Findings from P4C

Extent of Motor Difficulties

Evaluation at the end of the study confirmed that the occupational therapists (OTs) were able to identify children who were in need of health care services but who had not previously been recognized as needing service. Children were identified because the OT spent consistent time observing children in various school settings throughout their day (e.g. classroom, playground, cloak room, lunch room, and gym). Formal assessments or diagnoses were not required.

  • Children who had been on the waitlist and those identified by P4C OTs had significant motor coordination challenges.
  • OTs delivered the P4C service to children with special needs who had issues in school other than motor challenges.

Measuring Motor Challenges

The Movement Assessment Battery for Children (MABC-2) (Henderson, Sugden, & Barnett, 2007) is a measure that describes the severity of children’s motor impairment. In this study, change over time was not expected on this measure because it assessed children’s underlying motor abilities (which tend to be stable across time) rather than their actual participation (which was the target of the P4C service). Therefore, the MABC-2 permitted us to determine whether children’s motor difficulties were severe, moderate, or borderline, or if they were performing in the normal range for their age. The measure was administered at the end of the study to allow us to determine the extent to which the children who were referred to the P4C service, without the use of any formal assessments, did indeed have motor coordination difficulties.

We were only permitted by the ethics board to approach parents who had provided written consent at the outset of the study to ask if we could administer the MABC-2. Seventy-two percent agreed and the MABC-2 was completed by trained research assessors in March and April 2015, long after the OTs had identified and obtained health care consent for intervention.

Active/Waitlist Newly Identified Total
Children experiencing motor coordination issues 49 (67%) 57 (72%) 106 (70%)
Children with other non-motor issues 24 (33%) 22 (28%) 46 (30%)
Table 1

The findings confirm that the children who had been on the waitlist and those identified by the P4C OTs did, in fact, have significant motor coordination challenges. Seventy percent of the children who received the P4C service had significant motor impairments that, based upon the OT reports and this assessment, were impacting on many activities in school. Although 46 (30%) of children tested within the normal range for overall motor impairment, four of these children still showed a great deal of difficulty in one area of the motor test (e.g. balance, use of their hands for written tasks). The research team will be looking more closely at the 30% of children who did not have significant motor impairment. From early analysis of the OT daily logs and child files, we have noted that many of these children had attentional or sensory difficulties. These findings suggest that the P4C OTs were able to provide service to children who had other types of difficulties that were impacting on their participation at school.

MABC-2 results confirmed that the P4C OTs identified an equally large group of children who had significant motor impairments and school issues but who had not been recognized; the severity of motor coordination problems was similar for both the waitlist and the newly identified group. This finding suggests that there are children who have motor coordination difficulties who are not noticed in alternate models of service, or who have to wait until they are older and their difficulties potentially worsen before they are referred. Early identification may prevent early motor difficulties from becoming more severe or contributing to secondary consequences in other areas; however, longitudinal studies are required to determine whether children who were identified at an early point in their school years do indeed have a different and more positive trajectory than those who are not identified until later.

When OTs spend consistent time in schools, children with special needs who are in need of service can be identified without using any formal assessments. Children were identified when the P4C OT:

  • spent time regularly observing children in context (in the classroom, gym, locker/cubby area or playground),
  • collaborated with, and was responsive to, educators and parents,
  • used differentiated instruction to determine which children had needs and monitored children’s response to the strategies that were implemented.


  • Henderson, S., Sugden, D., Barnett, A. (2007). The Movement Assessment Battery for Children (2nd Ed.). London: Pearson Assessment.