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Dev Psychobiol. Author manuscript; available in PMC 2024 July 01.
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Published in final edited form as:

Dev Psychobiol. 2023 July ; 65(5): e22397. doi:10.1002/dev.22397.

Early, Concurrent, and Consistent Hand Preferences Predict

Stacking in Toddlerhood
Emily C. Marcinowski1, Eliza L. Nelson2, Julie M. Campbell3, George F. Michel4
1School of Kinesiology, Louisiana State University
2Department of Psychology, Florida International University
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3Department of Psychology, Illinois State University

4Department of Psychology, University of North Carolina at Greensboro

Abstract
Stacking is a hallmark of fine motor skill development and requires skilled hand use. One
mechanism for children to gain manual proficiency involves establishing a hand preference which
creates practice differences between the hands from the experience of using one hand over
the other. Prior work found that stacking skill emerged earlier in infants with an identifiable
hand preference. However, it is not known how hand preference relates to later toddler stacking
performance. This study examined the effects of early hand preference (infant pattern), concurrent
hand preference (toddler pattern), and consistent hand preference (infant to toddler pattern)
on toddler stacking skills. Sixty-one toddlers, whose hand preferences as infants was known,
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were assessed for their toddler hand preference and their stacking skill across 7 monthly visits
from 18-24 months of age. Using multilevel Poisson longitudinal analysis, children with hand
preferences that were consistent across both infancy and toddlerhood were more successful at
stacking, compared to those with inconsistent preferences across the infant and toddler periods.
These findings suggest that hand preference consistency has implications for development.

Keywords
stacking; handedness; laterality; motor development; manual skills; play; infancy

Introduction
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Stacking is a hallmark of fine motor skill development. Professional assessments like the
Peabody Developmental Motor Scales second edition (PDMS-2; Folio & Fewell, 2000)
track children’s stacking ability across age. Children are expected to stack 2-3 cubes at
15-18 months; 4-6 cubes at 19-24 months; and 8-10 cubes at 25-30 months. Yet, stacking
attainment is more than maturation. Stacking requires skilled hand use. One mechanism for
children to gain manual proficiency involves establishing a hand preference which creates

Corresponding Author: Emily Marcinowski, Ph.D., School of Kinesiology, Louisiana State University, [email protected].
Conflict of Interest Statement: We declare no conflicts of interest.
 Marcinowski et al. Page 2

practice differences between the hands from the experience of using one hand preferentially
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over the other. In a prior study, Marcinowski et al. (2016) identified different trajectories for
stacking skill from 10-14 months based on infants’ hand preferences for object acquisition
(i.e., reach-to-grasp actions), finding that having an identifiable hand preference predicted
earlier emergence of stacking skill. What is unknown is how hand preference is related to
later stacking skills when children are toddlers, and their preferences are more advanced.
This study adds to the literature by examining the effects of early hand preference (infant
pattern), concurrent hand preference (toddler pattern), and consistent hand preference (infant
to toddler pattern) on toddler stacking skills from 18-24 months.

Infants with an early hand preference are more successful in early stacking
Infants are variable in how they use their hands to acquire objects, and this variability can
be parsed into different hand preference trajectories (Campbell et al., 2018; Michel et al.,
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2014); these infant hand use patterns, in turn, predict developmental outcomes like early
stacking. Marcinowski et al. (2016) examined infant hand preference for object acquisition
across 9 visits from 6-14 months, and infant stacking skill from 10-14 months (prior to 10
months infants exhibited no object stacking). Stacking was defined as the infant successfully
placing one object upon a base object without the object falling after their hand was
removed, and the infants’ sum of stacks across trials for each month was used in analyses.
Previously four hand preference trajectories were identified for these infants: stable right,
stable left, trending right and no preference. Infants without a hand preference had the
lowest level of stacking and the slowest development of stacking skill whereas infants with a
stable right- or left-hand preference developed stacking skills faster and had greater stacking
success by 14 months of age. Infants without a stable hand preference that trended towards a
right preference resembled the no hand preference group. Perhaps, infants in the “trending”
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right group had not had enough experience of using one hand to develop manual proficiency
which may have diminished their early stacking skills. The current study extends these
findings by asking whether these four infant hand preference patterns continue to predict
later stacking skill when the children become toddlers. This study also examines whether
hand preference consistency from infancy through toddlerhood affects the development of
stacking skill.

