Assessment and Exercise Interventions in Early and Middle Childhood Development

Original Editor - Jess Bell based on the course by Tracy Prowse
Top Contributors - Jess Bell, Wanda van Niekerk, Tarina van der Stockt, Kim Jackson, Aminat Abolade, Cindy John-Chu and Olajumoke Ogunleye

Introduction

In recent years, the number of children being diagnosed with developmental disabilities has increased. It is, therefore, important that therapists and teachers are able to screen children for any difficulties, which may affect a child's readiness to participate in school or sport. This page discusses a number of quick assessments that can be used to screen children and also looks at ways to increase a child's engagement in physical activity.

PhysiFun Checklist

The PhysiFun checklist has been developed to highlight to the teacher / therapist if a particular student needs help with specific activities. It is also a useful feedback tool for parents:

• Class list check
  • Completed by the teacher and takes approximately 10 minutes
• Grade / Year 0 - 1 check
  • Completed by either the parent or the teacher and takes approximately 5 minutes
• Quick tests (listed in Table 1)
  • Checked each term
• Specific assessments for the delayed child
  • Always refer for one on one physiotherapy if a child is severely delayed

Table 1. Quick Tests

Skill	4 years	5 years	6 years
Stand on 1 leg (seconds)	7	10	15
Walk heel to toe on a line (steps)	4	5	6
Knee push up in 30 secs (repetitions)	3 to 5	6 to 10	11 to 15

Specific Tests

The following balance, strength and activity tests can also be used to quickly identify if a child has any deficits:

• Standing on one leg:
  • Children aged 4 years tend to be able to hold this position for 7 seconds
  • Children aged 5 years for 10 seconds
  • Children aged 6 years for 15 seconds

• Walking heel to toe on a line:
  • Children aged 4 years tend to be able to take 4 steps
  • Children aged 5 years, 5 steps
  • Children aged 6 years, 6 steps

• Number of knee push ups in 30 seconds:
  • Children aged 4 years, tend to be able to do 3 to 5 repetitions
  • Children aged 5 years, 6 to 10 repetitions
  • Children aged 6 years, 11 to 15 repetitions

• The plank test can also be used to assess torso strength in children aged 8 to 12 years:
  • Children aged 8 to 10 years can typically hold this position for 69 to 108 seconds
  • Children aged 11 to 12 years can typically hold for 86 to 127 seconds

• Taking a daily step count using a pedometer can also be used as a measure of physical activity:
  • Children aged 6 to 19 years take an average of around 12,000 steps per day:
    • Girls average 11,000 to 12,000 steps
    • Boys average 13,000 to 15,000 steps

• Supine flexion (i.e. lie on back and bring knees to chest and lift head up):
  • Children aged 3 years should be able to hold this position for around 15 seconds
  • Children aged 4 years hold for around 17 seconds
  • Children aged 5 years hold for around 27 seconds
  • Children aged 6 years hold for around 53 seconds

• Prone extension test (i.e. lifting arms, head and legs off floor):
  • Children aged 4 years should be able to hold this position for around 18 seconds
  • Children aged 6 years should be able to hold for around 29 seconds
  • Children aged over 8 years should be able to hold for over 30 seconds

• Push-ups:
  • Children aged 5 and 6 years should be able to complete 3 repetitions
  • Children aged 7 years should be able to complete 4 repetitions
  • Children aged 8 years should be able to complete 5 repetitions

• Curl up (i.e. a sit up with legs straight):
  • Children aged 5 and 6 years should be able to do 2 repetitions
  • Children aged 7 years should do 4 repetitions
  • Children aged 8 years should do 6 repetitions

Monitoring Effectiveness

It is important to consider your aims when monitoring the effectiveness of an intervention (see below). The above tests can be repeated every few months in order to measure changes following an intervention. There is also a range of outcome measures that can assess specific areas.

• For increasing physical activity, literacy and fitness, the following tools can be used as both assessment and outcome measures:
  • Canadian Assessment of Physical Literacy
  • Progressive Aerobic Cardiovascular Endurance (PACER) Run (similar to a beep test)
  • PANIC Physical Activity Questionnaire
• For assessing motor coordination skills (i.e for developmental coordination disorder), the following can be used as both assessment and outcome measures:
  • Movement ABC and Movement ABC Checklist
  • Bruininks Oseretsky Test (BOT) and BOT2

• For improving concentration, self-regulation and social participation:
  • The Strength and Difficulties Questionnaire is a freely available self-report assessment tool

• For improving the experience of the child in all aspects of life (i.e. an ecological intervention), it is important to use intervention outcome measures that look at the environment, task and child. Examples include:
  • School Function Assessment
  • Goal Attainment Scaling (GAS)

Intervention

For children who need more input in their physical development, it can be useful to introduce an ecological intervention - i.e. an intervention that happens as part of the child's routine, ideally as part of their school day.

