Sex differences in 3- to 5-year-old children's motor competence: A pooled cross-sectional analysis of 6241 children.

There is some, albeit inconsistent, evidence supporting sex differences in preschoolers' motor competence (MC), with these observations not uniform when analyzed by age, and cultural groups. Thus, this study examined sex differences across ages in 3- to 5-year-old children's MC. A cross-country pooled sample of 6241 children aged 3-5 years (49.6% girls) was assessed for MC using the Test of Gross Motor Development-2nd/3rd edition, and children were categorized into groups of age in months. Multiple linear regression models and predictive margins were calculated to explore how sex and age in months affect scores of MC (i.e., locomotor and ball skills), with adjustments for country and BMI. The Chow's Test was used to test for the presence of a structural break in the data. Significant differences in favor of girls were seen at 57-59 and 66-68 months of age for locomotor skills; boys performed better in ball skills in all age periods, except for 42-44 and 45-47 months of age. The higher marginal effects were observed for the period between 45-47 and 48-50 months for locomotor skills (F = 30.21; and F = 25.90 for girls and boys, respectively), and ball skills (F = 19.01; and F = 42.11 for girls and boys, respectively). A significantly positive break point was seen at 45-47 months, highlighting the age interval where children's MC drastically improved. The identification of this breakpoint provides an evidence-based metric for when we might expect MC to rapidly increase, and an indicator of early delay when change does not occur at that age.

A systematic evaluation of physical activity and diet policies in Scotland: results from the 2021 Active Healthy Kids Report Card.

BACKGROUND: Policymaking regarding physical activity (PA) and diet plays an important role in childhood health promotion. This study provides a detailed examination of Scottish government and policy for child and adolescent PA and diet and discusses strengths and areas for improvement. METHODS: Scottish policy documents (n = 18 [PA]; n = 10 [diet])-published in 2011-20-were reviewed for grading using an adapted version of the Health-Enhancing Physical Activity Policy Audit Tool Version 2. RESULTS: There is clear evidence of leadership and commitment to improving PA and diet and tackling obesity in children and adolescents. The allocation of funds and resources for policy implementation has increased substantially over the past decade. Progress through early key stages of public policymaking-policy agenda and formation-has improved. However, there is limited information on later key stages, including policy monitoring and evaluation. CONCLUSIONS: Childhood PA and diet are a clear priority in Scotland, and PA and diet policies clearly support the desire to achieve other goals, including reducing inequalities and increasing active travel in Scotland. Nonetheless, future policies should be further strengthened through clear(er) plans of implementation, and monitoring and evaluation to support their societal impact.

Results from Scotland's 2021 report card on physical activity and health for children and youth: Grades, secular trends, and socio-economic inequalities.

Background: The 2021 Active Healthy Kids Scotland Report Card aimed to identify secular trends and socio-economic inequalities, and to assess the physical activity and health of children and youth prior to COVID-19. Methods: An expert panel searched for data published in 2018-2020. Grades were assigned to nationally representative data using the Active Healthy Kids Global Alliance methodology. Results: The expert panel, following national consultation, awarded the following grades: Community/Environment B-, Organized Sport and Physical Activity B-, Government/Policy C-/C+, Active Transportation C-, Family/Peers D-, Recreational Screen Time F. Five indicators were graded inconclusive (INC): Overall Physical Activity; Active Play; Physical Fitness; Diet; Obesity. Grades have remained stable or declined, and surveillance has reduced, increasing the number of INC grades. There were marked socio-economic inequalities for eight indicators (Recreational Screen Time; Overall Physical Activity; Organized Sport & Physical Activity; Active Transportation; Diet; Obesity; Family/Peers; Community/Environment). Conclusions: Despite a decade of favorable policy, physical activity and health of children and youth has not improved, and marked socio-economic inequalities continue to persist in Scotland. There is a clear need for greater monitoring of physical activity and health, and improved policy implementation and evaluation, particularly as many indicators and related inequalities may have worsened following the COVID-19 pandemic.

Long-term effectiveness of a fundamental motor skill intervention in Belgian children: A 6-year follow-up.

