BACKGROUND:Fine-motor difficulties are associated with adverse educational, physical and socioemotional outcomes. Multiple tools are used to assess these difficulties. The International Classification of Functioning, Disability and Health (ICF) distinguishes body function, activity and participation as separate domains requiring measurement. We examined whether scores from measures sampling these domains align sufficiently for the tools to be treated as interchangeable. METHODS:Data were collected across four groups: (i)a whole-school sample(n = 415); (ii)a nested subsample with teacher-identified handwriting difficulties(n = 91; not independent of the whole school sample); (iii)a multi-school sample with teacher-identified handwriting difficulties(n = 172); and (iv)a clinical sample referred for occupational-therapy assessment(n = 33). Measures included the relevant fine-motor subscales of the Movement Assessment Battery for Children, Clinical Kinematic Assessment Tool, DCD Questionnaire, Detailed Assessment of Speed of Handwriting, and Beery-Buktenica Developmental Test of Visual-Motor Integration. Correlation and linear regression quantified observed-score associations and shared variance. Principal component analysis was used as exploratory data reduction. RESULTS:Cross-tool associations were generally small, if significant. Regression models showed that any given tool predicted only a small proportion of variance in scores on the remaining tools (approximately 1-22 %). Principal component analyses consistently yielded multiple components, with scores from different tools often represented on different components. CONCLUSION:Measures commonly described as assessing fine-motor skills were not sufficiently aligned to be treated as interchangeable, consistent with the tools sampling different combinations of ICF domains and task demands. An ICF-informed assessment battery may provide a more useful basis for characterising need and planning targeted support than reliance on a single score.

BackgroundApproximately 5% of children are affected by a neurodevelopmental disorder of their sensorimotor skills. DSM-V and ICD-10, the two most widely used diagnostic systems, define this diagnostically as 'Developmental Coordination Disorder' (DCD) or 'Specific Developmental Disorder of Motor Function' (SDDMF), respectively. A diagnosis of DCD has been found to have a detrimental impact on a range of outcomes (e.g., health and education). It is therefore crucial that these children receive timely intervention. This is reliant, however, on effective assessment and support pathways. Research has shown there is great parental dissatisfaction, but there has been limited research exploring a clinical and education perspective. This study therefore aimed to understand barriers and facilitators for clinical and education practitioners in the pathway in a diverse district in the UK (Bradford).MethodsSemi-structured interviews were completed with stakeholders across the pathway to identify barriers and facilitators to assessing, diagnosing, and supporting children with sensorimotor skill difficulties. Theoretical thematic analysis aligned to the Capability, Opportunity, Motivation model of Behaviour change (COM-B) was used to analyse the qualitative data.ResultsInterviews revealed many barriers in the DCD pathway related to capability (confusing terminology, inconsistent knowledge, inappropriate referrals), opportunity (resource constraints, DCD being considered low priority, and disconnected services), and motivation (overlapping job roles, a desire to consider those with difficulties not eligible for a diagnosis). No facilitators were consistently identified across interviews.ConclusionFamilies face multiple barriers to obtaining a diagnosis for their child through existing clinical pathways for assessment and support. These findings are unlikely to be unique to Bradford, due to international research highlighting these issues via parental interviews. These findings therefore may reflect challenges both nationally and internationally within DCD pathways. There is an urgent need for: (i) clear communication across different services (with consistency in terminology), and (ii) a more collaborative and integrated approach to assessment, diagnosis, and support in order to help these children thrive.

