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How else can we study sex differences in early

infancy?

ARTICLE in DEVELOPMENTAL PSYCHOBIOLOGY AUGUST 2015

Impact Factor: 3.31 DOI: 10.1002/dev.21345

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Anne Fausto-Sterling
Brown University
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 Developmental Psychobiology

Anne Fausto-Sterling
Department of Molecular Biology, Cell
Biology and Biochemistry
Brown University
Providence, RI, 02912
E-mail: afs@brown.edu
How Else Can We Study Sex
Differences in Early Infancy?
ABSTRACT: This paper revisits group difference and individual variability in
birth weight, head size, Apgar score, and motor performance in neonatal and
8-month-old males and females using a large existing data set. The goal is
primarily theoreticalto reframe existing analyses with an eye toward designing
and executing more predictive analyses in the future. 3D graphing to visualize
both the areas of overlap and regions of disparity between boys and girls has
been used. A two-step cluster analysis of boys and girls together revealed three
clusters. One was almost equally divided between boys and girls, but a second
was highly enriched for boys and the third highly skewed toward girls. The
relationship between cluster membership and Bayley motor scores at 8 months
tested the hypothesis that initial differences that have no sex-related behavioral
content might start processes that produce later sex-related differences. Initially,
parental belief systems may be less important than infant care patterns evoked
by basic size and health characteristics, even though later parental behaviors
assume a decidedly gendered pattern. 2015 Wiley Periodicals, Inc. Dev
Psychobiol 9999: 112, 2015.

Keywords: sex-related differences; activity level; birth characteristics; 3D mesh

