Abstract

This study aimed to analyze the neuropsychomotor performance of children by implementing the Denver Developmental Screening Test-II (DDST-II). We evaluated a sample of 318 children aged 36 to 48 months. Results indicated that girls performed better in three of the four areas analyzed in the test: Personal-Social (p < 0.001), Fine Motor-adaptive (p = 0.020) and Language (p = 0.028). No significant difference was observed between genders in the Gross Motor skills area. Analyzing the performance of children in implementing the tasks expected in the test, we found significant differences in the following items: in the Personal–Social area, the worst-performing item was “Brushes teeth without help”; in the Fine Motor area, the worst-performing item was “shows the longest line”; in the Language area, the worst-performing items were “Knows two adjectives”, “Knows four actions” and “Understands four prepositions”; and in the Gross Motor area, the worst-performing item was “Hops on one foot”. The results suggest that socially-imposed standards, based on gender differences, may interfere with the neuropsychomotor behavior of children. Furthermore, knowing such development profile is crucial in the formulation of public policies and actions that can contribute to child development.

Child development; Development evaluation; Gender differences

Introduction

Understanding the process of human development has been a worldwide concern, particularly among countries with low economic growth and high levels of social inequality. Studies in low- and middle-income countries emphasized the importance of intervention in the first years of life as a primary factor to improve the neurodevelopment of children¹1. Engle PL, Fernald LCH, Alderman H, Behrman J, O’Gara C, Yousafzai A, Mello MC, Hidrobo M, Ulkuer N, Ertem I, Iltus S, The Global Child Development Steering Group. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet 2011; 378(9799):1339-1353.. The Neuropsychomotor Development (NPMD) is an essential parameter of evaluation in the early years of life, allowing researchers and professionals to detect early changes.

NPMD is associated with maturation of the central nervous system (CNS) and comprises four broad fields: Gross Motor, Fine Motor (Adaptive), Social and Linguistic. However, the skills that underpin each field come in sequence: the most straightforward skills serve as the basis for the most complex, and it is essential to understand and distinguish them. As the primitive reflexes are inhibited, the child acquires new skills within the four fields mentioned, reaching the developmental milestones. Each has its growth rate and is expected not to deviate drastically from the pattern observed for its age, among other established criteria²2. Martins TSA, Vilela RV, Pereira FV, Cária NZ, Faria HP. Implementação da avaliação do crescimento e do desenvolvimento neuropsicomotor em crianças menores de 5 anos na USF Grajaú na cidade de Brumadinho – MG, pelo internato rural da UFMG. Revista Médica de Minas Gerais 2013; 23(1):27-32..

The NPMD evaluation allows exploration of developmental milestones in children populations, ideally through standardized instruments. The early diagnosis of NPMD delay allows for timely therapeutic interventions, reducing the incidence of often permanent neurological complications. A study carried out in Curralinho, state of Minas Gerais, confirms the importance of this diagnosis through the Denver Development Screening Test-II (DDST-II) in routine childcare consultations, which can anticipate losses in patients and act preventively. It also states that the lack of qualified monitoring can lead to human and social harm, as well as financial loss to the municipality resulting from not intervening at an early stage in case of avoidable developmental delays²2. Martins TSA, Vilela RV, Pereira FV, Cária NZ, Faria HP. Implementação da avaliação do crescimento e do desenvolvimento neuropsicomotor em crianças menores de 5 anos na USF Grajaú na cidade de Brumadinho – MG, pelo internato rural da UFMG. Revista Médica de Minas Gerais 2013; 23(1):27-32..

