Early Intervention. Dr Mary Chambers School of Education University of Leeds UK. DCD Conference Oslo, Norway May 2008

Transcription

1 Early Intervention Dr Mary Chambers School of Education University of Leeds UK DCD Conference Oslo, Norway May 2008

2 The Early Years Movement Skills Checklist (EYMSC)

3 Aims To construct a checklist (Early Years Movement Skills Checklist) to identify and assess movement difficulties in young children, aged 3 to 5 years To identify and assess movement difficulties in young children To assess the nature of movement difficulties in children identified as displaying movement difficulties

4 Theoretical Foundations of the Checklist A realistic estimate is that there are around 5% of young children with motor difficulties requiring immediate attention. In addition various studies have indicated a number of associated problems: underachievement at school behaviour problems low self esteem poor social competence

5 Construction of the draft checklist Self help skills Desk skills General classroom skills Recreational/playground skills

6 Self Help Skills Clothing Small fasteners Feed/drink Washing etc.

7 Desk Skills Representation (circle/cross) Small object manipulation (beads, puzzles) Page/paper manipulation Scissors, glue etc. Constructing models

8 General Classroom Skills Sitting appropriately Carrying Moving around not bumping into people/objects Directional commands

9 Recreational/Playground Skills Use of playground equipment Moving etc. Ball skills Run/jump/hop etc. Balance

10 Results Mean Scores Year Old Boys 3 Year Old Girls 4 Year Old Boys 4 Year Old Girls 5 Year Old Boys 5 Year Old Girls 6 5 Section 1 Section 2 Section 3 Section 4 Checklist Sections Figure 1 Mean scores per section according to age and gender

11 Results Interrater Reliability Pearson s correlation coefficient for the total motor score was 0.96 (p<0.01) (Sections 1 to 4). Section Section Section Section Section

12 Results Test-Retest Reliability Pearson s correlation coefficient for the total motor score was 0.95 (p<0.01) (Sections 1 to 4). Section Section Section Section Section

13 Results Total persons 45 Test positive 29 Test negative 16 Impairment present 20 True positive 20 False negative 0 Impairment absent 25 False positive 9 True negative 16 Sensitivity Index 1.00 Specificity Index 0.64

14 Intervention in the Early Years for Children with Coordination Disorders

15 Aims Trial the use of an assessment instrument designed to identify and assess movement difficulties in the age range three to six years Examine the efficacy of low level intervention programmes for children identified with problems Produce guidelines in assessment and management for teachers, nursery care workers and parents of children in the age range three to six for working with children who have motor delays or impairment.

16 Sequence of Events January September 2005 Selection of sample using the Early Years Movement Skills Checklist (Chambers & Sugden, 2006) and the Movement ABC Test (Henderson & Sugden, 1992). October December 2005 Group 1 10 weeks intervention EYMSC assessment January March 2006 Group 2 10 weeks intervention EYMSC assessment April July 2006 Movement ABC Test for all children. Interviews with teachers and parents.

17 Study Protocol LEA approval, Local Research Ethics Committee approval 14 Primary schools in a local education authority were randomly selected to participate in the study 340 EYMSC sent to schools 3 boys and 3 girls randomly chosen from each class (Nursery, Reception, Year 1)

18 Participants in Project 317 (93%) EYMSC returned from 41 classes Selected Sample Children scoring <15%ile n = 96 Consent from 38 parents Random sample Children scoring >15%ile n = 26 Consent from 20 parents Total = 58 children Mean Age 4.02 years Range 3.04 to 5.11 years EYMSC Mean Score Range 23 to 74

19 Participants in Project Children assigned to one of three groups (n=54) Group 1 17 children EYMSC <15th %ile Movement ABC score Overall mean = Range 11.5 to 23.5 Group 2 18 children EYMSC <15th %ile Movement ABC score Overall mean = 18.7 Range 12 to 36.5 Group 3 19 children EYMSC >15th %ile Movement ABC score Overall mean = 3.57 Range 0 to 9

20 Intervention After first assessment individual profiles developed from both the ABC Test and the Checklist Strengths and weaknesses and priorities for intervention Every three weeks, teachers given guidelines for working with the children Contained abilities to work on, activities to include and suggestions for manner of teaching Principles underlying guidelines came from Cognitive motor approach to intervention (Henderson & Sugden, 1992)

21 Global, Experiential, low level Intervention Experience Practice Targeted Practice

22 Low Level Intervention EXPERIENCE Based on a class approach such that the individual child with difficulties is not specifically identifiable to the rest of the class or visitors. PRACTICE The intervention takes the fundamental motor skills that are deemed necessary for activities of daily life and academic performance and teaches them such that each child has the opportunity to learn them. TARGETED PRACTICE Specific methods such as task analysis, the use of context for motivation, paired learning and modified equipment such as different shaped writing implements.

