Premature birth has long-term effects on sensory, motor, and cognitive development. Despite evidence of impaired motor function in young children born preterm, there is less known about motor learning and the characterization of the acquisition and retention of motor skills in this population. Furthermore, bimanual movements, important for performing everyday activities, may be preferentially affected in preterm children. In this study, we compared unimanual and bimanual motor skill learning in young children born preterm compared to children born at term age. Unimanual and bimanual de novo visuomotor learning tasks were implemented on a computerized tablet (Apple iPad). Fifty-five participants (N = 14 preterm), corrected age 5-8 years, completed three testing sessions: initial practice (72 practice attempts), 24-h retention (24 practice attempts), and 7-day retention (24 practice attempts). Speed (completion time) and accuracy (movement path length) characterized motor performance. Learning was determined by comparing performance at the end of initial practice to each retention test. Overall, preterm children exhibited reduced speed and accuracy on both tasks compared to term-born children. All children performed better on the unimanual version of the task. Retention was similar between groups and tasks. Biological age had a small, nonlinear relationship with performance. These results confirm that preterm children have impaired unimanual and bimanual skills but are capable of learning new visuomotor patterns, with potential differences in skill retention. This evidence provides insight into the varied trajectories of motor development of preterm children.
Objectives Research has indicated that many medical and psychosocial factors contribute to cognitive deficits in sickle cell disease (SCD). Some studies of SCD in early childhood found cognitive functioning to be associated with socioeconomic status but not disease severity. The current study examined how the home environment is associated with cognitive functioning and school readiness in children with SCD. Methods Young children (n = 29; M age = 4.4 years SD = 0.3) with SCD underwent an evaluation of cognitive and academic skills. Subsequently, researchers and caregivers completed the Home Observation for Measurement of the Environment (HOME), an in-home measure of cognitive stimulation. Linear regression was used to examine the relationship between each of the HOME subscales and cognitive and academic measures while controlling for genotype. Results The total score from the HOME inventory was associated with overall IQ, working memory, and school readiness. Among the subscales of the HOME inventory, Learning Materials, Modeling, and Variety were associated with cognitive and academic outcomes. Conclusions Stimulation in a child's home may affect cognitive and academic development in young children with SCD. Future research should examine the benefits of increasing learning materials and the variety of activities in the homes of young SCD patients.
Despite major advances in cardiac care and decades of research, neurodevelopmental (ND) outcomes among children with congenital heart disease (CHD) have shown little improvement over time, substantial variability in outcomes remains unexplained, and prediction of individual developmental trajectories remains limited. This article argues that one contributor to these limitations is the field's reliance on descriptive but mechanistically underspecified models that catalog risk factors without clearly explaining how specific environmental experiences influence neurobehavioral development. To address this gap, this paper proposes an integrated dimensional model of neurodevelopment in CHD that conceptualizes ND outcomes as arising from the independent and interactive effects of CHD-related brain vulnerability and exposure to environmental medical adversity organized along the dimensions of deprivation and threat. Drawing from the Dimensional Model of Adversity and Psychopathology, the framework integrates prenatal dysmaturation, perioperative brain injury, and persistent alterations in brain structure and connectivity with adverse experiences occurring across prenatal, intensive care, caregiving, educational, and socioeconomic contexts. The model predicts that deprivation-related exposures will preferentially affect cognitive, language, and executive functioning systems, whereas threat-related exposures will more strongly influence emotional learning, stress regulation, and risk for psychopathology. By organizing CHD-related experiences according to developmentally meaningful dimensions of adversity, this framework provides a more mechanistic account of ND heterogeneity in CHD, generates testable hypotheses regarding developmental trajectories, and may support more precise developmental surveillance and targeted intervention strategies.
