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Opportunities for Learning and Social Interaction in Infant Sitting: Effects of Sitting Support, Sitting Skill, and Gross Motor Delay

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Title: Opportunities for Learning and Social Interaction in Infant Sitting: Effects of Sitting Support, Sitting Skill, and Gross Motor Delay
Language: English
Authors: Kretch, Kari S. (ORCID 0000-0001-8678-1749), Marcinowski, Emily C., Hsu, Lin-Ya, Koziol, Natalie A., Harbourne, Regina T., Lobo, Michele A., Dusing, Stacey C.
Source: Developmental Science. May 2023 26(3).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 16
Publication Date: 2023
Sponsoring Agency: Institute of Education Sciences (ED)
National Center for Medical Rehabilitation Research (NCMRR) (NICHD/NIH)
Contract Number: R324A150103
K12HD055929
Document Type: Journal Articles
Reports - Research
Descriptors: Psychomotor Skills, Motor Development, Cognitive Development, Language Acquisition, Infants, Caregiver Role, Interpersonal Relationship, Educational Opportunities
DOI: 10.1111/desc.13318
ISSN: 1363-755X
1467-7687
Abstract: The development of independent sitting changes everyday opportunities for learning and has cascading effects on cognitive and language development. Prior to independent sitting, infants experience the sitting position with physical support from caregivers. Why does supported sitting not provide the same input for learning that is experienced in independent sitting? This question is especially relevant for infants with gross motor delay, who require support in sitting for many months after typically developing infants sit independently. We observed infants with typical development (n = 34, ages 4-7 months) and infants with gross motor delay (n = 128, ages 7-16 months) in early stages of sitting development, and their caregivers, in a dyadic play observation. We predicted that infants who required caregiver support for sitting would spend more time facing away from the caregiver and less time contacting objects than infants who could sit independently. We also predicted that caregivers of supported sitters would spend less time contacting objects because their hands would be full supporting their infants. Our first two hypotheses were confirmed; however, caregivers spent surprisingly little time using both hands to provide support, and caregivers of supported sitters spent more time contacting objects than caregivers of independent sitters. Similar patterns were seen in the group of typically developing infants and the infants with motor delay. Our findings suggest that independent sitting and supported sitting provide qualitatively distinct experiences with different implications for social interaction and learning opportunities.
Abstractor: As Provided
IES Funded: Yes
Entry Date: 2023
Accession Number: EJ1372299
Database: ERIC
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  Value: <anid>AN0162916546;5g501may.23;2023Apr07.05:49;v2.2.500</anid> <title id="AN0162916546-1">Opportunities for learning and social interaction in infant sitting: Effects of sitting support, sitting skill, and gross motor delay </title> <p>The development of independent sitting changes everyday opportunities for learning and has cascading effects on cognitive and language development. Prior to independent sitting, infants experience the sitting position with physical support from caregivers. Why does supported sitting not provide the same input for learning that is experienced in independent sitting? This question is especially relevant for infants with gross motor delay, who require support in sitting for many months after typically developing infants sit independently. We observed infants with typical development (n = 34, ages 4–7 months) and infants with gross motor delay (n = 128, ages 7–16 months) in early stages of sitting development, and their caregivers, in a dyadic play observation. We predicted that infants who required caregiver support for sitting would spend more time facing away from the caregiver and less time contacting objects than infants who could sit independently. We also predicted that caregivers of supported sitters would spend less time contacting objects because their hands would be full supporting their infants. Our first two hypotheses were confirmed; however, caregivers spent surprisingly little time using both hands to provide support, and caregivers of supported sitters spent more time contacting objects than caregivers of independent sitters. Similar patterns were seen in the group of typically developing infants and the infants with motor delay. Our findings suggest that independent sitting and supported sitting provide qualitatively distinct experiences with different implications for social interaction and learning opportunities. Highlights: During seated free play, supported sitters spent more time facing away from their caregivers and less time handling objects than independent sitters.Caregivers who spent more time supporting infants with both hands spent less time handling objects; however, caregivers mostly supported infants with one or no hands.A continuous measure of sitting skill did not uniquely contribute to these behaviors beyond the effect of binary sitting support (supported vs. independent sitter).The pattern of results was similar for typically developing infants and infants with gross motor delay, despite differences in age.</p> <p>Keywords: developmental delay; dyadic interaction; infancy; joint attention; motor development; sitting</p> <p>This study compared the content of supported vs. independent sitting experience during dyadic play in infants with typical development and infants with gross motor delay. We found that—for both groups—the amount of time infants and caregivers were positioned to view each other's face, and the amount of time each handled objects, varied between supported and independent sitters. Our findings suggest that independent sitting and supported sitting provide qualitatively distinct experience with different implications for social interaction and learning opportunities, and that caregiver‐supported sitting may not be a sufficient substitute for infants with delays in independent sitting.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/5G5/01may23/desc13318-gra-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="desc13318-gra-0001.jpg" title="." /> </p> <p></p> <hd id="AN0162916546-3">INTRODUCTION</hd> <p></p> <hd id="AN0162916546-4">Sitting and infant learning opportunities</hd> <p>The onset of independent sitting is a major developmental milestone. But sitting is more than a developmental outcome in its own right. Sitting has cascading effects on outcomes in a variety of domains, including object perception (Ross‐Sheehy et al., [<reflink idref="bib61" id="ref1">61</reflink>]; Soska et al., [<reflink idref="bib72" id="ref2">72</reflink>]), language development (Jensen‐Willett et al., [<reflink idref="bib29" id="ref3">29</reflink>]; LeBarton & Iverson, [<reflink idref="bib41" id="ref4">41</reflink>]; Libertus & Violi, [<reflink idref="bib42" id="ref5">42</reflink>]; Oudgenoeg‐Paz et al., [<reflink idref="bib53" id="ref6">53</reflink>]), spatial memory (Oudgenoeg‐Paz et al., [<reflink idref="bib52" id="ref7">52</reflink>]), visual processing (Harbourne et al., [<reflink idref="bib24" id="ref8">24</reflink>]), and overall cognition (Jensen‐Willett et al., [<reflink idref="bib29" id="ref9">29</reflink>]).</p> <p>Sitting affects the above‐described cognitive outcomes because it alters everyday opportunities for learning. While sitting, infants demonstrate improved ability to attain and explore objects (Out et al., [<reflink idref="bib54" id="ref10">54</reflink>]; Rochat, [<reflink idref="bib58" id="ref11">58</reflink>]; Savelsbergh & van der Kamp, [<reflink idref="bib67" id="ref12">67</reflink>]; Soska & Adolph, [<reflink idref="bib71" id="ref13">71</reflink>]), greater visual access to the environment and to social information (Frank et al., [<reflink idref="bib20" id="ref14">20</reflink>]; Kretch et al., [<reflink idref="bib37" id="ref15">37</reflink>]; Long et al., [<reflink idref="bib45" id="ref16">45</reflink>]; Sanchez et al., [<reflink idref="bib65" id="ref17">65</reflink>]), and increased social attention (Franchak et al., [<reflink idref="bib18" id="ref18">18</reflink>]). Sitting even affects caregiver behavior: Caregivers provide more opportunities to practice cognitive skills while infants are sitting compared to other postures (Kretch et al., [<reflink idref="bib38" id="ref19">38</reflink>]).</p> <p>Infants who are unable to sit independently still experience sitting with support from caregivers or devices (Franchak, [<reflink idref="bib17" id="ref20">17</reflink>]; Frank et al., [<reflink idref="bib20" id="ref21">20</reflink>]; Karasik et al., [<reflink idref="bib32" id="ref22">32</reflink>]; Kretch et al., [<reflink idref="bib38" id="ref23">38</reflink>]). However, it is the milestone of <emph>independent</emph> sitting that is linked with cognitive outcomes (e.g., Oudgenoeg‐Paz et al., [<reflink idref="bib53" id="ref24">53</reflink>]; Soska et al., [<reflink idref="bib72" id="ref25">72</reflink>]). This suggests that independent sitting offers unique experiences not attained through supported sitting. Independent sitters spend more time sitting than age‐matched infants who are not able to sit (Franchak, [<reflink idref="bib17" id="ref26">17</reflink>]), allowing greater accumulated opportunities for practicing object manipulation and other skills. However, there may also be differences in the content of experiences during supported compared with unsupported sitting. In other words, being able to sit independently may provide not just <emph>more</emph> sitting experience, but also qualitatively <emph>different</emph> sitting experience. In particular, recent evidence demonstrating higher rates of caregiver‐provided learning opportunities during independent sitting compared to caregiver‐supported sitting (Kretch et al., [<reflink idref="bib38" id="ref27">38</reflink>]) suggests that independent sitting may offer unique opportunities for caregiver‐infant interaction.</p> <hd id="AN0162916546-5">Social information from faces and hands</hd> <p>Caregiver‐infant interaction encompasses a variety of social cues and multiple sources of social information. Faces are a particularly salient source. During face‐to‐face interactions, caregivers monitor changes in infants' facial expressions to respond contingently, and infants learn about social routines and reciprocal communication (Cohn & Tronick, [<reflink idref="bib8" id="ref28">8</reflink>]; Kaye & Fogel, [<reflink idref="bib33" id="ref29">33</reflink>]; Lavelli & Fogel, [<reflink idref="bib39" id="ref30">39</reflink>]; Yale et al., [<reflink idref="bib85" id="ref31">85</reflink>]). Caregiver facial expressions help infants appraise uncertain situations (Feinman, [<reflink idref="bib15" id="ref32">15</reflink>]; Hornik & Gunnar, [<reflink idref="bib26" id="ref33">26</reflink>]; Walden & Ogan, [<reflink idref="bib80" id="ref34">80</reflink>]), and following a speaker's gaze can resolve ambiguity about the referent of a novel word (Brooks & Meltzoff, [<reflink idref="bib6" id="ref35">6</reflink>]; Moore, [<reflink idref="bib49" id="ref36">49</reflink>]; Moore et al., [<reflink idref="bib50" id="ref37">50</reflink>]; Tomasello, [<reflink idref="bib77" id="ref38">77</reflink>]).</p> <p>Perhaps less obviously, hands are also valuable and ubiquitous social stimuli. Despite a long history in developmental research of prioritizing eyes and faces, older infants and toddlers spend considerably more time viewing hands (Fausey et al., [<reflink idref="bib14" id="ref39">14</reflink>]; Franchak et al., [<reflink idref="bib19" id="ref40">19</reflink>]; Yoshida & Smith, [<reflink idref="bib86" id="ref41">86</reflink>]). Caregivers' hands produce referential gestures and act on objects to demonstrate their properties and affordances (Belsky et al., [<reflink idref="bib3" id="ref42">3</reflink>]; de Villiers Rader & Zukow‐Goldring, [<reflink idref="bib10" id="ref43">10</reflink>]; Johnson & Woods, [<reflink idref="bib30" id="ref44">30</reflink>]; Liszkowski & Tomasello, [<reflink idref="bib43" id="ref45">43</reflink>]). Infants' hands also contribute to social learning opportunities; for example, caregivers provide more informative verbal input while infants are manipulating objects (Tamis‐LeMonda et al., [<reflink idref="bib75" id="ref46">75</reflink>]; West & Iverson, [<reflink idref="bib82" id="ref47">82</reflink>]). Both infants' and caregivers' hands structure the visual environment by bringing relevant objects into view, reducing referential uncertainty during object naming and facilitating word learning (Smith et al., [<reflink idref="bib69" id="ref48">69</reflink>]; Suanda et al., [<reflink idref="bib73" id="ref49">73</reflink>]; Yu & Smith, [<reflink idref="bib87" id="ref50">87</reflink>]).</p> <p>One of the best‐characterized examples of the roles of faces and hands in infant‐caregiver interaction is the real‐time dynamics of <emph>joint attention</emph>. Joint attention is attained when two social partners simultaneously attend to the same object. A wealth of research suggests that joint attention promotes learning and is associated with improved cognitive and language outcomes (Bigelow et al., [<reflink idref="bib5" id="ref51">5</reflink>]; Carpenter et al., [<reflink idref="bib7" id="ref52">7</reflink>]; Moore et al., [<reflink idref="bib51" id="ref53">51</reflink>]; Tomasello & Farrar, [<reflink idref="bib78" id="ref54">78</reflink>]). The state of joint attention can be achieved through two different sensorimotor pathways (Yu & Smith, [[<reflink idref="bib88" id="ref55">88</reflink>]], [<reflink idref="bib90" id="ref56">90</reflink>], [<reflink idref="bib91" id="ref57">91</reflink>]). In the gaze‐following pathway, one partner (infant or caregiver) fixates the other's face and follows their gaze direction. In the hand‐following pathway, one partner gazes at the object being held or manipulated by the other; this results in joint attention because the touched object is likely also the partner's gaze target. Infants are more likely to use hand following than gaze following to attain joint attention with their caregivers, while caregivers frequently use both pathways (Deák et al., [<reflink idref="bib11" id="ref58">11</reflink>]; Yu & Smith, [<reflink idref="bib88" id="ref59">88</reflink>], [<reflink idref="bib91" id="ref60">91</reflink>]). The hand‐following pathway to joint attention is present in early infancy and may be a developmental precursor to the more sophisticated gaze‐following pathway (Deák et al., [<reflink idref="bib11" id="ref61">11</reflink>]; Yu & Smith, [<reflink idref="bib91" id="ref62">91</reflink>]).