Infant stacking skills predict toddler stacking skills

Examining the effect of infant hand use patterns on toddler stacking are warranted because
infant stacking skills have been shown to predict toddler stacking skills. Marcinowski et
al. (2019) examined the development of object construction, measured as stacking, nesting,
and affixing, from infancy (10-14 months) through toddlerhood (18-24 months) to provide
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rich descriptions of the trajectories of these construction skills so that they could be used
for future hypothesis-driven research. For stacking specifically, the overall increase from
10-14 months was linear, although some individual infants demonstrated slow stacking
growth with a rapid increase at 13-14 months in a quadratic or cubic pattern. Because the
base object was not counted in the tower, adding “1” to each stack creates a comparable
benchmark to that of the PDMS-2. At 10 months, 84% of infants exhibited no stacking, and
16% could stack 1 item (i.e., 2 block tower). At 11 months, 73% of infants exhibited no
stacking, 22% could stack 1 item, and 5% could stack 2+ items. At 12 months, the number

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of infants not stacking had dropped to just more than half (55%), 35% could stack 1 item,
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and 9% could stack 2+ items. By 13 months, the number not stacking was about one-third
(34%), 39% could stack 1 item, and one-quarter (25%) could stack 2+ items. Finally, very
few infants at 14 months did not stack (13%), with nearly half stacking 1 item (46%), and
about one-third stacking 2+ items (38%).

Stacking also increased linearly across the toddler timepoints (Marcinowski et al., 2019).
The number of toddlers not stacking at any timepoint ranged from 0-4%. At 18 months, one-
half of children could stack 1-2 items, and about one-third (38%) could stack 3-5 items. By
24 months, 14% were stacking only 1-2 items, 31% were now stacking 3-5 items, and over
one-half (55%) were stacking 6+ items. Children’s stacking ability at 14 months predicted
18- and 24-months stacking. In other words, stacking skill at 14 months of age predicted
both the toddler stacking skill at 18 months and 24 months of age. However, potential
patterns between infant hand use preferences and toddler stacking skill were not examined
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in this prior study. Thus, there is a gap in our knowledge about whether the variability
in toddler stacking ability can be explained by different hand preference trajectories both
during infancy and during toddlerhood. The current study examines whether early hand
preference (i.e., infant hand preference trajectory), concurrent hand preference (i.e., toddler
hand preference trajectory), and consistent hand preference (i.e., same preference from
infancy to toddlerhood) can predict toddler stacking skills.

Hand preferences are linked through a developmental cascade

The cascade theory of handedness, first proposed by Michel (2002) and updated in Michel
(2021), posits that handedness emerges from a series of cascading developmental events.
Briefly, biases in intrauterine positioning predict the direction of head orientation preference
after birth (Michel & Goodwin, 1979), and this supine experience creates asymmetric
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multimodal feedback of the hands (Coryell & Michel, 1978; Michel & Harkins, 1986; van
der Meer et al., 1995). Head turn preference predicts reaching preference (Konishi et al.,
1987; Michel, 1981; Michel & Harkins, 1986), and reaching preference in turn predicts
a preference for unimanual manipulation (Campbell, Marcinowski, Babik, et al., 2015;
Hinojosa et al., 2003). Ultimately, unimanual manipulation preference cascades to the active
hand in role-differentiated bimanual manipulation (RDBM; Babik & Michel, 2016). To
summarize the key points, (1) manual experiences are cumulative across early development
and (2) preferences for early manual actions are tied to preferences for later manual actions.

How the hands are used in stacking may be a consequence of this developmental cascade
for handedness. Infants with a clear hand preference for acquiring objects have advantages in
stacking, as measured by age of skill attainment and the size of the block structures, relative
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to infants with no clear hand preference (Marcinowski et al., 2016). We have hypothesized
that this finding is due to infants with a hand preference having more experience using one
hand, since stacking is primarily unimanual. Occasionally, we have observed children use
two hands for stacking (e.g., one hand to stabilize the base while placing a block with the
opposite hand). Thus, stacking is positioned between reaching to acquire objects and RDBM
in the handedness cascade, which necessitates looking at stacking skill with respect to both
reaching and RDBM hand preference. Reaching-to-grasp objects is an age-appropriate skill

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with which to evaluate hand preference in infants, whereas RDBM is more appropriately
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used to evaluate hand preference in toddlers; comparing across these skills/age periods
yields insights into hand preference consistency (cf. Marschik et al., 2008; Nelson et al.,
2013).

Extending the handedness cascade further, Marschik et al. (2007) reported a relationship
between stacking hand use and school age hand preference. In this longitudinal study,
stacking was measured at five time points spanning 18 months to 7 years of age. At the
final stacking time point, the authors also collected hand preference data from a battery of
13 unimanual items and 6 bimanual items to generate a school age laterality quotient for
analyses. Hand use for stacking was related to school age (i.e., concurrent) hand preference
at 7 years of age. School age hand preference was also linked to preschool stacking hand
use at 4 and 5 years, but not to toddler stacking hand use at 18 or 26 months. However,
Marschik et al. (2007) did not use stacking skill or success as the metric for comparison to
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later or concurrent hand preference. Rather, these investigators ran correlations between the
percentage of right-hand use for stacking at each time point and the school age laterality
quotient. Hand use consistency was discussed descriptively, but not formally analyzed with
respect to stacking. Taken together with our prior work, we have empirical and theoretical
reasons to hypothesize a link between stacking and hand preference, and the current study
will further explore how these constructs are related in early development.