Several tests and scales have been used to evaluate children’s development in the country, most of them originated in other countries, such as the Bayle Scale³3. Guedes DZ, Primi R, Kopelman BI. BINS validation - Bayley neurodevelopmental screener in Brazilian preterm children under risk conditions. Infant Behav Dev 2011; 34(1):126-135. and the Alberta Scale⁴4. Saccani R, Valentini NC. Curvas de referência da Escala Motora Infantil de Alberta: percentis para descrição clínica e acompanhamento do desempenho motor ao longo do tempo. Jornal de Pediatria 2012; 88(1):40-47.. However, some instruments standardized by Brazilian researchers, such as the Rosa Neto Scale⁵5. Rosa Neto F. Manual de avaliação motora. Porto Alegre: Artmed; 2010. are also employed. The DDST-II, although not yet validated, has been widely used in research carried out in different Brazilian municipalities: Porto Alegre (RS)⁶6. Halpern R, Giugliani ERJ, Victora CG, Barros FC, Horta BL. Fatores de risco para suspeita de atraso no desenvolvimento neuropsicomotoraos 12 meses de vida. Jornal de pediatria 2000; 76(6):421-428., Ribeirão Preto (SP)⁷7. Rezende MA, Beteli VC, Santos JLS. Follow-up of the child’s motor abilities in day-care centers and pre-schools. Rev Lat Am Enfermagem 2005; 13(5):619-625., São Carlos (SP)⁸8. Sigolo ARL, Aiello ALR. Análise de instrumentos para triagem do desenvolvimento infantil. Paidéia (Ribeirão Preto) 2011; 21(48):51-60., São Paulo (SP)⁹9. Torquato JA, Paes JB, Bento MC, Saikai GMPN, Souto JN, Lima EAM, Abreu LC. Prevalência de atraso do desenvolvimento neuropsicomotor em pré-escolares. Revista brasileira de crescimento e desenvolvimento humano 2011; 21(2):259-268., Cuiabá (MT)¹⁰10. Souza SC, Leone C, Takano OA, Moratelli HB. Desenvolvimento de pré-escolares na educação infantil em Cuiabá, Mato Grosso, Brasil. Cad Saude Publica 2008; 24(8):1917-1926., Belo Ipatinga (MG)¹¹11. Carneiro JM, Brito APB, Santos MEA. Avaliação Do Desenvolvimento De Crianças De Uma Creche Através Da Escala Denver II. Revista Mineira de Enfermagem 2011; 15(2):174-180., Belo Horizonte (MG)¹²12. Magalhães LC, Fonseca KL, Martins LDTB, Dornelas LF. Desempenho de crianças pré-termo com muito baixo peso e extremo baixo peso segundo o teste Denver-II. Revista Brasileira de Saúde Materno Infantil 2011; 11(4):445-453., among others, possibly because of its quick and easy applicability by technicians and researchers from many areas, provided they are adequately trained. It is worth noting that most of the studies were carried out in the Center-South region of the country, with only two in cities in the North of Brazil¹³13. Guerreiro TBF. Desenvolvimento neuropsicomotor de crianças de Belém: associação com características pessoais e variáveis do seu ambiente ecológico [tese]. Belém: Universidade Federal do Pará; 2013.,¹⁴14. Costa EF. Desenvolvimento Linguístico de Crianças de Belém: Associação com características pessoais e ambientais [tese]. Belém: Universidade Federal do Pará; 2014..

Building a solid foundation for healthy development in the early years of life is a prerequisite not only for individual well-being but also for the economic productivity of societies. Scientific evidence shows that adverse physical and social environments threaten human development and can generate long-term losses¹⁵15. Shonkoff JP, Richter L, Gaag JV, Bhutta ZA. Development An Integrated Scientific Framework for Child Survival and Early Childhood. Pediatrics 2012; 129(2):e460-472.. Knowing that development relies on biological and environmental factors, one should consider the types of stimuli that are provided to the child.

Studies have identified the consequences of the type of stimuli provided and expected social roles, giving children toys and proposing activities appropriate for each gender¹⁶16. AltmannH, Ayoub E, Amaral SCF. Gênero na prática docente em educação física: meninas não gostam de suar, meninos são habilidosos ao jogar? Rev Est Fem 2011; 19(2):491-501.

17. Carvalhal MIM, Vasconcelos-Raposo J. Diferenças entre gêneros nas habilidades: correr, saltar, lançar e pontapear. Motricidade 2007; 3(3):44-56.

18. Finco D. Relações de gênero nas brincadeiras de meninos e meninas na Educação Infantil. Pro-Posições: Dossiê Educação Infantil e Gênero 2003; 14(42):89-102.

19. Vianna C, Finco D. Meninas e meninos na Educação Infantil: uma questão de gênero e poder. Cad. Pagu 2009; (33):265-283.