</p> <hd id="AN0162916546-6">Dyadic interaction in supported and unsupported sitting</hd> <p>When are facial and manual social cues available to infants and caregivers? Studies of joint attention and other forms of early social interaction typically constrain the spatial environment, with infant and caregiver facing one another and the infant fully supported in a seat. However, recent research has demonstrated that physical positioning impacts infant‐caregiver interactions (Franchak et al., [<reflink idref="bib18" id="ref63">18</reflink>]; Kretch et al., [<reflink idref="bib38" id="ref64">38</reflink>]; Long et al., [<reflink idref="bib45" id="ref65">45</reflink>]; Schneider et al., [<reflink idref="bib68" id="ref66">68</reflink>]; Suarez‐Rivera et al., [<reflink idref="bib74" id="ref67">74</reflink>]). Increased opportunities for joint attention and other socially mediated learning processes have been proposed as potential mechanisms linking sitting to cognitive and language development (Iverson, [<reflink idref="bib28" id="ref68">28</reflink>]; Libertus & Violi, [<reflink idref="bib42" id="ref69">42</reflink>]). Whether independent sitting promotes such interactions more than supported sitting is unknown. In particular, caregiver‐supported sitting may uniquely limit access to both faces and hands.</p> <p>One potential difference between independent and caregiver‐supported sitting is relative spatial positioning (Frank et al., [<reflink idref="bib20" id="ref70">20</reflink>]; Long et al., [<reflink idref="bib45" id="ref71">45</reflink>]; Sanchez et al., [<reflink idref="bib65" id="ref72">65</reflink>]). Infants who can sit independently may have more opportunities to sit apart from and facing the caregiver, increasing mutual face viewing; infants who require support may spend more time with caregivers propping them up from behind. Indeed, Frank et al. ([<reflink idref="bib20" id="ref73">20</reflink>]) reported that infants spent more time with their caregivers behind them at 4 months of age (presumably pre‐sitting) than at 8 months (presumably sitting). While caregivers were behind, their faces were rarely in infants' view (Frank et al., [<reflink idref="bib20" id="ref74">20</reflink>]; Long et al., [<reflink idref="bib45" id="ref75">45</reflink>]; Sanchez et al., [<reflink idref="bib65" id="ref76">65</reflink>]). But how caregiver‐infant positioning relates specifically to independent versus supported sitting has not been measured.</p> <p>Independent sitters spend more time manually exploring objects than infants who require support (Marcinowski et al., [<reflink idref="bib46" id="ref77">46</reflink>]); this increases opportunities for caregivers to identify the focus of infants' attention through manual cues. Independent and supported sitters may also differ in the extent to which the caregiver can handle objects. In standardized assessments and experimental tasks, the assessor typically supports infants by placing both hands on the infant's trunk (e.g., Marcinowski et al., [<reflink idref="bib46" id="ref78">46</reflink>]; Soska & Adolph, [<reflink idref="bib71" id="ref79">71</reflink>]); this is also a commonly used handling technique in clinical intervention for children learning to sit (Diamant & Whiteside, [<reflink idref="bib12" id="ref80">12</reflink>]). However, we do not know how caregivers support their infants in natural settings. If caregivers' hands are indeed occupied with keeping their infant upright, this may limit their own object manipulation and decrease opportunities for infants to view adult object handling.</p> <p>Furthermore, availability of face and hand information may scale to infants' sitting skill. Even during supported sitting, social interactions may be easier to facilitate for infants with better sitting skill than for infants with poorer sitting skill. Caregivers are sensitive to the support needs of their infants and tend to provide manual support at the appropriate level (Duncan et al., [<reflink idref="bib13" id="ref81">13</reflink>]). Therefore, caregivers of infants who need more support to stay upright may be more limited in their ability to engage in face‐to‐face play and handle objects than caregivers of infants who need less support. Moreover, during independent sitting, infants with poorer sitting skill may need to devote greater effort to maintaining balance, leaving fewer attentional resources for object manipulation (Berger et al., [<reflink idref="bib4" id="ref82">4</reflink>]).</p> <hd id="AN0162916546-7">Sitting and dyadic interaction in infants with motor delays</hd> <p>If independent sitting leads to cascading advancements in cognitive and language skills, an altered trajectory of sitting development may have consequences for developmental outcomes (Iverson, [<reflink idref="bib28" id="ref83">28</reflink>]; Lobo et al., [<reflink idref="bib44" id="ref84">44</reflink>]). Infants with motor delays resulting from cerebral palsy, preterm birth, or other developmental conditions often develop sitting skills many months later than typically developing infants (Rosenbaum et al., [<reflink idref="bib60" id="ref85">60</reflink>]; Winders et al., [<reflink idref="bib83" id="ref86">83</reflink>]). Around one year of age, when typically developing infants possess considerable social cognitive skills and engage in sophisticated joint attention interactions (Adamson & Bakeman, [<reflink idref="bib1" id="ref87">1</reflink>]; Bakeman & Adamson, [<reflink idref="bib2" id="ref88">2</reflink>]; Carpenter et al., [<reflink idref="bib7" id="ref89">7</reflink>]), their peers with motor delays may still require support for sitting. Previous work documented that infants with significant motor delay, like infants with typical development, experienced fewer caregiver‐initiated learning opportunities while in caregiver‐supported compared to independent sitting (Kretch et al., [<reflink idref="bib38" id="ref90">38</reflink>]). Notably, the infants with motor delay still spent substantial amounts of time in caregiver‐supported sitting around 2 years of age, whereas sitting time was mostly independent in typically developing infants by 9 months. Although caregiver‐provided learning opportunities increased over time for both groups, infants with motor delay were exposed to the same frequency of learning opportunities as typically developing infants who were 6 months younger.</p> <p>Social interaction may be an area of vulnerability for many infants with developmental delays and disabilities. Infants at risk for cerebral palsy demonstrate decreased engagement and coordination with caregivers in dyadic interactions (Festante et al., [<reflink idref="bib16" id="ref91">16</reflink>]); infants born preterm demonstrate poorer gaze following (Imafuku et al., [<reflink idref="bib27" id="ref92">27</reflink>]) and decreased social orienting (Telford et al., [<reflink idref="bib76" id="ref93">76</reflink>]), and are less responsive to mothers' attempts to direct their attention to toys (Gattis et al., [<reflink idref="bib21" id="ref94">21</reflink>]). Therefore, it is crucial to understand how motor skills may support or hinder opportunities for social interaction in infants at risk. Potentially, infants with motor delay may experience sequelae of independent sitting at a later age, exacerbating delays in cognitive and social skills; conversely, caregivers of infants with delays may compensate by employing different support methods that permit more face‐to‐face interaction and object handling prior to independent sitting.</p> <hd id="AN0162916546-8">Current study</hd> <p>Prior work has demonstrated that sitting experience is important for development. In the current study, we ask whether the <emph>content of sitting experience</emph> differs based on infant sitting behavior and ability. Our primary aims were to determine if <emph>sitting support</emph>—whether infants sit independently or with caregiver support during free play—and <emph>sitting skill</emph>—a continuous measure based on a standardized assessment—are associated with differences in opportunities for the infant and caregiver to view (<reflink idref="bib1" id="ref95">1</reflink>) their partner's face and (<reflink idref="bib2" id="ref96">2</reflink>) their partner manipulating objects. To capture these opportunities, we measured three behaviors during seated dyadic play: spatial positioning (facing toward vs. away), infant object contact, and caregiver object contact.</p> <p>We compared these three outcomes in infants who sat with vs. without caregiver support, and examined whether the outcomes were associated with scores on the Gross Motor Function Measure Sitting Dimension. By assessing the effects of both a continuous measure of sitting skill and a binary measure of sitting support, we explored whether the outcomes scaled to infants' ability and/or differed categorically based on the real‐time use of their sitting skill. We predicted that independent sitters (compared to infants who sat with caregiver support) and infants with greater sitting skill would (<reflink idref="bib1" id="ref97">1</reflink>) spend less time facing away from caregivers, (<reflink idref="bib2" id="ref98">2</reflink>) spend more time contacting objects, and (<reflink idref="bib3" id="ref99">3</reflink>) have caregivers who spend more time contacting objects.</p> <p>Our secondary aim was to explore the various ways in which caregivers use their own bodies to support infants in a sitting position. We examined how much time caregivers spent supporting infants with two hands, one hand, or no hands to determine whether the bimanual method common in lab‐based assessments and therapeutic handling is typical of natural play interactions. Additionally, we examined whether support type was predicted by sitting skill, and whether support type predicted caregiver object contact. We predicted that greater use of bimanual support would be observed with less skilled infants, and that more bimanual support would result in decreased caregiver object contact.</p> <p>To examine the effect of delayed sitting, we compared a group of typically developing infants in the early stages of sitting with a skill‐matched group of older infants with gross motor delay. We predicted that the effects would be similar between the groups at this stage of sitting development, despite the later age in the gross motor delay group. Because age varied within and between groups, we also examined the effects of age on our outcome measures. We predicted that age would not be a significant predictor of any outcomes once sitting behavior was taken into account.</p> <hd id="AN0162916546-9">METHOD</hd> <p></p> <hd id="AN0162916546-10">Participants</hd> <p>A total of <emph>N</emph> = 162 infants participated. <emph>Infants with gross motor delay</emph> (<emph>n</emph> = 128) were recruited from five sites across the United States as part of a longitudinal clinical trial of the Sitting Together and Reaching to Play (START‐Play) intervention (Harbourne et al., [[<reflink idref="bib22" id="ref100">22</reflink>]]). Infants were recruited via medical and therapy providers as well as community recruitment strategies including flyers and websites/social media. Infants were eligible for the study when they demonstrated early sitting skills: All infants were able to sit (using hands for support if needed) for at least three seconds but were not able to transition in and out of sitting. Other inclusion criteria were: age between 7 and 16 months (corrected for prematurity if applicable); score more than 1 SD below the mean on the gross motor subtest of the Bayley Scales of Infant Development, Third Edition; neuromotor disorder related to cerebral palsy, prematurity, perinatal brain injury, or delay of unspecified origin; and ability to spontaneously move the arms. Infants were excluded if they had primary diagnoses of autism, Down Syndrome, spinal cord injury, or a degenerative/neurodegenerative disorder; medical complications such as severe orthopedic or visual disorders that would limit their ability to participate in assessment and intervention; or uncontrolled seizures. Six additional infants participated in the larger study but were excluded from this analysis because more than one caregiver participated in the free play task, which was intended to be a dyadic play interaction. The second group was a sample of <emph>infants with typical development</emph> (<emph>n</emph> = 34) at the same stage of sitting skill. These infants were recruited from a single site in the US via a large children's hospital and community recruitment. Other inclusion criteria included age younger than 7 months and score ≥ 1 SD below the mean on the Bayley gross motor subtest. Infants were excluded if they had a history of preterm birth, developmental delay, or any medical complications. One additional infant was excluded because they demonstrated a motor delay, and one was excluded due to more than one caregiver participating in the free play task. Demographic information for both groups of infants can be found in Table 1. Note that because infants in the two groups were matched on sitting skill, the gross motor delay group was older than the typically developing group.</p> <p>1 TABLE Sample demographics</p> <p> <ephtml> <table><thead><tr><th /><th><p>Gross motor delay</p><p>(full sample)</p></th><th><p>Gross motor delay</p><p>(sitters)</p></th><th><p>Typical development</p><p>(full sample)</p></th><th><p>Typical development</p><p>(sitters)</p></th></tr></thead><tbody><tr><td>Age (months)<sup>1</sup></td><td>M = 10.64SD = 2.58</td><td>M = 10.65SD = 2.47</td><td>M = 5.70SD = 0.76</td><td>M = 5.80SD = 0.72</td></tr><tr><td>Sex</td><td /><td /><td /><td /></tr><tr><td>Female</td><td>55 (43%)</td><td>48 (44%)</td><td>18 (53%)</td><td>15 (54%)</td></tr><tr><td>Male</td><td>73 (57%)</td><td>62 (56%)</td><td>16 (47%)</td><td>13 (46%)</td></tr><tr><td>Race</td><td /><td /><td /><td /></tr><tr><td>Asian</td><td>9 (7%)</td><td>7 (6%)</td><td>1 (3%)</td><td>1 (4%)</td></tr><tr><td>Black or African American</td><td>15 (12%)</td><td>14 (13%)</td><td>4 (12%)</td><td>3 (11%)</td></tr><tr><td>White</td><td>84 (66%)</td><td>72 (65%)</td><td>24 (71%)</td><td>20 (71%)</td></tr><tr><td>More than one race</td><td>11 (9%)</td><td>9 (8%)</td><td>4 (12%)</td><td>3 (11%)</td></tr><tr><td>Other</td><td>4 (3%)</td><td>4 (4%)</td><td>1 (3%)</td><td>1 (4%)</td></tr><tr><td>Unknown or not reported</td><td>5 (4%)</td><td>4 (4%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Ethnicity</td><td /><td /><td /><td /></tr><tr><td>Hispanic or Latino</td><td>19 (15%)</td><td>18 (16%)</td><td>3 (9%)</td><td>3 (11%)</td></tr><tr><td>Not Hispanic or Latino</td><td>105 (82%)</td><td>88 (80%)</td><td>31 (91%)</td><td>25 (89%)</td></tr><tr><td>Unknown or not reported</td><td>4 (3%)</td><td>4 (4%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Gestational age</td><td /><td /><td /><td /></tr><tr><td>Full term (37+ weeks)</td><td>82 (64%)</td><td>74 (67%)</td><td>34 (100%)</td><td>28 (100%)</td></tr><tr><td>Late preterm (34‐36 weeks)</td><td>8 (6%)</td><td>8 (7%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Moderately preterm (32‐33 weeks)</td><td>10 (8%)</td><td>7 (6%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Very preterm (25‐31 weeks)</td><td>16 (13%)</td><td>12 (11%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Extremely preterm (<25 weeks)</td><td>12 (9%)</td><td>9 (8%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Diagnosis</td><td /><td /><td /><td /></tr><tr><td>Cerebral palsy/stroke<sup>2</sup></td><td>30 (23%)</td><td>24 (22%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Genetic syndrome</td><td>18 (14%)</td><td>14 (13%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Motor delay of prematurity</td><td>9 (7%)</td><td>6 (5%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Seizure disorder<sup>3</sup></td><td>5 (4%)</td><td>5 (5%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Motor or global developmental delay, unspecified</td><td>18 (14%)</td><td>17 (15%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>Other</td><td>7 (5%)</td><td>6 (5%)</td><td>0 (0%)</td><td>0 (0%)</td></tr><tr><td>None or unknown</td><td>41 (32%)</td><td>38 (35%)</td><td>34 (100%)</td><td>28 (100%)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>: <sups>1</sups>Represents adjusted age for infants born preterm (<37 weeks gestation). <sups>2</sups>Includes diagnoses reported as cerebral palsy, spastic cerebral palsy, hemiplegia, diplegia, quadriplegia, and/or stroke. <sups>3</sups>Represents only infants who reported seizure disorder alone, <emph>without</emph> cerebral palsy or genetic diagnosis. <emph>M</emph> = group mean, <emph>SD</emph> = standard deviation.