graphing; cluster analysis

RETHINKING SEX-RELATED DIFFERENCES IN
ACTIVITY LEVELS AND MOTOR
DEVELOPMENT DURING THE FIRST YEAR OF
INFANCY
Many reports document sex-related differences in neo-
natal behaviors and interpret these early differences as
evidence for an innate, biological contribution to group
differences. For example, Campbell and Eaton (1999)
suggest that the existence of neonatal differences in
activity levels (AL) and intra- and inter-limb coordina-
tion (Piek, Gasson, Barrett, & Case, 2002) supports the
idea of a biological origin for such differences.
Similarly, a number of studies report neonatal sex
differences in some aspect of eye contact or responsive-
ness to social interactions (Connellan, Baron-Cohen,
Manuscript Received: 23 December 2014
Manuscript Accepted: 3 August 2015
Correspondence to: Anne Fausto-Sterling
Contract grant sponsor: Ford Foundation
Contract grant sponsor: Pembroke Center for Teaching and
Research on Women
Article first published online in Wiley Online Library
(wileyonlinelibrary.com).
DOI 10.1002/dev.21345
2015 Wiley Periodicals, Inc.
Wheelwright, Batki, & Ahluwalia, 2000; Hittelman &
Dickes, 1979; Lundqvist & Sabel, 2000). These authors
also suggest that findings of differences at birth or in
the first several months of infancy provide evidence for
innate sex-related differences and, in turn, posit the
early differences as a basis for sex-related differences
in play behaviors and social skills that develop months
or even years after birth.
We find this appeal to biological origins unsatisfac-
tory. First, the documented differences are not dimor-
phic, but reflect mean differences between heavily
overlapping populations. The appeal to biology does
little to explain the overlap or sameness between
populations. Nor does it explain intra-group variability.
Finally, even if mean differences originate from prena-
tal biological events, the appeal offers little insight into
the processes by which something that happens during
gestation leads months or even years later to a sex-
related behavioral difference. In other words, there is
no developmental story of the sort pioneered by
Gottlieb, Wahlsten, and Lickliter (1998), Lerner, Boyd,
Kiely, Napolitano, and Schmid (2010), and Wahlsten
(2010). Animal behaviorists have studied the effects of
experience on behavioral development for many deca-
2 Fausto-Sterling
des, developing an understanding of complex progres-
sionthe idea that each moment in time proceeds from
what has gone before and sets the stage for what
follows (Gottlieb, 1997; Kuo, 1976; Rosenblatt &
Lehrman, 1963; Schnierla, 1957). Students of mamma-
lian behavior typically divide the times seen to shape
adult behavior into the prenatal, postnatal, and adoles-
cent periods, but the impact of events in the previous
period on the phase that follows is in many cases
poorly understood. This paper focuses on the transition
from birth to early infancy in humans, and more
specifically on the importance of infant adult interactive
dyads for behavioral development. In an incisive review
of the current state of knowledge of parentinfant
interactions in the neonatal period, Feldman (2015)
examines what we know about the biology of parent
infant interactions in humans and contrasts known
mechanisms with knowledge gleaned from the animal
literature.
When we think about early-appearing group differ-
ences, what is at stake is not so much whether any
particular observation is right or wrong, but rather,
what it provides evidence of. Consider, for example, a
recent study by Moon, Lagercrantz, and Kuhl (2013)
on neonatal language. In the study, Swedish and US
neonates controlled what vowel sounds they listened to
by sucking on a pacifier. The researchers interpreted
the sucking number to indicate what sounds most
attracted the newborn. Swedish newborns sucked more
in response to Swedish vowel sounds while American
neonates responded more to English. Presumably, the
early difference in language skills does not, in this
instance, signify an innate difference between Ameri-
can and Swedish children, but rather that prenatal
exposure to spoken sound affects the perception of
native phonemes even as early as 48 hr after birth.
Relatedly, Kuhl and others brilliantly argue for lan-
guage acquisition as a dynamic, progressive (devel-
opmental) process in which context and body (auditory
and vocal developments) are intimately intertwined
(Dehaene-Lambertz, Hertz-Pannier, & Dubois, 2006;
Kuhl, Tsao, Liu, Zhang, & De Boer, 2001; Kuhl et al.,
2006; Kuhl & Rivera-Gaxiola, 2008; Kuhl, 2010).
The work in this paper explores an alternate
approach to understanding the importance of neonatal
sex-related differences in humans. The aim is to shift
how researchers might think about early differences
and to consider how such a shift could lead to new,
empirically testable research studies. Consider again
Campbell and Eatons work on activity level differ-
ences. Fausto-Sterling, Garc
a Coll, and Lamarre note
(2012) that a more fine-tuned analysis of their data
suggests nuanced changes in AL during the first several
months after birth. A difference that is small (effect
Developmental Psychobiology
size 0.35) at birth seems to decline to zero between 4
and 6 months, only to climb again to much larger
differentials at year 1 and thereafter. To what might one
attribute such developmental changes? Historically,
activity level has been understood to be a character trait
that is, more or less fixed over time. Although some are
beginning to think about the neural basis of tempera-
ment (Henderson & Wachs, 2007), no theory about the
underlying neuromuscular basis of AL exists. Hadders-
Algra (2002) discusses central pattern generators which
are roughed out with huge individual variation in fetal
life, using an initial genetic program. However, move-
ment itself, both in utero and postnatally, structures
continued development. Recent studies on embryonic
chickens and perinatal rats provide evidence that fetal
and neonatal sensorimotor experience can change
motility and is thus most likely an important compo-
nent of sensorimotor development (Sharp, 2015). Neu-
romuscular development and movement begin early in
fetal development and are shaped by the physical
constraints of the uterine environment (Adolf & Berger,
2011; Robinson & M
endez-Gallardo, 2010). Further-
more, fetal motor activity and development respond to
changes in maternal behavior and vary with socio-
economic status and cultural location (DiPietro, Cos-
tigan, Shupe, Pressman, & Johnson, 1998; DiPietro
et al., 2004; Dipietro, 2010). Most such responses are
sex neutral but there are some small differences in
male versus female fetal responses to changes in
maternal physiology (DiPietro, Kivlighan, Costigan, &
Laudenslager, 2009). In the current example, perhaps
initial high activity levels result from small sex differ-
ences in the timing of neuromuscular development (see
for example, Buss et al. (2009) report of timing
differences in development of the fetal startle
response), with higher AL levels indicating a relative
lack of motor stability or control. Or, given data
discussed in the body of this paper, perhaps the
movement in utero of larger infants is more con-
strained, thus slowing neuromuscular development
(DiPietro, Hodgson, Costigan, Hilton, & Johnson,
1996).
Consistent with the idea that boys neuromuscular
development is at first a bit slower, the authors of a
