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Methods and Statistics in Social Sciences Specialization

Critically Analyze Research and Results Using R. Learn to recognize sloppy science, perform solid research and do appropriate data analysis.

Taught in English

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Instructors: Emiel van Loon +3 more

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Specialization - 5 course series

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Skills you'll gain

• Statistical Inference
• R Programming
• Qualitative Research

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Identify interesting questions, analyze data sets, and correctly interpret results to make solid, evidence-based decisions.

This Specialization covers research methods, design and statistical analysis for social science research questions. In the final Capstone Project, you’ll apply the skills you learned by developing your own research question, gathering data, and analyzing and reporting on the results using statistical methods.

Quantitative Methods

What you'll learn.

Discover the principles of solid scientific methods in the behavioral and social sciences. Join us and learn to separate sloppy science from solid research!

This course will cover the fundamental principles of science, some history and philosophy of science, research designs, measurement, sampling and ethics. The course is comparable to a university level introductory course on quantitative research methods in the social sciences, but has a strong focus on research integrity. We will use examples from sociology, political sciences, educational sciences, communication sciences and psychology.

Qualitative Research Methods

In this course you will be introduced to the basic ideas behind the qualitative research in social science. You will learn about data collection, description, analysis and interpretation in qualitative research. Qualitative research often involves an iterative process. We will focus on the ingredients required for this process: data collection and analysis.

You won't learn how to use qualitative methods by just watching video's, so we put much stress on collecting data through observation and interviewing and on analysing and interpreting the collected data in other assignments. Obviously, the most important concepts in qualitative research will be discussed, just as we will discuss quality criteria, good practices, ethics, writing some methods of analysis, and mixing methods. We hope to take away some prejudice, and enthuse many students for qualitative research.

Basic Statistics

Understanding statistics is essential to understand research in the social and behavioral sciences. In this course you will learn the basics of statistics; not just how to calculate them, but also how to evaluate them. This course will also prepare you for the next course in the specialization - the course Inferential Statistics.

In the first part of the course we will discuss methods of descriptive statistics. You will learn what cases and variables are and how you can compute measures of central tendency (mean, median and mode) and dispersion (standard deviation and variance). Next, we discuss how to assess relationships between variables, and we introduce the concepts correlation and regression. The second part of the course is concerned with the basics of probability: calculating probabilities, probability distributions and sampling distributions. You need to know about these things in order to understand how inferential statistics work. The third part of the course consists of an introduction to methods of inferential statistics - methods that help us decide whether the patterns we see in our data are strong enough to draw conclusions about the underlying population we are interested in. We will discuss confidence intervals and significance tests. You will not only learn about all these statistical concepts, you will also be trained to calculate and generate these statistics yourself using freely available statistical software.

Inferential Statistics

Inferential statistics are concerned with making inferences based on relations found in the sample, to relations in the population. Inferential statistics help us decide, for example, whether the differences between groups that we see in our data are strong enough to provide support for our hypothesis that group differences exist in general, in the entire population.

We will start by considering the basic principles of significance testing: the sampling and test statistic distribution, p-value, significance level, power and type I and type II errors. Then we will consider a large number of statistical tests and techniques that help us make inferences for different types of data and different types of research designs. For each individual statistical test we will consider how it works, for what data and design it is appropriate and how results should be interpreted. You will also learn how to perform these tests using freely available software. For those who are already familiar with statistical testing: We will look at z-tests for 1 and 2 proportions, McNemar's test for dependent proportions, t-tests for 1 mean (paired differences) and 2 means, the Chi-square test for independence, Fisher’s exact test, simple regression (linear and exponential) and multiple regression (linear and logistic), one way and factorial analysis of variance, and non-parametric tests (Wilcoxon, Kruskal-Wallis, sign test, signed-rank test, runs test).

Methods and Statistics in Social Science - Final Research Project

The Final Research Project consists of a research study that you will perform in collaboration with fellow learners. Together you will formulate a research hypothesis and design, come up with operationalizations, create manipulation and measurement instruments, collect data, perform statistical analyses and document the results.