</p> <hd id="AN0162916546-11">Procedure</hd> <p>Although infants were recruited for a longitudinal study, procedures for this analysis were performed at the baseline study visit (prior to randomization into intervention and control groups for the clinical trial). Visits typically took place in the families' homes but were occasionally performed in a laboratory per family preference. Visits consisted of a battery of standardized assessments of motor and cognitive development (Harbourne et al., [<reflink idref="bib23" id="ref101">23</reflink>]). Assessments were performed by a trained therapist or researcher who had demonstrated reliability performing and scoring the standardized assessments. The current study used data from the Gross Motor Function Measure sitting dimension and a dyadic play observation.</p> <hd id="AN0162916546-12">1 GMFM Sitting dimension</hd> <p>The Gross Motor Function Measure (GMFM) was used to quantify <emph>sitting skill</emph>. The GMFM is a standardized assessment of gross motor function originally designed for children with cerebral palsy (Russell et al., [<reflink idref="bib62" id="ref102">62</reflink>]). The Sitting dimension of the GMFM includes 20 items assessing functional sitting skills including head control, static and dynamic sitting, and transitions. Scores on each item range from 0 (does not initiate) to 3 (completes), so that the total score ranges from 0 to 60. The assessment was videotaped and 20% of videos were scored by a second assessor to assess interrater reliability (ICC(<reflink idref="bib2" id="ref103">2</reflink>,<reflink idref="bib1" id="ref104">1</reflink>) = 0.97).</p> <hd id="AN0162916546-13">Dyadic play observation</hd> <p>Infants were videotaped for five minutes in a free play interaction with a primary caregiver. Caregivers were instructed: "We'd like to record you spending time with [baby], as you normally would, for five minutes. You can use these toys if you want." They were provided with four standardized toys but were also free to play with any other objects in their environment. Caregivers were not instructed on how to position their infant or interact with toys.</p> <hd id="AN0162916546-14">Dyadic play data coding</hd> <p>The free play sessions were coded from video using Datavyu coding software (datavyu.org). Subsets of videos were scored by a second coder to assess interrater reliability.</p> <hd id="AN0162916546-15">Sitting</hd> <p>On a first pass through the video, coders annotated all times when infants were in a sitting position. Because infants were rarely supported by seats or other devices (only 10/162 caregivers chose to use seats), and because this seating context is qualitatively different from caregiver‐supported sitting, we did not include these portions of the videos as sitting. For each period of sitting, coders scored whether sitting was <emph>independent</emph> (without physical assistance from the caregiver) or <emph>supported</emph> (with physical assistance from the caregiver). Independent sitting included times when infants used their own hands on the floor for support ("prop sitting"), but this was uncommon (34/162 infants) and typically occurred as brief bouts—mostly under 10 s—within independent sitting; therefore, prop sitting was not separated from hands‐free sitting for analysis. Seventeen percent of the videos were coded for reliability and coders agreed on 96.5% of video frames (Cohen's <emph>κ</emph> = 0.945).</p> <p>Infants were classified into three categories of <emph>sitting support</emph> based on their demonstration of sitting during the dyadic play task: <emph>independent sitters</emph> were infants who sat independently for at least 30 s during the task, <emph>supported sitters</emph> were infants who only sat with support or sat independently for <30 s, and <emph>non‐sitters</emph> were infants who did not sit at all.</p> <p>For all portions of the video where infants were sitting (independent or supported), coders scored <emph>facing away</emph> and <emph>object contact</emph> as described below. For all portions of the video where infants were sitting supported, coders also scored the level of manual support as described below.</p> <hd id="AN0162916546-16">Facing away</hd> <p>Coders continuously scored the sitting periods to classify portions of time in which the infant was facing away from the caregiver. Times that were not included in this code comprised periods when the infant was facing the caregiver and periods when the infant sat at an angle to the caregiver. Forty percent of videos were coded for reliability and coders agreed on 95.1% of video frames (<emph>κ</emph> = 0.895).</p> <hd id="AN0162916546-17">Object contact (infant and caregiver)</hd> <p>On two separate passes through the videos, coders scored the timing and duration of (<reflink idref="bib1" id="ref105">1</reflink>) each time that the infant contacted an object and (<reflink idref="bib2" id="ref106">2</reflink>) each time that the caregiver contacted an object. Objects included toys and other small manipulable items but did not include furniture, surfaces, or body parts of either partner. A bout of object contact ended when the hand separated from the object for at least 1 s. Portions of the video where infants' or caregivers' hands were occluded from the camera such that object contact could not be determined were marked so that they could be excluded from the total duration. Coders agreed on 97.4% of video frames (<emph>κ</emph> = 0.947) for infant object contact with 12% of videos double‐coded for reliability, and agreed on 93.9% of video frames (<emph>κ</emph> = 0.880) for caregiver object contact with 27% of videos double‐coded for reliability.</p> <hd id="AN0162916546-18">Manual support</hd> <p>Finally, coders scored the supported sitting bouts to classify each moment into one of three manual support types: <emph>bimanual</emph> (caregivers used both hands to support the infant), <emph>unimanual</emph> (one hand), or <emph>hands‐free</emph> (no hands). Caregivers could support their infants hands‐free by using their arms above the wrist, or other parts of their body (trunk, legs), to provide support. Codes were mutually exclusive and exhaustive such that every video frame in which infants were sitting supported was classified into one of the three categories. Portions of the video where one or both of the caregivers' hands were occluded from the camera such that support type could not be determined were excluded. Twenty‐nine percent of videos were coded for reliability and coders agreed on 90.3% of video frames (<emph>κ</emph> = 0.837).</p> <hd id="AN0162916546-19">Data analysis</hd> <p>For each binary coded variable (facing away, infant/caregiver object contact), events were summed to calculate the total duration; for manual support, events were summed to calculate the total duration in each category. Because the amount of time in sitting/supported sitting varied between infants, and we aimed to capture differences in sitting experience specifically, proportions were used for analysis rather than raw durations. Outcome variables were (<reflink idref="bib1" id="ref107">1</reflink>) proportion of total sit duration with the infant facing away from the caregiver, (<reflink idref="bib2" id="ref108">2</reflink>) proportion of total sit duration with infant object contact, (<reflink idref="bib3" id="ref109">3</reflink>) proportion of total sit duration with caregiver object contact, and (<reflink idref="bib4" id="ref110">4</reflink>) proportion of supported sit duration in each manual support category. Table 2 depicts the summed durations (numerators), the total duration coded (denominators), and the calculated proportions for each outcome.</p> <p>2 TABLE Durations and computed proportions for all outcome variables</p> <p> <ephtml> <table><thead><tr><th /><th /><th align="left" /><th align="left">Gross motor delay</th><th align="left">Typical development</th></tr><tr><th /><th /><th align="left" /><th align="left"><p>Supported sitters</p><p><italic>M (SD)</italic></p></th><th align="left"><p>Independent sitters</p><p><italic>M (SD)</italic></p></th><th align="left"><p>Supported sitters</p><p><italic>M (SD)</italic></p></th><th align="left"><p>Independent sitters</p><p><italic>M (SD)</italic></p></th></tr></thead><tbody><tr><td>Facing away</td><td /><td /><td /><td /></tr><tr><td /><td>Denominator (min)<sup>1</sup></td><td>2.885 (1.479)</td><td>4.021 (0.959)</td><td>2.774 (1.700)</td><td>3.379 (1.434)</td></tr><tr><td /><td>Yes<sup>2</sup></td><td /><td /><td /><td /></tr><tr><td /><td /><td align="left">Numerator (min)</td><td>1.885 (1.644)</td><td>0.890 (1.261)</td><td>2.161 (1.759)</td><td>1.459 (1.732)</td></tr><tr><td /><td /><td align="left">Proportion</td><td>.640 (.374)</td><td>.234 (.334)</td><td>.788 (.327)</td><td>.396 (.415)</td></tr><tr><td /><td>No<sup>3</sup></td><td /><td /><td /><td /></tr><tr><td /><td /><td align="left">Numerator (min)</td><td>1.000 (1.357)</td><td>3.131 (1.635)</td><td>0.613 (1.288)</td><td>1.920 (1.716)</td></tr><tr><td /><td /><td align="left">Proportion</td><td>.360 (.374)</td><td>.766 (.334)</td><td>.212 (.327)</td><td>.604 (.415)</td></tr><tr><td>Infant object contact</td><td /><td /><td /><td /></tr><tr><td /><td>Denominator (min)<sup>4</sup></td><td>2.881 (1.476)</td><td>4.021 (0.959)</td><td>2.760 (1.683)</td><td>3.369 (1.430)</td></tr><tr><td /><td>Numerator (min)</td><td>1.532 (1.281)</td><td>2.466 (1.174)</td><td>1.708 (1.056)</td><td>2.380 (1.155)</td></tr><tr><td /><td>Proportion</td><td>0.486 (0.280)</td><td>0.604 (0.214)</td><td>0.646 (0.218)</td><td>0.699 (0.254)</td></tr><tr><td>Caregiver object contact</td><td /><td /><td /><td /></tr><tr><td /><td>Denominator (min)<sup>5</sup></td><td>2.871 (1.478)</td><td>3.934 (0.960)</td><td>2.774 (1.700)</td><td>3.337 (1.403)</td></tr><tr><td /><td>Numerator (min)</td><td>1.715 (1.277)</td><td>1.867 (1.061)</td><td>1.743 (1.384)</td><td>1.886 (1.135)</td></tr><tr><td /><td>Proportion</td><td>0.563 (0.237)</td><td>0.468 (0.219)</td><td>0.622 (0.205)</td><td>0.552 (0.189)</td></tr><tr><td>Support</td><td /><td /><td /><td /></tr><tr><td /><td>Denominator (min)<sup>6</sup></td><td>2.807 (1.514)</td><td>1.439 (1.352)</td><td>2.728 (1.741)</td><td>1.793 (1.355)</td></tr><tr><td /><td>Bimanual</td><td /><td /><td /><td /></tr><tr><td /><td /><td align="left">Numerator (min)</td><td>0.703 (0.607)</td><td>0.365 (0.477)</td><td>0.478 (0.457)</td><td>0.467 (0.624)</td></tr><tr><td /><td /><td align="left">Proportion</td><td>0.281 (0.201)</td><td>0.298 (0.290)</td><td>0.179 (0.118)</td><td>0.306 (0.341)</td></tr><tr><td /><td>Unimanual</td><td /><td /><td /><td /></tr><tr><td /><td /><td align="left">Numerator (min)</td><td>1.337 (0.984)</td><td>0.618 (0.866)</td><td>1.301 (1.117)</td><td>1.133 (1.311)</td></tr><tr><td /><td /><td align="left">Proportion</td><td>0.488 (0.212)</td><td>0.409 (0.318)</td><td>0.484 (0.252)</td><td>0.545 (0.343)</td></tr><tr><td /><td>Hands‐free</td><td /><td /><td /><td /></tr><tr><td /><td /><td align="left">Numerator (min)</td><td>0.767 (1.104)</td><td>0.456 (0.783)</td><td>0.949 (1.317)</td><td>0.194 (0.363)</td></tr><tr><td /><td /><td align="left">Proportion</td><td>0.231 (0.262)</td><td>0.294 (0.370)</td><td>0.337 (0.325)</td><td>0.149 (0.269)</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>: Denominators represent the total time in minutes coded for that variable. Numerators represent the summed duration in minutes in the coded category. <sups>1</sups>Total duration with infants in a sitting position. <sups>2</sups>Time in which infants faced away. <sups>3</sups>Time in which infants did <emph>not</emph> face away (i.e. were directly facing or at an angle to the caregiver). <sups>4</sups>Total duration with infants in a sitting position, minus time that infants' hands were out of view and object contact could not be determined. <sups>5</sups>Total duration with infants in a sitting position, minus time that caregivers' hands were out of view and object contact could not be determined. <sups>6</sups>Total duration with infants in supported sitting, minus time that caregivers' hands were out of view and support type could not be determined. <emph>M</emph> = group mean, <emph>SD</emph> = standard deviation.</p> <p>Because proportion outcomes are not normally distributed, primary analyses were performed via beta regression using the <emph>betareg</emph> package in R. Outcome measures were rescaled to fall within the (0,1) interval using the method described by Smithson and Verkuilen ([<reflink idref="bib70" id="ref111">70</reflink>]). Binary predictors were dummy coded (supported sitters = 0, independent sitters = 1; typically developing = 0, gross motor delay = 1) and all predictors were centered at the mean so that coefficient estimates for single predictors represent main effects.</p> <p>To tease apart the role of sitting support and sitting skill on facing away and object contact, the following analysis strategy was used: Model 1 included group (gross motor delay vs. typical development), sitting <emph>support</emph>, and their interaction as predictors. Model 2 included group, sitting <emph>skill</emph>, and their interaction. Model 3 included all variables together: group, sitting support, group*sitting support, sitting skill, and group*sitting skill. Likelihood ratio tests were used to determine whether Model 3 was a better fit for the data than Models 1 and 2—that is, if adding sitting skill significantly improved the prediction for Model 1 and if sitting support significantly improved the prediction for Model 2.