20. Menezes AB, Brito RCS, Henriques AL. Relação entre Gênero e Orientação Sexual a partir da Perspectiva Evolucionista. Psicologia: Teoria e Pesquisa 2010; 26(2):245-252.-²¹21. Menezes AB, Brito RCS. Diferenças de gênero na preferência de pares e brincadeiras de crianças. Psicologia Reflexão e Crítica 2013; 26(1):193-201.. There is evidence that this type of directed stimulus may affect the performance of the NPMD’s areas²²22. Alexander GM, Wilcox T, Woods R. Sex differences in infants’ visual interest in toys. Arch Sex Behav 2009; 38(3):427-433.,²³23. Hansen J, Macarini SM, Martins GDF, Wanderlind FH, Vieira ML. O brincar e suas implicações para o desenvolvimento infantil a partir da Psicologia Evolucionista. Revista Brasileira de Crescimento e Desenvolvimento Humano 2007; 17(2):133-143.. Research by Van Beek et al.²⁴24. Van de Beek C, Van Goozen SHM, Buitelaar JK, Cohen-Kettenis PT. Prenatal sex hormones (maternal and amniotic fluid) and gender related play behavior in 13-month-old infants. Arch Sex Behav 2009; 38(1):6-15.corroborates the relevance of the biology-environment binomial in children’s NPMD (socioeconomic conditions, parental schooling, participation in social activities, among others).

Some environments in which NPMD has been studied are outpatient clinics²⁵25. Moraes MW, Weber APR, Santos MCO, Almeida FA. Denver II: evaluation of the development of children treated in the outpatient clinic of Project Einstein in the Community of Paraisópolis. Einstein 2010; 8(21):149-153., nursing homes²⁶26. Lima AKP, Lima AO. Neuropsychomotor develompent profile and family aspects of institutionalized children living in Recife. Revista CES Psicología 2012; 5(1):11-25., and schools⁷7. Rezende MA, Beteli VC, Santos JLS. Follow-up of the child’s motor abilities in day-care centers and pre-schools. Rev Lat Am Enfermagem 2005; 13(5):619-625.,²⁷27. Santos AM, Neto FR, Pimenta RA. Avaliação das habilidades motoras de crianças participantes de projetos sociais/esportivos. Motricidade 2013; 9(2):50-60.. In the latter, nurseries and pre-schools predominate because of their contextual importance in the first years of children’s development²⁸28. Stich HL, Baune BT, Caniato RN, Mikolajczyk RT, Krämer A. Individual development of preschool children-prevalences and determinants of delays in Germany: a cross-sectional study in Southern Bavaria. BMC Pediatrics 2012; 12:188.,²⁹29. Bernal R, Fernández C. Subsidized childcare and child development in Colombia: Effects of Hogares Comunitarios de Bien estar as a function of timing and length of exposure. Soc Sci Med 2013; 97:241-249.. According to Bronfenbrenner³⁰30. Bronfenbrenner U. A ecologia do Desenvolvimento Humano: Experimentos Naturais e planejados. Porto Alegre: Artes médicas; 1996., school is the second most crucial microsystem for a child after the family, and thus its recognition as an essential research environment.

This work aimed to analyze the neuropsychomotor development of children enrolled in Child Education Units (UEI) of the public network of the municipality of Belém, in the North region of the country, based on their performance in DDST-II, and thus to establish a hypothesis of the relationship between these results and the gender variable of the child, as well as identify the items of the test in which these children obtained more failures.

Methods

This is an exploratory, cross-sectional study with a quantitative and descriptive approach. Data were collected in the UEIs of Belém linked to the municipality and with similar routines, with small working hours’ variations. Some units have the structure and resources to carry out the activities correctly. However, many are improvised in rented houses with no room for games and gross motor activities. Evaluations were carried out in UEI’s internal dependencies, usually in the cafeteria, or in another space that had tables and chairs that were suitable for children, following all the recommendations of the DDST-II manual.

