Katherine A. Benfer

Aim: To determine the predictive relationship between evidence‐based screening tools and neurodevelopmental outcomes in Australian First Nations infants. Method: This prospective cohort study invited First Nations families to participate in a culturally adapted early developmental screening programme. A total of 156 infants (55.1% male, mean gestational age = 33.6 weeks, SD = 4.6) were screened using the Prechtl's General Movements Assessment, with optimality scoring using the Motor Optimality Score‐Revised (MOS‐R) at 3 to 5 months and the Hammersmith Infant Neurological Examination (HINE) at 4 to 9 months. Participants completed ‘baby movement (BM) checks’ at two time points (BM1, 3–5 months corrected age; BM2, 4–9 months corrected age), with final movement and learning checks at 12 months corrected age. At 12 months corrected age, standardized motor, cognitive, and communication assessments, neurodisability‐specific symptomology, or a diagnosis made by a paediatrician classified infants as developing typically (‘on track’) or (1) with a high chance of or confirmed cerebral palsy (CP) or (2) non‐CP neurodevelopmental delay (NDD), including autism and fetal alcohol spectrum disorder (FASD). Predictive relationships were investigated using logistic regression and diagnostic statistics. Results: At 12 months, 127 of 147 (86%) eligible infants ( n = 9 withdrawn or deceased) were classified as ‘on track’ ( n = 55, 43%), NDD ( n = 59, 47%), or CP ( n = 13, 10%). MOS‐R (≥ 14 weeks) and the HINE distinguished infants as ‘on track’, CP, or NDD. [Correction added on 1 November 2025 after first online publication: In the preceding sentence, “MOS‐R (≥ 14 weeks). The HINE distinguished infants…” has been updated to “MOS‐R (≥ 14 weeks) and the HINE distinguished infants…”.] Each 1‐point decrease on both tools increased the odds of NDD (OR _MOS‐R = 1.40, 95% confidence interval [CI] = 1.00–1.96; OR _HINE = 1.12, 95% CI = 1.05–1.21) and CP (OR _MOS‐R = 1.47, 95% CI = 1.08–2.01; OR _HINE = 1.41, 95% CI = 1.21–1.65,). The MOS‐R (cut‐off of less than 23) and HINE (moderate to severely reduced) were best for identifying any NDD and CP (MOS‐R: sensitivity = 84%, specificity = 38%; HINE: sensitivity = 64%, specificity = 63%). Combined trajectories across both tools were the strongest predictors of CP (sensitivity = 73%, specificity = 96%), autism (sensitivity = 59%, specificity = 95%), and FASD (sensitivity = 89%, specificity = 93%). Interpretation: Evidence‐based screening tools demonstrate promising transdiagnostic prediction of ‘on‐track’ development and not only high chance of CP but also autism, FASD, and other NDDs.

Aim: To investigate the relationship between growth, body composition, and the extent of brain lesion measured using structural magnetic resonance imaging (MRI) in children with cerebral palsy (CP). Method: This prospective population‐based cohort study recorded 359 assessments from 124 children with CP aged 18 months to 13 years (38% female, Gross Motor Function Classification System [GMFCS] levels I = 50, II = 24, III = 17, IV = 12, and V = 21). A neurologist assessed the extent of the brain lesion using a validated semi‐quantitative scale (global, basal ganglia/brainstem, hemispheric and corpus callosum scores). Height (HTZ), weight (WTZ), and head circumference (HDZ) z‐scores were calculated. The Fat Mass Index (FMI) and Fat‐Free Mass Index (FFMI) were determined using a deuterium dilution technique, bioelectrical impedance or dual‐energy X‐ray absorptiometry, and height. Data were analysed using mixed‐effects linear regression. Results: Greater global ( β = −0.04, 95% confidence interval [CI] = −0.07 to −0.02), basal ganglia/brainstem ( β = −0.06, 95% CI = −0.11 to −0.02), corpus callosum ( β = −0.27, 95% CI = −0.27 to −0.12), and hemispheric ( β = −0.08, 95% CI = −0.12 to −0.04) scores were associated with lower HTZ. Greater global ( β = −0.03,95% CI = −0.06 to −0.01) and corpus callosum ( β = −0.23, 95% CI = −0.40 to −0.06) scores were associated with lower WTZ. A greater hemispheric score ( β = −0.06, 95% CI = −0.119 to −0.001) was associated with lower HDZ. Semi‐quantitative MRI scores were not associated with FMI or FFMI. Interpretation: Greater extent of the brain lesion was significantly associated with lower HDZ, HTZ, and WTZ but not body composition in children with CP aged 18 months to 13 years.