</p> <p>To explore how caregivers use their hands and bodies to support their infants in sitting, we examined the results of the manual support coding descriptively. To examine whether the extent of manual support was associated with sitting skill, we performed a beta regression model with the most extensive manual support category—bimanual support—as the outcome, using group, sitting skill, and group*sitting skill as predictors. Finally, to examine whether the duration of caregiver object contact was related to bimanual support, we examined the effect of bimanual support when added as a predictor to the caregiver object contact Model 2 for supported sitters. Only supported sitters were included in this last analysis because manual support and caregiver object contact were both measured during the same bouts of supported sitting for these infants. (For independent sitters, caregiver object contact also included bouts of independent sitting.)</p> <p>To examine effects of age, we tested additional models using age, group, and their interaction as predictors for each outcome; we also used likelihood ratio tests to determine whether adding age and age*group significantly improved the primary models.</p> <p>Prior to examining sitting support, sitting skill, and age as potential predictors of our coded outcome measures, we first explored how these variables related to each other using chi‐square test of independence (<emph>chisq.test</emph> function in base R) and linear regression (<emph>lmtest</emph> package).</p> <hd id="AN0162916546-20">RESULTS</hd> <p></p> <hd id="AN0162916546-21">Sitting support, sitting skill, and age</hd> <p></p> <hd id="AN0162916546-22">Sitting support</hd> <p>On average, infants spent a slight majority of the task (<emph>M</emph> = 57%, <emph>SD</emph> = 35%) in a sitting position. In the typically developing group, 13 infants (38%) were classified as independent sitters, 15 (44%) as supported sitters, and 6 (18%) as non‐sitters; in the motor delay group, 50 infants (39%) were classified as independent sitters, 67 (52%) as supported sitters, and 11 (9%) as non‐sitters. There was no difference in the distribution of independent, supported, and non‐sitters between the groups, <emph>χ</emph><sups>2</sups> = 2.462, <emph>p</emph> = 0.282. Independent sitters spent more time sitting than supported sitters (<emph>M</emph> = 78%, <emph>SD</emph> = 22% vs. <emph>M</emph> = 53%, <emph>SD</emph> = 33%), <emph>B</emph> = 0.251, <emph>p</emph> <.001, but there was no difference between the groups, <emph>B</emph> = 0.037, <emph>p</emph> =.535, and no interaction, <emph>B</emph> = 0.162, <emph>p</emph> =.181. Because the primary focus of this paper is on infants' experiences in sitting, only infants who spent at least 30 seconds in a sitting position (28 typically developing infants—15 supported sitters and 13 independent sitters—and 110 infants with motor delay—60 supported sitters and 50 independent sitters) are included in the rest of the analyses.</p> <hd id="AN0162916546-23">Sitting skill</hd> <p>Sitting skill measured via the GMFM sitting dimension was greater in the independent sitters than the supported sitters, <emph>B</emph> = 8.974, <emph>p</emph> <.001. However, there was considerable variability within and overlap between supported and unsupported sitters (Figure 1). There was no significant effect of group, <emph>B</emph> = 2.563, <emph>p</emph> =.081 and no interaction, <emph>B</emph> = 4.483, <emph>p</emph> =.128.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/5G5/01may23/desc13318-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="desc13318-fig-0001.jpg" title="1 Age and GMFM sitting score for infants with gross motor delay and infants with typical development. Light gray diamonds represent infants who demonstrated independent sitting during the dyadic play observation, and dark gray circles represent infants who only sat with support during the dyadic play observation. Age represents chronological age for infants born full term and adjusted age for infants born preterm" /> </p> <p></p> <hd id="AN0162916546-25">Age</hd> <p>By design, the infants with motor delay were older than the infants with typical development, <emph>B</emph> = 4.851, <emph>p</emph> <.001. But there was no significant difference in age between independent and supported sitters, <emph>B</emph> = 0.041, <emph>p</emph> =.916, and no sitting support*group interaction, <emph>B</emph> = 0.063, <emph>p</emph> =.948. Because age was non‐overlapping between the groups, we examined the association between age and sitting skill separately for each group; age was positively correlated with sitting skill for the typically developing infants, <emph>r</emph>(<reflink idref="bib26" id="ref112">26</reflink>) = 0.48, <emph>p</emph> =.01, but not for the infants with gross motor delay, <emph>r</emph>(<reflink idref="bib108" id="ref113">108</reflink>) = ‐0.13, <emph>p</emph> =.17 (Figure 1).</p> <p>As sitting support, sitting skill, and age were moderately interrelated, Variance Inflation Factors (VIFs) were examined for each regression model to test for multicollinearity. VIF values were < 2 for all models, indicating acceptably low levels of association between predictors.</p> <hd id="AN0162916546-26">Facing away</hd> <p>The proportion of sitting duration with the infant facing away was significantly associated with sitting support and sitting skill (Figure 2a). 32% of supported sitters spent <emph>all</emph> their sitting time facing away from their caregiver, compared with 6% of independent sitters; 48% of independent sitters spent <emph>none</emph> of their sitting time facing away, compared with 12% of supported sitters. Model 1 confirmed that supported sitters spent more time facing away than independent sitters (Table 3), and Model 2 confirmed that greater sitting skill was associated with less time facing away (Table 4). The effect of group was significant in Model 2, with typically developing infants spending more time facing away than infants with motor delay. The interaction was not significant in either model.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/5G5/01may23/desc13318-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="desc13318-fig-0002.jpg" title="2 Primary outcomes—(a) proportion of sit duration with infant facing away, (b) proportion of sit duration with infant object contact, (c) proportion of sit duration with caregiver object contact—for infants with gross motor delay (left of dashed line) and infants with typical development (right of dashed line). Scatter plots (far left and far right columns) depict effects of sitting skill, that is, relations between GMFM sitting score and the outcome. Light gray diamonds represent infants who demonstrated independent sitting during the dyadic play observation, and dark gray circles represent infants who only sat with support during the dyadic play observation. Lines represent model predictions from the beta regression models (Model 2). Bold symbols (middle columns) represent group means for supported and independent sitters. Error bars represent standard error of the mean" /> </p> <p></p> <p>3 TABLE Model 1: Sitting support only</p> <p> <ephtml> <table><thead><tr><th /><th>Facing away</th><th>Infant object contact</th><th>Caregiver object contact</th></tr><tr><th /><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th></tr></thead><tbody><tr><td>Group</td><td>−0.514</td><td>−1.044,0.016</td><td>0.058</td><td>−0.654</td><td>−1.089,−0.220</td><td>0.003</td><td>−0.221</td><td>−0.593,0.151</td><td>0.244</td></tr><tr><td>Sitting support</td><td>−1.290</td><td>−1.748,−0.832</td><td><0.001</td><td>0.519</td><td>0.170,0.868</td><td>0.004</td><td>−0.401</td><td>−0.701,−0.102</td><td>0.009</td></tr><tr><td>Group × sitting support</td><td>−0.096</td><td>−1.154,0.962</td><td>0.859</td><td>0.222</td><td>−0.644,1.088</td><td>0.615</td><td>−0.144</td><td>−0.889,0.600</td><td>0.704</td></tr></tbody></table> </ephtml> </p> <ulist> <item>3 <emph>Note</emph>: Coefficient estimates representing main effects of group and sitting support and the group*sitting support interaction from beta regression models for each outcome measure. All predictors are centered at the mean. Binary predictors were dummy coded with supported sitters = 0, independent sitters = 1 and typically developing = 0, gross motor delay = 1. CI = confidence interval of the estimate. Bold numbers represent statistically significant findings at <emph>α</emph> = 0.05.</item> <item>4 TABLE Model 2: Sitting skill only</item> </ulist> <p> <ephtml> <table><thead><tr><th /><th>Facing away</th><th>Infant object contact</th><th>Caregiver object contact</th></tr><tr><th /><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th></tr></thead><tbody><tr><td>Group</td><td>−2.090</td><td>−3.921,−0.258</td><td>0.025</td><td>−1.700</td><td>−3.221,−0.178</td><td>0.029</td><td>−0.132</td><td>−1.426,1.162</td><td>0.842</td></tr><tr><td>Sitting skill</td><td>−0.062</td><td>−0.094,−0.031</td><td><0.001</td><td>0.016</td><td>−0.001,0.041</td><td>0.228</td><td>−0.028</td><td>−0.049,−0.006</td><td>0.012</td></tr><tr><td>Group × sitting skill</td><td>0.110</td><td>−0.002,0.221</td><td>0.054</td><td>0.063</td><td>−0.030,0.155</td><td>0.184</td><td>−0.001</td><td>−0.080,0.078</td><td>0.976</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note</emph>: Coefficient estimates representing main effects of group and sitting skill and the group*sitting skill interaction from beta regression models for each outcome measure. All predictors are centered at the mean. Group was dummy coded with typically developing = 0 and gross motor delay = 1. CI = confidence interval of the estimate. Bold numbers represent statistically significant findings at <emph>α</emph> = 0.05.</p> <p>In Model 3, when both sitting support and sitting skill were included, sitting support and group remained significant predictors of time facing away (Table 5). This model fit the data significantly better than Model 2 but not Model 1 (Table 6). In other words, adding sitting support significantly improved Model 2 but adding sitting skill did not significantly improve Model 1. Therefore, facing away seems to be more closely related to sitting support than sitting skill.</p> <p>5 TABLE Model 3: Sitting support and sitting skill</p> <p> <ephtml> <table><thead><tr><th /><th>Facing away</th><th>Infant object contact</th><th>Caregiver object contact</th></tr><tr><th /><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th><th>Estimate</th><th>95% CI</th><th><italic>p</italic></th></tr></thead><tbody><tr><td>Group</td><td>−2.491</td><td>−4.798,−0.183</td><td>0.034</td><td>−2.285</td><td>−4.181,−0.388</td><td>0.018</td><td>0.008</td><td>−1.611,1.627</td><td>0.992</td></tr><tr><td>Sitting support</td><td>−1.146</td><td>−1.684,−0.607</td><td><0.001</td><td>0.488</td><td>0.068,0.908</td><td>0.023</td><td>−0.228</td><td>−0.589,0.132</td><td>0.215</td></tr><tr><td>Group × sitting support</td><td>−0.816</td><td>−2.165,0.533</td><td>0.236</td><td>−0.353</td><td>−1.441,0.735</td><td>0.525</td><td>0.011</td><td>−0.922,0.943</td><td>0.982</td></tr><tr><td>Sitting skill</td><td>−0.028</td><td>−0.066,0.010</td><td>0.149</td><td>−0.005</td><td>−0.036,0.026</td><td>0.753</td><td>−0.018</td><td>−0.045,0.008</td><td>0.174</td></tr><tr><td>Group × sitting skill</td><td>0.127</td><td>−0.016,0.269</td><td>0.082</td><td>0.103</td><td>−0.014,0.219</td><td>0.085</td><td>−0.011</td><td>−0.112,0.089</td><td>0.823</td></tr></tbody></table> </ephtml> </p> <ulist> <item>5 <emph>Note</emph>: Coefficient estimates represent main effects of group, sitting support, and sitting skill and two‐way interactions from beta regression models for each outcome measure. All predictors are centered at the mean. Binary predictors were dummy coded with supported sitters = 0, independent sitters = 1 and typically developing = 0, gross motor delay = 1. CI = confidence interval of the estimate. Bold numbers represent statistically significant findings at <emph>α</emph> = 0.05.</item> <item>6 TABLE Model comparison</item> </ulist> <p> <ephtml> <table><thead><tr><th /><th>Facing away</th><th>Infant object contact</th><th>Caregiver object contact</th></tr><tr><th /><th><italic>χ</italic><sup>2</sup></th><th><italic>p</italic></th><th><italic>χ</italic><sup>2</sup></th><th><italic>p</italic></th><th><italic>χ</italic><sup>2</sup></th><th><italic>p</italic></th></tr></thead><tbody><tr><td>Model 3 vs. 1</td><td>3.424</td><td>0.181</td><td>3.777</td><td>0.151</td><td>3.313</td><td>0.191</td></tr><tr><td>Model 3 vs. 2</td><td>18.56</td><td><.001</td><td>5.681</td><td>0.058</td><td>1.517</td><td>0.468</td></tr></tbody></table> </ephtml> </p> <p>6 <emph>Note</emph>: <emph>χ</emph><sups>2</sups> values represent results from likelihood ratio tests comparing Model 3 to nested Models 1 and 2. Bold numbers represent statistically significant findings at <emph>α</emph> = 0.05.</p> <hd id="AN0162916546-28">Infant object contact</hd> <p>Infant object contact was significantly associated with sitting support and group, but not sitting skill (Figure 2b). Model 1 confirmed that independent sitters spent significantly more time contacting objects than supported sitters (Table 3); Models 1 and 2 revealed that typically developing infants spent more time contacting objects than infants with motor delay (Tables 3–4). The interaction was not significant in either model.</p> <p>In Model 3, sitting support and group remained significant predictors of infant object contact (Table 5). Model 3 did not fit the data significantly better than either Model 1 or Model 2 (Table 6).</p> <hd id="AN0162916546-29">Caregiver object contact</hd> <p>Model 1 revealed that caregiver object contact did differ significantly between supported and unsupported sitters (Figure 2c). However, the effect was in the opposite direction as predicted: Caregivers of supported sitters spent <emph>more</emph> time contacting objects than those of independent sitters (Table 3). Similarly, Model 2 revealed that higher levels of sitting skill were associated with less caregiver object contact (Table 4). Group and group*sitting interactions were not significant in either model.</p> <p>Neither sitting support nor sitting skill remained significant predictors in Model 3 (Table 5), suggesting that both measures explained similar portions of the variance in caregiver object contact. Model 3 did not fit the data significantly better than either Model 1 or Model 2 (Table 6).