The neuromotor examination of the preschool child and its prognostic significance

The present paper reviews the methods available for neurological or neuromotor evaluation at preschool age. General textbooks on pediatric neurology describe the neurological examination at preschool age in terms of the assessment of the evaluation of cranial nerves, muscle tone, muscle power, reflexes, and the presence of abnormal movements. They stress the fact that assessment at preschool age is difficult because of the time needed to achieve the child's cooperation. Noncooperation at the preschool neurological exam is associated with an increased risk for learning and behavioral problems at school age. At present three age-specific and standardized test for neurological or neuromotor evaluation at preschool age are available. The method of Amiel-Tison and Gosselin, of which information can be accessed easily, has the drawback that it focuses on muscle tone and reflexes. It pays little attention to the quality of spontaneous motor behavior. The other two methods, i.e., the neuromotor behavioral inventory (NBI) and the Hempel assessment, are probably more promising in terms of assessment of minor neurological dysfunction as these methods pay ample attention to the child's quality of motor behavior. All methods have in common that information in terms of concurrent validity is scarce, with no information on predictive validity. This means that further research on applicability and validity of preschool neuromotor assessment is urgently needed.