Current Study
The current study extends the findings of Marcinowski et al. (2016), which linked infant
hand preference trajectories to infant stacking skill. Drawing on the same rich longitudinal
dataset, we tested three hypotheses concerning the relation of hand preference and stacking
skill measured during toddlerhood:
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(H1) Early hand preference (infant pattern) predicts toddler stacking

(H2) Concurrent hand preference (toddler pattern) predicts toddler stacking

(H3) Consistent hand preference (from infancy to toddlerhood) predicts toddler

stacking

Consistent with Marcinowski et al. (2016), we predicted greater toddler stacking skill
with more rapidly developing stacking trajectories from 18 to 24 months in children with
an identifiable early hand preference (H1: measured from object acquisition preference
over nine infant visits), an identifiable concurrent hand preference (H2: measured from
RDBM hand preference over seven toddler visits), and a consistent hand preference from
infancy through toddlerhood (H3: determined by comparing the infant hand preference
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trajectory classification to the toddler hand preference trajectory classification) as compared

to children with no identifiable hand preference or an inconsistent hand preference
relative to each hypothesis that was tested. The overall goal of this work was to
further characterize how hand use patterns across development, captured as different hand
preference trajectories, contribute to the development of stacking.

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Methods
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Participants
The dataset used in these secondary analyses was from a larger project on the development
of handedness that assessed hand use for acquiring objects over nine monthly visits in eight
rolling infant cohorts (N = 380; data used to determine infant hand preference trajectory
membership). Enrollment into the original infant study required that the child was born to
term at 37 or more weeks, had no complications during their birth, and no serious medical
conditions as reported by one of their parents. The sample was recruited from Guilford
County (North Carolina) birth records and all testing took place at the University of North
Carolina Greensboro Infant Development Center. Details of the larger project have been
described elsewhere (see Campbell et al., 2018).

Families with children in the last three cohorts were invited back to the lab for seven
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additional monthly toddler RDBM hand use assessments (N = 101; data used to determine
toddler hand preference trajectory membership). Only some children from the rolling toddler
follow ups of the original project received the toddler stacking assessment because of
the need for piloting work, changes in lab staffing, and a loss of funding (N = 61; 28
females). For the toddler stacking subsample, father’s education level ranged from some
high school/no diploma to a doctorate degree. Eighteen families did not report father’s
education. Mother’s education level ranged from some college/no degree to a professional
degree. Sixteen families did not report mother’s education. The median education level for
fathers and mothers was a bachelor’s degree. Family income ranged from $10,000-19,999 to
over $150,000 with a median income level of $60,000-$69,999. Seventeen families did not
report income. The racial and ethnic make-up of the toddler stacking subsample was 67%
White (Not Hispanic or Latino), 23% Black or African American (Not Hispanic or Latino),
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3% Other Race, 2% White Hispanic or Latino, and 2% More than One Race (Not Hispanic
or Latino). An additional 3% self-identified their child only as Hispanic or Latino. Most
children had complete data across the 16 time points. Of children who missed visits, 0-7%
missed 1-2 infants visits and 9-19% missed 1-2 toddler visits. No child missed more than 2
infant or 2 toddler visits.

Procedure
The following procedure were approved by the University of North Carolina Greensboro
Institutional Review Board (project title: “Development of Infant Handedness”; research
protocol number IRB 05-0071). Children were brought to the University of North Carolina
Greensboro Infant Development Center for 16 visits within +/− 7 days of their monthly
birthdate. Nine visits occurred during infancy from 6-14 months, and seven visits occurred
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during toddlerhood from 18-24 months. In the analyses reported here, infant visits measured
hand use preference for acquisition and toddler visits measured hand use preference for
RDBM and stacking. Informed consent was obtained from parents for their child to
participate in the study at the first infant visit. Informed consent was obtained again at the
first toddler visit. All assessments were given by trained experimenters and video recorded
for later analyses using two cameras (Panasonic WV-CP240) that provided overhead and left
side views of the session. The child sat supported on a parent’s lap at a crescent-shaped

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table. If a child got fussy, a short break was taken in an adjacent waiting room. Any partially
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completed trials were re-started after the break. If a second visit was needed to complete
data collection, the appointment was within 5 days of the first visit. Parents were asked not
to distract or interfere with their child’s play. Experimenters used child-friendly affect, toy
engagement, and vocal tone to encourage play. Parents received a $10 Target gift card at
each lab visit. Neither the original study nor the secondary analyses were preregistered.

Measures
The current study reports on three measures from the longitudinal study: (1) an infant
hand preference assessment given at the 6-14 months visits, (2) a toddler hand preference
assessment given at the 18-24 months visits, and (3) a stacking task given at the 18-24
months visits. For toddler visits, the stacking task always followed the hand preference
assessment.
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Infant Hand Preference Assessment (6-14 months; Michel et al., 1985).—The