study of Spanish neonates using a Brazelton behavioral
scale, report that girls scored higher on assessments of
alertness and state regulation, while boys were some-
what more irritable (Boatella-Costa, Costas-Moragas,
Botet-Mussons, Fornieles-Deu, & De C
aceres-Zurita,
2007) (on gender and state regulation see also (Lundqv-
ist & Sabel, 2000)). As postnatal development pro-
gresses to the period from 4 to 6 months, perhaps
neuromuscular development equalizes in boys and girls
as infants begin to explore directed motion with random
Developmental Psychobiology
movement variations that become more controlled over
subsequent months (Heineman, Bos, & Hadders-Algra,
2008; Heineman, Middelburg, & Hadders-Algra, 2010).
Could it be that divergence after 46 months indicates
increased abilities and motor interest in boys compared
to girls? And could this in turn, develop as part of a
maternal-infant motor development system (Krishna,
2013; Lin, 2011)? The observation that mothers under-
estimated their 11-month-old daughters crawling abil-
ities while overestimating their sons performance is the
sort of finding begging for deeper and earlier exploration
(Mondschein, Adolf, & Tamis-LeMonda, 2000).
Seen as a temperament trait, activity level has been
linked to a variety of negative behavioral outcomes
such as hyperactivity, externalizing behavior, and poor
adjustment to daycare (Saudino, 2012). Hines (2009)
links sex differences in activity levels to sex differences
in rough and tumble play in toddlers, but Eaton (2001)
emphasizes that activity level differences may be
context specific and that measured over the course of
an entire day and in a variety of contexts sex differ-
ences are less evident. In contrast to AL, motor skill
development is often treated as an ordered developmen-
tal sequence which boys and girls seem to accomplish
equally well and in the same time sequence (Bayley,
1965). Thelen (2005), Piek et al. (2002), and Newell,
Liu, and Mayer-Kress (2003) used dynamic systems
approaches to link AL (a supposedly fixed trait) to
motor skill development (learned, developmental
behaviors), but do not suggest how a trait with manifest
sex differences transforms into a set of skills lacking in
difference. The extensive and fascinating work of Adolf
and her coworkers demonstrating the importance of
physical (Cole, Lingeman, & Adolph, 2012) and human
contexts for the development of motor skills provides
an important context for thinking about this question.
At the same time that works such as those just
reviewed link early physiological differences to the
idea of innate sex differences, a number of studies find
that adults respond to or treat very young infants
differently depending on whether they are, or are
believed to be, boys or girls (Condry & Condry, 1976;
Karraker, Vogel, & Lake, 1995; Rubin, Provenzano, &
Luria, 1974; Reid, 1994; Sweeney & Bradbard, 1988;
Will, Self, & Datan, 1976). There is a presumption that
differences in treatment contribute to the emergence of
behavioral differences (e.g., toy preference at 1 year of
age) through socialization mechanisms that might
include social learning, and infant response to rein-
forcement via parental praise or discouragement (Mon-
dschein et al., 2000; Roopnarine, Fouts, Lamb, &
Lewis-Elligan, 2005). But social science literature
linking adult perceptions of gender to specific devel-
opmental outcomes is weak (Fausto-Sterling et al.,
How Else Can We Study Sex Differences in Early Infancy 3
2012, p. 1689; Stern & Karraker, 1989). In general, just
as the author believes that reflexive appeals to innate or
biological causes are not that helpful, she also finds
that theories of socialization are weak because they do
not usually contain a theory of embodiment.
Because the term socialization is associated with a
type of social learning theory that seems to be disem-
bodied, the author prefers to use the intertwined
concepts of physical, social, and emotional experience.
As insisted upon by Thelen (Thelen et al., 1993; Thelen
& Corbetta, 1994; Thelen, Schoener, Scheier, & Smith,
2001; Smith, 2005; van Geert & Steenbeek, 2005) the
infants experiential world leaves neuro-muscular traces
which we call embodied experience. Physical con-
straints and feedback from maternal emotional experi-
ences already shape motor development in the womb
(Adolf & Berger, 2011; DiPietro et al., 2009), and after
birth include, for example, diapers (Cole et al., 2012),
sleeping position (Feldman & Greenbaum, 1997; Salls,
Silverman, & Gatty, 2002), differential maternal han-
dling of male and female infants (Fausto-Sterling,
Crews, Sung, Garc
a-Coll, & Seifer, 2015), and different
experiential worlds encountered in the home and in
pre-school (Martin, 1998). Specific cultural practices,
including infant clothing, methods of carrying the
infant, and practices such as infant massage and limb
exercise have been shown to affect motor development
(Adolph & Robinson, 2013). Thus the concept of
experience casts a wider net than that of socialization,
invoking the mutual interplay between the physiolog-
ical, the physical environment, and individual daily
practices of child rearing. The latter, of course, are
shaped by the wider culture in which they occur.
Small infantcaregiver interactions, the moment-to-
moment activities of infant care, should be investigated
as important aspects of early infant experience. Ander-
son et al. (2000) define experience as a process that
captures transactions between the organism at multiple
levels of analysis (p.249) from the cellular, to the
behavioral to the cultural. For motor development, they
further distinguish active, self-generated activity from
passive locomotion such as being carried by a parent or
having their limbs stimulated by an adult. Thus, as the
citations in the previous paragraph demonstrate for the
field of motor development, a dynamic account of
experience that includes different cultural worlds is
well developed.
The work in this paper, using a pre-existing data set,
revisits in an exploratory and theoretical fashion, group
difference, and individual variability in basic physical
and physiological birth characteristics (birth weight,
head size, Apgar score, motor performance) in natal
and 8-month-old males and females. The hypothesis is
that small initial differences that have no behavioral
4 Fausto-Sterling
content of the sort associated with older infants and
toddlers might be at the starting point of a process that
produces later sex-related behavior differences. Ini-
tially, parental belief systems about sex-related differ-
ences may be less important than infant care patterns
evoked by these basic characteristics, although later
parental behaviors take on a decidedly gendered pattern
(Ahl, Fausto-Sterling, Garcia-Coll, & Seifer, 2013;
Sung, Fausto-Sterling, Garcia Coll, & Seifer, 2013).
METHOD
Developmental Psychobiology
used Matlabs Data Cursor feature to identify individual
data points on the 3D graphs. In some cases, we used
Adobe Photoshop to overlay graphs for visual compar-
ison. In these overlaid 3D graphs, we reduced the size
of our starting data set from more than 17,000 subjects
to 600 (300 of each sex) to enhance visual clarity. We
accomplished this reduction using Matlabs
randsample function to randomly sample the larger
data set. The means and standard deviations for the
smaller random sample are similar to those of the large
data set (data not shown).