23 Low Level Intervention 10 week intervention 5 weeks intervention - 1 week no intervention - 5 weeks intervention Guidelines distributed every three weeks and queries addressed Informal contact about progress Half way through intervention period short questionnaire to teachers Teachers completed diary/log of sessions with comments

24 Intervention Phases October to December January to March Group 1 Group 2 Group 3 Intervention No No 10 weeks intervention intervention No Intervention No intervention 10 weeks intervention Each intervention phase was followed by assessment with the EYMSC and after the final intervention phase, all children were assessed with the Movement ABC Test

25 Intervention Phase 1 Group 1 Intervention 10 weeks October to December children Mean age 4.00 Range 3.04 to 5.11 EYMSC Scores Overall X = Range 33 to 74 Group 2 No Intervention Group 3 No Intervention (control group)

26 Phase 1 Results ANOVA 3 (Group) x 2 (Test) F (2, ) = , p<0.05 Significant difference between mean scores for all 3 groups after Phase 1 intervention. Significant difference for Group 1 between mean scores for Test 1 and Test 2 (after intervention) Test 1 mean Test 2 mean F (1, ) = p<0.05

27 Intervention Phase 2 Group 2 Intervention 10 weeks January to March children Mean age 4.04 Range 3.06 to 5.11 EYMSC Scores Overall X = Range 34 to 69 Group 1 No Intervention Group 3 No Intervention (control group)

28 Phase 2 Results Significant difference for Group 2 between mean scores for Test 1 and Test 3 (after intervention) Test 1 mean Test 3 mean F (1, ) = p<0.05

29 Phase 2 Results ANOVA 3 (Group) x 2 (Test) F (2, ) = p<0.05 Significant difference between mean scores for all 3 groups after Phase 1 intervention but not after Phase 2 showing that the children who had received intervention have improved their movement skills

30 Results Frequencies of Impairment Test Below 5% ile % ile N

31 Movement ABC Test Results Movement ABC Test 20 Mean Scores Group 1 Group 2 Group 3 0 Test 1 Test 2 Test

32 Results: Child year old girl Typically developing child Movement ABC Test Scores: 4, 0 Reported by teachers as a very bright child. Excellent academic achievement and behaviour S c o r e s Test 1 Test 2 Test 3 EYMSC Assessments

33 Results: Child year old girl Movement ABC Test Scores: 18.5, 1.5 Reported by teachers as a very bright child. Excellent academic achievement and behaviour S c o r e s Test 1 Test 2 Test 3 EYMSC Assessments

34 Results: Child year old boy Movement ABC Test Scores: 3 Reported by teachers as a bright, cooperative child. Very good academic progress since being involved in the study S c o r e s Test 1 Test 2 Test 3 EYMSC Assessments

35 Results: Child year old girl Movement ABC Test Scores: 23, 1 Reported by teachers as a very quiet, timid child Steady academic achievement S c o r e s Test 1 Test 2 Test 3 EYMSC Assessments

36 Conclusions Low level intervention programmes for children identified with problems have been found to be effective. Children who received low level intervention programmes have shown significant improvement in their motor skills. Cautiously optimistic that children in the age range of 3 to 5/6 years of age can be helped in the development of their motor skills.

37 From Identification to Intervention: Activity Development

38 Aims A detailed analysis of the preparation of an individual set of activities; looking at initial assessment, developing a profile, setting out priorities for intervention and the development of appropriate activities

39 Global, Experiential, low level Intervention Experience Practice Targeted Practice

40 Low Level Intervention EXPERIENCE Based on a class approach such that the individual child with difficulties is not specifically identifiable to the rest of the class or visitors. PRACTICE The intervention takes the fundamental motor skills that are deemed necessary for activities of daily life and academic performance and teaches them such that each child has the opportunity to learn them. TARGETED PRACTICE Specific methods such as task analysis, the use of context for motivation, paired learning and modified equipment such as different shaped writing implements.

41 Low Level Intervention 10 weeks intervention 5 weeks intervention - 1 week no intervention - 5 weeks intervention Guidelines distributed every three weeks and queries addressed Informal contact about progress Half way through intervention period short questionnaire to teachers Teachers completed diary/log of sessions with comments

42 Results Frequencies of Impairment - EYMSC Test Below 5% ile % ile N

43 Movement ABC Test Results Movement ABC Test 20 Mean Scores Group 1 Group 2 Group 3 0 Test 1 Test 2 Test

44 Conclusions Low level intervention programmes for children identified with problems have been found to be effective. Children who received low level intervention programmes have shown significant improvement in their motor skills. Cautiously optimistic that children in the age range of 3 to 5/6 years of age can be helped in the development of their motor skills.