Key Benefits of Classroom Integration

There is a need for interventions that:

• Are cost-effective
• Are easy to implement during school hours
• Address gross motor difficulties, postural problems, poor physical activity participation levels and concentration difficulties during school hours
• Can be implemented “little and often”

Physical Activity Guidelines

The following guidelines are based on recommendations by the World Health Organisation:

• Children aged 5 to 18 years should engage in:
  • Moderate (5-6/10) to vigorous activity (8/10) for 60 minutes per day
  • Screen time should be less than 2 hours

• Children aged 3 to 5 years should aim for:
  • 3 hours of exercise per day
  • Screen time should be less than 1 hour

• Children’s physical activity should include a variety of aerobic activities, including some vigorous activity
• On at least 3 days per week, children should engage in activities that strengthen muscle and bone
• To achieve additional health benefits, children should engage in more activity – up to several hours per day

Components of a Physical Activity Intervention

An exercise intervention should address all the key areas of a child's development and exercises should include a variety of skills. The following aspects should be included:

• Warm-up activities based on:
  • Injury prevention strategies
  • Targeting health benefits
  • Targeting the cognitive benefits of short bursts of vigorous activity  
• General core and body strengthening exercises to:
  • Prevent injury
  • Prevent pain associated with hypermobility / ligament laxity
  • Prevent fidgeting and improve postural control for learning
  • Increase upper body strength to help with handwriting
  • Increase lower body strength for playground and sport activities
• Fundamental movement / motor skills to help achieve:
  • Lifelong enjoyment in sport
  • These skills include jumping, standing on one leg, hopping, skipping, galloping, catching, throwing and rolling a ball etc
• Self regulation and executive attention skills through:
  • Mindfulness training during yoga and mobility movements and postures
• Inclusion of all children regardless of physical capability, through:
  • Understanding of the difficulties faced by some children through the education and empowerment of teachers and coaches
  • Coaches and teachers should be taught to choose appropriate activities that are tailored to a child’s specific ability and needs
• Children should be encouraged to have self efficacy and self esteem about their physical capabilities - coaches should also be taught methods to develop these skills

The following video includes a demonstration of a PhysiFun training session.

Warm-Up

A warm-up should include:

• Half or three-quarters speed jogging and backwards jogging
• Mild jog with high knees, skipping, butt kicks and toe reaching
• Crawling calf stretch
• Lunges with twist
• Walking quadriceps stretch

Active, dynamic mobility exercises are essential in a warm-up. Children should be encouraged to move through the range of motion required for a specific sport. If a child does not have the range of motion / flexibility required for a sport, they should be encouraged to stretch during the cool-down or at home.

A warm-up should also include three-quarter speed sport-specific coordination training (i.e. anything that challenges balance / stability and agility such as bounding, hopping and diagonal cutting).

Some strengthening exercises should be included. It is particularly important to include exercises that focus on muscles that tend to become strained in the child's preferred / regular sport (such as the hamstrings or groin muscles).

Cool-Down

The cool-down should include static stretches and children should be allowed time to drink fluid.

NB: Dynamic stretches facilitate movements similar to those during play. They raise muscle tissue temperature in the body, increase blood flow and activate the nervous system, thus preparing the body for movements during play.

Strength Training

Strength training should be included in programmes for children. Both general and core strength training should be included. NB: any basic strength training will also train the core.

• Strength training should be introduced prior to power training, so that young athletes develop sufficient strength for power training activities
• Strength training may help children to develop fundamental movement skills

• Basic running around or chasing activities encourage endurance adaptations in the core (and other systems)
• Three bouts of high intensity activity (one minute long, 60 to 95 percent maximum effort) should be included in a programme in order to achieve the potential cognitive and metabolic benefits of exercise
  • High intensity exercise has been found to benefit inhibition and working memory in children

Summary

• Children should be assessed for any developmental difficulties
• Quick assessments can be completed by teachers or parents
• If needed, children can be referred for physiotherapy
• Interventions should be designed to safely increase a child's physical activity