BackgroundDevelopmental Coordination Disorder (DCD) affects around 5% of the global population, but difficulties in accessing specialist diagnoses lead to underdiagnosis. In Spain, there are no school-based screening protocols for motor coordination difficulties with published evidence of reliability and validity, and specialist assessment is only available through overburdened healthcare services. Despite its prevalence, DCD often goes undetected due to limited access to assessments and the lack of easy-to-use tools in educational settings. FUNMOVES was developed to assess fundamental motor skills (FMS) and has shown promising signs of validity and reliability in the UK. It allows entire classes to be screened during a single Physical Education (PE) session, helping identify children with motor difficulties.AimTo adapt FUNMOVES to the Spanish school context and evaluate its psychometric properties and diagnostic accuracy when used by PE teachers.MethodsFUNMOVES was translated and culturally adapted for Spain. Structural validity was assessed using Rasch analysis with data from 243 children. Convergent validity was evaluated in a subsample of 50 children by comparing FUNMOVES with the MABC-2, the gold-standard motor assessment.ResultsRasch analysis confirmed the unidimensionality and local independence of the Spanish FUNMOVES, with good model fit. Some item thresholds were initially disordered but were corrected through rescoring. Using the MABC-2 10th percentile in total score as the criterion for motor impairment, FUNMOVES showed moderate accuracy (AUC = 0.78), with 80% sensitivity and 68% specificity at the 17th percentile cut-off. It also showed a high negative predictive value (0.89). Broadening the diagnostic criteria did not significantly improve accuracy.ImplicationsThe Spanish FUNMOVES shows initial structural and convergent validity for school-based FMS screening. Its simplicity, low cost, and scalability support early detection and intervention. The tool is freely available and can be implemented using existing school resources in one PE session, potentially accelerating the diagnostic process.

AIM:Assess whether school-based teacher-led screening is effective at identifying children with motor difficulties. METHODS:Teachers tested 217 children aged between 5 and 11 years old, after a one hour training session, using a freely available tool (FUNMOVES). Four classes (n = 91) were scored by both researchers and teachers to evaluate inter-rater reliability. Researchers assessed 22 children using the Movement Assessment Battery for Children (MABC-2; considered to be the 'gold standard' in Europe for use as part of the diagnostic process for Developmental Coordination Disorder) to assess concurrent and predictive validity. RESULTS:Inter-rater reliability for all individual activities within FUNMOVES ranged from 0.85-0.97 (unweighted Kappa; with 95%CI ranging from 0.77-1). For total score this was lower (κ = 0.76, 95%CI = 0.68-0.84), however when incorporating linear weighting, this improved (κ = 0.94, 95%CI = 0.89-0.99). When evaluating FUNMOVES total score against the MABC-2 total score, the specificity (1, 95%CI = 0.63-1) and positive predictive value (1; 95%CI = 0.68-1) of FUNMOVES were high, whereas sensitivity (0.57, 95%CI = 0.29-0.82) and negative predictive values (0.57, 95%CI = 0.42-0.71) were moderate. Evaluating only MABC-2 subscales which are directly related to fundamental movement skills (Aiming & Catching, and Balance) improved these values to 0.89 (95%CI = 0.52-1) and 0.93 (95%CI = 0.67-0.99) respectively. INTERPRETATION:Teacher-led screening of fundamental movement skills (via FUNMOVES) is an effective method of identifying children with motor difficulties. Such universal screening in schools has the potential to identify movement difficulties and enable earlier intervention than the current norm.

Background Sensorimotor processes underpin skilled human behaviour and can thus act as an important marker of neurological status. Kinematic assessments offer objective measures of sensorimotor control but can generate countless output variables. This study sought to guide future analyses of such data by determining the key variables that capture children’s sensorimotor control on a standardised assessment battery deployed in cohort studies. Methods The Born in Bradford (BiB) longitudinal cohort study has collected sensorimotor data from 22,266 children aged 4–11 years via a computerised kinematic assessment battery (“CKAT”). CKAT measures three sensorimotor processing tasks (Tracking, Aiming, Steering). The BiB CKAT data were analysed using a “train then test” approach with two independent samples. Independent models were constructed for Tracking, Aiming, and Steering. The data were analysed using Principal Components Analysis followed by Confirmatory Factor Analysis. Results The kinematic data could be reduced to 4-7 principal components per task (decreased from >600 individual data points). These components reflect a wide range of core sensorimotor competencies including measures of both spatial and temporal accuracy. Further analyses using the derived variables showed these components capture the age-related differences reported in the literature (via a range of measures selected previously in a necessarily arbitrary way by study authors). Conclusions We identified the key variables of interest within the rich kinematic measures generated by a standardised tool for assessing sensorimotor control processes (CKAT). This work can guide future use of such data by providing a principled framework for the selection of the appropriate variables for analysis (where otherwise high levels of redundancy cause researchers to make arbitrary decisions). These methods could and should be applied in any form of kinematic assessment.