infant hand preference assessment comprised 32 presentations of a varied assortment of
objects, presented singly on the table to midline (23 objects), single in the air to midline (3
objects), or in pairs on the table in line with the infant’s shoulders (6 objects). After placing
the object, the presenter allowed the infant to manipulate the object for 20 seconds or until
acquisition, whichever occurred first. The assessment took 15 minutes. Videos were scored
by trained coders with the Observer XT software program (Noldus Information Technology,
v.10.1). Coders scored which hand initially acquired the object for each presentation.
Acquisition was recorded when a grasped object was lifted off the table or significantly
changing its location in space (e.g., fully rotating the object; Michel et al., 2002). Coders
marked when the object was acquired by the left, right, or both hand(s). For a “both”
code, hands had to grasp the object simultaneously and both hands had to be involved with
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the lift/action. Twenty percent of videos stratified by age were fully recoded for interrater
reliability. Overall interrater agreement was 93%. Any disagreements between coders were
resolved with discussion. Each infant’s scores were converted into a proportion of right
hand use (Total Right Hand acquisitions/(Total Right Hand acquisitions + Total Left Hand
acquisitions)) for each visit and used in analyses for infant hand preference trajectory
classification.

Toddler Hand Preference Assessment (18-24 months; Nelson et al., 2013).

—The toddler hand preference assessment comprised 29 presentations to elicit role-
differentiated bimanual manipulation (RDBM) where one hand (non-preferred) supported
the object for manipulation by the other hand (preferred). Target RDBM actions in the test
battery included unzipping a bag, removing a toy from inside another toy, unlatching a
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container, removing a lid, peeling a sticker from its backing, etc. During this assessment,
the experimenter drew attention to the intended RDBM action (e.g., unzipping a bag)
and presented the object to the toddler’s midline. The assessment took approximately 10
minutes. Videos were scored by trained coders with the Observer XT software program
(Noldus Information Technology, v.10.5). Coders scored which hand actively manipulated
the object in the first successful RDBM for each presentation. If the RDBM was not
completed successfully, no data point was taken on hand use. Coders were blind to infant

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hand preference scores, and infant hand preference trajectory membership. Twenty percent
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of toddler videos stratified by age were fully recoded for interrater reliability using percent
agreement. Interrater reliability was 96%. Any disagreements between coders were resolved
with discussion. Each toddler’s scores were converted into a proportion of right hand use
(Total Right Hand RDBMs/(Total Right Hand RDBMs + Total Left Hand RDBMs)) for each
visit and used in analyses for toddler hand preference trajectory classification.

Stacking Task (18-24 months; Marcinowski et al., 2019).—The toddler stacking

task used three sets of stacking toys: 1 in. cubic blocks (10 items; presented once), 2
in. cubic blocks (10 items; presented once), and seriated cups (9 items; presented twice).
Seriated cups were presented once with the open side down and once with the open side
up. All toy sets were de-constructed pieces placed at the child’s midline. Children engaged
with stacking sets for 20 seconds or until the child refused further play. If the toddler was
building a tower at the end of the 20 second period, they were allowed to complete that
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tower before toys were removed. The task took 7 minutes. Coders scored the number of
stacks in the tallest tower for each presentation. Children had to successfully place one
object upon a base object without the object falling after their hand was removed, and the
base was not counted in the tower height (e.g., 3 stacks in a 4-block tower; Marcinowski
et al., 2019). For seriated cups that differed in size, a successful stack was only coded
when the base cup was larger than any cup placed on top. Instances of “upside down
stacking” where a larger cup (open side up) was place on a smaller cup (open side up)
were not considered a successful stack. Twenty percent of toddler videos stratified by age
were fully recoded for interrater reliability using percent agreement. Interrater reliability was
98%1. Any disagreements between coders were resolved with discussion. Two dependent
variables were used in stacking models (1) Sum stacks defined as a sum of all the child’s
stacking across presentations (i.e., monthly stacking activity) and (2) Max stacks defined
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as the child’s best performance on any of the stacking presentations (i.e., monthly stacking
achievement).

Data Analysis
Hand Preference Classifications.—Group-based trajectory models using the SAS
TRAJ procedure (Jones et al., 2001) were used to determine hand preference trajectory
membership across infant visits (i.e., acquisition hand preference) and separately across
toddler visits (i.e., RDBM hand preference). In this approach, each child’s probability of
membership for all hand preference trajectory groups within the manual skill was calculated.
Members of a group share a similar developmental pattern (Haviland et al., 2008). The child
is identified as most likely belonging to one hand preference trajectory group based on the
highest membership probability.
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Classifying infant hand preference was done to test H1. Infant hand preference classification
used the proportion of right-hand use for object acquisition. Four infant hand preference
trajectories were identified from the full infant sample (N = 380; Marcinowski et al., 2016):

1.Interrater reliability also includes coding for the object construction actions “nesting” and “affixing” as reported in the original
analyses performed by Marcinowski et al. (2019).

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stable right hand preference (32.2%), trending right hand preference (25.4%), left hand
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preference (12.2%), and no hand preference (30.2%). The average posterior probability was
0.80. For the subsample of 61 children in the current study, 20 were classified as stable right
hand preference (32.8%), 16 were trending right hand preference (26.2%), 13 were left hand
preference (21.3%), and 12 exhibited no hand preference (19.7%) in infancy.

