The feasibility of a strategy for the remote recruitment, consenting and assessment of recent referrals: a protocol for phase 1 of the On-Line Parent Training for the Initial Management of ADHD referrals (OPTIMA).

BACKGROUND: In the UK, children with high levels of hyperactivity, impulsivity and inattention referred to clinical services with possible attention-deficit/hyperactivity disorder (ADHD) often wait a long time for specialist diagnostic assessment. Parent training (PT) has the potential to support parents during this difficult period, especially regarding the management of challenging and disruptive behaviours that often accompany ADHD. However, traditional face-to-face PT is costly and difficult to organise in a timely way. We have created a low-cost, easily accessible PT programme delivered via a phone app, Structured E-Parenting Support (STEPS), to address this problem. The overall OPTIMA programme will evaluate the efficacy and cost-effectiveness of STEPS as a way of helping parents manage their children behaviour while on the waitlist. To ensure the timely and efficient evaluation of STEPS in OPTIMA, we have worked with children's health services to implement a remote strategy for recruitment, screening and assessment of recently referred families. Part of this strategy is incorporated into routine clinical practice and part is OPTIMA specific. Here, we present the protocol for Phase 1 of OPTIMA-a study of the feasibility of this remote strategy, as a basis for a large-scale STEPS randomised controlled trial (RCT). METHODS: This is a single arm observational feasibility study. Participants will be parents of up to 100 children aged 5-11 years with high levels of hyperactivity/impulsivity, inattention and challenging behaviour who are waiting for assessment in one of five UK child and adolescent mental health or behavioural services. Recruitment, consenting and data collection will occur remotely. The primary outcome will be the rate at which the families, who meet inclusion criteria, agree in principle to take part in a full STEPS RCT. Secondary outcomes include acceptability of remote consenting and online data collection procedures; the feasibility of collecting teacher data remotely within the required timeframe, and technical difficulties with completing online questionnaires. All parents in the study will receive access to STEPS. DISCUSSION: Establishing the feasibility of our remote recruitment, consenting and assessment strategy is a pre-requisite for the full trial of OPTIMA. It can also provide a model for future trials conducted remotely.

Correction: Ceiling effects in the Movement Assessment Battery for Children-2 (MABC-2) suggest that non-parametric scoring methods are required.

[This corrects the article DOI: 10.1371/journal.pone.0198426.].

Ceiling effects in the Movement Assessment Battery for Children-2 (MABC-2) suggest that non-parametric scoring methods are required.

Initially designed to identify children's movement impairments in clinical settings, the Movement Assessment Battery for Children-2 (MABC-2) is also widely used to evaluate children's movement in research. Standardised scores on the test are calculated using parametric methods under the assumption of normally-distributed data. In a pilot study with thirty five 8-10 year old children (i.e., in Age Band 2 of the MABC-2), we found that maximal performance was often reached. These 'ceiling effects' created distributions of scores that may violate parametric assumptions. Tests of normality, skew, and goodness-of-fit revealed this violation, most clearly on three of the eight sub-tests. A strong deviation from normality was again observed in a sample of 161 children (8-10 years, Experiment 1), however ceiling effects were reduced by modifying the scoring methods, and administering items designed for older children when maximal performance was reached. Experiment 2 (n = 81, 7-10 years) further refined the administration and scoring methods, and again improved the distributions of scores. Despite reducing ceiling effects, scores remained non-parametrically distributed, justifying non-parametric analytic approaches. By randomly and repeatedly resampling from the raw data, we generated non-parametric reference distributions for assigning percentiles to each child's performance, and compared the results with the standardised scores. Distributions of scores obtained with both parametric and non-parametric methods were skewed, and the methods resulted in different rankings of the same data. Overall, we demonstrate that some MABC-2 item scores are not normally-distributed, and violate parametric assumptions. Changes in administering and scoring may partially address these issues. We propose that resampling or other non-parametric methods are required to create new reference distributions to which an individual child's performance can be referred. The modifications we propose are preliminary, but the implication is that a new standardisation is required to deal with the non-parametric data acquired with the MABC-2 performance test.

Online Control of Prehension Predicts Performance on a Standardized Motor Assessment Test in 8- to 12-Year-Old Children.

Goal-directed hand movements are guided by sensory information and may be adjusted 'online,' during the movement. If the target of a movement unexpectedly changes position, trajectory corrections can be initiated in as little as 100 ms in adults. This rapid visual online control is impaired in children with developmental coordination disorder (DCD), and potentially in other neurodevelopmental conditions. We investigated the visual control of hand movements in children in a 'center-out' double-step reaching and grasping task, and examined how parameters of this visuomotor control co-vary with performance on standardized motor tests often used with typically and atypically developing children. Two groups of children aged 8-12 years were asked to reach and grasp an illuminated central ball on a vertically oriented board. On a proportion of trials, and at movement onset, the illumination switched unpredictably to one of four other balls in a center-out configuration (left, right, up, or down). When the target moved, all but one of the children were able to correct their movements before reaching the initial target, at least on some trials, but the latencies to initiate these corrections were longer than those typically reported in the adult literature, ranging from 211 to 581 ms. These later corrections may be due to less developed motor skills in children, or to the increased cognitive and biomechanical complexity of switching movements in four directions. In the first group (n = 187), reaching and grasping parameters significantly predicted standardized movement scores on the MABC-2, most strongly for the aiming and catching component. In the second group (n = 85), these same parameters did not significantly predict scores on the DCDQ'07 parent questionnaire. Our reaching and grasping task provides a sensitive and continuous measure of movement skill that predicts scores on standardized movement tasks used to screen for DCD.