The aim of this study was (1) to examine the long-term effectiveness of the "Multimove for Kids" program, a 30-week fundamental motor skill intervention (approximately 1 hour per week) for typically developing children between 3 and 8 years, and (2) to determine the influence of participation in organized sports on motor competence (MC) six years after the intervention. Of the 992 children who took part in the "Multimove" program, 399 (intervention group: N = 228, control group: N = 171) were tested again at 6-year follow-up. MC was measured with the Test of Gross Motor Development, 2nd Edition. To examine the long-term impact of "Multimove" on MC, and the effect of participation in organized sports a latent growth curve analysis was conducted. After the 30-week intervention, the intervention group outperformed the control group (ß = 5.57, P < .001). However, when the entire study period, including the 6-year follow-up, was considered, the intervention group made less progress in MC than the control group (ß = -0.41, P < .05). Looking at the engagement in organized sports, it was found that years of experience before the intervention had no significant influence on the evolution of MC over time, whereas a positive effect was observed for children's average sports participation (h/week) during the 6-year retention period (ß = 0.14, P < .001). Finally, children practicing predominantly object control-oriented sports during retention obtained slightly better MC scores at follow-up (ß = 0.01, P < .01). The "Multimove" intervention does not have a long-term effect on the development of MC. However, participation in organized sports has a positive influence on MC evolution over time.

Global levels of fundamental motor skills in children: A systematic review.

Competence in fundamental motor skills (FMS) facilitates physical activity participation and is important for children's holistic development. This study aimed to systematically review the FMS levels of children worldwide, using the Test of Gross Motor Development-2 (TGMD-2). In accordance with PRISMA guidelines, studies were identified from searches across 7 databases. Studies were required to: (i) include typically developing children (3-10 years), (ii) be published in English, (iii) have been published between 2004 and 2019 and, (iv) report ≥1 TGMD-2 outcome scores. Extracted data were evaluated based on importance of determinants, strength of evidence, and methodological quality. Data from 64 articles were included. Weighted mean (and standard deviation) scores were calculated for each FMS outcome score. Analyses revealed FMS competence increases across age during childhood, with greater proficiency in locomotor skills than object control skills. Additionally, boys exhibit higher object control skill proficiency than girls. Compared to TGMD-2 normative data, children demonstrate "below average" to "average" FMS levels. This review highlights the scope for FMS development among children worldwide. These findings reinforce the necessity for FMS interventions in early educational settings, as FMS competence is positively associated with physical activity and other health outcomes.

Comparison of motor competence in children aged 6-9 years across northern, central, and southern European regions.

The present study aimed to examine differences in motor competence (MC) in children aged 6-9 years old in northern, central, and southern European regions using the Körperkoordinationstest für Kinder (KTK). The secondary aim of the study was to examine interactions between region and children's age, sex, and weight status (determined as healthy weight or overweight/obese). Data were pooled from independent studies conducted in Finland (mean age 7.81 ± 1.19 years, n = 690), Belgium (mean age 8.25 ± 1.09 years, n = 1896), and Portugal (mean age 8.31 ± 1.02 years, n = 758) between 2008 and 2016. Cross-cultural differences in MC and interaction effects were tested using ANOVAs and ANCOVAs. Age, sex, and BMI percentile were used as covariates. Geographical region significantly explained 19% of the variance in MC, while BMI (5%), sex (3%), and age (0.3%) were significant covariates. The interaction effect of region and age (5%), region and sex (0.6%), and region and BMI (0.2%) on MC was also significant. Cross-cultural differences in children's MC increased substantially across age, independent of weight status. Girls slightly underperformed in MC compared to boys in regions where the overall level of MC was lower. Interestingly, the association between body weight status and MC was relatively consistent across the regions. Future cross-cultural studies should further explore the influence of individual (eg, physical activity) and environmental (eg, physical activity and sport policy) factors on MC development.

Assessing the acceptability of an adapted preschool obesity prevention programme: ToyBox-Scotland.

