Sensory and Motor Interventions for Very Early School-age Children: a Cluster Pragmatic Randomised Controlled Trial Examining Effect on Development, Behaviour and Academic Learning Outcomes.

Sensory and motor interventions are implemented in schools with the aim to improve children's development, behaviour and academic learning outcomes, albeit with limited research evidence of effect. These are particularly used as an early intervention with very early school-age children in an effort to ease the transition to formal schooling and enhance school readiness. This thesis presents a six-phase study undertaken to examine the effect of one such intervention. The aim of this study was to determine any effect from a mixed sensorimotor and sensory integration group intervention, on early academic skills and cognitive, behavioural and socioemotional development of very early school-age children in the school setting, by using a two-year, un-blinded, cluster randomized controlled trial. A scoping exercise undertaken in Phase 1 determined the nature and extent of intervention use within schools in the study setting. A literature review, undertaken as Phase 2, identified a variety of intervention types and approaches, narrowing the focus to those using an impairment-orientation approach to intervention, with particular focus on those using a sensory integration frame of reference or mixed sensorimotor approach. A scoping review of published and unpublished research trials of interventions, undertaken in Phase 3, identified a suitable intervention to use in a research trial. The Learning Connections School Program is classifiable as a mixed sensorimotor and sensory integration group intervention using an impairment-orientation approach, where some type of learning, behavioural or developmental impairment is assumed for many children within the general school population. In Phase 4, an evaluative literature review determined suitable measurement instruments to use in a trial. The Astronaut Invented Spelling Test (2nd ed.) and the Sutherland Phonological Awareness Test – Revised were selected for their Australian norms, low cost and high usability to measure early language skills. The Draw a Person test met suitability requirements to measure cognition, with universal norms, use in international research, high usability and low cost. The Behavior Assessment System for Children (2nd ed.) - Teacher Rating Scales was selected for its high technical adequacy, excellent computerised scoring and familiarity to members of the research team. Two sets of brief, multiple-proficiency mathematics measures, Early Mathematics Concepts A and B (EMCA, EMCB), were specifically developed for this study. These included mathematical computation concepts suitable to the two age-groups in the trial. A pilot study undertaken in Phase 5 enabled pilot-testing of the selected instruments and intervention in the study setting, to confirm the suitability and feasibility of their use within the study setting for a research trial. In Phase 6, a two-year cluster pragmatic un-blinded randomised controlled trial was conducted in 2012 and 2013. Schools (n = 116) in one large Catholic Church Archdiocese in Brisbane, Queensland with at least one Prep class, the first year of formal schooling, were eligible to participate in the research trial, with recruitment via email invitation to School Principals. Ethical approval was obtained from the Australian Catholic University Human Research Ethics Committee and further approval for a research trial was obtained from Brisbane Catholic Education. School principals, teachers and parents provided consent to participate, while assent from children was also sought as a form of respect and engagement. Following consent, 480 children across ten schools participated. The intervention, The Learning Connections School Program, was implemented for 20 minutes daily in the classroom by the trained class teacher for the intervention arm (n = 286), while children in the control arm (n = 194) attended schooling as usual (no intervention). Multivariable analysis using the Generalized Estimating Equations modelling approach and accounting for the effects of clustering and time, showed a positive effect for intervention on two mathematics skills measures (EMCA, EMCB). Children in the intervention arm were significantly more likely to have higher scores in mathematics compared to those in the control arm (p < 0.05). Despite a relatively large incidence-rate ratio for EMCA (3.9, 95%CI 1.45-11.02), the crude effect of the intervention on math scores was small (Cohen’s d=0.21). No effect was seen for gender, location, school socioeconomic/educational advantage score, or on measures of early language development, drawing or developmental and behavioural outcomes, despite anecdotal teacher reports of enhanced school-readiness. This study adds Level 1.c evidence in regard to such interventions in school settings. The practical significance of small absolute differences in test scores needs to be considered with regard to intervention funding in each school setting. Despite being a group, low-cost, easy-to-implement early intervention, it is difficult to recommend sensorimotor interventions based on such limited evidence of effect. Further research should focus on visuospatial integration, which may influence mathematical achievement, and specific school-readiness intervention effects