of it, and arms jutting out from each leg. Furthermore, some children are able to print their name in capital letter [23].

School Age (five years and on)

Observable maturations in fine motor skills occur during this stage of development [24]. By five years of age, the majority of children have advanced to be able to draw recognizable human figures, which now includes a trunk, connected properly to a head, arms, and legs. Aside from drawing, children’ right- or left-handedness is well established. This is observed when a child only uses one preferred hand when writing and drawing. Moreover, other skills school aged children have mastered are cutting, pasting and tracing shapes, fastening visible buttons of various sizes, tie bows, and shoelaces [25]. If a child cannot make any recognizable drawings, colour inside lines in colouring book, and/or holds writing utensil with full fist, he/she is not developing fine motor skills at the appropriate pace [26].

Atypical Development

In most cases, difficulty with specific fine motor skills during differing stages of development is temporary and does not indicate a serious problem. However, if a child is significantly, and noticeably behind his peers in various aspects of fine motor development (refer to developmental milestones above), or if a child regresses by losing previously acquired fine motor skills, medical help should be sought.

Risk Factors

Neurofibromatosis type 1 (NF1)

NF1 is an autosomal dominant disorder that is caused by a mutation of a gene on chromosome 17, which is responsible for encoding neurofibromin [27] This disorder impairs fine motor skill development because neurofibromin are involved in a process that leads to central nervous system abnormalities. The specific skills that are effected are fine motor precision, upper limb coordination, and bilateral coordination [28]

Developmental Coordination Disorder

This disorder is commonly referred to as developmental dyspraxia [29]. It is a chronic neurological disorder where brain messages are not accurately transmitted to ones muscles. This disorder begins in childhood and affects the planning and coordination of movements. In turn, this disorder constrains the maturation of fine motor skills [30]

Intra-uterine growth restriction

Children with growth restrictions have an increased prevalence of fine motor impairments than their non-growth-restricted counterparts. Growth restriction only affects fine motor skills in the larger motor domain [31]

Down Syndrome

Attainment of early motor milestones may be delayed due to problems with ligamentous laxity, decreased strength, hypotonia, and postural control. Motor proficiencies were studied in older children. The studies found that children with Down Syndrome have deficits in hand-eye coordination, laterality, reaction time, and significant deficits in visual motor control. Children with Down Syndrome develop fine motor skills at a slower rate than gross motor skills [32]

Infections and Necrotizing Enterocolitis

In preterm infants, infections and necrotizing enterocolitis risk factors for impaired motor, cognitive, and developmental outcomes have been identified. Out of those three domains, fine motor skills is the most negatively affected. The prevalence of impaired fine motor skills in children with necrotizing enterocolotis is very high at 60%. This impairment can be explained by considering the high inflammatory conditions these children experience, which leads to a considerable decrease in fine motor skills [33].

Bronchopulmonary Dysplasia and Dexamethasone Treatment

The risk factor for impaired motor development for children with this condition is due to the severity of the condition and the duration of the oxygen treatment, specifically the systemic corticosteroid treatment. Children treated with dexamethasone showed a fine motor skills impairment prevalence of 72% [34].

Diffuse White Matter Injury

This injury is a common type of injury that occurs in preterm infants. Pre-oligodendrocytes are the primary cellular target in cerebral white matter injury, which leads to this specific brain injury. An outcome of this injury is impairment in motor functioning. Every preterm infant is subject to experience varying degrees of hypoxia-ischemia and inflammation. This is important when considering fine motor movements because they require an integrated and highly efficient brain network to communicate with sensory information from multiple sensory cortices to the motor cortex. Every preterm child’s increased susceptibility to white matter damage can effect the development of these processes (Boz, et al., 2013).