Participants and Data Sources

RESULTS
The data used to analyze neonatal and 8 month sex
differences were culled from the Collaborative Perinatal Birth Characteristics
Project (CPP), a birth cohort study established in 1959
Birth weight, head circumference, and Apgar scores are
which involved the examination of over 50,000 children
well-known but poorly theorized neonatal sex-related
through the first 7 years of life (Gilman, Gardener, &
differences. The descriptive statistics and malefemale
Buka, 2008; Klebanoff, 2009). A subset (8,932 males,
comparisons of the larger set can be found in Table 1.
8,858 females) of these data, shared with us by Professor
At birth, boys outweigh girls by one tenth of a
Stephen Buka of Brown University, was used to
kilogram. Biparietal measurements (differences range
illustrate and compare the relationships between birth
from 1.3 to 4.4%) or measurements of head circum-
weight, neonatal head circumference, Apgar scores, and
ference (differences range from 1.9 to 3.9%) on fetuses
8 month outcomes for the motor performance subset of
as young as 18 weeks through to newborns, show that
the Brazelton Behavioral Assessment Scale.
males have slightly larger brain or head sizes than
females (Fausto-Sterling et al., 2012). The data pro-
Statistics and Graphing
vided by the Perinatal Data Collaborative, confirm
We used the 3D mesh graphing capabilities of MAT- these findings and also evidence modest sex-related
LAB (www.mathworks.com) to create graphs and differences in Apgar scores (girls slightly higher). As
scatterplots that compared three traits at a time. We can also be seen in Table 1, the head size and body