The UEI were distributed in eight Administrative Districts (DA): Administrative District of Belém (DABEL), Guamá (DAGUA), Benguí (DABEN), Sacramenta (DASAC), Entroncamento (DAENT), Icoaraci (DAICO), District of Mosqueiro (DAMOS) and Outeiro (DAOUT). The first six DAs are located in the so-called Continental Belém (downtown and outskirts) and the last two in Insular Belém (Islands’ region).

The sampling process was used by conglomerate, with a sample calculation error margin of 5% and confidence level of 95%. The UEIs studied were distributed according to the total number in each district, and to the number of children of the age group surveyed. The study comprised 19 UEIs that were selected in a universe of 35, as described in Table 1.

The database consisted of 318 children, after excluding one of them who did not perform all the items of the test. Both genders were selected, with ages between 36 and 48 months, without speech disturbances, sensory, auditory or visual changes and sequelae left by compromised CNS, as well as malformations, diagnosed osteoarticular pathologies or any other type of chronic, severe or debilitating diseases.

The subjects’ characterization data were obtained with the Childhood Biopsychosocial Characteristics Questionnaire (CBCQ), produced especially for this study based on the literature on child development determinants. The questionnaire consisted of 48 questions, of which 19 were open-ended and 29 closed-ended, addressed to parents and distributed around the following thematic axes: (a) Identification of children and parents (19 questions); (b) Pre-, peri- and postnatal history (6 questions); (c) Socioeconomic and environmental conditions (20 questions).

A Spanish version of the DDST-II³¹31. Frankenburg WK, Dodds J, Archer P, Shapiro H, Bresnick B. The Denver II: a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics 1992; 89(1):91-97 adapted by the researchers, using kit materials accompanying the manual and others needed to perform the tasks (paper and pencil, table and child-sized chair) was adopted to obtain data on neuropsychomotor development.

This research was authorized by the Municipal Education Secretariat (SEMEC) and approved by the Human Research Ethics Committee of Tropical Medicine Center (NMT/UFPA). The procedures used obeyed the recommendations of Resolution Nº 196/96 of the National Health Council and the National Research Ethics Committee in force at the time.

Once informed of the written authorization of SEMEC, the management of each UEI was invited to participate in the research. The researchers were asked to access their facilities, the children, and their families, prioritizing not to disrupt the routine of the institution or cause any discomfort.

The project was presented in the initial visits to the UEI, with preliminary contact with children, teachers and research environment. On this occasion, researchers met with teachers and parents of children to read and sign the Informed Consent Form. DDST-II was applied to children in the presence of their parents and, if impracticable, of teachers indicated by the institution. The duration of the researchers in the UEI varied according to the number of children selected and the availability of the institution to collect data, lasting on average one week for each institution. The test was applied individually for approximately 30 minutes. During the rest of the time, the researchers remained in the institution interacting with the children in other activities, aiming to introduce them in the environment and have a closer relationship with the children.

The researcher responsible applied DDST-II together with two previously trained research assistants, with a support team. Each child was tested on the specific skills expected within its age range to verify slower or faster development rate. The performance of children in each item was evaluated and recorded, and their data are recorded in the Results Record Sheet. In this sheet, the term Pass (P) was recorded to indicate that the evaluated child had performed the requested task successfully or when its compliance had been reported by the mother or family member. Otherwise, Failed (F) was recorded.

The data collected were organized in a database using SPSS 20 software. A new database was prepared based on the nature of the data and the intended objective, which gathered information on each item evaluated and the percentage P or F. Descriptive and inferential statistics were generated. The Kolmogorov-Smirnov test was applied to verify the normality of the sample distribution; the t-test verified the differences between the means of failure by test areas (dependent variable), according to gender (independent variable); and the chi-square verified an association between the number of failures per item in relation to gender. All considered a significance level of 5% (p-value < 0.05).

Results

The sample distribution was considered normal (p-value < 0.001). Of the 318 children, 177 (56%) were boys and 141 (44%) girls, aged between 36 and 48 months, 87% were born at full term. Most families were low-income, with 31% receiving less than one minimum wage (MW), 65% receiving 1-3 MWs, and only 4% had an income above three MWs. Most of the mothers reported 12 years or more of study (40.4%) and performing some regular work (37.3%), while fathers had 9-11 years of schooling (29.8%), mostly performing some informal work (51.4%).