Background Trauma and violence exposure are critical barriers to educational equity, affecting student mental health and academic achievement. Despite growing attention to trauma-informed practices in schools, implementation remains uneven and often overlooks the complexity of trauma experiences or their systemic roots. Contributions to theory Grounded in and extending Basch's (2011) framework for prioritizing health conditions to reduce educational disparities, this paper synthesizes lessons learned and proposes a path forward for school-based trauma prevention and intervention. We identify three key opportunities: (1) expanding school-based trauma definitions to include chronic and identity-based stressors such as racialized trauma and immigration-related adversity; (2) leveraging comprehensive, school-wide frameworks to support infrastructure development, cross-sector partnerships, and sustainable implementation; and (3) elevating secondary traumatic stress as a core concern within trauma-informed systems. Implications for school health policy, practice, and equity Schools can use public health-oriented frameworks to align trauma-informed practices with equity goals. Key actions include conducting inclusive needs assessments, providing culturally responsive professional development, fostering cross-sector partnerships, and embedding policies that support educator wellness and prevent secondary traumatic stress. Conclusions By broadening definitions, centering equity, and supporting staff well-being, schools can create trauma-informed systems that are sustainable, responsive, and healing-centered.
Background Persistent pain affects approximately one in five children and adolescents globally and is associated with school absenteeism, reduced academic engagement, psychosocial distress, and long-term health consequences. Schools are important settings for developing health beliefs and self-management behaviors, yet educators receive little formal preparation about pain. Contributions to practice This Practitioner's Perspective describes integration of a brief contemporary pain neuroscience education (CPNE) module into an undergraduate teacher preparation course. Two interactive sessions delivered by a physical therapist introduced pain as a protective nervous system output influenced by biological, psychological, and social factors. Participants demonstrated improved pain knowledge and beliefs, increased confidence discussing pain-related concepts, and greater appreciation for the relevance of pain literacy to educational practice. Implications for school health policy, practice, and equity Pain literacy may improve educator responses to student pain, reduce stigma, support appropriate participation, and promote equitable school environments. Physical therapists may be well positioned to collaborate with teachers, school nurses, counselors, coaches, and other school-based professionals. Conclusions Teacher preparation programs may represent an upstream opportunity to improve pain literacy, support student health and learning, and contribute to the prevention of persistent pain.
Background Children with hearing impairments (HIs) have traditionally faced difficulties with language acquisition due to various factors, such as difficulties in accessing early intervention and therapy, among others. There is an opportunity for digital technology to address this problem; however, how different technologies can facilitate language acquisition, as well as the level of evidence, is not well understood. Objective This study aimed to explore the types, roles, and outcomes of different digital technologies in supporting language development in children with HIs. Methods Following Arksey and O'Malley's framework for conducting a scoping review and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), we systematically searched 6 online databases from 2014 to September 2024 for relevant studies on the role of digital technologies in supporting language learning among children with HIs (aged <18 years). Results A total of 45 studies met the inclusion criteria. Mobile apps were the most frequently reported technologies, followed by digital books, extended reality, computer-based programs, and tangible or robotic tools. The most commonly used signed-language apps focus on vocabulary development and visual communication. Spoken language tools were less common but included augmentative and alternative communication (AAC) systems and auditory training apps. The efficacy outcomes of 12 studies included in this review showed that AAC-based apps had stronger effects on expressive language, pragmatic communication skills, and vocabulary development. These outcomes occurred when AAC-based apps were used in structured contexts with a therapist or parent. In contrast, signed language apps often reported narrower, word-level outcomes. Notably, relatively few interventions targeted early spoken language development, despite early childhood being a critical period for language acquisition. In addition, limited attention was given to visual design considerations related to user comfort, cultural relevance, and contextual adaptation. Conclusions The evidence base reveals 3 structural patterns: the dominance of accessibility-driven mobile technologies; an imbalance between signed and spoken-language interventions, characterized by a greater number of signed-language tools but stronger and more consistent evidence for spoken-language outcomes, particularly in AAC-based interventions; and limited integration of digital technologies across home, school, and clinical contexts. Future research should prioritize the co-design and evaluation of culturally responsive, integrated, developmentally appropriate digital systems that support early spoken-language development and sustained, family-mediated language learning across contexts.