</p> <hd id="AN0162916546-30">Manual support</hd> <p>In our analysis of manual support strategies, we included data for infants who spent at least 30 s in <emph>supported</emph> sitting; this comprised 72 supported sitters and 29 independent sitters. On average, caregivers spent about half of the time using one hand to support their infants (<emph>M</emph> = 52.3%, <emph>SD</emph> = 27.0% in the typically developing group and <emph>M</emph> = 44.5%, <emph>SD</emph> = 22.6% in the motor delay group; Figure 3). The other half of supported sitting time was split fairly evenly between bimanual support (<emph>M</emph> = 21.2%, <emph>SD</emph> = 20.0% in the typically developing group and <emph>M</emph> = 28.3%, <emph>SD</emph> = 21.7% in the motor delay group) and hands‐free support (<emph>M</emph> = 26.4%, <emph>SD</emph> = 32.4% in the typically developing group and <emph>M</emph> = 27.2%, <emph>SD</emph> = 30.0% in the motor delay group).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/5G5/01may23/desc13318-fig-0003.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="desc13318-fig-0003.jpg" title="3 Average proportion of supported sit duration with three types of caregiver support for infants with gross motor delay and infants with typical development. Error bars depict standard error of the mean." /> </p> <p></p> <p>We did not find support for our hypothesis that use of both hands for support would be more common with less skilled sitters. Proportion of time with bimanual support was not significantly predicted by sitting skill (<emph>B</emph> = −0.013, <emph>p</emph> =.396), group (<emph>B</emph> = 0.687, <emph>p</emph> =.384), or their interaction (<emph>B</emph> = −0.028, <emph>p</emph> =.570). However, for supported sitters, bimanual support was associated with caregiver object contact. We re‐ran the caregiver object contact Model 2 for supported sitters only; this subgroup analysis revealed no significant effects of group, sitting skill, or their interaction. We then added bimanual support and bimanual support*group as predictors to this model and found a significant effect of bimanual support (<emph>B</emph> = −4.018, <emph>p</emph> <.001); the more time caregivers spent supporting their infants with both hands, the less time they spent contacting objects (Figure 4).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/5G5/01may23/desc13318-fig-0004.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="desc13318-fig-0004.jpg" title="4 Relations between proportion of sit duration with bimanual support and proportion of sit duration with caregiver object contact for infants with gross motor delay and infants with typical development. All points represent supported sitters. Lines represent model predictions from the beta regression model." /> </p> <p></p> <hd id="AN0162916546-33">Effects of age</hd> <p>Age and age*group were not significantly associated with the outcome measures with one exception: Older infants spent less time facing away from caregivers (<emph>B</emph> = −0.167, <emph>p</emph> =.041). Age was a significant predictor of facing away when added to Model 1, but not Model 2, and adding age and age*group as predictors did not significantly improve either of the models.</p> <hd id="AN0162916546-34">DISCUSSION</hd> <p>Independent sitting experience leads to advances in infants' global development. Why doesn't supported sitting experience provide the same benefits? The aim of this study was to determine whether the content of infant sitting experience differs between independent and caregiver‐supported sitting. We examined relations between sitting behavior and access to social information from faces and hands during free play in infants with typical development and infants with gross motor delay. We found that the amount of time infants and caregivers were positioned to view each other's faces, and the amount of time each handled objects, varied by sitting support. As predicted, supported sitters spent more time facing away from their caregivers and less time handling objects than independent sitters. We also predicted that supporting infants' sitting posture would occupy caregivers' hands, rendering them less available for object manipulation. Indeed, caregivers who spent more time supporting their infants with both hands spent less time contacting objects. However, we found that caregivers of supported sitters spent <emph>more</emph> time handling objects than caregivers of independent sitters. To our surprise, caregivers only spent about a quarter of the time using two hands to support their infants, leaving one or both hands mostly free for object play.</p> <p>Our continuous measure of sitting skill (GMFM) did not uniquely contribute to these behaviors beyond the effect of binary sitting support. Caregivers of infants with greater sitting skill spent less time handling objects; infants with greater sitting skill spent less time facing away, but this effect was no longer significant when controlling for sitting support.</p> <p>These patterns were similar for typically developing infants and infants with gross motor delay—despite the difference in age—as demonstrated by non‐significant interaction effects. However, infants with motor delay spent less time facing away and less time contacting objects than typically developing infants.</p> <hd id="AN0162916546-35">Independent sitting changes dyadic positioning</hd> <p>The visual information available to infants and caregivers during play is constrained by dyads' physical positioning (Franchak et al., [<reflink idref="bib18" id="ref114">18</reflink>]; Frank et al., [<reflink idref="bib20" id="ref115">20</reflink>]; Kretch et al., [<reflink idref="bib37" id="ref116">37</reflink>]; Long et al., [<reflink idref="bib45" id="ref117">45</reflink>]; Sanchez et al., [<reflink idref="bib65" id="ref118">65</reflink>]; Schneider et al., [<reflink idref="bib68" id="ref119">68</reflink>]). How infants' and caregivers' bodies are oriented in space impacts how much of each other they can see; in particular, when caregivers are positioned behind their infants with infants facing away, infants and caregivers have difficulty seeing each other's faces (Frank et al., [<reflink idref="bib20" id="ref120">20</reflink>]; Long et al., [<reflink idref="bib45" id="ref121">45</reflink>]; Sanchez et al., [<reflink idref="bib65" id="ref122">65</reflink>]). This may limit infants' ability to use cues such as facial expression and eye gaze to learn about the external world and develop communication skills (Brooks & Meltzoff, [<reflink idref="bib6" id="ref123">6</reflink>]; Feinman, [<reflink idref="bib15" id="ref124">15</reflink>]; Hornik & Gunnar, [<reflink idref="bib26" id="ref125">26</reflink>]; Kaye & Fogel, [<reflink idref="bib33" id="ref126">33</reflink>]; Klinnert et al., [<reflink idref="bib34" id="ref127">34</reflink>]; Moore, [<reflink idref="bib49" id="ref128">49</reflink>]; Moore et al., [<reflink idref="bib50" id="ref129">50</reflink>]; Tomasello, [<reflink idref="bib77" id="ref130">77</reflink>]; Walden & Ogan, [<reflink idref="bib80" id="ref131">80</reflink>]; Yale et al., [<reflink idref="bib85" id="ref132">85</reflink>]). For caregivers, visual access to infants' faces enables monitoring of infants' attentional and emotional state (Cohn & Tronick, [<reflink idref="bib8" id="ref133">8</reflink>]; Deák et al., [<reflink idref="bib11" id="ref134">11</reflink>]; Yu & Smith, [<reflink idref="bib88" id="ref135">88</reflink>], [<reflink idref="bib91" id="ref136">91</reflink>]); without this information, caregivers may have difficulty providing learning opportunities at optimal moments and shifting tasks when needed.</p> <p>We found that independent sitters spent most of their sitting time facing or at right angles to their caregivers, but supported sitters mostly faced away from their caregivers; this may result in fewer opportunities for face viewing. In the current study, we compared facing away and other outcomes as a proportion of sitting duration to specifically compare the content of independent vs. caregiver‐supported sitting. Due to the differences in overall sitting time between supported and independent sitters, these differences may be even larger when considering raw durations. For example, for the infants with gross motor delay, supported sitters on average spent 1 min of the 5‐min task in a sitting position <emph>and</emph> facing toward the caregiver, whereas independent sitters spent over 3 min in this configuration.</p> <p>Note that facing away is likely to be specific to <emph>caregiver‐</emph>supported sitting. In a recent study of dyadic positioning during natural play interactions, caregivers were provided a support pillow to prop up their infants; in this context, infants rarely faced away (Schneider et al., [<reflink idref="bib68" id="ref137">68</reflink>]). Although we were not able to examine this question in the current study due to the limited number of caregivers who chose to use seats, seating supports may play a role in increasing face viewing for pre‐sitting infants.</p> <p>It is also important to note that infants and toddlers do not spend a great deal of time fixating their caregivers' faces (Franchak et al., [<reflink idref="bib18" id="ref138">18</reflink>]), even when positioned face‐to‐face (Yoshida & Smith, [<reflink idref="bib86" id="ref139">86</reflink>]; Yu & Smith, [<reflink idref="bib88" id="ref140">88</reflink>]); thus the importance of the lack of access to caregivers' faces while sitting is unclear. However, caregivers spend a great deal of time looking at infants' faces and frequently use gaze‐following to attain joint attention (Franchak et al., [<reflink idref="bib18" id="ref141">18</reflink>]; Yu & Smith, [<reflink idref="bib88" id="ref142">88</reflink>], [<reflink idref="bib91" id="ref143">91</reflink>]). Without access to infants' facial cues, rich caregiver‐infant engagement may be more difficult to sustain. This may contribute to lower rates of caregiver‐provided learning opportunities during caregiver‐supported sitting compared to independent sitting (Kretch et al., [<reflink idref="bib38" id="ref144">38</reflink>]).</p> <p>The primary contributor to the facing away outcome was sitting support. Although facing away was associated with GMFM score—our continuous measure of sitting skill—this effect disappeared when sitting support was included, and adding sitting support significantly improved the fit of the model. In other words, infants who sat independently during the play observation were less likely to face away than infants who did not, regardless of their level of sitting skill. This suggests that dyadic positioning during play is more closely linked to what infants <emph>do</emph>, in real time, than what they <emph>can do</emph> as measured on a standardized assessment.</p> <p>Most outcomes measured in this study were linked to sitting but not to age. However, dyadic positioning was the one measure that was associated with age: Facing away was less common in older infants. This suggests that caregivers may attempt to create more opportunities for face‐to‐face interaction with children who are older and (perceived as) more socially sophisticated.</p> <hd id="AN0162916546-36">Independent sitting changes infant and caregiver object manipulation</hd> <p>Object exploration is one of the best‐studied learning experiences in the infant cognitive development literature. Although object manipulation is often investigated as a solo pursuit, it largely occurs in a social context (Bakeman & Adamson, [<reflink idref="bib2" id="ref145">2</reflink>]; Deák et al., [<reflink idref="bib11" id="ref146">11</reflink>]; Karasik et al., [<reflink idref="bib31" id="ref147">31</reflink>]; McQuillan et al., [<reflink idref="bib47" id="ref148">47</reflink>]; West & Iverson, [<reflink idref="bib82" id="ref149">82</reflink>]). Infant object handling facilitates language learning—holding objects increases caregiver talk about the held objects and reduces uncertainty about the referent of utterances (Smith et al., [<reflink idref="bib69" id="ref150">69</reflink>]; Suanda et al., [<reflink idref="bib73" id="ref151">73</reflink>]; Tamis‐LeMonda et al., [<reflink idref="bib75" id="ref152">75</reflink>]; West & Iverson, [<reflink idref="bib82" id="ref153">82</reflink>]; Yu & Smith, [<reflink idref="bib87" id="ref154">87</reflink>]). Caregivers use their hands to direct or maintain infants' attention to objects and to demonstrate object properties and affordances (Belsky et al., [<reflink idref="bib3" id="ref155">3</reflink>]; Johnson & Woods, [<reflink idref="bib30" id="ref156">30</reflink>]; Lawson et al., [<reflink idref="bib40" id="ref157">40</reflink>]; Mendive et al., [<reflink idref="bib48" id="ref158">48</reflink>]; Vaughan et al., [<reflink idref="bib79" id="ref159">79</reflink>]). In the absence of eye gaze information, object handling provides a strong cue to the handler's attentional focus and facilitates joint attention (Yu & Smith, [<reflink idref="bib88" id="ref160">88</reflink>], [<reflink idref="bib91" id="ref161">91</reflink>]).</p> <p>Although we did not require infants or caregivers to play with toys during the play observation, they did; on average, infants spent 57% of the time contacting an object, and caregivers spent 53%. Independent sitters spent more sitting time contacting objects than supported sitters: 2.5 min for independent sitters and 1.5 min for supported sitters in the gross motor delay group. This is consistent with prior work showing increased object exploration in infants who could sit hands‐free (Marcinowski et al., [<reflink idref="bib46" id="ref162">46</reflink>]). This may reflect better overall motor skill in independent sitters; however, infant object contact was not associated with sitting skill. Because caregivers follow infants' hands to determine where they are attending, more object manipulation may lead to more joint attention (Yu & Smith, [<reflink idref="bib89" id="ref163">89</reflink>]). Considering the results for facing away and infant object contact, caregivers of independent sitters may benefit from increased opportunities to use both the gaze‐following and hand‐following pathways to attain joint attention with their infants.</p> <p>In contrast, caregivers of supported sitters spent more time contacting objects than caregivers of independent sitters. It is possible that this represents an attempt to maintain object engagement despite supported sitters' decreased object manipulation. Although supported sitters spent a large proportion of time unable to see caregivers' faces, caregivers' hands were typically well within infants' field of view. Potentially, caregivers used their own hands to facilitate joint attention in the context of fewer gaze‐following and infant‐hand‐following opportunities. This may appear to conflict with prior work demonstrating greater caregiver‐provided learning opportunities during independent compared to caregiver‐supported sitting (Kretch et al., [<reflink idref="bib38" id="ref164">38</reflink>]). However, the quality of object contact was not measured here; it is possible that caregivers of supported sitters spend more time simply holding or showing objects, whereas caregivers of independent sitters provide more enriching activities. Overall, the object contact findings may suggest that object play in sitting consists of more passive viewing for supported sitters and more active engagement for independent sitters.