Table 1. Descriptive Statistics and Independent Sample t-Tests of Data Obtained From the Collaborative Perinatal
Project
Gender Mean Std. Deviation t Sig. (Two-Tailed)
a b
Birth weight (gms) Male 3219.45 533.977 14.160 .000
Femalec 3107.66 519.048 .000
Weight 8 months (kg) Male 8.81 1.152 35.521 .000
Female 8.22 1.065 .000
Bayley 8 monthsa Male 33.52 4.655 4.422 .000
Female 33.82 4.362 .000
Apgar 1 min Male 7.85 1.810 2.912 .004
Female 7.93 1.724 .004
Apgar 5 mina Male 9.06 1.087 3.322 .001
Female 9.11 .999 .001
Birth HC (cm) Male 33.99 1.561 24.169 .000
Female 33.43 1.518 .000
HC8MO (cm) Male 44.68 1.889 40.747 .000
Female 43.55 1.799 .000
a
Levenes test indicates unequal variance and the given t reflects that assumption.
b
N 8932.
c
N 8858.
Developmental Psychobiology
weight differences persist at 8 months. Although the
Apgar is a neonatal health measure and hence not
applicable at 8 months, small differences in Bayley
Motor scores favor girls at 8 months.
Although information about the range and variability
of each characteristic in the dataset can be gleaned
from the basic statistical information presented in the
tables, it is instructive to visualize all three character-
istics in relationship to one another for both between
and within sex comparisons, since presumably a parent
will react to a particular infant based on a combination
of traits. Figure 1A shows the 3D space occupied by
individual female infants for weight, head circumfer-
ence, and Apgar scores taken 5 min after birth while
Figure 1B offers the same information for male infants.
The big question raised in this paper is how do
combinations of infant traits affect adult care-giving
responses?
Some of our graphic analysis (graphs not shown)
suggested a correlation between weight and head size
but a comparative lack of correlation between Apgar
scores and infant size. The actual correlations and their
significance are shown in Tables 2 and 3. Although the
correlation for female Apgar scores and head circum-
How Else Can We Study Sex Differences in Early Infancy 5
ference is significant (Pearson Correlation .092), it is
dramatically smaller than the correlation between neo-
natal head size and birth weight (Pearson Correlation
.757). Both the birth and 8 month correlations are
similar for boys and girls. The strong relationship
between head circumference and body weight is greatly
diminished by 8 months. There is a moderately strong
correlation between neonatal body weight/head size
and 8 month Bayley motor scores (girls Pearson
Correlation ranges from .220 to .249; boys .210 to
.245). There is a diminished correlation between head
circumference and body weight at birth (Pearson
Correlation for girls .757; boys .761) compared to
8 month head size and body weight (Pearson Correla-
tion for girls .096; boys .385).
Constructing a 3D representation of several birth
traits helps to define each individual by the intersection
of three specific traits. This permits us in turn to think
about a combined population of males and females in
terms of coordinate similarity rather than mean popula-
tion-wide differences. To further explore, we used
SPSS to define three clusters (using a Two-Step Cluster
analysis) within the combined population of boys and
girls (Table 4) and then we examined the sex composi-

FIGURE 1 3D mesh and scatterplots of weight (in kilograms) on the X-axis, head circum-
ference (in centimeters) on the Y-axis, and Apgar Score at 5 min after birth on the Z-axis. (A)
Girls at 5 min after birth. (B) Boys at 5 min after birth. (C) Overlaid scatterplots of boys ( ) and
girls ( ). ( ) Approximate location of cluster 1. ( ) Approximate location of cluster 2
and ( ) approximate location of cluster 3.
6 Fausto-Sterling Developmental Psychobiology
Table 2. Pearson Correlations for Girls Traits at Birth and 8 Months
5 Min Head Circum. Birth Bayley Motor 8 Head Circum. 8 Weight 8
Apgar Birth Weight Months Months Months
 
5 min Apgar 1 .092 .073 .075 .008 .030
Head circumference (cm)- .092 1 .757 .220 .356 .313
birth
Birth weight (gms) .073 .757 1 .249 .241 .423
Bayley motor 8 months .075 .220 .249 1 .112 .089
Head circumference (cm)-8 .008 .356 .241 .112 1 .096
months
Weight (kg) 8 months .030 .313 .423 .089 .096 1

Correlation is significant at the .01 to .001 level (two-tailed).