Ways to Encourage Fine Motor Skill Development

An essential component of encouraging fine motor development is the variety of play materials available to a child (“Fine motor skills,” 2001). Fine motor tasks require planning by caregivers, and time to deeply interact with various objects. The most successful strategy to engage your child in fine motor movements is to use play materials that your child, specifically, is interested in, and has previously shown enjoyment when playing with that toy. These play materials can include simple crafts, puzzles, building blocks, and rattles. Another way to engage children is to have them help their parents with everyday domestic activities, such as baking, and typing on a keyboard. Movements, such as stirring batter, cutting shapes into cookies, and clicking a computer mouse can strengthen finger, hand, and arm muscles, and improve hand-eye coordination (“Fine motor skills,” 2001). If a family cannot afford to purchase various play materials that are designed to improve fine motor skills, it is recommended that they visit a friend or a local community centre that does have these materials. Community centers typically have drop-in times where toys are scattered in a gym area and the fee is minimal, or occasionally free (“Fine motor skills,” 2001).

Long-Term Influences of Early Acquisition of FMS

Academic Achievement

Recent research has shown that children who engage in object exploration at five months of age can predict academic achievement at fourteen years of age. Extensive observations suggest that object-exploration experiences could potentially play a large role of a developmental cascade that promotes social and cognitive growth. Fine motor skills developed between twelve and fourteen months of age were shown to predict expressive language skills at thirty-six months of age [35].

Mathematical Performance

Children who have developed mature fine motor skills, particularly figure copying, drawing, and block arrangement, by six years of age, have been shown to have more advanced math performance than children with less developed fine motor skills. The acquisition of fine motor skills during infancy to preschool is an important predictor of math achievement in later years [36]

Working Memory

Various studies have all come to the same finding that higher levels of motor skills predict better cognitive functioning. Moreover, improved cognitive functioning in school-aged children and executive functioning in adults can be predicted by their level of motor functioning when infants. This predictive relationship may be comprehended in terms of all these domains having common neural mechanisms [37].

Assessment

Movement Assessment Battery for Children (MACB)

This assessment is the most widely used test to examine fine motor skills of school aged preterm children [38]. The MABC test battery assesses three main domains: manual dexterity, balance, and ball skills. Under these domains are several subtests, which are mainly used as the assessment of fine motor skills. The subtests used to measure fine motor skills are speed and accuracy of finger movements. An example of a test that is done is inserting pegs into a pegboard, and drawing a line between two closely positioned lines forming a flower [39].

Bruininks-Oseretsky Test of Motor Proficiency (BOTMP)

This assessment measures a broad spectrum of skills, including fine motor control, and manual coordination [40]. Example of tests that are done to assess these domains are cutting out a circle from a piece of paper, and stringing on blocks [41].

Jebsen Hand Function Test

This assessment is mainly used for rehabilitation research [42]. This test is made up of seven times subtests, including writing, turning over cards, and picking up objects of varying weights [43].

Peabody Development Motor Scales

This evaluation is conducted on children from birth to seven years of age. It assesses the child’s ability to grasp a multitude of objects, the level of development of hand-eye coordination, and the child’s overall finger dexterity [44].


Treatment/Therapy

Therapeutic interventions, functional interventions, and occupational therapy have shown encouraging results for children with atypical development of fine motor skills. If your child’s development does not appear to be on the same level as his/her peers, or his/her developmental level has regressed, seek medical help [45]