BACKGROUND: Childhood obesity is a global public health issue. Interventions to prevent the onset of obesity in the early years are often implemented in preschool settings. The ToyBox intervention was delivered across Europe and targeted energy balance-related behaviours in preschools and children's homes through teacher-led activities and parental education materials and was adapted for use in Scotland. This study assessed the acceptability of the 18-week adapted intervention to both parents and teachers. METHODS: Mixed methods were employed to collect both qualitative and quantitative data. Preschool staff and children's parents/caregivers completed post-intervention feedback surveys, from which acceptability scores were calculated and presented as proportions. Focus groups were conducted with preschool staff, whereas parents/caregivers participated in semi-structured interviews. A thematic analysis was applied to qualitative data following the development of a coding framework. Quantitative and qualitative data were analysed using SPSS and NVivo 10, respectively. RESULTS: Preschool staff rated the intervention as highly acceptable based on post-intervention feedback surveys (80%; mean score 8.8/11). Lower acceptability scores were observed for parents/caregivers (49%; 3.9/8). Nine preschool practitioners participated in focus groups (n = 3). User-friendliness of the intervention materials, integration of the intervention with the curriculum, and flexibility of the intervention were identified as facilitators to delivery. Barriers to delivery were time, insufficient space, and conflicting policies within preschools with regard to changing classroom layouts. Parental interviews (n = 4) revealed a lack of time to be a major barrier, which prevented parents from participating in home-based activities. Parents perceived the materials to be simple to understand and visually appealing. CONCLUSIONS: This study identified a number of barriers and facilitators to the delivery and evaluation of the ToyBox Scotland preschool obesity prevention programme, which should be considered before any further scale-up of the intervention.

Investigating the construct of motor competence in middle childhood using the BOT-2 Short Form: An item response theory perspective.

PURPOSE: Motor assessments generally produce a single motor competence score based on the general motor ability hypothesis, which states that motor competence is a one-dimensional trait underlying a wide range of motor skills. Yet, it is unclear whether the general motor ability hypothesis holds true in middle childhood, which is marked by an increased participation in sports and other types of physical activity. Therefore, the aim of the study was to evaluate the structure of motor competence in middle childhood using a test battery with a large item set. METHOD: A cross-sectional design was used to collect motor competence data of 2538 children aged 6-11 years. Participants completed the Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition Short Form (BOT-2 SF), which consists of 14 skill items and covers different motor domains. In accordance with the BOT-2 SF manual, point scores were computed for each item. Polytomous Rasch analyses (ie, general partial credit model) were carried out to investigate the construct of motor competence. RESULTS: Rasch analyses revealed different items with unordered threshold parameters, due to ceiling effects. However, after empirically rescaling the category width for each item, follow-up analyses revealed a one-dimensional structure with 12 items. CONCLUSION: The study provides some evidence of a one-dimensional construct (ie, motor competence) underlying motor assessment in middle childhood. Continued efforts should be made to ensure that valid composite scores are used in motor assessment and to better understand the development of motor competence across childhood and into adolescence and adulthood.

Children's metabolic expenditure during object projection skill performance: New insight for activity intensity relativity.

Objective: To examine children's energy expenditure (EE) during object projection skill performance at three intensity intervals. Methods: Children's (42, Mage = 8.1) average metabolic equivalents of task (METs) were calculated using a COSMED K4b2 while they repeatedly performed blocks of kicking, throwing (overhand), and striking (two-handed) during 6, 12, and 30-s interval conditions. A repeated-measures analysis of covariance examined differences in METs while controlling for skill level. Results: Data indicated a main effect for interval condition (df = 2, 123, F = 94.36, p <.001, η2 = .605). Post hoc t-tests demonstrated decreasing performance interval times yielded progressively higher METs (p <.001) across the three conditions (30s = 4.5±0.8 METs, 12s = 6.3±1.3, 6s = 8.3±1.6). There also was a main effect for sex (df = 1,120, F = 52.28, p <.001 η2 = .305). Boys demonstrated higher METs at each performance interval (p <.001). Conclusion: Skill practice with a maximum of one trial every 30s resulted in the equivalent of at least moderate physical activity (>4.0 METs) and intervals of 6s demonstrated vigorous physical activity (>7.0 METs). Practicing/performing object projection skills, even at intervals that allow for adequate instruction and feedback (i.e., 1 trial/30s), promotes MVPA in children.