tion of membership in each of the clusters (Table 5).
Cluster membership varies significantly by birth sex
(Table 6). Cluster 1, characterized by the heaviest,
largest head circumference children with Apgar scores
averaging 9.0, has about 40% more boys than girls.
Figure 1C presents the individual data for male and
female infants as superimposed scatterplots. Three
individual data points that fall within clusters 1, 2, or 3,
respectively, are also indicated. Finally, we have shown
the approximate location of each of the three clusters.
One interesting point is that cluster 2, which is over
represented for girls, shows the largest data spread, also
confirmed by the standard deviations for each cluster.
At 8 months, the mean Bayley motor score for
cluster 1 is 34.10 (SD 4.20). Cluster 2, which
contains the smallest children and mean Apgar scores
of 8.4 has about 25% more girls. At 8 months, the
mean Bayley motor score for cluster 2 is 34.25
(SD 4.20). Cluster 3, containing intermediate sized
infants with mean Apgar Scores of 9.4 is almost
equally divided between males and females and the
mean Bayley motor score at 8 months for this group is
32.48 (SD 5.01). A univariate ANOVA (SPSS) indi-
cated a significant relationship between cluster mem-
bership at birth and Bayley motor scores at 8 months
(F(2, 17790) 268, p < .001). Thus the heaviest chil-
dren at birth, a cohort enriched for boys, have slightly
lower motor scores at 8 months, while the smallest
birth cohort, which is enriched for girls, has the highest
motor scores at 8 months. The intermediate size birth
cohort remains in the motor middle and equally divided
between boys and girls.
DISCUSSION
The re-examination of the relationships between three
birth characteristicsweight, head circumference, and
Apgar scores confirmed the existence of small but
significant neonatal sex differences. With the exception
of Reinisch, Rosenblum, Rubin, and Schulsinger
(1991), studies of sex-related differences in head size
and weight have been conducted in order to provide
norms for assessing infant health and development at
birth, rather than to provide a basis for understanding
the development of sex-related behaviors. Crawford,
Doyle, and Meadows (1987) and Davis et al. (1993) for
example, concentrate on fetal and genetic origins of

Table 3. Pearson Correlations for Boys Traits at Birth and 8 Months

5 Min Head Circum. Birth Bayley Motor 8 Head Circum. 8 Weight 8
Apgar Birth Weight Months Months months
 
5 min Apgar 1 .036 .058 .076 .008 .003
Head circumference (cm)- .036 1 .761 .210 .325 .299
birth
Birth weight (gms) .058 .761 1 .248 .254 .388
Bayley motor 8 months .076 .210 .248 1 .091 .141
Head circumference .008 .325 .254 .091 1 .385
(cm)-8 months
Weight (kg) 8 months .003 .299 .388 .141 .385 1

Correlation is significant at the .001 to .01 level (two-tailed).
Developmental Psychobiology How Else Can We Study Sex Differences in Early Infancy 7
Table 4. Clusters for Birth Weight, Apgar Score, and Head Circumference Using a Two-Step Cluster Analysis
Birth Weight (gms) Apgar 5 Min Birth Head Circumference (cm)
Mean Std. Dev. Mean Std. Dev. Mean Std. Dev.
Cluster 1 3732.32 335.632 9.05 .674 35.36 .836
2 2570.00 456.314 8.42 1.689 31.98 1.548
3 3144.59 262.270 9.41 .536 33.65 .749
Combined 3163.79 529.541 9.09 1.044 33.71 1.565