Classifying toddler hand preference was done to test H2. Toddler hand preference
classification used the proportion of right-hand use for RDBM. Four toddler hand preference
trajectories were identified from the full toddler sample (N = 101): high right hand
preference (32%), moderate right hand preference (28%), left hand preference (20%), and no
hand preference (20%). The average posterior probability was 0.93. For the subsample of 61
children in the current study, 15 were classified as high right hand preference (27.9%), 17
were moderate right hand preference (29.5%), 13 were left hand preference (23%), and 15
exhibited no hand preference in toddlerhood (26.2%).
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To test H3, children were considered consistently lateralized if they were classified as stable
right hand preference during infancy and moderate or high right hand preference during
toddlerhood (N=16), or if they were left hand preference during infancy and toddlerhood
(N=4). Due to small sample size for consistent left infants, only consistent right infants were
examined separately.

Models Testing Stacking Predictions.—A standard model-building procedure with

model reduction was used to first test an unconditional growth model to map change across
time and then a conditional growth model to test H1-3 (Raudenbush et al., 2004; Singer
& Willett, 2003). Since stacking was Poisson-distributed, a multilevel Poisson longitudinal
model was used. The Level 1 (time-varying) independent variables were Continuous Age
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centered on 18 months (exact number of months since birth). The Level 2 (time-stable)
independent variables were infant hand preferences dummy coded (reference group: no
preference), toddler hand preferences dummy coded (reference group: no preference),
and consistently lateralized (reference group: not consistently lateralized). The dependent
variables were Sum stacks and Max stacks. All group differences between ages were tested
using Mann-Whitney Us in SPSS. Alpha was .05.

Results
Infant Hand Preferences and Toddler Stacking (H1 – Early Hand Preference)
Variability differed between infant hand preference groups across Sum stacks. According
to Mauchly’s Test of Sphericity, trending right hand preference infants exhibited significant
variability across time for Sum stacks (χ2(20)=33.68, p=0.04), whereas all other infant hand
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preference groups did not (ps>0.12). No differences in variability were found for Max stacks
for individual infant hand preference groups (ps>0.36).

Sum stacks exhibited linear change (β1=0.12, t(329)=10.42, p<0.01) across time, was over-
dispersed (sε2=1.68), and had significant variance at the intercept (r0=0.11, χ2(58)=2.6983,
p<0.01; Table 1). Toddlers with a trending right hand preference during infancy had a
significantly lower intercept (β01=−0.34, t(58)=−3.01, p<0.01). Max stacks exhibited linear

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change (β1=0.10, t(329)=8.91, p<0.01) across time, was under-dispersed (sε2=0.83), and
had significant variance at the intercept (r0=0.06, χ2(59)=185.71, p<0.01; Table 1). Like
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Sum stacks, children with a trending right infant hand preference had a significantly
lower intercept (i.e., at 18 months) than all other hand preference groups (β01=−0.32,
t(58)=−3.42, p<0.01). No group differences were found at the intercept for the other infant
hand preference groups (ps>0.39), and no group differences were detected at the slope for
any infant hand preference group (ps>0.95) for Max stacks.

When each visit was compared using a Mann-Whitney U, infants in the trending right group
were significantly lower for Max stacks at 19 and 21 months relative to the other infant hand
preference groups (Table 2). Also, trending right infants just failed to achieve significance
at 20 and 24 months (p<0.07). Regarding H1, the early, inconsistent preference of trending
right infants exhibited worse stacking achievement for some visits (measured as Max stacks)
but no difference in the rate of their development of stacking skill (measured by Sum stacks;
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Figure 1). Those with early, consistent hand preferences during infancy did not exhibit
more stacking success or more rapid development of stacking skill during toddlerhood, as
compared to those who had no hand preference during infancy.

Toddler Hand Preferences and Toddler Stacking (H2 – Concurrent Hand Preference)
No differences in variability were found for Max stacks or Sum stacks by individual toddler
hand preference groups (ps>0.36). For Sum stacks, toddlers with a high right preference
exhibited a significantly higher intercept at 18 months (β01=0.36, t(58)=3.32, p<0.01; Table
3) than all other toddler hand preference groups. Toddlers with a high right preference
also exhibited a significantly higher intercept for Max stacks (β01=0.26, t(58)=2.85, p<0.01;
Table 3), than all other groups. No group differences were found at the intercept for the other
toddler handedness groups (ps>0.13), and no group differences were detected at the slope
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for any toddler preference group (ps>0.22).

When each visit was compared using a Mann-Whitney U, toddlers in the high right hand
group were significantly higher on Max stacks than all other groups at 18, 22, and 23
months (Table 2). Regarding H2, the children with the most strongly right-biased toddler
hand preference (i.e., high right), created significantly higher stacks than all other toddler
groups (Figure 2). Over half of high right toddlers were composed of children who were
previously classified in the stable right hand preference group as infants.