Aim: To determine reproducibility and diagnostic accuracy of screening tools for neuromotor concerns indicative of cerebral palsy (CP) at 18 months corrected age by using the General Movements Assessment (GMA) and/or Hammersmith Infant Neurological Examination (HINE) in West Bengal, India. Method: This prospective substudy tested psychometrics of screening tools nested within an overarching randomized control trial. A total of 785 infants with birth/infant‐detectable risk factors, aged 12 to 40 weeks corrected age ( n = 422 male, mean corrected age 22.6 weeks, SD = 10.2), were recruited. Infants were screened for ‘high‐risk CP’ using the GMA (absent/abnormal fidgety, 12–17 weeks corrected age) and/or HINE (3 months < 56, 6 months < 59, 9 months < 62, 18–40 weeks corrected age). ‘Neuromotor concerns indicative of CP’ were classified at 18 months corrected age by a physician from a videoed neurological examination and semi‐structured movement protocol. We analysed the results (1) using Gwet's AC1 and (2) for sensitivity and specificity. Results: Interrater reproducibility was strong (Gwet's AC1 = 0.89, p < 0.001). A total of 165 out of 749 assessments were screened as ‘high‐risk CP’ (22.0%; 95% confidence interval 19.2–25.1). The screening programme (GMA/HINE) was 80.1% accurate (GMA [only] sensitivity = 87.8%, specificity = 44.4%; HINE [only] sensitivity = 94.0%, specificity = 60.0%). Interpretation: The GMA and/or HINE are reliable and accurate tools for screening high‐risk populations in India, and may be useful in other low‐ and middle‐income countries to identify infants with neuromotor concerns indicative of CP who could be triaged to early intervention.

Aim: To determine reproducibility of the Motor Optimality Score–Revised (MOS‐R) to assess infants at high risk of adverse neurodevelopmental outcomes, including cerebral palsy (CP), autism, and developmental delays.Method: Thirty infants (18 males, 12 females, gestational age mean [range] = 32.5 [23–41] weeks) were randomly selected, according to 2‐year outcome (typically developing; CP; or adverse neurodevelopmental outcome [ad‐NDO]) from a prospective cohort. Participants had two General Movements videos between 12 weeks and 15 + 6 weeks corrected age. Six assessors, masked to history and outcomes, independently scored the MOS‐R from videos. Assessors scored either one (Group 1; n = 3) or two videos for each infant (Group 2; n = 3). Intraclass correlation coefficient (ICC), Gwet's agreement coefficient, and limits of agreement were calculated.Results: Combined interassessor reliability (IRR) over six assessors for total MOS‐R was ‘fair’ (ICC = 0.56, 95% confidence interval [CI] 0.41–0.72), and ‘excellent’ with consensus agreement (ICC = 0.99, 95% CI 0.98–0.99). Analyses demonstrated a mean interrater difference of 0.316 (95% limits of agreement −11.51, 12.14) over 450 comparisons (15 pairs). IRR was ‘moderate’ to ‘almost perfect’ across subcategories, with the highest reliability ‘movement patterns’ (Gwet's agreement coefficient = 0.73–1.00) and the lowest ‘postural patterns’ (0.45–0.73). Assessors who scored two videos (Group 2) demonstrated higher reproducibility. IRR for total MOS‐R was ‘excellent’ when infants were typically developing (ICC = 0.90), and ‘good’ for CP (0.74) and ad‐NDO (0.68).Interpretation: The MOS‐R is a highly reproducible tool for assessing infants at high risk of ad‐NDOs and is feasible for implementation in clinical settings. Reproducibility is best when the tool is used by experienced assessors to gain consensus agreement.