</p> <hd id="AN0162916546-37">Caregivers use unconventional strategies to support infants' sitting posture</hd> <p>The findings for caregiver object contact were unexpected. We anticipated that caregivers of supported sitters would be more limited in their object contact because they would have their hands full supporting their infants. This was not the case. Rather than employing the stereotypical strategy of placing two hands on the infant's trunk, caregivers used less manually demanding methods to maintain infants' sitting posture. Many caregivers allowed their infants to lean back while they provided full‐body support from behind. Others positioned infants on their laps and wrapped an arm around infants' trunks, leaving at least one of the caregiver's hands free. Caregivers switched support types on average 7 times per minute, suggesting that they modified support strategies moment‐by‐moment to accommodate changing task demands and play activities.</p> <p>Our results indicate that natural play in the home differs from standardized lab tasks or clinical assessments, and provide the first description of what caregiver‐supported sitting looks like in infants' everyday lives. During everyday object play, caregivers have multiple tasks and goals. They facilitate learning opportunities in a variety of domains while maintaining infants' safety and attending to their social‐emotional needs. For infants who are not yet able to sit independently, caregivers may need to balance competing priorities to ensure infants' safety and stability in a sitting posture and to engage them in object play. A bimanual support strategy with two hands on the infant's trunk may be beneficial for promoting upright, symmetrical alignment; when employed with the appropriate force and at the appropriate level for the infant's skill, this method allows infants to actively engage their muscles and practice maintaining balance (Duncan et al., [<reflink idref="bib13" id="ref165">13</reflink>]). However, our findings suggest that in real‐world play, caregivers may prioritize object engagement over providing "optimal" sitting support.</p> <p>Individual differences in caregivers' choice of support strategy were related to their object manipulation; the more time the caregiver spent supporting the infant with both hands, the less time they spent contacting objects. How do caregivers choose which support strategies to use? Surprisingly, this did not seem to be influenced by infants' sitting skill, as bimanual support was unrelated to GMFM scores. Variation in support strategies may be influenced by parent preferences or other influences not measured in the current study.</p> <p>The consequences of different support strategies for infants' ability to engage and learn remain to be investigated. Strategies that under‐support may decrease infants' postural stability, which may limit their ability to reach and manipulate toys (Rachwani et al., [<reflink idref="bib56" id="ref166">56</reflink>]; Woods & Wilcox, [<reflink idref="bib84" id="ref167">84</reflink>]). This may partially explain our finding that supported sitters demonstrated less object contact than independent sitters. On the other hand, strategies that over‐support infants may decrease their postural muscle activation and ability to practice sitting balance. It is likely the use of a range of support strategies, as demonstrated by caregivers in this task, provides variability that supports exploration and flexible, adaptive action and is beneficial for motor learning. Further investigation of the use and consequences of different types of support methods will help to gain a fuller picture of infant positioning practices in everyday life.</p> <hd id="AN0162916546-38">Implications for infants with motor delay</hd> <p>Although infants with gross motor delay were 7–16 months of age, they experienced the same effects of sitting support and sitting skill as did infants with typical development at 4–7 months. However, there were overall differences between the groups. Infants with motor delay spent less time facing away than infants with typical development. Caregivers of infants with motor delay may have devised alternative ways to position their infants to gain more face time, in order to compensate for the delayed development of sitting. For example, one caregiver supported her infant by extending her legs and wedging her infant between them. However, the difference between groups was small compared to the effect of sitting support, suggesting that infants with motor delay remain at a disadvantage prior to the development of independent sitting. Infants with gross motor delay also spent less time contacting objects than infants with typical development. This may reflect overall poorer motor skill in this group of infants and suggests that they may not reap the full benefits of independent sitting for object exploration.</p> <p>For typically developing infants, small variations in the timing of motor skill acquisition provide insights into developmental processes linking motor skills to cognitive outcomes (Libertus & Violi, [<reflink idref="bib42" id="ref168">42</reflink>]; Oudgenoeg‐Paz et al., [<reflink idref="bib53" id="ref169">53</reflink>]; Soska et al., [<reflink idref="bib72" id="ref170">72</reflink>]), but may not have long‐term consequences—infants eventually catch up or reach the same developmental endpoints through alternative pathways. But for more vulnerable infants with neurodevelopmental disabilities, altered motor skill trajectories have the potential to disrupt the developmental cascades that support global learning and development (Iverson, [<reflink idref="bib28" id="ref171">28</reflink>]; Lobo et al., [<reflink idref="bib44" id="ref172">44</reflink>]). For infants who demonstrate significant delays in independent sitting, our findings suggest that caregiver‐supported sitting may be an insufficient compensatory strategy for providing learning opportunities typically associated with independent sitting.</p> <p>For children with motor delays and disabilities, as for younger infants with typical development, alternative sitting supports and devices are often introduced to improve posture, play, and participation (Ryan, [<reflink idref="bib63" id="ref173">63</reflink>]). Typically developing infants and children with cerebral palsy demonstrate improved reaching and object exploration when positioned in a supportive seating device (Hopkins & Rönnqvist, [<reflink idref="bib25" id="ref174">25</reflink>]; Rachwani et al., [<reflink idref="bib56" id="ref175">56</reflink>]; Rochat & Goubet, [<reflink idref="bib59" id="ref176">59</reflink>]; Santamaria et al., [<reflink idref="bib66" id="ref177">66</reflink>]; Washington et al., [<reflink idref="bib81" id="ref178">81</reflink>]; Woods & Wilcox, [<reflink idref="bib84" id="ref179">84</reflink>]). When children with cerebral palsy begin using adaptive seating devices, their caregivers report improvements in play and social interaction (Rigby et al., [<reflink idref="bib57" id="ref180">57</reflink>]; Ryan et al., [<reflink idref="bib64" id="ref181">64</reflink>]). In fact, parents report that a major benefit of adaptive seating is the ability to engage with their infants face to face (Rigby et al., [<reflink idref="bib57" id="ref182">57</reflink>]; Washington et al., [<reflink idref="bib81" id="ref183">81</reflink>]). Of course, seating devices must be used judiciously—we do not suggest that infants with motor delay spend their days strapped into restrictive devices that limit practice with independent sitting. However, there may be a role for novel support systems that allow self‐initiated, variable movement while allowing infants to experience the benefits of enhanced motor experience (Kokkoni & Galloway, [<reflink idref="bib35" id="ref184">35</reflink>]; Kokkoni et al., [<reflink idref="bib36" id="ref185">36</reflink>]; Prosser et al., [<reflink idref="bib55" id="ref186">55</reflink>]).</p> <hd id="AN0162916546-39">Limitations and future directions</hd> <p>This study examined one component of the developmental cascade that links independent sitting—but not supported sitting—to advancements in cognitive and language development. There remains much work to be done to characterize the full sequences of events by which sitting leads to developmental outcomes. We demonstrated that independent sitting affects <emph>opportunities</emph> for socially mediated learning processes. However, this paper did not assess the extent to which the opportunities were exploited by infants and caregivers, nor did we examine developmental outcomes. Although prior work has demonstrated that typically developing toddlers demonstrate more joint attention while sitting than while prone or standing (Franchak et al., [<reflink idref="bib18" id="ref187">18</reflink>]), we do not know whether independent sitting truly results in different rates of joint attention compared to supported sitting. The increase in face‐to‐face interaction may benefit independent sitters, but it is also possible that the higher rate of caregiver object contact in supported sitters makes up for the decreased face time. It is especially important to characterize these developmental cascades in infants with motor delays who are at risk of secondary impairments in cognitive and language outcomes.</p> <p>Another important limitation is the short duration of the play observation task. Five minutes of play may or may not be representative of what infants and their caregivers do over hours, days, or weeks of everyday interaction. We encourage researchers interested in everyday learning opportunities to take advantage of high‐ and low‐tech methods for measuring infant and caregiver behavior in the home over longer periods (de Barbaro & Fausey, [<reflink idref="bib9" id="ref188">9</reflink>]). Collecting such data will allow us to fully capture the rich, dynamic inputs for learning that contribute to developmental change in infants with typical and atypical development.</p> <hd id="AN0162916546-40">ACKNOWLEDGMENTS</hd> <p>This project was supported by the Institute of Education Sciences, National Center for Special Education Research, Early Intervention and Early Learning in Special Education Award R324A150103; a Children's Hospital Foundation Research Grant; a Virginia Commonwealth University Post‐Doctoral Association Research Grant; and National Institutes of Child Health and Human Development K12 HD055929. We gratefully acknowledge the infants and caregivers who volunteered to participate in this study, the clinical trial assessors for their assistance in data collection, and members of the Virginia Commonwealth University and University of Southern California Motor Development Labs for their assistance in video coding.</p> <hd id="AN0162916546-41">CONFLICTS OF INTEREST</hd> <p>The authors report no conflicts of interest.</p> <hd id="AN0162916546-42">DATA AVAILABILITY STATEMENT</hd> <p>The data sets used in this analysis are available from the START‐Play research team upon reasonable request.</p> <ref id="AN0162916546-43"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref87" type="bt">1</bibl> <bibtext> Adamson, L. B., & Bakeman, R. (1991). The development of shared attention during infancy. In R. Vasta (Ed.), Annals of child development, (Vol. 8, pp. 1 – 41). Jessica Kingsley Publishers.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref88" type="bt">2</bibl> <bibtext> Bakeman, R., & Adamson, L. B. (1984). Coordinating attention to people and objects in mother–infant and peer–infant interaction. Child Development, 55 (4), 1278 – 1289.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref42" type="bt">3</bibl> <bibtext> Belsky, J., Goode, M. K., & Most, R. K. (1980). Maternal stimulation and infant exploratory competence: cross‐sectional, correlational, and experimental analyses. Child Development, 51 (4), 1168 – 1178.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref82" type="bt">4</bibl> <bibtext> Berger, S. E., Harbourne, R. T., Arman, F., & Sonsini, J. (2019). Balancing act(ion): Attentional and postural control strategies predict extent of infants' perseveration in a sitting and reaching task. Cognitive Development, 50, 13 – 21.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref51" type="bt">5</bibl> <bibtext> Bigelow, A. E., MacLean, K., & Proctor, J. (2004). The role of joint attention in the development of infants' play with objects. Developmental Science, 7 (5), 518 – 526.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref35" type="bt">6</bibl> <bibtext> Brooks, R., & Meltzoff, A. N. (2005). The development of gaze following and its relation to language. Developmental Science, 8 (6), 535 – 543.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref52" type="bt">7</bibl> <bibtext> Carpenter, M., Nagell, K., & Tomasello, M. (1998). Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monographs of the Society for Research in Child Development, 63 (4), i–vi, 1 – 143.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref28" type="bt">8</bibl> <bibtext> Cohn, J. F., & Tronick, E. Z. (1987). Mother–infant face‐to‐face interaction: The sequence of dyadic states at 3, 6, and 9 months. Developmental Psychology, 23 (1), 68 – 77.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref188" type="bt">9</bibl> <bibtext> de Barbaro, K., & Fausey, C. M. (2022). Ten lessons about infants' everyday experiences. Current Directions in Psychological Science, 31 (1), 28 – 33.</bibtext> </blist> <blist> <bibtext> de Villiers Rader, N., & Zukow‐Goldring, P. (2010). How the hands control attention during early word learning. Gesture, 10 (2–3), 202 – 221.</bibtext> </blist> <blist> <bibtext> Deák, G. O., Krasno, A. M., Triesch, J., Lewis, J., & Sepeta, L. (2014). Watch the hands: Infants can learn to follow gaze by seeing adults manipulate objects. Developmental Science, 17 (2), 270 – 281.</bibtext> </blist> <blist> <bibtext> Diamant, R. B., & Whiteside, A. (2010). Positioning for play: Interactive activities to enhance movement and sensory exploration. Pro‐ed.</bibtext> </blist> <blist> <bibtext> Duncan, K., Goodworth, A., Da Costa, C. S. N., Wininger, M., & Saavedra, S. (2018). Parent handling of typical infants varies segmentally across development of postural control. Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale, 236 (3), 645 – 654.</bibtext> </blist> <blist> <bibtext> Fausey, C. M., Jayaraman, S., & Smith, L. B. (2016). From faces to hands: Changing visual input in the first two years. Cognition, 152, 101 – 107.