Connecting Hand Preferences and Toddler Stacking (H3 – Consistent Hand Preference)
The distribution of infant and toddler hand preference groups is shown in Table 4. Children
classified as having a left preference for object acquisition as infants were most often
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classified as no preference for RDBM as toddlers (46%) followed by left preference for
RDBM (31%) and moderate right preference for RDBM (23%). No child identified as left
as an infant for acquisition was in the high right group for RDBM as a toddler. Children
with no identifiable hand preference as an infant for acquisition were equally likely to be
in any of the four toddler RDBM groups (moderate right 33%, no preference 25%, high
right 25%, and left 17%). Children with a trending right hand preference as an infant for
acquisition were highly variable as toddlers for RDBM, with most children identified as

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no hand preference (33%) followed by left (27%) or high right preference (27%). These
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children were least likely to be classified as moderate right preference (13%) for toddler
RDBM. Finally, children classified as stable right preference during infancy for acquisition
were highly likely to be high right (40%) or moderate right (40%) as toddlers for RDBM
with few classified into the non-right groups of left (15%) or no hand preference (5%).

Toddlers who exhibited a consistent preference from infancy through toddlerhood had
a significantly higher intercept than inconsistent toddlers for Max stacks (β01=0.17,
t(58)=2.01, p=0.049). When each visit was compared using a Mann-Whitney U, consistent
right preference children were significantly higher for stacking achievement at 21 and
24 months and approached significance at 23 months (Table 2). For Sum stacks, only
the consistent right hand preference group had a significantly higher intercept (β01=0.23,
t(58)=2.04, p=0.044) than the other toddlers. Children in the consistent right preference
trajectory had higher stacking activity than all the other groups from 21-24 months of age
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(Figure 3). No other trajectory differences were found, based on hand preference consistency
(ps >0.17). This finding does not support differences in the rate of developmental change for
consistently lateralized versus inconsistent groups.

Discussion
The goal of this study was to characterize how hand-use patterns across development,
captured as different hand preference trajectories, contribute to the development of stacking
skills. We tested three hypotheses on hand preference and stacking skill measured during
toddlerhood: (H1) early hand preference (infant pattern) predicts toddler stacking, (H2)
concurrent hand preference (toddler pattern) predicts toddler stacking, and (H3) consistent
hand preference (infant to toddler pattern) predicts toddler stacking. Participating children
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were classified into one of four hand preference groups during infancy and separately into
one of four hand preference groups toddlers. For H1, the key comparison that emerged was
between children in the trending right hand preference group in infancy, who tended to be
slower on toddler stacking achievement, versus all other groups. For H2, the children in the
high right hand preference group in toddlerhood tended to be higher on toddler stacking
achievement, versus all other groups. Finally, for H3, consistent right lateralized children
built taller towers at some time points as well as engaged in more stacking activity at
some time points than the other groups. These results confirm that hand preferences during
infancy and toddlerhood play a role in the manifestation of object stacking skills.

Consistency matters in mapping hand preference trajectories to toddler stacking skills

Beginning with the infant hand preference trajectories, those with the trending right
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preference started their toddler visits with lower skill in both stacking achievement (Max
stack) and stacking activity (Sum stack). While the growth of stacking skill in this group
did not differ from that of the other groups, their toddler structures were smaller or trending
smaller at four of the subsequent six assessment ages. These same children were also
lower than their peers when they were assessed previously for infant stacking success
(Marcinowski et al., 2016). In contrast, children from the high right toddler group (i.e.,
concurrent consistent) started the toddler stacking assessments with greater skill relative to

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 Marcinowski et al. Page 11

all other trajectories on both stacking variables. Again, no differences were found between
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toddler trajectories on toddler stacking growth, but the high right group’s structures were
taller than that of their peers at three additional ages. Many children in the high right toddler
trajectory, but not all, originated from the stable right infant group where an advantage was
observed for infant stacking (Marcinowski et al., 2016). Indeed, when we examined the
infant and toddler classifications together, children with a consistent right preference across
the 16 study time points stacked taller towers from 21 months on. Examining “consistency”
within an age band and across age bands offered different insights into the development of
stacking that would otherwise be masked by traditional one-time assessments that include
stacking or cross-sectional designs.

As observed originally by Marcinowski et al. (2016), the trending right-handers are an

