Have the Fundamental Movement Skills of U.S. Children Changed?

Purpose: By using four national data sets, this study aimed to examine the changes in U.S. children's fundamental movement skills (FMS) from 1985 to 2019. Method: Three Tests Gross of Motor Development (TGMD) normative studies, i.e. TGMD-1 (N = 909, male% = 50), TGMD-2 (N = 1143, male% = 50) and TGMD-3 (N = 864, male% = 51), and the TGMD-2 data of the 2012 NHANES National Youth Fitness Survey (NNYFS-2012; raw N = 352, national represented population = 12,509,706, male% = 51) were used for analyses. Each item in TGMD-2/NNYFS and TGMD-3 was carefully examined, and these that did not match to TGMD-1 were deleted. Cohen's D effect size (ES) was utilized for the difference among year-to-year comparisons. Result: From 1985 to 2000, FMS in US children of 3-7 years old (90% increase & 10% no change) increased temporarily, but remained stable (17% increase & 83% no change) among 8-10 years old. Between 2000 and 2019, however, U.S. children began to demonstrate a slight/stable drop in FMS among 3-5 years old (22% decrease & 78% no change), and a distinct decline among 6-10 years old (80% decrease & 20% no change). While children with normal BMI showed the highest FMS score, the direct cause of reduction in FMS is still unknown. Conclusion: An overall up-and-down change was observed in U.S. children's FMS between 1985 and 2019, and more longitudinal studies with FMS-related variables are needed.

Assessing the Satisfaction and Acceptability of an Online Parent Coaching Intervention: A Mixed-Methods Approach.

Background: Parent-mediated intervention (PMI) has been studied in promoting skill acquisition or behavior change in the children with autism spectrum disorder. Most studies emphasize on the improvement of child's core symptoms or maladaptive behaviors, making parental perceived competence and self-efficacy secondary. Yet, the evaluations of intervention implementation are under-reported, especially when translating such interventions into a new population or context. This research investigated the intervention implementation of a 12-week parent coaching intervention which was delivered through telehealth and tailored to Chinese population. The intervention was based on the Parent-mediated Early Start Denver Model with culturally adapted lectures, manuals, and demonstration and commentary videos. This study aimed to evaluate the intervention implementation by assessing parents' satisfaction, acceptability, appropriateness, and feasibility. Method: A randomized controlled trial was conducted with two telehealth conditions: self-directed and web+group therapy. Parents in the self-directed condition received intervention individually through the online learning platform. The web+group therapy condition navigated the same program with weekly 1.5-h group coaching sessions via videoconferencing. This mixed-methods study used a concurrent convergent design to evaluate the intervention implementation at post-intervention. The quantitative data was collected from the Program Evaluation Survey and the qualitative data was collected from five focus groups. Results: Parents in self-directed group reported significantly lower scores in total perceived competence than parents in web+group therapy condition, while there was no group difference on the total self-efficacy. Tailored feedback, demonstration and commentary videos, peer commenting, live coaching, and guided reflection were the top-five acceptable telehealth strategies that were strongly endorsed by parents. Family centered care, home-based intervention, strategies relative to daily activities, the remote learning platform, and the program-based community were elements that parents considered when evaluating the program's appropriateness. Parent modeling, step-by-step instructions, and tailored feedback were key components in making intervention strategies feasible for parents to implement at home. Conclusion: Findings indicate the application of telehealth was acceptable, appropriate, and feasible for Chinese parents. Group-based parent coaching intervention via videoconferencing could be a promising home-based service model to increase parental perceived competence. A large-scale RCT is needed to investigate the effectiveness of group-based PMI via telehealth.

Relations among parent-reported physical activity and interoception in children.