</bibtext> </blist> <blist> <bibtext> Feinman, S. (1982). Social referencing in infancy. Merrill‐Palmer Quarterly, 28 (4), 445 – 470.</bibtext> </blist> <blist> <bibtext> Festante, F., Antonelli, C., Chorna, O., Corsi, G., & Guzzetta, A. (2019). Parent‐infant interaction during the first year of life in infants at high risk for cerebral palsy: A systematic review of the literature. Neural Plasticity, 2019, 5759694.</bibtext> </blist> <blist> <bibtext> Franchak, J. M. (2019). Changing opportunities for learning in everyday life: Infant body position over the first year. Infancy: The Official Journal of the International Society on Infant Studies, 24 (2), 187 – 209.</bibtext> </blist> <blist> <bibtext> Franchak, J. M., Kretch, K. S., & Adolph, K. E. (2018). See and be seen: Infant–caregiver social looking during locomotor free play. Developmental Science, 21 (4), e12626.</bibtext> </blist> <blist> <bibtext> Franchak, J. M., Kretch, K. S., Soska, K. C., & Adolph, K. E. (2011). Head‐mounted eye tracking: A new method to describe infant looking. Child Development, 82 (6), 1738 – 1750.</bibtext> </blist> <blist> <bibtext> Frank, M., Simmons, K., Yurovsky, D., & Pusiol, G. (2013). Developmental and postural changes in children's visual access to faces. Proceedings of the Annual Meeting of the Cognitive Science Society, 35.</bibtext> </blist> <blist> <bibtext> Gattis, M., Winstanley, A., Sperotto, R., Putnick, D. L., & Bornstein, M. H. (2020). Foundations of attention sharing: Orienting and responding to attention in term and preterm 5‐month‐old infants. Infant Behavior & Development, 61, 101466.</bibtext> </blist> <blist> <bibtext> Harbourne, R. T., Dusing, S. C., Lobo, M. A., McCoy, S. W., Koziol, N. A., Hsu, L.‐Y., Willet, S., Marcinowski, E. C., Babik, I. C., ... Sheridan, S. M. (2021). START‐play physical therapy intervention impacts motor and cognitive outcomes in infants with neuromotor disorders: A multisite randomized clinical trial. Physical Therapy, 101 (2). https://doi.org/10.1093/ptj/pzaa232</bibtext> </blist> <blist> <bibtext> Harbourne, R. T., Dusing, S. C., Lobo, M. A., Westcott‐McCoy, S., Bovaird, J., Sheridan, S., ... Babik, I. (2018). Sitting together and reaching to play (START‐play): Protocol for a multisite randomized controlled efficacy trial on intervention for infants with neuromotor disorders. Physical Therapy, 98 (6), 494 – 502.</bibtext> </blist> <blist> <bibtext> Harbourne, R. T., Ryalls, B., & Stergiou, N. (2014). Sitting and looking: A comparison of stability and visual exploration in infants with typical development and infants with motor delay. Physical & Occupational Therapy in Pediatrics, 34 (2), 197 – 212.</bibtext> </blist> <blist> <bibtext> Hopkins, B., & Rönnqvist, L. (2002). Facilitating postural control: Effects on the reaching behavior of 6‐month‐old infants. Developmental Psychobiology, 40 (2), 168 – 182.</bibtext> </blist> <blist> <bibtext> Hornik, R., & Gunnar, M. R. (1988). A descriptive analysis of infant social referencing. Child Development, 59 (3), 626 – 634.</bibtext> </blist> <blist> <bibtext> Imafuku, M., Kawai, M., Niwa, F., Shinya, Y., Inagawa, M., & Myowa‐Yamakoshi, M. (2017). Preference for dynamic human images and gaze‐following abilities in preterm infants at 6 and 12 months of age: An eye‐tracking study. Infancy: The Official Journal of the International Society on Infant Studies, 22 (2), 223 – 239.</bibtext> </blist> <blist> <bibtext> Iverson, J. M. (2021). Developmental variability and developmental cascades: Lessons from motor and language development in infancy. Current Directions in Psychological Science, 0963721421993822.</bibtext> </blist> <blist> <bibtext> Jensen‐Willett, S., Pleasant, M., Jackson, B., Needelman, H., Roberts, H., & McMorris, C. (2019). Sitting matters! Differences between sitters and nonsitters at 6 months' adjusted age in infants at‐risk and born preterm. Pediatric Physical Therapy: The Official Publication of the Section on Pediatrics of the American Physical Therapy Association, 31 (3), 257 – 262.</bibtext> </blist> <blist> <bibtext> Johnson, K. M., & Woods, R. J. (2016). Give me a hand: Adult involvement during object exploration affects object individuation in infancy. Infant and Child Development, 25 (5), 406 – 425.</bibtext> </blist> <blist> <bibtext> Karasik, L. B., Tamis‐LeMonda, C. S., & Adolph, K. E. (2011). Transition from crawling to walking and infants' actions with objects and people. Child Development, 82 (4), 1199 – 1209.</bibtext> </blist> <blist> <bibtext> Karasik, L. B., Tamis‐LeMonda, C. S., Adolph, K. E., & Bornstein, M. H. (2015). Places and postures: A cross‐cultural comparison of sitting in 5‐month‐olds. Journal of Cross‐Cultural Psychology, 46 (8), 1023 – 1038.</bibtext> </blist> <blist> <bibtext> Kaye, K., & Fogel, A. (1980). The temporal structure of face‐to‐face communication between mothers and infants. Developmental Psychology, 16 (5), 454 – 464.</bibtext> </blist> <blist> <bibtext> Klinnert, M. D., Campos, J. J., Sorce, J. F., Emde, R. N., & Svejda, M. (1983). Emotions as behavior regulators: Social referencing in infancy. In Emotions in early development (pp. 57 – 86). Elsevier.</bibtext> </blist> <blist> <bibtext> Kokkoni, E., & Galloway, J. C. (2019). User‐centred assistive technology assessment of a portable open‐area body weight support system for in‐home use. Disability and Rehabilitation. Assistive Technology, 1 – 8.</bibtext> </blist> <blist> <bibtext> Kokkoni, E., Stoner, T., & Galloway, J. C. (2020). In‐home mobility training with a portable body weight support system of an infant with down syndrome. Pediatric Physical Therapy: The Official Publication of the Section on Pediatrics of the American Physical Therapy Association, 32 (4), E76 – E82.</bibtext> </blist> <blist> <bibtext> Kretch, K. S., Franchak, J. M., & Adolph, K. E. (2014). Crawling and walking infants see the world differently. Child Development, 85 (4), 1503 – 1518.</bibtext> </blist> <blist> <bibtext> Kretch, K. S., Koziol, N. A., Marcinowski, E. C., Kane, A. E., Inamdar, K., Brown, E. D., ... Dusing, S. C. (2022). Infant posture and caregiver‐provided cognitive opportunities in typically developing infants and infants with motor delay. Developmental Psychobiology, 64 (1). https://doi.org/10.1002/dev.22233</bibtext> </blist> <blist> <bibtext> Lavelli, M., & Fogel, A. (2013). Interdyad differences in early mother–infant face‐to‐face communication: Real‐time dynamics and developmental pathways. Developmental Psychology, 49 (12), 2257 – 2271.</bibtext> </blist> <blist> <bibtext> Lawson, K. R., Parrinello, R., & Ruff, H. A. (1992). Maternal behavior and infant attention. Infant Behavior & Development, 15 (2), 209 – 229.</bibtext> </blist> <blist> <bibtext> LeBarton, E. S., & Iverson, J. M. (2016). Associations between gross motor and communicative development in at‐risk infants. Infant Behavior & Development, 44, 59 – 67.</bibtext> </blist> <blist> <bibtext> Libertus, K., & Violi, D. A. (2016). Sit to talk: Relation between motor skills and language development in infancy. Frontiers in Psychology, 7, 475.</bibtext> </blist> <blist> <bibtext> Liszkowski, U., & Tomasello, M. (2011). Individual differences in social, cognitive, and morphological aspects of infant pointing. Cognitive Development, 26 (1), 16 – 29.</bibtext> </blist> <blist> <bibtext> Lobo, M. A., Harbourne, R. T., Dusing, S. C., & McCoy, S. W. (2013). Grounding early intervention: physical therapy cannot just be about motor skills anymore. Physical Therapy, 93 (1), 94 – 103.</bibtext> </blist> <blist> <bibtext> Long, B. L., Sanchez, A., Kraus, A. M., Agrawal, K., & Frank, M. C. (2021). Automated detections reveal the social information in the changing infant view. Child Development, https://doi.org/10.1111/cdev.13648</bibtext> </blist> <blist> <bibtext> Marcinowski, E. C., Tripathi, T., Hsu, L.‐Y., Westcott McCoy, S., & Dusing, S. C. (2019). Sitting skill and the emergence of arms‐free sitting affects the frequency of object looking and exploration. Developmental Psychobiology, 61 (7), 1035 – 1047.</bibtext> </blist> <blist> <bibtext> McQuillan, M. E., Smith, L. B., Yu, C., & Bates, J. E. (2020). Parents influence the visual learning environment through children's manual actions. Child Development, 91 (3), 1.</bibtext> </blist> <blist> <bibtext> Mendive, S., Bornstein, M. H., & Sebastián, C. (2013). The role of maternal attention‐directing strategies in 9‐month‐old infants attaining joint engagement. Infant Behavior & Development, 36 (1), 115 – 123.</bibtext> </blist> <blist> <bibtext> Moore, C. (2008). The development of gaze following. Child Development Perspectives, 2 (2), 66 – 70.</bibtext> </blist> <blist> <bibtext> Moore, C., Angelopoulos, M., & Bennett, P. (1999). Word learning in the context of referential and salience cues. Developmental Psychology, 35 (1), 60 – 68.</bibtext> </blist> <blist> <bibtext> Moore, C., Dunham, P. J., & Dunham, P. (2014). Joint attention: Its origins and role in development. Psychology Press.</bibtext> </blist> <blist> <bibtext> Oudgenoeg‐Paz, O., Leseman, P. P. M., & Volman, M. J. M. (2015). Exploration as a mediator of the relation between the attainment of motor milestones and the development of spatial cognition and spatial language. Developmental Psychology, 51 (9), 1241 – 1253.</bibtext> </blist> <blist> <bibtext> Oudgenoeg‐Paz, O., Volman, M. J. M., & Leseman, P. P. M. (2012). Attainment of sitting and walking predicts development of productive vocabulary between ages 16 and 28 months. Infant Behavior & Development, 35 (4), 733 – 736.</bibtext> </blist> <blist> <bibtext> Out, L., Van Soest, A. J., Savelsbergh, G. J., & Hopkins, B. (1998). The effect of posture on early reaching movements. Journal of Motor Behavior, 30 (3), 260 – 272.</bibtext> </blist> <blist> <bibtext> Prosser, L. A., Ohlrich, L. B., Curatalo, L. A., Alter, K. E., & Damiano, D. L. (2012). Feasibility and preliminary effectiveness of a novel mobility training intervention in infants and toddlers with cerebral palsy. Developmental Neurorehabilitation, 15 (4), 259 – 266.</bibtext> </blist> <blist> <bibtext> Rachwani, J., Santamaria, V., Saavedra, S. L., Wood, S., Porter, F., & Woollacott, M. H. (2013). Segmental trunk control acquisition and reaching in typically developing infants. Experimental Brain Research. Experimentelle Hirnforschung. Experimentation Cerebrale, 228 (1), 131 – 139.</bibtext> </blist> <blist> <bibtext> Rigby, P. J., Ryan, S. E., & Campbell, K. A. (2009). Effect of adaptive seating devices on the activity performance of children with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 90 (8), 1389 – 1395.</bibtext> </blist> <blist> <bibtext> Rochat, P. (1992). Self‐sitting and reaching in 5‐ to 8‐month‐old infants: The impact of posture and its development on early eye‐hand coordination. Journal of Motor Behavior, 24 (2), 210 – 220.</bibtext> </blist> <blist> <bibtext> Rochat, P., & Goubet, N. (1995). Development of sitting and reaching in 5‐ to 6‐month‐old infants. Infant Behavior & Development, 18 (1), 53 – 68.</bibtext> </blist> <blist> <bibtext> Rosenbaum, P. L., Walter, S. D., Hanna, S. E., Palisano, R. J., Russell, D. J., Raina, P., ... Galuppi, B. E. (2002). Prognosis for gross motor function in cerebral palsy: Creation of motor development curves. JAMA: The Journal of the American Medical Association, 288 (11), 1357 – 1363.</bibtext> </blist> <blist> <bibtext> Ross‐Sheehy, S., Perone, S., Vecera, S. P., & Oakes, L. M. (2016). The relationship between sitting and the use of symmetry as a cue to figure‐ground assignment in 6.5‐month‐old infants. Frontiers in Psychology, 7, 759.</bibtext> </blist> <blist> <bibtext> Russell, D. J., Rosenbaum, P. L., Avery, L. M., & Lane, M. (2002). Gross motor function measure (GMFM‐66 & GMFM‐88) user's manual. Mac Keith Press.</bibtext> </blist> <blist> <bibtext> Ryan, S. E. (2012). An overview of systematic reviews of adaptive seating interventions for children with cerebral palsy: Where do we go from here? Disability and Rehabilitation. Assistive Technology, 7 (2), 104 – 111.</bibtext> </blist> <blist> <bibtext> Ryan, S. E., Campbell, K. A., Rigby, P. J., Fishbein‐Germon, B., Hubley, D., & Chan, B. (2009). The impact of adaptive seating devices on the lives of young children with cerebral palsy and their families. Archives of Physical Medicine and Rehabilitation, 90 (1), 27 – 33.</bibtext> </blist> <blist> <bibtext> Sanchez, A., Long, B., Kraus, A. M., & Frank, M. C. (2018). Postural developments modulate children's visual access to social information. doi: 10.31234/osf.io/th92b</bibtext> </blist> <blist> <bibtext> Santamaria, V., Rachwani, J., Saavedra, S., & Woollacott, M. (2016). The impact of segmental trunk support on posture and reaching in children with cerebral palsy. Pediatric Physical Therapy: The Official Publication of the Section on Pediatrics of the American Physical Therapy Association, 28 (3), 285 – 293.</bibtext> </blist> <blist> <bibtext> Savelsbergh, G. J., & van der Kamp, J. (1994). The effect of body orientation to gravity on early infant reaching. Journal of Experimental Child Psychology, 58 (3), 510 – 528.</bibtext> </blist> <blist> <bibtext> Schneider, J. L., Roemer, E. J., Northrup, J. B., & Iverson, J. M. (2022). Dynamics of the dyad: How mothers and infants co‐construct interaction spaces during object play. Developmental Science, e13281.</bibtext> </blist> <blist> <bibtext> Smith, L. B., Yu, C., & Pereira, A. F. (2011). Not your mother's view: The dynamics of toddler visual experience. Developmental Science, 14 (1), 9 – 17.</bibtext> </blist> <blist> <bibtext> Smithson, M., & Verkuilen, J. (2006). A better lemon squeezer? Maximum‐likelihood regression with beta‐distributed dependent variables. Psychological Methods, 11 (1), 54 – 71.</bibtext> </blist> <blist> <bibtext> Soska, K. C., & Adolph, K. E. (2014). Postural position constrains multimodal object exploration in infants. Infancy: The Official Journal of the International Society on Infant Studies, 19 (2), 138 – 161.</bibtext> </blist> <blist> <bibtext> Soska, K. C., Adolph, K. E., & Johnson, S. P. (2010). Systems in development: Motor skill acquisition facilitates three‐dimensional object completion. Developmental Psychology, 46 (1), 129 – 138.</bibtext> </blist> <blist> <bibtext> Suanda, S. H., Barnhart, M., Smith, L. B., & Yu, C. (2019). The signal in the noise: The visual ecology of parents' object naming. Infancy: The Official Journal of the International Society on Infant Studies, 24 (3), 455 – 476.</bibtext> </blist> <blist> <bibtext> Suarez‐Rivera, C., Schatz, J. L., Herzberg, O., & Tamis‐LeMonda, C. S. (2022). Joint engagement in the home environment is frequent, multimodal, timely, and structured. Infancy: The Official Journal of the International Society on Infant Studies, https://doi.org/10.1111/infa.12446</bibtext> </blist> <blist> <bibtext> Tamis‐LeMonda, C. S., Kuchirko, Y., & Tafuro, L. (2013). From action to interaction: Infant object exploration and mothers' contingent responsiveness. IEEE Transactions on Autonomous Mental Development, 5 (3), 202 – 209.