interesting group within this study. They are less consistent in their hand preference during
infancy, more variable in stacking trajectories in toddlerhood, and demonstrate significantly
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worse stacking skill initially. In another study describing this same group of right-handers
from 6-14 months of age ("Late Right": Campbell et al., 2018), they exhibited less advanced
neuromotor level at 6 months, which included assessments of limb movement, postural
control, sitting duration, resistance to perturbation in sitting, and locomotion. By the end of
the study period, these late right-handers never caught up to stable right- and left-handers
in neuromotor score. Trending right-handers’ differences in stacking could be a function of
their hand use variability across development. Though they exhibit a right bias overall, their
trajectories are variable and significantly left biased early in the trajectory (Marcinowski et
al., 2016). This history of mixed hand use could be responsible for why this group differs
in their performance from other groups. They improve their stacking skill more slowly
in infancy (Marcinowski et al., 2016) and toddlerhood (current study), than other groups.
They exhibit poorer scores on neuromotor levels (Campbell et al., 2018). Consequently,
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trending right-handers could be one reason why some studies fail to replicate effects or
find negligible effects when assessing the relation between handedness and extra-domain
factors. Methodology, point in developmental time, and choice of manual behavior are not
standard across the literature (Michel, 2021; Nelson & Gonzalez, 2020) and procedures
can vary how children’s handedness is classified (Campbell, Marcinowski, Latta, et al.,
2015; Fagard et al., 2017). Depending on the age at which a preference is assessed, and
criteria used, trending right-handers could easily be lumped into stable preference groups,
infants exhibiting no hand preference, or any of the toddler hand preference groups. Future
directions of research should focus on this trending right-handed group as a new way
to conceptualize consistency of hand preferences. Inconsistency may reflect more than
different preference classifications at different age periods (e.g., Gottfried & Bathurst, 1983;
Kee et al., 1991; Kee et al., 1987; Wilbourn et al., 2011). Instead, consistency could extend
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to trajectories with high variability or dramatic change in manual asymmetry within a single
age period.

Examining strategy may add context to differences in stacking activity and achievement
In our prior study on infant stacking, we reported differences in stacking activity among
infant hand preference groups (Marcinowski et al., 2016). In those analyses, we did not
examine stacking achievement statistically because tower height did not provide sufficient

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 Marcinowski et al. Page 12

variability. By contrast, we found differences in stacking achievement when children were

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toddlers by hand preference trajectory. We hypothesize that differences in building strategy

may underlie this finding. Toddlers are more flexible, goal-directed, and strategic in their
play than infants. Toddlers use more sophisticated strategies to build (Greenfield et al.,
1972) and need to correct for errors less frequently (DeLoache et al., 1985). Toddlers
who are inconsistent in their hand use may be inconsistent in their building strategies
and initially exhibit higher rates of errors (i.e., lower number of successful stacks, smaller
towers) and vice versa – these predictions could be tested in future studies. Toddlers shift
their play engagement to goal-directed activities with increasingly distal goals from 1 to
3 years of age (Jennings, 2004), and children exhibit a high rate of cognitive variability
for problem-solving strategies during this period (Siegler, 2006). While it was beyond the
scope of the current study to examine building strategy in detail, we have reason to think
that this component of stacking would be worthy of pursuit in future work, especially
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studies that examine stacking and hand use in preschool and school age samples. We
know from longitudinal work examining block building from toddlerhood through age 6
that stacking success continues to increase in complexity, and that the child’s stacking
experience, measured as time spent in activity, is linked to stacking complexity (Hanline et
al., 2001). In a related construction activity involving stringing beads rather than stacking,
Scharoun Benson and Bryden (2019) reported differences in strategies across age from 3 to
12 years old that may be related to handedness. Thus, there are several avenues to pursue
regarding stacking strategy that could yield additional insight.

Stacking skills have been linked to gains in other developmental domains

Although we do not know whether the differences in stacking that we observed between
hand preference trajectory groups are meaningful for development further downstream, other
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studies have shown a link between stacking skills and performance in other domains. In a
retrospectively reported study with parents of toddlers, Bedford et al. (2016) found a link
between achievement of a stacking milestone (i.e., ability to build a 3-block tower; M =
13.29 months) and age of first touchscreen scrolling (M = 15.11 months). Touchscreen use
was not associated with gross motor or language milestones. In this study, the order of
the effect was unknown – stacking skill may have transferred to touchscreen skill, or vice
versa. Drawing on a longitudinal experimental design, Marcinowski and Campbell (2017)
reported a link between infant construction skills, which included stacking as well as other
spatial actions on objects like nesting and affixing, and comprehension of spatial relation
words at 3 years of age. Infants who were “high” constructors knew more spatial words
relative to “low” constructors. No differences were found in general cognition or language
skills. It is possible that advancements in how children spatially relate objects to each other
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could provide opportunities for learning spatial language by changing caregiver’s spatial
talk. Block building in preschoolers (3-years-old) has been linked to early mathematical
skills (Verdine, Golinkoff, Hirsh-Pasek, et al., 2014), and spatial experience with toys like
blocks has been tied to school readiness (Verdine, Golinkoff, Hirsh-Pasek, et al., 2014).
These findings suggest stacking has broader implications for development, and should be
studied longitudinally with multiple developmental domains (Casasola, 2018).