these differences but do not speculate on developmental
consequences for sex-related differences in behavior
(Crawford et al., 1987; Davis et al., 1993). In contrast,
Reinisch and coworkers (1991) studied sex differences
in the timing of motor and social milestones in infant
development and correlated these with variables (which
they called background variables) such as birth weight
and birth stage. It is instructive to consider this paper in
a bit of detail because the authors articulate a
frequently encountered theoretical framework that con-
trasts with the one I am urging researchers to adopt.
Reinisch et al. used maternal diaries kept during the
first 12 months of infancy to assess the timing of 10
predefined developmental milestones. These include
one social marker (smiles) and nine motor milestones.
Using a large sample size (5,000), they detected a
number of small but significant timing differences. For
example boys crawled independently 7.4 days and
stood 5.6 days earlier than girls. The most marked
differences in developmental patterns appeared between
7 and 11 months. Importantly, however, the final
milestonewalks without supportoccurred at identi-
cal ages in each sex. In retrospect, given the more
recent finding that crawling and walking may be
independently learned skills, this latter result may not
be that surprising (Adolph, Berger, & Leo, 2011).
Reinisch and coworkers considered the birth varia-
bles to be possibly confounding, and, indeed, found
that heavier, more fully developed newborns reached
milestones sooner. But following multiple regression
analyses they suggested that sex differences in timing
existed over and above starting differences in size and
Table 5. Male and Female Membership in the Clusters
13
Two-Step Cluster Number
1 2 3 Total
Gender Male 2877 1782 4273 8932
Female 1781 2388 4689 8858
Total 4658 4170 8962 17790
development. To illuminate an alternative to Reinischs
standard approach, Table 7 contrasts two theoretical
and methodological approaches. Prior work by Fogel
and Thelen (1987) on the development of smiling also
illustrates these differences. These authors document
the transitions from neonatal reflexive but muscularly
limited sleep smiling to a complex smile that gradually
becomes tailored to specific social interactions, noting
as well the accompanying changes in external stimuli
that elicit smiling. For Fogel and Thelen, smiling is a
continuous neuro-muscularly morphing phenomenon
that can only be understood developmentally. In
contrast, Reinisch et al. see smiling as a singular trait
that appears at a certain moment (4849 days) in
development. Although they consider how a babys
smile may facilitate interactions with adult caregivers,
they develop no hypotheses about how sensory stimuli
might facilitate smile development in the first place.
Rather than thinking of birth characteristics such as
weight and head size as confounding variables, let us
consider them as potential developmental starting
points. This allows us to conceptualize how small mean
population level differences in birth characteristics
might have surprisingly large differential developmen-
tal effects on males and females, while at the same
time, by using distribution analyses such as the cluster
analysis presented in Tables 46, to understand more
about both between and within sex variation in gender
expression. The fact that the cluster analysis reveals
Table 6. x2 Tests for Significance of Male and Female
Cluster Distribution
Asymp. Sig.
Value df (Two-Sided)
Pearson x2 364.957a 2 .000
Likelihood ratio 367.704 2 .000
Linear-by-linear 186.069 1 .000
association
N of valid cases 17790
a
Zero cells (.0%) have expected count less than 5. The minimum
expected count is 2076.33.
8 Fausto-Sterling
Table 7. Comparing Frameworks and Methodological Approaches
Analytical
Component Additive Development (e.g., Reinisch et al.)
Birth variables Confounding or background/subtract using
multiple regression analysis
Infant behaviors Seen as these fundamental sex differences (p. 28)
Do not study correlations to parental behavior
Theory/method Biology produces individual behavior
Behavior further develops independently as small
behavior differences are slowly magnified by
environmental influences
Environmental influences not clearly defined or
specifically examined
Specific milestones studied independently of one
another
different weights of male or female membership in two
of the three clusters suggests potential developmental
narratives that do not emerge when one considers
weight, brain size, etc., merely as background variables.
This idea is further supported by the suggestion that
cluster membership is one (of presumably several)
factors contributing to ongoing motor development.
What might cluster membership imply for the first few
months of parental care? Does cluster membership
correlate with infant characteristics such as activity
level, which show sex-related differences at birth? Does
AL, combined with care-giver responses that might
differ depending on infant sex feed into motor skill
development? And what, if any, might the developmen-
tal sequelae be, especially with regard to the acquisition
of sex-related behaviors at 1 year and later?
Here are some ideas which could be tested in
appropriately designed observational studies. As one
example, consider cluster 2, in which girls predominate.
The infants in this group are smaller and a little less
robust at birth (lower Apgar scores). Suppose this led
parents to handle these babies more carefully, to hold
them more, and to monitor them more closely than
might the parents of children in cluster 1. Might the
group 2 activity levels be a bit lower than the ALs for
infants in cluster 1? Any of these possibilities could
affect the style of parentinfant interaction that devel-
ops by 4 months and which subsequently correlates
with motor and cognitive developmental outcomes and
patterns of attachment (Beebe et al., 2010). If, in turn,
a cluster is more heavily weighted toward boys or girls,