</bibtext> </blist> <blist> <bibtext> Telford, E. J., Fletcher‐Watson, S., Gillespie‐Smith, K., Pataky, R., Sparrow, S., Murray, I. C., ... Boardman, J. P. (2016). Preterm birth is associated with atypical social orienting in infancy detected using eye tracking. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 57 (7), 861 – 868.</bibtext> </blist> <blist> <bibtext> Tomasello, M. (2000). The social‐pragmatic theory of word learning. Pragmatics, 10 (4), 401 – 413.</bibtext> </blist> <blist> <bibtext> Tomasello, M., & Farrar, M. J. (1986). Joint attention and early language. Child Development, 57 (6), 1454 – 1463.</bibtext> </blist> <blist> <bibtext> Vaughan, A., Mundy, P., Block, J., Burnette, C., Delgado, C., Gomez, Y., ... Pomares, Y. (2003). Child, caregiver, and temperament contributions to infant joint attention. Infancy: The Official Journal of the International Society on Infant Studies, 4 (4), 603 – 616.</bibtext> </blist> <blist> <bibtext> Walden, T. A., & Ogan, T. A. (1988). The development of social referencing. Child Development, 59 (5), 1230 – 1240.</bibtext> </blist> <blist> <bibtext> Washington, K., Deitz, J. C., White, O. R., & Schwartz, I. S. (2002). The effects of a contoured foam seat on postural alignment and upper‐extremity function in infants with neuromotor impairments. Physical Therapy, 82 (11), 1064 – 1076.</bibtext> </blist> <blist> <bibtext> West, K. L., & Iverson, J. M. (2017). Language learning is hands‐on: Exploring links between infants' object manipulation and verbal input. Cognitive Development, 43, 190 – 200.</bibtext> </blist> <blist> <bibtext> Winders, P., Wolter‐Warmerdam, K., & Hickey, F. (2019). A schedule of gross motor development for children with Down syndrome. Journal of Intellectual Disability Research: JIDR, 63 (4), 346 – 356.</bibtext> </blist> <blist> <bibtext> Woods, R. J., & Wilcox, T. (2013). Posture support improves object individuation in infants. Developmental Psychology, 49 (8), 1413 – 1424.</bibtext> </blist> <blist> <bibtext> Yale, M. E., Messinger, D. S., Cobo‐Lewis, A. B., & Delgado, C. F. (2003). The temporal coordination of early infant communication. Developmental Psychology, 39 (5), 815 – 824.</bibtext> </blist> <blist> <bibtext> Yoshida, H., & Smith, L. B. (2008). What's in view for toddlers? Using a head camera to study visual experience. Infancy: The Official Journal of the International Society on Infant Studies, 13 (3), 229 – 248.</bibtext> </blist> <blist> <bibtext> Yu, C., & Smith, L. B. (2012). Embodied attention and word learning by toddlers. Cognition, 125 (2), 244 – 262.</bibtext> </blist> <blist> <bibtext> Yu, C., & Smith, L. B. (2013). Joint attention without gaze following: human infants and their parents coordinate visual attention to objects through eye‐hand coordination. PloS One, 8 (11), e79659.</bibtext> </blist> <blist> <bibtext> Yu, C., & Smith, L. B. (2015). linking joint attention with hand‐eye coordination – A sensorimotor approach to understanding child‐parent social interaction. CogSci ... Annual Conference of the Cognitive Science Society. Cognitive Science Society (U.S.) Conference, 2015, 2763 – 2768.</bibtext> </blist> <blist> <bibtext> Yu, C., & Smith, L. B. (2017a). Hand‐eye coordination predicts joint attention. Child Development, 88 (6), 2060 – 2078.</bibtext> </blist> <blist> <bibtext> Yu, C., & Smith, L. B. (2017b). Multiple sensory‐motor pathways lead to coordinated visual attention. Cognitive Science, 41 (S1), 5 – 31.</bibtext> </blist> </ref> <aug> <p>By Kari S. Kretch; Emily C. Marcinowski; Lin‐Ya Hsu; Natalie A. Koziol; Regina T. Harbourne; Michele A. Lobo and Stacey C. Dusing</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib61" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib72" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib29" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib41" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib42" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib53" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib52" firstref="ref7"></nolink> <nolink nlid="nl8" bibid="bib24" firstref="ref8"></nolink> <nolink nlid="nl9" bibid="bib54" firstref="ref10"></nolink> <nolink nlid="nl10" bibid="bib58" firstref="ref11"></nolink> <nolink nlid="nl11" bibid="bib67" firstref="ref12"></nolink> <nolink nlid="nl12" bibid="bib71" firstref="ref13"></nolink> <nolink nlid="nl13" bibid="bib20" firstref="ref14"></nolink> <nolink nlid="nl14" bibid="bib37" firstref="ref15"></nolink> <nolink nlid="nl15" bibid="bib45" firstref="ref16"></nolink> <nolink nlid="nl16" bibid="bib65" firstref="ref17"></nolink> <nolink nlid="nl17" bibid="bib18" firstref="ref18"></nolink> <nolink nlid="nl18" bibid="bib38" firstref="ref19"></nolink> <nolink nlid="nl19" bibid="bib17" firstref="ref20"></nolink> <nolink nlid="nl20" bibid="bib32" firstref="ref22"></nolink> <nolink nlid="nl21" bibid="bib33" firstref="ref29"></nolink> <nolink nlid="nl22" bibid="bib39" firstref="ref30"></nolink> <nolink nlid="nl23" bibid="bib85" firstref="ref31"></nolink> <nolink nlid="nl24" bibid="bib15" firstref="ref32"></nolink> <nolink nlid="nl25" bibid="bib26" firstref="ref33"></nolink> <nolink nlid="nl26" bibid="bib80" firstref="ref34"></nolink> <nolink nlid="nl27" bibid="bib49" firstref="ref36"></nolink> <nolink nlid="nl28" bibid="bib50" firstref="ref37"></nolink> <nolink nlid="nl29" bibid="bib77" firstref="ref38"></nolink> <nolink nlid="nl30" bibid="bib14" firstref="ref39"></nolink> <nolink nlid="nl31" bibid="bib19" firstref="ref40"></nolink> <nolink nlid="nl32" bibid="bib86" firstref="ref41"></nolink> <nolink nlid="nl33" bibid="bib10" firstref="ref43"></nolink> <nolink nlid="nl34" bibid="bib30" firstref="ref44"></nolink> <nolink nlid="nl35" bibid="bib43" firstref="ref45"></nolink> <nolink nlid="nl36" bibid="bib75" firstref="ref46"></nolink> <nolink nlid="nl37" bibid="bib82" firstref="ref47"></nolink> <nolink nlid="nl38" bibid="bib69" firstref="ref48"></nolink> <nolink nlid="nl39" bibid="bib73" firstref="ref49"></nolink> <nolink nlid="nl40" bibid="bib87" firstref="ref50"></nolink> <nolink nlid="nl41" bibid="bib51" firstref="ref53"></nolink> <nolink nlid="nl42" bibid="bib78" firstref="ref54"></nolink> <nolink nlid="nl43" bibid="bib88" firstref="ref55"></nolink> <nolink nlid="nl44" bibid="bib90" firstref="ref56"></nolink> <nolink nlid="nl45" bibid="bib91" firstref="ref57"></nolink> <nolink nlid="nl46" bibid="bib11" firstref="ref58"></nolink> <nolink nlid="nl47" bibid="bib68" firstref="ref66"></nolink> <nolink nlid="nl48" bibid="bib74" firstref="ref67"></nolink> <nolink nlid="nl49" bibid="bib28" firstref="ref68"></nolink> <nolink nlid="nl50" bibid="bib46" firstref="ref77"></nolink> <nolink nlid="nl51" bibid="bib12" firstref="ref80"></nolink> <nolink nlid="nl52" bibid="bib13" firstref="ref81"></nolink> <nolink nlid="nl53" bibid="bib44" firstref="ref84"></nolink> <nolink nlid="nl54" bibid="bib60" firstref="ref85"></nolink> <nolink nlid="nl55" bibid="bib83" firstref="ref86"></nolink> <nolink nlid="nl56" bibid="bib16" firstref="ref91"></nolink> <nolink nlid="nl57" bibid="bib27" firstref="ref92"></nolink> <nolink nlid="nl58" bibid="bib76" firstref="ref93"></nolink> <nolink nlid="nl59" bibid="bib21" firstref="ref94"></nolink> <nolink nlid="nl60" bibid="bib22" firstref="ref100"></nolink> <nolink nlid="nl61" bibid="bib23" firstref="ref101"></nolink> <nolink nlid="nl62" bibid="bib62" firstref="ref102"></nolink> <nolink nlid="nl63" bibid="bib70" firstref="ref111"></nolink> <nolink nlid="nl64" bibid="bib108" firstref="ref113"></nolink> <nolink nlid="nl65" bibid="bib34" firstref="ref127"></nolink> <nolink nlid="nl66" bibid="bib31" firstref="ref147"></nolink> <nolink nlid="nl67" bibid="bib47" firstref="ref148"></nolink> <nolink nlid="nl68" bibid="bib40" firstref="ref157"></nolink> <nolink nlid="nl69" bibid="bib48" firstref="ref158"></nolink> <nolink nlid="nl70" bibid="bib79" firstref="ref159"></nolink> <nolink nlid="nl71" bibid="bib89" firstref="ref163"></nolink> <nolink nlid="nl72" bibid="bib56" firstref="ref166"></nolink> <nolink nlid="nl73" bibid="bib84" firstref="ref167"></nolink> <nolink nlid="nl74" bibid="bib63" firstref="ref173"></nolink> <nolink nlid="nl75" bibid="bib25" firstref="ref174"></nolink> <nolink nlid="nl76" bibid="bib59" firstref="ref176"></nolink> <nolink nlid="nl77" bibid="bib66" firstref="ref177"></nolink> <nolink nlid="nl78" bibid="bib81" firstref="ref178"></nolink> <nolink nlid="nl79" bibid="bib57" firstref="ref180"></nolink> <nolink nlid="nl80" bibid="bib64" firstref="ref181"></nolink> <nolink nlid="nl81" bibid="bib35" firstref="ref184"></nolink> <nolink nlid="nl82" bibid="bib36" firstref="ref185"></nolink> <nolink nlid="nl83" bibid="bib55" firstref="ref186"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Opportunities for Learning and Social Interaction in Infant Sitting: Effects of Sitting Support, Sitting Skill, and Gross Motor Delay
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Kretch%2C+Kari+S%2E%22">Kretch, Kari S.</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8678-1749">0000-0001-8678-1749</externalLink>)<br /><searchLink fieldCode="AR" term="%22Marcinowski%2C+Emily+C%2E%22">Marcinowski, Emily C.</searchLink><br /><searchLink fieldCode="AR" term="%22Hsu%2C+Lin-Ya%22">Hsu, Lin-Ya</searchLink><br /><searchLink fieldCode="AR" term="%22Koziol%2C+Natalie+A%2E%22">Koziol, Natalie A.</searchLink><br /><searchLink fieldCode="AR" term="%22Harbourne%2C+Regina+T%2E%22">Harbourne, Regina T.</searchLink><br /><searchLink fieldCode="AR" term="%22Lobo%2C+Michele+A%2E%22">Lobo, Michele A.</searchLink><br /><searchLink fieldCode="AR" term="%22Dusing%2C+Stacey+C%2E%22">Dusing, Stacey C.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Developmental+Science%22"><i>Developmental Science</i></searchLink>. May 2023 26(3).
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 16
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: Institute of Education Sciences (ED)<br />National Center for Medical Rehabilitation Research (NCMRR) (NICHD/NIH)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: R324A150103<br />K12HD055929
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Psychomotor+Skills%22">Psychomotor Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Motor+Development%22">Motor Development</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Development%22">Cognitive Development</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Acquisition%22">Language Acquisition</searchLink><br /><searchLink fieldCode="DE" term="%22Infants%22">Infants</searchLink><br /><searchLink fieldCode="DE" term="%22Caregiver+Role%22">Caregiver Role</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Relationship%22">Interpersonal Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Opportunities%22">Educational Opportunities</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/desc.13318
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1363-755X<br />1467-7687
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The development of independent sitting changes everyday opportunities for learning and has cascading effects on cognitive and language development. Prior to independent sitting, infants experience the sitting position with physical support from caregivers. Why does supported sitting not provide the same input for learning that is experienced in independent sitting? This question is especially relevant for infants with gross motor delay, who require support in sitting for many months after typically developing infants sit independently. We observed infants with typical development (n = 34, ages 4-7 months) and infants with gross motor delay (n = 128, ages 7-16 months) in early stages of sitting development, and their caregivers, in a dyadic play observation. We predicted that infants who required caregiver support for sitting would spend more time facing away from the caregiver and less time contacting objects than infants who could sit independently. We also predicted that caregivers of supported sitters would spend less time contacting objects because their hands would be full supporting their infants. Our first two hypotheses were confirmed; however, caregivers spent surprisingly little time using both hands to provide support, and caregivers of supported sitters spent more time contacting objects than caregivers of independent sitters. Similar patterns were seen in the group of typically developing infants and the infants with motor delay. Our findings suggest that independent sitting and supported sitting provide qualitatively distinct experiences with different implications for social interaction and learning opportunities.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: CodeSource
  Label: IES Funded
  Group: SrcInfo
  Data: Yes
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1372299
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1372299
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    Identifiers:
      – Type: doi
        Value: 10.1111/desc.13318
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
    Subjects:
      – SubjectFull: Psychomotor Skills
        Type: general
      – SubjectFull: Motor Development
        Type: general
      – SubjectFull: Cognitive Development
        Type: general
      – SubjectFull: Language Acquisition
        Type: general
      – SubjectFull: Infants
        Type: general
      – SubjectFull: Caregiver Role
        Type: general
      – SubjectFull: Interpersonal Relationship
        Type: general
      – SubjectFull: Educational Opportunities
        Type: general
    Titles:
      – TitleFull: Opportunities for Learning and Social Interaction in Infant Sitting: Effects of Sitting Support, Sitting Skill, and Gross Motor Delay
        Type: main
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            NameFull: Kretch, Kari S.
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            NameFull: Marcinowski, Emily C.
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            NameFull: Hsu, Lin-Ya
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            NameFull: Harbourne, Regina T.
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            NameFull: Lobo, Michele A.
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            NameFull: Dusing, Stacey C.
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            – D: 01
              M: 05
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 1363-755X
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              Value: 1467-7687
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              Value: 26
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              Value: 3
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            – TitleFull: Developmental Science
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