Educator-Led Screening to Identify 4-Year-Old Children At-Risk of Motor Delay: A Mixed Methods Convergent Study.
Laura Brown, Amanda Bacon, Annie Chappell and 3 others
Trained childcare educators can screen four-year-olds for motor delay; their scores matched physiotherapists' exactly on co-scored assessments.
But 34 of 51 children flagged as at-risk likely reflects parents seeking confirmation, not true prevalence.
Key findings
1After training and initial physiotherapist support, 13 early childhood educators performed the TMC motor screening on 51 children, with 100% agreement between educator and physiotherapist scoring on all subarea and total scores.
234 of the 51 children scored below the at-risk threshold (less than 9 out of 11), though the authors note this high rate likely reflects parents enrolling children they already suspected had motor concerns, rather than a representative sample.
3Educators reported needing additional training on how to communicate results to families and how to support at-risk children after screening, which the current training package does not include.
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What it does not show
Only 13 educators and 51 children, recruited by convenience from two cities; the authors themselves flag the small sample and limited generalisability. Ten of the 13 educators had more than 10 years' experience in childcare, so the findings may not apply to newer or less experienced educators. Educators came from privately funded centres and were described as highly motivated, which may not reflect the wider educator population. The high at-risk rate (34 of 51) is likely inflated by selection bias: parents who enrolled probably already had concerns and the free assessment gave them a reason to seek confirmation. Only two open-ended survey questions generated the qualitative data, so educators were not prompted to comment on each feasibility domain individually. The 100% agreement figure comes from a single co-scored assessment per educator (13 total), not from all 51 screenings.
Declared interests
No external funding; supported by an internal research fellowship (salary grant for 3 months). Amanda Bacon developed the TMC in 2011 and uses it in her private practice. Laura Brown and Amanda Bacon are in the process of accrediting health and non-health professionals to use the TMC for a fee. The two physiotherapists who trained the educators and co-scored assessments were also authors of the study. Three other authors declared no conflicts.
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