BACKGROUND: Interoception is the sense of one's internal body and emotional state; it plays a critical role in guiding self-regulatory behaviors. Physical activity (PA) can support interoceptive processes, but limited research has examined the association in children. This study explored the relations among parent-reported PA and several interoceptive domains in children aged 3 - 10 years old. METHODS: Baseline data were analyzed from a cluster-randomized controlled study examining a yoga intervention (N = 122). Parents completed a questionnaire that included the Caregiver Questionnaire for Interoceptive Awareness, Second Edition (CQIA-2) and two measures of PA, the PROMIS Parent-Proxy Short Form (PROMIS-PA) and the adapted Burdette Proxy Report (aBPR-PA). Psychometrics of the CQIA-2 subscales were assessed and then used in subsequent analyses to examine the association between PA and interoceptive sensibility. RESULTS: Seventy percent of the surveys were completed by mothers (30% by fathers), and their children (56% female, Mage = 5.81 ± 1.7 years) were predominately white. Across all children, PA had a significant positive relationship with interoceptive domains related to emotion and physical energy (p < 0.01). Children who met the PROMIS-PA "good" cutoff had a clearer sense of emotion and physical energy (F(2,115) = 4.30, p = 0.016, R2 = 0.070), compared to children who did not. Children's age predicted interoceptive sensibility of illness and toileting needs (F(1,116) = 14.16, p < 0.001, R2 = 0.109). CONCLUSION: Children with higher PA levels were perceived to have better interoceptive sensibility of emotion and physical energy. Children's age was predictive of interoceptive domains representing the awareness of illness and toileting needs. Future work should consider incorporating direct measures of PA and child-reported interoceptive sensibility. A better understanding of their relationship will likely help guide the design of more effective interventions for health behavior development.

Using process- and product-oriented measures to evaluate changes in motor skills across an intervention.

The purpose of this study was to: (1) determine if process- and product-oriented measures similarly evaluate changes in motor skills across an intervention and (2) examine the relationship between preschoolers' motor skills when assessed using process-oriented and product-oriented measures before (pretest) and after (posttest) the intervention. Preschoolers (n= 65, M age= 4.6±0.42 years) completed both process- and product-oriented measures of six FMS- run, hop, jump, catch, throw, and kick, before and after a high-autonomy motor skill intervention. Aggregate total, locomotor, and ball skills, as well as each individual skill, were examined. Children demonstrated improvements in process-oriented (p<0.01) skills, but only improved on the product hop, throw, and kick (p<0.001) after the intervention. Children's ranks on process- and product-oriented measures were correlated at pretest (r s = 0.28-0.72) and posttest (r s = 0.39-0.68). Therefore, process- and product-oriented measures assess different aspects of motor competence and do not equally evaluate intervention efficacy.

The Instructional Sensitivity of the Test of Gross Motor Development-3 to Detect Changes in Performance for Young Children With and Without Down Syndrome.

The Test of Gross Motor Development is among the most commonly used measures of gross motor competency in children. An important attribute of any developmental assessment is its sensitivity to detect change. The purpose of this study was to examine the instructional sensitivity of the Test of Gross Motor Development-third edition (TGMD-3) performance criteria to changes in performance for 48 children (age 4-7 years) with and without Down syndrome following 10 weeks of physical education. Paired t tests identified significant improvements for all children on locomotor (p < .01) and ball skills (p < .01). These significant differences were associated with moderate to large effect sizes. SEM was low relative to the maximum raw score for each subtest, indicating high confidence in the scores. These findings provide evidence that the TGMD-3 is sensitive to change in performance for children with and without Down syndrome.

Association between Physical Activity and Adiposity in Adolescents with Down Syndrome.

PURPOSE: Obesity is highly prevalent among adolescents with Down syndrome (DS); however, reported associations between body composition and moderate-to-vigorous physical activity (MVPA) have been small and nonsignificant. The purpose of this study was to compare group differences between adolescents with and without DS, including dual-energy x-ray absorptiometry (DXA) measured body composition and accelerometer-measured physical activity, and then examine associations within adolescents with DS. METHODS: Thirty-nine adolescents (22 with DS and 17 typically developing controls) 12-18 yr of age participated in the study. Groups had similar distributions of age, sex, and Tanner pubertal stage. Body composition was assessed by DXA, body mass index (BMI), and BMI percentile. MVPA was measured with ActiGraph GT3X+ accelerometers. RESULTS: Adolescents with DS had significantly higher BMI, BMI percentile, and DXA-derived percent body fat (%BF) as well as lower MVPA compared with controls (P < 0.05). Associations between MVPA and %BF in adolescents with DS were moderate (r = -0.39, P = 0.07) but substantially stronger than BMI (r = -0.19, P = 0.40). However, linear regression analyses identified Tanner stage (ß = -0.77, P < 0.001) and MVPA (ß = -0.34, P = 0.047) as significant predictors of %BF. No relevant associations between body composition and MVPA were observed in adolescents with typical development (P > 0.05). CONCLUSIONS: Our findings suggest that MVPA is associated with adiposity when measured with DXA among adolescents with DS.

Inter- and Intrarater Reliabilities of the Test of Gross Motor Development-Third Edition Among Experienced TGMD-2 Raters.