Background Mathematical learning difficulties (MLD) are associated with weaknesses in both domain-specific numerical abilities and domain-general neurocognitive processes. In this study, we developed and validated a web-based neuropsychological screener, Askisi-Mathematical Difficulties (MD), that integrates cognitive control and mathematics-related tasks for the first-line identification of children at risk for MLD was developed and validated. Methods We enrolled 564 children, including 282 children with an established MLD diagnosis recruited from a state diagnostic center and 282 typically developing children pair-matched for age and gender. Askisi-MD consisted of six tasks, including three cognitive tasks assessing inhibitory control, visual pattern recognition, and visual working memory, as well as three mathematics-related tasks assessing mental calculation verification, mathematical terminology comprehension, and arithmetic word problem operation selection. Accuracy scores and latency indicators were analyzed. Differences among groups were examined using Welch's independent-samples t-tests, Benjamini-Hochberg False Discovery Rate (FDR) correction, and Hedges' g effect sizes. Internal coherence was examined using McDonald's Ω. Discriminant validity was evaluated via receiver operating characteristic (ROC) analysis and through the use of classification indices. Supervised machine learning models, including Support Vector Classifier, Random Forest, and eXtreme Gradient Boosting (XGBoost) classifiers, were trained and cross-validated, while model interpretability was examined via SHapley Additive exPlanations (SHAP) analysis. Results Children with MLD showed significantly poorer performance across all six task-score indicators after FDR correction, with moderate-to-large effect sizes. Minute-based task-completion time differences were more selective. Children with MLD showed significantly longer completion times on the Mental Calculation and Arithmetic Word Problem tasks, whereas completion-time differences were not significant for Visual Pattern Recognition Abilities or Mathematical Terminology Comprehension. McDonald's Ω indicated modest internal coherence for the neuropsychological task-score composite and the total task-score composite. The strongest internal coherence was observed for the mathematical processing-efficiency composite. ROC analysis supported strong case-control discrimination, and classification indices indicated balanced group classification. Across the cross-validation folds, XGBoost achieved the highest mean accuracy, precision, and F1 score, while XGBoost and Random Forest demonstrated the same mean recall. XGBoost also showed strong discriminative performance, as indicated by the cross-validated area under the receiver operating characteristic curve (ROC-AUC). SHAP analysis indicated that Arithmetic Word-Problem Task Latency, Arithmetic Word Problem performance, Mathematical Terminology Comprehension, Mental Calculation, and Go/No-Go error score had greater influence on XGBoost model predictions than the remaining task indicators. Conclusions Askisi-MD provides a neuropsychologically informed web-based approach to MLD screening by jointly sampling mathematical performance and supporting cognitive control functions. The composite-level internal coherence findings support the use of Askisi-MD as a multidomain screener rather than as a set of independent mathematics subscales. Its explainable machine learning framework further enhances model interpretability by identifying the task-level indicators most strongly contributing to classification outcomes. Askisi-MD thus offers promise as a first-line screening tool to support referral decisions, rather than a stand-alone diagnostic instrument.
Introduction Sickle cell disease (SCD) is a monogenic blood disorder that places individuals at risk for poorer/lower neurocognitive function. In this population, the impact of changes in academic instruction related to the COVID-19 pandemic is unknown. We examined whether children who were assessed before schools closed showed higher academic and neurocognitive performance than did children who were assessed after schools reopened. Secondarily, we sought to evaluate whether these associations were moderated by age or socioeconomic status. Methods This retrospective study included 488 children with SCD (ages 7-18 years) who participated in a clinical cognitive surveillance program. Children assessed before school closures (March 1, 2020) and after re-openings (January 1, 2021) during the COVID-19 pandemic were matched on the following variables: age, sex, genotype, hydroxyurea treatment history, socioeconomic status, fetal hemoglobin, and oxygen saturation using propensity scores. Results Children assessed before school closures displayed higher scores on measures of visuomotor integration (q = 0.006, estimate = -4.20), processing speed (q = 0.004, estimate = -0.96), math fluency (q = 0.05, estimate = -3.50), and basic reading (q = 0.006, estimate = -5.70) after controlling for confounding factors. These effects were moderated by age, such that the difference in outcomes between the groups was larger for younger patients. Discussion Changes in academic instruction during the COVID-19 pandemic were associated with decreased neurocognitive and academic outcomes for children with SCD. The negative effect observed in this population is greater than that observed in the general population, suggesting that these students were particularly susceptible to learning loss.