The t-test indicated a significant difference between the genders and the number of failures obtained by children in almost all the areas evaluated by DDST-II, except for the Gross Motor area. In all areas, higher averages were associated with females (Table 2) suggesting better performance of girls.

An attempt was also made to relate the results to other variables, besides the gender, among them mother schooling, father schooling, household income and situation at birth (term or preterm). None of them, however, showed a statistically significant association with the children’s failures, so they were omitted from the final results.

A more detailed analysis showed that the rate of failure varied by gender. Table 3 shows the performance of children in each task by area of development evaluated and gender.

In absolute results, there were indications of inferior performance of boys in three of the four areas evaluated and also in most of the cited items (N=19). Girls performed worse than boys in the Gross Motor area items only.

In the Language Area, where both genders showed worse performances, with higher failure rates for boys, the items observed with the highest statistical differences were: “knows two adjectives”, “knows four actions” and “understands four prepositions”. In the Personal Social and Fine Motor areas, in which boys also had worse performance, the most failed items were “brushes teeth without help” and “indicates the longest line”, respectively. In the Gross Motor area, the item with the greatest statistical difference was “hops on one foot”.

Discussion

Performance by areas

The results show that girls obtained better performance in three of the areas surveyed (Social, Fine Motor, and Language), and only one area (Gross Motor) showed no statistically significant difference between genders. This data corroborates that found in a preschool study conducted in Cuiabá, pointing out that girls display superior performance in DDST¹⁰10. Souza SC, Leone C, Takano OA, Moratelli HB. Desenvolvimento de pré-escolares na educação infantil em Cuiabá, Mato Grosso, Brasil. Cad Saude Publica 2008; 24(8):1917-1926.. Andrade and Negreiros³²32. Andrade JL, Negreiros MM. Suspeita de atraso no desenvolvimento neuropsicomotor em crianças menores de um ano atendidas em uma unidade de saúde da família de rio branco (acre). Revista APS 2013; 16(1):60-65. also found superior NPMD results in girls in the first two years of life, probably due to the faster myelination of girls’ cerebral cortex. Such differentiation was also described using the Alberta Infant Motor Scale, with again a female superiority in the total score and percentile at 14 months⁴4. Saccani R, Valentini NC. Curvas de referência da Escala Motora Infantil de Alberta: percentis para descrição clínica e acompanhamento do desempenho motor ao longo do tempo. Jornal de Pediatria 2012; 88(1):40-47., as boys showed a greater tendency in suspected developmental delays in areas such as motricity³³33. Braga AKP, Rodovalho JC, Formiga CKMR. Evolução do crescimento e desenvolvimento neuropsicomotor de crianças pré-escolares de zero a dois anos do município de Goiânia (GO). Revista brasileira de crescimento e desenvolvimento humano 2011. 21(2):230-239.

34. Brito CML, Vieira GO, Costa MCO, Oliveira NS. Desenvolvimento neuropsicomotor: o teste de Denver na triagem dos atrasos cognitivos e neuromotores de pré-escolares. Cad Saude Publica 2011; 27(7):1403-1414.-³⁵35. Fernandes LV, Goulart AL, Santos AMN, Barros MCM, Guerra CC, Kopelman BI. Neurodevelopmental assessment of very low birth weight preterm infants at corrected age of 18-24 months by Bayley III scales. Jornal de Pediatria 2012; 88(6):471-478. and language³⁶36. Paiva GS, Lima ACVMS, Lima MC, Eickmann SH. O efeito da pobreza no escore de triagem do desenvolvimento de lactentes. Sao Paulo Med. J. 2010; 128(5):276-283..