45 Case Study 3.05 year old boy, Harry Reported by teachers as a bright, cooperative child Initial EYMSC score of 53 (between the 5th and 15th %ile) Scores Recreational Skills Classroom Skills Desk Skills Self Help Skills EYMSC Sections

46 Developing a Profile Strengths Difficulties Priorities

47 Analysis of EYMSC Difficulties displayed in: manual dexterity fine motor skills manipulative skills poor judgement of force for aiming, catching and striking balancing skills large movements

48 Strengths Bright child, cooperative Likes to contribute in class Enjoys small group work Popular member of the class

49 Priorities Interview with teacher and parents Fine motor skills Handwriting Manipulative skills Balancing skills

50 Principles of Intervention in the Early Years Opportunity of Experience A fundamental principle is the one surrounding experience; that a child must be given the opportunity to engage in those motor activities normally experienced in the early years.

51 Principles of Intervention in the Early Years Accurate assessment to identify the nature of the difficulty Priorities Active participation of the child Knowing and doing Little and often Variety of practice Meaningful and enjoyable Adapting and analysing tasks Expert Scaffolding

52 Activities Encourage Harry to sit still while listening to instructions. Get him to repeat instructions before he starts an activity to help him remember the sub-components of an activity In all activities ensure that Harry understands what he has to do, give him plenty of practice and provide feedback praise him for what he has done well, moving on to what he can do next to build on that success. Try and encourage Harry to begin to evaluate his performance - providing feedback for himself and eventually enabling him to make adjustments to tasks as he feels necessary.

53 Activities: Fine Motor Skills, Manipulative Skills Weeks 1 3 Paper crumpling and tearing Playdoh activities that require pinch e,g, making spines for hedgehogs etc. Link up toys e.g. pop apart beads, Lego, magnetic blocks Threading activities start with large objects (e.g. a cotton reel) gradually moving onto smaller objects (beads, buttons etc.). Introduce variation in the activities e.g. size of objects, speed at which activities are completed.

54 Activities: Fine Motor Skills, Manipulative Skills Weeks 4 5 Continue activities from Weeks 1 3 and introduce variation in the activities e.g. size of objects, speed at which activities are completed Picking up objects using tweezers (start with smallish objects, gradually moving on to very small objects) Bursting bubbles in bubble wrap When Harry is a little more confident with these activities, introduce a time element - see how quickly he can complete the activities. Perhaps, partner him with another child and introduce an element of cooperation and competition.

55 Activities: Fine Motor Skills, Manipulative Skills Weeks 6 8 Continue activities from Weeks 1 3 and Weeks 4 5. Continue to introduce variation in the activities e.g. size of objects used, speed at which the activities are completed. Bursting bubbles in bubble wrap see how many Harry can burst in 1 minute. Play card games - picking up cards, dealing and holding them are good for manual dexterity. Play any game appropriate to the child to train several skills at once e.g. pairs is a good visual memory training game as well as improving manual dexterity. As previously, partner him with another child and introduce an element of cooperation and competition.

56 Activities: Fine Motor Skills, Manipulative Skills Weeks 9 10 Continue activities from previous weeks and continue to introduce variation in the activities. Cutting skills: encourage Harry to use scissors. Begin with simple snips at the edge of a card make a fringe, make a centipede. Draw two black lines half an inch apart and get him to cut between them. Reduce the distance between the lines and eventually follow the line. Introduce variable practice i.e. setting up situations which require Harry to perform the same action in slightly different ways each time, partner with another child and introduce an element of cooperation and competition etc., vary the size of objects used, the speed at which activities are done and introduce an element of time constraint

57 Early Years Movement Skills Checklist Scores Section 1 (Self Help Skills) Self Help Skills 14 S c o r e s Test 1 Test 2 Test 3

58 Early Years Movement Skills Checklist Scores Section 2 (Desk Skills) Desk Skills S c o r e s Test 1 Test 2 Test 3

59 Early Years Movement Skills Checklist Scores 60 S c o r e s Test 1 Test 2 Test 3 EYMSC Assessments Movement ABC Test Total Score 3

60 Acknowledgements Grateful thanks to All the teachers, parents and children who have participated in this study over the last 18 months and to