OBJECTIVE:To investigate the effects of being born late preterm (LPT, 34-36 weeks' gestation) or early term (37-38 weeks) on children's educational achievement between ages 5 and 11 years. DESIGN:A series of observational studies of longitudinal linked health and education data. SETTING:The Born-in-Bradford (BiB) birth cohort study, which recruited mothers during pregnancy between 2007 and 2011. PARTICIPANTS:The participants are children born between 2007 and 2011. Children with missing data, looked-after-children, multiple births and births post-term were excluded. The sample size varies by age according to amount of missing data, from 7860 children at age 5 years to 2386 at age 11 years (8031 at age 6 years and 5560 at age 7 years). MAIN OUTCOME MEASURES:Binary variables of whether a child reached the 'expected' level of overall educational achievement across subjects at the ages of 5, 6, 7 and 11 years. The achievement levels are measured using standardised teacher assessments and national tests. RESULTS:Compared with full-term births (39-41 weeks), there were significantly increased adjusted odds of children born LPT, but not early term, of failing to achieve expected levels of overall educational achievement at ages 5 years (adjusted OR (aOR) 1.72,95% CI 1.34 to 2.21) and 7 years (aOR 1.46, 95% CI 1.08 to 1.97) but not at age 11 years (aOR 1.51, 95% CI 0.99 to 2.30). Being born LPT still had statistically significant effects on writing and mathematics at age 11 years. CONCLUSIONS:There is a strong association between LPT and education at age 5 years, which remains strong and statistically significant through age 11 years for mathematics but not for other key subjects.

This study examined the predictive validity of holistic school readiness evaluations using the 'good level of development' outcome from the Early Years Foundation Stage Profile (EYFSP). The EYFSP assesses a range of abilities at school entry including academic, language, socio-emotional, and motor skills. In particular, we examined whether the assessment predicted reading, writing, maths, and science ability two years later and future special educational needs (SEN) status (N = 3739-5768). Children who reached a good level of devel-opment had higher odds of performing at expected (vs. below expected) levels on later academic assessments. This was particularly true for children with SEN. Reaching a good level of development also increased the odds of performing at above expected (vs. expected) levels on the academic assessments and lowered the odds of requiring SEN support. This demonstrates that holistic school readiness evaluations are powerful tools that can identify 'at risk' children.

Aging tissues accumulate somatic mutations, yet cancer occurrence is relatively rare. A new study provides compelling evidence for why this may be the case and reveals that competition between mutant clones in oesophageal tissues protects against early tumorigenesis.

Background: Cognitive ability and sensorimotor function are crucial aspects of children's development, and are associated with physical and mental health outcomes and educational attainment. This paper describes cross-sectional sensorimotor and cognitive function data collected on over 15,000 children aged 7-10 years, collected as part of the Born in Bradford (BiB) longitudinal birth-cohort study. Methodological details of the large-scale data collection process are described, along with initial analyses of the data involving the relationship between cognition/sensorimotor ability and age and task difficulty, and associations between tasks. Method: Data collection was completed in 86 schools between May 2016 and July 2019. Children were tested at school, individually, using a tablet computer with a digital stylus or finger touch for input. Assessments comprised a battery of three sensorimotor tasks (Tracking, Aiming, & Steering) and five cognitive tasks (three Working Memory tasks, Inhibition, and Processing Speed), which took approximately 40 minutes. Results: Performance improved with increasing age and decreasing task difficulty, for each task. Performance on all three sensorimotor tasks was correlated, as was performance on the three working memory tasks. In addition, performance on a composite working memory score correlated with performance on both inhibition and processing speed. Interestingly, within age-group variation was much larger than between age-group variation. Conclusions: The current project collected computerised measures of a range of cognitive and sensorimotor functions at 7-10 years of age in over 15,000 children. Performance varied as expected by age and task difficulty, and showed the predicted correlations between related tasks. Large within-age group variation highlights the need to consider the profile of individual children in studying cognitive and sensorimotor development. These data can be linked to the wider BiB dataset including measures of physical and mental health, biomarkers and genome-wide data, socio-demographic information, and routine data from local health and education services.

