Identifying and supporting children with neurodeveIopmental difficulties

Background: The Chief Medical Officer’s 2012 report described an urgent need for early identification of children with developmental difficulties because it is known that treatment is effective if children are identified in the primary school years. Core cognitive and sensorimotor skills are required for children to succeed in primary school. A wealth of research has shown that children with motor and/or working memory and executive function deficits have poor physical and mental health outcomes if they are not treated. Moreover, these deficits interact to cause poor educational outcomes. Unfortunately, large numbers of children with neurodevelopmental difficulties fail to receive attention because traditional methods to measure cognitive skills rely on the subjective evaluation of specialists using time consuming measures.  Thus, these children are often missed or identified too late for optimal remedial action.

 A LYBRA CLAHRC collaborative effort has resulted in the development of an objective classroom based system to detect children at risk of motor and cognitive deficit. This system presents sensorimotor tasks with different cognitive demands whilst simultaneously recording responses via interactions with a tablet screen using a pen-like stylus. The system was tested with 6,500 primary school children as they started school in Reception Year and norms have been generated. The system uses sophisticated processing algorithms (previously only available in research laboratories) to generate outcomes describing the behaviour – outcomes that provide useful information to support children experiencing difficulties in the classroom (and metrics with the potential to streamline referrals to CAMHS).

Aims: This project aims to develop our assessment systems further to include other cognitive and motor domains, further develop norms for primary school aged children and provide guidelines to schools within the local authority for supporting children with cognitive problems.

Progress: Since 2015, the battery of tests has been modified to include detailed ‘cognitive’ measures, including domains such as working memory. The system we created has been developed further by an SME (ReSolve Research Engineering). Our collaboration recently won an award for Research Innovation

The tasks presented within the battery of tests were conceived and designed by the LYBRA CLAHRC committee and supported by an MRC/ESRC grant held across CLAHRC members [iii].

Data have been collected and analysed (2010-present), showing the system is capable of generating data that are predictive of emotional wellbeing and educational attainment.  The system has been shown to measure a core cognitive ability that underpins writing and reading.

A systematic review was conducted to identify evidence-based interventions that could be used to treat the motor deficits identified by the system [5]. We developed a school-based intervention programme on the basis of the review and conducted a study on the feasibility of delivering our programme within schools [6].

Awareness of cognitive problems creating physical and mental health problems in schools across Bradford has been raised. Guidelines to schools within the local authority for supporting children with cognitive problems have been provided.

Plans: Between 2016-18, Year 3 and 4 children in Bradford schools are being screened for cognitive deficits.   We are planning to provided intervention guidelines to schools if problems are detected.  To date, over 5000 children from 50 schools have been screened. Results of individual children’s assessments are being provided to participating schools and teachers then use this information to guide additional investigation and support children identified as being at risk of cognitive deficit. The local educational authority view this initiative as being of great benefit as our system is:

 “…giving our teachers the ability to augment their professional judgements with detailed objective assessments that allow them to make properly informed judgements about how best to support their students.  Results are also aggregated and given to schools that work together in a Local Area Partnerships (LAPs), helping us in our strategic planning as well.”


  • Hill, L. J. B., Coats, R. O., Mushtaq, F., Williams, J. H. G., Aucott, L. S., & Mon-Williams, M. (2016). Moving to Capture Children’s Attention: Developing a Methodology for Measuring Visuomotor Attention. PLoS ONE, 11(7), e0159543. 
  •, N., Magallon, S., Hill, L. J.B., Andrews, E., Ahern, S.M., and Mon-Williams, M. (2016) A systematic review of high quality randomised controlled trials investigating motor skill programs for children with developmental coordination disorder. Clin Rehabil. pii: 0269215516661014.
  • Štochl, J., Prady, S., Andrews, E.C., Pickett, K.E. & Croudace, T., (2016). The psychometric properties of the Strengths and Difficulties Questionnaire in a multi-ethnic sample of young children.  Kinanthropologica, 52(1), 15-37.
  • Hill, LJB, Mushtaq, F, O’Neill, L, Flatters, I, Williams, JHG & Mon-Williams, M. (2015) The relationship between manual coordination and mental health. European Child & Adolescent Psychiatry 25 (3):283-295.
  • Waterman, AH, Havelka, J, Culmer, PR, Hill, LJB & Mon-Williams M. (2014) The ontogeny of visual motor memory and its importance in handwriting and reading: A developing construct. Proceedings Royal Society: B282 (1798) 20140896
  • Shire KA, Hill LJB, Snapp-Childs W, Bingham GP, Kountouriotis GK, Barber S, Williams MM. Robot Guided ‘Pen Skill’ Training in Children with Motor Difficulties. PLoS ONE, 2016;11(3): e0151354. doi:10.1371/journal.pone.0151354