Aim: To explore the clinical utility and psychometric properties of standardized tools for the early detection of developmental concerns or disability in young children.Method: Systematic reviews and clinical practice guidelines containing psychometric data on tools appropriate for use with children from birth to 5 years 11 months were searched for in MEDLINE, CINAHL, Embase, and PsycINFO for the years 2000 to 2023, with no language restrictions.Results: Eighty‐six systematic reviews and six clinical practice guidelines guided identification of tools. A total of 246 tools were identified across domains of neurological, motor, cognition, communication/language, social–emotional, sensory processing, and/or specific diagnostic conditions of attention‐deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, developmental coordination disorder, and fetal alcohol spectrum disorder. After critical evaluation, 67 tools were included in the recommendations. Recommendations for screening and diagnostic assessment tools were based on best available evidence for predictive and discriminative validity, diagnostic accuracy, together with consideration of resource use and accessibility.Interpretation: This comprehensive scoping review provides recommendations on the best tools for primary care, medical, allied health professionals, nursing, and other health workers to detect and identify developmental concerns or disability in young children using evidence‐based tools.

Video Abstract Video Abstract To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health. This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale. Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI −1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA. Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.

Introduction Cerebral palsy (CP) is the most common childhood physical disability with rates approximately 50% higher in First Nations Australian children. This study aims to evaluate a culturally-adapted parent-delivered early intervention programme for First Nations Australian infants at high risk of CP (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP). Methods and analysis This study is a randomised assessor masked controlled trial. Infants with birth/postnatal risk factors will be eligible for screening. Infants at high risk of CP (‘absent fidgety’ on General Movements Assessment, and/or ‘suboptimal score’ on the Hammersmith Infant Neurological Examination) aged 12–52 weeks corrected age will be recruited. Infants and their caregivers will be randomised to receive LEAP-CP (intervention) or health advice (comparator). LEAP-CP is a culturally-adapted programme of 30 home visits delivered by a peer trainer (First Nations Community Health Worker); and includes goal-directed active motor/cognitive strategies, CP learning games and caregiver educational modules. The control arm receives a monthly health advice visit, based on the Key Family Practices, WHO. All infants continue to receive standard (mainstream) Care as Usual. Dual child primary outcomes are Peabody Developmental Motor Scales-2 (PDMS-2) and Bayley Scales of Infant Development-III. The primary caregiver outcome is the Depression, Anxiety and Stress Scale. Secondary outcomes include function, goal attainment, vision, nutritional status and emotional availability. Sample size: total of 86 children (43/group) will enable an effect size of 0.65 on the PDMS-2 to be detected (80% power, α=0.05; 10% attrition). Ethics and dissemination Ethics approval through Queensland ethics committees and Aboriginal Controlled Community Health Organisation Research Governance Groups, with families providing written informed consent. Findings will be disseminated with guidance from the Participatory Action Research, in collaboration with First Nations communities; peer-reviewed journal publications and national/international conference presentations. Trial registration number ACTRN12619000969167p.

Purpose: Dysphagia (swallowing difficulty) impacts physical health, quality of life, and mealtime enjoyment. Staff who provide mealtime assistance to people with dysphagia require adequate training to help ensure that the mealtimes are safe and enjoyable. This systematic review examined literature relating to training in dysphagia (e.g., recognizing signs and symptoms) and mealtime assistance, its components, and benefits for people with dysphagia. Method: In July 2020, five scientific databases were searched for papers meeting the inclusion criteria relating to mealtime assistance training. The quality of the studies was evaluated using the Quality Assessment Tool for Studies of Diverse Design, with scores ranging from 38.1% to 83.3%. We completed a qualitative synthesis using the data extracted from the included studies. Results: Twenty-four studies met the inclusion criteria. Participants in these studies benefited from both group training and one-on-one training. Training programs had many formats including computer-based, face-to-face, individual training, and group training. Each included study demonstrated some level of positive impact to the learners, such as improved knowledge and skills in mealtime management for people with dysphagia. No studies reported negative outcomes. Training duration ranged from 30 min to 5 days. Conclusions: The benefits of different components of mealtime training (e.g., group training, or face-to-face training) for mealtime assistance for people with dysphagia were reviewed. Further research is needed to compare the effectiveness of different training formats, involving not only the assistant but also people with dysphagia as both trainers and trainees, and determine the health outcomes of training programs for people with dysphagia.