However, some studies did not find significant relationships between gender and NPMD delay, in the Social and Language⁷7. Rezende MA, Beteli VC, Santos JLS. Follow-up of the child’s motor abilities in day-care centers and pre-schools. Rev Lat Am Enfermagem 2005; 13(5):619-625. areas and motor performance³⁷37. Venturella CB, ZanandreaG, Saccani R, Valentini NC. Desenvolvimento motor de crianças entre 0 e 18 meses de idade: Diferenças entre os sexos. Motricidade 2010; 9(2):3-12.. Other authors³⁸38. Biscegli TS, Polis LB, Santos LM, Vicentin M. Suspeita de atraso no desenvolvimento neuropsicomotor em crianças menores de um ano atendidas em uma unidade de saúde da familia de Rio Branco. Revista Paulista de Pediatria 2007; 25(4):337-342. also did not find significant differences comparing gender with overall results of the developmental test. Oliveira et al.³⁹39. Oliveira DS, Oliveira LS, Cattuzzo MT. A influência do gênero e idade no desempenho das habilidades locomotoras de crianças de primeira infância. Revista brasileira de educação física e esporte 2013; 27(4):647-655. showed that boys have more developed global motor skills than girls. Only one study on locomotor performance and early childhood control of objects of premature children suggested impaired development of girls⁴⁰40. Campos CMC, Soares MMA, Cattuzzo MT. O efeito da prematuridade em habilidades locomotoras e de controle de objetos de crianças de primeira infância. Motriz: rev. educ. fis. 2013; 19(1):22-33..

Thus, we find quite controversial research results. Authors differ in attempting to explain the differences in the performance of children of different genders. Such gaps may not be directly associated with the gender variable as an attribute of a biological nature, but to education historically differentiated according to social expectations of gender and, therefore, the nature of the activities provided, such as games.

Thus, it is accepted that the social roles attributed to each gender differ from birth. Activities such as competition, physical contact and interdependence games requiring strength, endurance, and power, with the predominance of actions involving jumps and races, in larger spaces, are characteristics of boys’ games, while girls are stimulated to activities of aesthetic or rhythmic nature, with finer and more controlled movements in smaller spaces³⁷37. Venturella CB, ZanandreaG, Saccani R, Valentini NC. Desenvolvimento motor de crianças entre 0 e 18 meses de idade: Diferenças entre os sexos. Motricidade 2010; 9(2):3-12.. Similar results were obtained for the 7 to 8-year-old age group, when there was a higher preference for toys with mobile components and motor activity in large spaces (for example, balls and cars); and among girls for more static games and more verbal than motor behavior, such as playing with dolls¹⁷17. Carvalhal MIM, Vasconcelos-Raposo J. Diferenças entre gêneros nas habilidades: correr, saltar, lançar e pontapear. Motricidade 2007; 3(3):44-56.. Thus, the personal and social expectations experienced by the child from birth could direct their behaviors according to the social roles expected for each gender and fit into gender stereotypes (attitudes, skills and personality traits considered appropriate for boys and girls according to the socio-cultural context)⁴¹41. Papalia DE, Olds SW, Feldman, RT. Desenvolvimento Humano. Porto Alegre: Art Med; 2010.,⁴²42. Haywood KM, Getchell N. Desenvolvimento Motor ao longo da vida. Porto Alegre: Art Med; 2010..

From the above, and considering that the DDST-II is a test built from the performance of tasks related to specific skills of each area that includes it, it can be suggested that the performance gaps shown here depict what can be observed in social life. If girls are more stimulated to perform predominantly fine motor and communication skills activities in generally more confined spaces, then it is understandable that they perform better than boys when assessed in these areas.

Percentage of failures per test items

We tried to identify items with more failures by gender in the four areas of the test. As shown in Table 3, the worst-performing items were similar between the two. For girls, the percentage of tasks not performed successfully was lower in Social Personal, Fine Motor, and Language, which assess skills related to fine motor coordination, interaction, and communication. In the Gross Motor area, which evaluates skills such as balance and overall motor coordination, both had a small but slightly higher percentage for girls.

One possible explanation for such diversity is that genders differ in their preferences in daily life. Girls seem to be more interested in social interactions and communication⁴³43. Garcia C. Gender differences in young children’s interactions when learning fundamental motor skills. Res Q Exerc Sport 1994; 65(3):213-225., while boys have a greater motor ability to run, jump and slide³⁹39. Oliveira DS, Oliveira LS, Cattuzzo MT. A influência do gênero e idade no desempenho das habilidades locomotoras de crianças de primeira infância. Revista brasileira de educação física e esporte 2013; 27(4):647-655., which justifies the differentiated performance in the test. Gabbard⁴⁴44. Gabbard C. Lifelong motor development. 4th ed. San Francisco: Pearson; 2004. agrees with this data, stating that, in early childhood, boys tend to have a greater ability to run and jump, while girls have greater ease with fine motor skills and balance.