Assessing fundamental motor skills in Belgian children aged 3-8 years highlights differences to US reference sample.

AIM: This study aimed to understand the fundamental motor skills (FMS) of Belgian children using the process-oriented Test of Gross Motor Development, Second Edition (TGMD-2) and to investigate the suitability of using the United States (USA) test norms in Belgium. METHODS: FMS were assessed using the TGMD-2. Gender, age and motor performance were examined in 1614 Belgian children aged 3-8 years (52.1% boys) and compared with the US reference sample. RESULTS: More proficient FMS performance was found with increasing age, from 3 to 6 years for locomotor skills and 3 to 7 years for object control skills. Gender differences were observed in object control skills, with boys performing better than girls. In general, Belgian children had lower levels of motor competence than the US reference sample, specifically for object control skills. The score distribution of the Belgian sample was skewed, with 37.4% scoring below average and only 6.9% scoring above average. CONCLUSION: This study supported the usefulness of the TGMD-2 as a process-oriented instrument to measure gross motor development in early childhood in Belgium. However, it also demonstrated that caution is warranted when using the US reference norms.

Convergent and Divergent Validity Between the KTK and MOT 4-6 Motor Tests in Early Childhood.

The aim of this study was to investigate the convergent and divergent validity between the Body Coordination Test for Children (KTK) and the Motor Proficiency Test for 4- to 6-Year-Old Children (MOT 4-6). A total of 638 children (5-6 yr old) took part in the study. The results showed a moderately positive association between the total scores of both tests (r(s) = .63). Moreover, the KTK total score correlated more highly with the MOT 4-6 gross motor score than with the MOT 4-6 fine motor score (r(s) = .62 vs. .32). Levels of agreement were moderate when identifying children with moderate or severe motor problems and low at best when detecting children with higher motor-competence levels. This study provides evidence of convergent and divergent validity between the KTK and MOT 4-6. However, given the moderate to low levels of agreement, either measurement may lead to possible categorization errors. Children's motor competence should therefore not be judged based on the result of a single test.

Convergent and Divergent Validity Between the KTK and MOT 4-6 Motor Tests in Early Childhood.

The aim of this study was to investigate the convergent and divergent validity between the Body Coordination Test for Children (KTK) and the Motor Proficiency Test for 4- to 6-Year-Old Children (MOT 4-6). A total of 638 children (5-6 yr old) took part in the study. The results showed a moderately positive association between the total scores of both tests (rs = .63). Moreover, the KTK total score correlated more highly with the MOT 4-6 gross motor score than with the MOT 4-6 fine motor score (rs = .62 vs. .32). Levels of agreement were moderate when identifying children with moderate or severe motor problems and low at best when detecting children with higher motor-competence levels. This study provides evidence of convergent and divergent validity between the KTK and MOT 4-6. However, given the moderate to low levels of agreement, either measurement may lead to possible categorization errors. Therefore, it is recommended that children's motor competence not be judged based on the result of a single test.

(Two) Wheels on the Bus: Road User Perceptions of a Bike Bus and How This Links to Addressing Global Health Challenges.

BACKGROUND: Excessive car use hampers progress toward tackling global health challenges, including climate and sustainability issues, and is linked to lower physical activity. Local communities have been developing solutions through bike buses. This paper, one of the first on bike buses, explores how a bike bus is perceived by other road and place users. METHODS: An interdisciplinary survey instrument with dialogic-style questions was distributed on flyers to road and place users on 1 bike bus route including when the bike bus was passing. Responses were thematically analyzed using analytic framing to identify themes and subthemes. This paper focuses on 2 domains related to physical activity's link to the global health challenges of climate change and sustainability issues of excess car traffic: climate actions and community-level activism. RESULTS: Overall, 172 responses were received from 542 distributed flyers (31.8%). The climate actions domain identified a bike bus as a solution that creates a transport mode shift, reduces emissions, and improves air quality. Themes associated with community-level activism domain include perception that a bike bus is a form of activism or a protest and that it is a disruption to the status quo on the roads. CONCLUSIONS: Our findings indicate that this active mobility practice goes beyond the utility of getting children to school and being a way to promote physical activity. A bike bus is seen as local community action that could create a transport mode shift, draw attention to road space allocation, and help tackle global health challenges.