a particular parenting style or set of interactionseven
though developed as a response to the individual baby
Developmental Psychobiology
Non-Linear, Dynamic Development
Potential developmental starting points that condition
parental behaviors/multimodal visualization
Emerging characteristics resulting from parentinfant
interaction
Correlate with parental behavior
Behavior and biology are different manifestations of the
same complex system that includes infant and adult
caregivers
Behavioral sex differences emerge from this system
during year 1 as infants and caregivers produce
differently gendered experience
Experience given theoretical specificity, studied as
caregiverinfant interaction
Behaviors visualized multimodally
could contribute to the emergence of group differ-
ences as development proceeds. Thus initial differ-
entiation might have as much to do with the physical/
physiological characteristics of a particular infant is it
does with pervasive sex-related differences in how
parents handle their newborns. But given the different
percentages of boys and girls in different clusters of
birth characteristics, this initial non-gender-driven han-
dling difference might gradually produce average sex-
related infant differences, first in motor or activity
levels and later in more complex behaviors and
preferences.
Several findings make this speculation worthy of
empirical testing. Lundqvist-Perrson (2001) classified a
group of 38 newborns based on tests of their self-
regulatory abilities (irritability, self-quieting, lability,
and other criteria). Thirty-five percent of the boys and
17% of the girls had low levels of self regulation; 40%
of the boys and 50% of the girls fell in the middle
range, while 25% of the boys and 33% of the girls had
a high level of self regulation. These starting points
correlate to some degree with developmental outcomes
at 2 years of age, but this author did not examine the
intervening care-giver infant interactions (Lundqvist &
Sabel, 2000; Lundqvist-Persson, 2001).
In contrast, Lavelli and Fogel (2002) report on the
development of motherinfant face to face interactions
during postnatal weeks 114 using detailed observatio-
nal analyses. They studied two conditionsheld versus
not held by mother. Although each dyad began with the
same duration of mutual gaze in week 1, by the third
month they observed that girls and their mothers spent
significantly longer time in face to face communication
Developmental Psychobiology
than did boys. This difference seemed to result from
the fact that girls and their mothers developed strong
dyadic communication under both conditions, whereas
the boys and their mothers showed scant communica-
tion while in the mothers arms (p.297) (Lavelli &
Fogel, 2002). Could such emerging gender differences
grow out of starting differences in combinations of
traits such as size, health, and self-regulatory abilities
at birth?
Although birth characteristics provide a moment to
begin analysis of developmental processes that lead to
sex-related differences in behavior and preference, this
too, is an arbitrary starting point. Most biologically
oriented research reports use prenatal sex differences in
hormone production as the go to explanation for later
behavioral differences (Berenbaum & Snyder, 1995;
Berenbaum & Bryk, 2008; Connellan et al., 2000).
Indeed, it is possible that prenatal sex-related hormone
variability contributes to variable growth patterns that
result in the birth traits we have examined. But it seems
likely that hormones are but one of many factors
affecting birth weight, head size, and Apgar score.
Thus, even if it were possible to study the many
influences on human fetal growth and development,
prenatal hormones would most likely be decentered and
we would still need to use a dynamic, non-linear
framework to examine the development of these stand-
ard birth measurements. In summary, the theoretical
framework of the majority of earlier work is that sex-
related differences in biology provide the foundation on
which later sex-related differences are built. In this
framework, behavior after birth develops independently
as small biological differences are slowly magnified by
environmental influences. Often environmental influ-
ences are not clearly defined, or they are studied under
the guise of socialization, which is itself often pre-
sented as an external, disembodied concept. The current
paper offers a different vision for how to approach
future studies of sex-related differences in infancy and
beyond. I argue that behavior and biology are different
manifestations of the same complex system that
includes infant and adult caregivers. Behavioral sex
differences gradually emerge from this system during
year 1 as infantcaregiver dyads produce differently
gendered experience. Experience should be given
theoretical specificity, and studied as caregiverinfant
interaction as seen, for example, in our work (Ahl
et al., 2013; Fausto-Sterling et al., 2015; Sung et al.,
2013) and in the work of researchers such as Beebe
et al. (2010) and Lavelli and Fogel (2002). These small
moment to moment interactions must affect infant
neural development in both the peripheral and central
nervous systems, leading to embodied gender. Further,
advances in neuroimaging may enable us to explore the
How Else Can We Study Sex Differences in Early Infancy 9
neural mapping of this embodiment. Finally, I urge that
experimenters visualize behaviors multi-modally and
study them in developmental sequence, with the idea
that later development builds on the platform created
by preceding events.
NOTES
This research was supported by funds from the Ford Foundation
and the Pembroke Center for Teaching and Research on Women
awarded to Anne Fausto-Sterling. The author thanks Dr. Stephen
Buka for sharing the infant birth characteristics data base. She
also acknowledges the coding assistance of a large group of
Brown University undergraduates.
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