Such skills, or their absence thereof, are likely to be the fruits of stimuli present in children’s daily lives. The influence of context and type of task has been discussed, and studies have shown that parents and socializing agents (teachers, caregivers, among others) often induce children to activities considered appropriate for each gender, supporting decisions, classifying toys and games, biological sexual characteristics¹⁶16. AltmannH, Ayoub E, Amaral SCF. Gênero na prática docente em educação física: meninas não gostam de suar, meninos são habilidosos ao jogar? Rev Est Fem 2011; 19(2):491-501.,³⁷37. Venturella CB, ZanandreaG, Saccani R, Valentini NC. Desenvolvimento motor de crianças entre 0 e 18 meses de idade: Diferenças entre os sexos. Motricidade 2010; 9(2):3-12..

In addition to differences between genders, the results show the significant number of items in which the children failed, evidencing the need to discuss the overall performance of children. It is worth noting that this study did not aim to analyze the socioeconomic variables impacting children’s performance, but since the screening was carried out in the municipal public network of Belém, the studied population was characterized almost exclusively as low income. Thus, it was not possible to show, by statistical regression tests, a possible influence of the socioeconomic factors on the NPMD of the studied children.

Previous research carried out in the same institutions as this study reports that the selection of children for admission to the UEI would be due to the level of social vulnerability of their families, including socioeconomic factors (especially the income of customary caregivers). The author argues that the lack of basic sanitation or drinking water and the poor health conditions of the family and the immediate environment of the child would expose them to diseases, justifying the priority of public services to such a population. Thus, children’s overall performance lower than expected for their age group could be directly related to the low socioeconomic level of their families (income, schooling, for example)¹³13. Guerreiro TBF. Desenvolvimento neuropsicomotor de crianças de Belém: associação com características pessoais e variáveis do seu ambiente ecológico [tese]. Belém: Universidade Federal do Pará; 2013..

The literature indicates that low socioeconomic levels have a direct association with the quality of neuropsychomotor development, pointing out that in addition to biological factors, environmental and socioeconomic conditions can determine NPMD⁴⁵45. Saccani R, Brizola E, Giordani AP, Bach S, Resende TL, Almeida CS. Avaliação do desenvolvimento neuropsicomotor em crianças de um 89 bairro da periferia de Porto Alegre. Scientia Medica 2007; 17(3):130-137. delay. Research seeking to assess the overall motor performance and motor and appendicular motor skills of infants in daycare setting found 30% of suspected cases of global motor delay in at least one of the evaluations performed. Such a result would be justified by the low level of environmental stimulation or the lack of opportunities for the development potential to be achieved⁴⁶46. Souza CT, Santos DCC, Tolocka RE, Baltier L, Gibim NC, Habechian FAP. Avaliação do desempenho motor global e em habilidades motoras axiais e apendiculares de lactentes frequentadores de creche. Revista Brasileira de Fisiotererapia 2010; 14(4):309-315.. Researchers evaluated the impact of poverty on the development of a population of infants, describing that about 20% had a higher frequency of suspected delay in open communication and stemmed from families that belonged to the lower quartile of the socioeconomic level index. According to the authors, maternal and paternal unemployment reduced, respectively, the open communication and cognition scores of the children studied³⁶36. Paiva GS, Lima ACVMS, Lima MC, Eickmann SH. O efeito da pobreza no escore de triagem do desenvolvimento de lactentes. Sao Paulo Med. J. 2010; 128(5):276-283..