Motor Competence and Body Mass Index in the Preschool Years: A Pooled Cross-Sectional Analysis of 5545 Children from Eight Countries.

BACKGROUND AND OBJECTIVE: One in five preschool children are overweight/obese, and increased weight status over time increases the risks of poorer future health. Motor skill competence may be a protective factor, giving children the ability to participate in health-enhancing physical activity. Yet, we do not know when the relationship between motor competence and weight status first emerges or whether it is evident across the body mass index (BMI) spectrum. This study examined the association between motor skill competence and BMI in a multi-country sample of 5545 preschoolers (54.36 ± 9.15 months of age; 50.5% boys) from eight countries. METHODS: Quantile regression analyses were used to explore the associations between motor skill competence (assessed using the Test of Gross Motor Development, Second/Third Edition) and quantiles of BMI (15th; 50th; 85th; and 97th percentiles), adjusted for sex, age in months, and country. RESULTS: Negative associations of locomotor skills, ball skills, and overall motor skill competence with BMI percentiles (p < 0.005) were seen, which became stronger at the higher end of the BMI distribution (97th percentile). Regardless of sex, for each raw score point increase in locomotor skills, ball skills, and overall motor skill competence scores, BMI is reduced by 8.9%, 6.8%, and 5.1%, respectively, for those preschoolers at the 97th BMI percentile onwards. CONCLUSIONS: Public health policies should position motor skill competence as critical for children's obesity prevention from early childhood onwards. Robust longitudinal and experimental designs are encouraged to explore a possible causal pathway between motor skill competence and BMI from early childhood.

Improving National and International Surveillance of Movement Behaviours in Childhood and Adolescence: An International Modified Delphi Study.

BACKGROUND: The actions required to achieve higher-quality and harmonised global surveillance of child and adolescent movement behaviours (physical activity, sedentary behaviour including screen time, sleep) are unclear. OBJECTIVE: To identify how to improve surveillance of movement behaviours, from the perspective of experts. METHODS: This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from 'extremely' to 'not at all' important. Consensus was defined as > 70% rating of 'extremely' or 'very' important. RESULTS: We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research. CONCLUSIONS: This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally.

Profiles of Physical Fitness and Fitness Enjoyment Among Children: Associations With Sports Participation.

Purpose: The present study examined whether groups of children with different physical fitness and fitness enjoyment profiles could be identified and, if so, whether the different groups varied from one another in terms of organized sports participation. Method: Five hundred and fifty-eight 8-11-year-olds (56.99% boys) participated in this cross-sectional study. Physical fitness and fitness enjoyment were assessed with seven items from a standardized test battery and a pictorial scale containing pictures referring to the enjoyment in those seven physical fitness tests, respectively. To examine whether groups with different fitness and enjoyment profiles could be identified, we conducted cluster analyses based on children's standardized physical fitness and fitness enjoyment scores. A two-way ANCOVA (sex*cluster) was conducted to investigate differences in weekly organized sports participation among each of the identified groups while controlling for age. Results: Cluster analyses revealed two groups with aligned levels of physical fitness and fitness enjoyment (i.e., relatively low-low and relatively high-high) and two groups with unaligned levels (i.e., relatively low-moderate and relatively high-moderate), respectively. Both groups with relatively high fitness scores were found to spend significantly more time in organized sports (M = 2.01 h and 2.29 h, respectively) than the two groups with relatively low fitness scores (M = 1.08 h and 0.98 h, respectively), irrespective of their enjoyment levels. Conclusion: Increasing physical fitness levels (especially among those children with suboptimal enjoyment levels) may lead to increased organized sports participation, while increased organized sports participation in its turn may lead to higher fitness levels. As such, participation in sports programs should be promoted in children of all age groups.