The purpose of this study was to examine the inter- and intrarater reliabilities of the Test of Gross Motor Development-third edition (TGMD-3). The TGMD-3 was administered to 10 typically developing children. Five raters with experience using the Test of Gross Motor Development-second edition (TGMD-2) scored the digitally recorded performances and then rescored the same performances after a period of 2 weeks. Intraclass correlation (ICC) was used to examine both inter- and intrarater reliabilities of scores. Interrater reliability for the total score, locomotor subscale, and ball skills subscale (ICC: 0.92-0.96) were all excellent, while individual skills (ICC: 0.51-0.93) had fair-to-excellent reliability. Intrarater reliability across all raters was also excellent (ICC: 0.77-0.98) but varied widely for individual raters (ICC: 0.28-1.00) including multiple examples of poor reliability. While raters experienced with the TGMD-2 can produce consistent scores for TGMD-3 total scale and subscales, additional training is needed to improve skill-specific reliability.

Physical Activity Patterns in Infants With and Without Down Syndrome.

PURPOSE: Individuals with Down syndrome (DS) are at greater risk for obesity than their peers who are developing typically. One factor contributing to an early onset of obesity is low levels of physical activity (PA). However, there is little known regarding PA patterns during infancy. METHODS: The purpose of this study was to examine the daily PA patterns in 22 infants developing typically and 11 infants with Down syndrome (aged 1-12 months) using Actigraph GT3X+ (wrist and ankle). RESULTS: No significant differences between groups were identified in PA counts at the ankle. Both groups produced significantly more PA at the wrist than at the ankle and PA counts increased across months in age. CONCLUSION: This study represents an important first step in establishing baseline PA patterns during infancy.

Minimum Accelerometer Wear Time in Infants: A Generalizability Study.

BACKGROUND: Research measuring physical activity behaviors during infancy is critical for evaluation of early intervention efforts to reduce rapid weight gain. There is little known about the physical activity patterns of infants, due in part to limited evidence for measurement procedures. This study sought to determine the minimal number of days and hours of accelerometry needed to reliably measure daily physical activity in infants using Generalizability (G) theory. METHODS: A total of 23 infants (14 female, 9 male) wore an accelerometer on the right ankle and right wrist for 7 days. Data were manually cleaned to remove activity counts not produced by the infant. G theory analyses were conducted on the average counts per epoch. RESULTS: Reliable estimates were observed with at least 2 days (G & Φ = .910) and 12 hours (G = .806, Φ = .803) at the ankle, and with at least 3 days (G & Φ = .906) and 15 hours (G = .802, Φ = .800) at the wrist. CONCLUSIONS: These results provide some of the first guidelines for objective physical activity measurement during infancy. Accelerometer monitoring periods of at least 3 days including all daytime hours appear to be sufficient for reliable measurement.

Gross Motor Development in Children Aged 3-5 Years, United States 2012.

Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which included TGMD-2 scores obtained according to an established protocol. Outcome measures included locomotor and object control raw and age-standardized scores. Means and standard errors were calculated for demographic and weight status with SUDAAN using sample weights to calculate nationally representative estimates, and survey design variables to account for the complex sampling methods. Results The sample included 339 children aged 3-5 years. As expected, locomotor and object control raw scores increased with age. Overall mean standardized scores for locomotor and object control were similar to the mean value previously determined using a normative sample. Girls had a higher mean locomotor, but not mean object control, standardized score than boys (p < 0.05). However, the mean locomotor standardized scores for both boys and girls fell into the range categorized as "average." There were no other differences by age, race/Hispanic origin, weight status, or income in either of the subtest standardized scores (p > 0.05). Conclusions In a nationally representative sample of US children aged 3-5 years, TGMD-2 mean locomotor and object control standardized scores were similar to the established mean. These results suggest that standardized gross motor development among young children generally did not differ by demographic or weight status.

Methodology to Promote Physical Activity Monitoring Adherence in Youth with Autism Spectrum Disorder.