Unfavorable socioeconomic conditions have a unique impact when experienced in early childhood. Researchers identified a prevalence of 17% suspected delays in the Gross Motor area and its association with neonatal, family and daycare exposure factors in children up to three years old, assisted in public day care centers with disadvantages in children up to 24 months in Locomotion Skills. The risk of gross motor performance delay increased 2.81 times for children from households with monthly income up to R$ 700.00; while the risk of Locomotion Skills delay increased 4.63 times for children of parents with up to eight years of schooling⁴⁷47. Santos DCC, Tolocka RE, Carvalho J, Heringer LRC, Almeida CM, Miquelote AF. Desempenho motor grosso e sua associação com fatores neonatais, familiares e de exposição à creche em crianças até três anos de idade. Revista Brasileira Fisioterapia 2009; 13(2):173-179.. Veleda et al.⁴⁸48. Veleda AA, Soares MCF, Cézar-Vaz MR. Fatores associados ao atraso no desenvolvimento em crianças, Rio Grande, Rio Grande do Sul, Brasil. Revista Gaúcha de Enfermagem 2011; 32(1):79-85., using DDST-II, observed that children from households with a lower income, a low weight-for-age index and less than six prenatal care visits had a higher development risk.

Thus, we observe the close relationship between environment and child development, generating a cycle in which several risk factors feedback and have an impact. For example, parents with few years of study have fewer resources to promote the adequate development of their children. Unfavorable conditions are knowingly possibly associated with child development delays, preventing the achievement of maximum potential. To analyze the relationship between neuropsychomotor development and family environment, a study carried out in Belo Horizonte emphasizes that the stimulation by the environment was the variable with the most significant impact in the process, showing that the organization of the physical environment by the parents and their interaction with their children directly influences child development⁴⁹49. Guimarães AF, Carvalho DV, Machado NAA, Baptista RAN, Lemos SMA. Risco de atraso no desenvolvimento de crianças de dois a 24 meses e sua associação com a qualidade do estímulo familiar. Revista Paulista de Pediatria 2013; 31(4):452-458..

Some studies highlight that the introduction of children in UEI without adequate physical and professional training structure may put development at risk. Using inappropriate toys for the age group, small physical location, lack of pedagogical guidance and extra-family socialization, and low family socioeconomic conditions are factors that can adversely affect development⁴⁶46. Souza CT, Santos DCC, Tolocka RE, Baltier L, Gibim NC, Habechian FAP. Avaliação do desempenho motor global e em habilidades motoras axiais e apendiculares de lactentes frequentadores de creche. Revista Brasileira de Fisiotererapia 2010; 14(4):309-315.. A survey of children of different age groups found negative impacts on the development of children from the age of three when the proportion of students per caregivers increases in institutions⁷7. Rezende MA, Beteli VC, Santos JLS. Follow-up of the child’s motor abilities in day-care centers and pre-schools. Rev Lat Am Enfermagem 2005; 13(5):619-625.. In this study, however, it cannot be said that these aspects influenced the results found since they were not evaluated variables. Thus, it is suggested that these aspects be considered in future research with similar objectives, method, and population.

Besides, it is important to highlight that, even without analyses that allow the assertion that the performance of children evaluated in this study relied on the low socioeconomic level of their families, this is a relevant variable when addressing populations covered by public services, as is the case of this research. A more comprehensive and correlational analysis of the variables with a significant influence level on the developmental acquisitions in the researched population would require us to investigate the offered stimuli, the activities performed and other characteristics of the children’s upbringing environment. Thus, the lack of information about their development contexts is characterized as a limitation of this study.

Final considerations

The analysis of the results allowed us to understand the essential aspects of the performance of boys and girls who attend the UEIs from their performance in a test that evaluates neuropsychomotor development. The differences show that girls performed better than boys, results that according to the literature may have relied more on the stimuli received in the environment than on biological differences.

We emphasize the importance of understanding the neuropsychomotor development in early childhood, in its various aspects, as this is the basis for the future acquisition of these children. Even when at risk, with the appropriate stimuli, deficiencies can be overcome, and development can occur satisfactorily. In short, the better the quality of the environmental stimulation available to the child, the better its development.

Finally, it is understood that preferences are built, and society tends to help young children follow a socially imposed standard of what it considers right or wrong, acceptable or unacceptable, and ends up opting for patterns of behavior that limit their growth. Thus, it is necessary to promote public policies aimed at guiding parents and educators who are the main stimulators in this first stage of life, so that they become aware of these differences and provide adequate stimuli to the development of all their children’s skills.

References

Publication Dates

History