Learning to Cycle: A Cross-Cultural and Cross-Generational Comparison.

Background: Learning to cycle is an important milestone for children, but the popularity of cycling and the environmental factors that promote the development and practice of this foundational movement skill vary among cultures and across time. This present study aimed to investigate if country of residence and the generation in which a person was born influence the age at which people learn to cycle. Methods: Data were collected through an online survey between November 2019 and December 2020. For this study, a total of 9,589 responses were obtained for adults (self-report) and children (parental report) living in 10 countries (Portugal, Italy, Brazil, Finland, Spain, Belgium, United Kingdom, Mexico, Croatia, and the Netherlands). Participants were grouped according to their year of birth with 20-year periods approximately corresponding to 3 generations: 1960-79 (generation X; n = 2,214); 1980-99 (generation Y; n = 3,994); 2000-2019 (generation Z; n = 3,381). Results: A two-way ANOVA showed a significant effect of country, F(9,8628) = 90.17, p < 0.001, ηp2 = 0.086, and generation, F(2,8628) = 47.21, p < 0.001, ηp2 = 0.122, on the age at which individuals learn to cycle. Countries with the lowest learning age were the Netherlands, Finland and Belgium and countries with the highest learning age were Brazil and Mexico. Furthermore, the age at which one learns to cycle has decreased across generations. There was also a significant country x generation interaction effect on learning age, F(18,8628) = 2.90, p < 0.001; however, this effect was negligible ( ηp2 = 0.006). Conclusions: These findings support the socio-ecological perspective that learning to cycle is a process affected by both proximal and distal influences, including individual, environment and time.

Differences in Weight Status and Autonomous Motivation towards Sports among Children with Various Profiles of Motor Competence and Organized Sports Participation.

This study aimed (1) to identify profiles in children based on actual motor competence (AMC), perceived motor competence (PMC), and organized sports participation (OSP), and (2) to examine differences among these profiles in weight status as well as autonomous motivation towards sports. Children's (N = 206; 112 boys; Mage = 10.83 ± 0.92 years) AMC, PMC, OSP, weight status, and autonomous motivation towards sports were measured using validated assessment tools. Cluster analyses identified three profiles with completely convergent levels of AMC, PMC, and OSP and three profiles with partially convergent levels. Children in the convergent profiles with average to high levels of AMC, PMC, and OSP had the most optimal profile, as they combined a healthier weight status with elevated levels of autonomous motivation, while the opposite was true for children with low levels on all three cluster-variables. Partially convergent profiles showed that AMC and PMC appear crucial for weight status, as profiles with relatively low levels of AMC and PMC had the highest weight status, independent of their OSP levels. Overall, the findings highlight the importance of promoting AMC, PMC, and OSP simultaneously to help children in achieving a healthy weight status and being autonomously motivated towards OSP.

Is Motor Milestone Assessment in Infancy Valid and Scaled Equally Across Sex, Birth Weight, and Gestational Age? Findings From the Millennium Cohort Study.

Is the assessment of motor milestones valid and scaled equivalently for all infants? It is not only important to understand if the way we use gross and fine motor scores are appropriate for monitoring motor milestones but also to determine if these scores are confounded by specific infant characteristics. Therefore, the aim of the study is to investigate the latent structure underlying motor milestone assessment in infancy and measurement invariance across sex, birth weight, and gestational age. For this study, the birth cohort data from the United Kingdom Millennium Cohort Study (MCS) was used, which includes the assessment of eight motor milestone tasks from the Denver Developmental Screening Test in 9-month-old infants (N = 18,531), depicting early motor development of the first children of generation Z. Confirmatory factor analyses showed a better model fit for a two-factor structure (i.e., gross and fine motor development) compared to a one-factor structure (i.e., general motor development), and multiple indicators multiple causes modeling revealed no differential item functioning related to sex, birth weight, and gestational age. The study provides support for the use of gross and fine motor scores when assessing motor milestones in infants-both boys and girls with different birth weights and of varying gestational ages. Further investigation into widely adopted assessment tools is recommended to support the use of valid composite scores in early childhood research and practice.