BACKGROUND: Objective physical activity (PA) monitoring via accelerometry is both costly and time consuming. Furthermore, overall adherence to a monitoring protocol is often complicated by disability. Therefore, it is essential that strategies for supporting accelerometer wear for youth with disabilities are maximized. The purpose of this perspective was to provide researchers a set of efficacious PA monitoring strategies based on the retrospective examination of support methodology on adherence rates for youth with autism spectrum disorder (ASD). METHOD: Accelerometer data were collected from 163 participants with ASD in three independent cohorts. Each cohort was provided a varying set of support strategies to help maximize adherence. Chi-square analysis was used to determine differences in adherence between each cohort. RESULTS: Adherence rates significantly increased from 51.9% in cohort 1 to 88.7% in cohort 2 [χ2(1) = 18.333, p < 0.001] and again from 88.7% in cohort 2 to 97.4% in cohort 3 [χ2(1) = 2.663, p = 0.103]. The greatest increase in adherence was observed from 51.9% in cohort 1 to 97.4% in cohort 3 [χ2(1) = 19.837, p < 0.001]. Support strategies associated with these increases included (1) social story, (2) incentive, (3) concealing techniques, and (4) 24 h/day wear instructions. CONCLUSION: Adherence to PA measurement increased when additional support strategies were utilized in combination with a traditional protocol. We recommend these support methodology to be considered as preliminary best practices when measuring objective PA in youth with ASD with likely success in other disability populations.

Acute Effects of a Therapeutic Mobility Device on Physical Activity and Heart Rate in Children With Down Syndrome.

PURPOSE: The purpose of this feasibility study was to provide an opportunity to increase physical activity (PA) and heart rate (HR) for children with Down syndrome (DS) during unstructured group exercise utilizing a riding device called the Power Pumper®. METHOD: Twenty-four children aged 5 to 7 years old participated in this case-control study, including 12 children with DS and 12 children without DS. Those without DS participated as age-matched controls. A 30-min unstructured PA session utilizing the Power Pumper was provided to both groups on 2 occasions. HR and PA were measured at baseline and during both sessions. RESULTS: For children with DS, findings revealed a statistically significant increase in time spent in moderate-to-vigorous PA (MVPA), F(1, 15) = 16.503, p < .010, ES = 0.76, and a nonsignificant increase in HR (ES = 0.41) when comparing exercise session performance to baseline. For children without DS, findings revealed statistically significant increases in time spent in MVPA, F(1, 15) = 73.604, p < .010, ES = 0.94, and HR, F(1, 22) = 34.634, p < .010, ES = 0.69, between exercise and baseline. Total MVPA approached the recommended 60 min following device use. PA and HR differences between baseline and exercise were greater in magnitude for children without DS. CONCLUSION: By participating in unstructured exercise in a social environment using the Power Pumper, children with DS engaged in higher-intensity PA accompanied by a nonsignificant physiological response in HR. These outcomes support PA guidelines recommended by the National Association for Sport and Physical Education. This device supports 1 option for achieving 60 min of MVPA daily.

Motor skills and calibrated autism severity in young children with autism spectrum disorder.

In addition to the core characteristics of autism spectrum disorder (ASD), motor skill deficits are present, persistent, and pervasive across age. Although motor skill deficits have been indicated in young children with autism, they have not been included in the primary discussion of early intervention content. One hundred fifty-nine young children with a confirmed diagnosis of ASD (n = 110), PDD-NOS (n = 26), and non-ASD (n = 23) between the ages of 14-33 months participated in this study.1 The univariate general linear model tested the relationship of fine and gross motor skills and social communicative skills (using calibrated autism severity scores). Fine motor and gross motor skills significantly predicted calibrated autism severity (p < .05). Children with weaker motor skills have greater social communicative skill deficits. Future directions and the role of motor skills in early intervention are discussed.

The relationship of motor skills and social communicative skills in school-aged children with autism spectrum disorder.

Motor skill deficits are present and persist in school-aged children with autism spectrum disorder (ASD; Staples & Reid, 2010). Yet the focus of intervention is on core impairments, which are part of the diagnostic criteria for ASD, deficits in social communication skills. The purpose of this study is to determine whether the functional motor skills, of 6- to 15-year-old children with high-functioning ASD, predict success in standardized social communicative skills. It is hypothesized that children with better motor skills will have better social communicative skills. A total of 35 children with ASD between the ages of 6-15 years participated in this study. The univariate GLM (general linear model) tested the relationship of motor skills on social communicative skills holding constant age, IQ, ethnicity, gender, and clinical ASD diagnosis. Object-control motor skills significantly predicted calibrated ASD severity (p < .05). Children with weaker motor skills have greater social communicative skill deficits. How this relationship exists behaviorally, needs to be explored further.

Physical activity patterns of youth with Down syndrome.