Background A large proportion of children are not able to perform age-appropriate fundamental movement skills (FMS). Thus, it is important to assess FMS so that children needing additional support can be identified in a timely fashion. There is great potential for universal screening of FMS in schools, but research has established that current assessment tools are not fit for purpose. Objective To develop and validate the psychometric properties of a FMS assessment tool designed specifically to meet the demands of universal screening in schools. Methods A working group consisting of academics from developmental psychology, public health and behavioural epidemiology developed an assessment tool (FUNMOVES) based on theory and prior evidence. Over three studies, 814 children aged 4 to 11 years were assessed in school using FUNMOVES. Rasch analysis was used to evaluate structural validity and modifications were then made to FUNMOVES activities after each study based on Rasch results and implementation fidelity. Results The initial Rasch analysis found numerous psychometric problems including multidimensionality, disordered thresholds, local dependency, and misfitting items. Study 2 showed a unidimensional measure, with acceptable internal consistency and no local dependency, but that did not fit the Rasch model. Performance on a jumping task was misfitting, and there were issues with disordered thresholds (for jumping, hopping and balance tasks). Study 3 revealed a unidimensional assessment tool with good fit to the Rasch model, and no further issues, once jumping and hopping scoring were modified. Implications The finalised version of FUNMOVES (after three iterations) meets standards for accurate measurement, is free and able to assess a whole class in under an hour using resources available in schools. Thus FUNMOVES has the potential to allow schools to efficiently screen FMS to ensure that targeted support can be provided and disability barriers removed.

ABSTRACT We describe the development of an evidence-based motor intervention and an implementation pilot study in ten primary schools, involving 515 children (4–11 years). ‘Helping Handwriting SHINE’ (HHS) is a novel, school-led, group-based handwriting intervention. Teaching staff delivered HHS and provided feedback through a questionnaire, reporting that: (i) the children found the tasks enjoyable; (ii) the background and booklet instructions were easy to understand, (iii) there was a need for more comprehensive staff training. The teaching staff made recommendations about session duration, group size, resource availability, and age differentiation of tasks. These suggestions are applicable to the development of any school-based group-led motor intervention, and we used this feedback to refine the HHS intervention. This study shows that implementing school-led motor interventions at scale is possible. Moreover, the work provides insights into the factors to consider when developing school-based motor interventions prior to conducting randomized controlled trials (RCT). The process outlined in this manuscript has led to an RCT to test the effectiveness of HHS within primary schools.

Children raised in neighborhoods with low socioeconomic status (SES) are at risk for low academic achievement. Identifying factors that help children from disadvantaged neighborhoods thrive is critical for reducing inequalities. We investigated whether children's prosocial behavior buffers concurrent and subsequent academic risk in disadvantaged neighborhoods in Bradford, UK. Diverse children (N = 1,175) were followed until age seven, with measurements taken at four times. We used governmental indices of neighborhood-level SES, teacher observations of prosocial behaviors, and direct assessments of academic achievement. Neighborhood SES was positively associated with academic achievement among children with low levels of prosocial behavior, but not among children with high levels of prosocial behavior. Prosocial behavior may mitigate academic risk across early childhood.