Background The science of deimplementation-reducing harmful or ineffective practices-has focused almost exclusively on clinical prescribing, with no studies conducted in community or educational settings. Early care and education (ECE) settings offer a strategic venue for shaping eating behaviors, with children consuming up to 500 meals annually in these environments. However, ECE educators routinely use feeding practices that undermine self-regulation, including pressuring children to eat, rushing mealtimes, and offering food as reward. These practices contribute to food aversions, diminished self-regulation, and obesity risk. Methods We will conduct a Hybrid Type 3 cluster-randomized trial evaluating a co-designed deimplementation strategy package (WISE Words) across 88 ECE sites in Arkansas and Louisiana. Sites will be randomized 1:1 to WISE Words or usual practice, with usual practice sites receiving the intervention after two years (waitlist design). WISE Words includes six strategies: dynamic training using improvisation methods, peer learning collaboratives with goal setting, external facilitation, audit and feedback, environmental reminders, and tailored educational materials. The primary outcome is de-adoption of inappropriate feeding practices measured via direct mealtime observation (Table Talk). Secondary outcomes include adoption of evidence-based practices, acceptability, appropriateness, and sustainability at 12- and 24-months post-intervention. Child outcomes include Body Mass Index, skin carotenoid levels (Veggie Meter) willingness to try new foods (observed) and food neophobia (teacher and caregiver report). An explanatory sequential mixed methods design will test mechanisms of change derived from the Implementation Trust Building Theory of Change examining whether trust mediates strategy effects on outcomes. Discussion This trial extends deimplementation science into community settings by targeting culturally embedded behavioral practices rather than clinical prescribing behaviors. Results will inform approaches to shifting entrenched practices in ECE and similar settings while testing trust as a deimplementation mechanism. Sustainability assessments will address a notable gap, as few studies have examined whether deimplementation effects persist. Trial registration NCT07101321, July 20, 2025.
Background Inclusive physical education (PE) plays a vital role in promoting participation and development among students with different abilities. However, many teachers do not have adequate tools to modify PE activities to meet these diverse needs. In addition, parents are essential partners, as their involvement helps reinforce strategies and provide useful information about their children. While online platforms provide a practical way to deliver such solutions, only a few have been intentionally created to support both teachers and parents in implementing inclusive PE learning. To address this gap, we codeveloped an online platform with adapted PE experts that digitizes an inclusion screening tool and delivers personalized, evidence-based inclusion strategies and resources to teachers and parents. Objective This study aimed to develop an online platform that provides inclusion strategies for PE teachers and to examine how teachers and parents perceived its usability, acceptability, and overall usefulness using a mixed methods approach. Methods A mixed methods design was used to evaluate the platform between September 2024 and March 2025. PE teachers (n=8) and parents of children with disabilities (n=8) were recruited through convenience sampling via national social media outreach and completed individual usability testing sessions via Zoom. Usability was assessed using the System Usability Scale (SUS), the Questionnaire for User Interaction Satisfaction (QUIS), and task performance metrics. Semistructured interviews were conducted to explore user experiences. Quantitative data were analyzed descriptively, while qualitative data were analyzed using codebook thematic analysis, with findings integrated using joint display analysis. Results All participants successfully completed the assigned tasks, with a few instances of minor difficulty (14 total errors across 136 task attempts). Participants completed both usability testing and semistructured interviews. Usability and satisfaction scores were high across both groups (SUS: mean 85.63, SD 9.14 for teachers and mean 84.69, SD 12.50 for parents; QUIS: mean 8.52, SD 0.82 for teachers and mean 8.00, SD 1.31 for parents, out of 9). Mixed methods integration showed convergence between positive usability ratings and perceived professional value, while also identifying challenges related to navigation, terminology, learning for first-time users, and mobile interface design. Conclusions The online platform provides strong usability and high satisfaction among PE teachers and parents. Future work will involve improving implementation and evaluating its impact on students' participation outcomes.