References

  1. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  2. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  3. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  4. Ben-Sassona, A., & Gill, S. (2014). Motor and language abilities from early to late toddlerhood: Using formalized assessments to capture continuity and discontinuity in development. Research in Developmental Disabilities, 35(7), 1425-1432.
  5. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  6. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  7. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  8. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  9. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  10. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  11. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  12. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  13. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  14. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  15. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  16. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  17. Printing and Handwriting Development. (2011, January 1). Retrieved February 22, 2015, from http://www.kamloopschildrenstherapy.org/printing-handwriting
  18. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  19. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  20. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  21. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  22. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  23. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  24. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  25. Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.doid=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f
  26. Printing and Handwriting Development. (2011, January 1). Retrieved February 22, 2015, from http://www.kamloopschildrenstherapy.org/printing-handwriting
  27. Casnar, C., Janke, K., Van der Fluit, F., Brei, N., & Klein-Tasman, B. (2014). Relations between fine motor skill and parental report of attention in young children with neurofibromatosis type 1. Journal of Clinical and Experimental Neuropsychology, 36(9), 930-943
  28. Casnar, C., Janke, K., Van der Fluit, F., Brei, N., & Klein-Tasman, B. (2014). Relations between fine motor skill and parental report of attention in young children with neurofibromatosis type 1. Journal of Clinical and Experimental Neuropsychology, 36(9), 930-943
  29. Ben-Sassona, A., & Gill, S. (2014). Motor and language abilities from early to late toddlerhood: Using formalized assessments to capture continuity and discontinuity in development. Research in Developmental Disabilities, 35(7), 1425-1432.
  30. Ben-Sassona, A., & Gill, S. (2014). Motor and language abilities from early to late toddlerhood: Using formalized assessments to capture continuity and discontinuity in development. Research in Developmental Disabilities, 35(7), 1425-1432.
  31. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  32. Connolly, B., Morgan, S., Russell, F., & Fulliton, W. (1993). A longitudinal study of children with down syndrome who experienced early intervention programming. Physical Therapy,73(3), 170-179.
  33. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  34. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  35. Libertus, K., Sheperd, K., Ross, S., & Landa, R. (2014). Limited fine motor and grasping skills in 6-month-old infants at high risk for autism. Child Development, 85(6), 2218–2231-2218–2231
  36. Suggate, S., & Stoeger, H. (2014). Do nimble hands make for nimble lexicons? Fine motor skills predict knowledge of embodied vocabulary items. First Language, 34(3), 244–261-244–261.
  37. Rigoli, D., Piek, J., Kane, R., Whillier, A., Baxter, C., & Wilson, P. (2013). An 18-month follow-up investigation of motor coordination and working memory in primary school children.Human Movement Science, 32(5), 1116-1126
  38. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  39. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  40. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  41. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  42. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  43. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.
  44. Maddox, T. (2007). Peabody developmental motor scales. In Encyclopedia of special education: A reference for the education of children, adolescents, and adults with disabilities and other exceptional individuals
  45. Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.

Ben-Sassona, A., & Gill, S. (2014). Motor and language abilities from early to late toddlerhood: Using formalized assessments to capture continuity and discontinuity in development. Research in Developmental Disabilities, 35(7), 1425-1432.

Bos, A., Van Braeckel, K., Hitzert, M., Tanis, J., & Roze, E. (2013). Development of fine motor skills in preterm infants. Developmental Medicine & Child Neurology, 4, 1-4.

Casnar, C., Janke, K., Van der Fluit, F., Brei, N., & Klein-Tasman, B. (2014). Relations between fine motor skill and parental report of attention in young children with neurofibromatosis type 1. Journal of Clinical and Experimental Neuropsychology, 36(9), 930-943.

Connolly, B., Morgan, S., Russell, F., & Fulliton, W. (1993). A longitudinal study of children with down syndrome who experienced early intervention programming. Physical Therapy,73(3), 170-179.

Fine motor skills. (2001). The Gale Encyclopedia of Psychology, 2, 250-252. Retrieved February 22, 2015, from http://go.galegroup.com/ps/i.do?id=GALE%7CCX3406000254&v=2.1&u=cuny_hunter&it=r&p=GVRL&sw=w&asid=97a89fbcaf8c9f07156e6a73b527135f

Libertus, K., Sheperd, K., Ross, S., & Landa, R. (2014). Limited fine motor and grasping skills in 6-month-old infants at high risk for autism. Child Development, 85(6), 2218–2231-2218–2231.

Maddox, T. (2007). Peabody developmental motor scales. In Encyclopedia of special education: A reference for the education of children, adolescents, and adults with disabilities and other exceptional individuals.

Printing and Handwriting Development. (2011, January 1). Retrieved February 22, 2015, from http://www.kamloopschildrenstherapy.org/printing-handwriting

Rigoli, D., Piek, J., Kane, R., Whillier, A., Baxter, C., & Wilson, P. (2013). An 18-month follow-up investigation of motor coordination and working memory in primary school children.Human Movement Science, 32(5), 1116-1126.

Suggate, S., & Stoeger, H. (2014). Do nimble hands make for nimble lexicons? Fine motor skills predict knowledge of embodied vocabulary items. First Language, 34(3), 244–261-244–261.