Evidence suggests that children struggle to acquire age-appropriate fundamental movement skills (FMS), despite their importance for facilitating physical activity. This has led to calls for routine school-based screening of children's FMS. However, there is limited research exploring schools' capacity to conduct such assessments. This study investigated what factors might affect the adoption and implementation of FMS assessments in primary schools. School staff (n = 853) completed an online questionnaire developed using the Capability, Opportunity, Motivation and Behavior (COM-B) model. A majority reported that knowledge of pupils' FMS ability would be beneficial (65.3%), and 71.8% would assess FMS if support was provided. Barriers included: Capability - few possessed knowledge of FMS (15%); Opportunity - teachers reported 30-60 minutes as acceptable for assessing a class, a substantially shorter period than current assessments require; Motivation - 57.2% stated FMS assessments would increase workload stress. Solutions to these issues are discussed using the COM-B theoretical framework.

Observed genetic associations with educational attainment may be due to direct or indirect genetic influences. Recent work highlights “genetic nurture”, the potential effect of a parents’ genetics on their child’s educational outcomes via rearing environments. To date, few mediating childhood environments have been tested. We use a large sample of genotyped mother-child dyads (N = 2,077) to investigate if genetic nurture occurs via the prenatal environment. We find that mothers with more education-related genes are generally healthier and more financially stable during pregnancy. Further, measured prenatal conditions explain up to one third of the associations between maternal genetics and children’s academic and developmental outcomes at ages 4-7. By providing the first evidence of prenatal genetic nurture and showing that genetic nurture is detectable in early childhood, this study broadens our understanding of how parental genetics may influence children and illustrates the challenges of within-person interpretation of existing genetic associations.

The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort.

Across the lifespan the ability to follow instructions is essential for the successful completion of a multitude of daily activities. This ability will often rely on the storage and processing of information in working memory, and previous research in this domain has found that self-enactment at encoding or observing other-enactment at encoding (demonstration) improves performance at recall. However, no working memory research has directly compared these manipulations. Experiment 1 explored the effects of both self-enactment and demonstration on young adults' (N=48) recall of action-object instruction sequences (e.g. 'spin the circle, tap the square'). Both manipulations improved recall, with demonstration providing relatively larger boosts to performance across conditions. More detailed analyses suggested that this improvement was driven by improving the representations of actions, rather than objects, in these action-object sequences. Experiment 2 (N=24) explored this further, removing the objects from the physical environment and comparing partial demonstration (i.e. action-only or object-only) with no or full demonstration. The results showed that partial demonstration only benefitted features that were demonstrated, while full demonstration improved memory for actions, objects and their pairings. Overall these experiments indicate how self-enactment, and particularly demonstration, can benefit verbal recall of instruction sequences through the engagement of visuo-motor processes that provide additional forms of coding to support working memory performance.

The Born in Bradford (BiB) cohort of 13,776 children born between 2007-2011 and their parents provides a rich data resource for researchers exploring protective and risk factors influencing long-term developmental and health outcomes. Educational attainment is a critical factor related to later health. Literacy and communication, fine motor skills and social and emotional health are key ‘early’ predictors of educational attainment and can be used to identify children in need of additional support. We describe our BiB ‘Starting School’ data collection protocol which assessed literacy and communication, fine motor skills and social and emotional health on 3,444 BiB children aged 4-5 years old. These measures supplement the existing dataset, and complement the routine educational, health and social care data available for the cohort.

Children born into neighborhood adversity are at risk for low academic achievement. Identifying factors that help children from disadvantaged neighborhoods thrive is critical for reducing inequalities. We investigated whether children’s prosocial behavior buffers concurrent and subsequent academic risk in disadvantaged neighborhoods in Bradford, UK. Diverse children (N = 1,185) were followed from before birth to age seven, with measurements taken at four time points. We used governmental indexes of neighborhood adversity, teachers observations of prosocial behaviors, and direct assessments of academic achievement. Neighborhood disadvantage was associated with lower academic achievement only among children who displayed low levels of prosocial behavior. Findings were robust to sensitivity and sub-group analyses. Prosocial behavior may mitigate early academic risk in contexts of neighborhood disadvantage.