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 Marcinowski et al. Page 13

Limitations and Future Directions

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This study was limited in that it missed the period between 14-18 months of age. Given the
increase in stacking from the infancy to toddlerhood reported by Marcinowski et al. (2019),
this period now seems vital for understanding the group differences by age and in the rate
of stacking development observed in the present study. During this age period, children
have been reported to improve in their problem-solving skills (McCarty et al., 1999). Future
longitudinal studies must include visits during this period, particularly as it relates to hand
preferences, object manipulation skills, and stacking strategy. Moreover, since these data
were collected Suh et al. (2019) reported ethnic differences in 4- and 5-year-old children’s
block building skills during mother-child interactions. Increasing representation in studies
of early stacking and examining stacking in ecological settings rather than only in the
lab are goals for future work. Finally, too few left-handers were sampled to provide a
nuanced analysis based on the direction of hand preference. Left-handers make up a small
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proportion of an infant sample (14%; Michel et al., 2014) as well as the adult population
(10%; for a meta-analysis, see Papadatou-Pastou et al., 2020). In the current study, children
with a consistent left preference comprised an even smaller proportion and sample size.
Unfortunately, this study – and much of the literature on handedness – suffers from the left
handedness sampling problem. Too few infants exhibit left hand preferences, particularly
early and consistent left. It is possible that the timing of leftward trajectories differs from
that of rightward trajectories, however, we simply do not yet have a way to reliably identify
leftward trajectories early in development except via vary large sample sizes.

Exploring the connections between hand preference trajectories across development and
their relations to performance in other domains also has broader theoretical implications for
the cascade theory of handedness (Michel, 2002, 2021). Descriptions of hand preferences
cascading onto emerging manual abilities (e.g., unimanual manipulation preference onto
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RDBM preference) have so far focused on direction (left or right) and same-same
patterning (right to right, left to left). The findings from the current study suggest a
more complicated integration of hand preferences whereby investigators should consider
patterns of inconsistency just as important as patterns of consistency for characterizing the
emergence of handedness. Infants with trending right hand preferences are of interest as
a newly identified group with interesting implications for motor, cognitive, and language
developments. We emphasize the importance of this variability and a trajectory approach to
assessing handedness when using hand preference as a predictor variable.

Conclusion
Our results suggest there is a nuanced relation between developing hand preference patterns
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and the development of toddler stacking skills. We recommend that investigators consider
longitudinal consistency of hand preference, rather than only its direction, when exploring
the relation between hand preference and other developmental domains.

Acknowledgements:
The authors would like to thank the families in this study for so faithfully visiting our lab over 2 years. This
research was supported by a National Science Foundation grant to GFM (DLS 0718045) and a NIH/NICHD
training grant to ELN (T32HD007376).

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 Marcinowski et al. Page 14

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Fig. 1.
Mean stacking activity (Sum stacks) for toddler visits by infant hand preference group.
There is no difference in the rate of development of stacking skill between groups. Bars
denote standard error.
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 Marcinowski et al. Page 18
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Fig. 2.
Mean stacking achievement (Max stacks) for toddler visits by toddler hand preference
group. The high right toddler hand preference group created significantly higher stacks than
all other groups. Bars denote standard error.
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 Marcinowski et al. Page 19
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Fig. 3.
Mean stacking activity (Sum stacks) for toddler visits by hand preference consistency group.
Toddlers with a consistent right preference stacked taller towers than all other groups from
21-24 months. Bars denote standard error.
* p<0.05, Mann-Whitney Us
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Table 1.

Growth models examining toddler stacking activity and toddler stacking achievement for infant hand
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preference groups.

Stacking Activity Stacking Achievement

(Sum stacks) (Max stacks)

Fixed effects Coefficient Coefficient

Intercept (γ00) 1.80 1.21***
Age (γ10) 0.12** 0.10**
Trending Right (γ02) −0.34** −0.32**

Random effects Variance component Variance component

Intercept (r0) 0.11** 0.06**
Level 1 error (σε2) 1.67 0.83
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*
p<0.05
**
p<0.01
***
p<0.001
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Table 2.

Comparing infant hand preference groups and toddler hand preference groups on toddler stacking achievement
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across monthly visits.

Comparison Visit

18 19 20 21 22 23 24
Infant HP: Trending Right vs. Others 207 166.5* 188.5† 154.5** 250 208 219.5†
Toddler HP: High Right vs. Others 140* 199.5 241.5 294.5 155.5** 137** 257.5

Toddler HP: Consistent Right vs. Others 175.5 243 244 192* 290 198† 223*

Note. Mann-Whitney Us are reported. Stacking achievement = Max stacks. HP = hand preference.
*
p<0.05
**
p<0.01
†
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Approaching significance criteria: p<0.07

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Table 3.

Growth models examining stacking activity and stacking achievement for toddler hand preference groups.
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Stacking Activity Stacking Achievement

(Sum stacks) (Max stacks)

Fixed effects Coefficient Coefficient

Intercept (γ00) 1.65*** 1.07***
Age (γ10) 0.12*** 0.10***
High Right (γ02) 0.23* 0.26**

Random effects Variance component Variance component

Intercept (r0) 0.12*** 0.07***
Level 1 error (σε 2) 1.67 0.82

*
p<0.05
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**
p<0.01
***
p<0.001
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Table 4.

Distribution of infant and toddler hand preference groups.

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Toddler Hand Preference

Infant Hand Preference Left No Moderate Right High Right
N=13 N=15 N=17 N=15
N=13 Left 4ξ 6 3 0

N=12 No 2 3 4 3
N=15 Trending Right 4 5 2 4
N=20 Stable Right 3 1 8ξ 8ξ

Note. Italicized N is total group N.

ξ
Consistent lateralized
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