The purpose of this study was to examine the physical activity patterns of children with Down syndrome. A cross-sectional approach and accelerometry were used to measure the time children with Down syndrome (N = 104) spent in sedentary, light, and moderate-to-vigorous physical activity. Results indicated that adolescents from ages 14 to 15 years were the most sedentary and spent the least amount of time in light and moderate-to-vigorous physical activity. A general trend of decreasing physical activity as children increase in age was found. This trend is similar to that found among typically developing youth. Participants in this study were found to spend a majority of their day engaged in sedentary activities. Results indicate that most participants were not accumulating the recommended 60 minutes of moderate or vigorous physical activity.

Physical activity benefits of learning to ride a two-wheel bicycle for children with Down syndrome: a randomized trial.

BACKGROUND: People with Down syndrome (DS) display consistent patterns of physical inactivity. If these sedentary behaviors continue over extended periods of time, there will be negative health consequences. OBJECTIVE: The objective of this study was to investigate the physical activity and health-related outcomes of teaching children with DS to ride a 2-wheel bicycle. DESIGN: This study was a randomized intervention in which the control group waited 1 year to receive the intervention. SETTING: This intervention study was conducted in a community setting. PARTICIPANTS: The participants were children who were 8 to 15 years of age and who had been diagnosed with DS. Intervention The participants were randomly assigned to an experimental group (bicycle intervention) or a control group (no intervention). MEASUREMENTS: Measurements were obtained in the month before the intervention (preintervention), at 7 weeks after the intervention, and at 12 months after the preintervention measurement for all participants. RESULTS: The results indicated no group differences at the preintervention session. Fifty-six percent of the participants in the experimental group successfully learned to ride a 2-wheel bicycle during the 5-day intervention. Analysis showed that participants who learned to ride spent significantly less time in sedentary activity at 12 months after the preintervention measurement and more time in moderate to vigorous physical activity than participants in the control group. Body fat appeared to be positively influenced over time in participants who learned to ride. LIMITATIONS: It is unknown how frequently the children in the experimental group rode their bicycles after the intervention. CONCLUSIONS: Most children who are 8 to 15 years of age and who have been diagnosed with DS can learn to ride a 2-wheel bicycle. Learning to ride can reduce time spent in sedentary activity and increase time spent in moderate to vigorous physical activity, which may influence the health and functioning of these children.

Effects of various treadmill interventions on the development of joint kinematics in infants with Down syndrome.

BACKGROUND: Infants with Down syndrome (DS) have delayed walking and produce less-coordinated walking patterns. OBJECTIVE: The aim of this study was to investigate whether 2 treadmill interventions would have different influences on the development of joint kinematic patterns in infants with DS. DESIGN: Thirty infants with DS were randomly assigned to a lower-intensity, generalized (LG) treadmill training group (LG group) or a higher-intensity, individualized (HI) treadmill training group (HI group) and trained until walking onset. Twenty-six participants (13 in each group) completed a 1-year gait follow-up assessment. METHODS: During the gait follow-up assessment, reflective markers were placed bilaterally on the participants to measure the kinematic patterns of the hip, knee, and ankle joints. Both the timing and the magnitude of peak extension and flexion at the hip, knee, and ankle joints, as well as peak adduction and abduction at the hip joint, in the 2 groups were compared. RESULTS: Both the LG group and the HI group showed significantly advanced development of joint kinematics at the gait follow-up. In the HI group, peak ankle plantar flexion occurred at or before toe-off, and the duration of the forward thigh swing after toe-off increased. LIMITATIONS: Joint kinematics in the lower extremities were evaluated in this study. It would be interesting to investigate the effect of treadmill interventions on kinematic patterns in the trunk and arm movement. CONCLUSIONS: The timing of peak ankle plantar flexion (before toe-off) in the HI group implies further benefits from the HI intervention; that is, the HI group may use mechanical energy transfer better at the end of stance and may show decreased hip muscle forces and moments during walking. It was concluded that the HI intervention can accelerate the development of joint kinematic patterns in infants with DS within 1 year after walking onset.

Physical activity and walking onset in infants with Down syndrome.

Infants with Down syndrome (DS) are described as being less active and they also experience significant delays in motor development. It is hypothesized that early infant physical activity may be influential for the acquisition of independent walking. Physical activity was monitored longitudinally in 30 infants with DS starting at an average age of 10 months participating in a treadmill training intervention. Actiwatches were placed on infants' trunk and right ankle for a 24-hr period, every other month until walking onset. Data were analyzed to separate sedentary-to-light activity (low-act) and moderate-to-vigorous activity (high-act). Results showed that more leg high-act at an average age of 12 and 14 months is related to earlier onset of walking. It is recommended that early leg activity should be promoted in infants with DS.