In this course you will go through the entire research process and will be able to help determine what research question we will investigate and how we design and perform the research. This is an invaluable experience if you want to be able to critically evaluate scientific research in the social and behavioral sciences or design and perform your own studies in the future.

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Frequently asked questions

How long does it take to complete the research methods and statistics in social science specialization.

Time to completion can vary based on your schedule, but most learners are able to complete the Specialization in 10 months.

How often is each course in the Specialization offered?

Each course in the Specialization is offered on demand, and may be taken at any time.

What background knowledge is necessary?

A basic understanding of scientific principles and research methods may be helpful, but is not required. Only very basic math skills are required, you should be able to perform: addition, subtraction, multiplication, calculation of square, square root, exponents and logarithms.

Do I need to take the courses in a specific order?

We recommend taking the courses in the order presented, as each subsequent course will build on material from previous courses.

Will I earn university credit for completing the Research Methods and Statistics Specialization?

Coursera courses and certificates don't carry university credit, though some universities may choose to accept Specialization Certificates for credit. Check with your institution to learn more.

What will I be able to do upon completing the Research Methods and Statistics Specialization?

At the end of this Specialization, you will be performing your own statistical analyses using the programming language R, with no prior knowledge of programming. Learners who complete the Research Methods and Statistics for Social Science Specialization will learn more about scientific rigor and integrity. You’ll have the methods, statistics and research skills required to complete a typical Masters program in the Social Sciences or the Johns Hopkins Data Science Specialization, and also be ready for more advanced courses on big data or multivariate statistics.

Is this course really 100% online? Do I need to attend any classes in person?

This course is completely online, so there’s no need to show up to a classroom in person. You can access your lectures, readings and assignments anytime and anywhere via the web or your mobile device.

What is the refund policy?

If you subscribed, you get a 7-day free trial during which you can cancel at no penalty. After that, we don’t give refunds, but you can cancel your subscription at any time. See our full refund policy Opens in a new tab .

Can I just enroll in a single course?

Yes! To get started, click the course card that interests you and enroll. You can enroll and complete the course to earn a shareable certificate, or you can audit it to view the course materials for free. When you subscribe to a course that is part of a Specialization, you’re automatically subscribed to the full Specialization. Visit your learner dashboard to track your progress.

Is financial aid available?

Yes. In select learning programs, you can apply for financial aid or a scholarship if you can’t afford the enrollment fee. If fin aid or scholarship is available for your learning program selection, you’ll find a link to apply on the description page.

Can I take the course for free?

When you enroll in the course, you get access to all of the courses in the Specialization, and you earn a certificate when you complete the work. If you only want to read and view the course content, you can audit the course for free. If you cannot afford the fee, you can apply for financial aid Opens in a new tab .

Will I earn university credit for completing the Specialization?

This Specialization doesn't carry university credit, but some universities may choose to accept Specialization Certificates for credit. Check with your institution to learn more.

More questions

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Primary Sources

• Professional Learning

Research-Based Best Practices in Social Studies Instruction

Just as the iPad revolutionized so many aspects of our daily lives, using an I.P.A.D. approach in your social studies classroom can be a helpful reminder of what to think about for your students every day. While I.P.A.D. doesn’t come with music and games, it does with decades of research about why it works and why it should be an essential part of your planning.

My top four research-based approaches to social studies instruction spell I.P.A.D. and can be used (in order) as either a planning framework or to self-check your existing lessons. In this case, I.P.A.D. stands for:

Disciplinary Literacy

I believe that if you thoughtfully incorporate these four practices in the manner described below, that you will be giving you and your students the best chance to learn the content in a meaningful way through the application of essential skills.

As the National Council for the Social Studies (NCSS) notes in their College, Career, and Civic Life (C3) Framework, “inquiry is the heart of social studies” (NCSS, 2017). Through inquiry, students are given the opportunity to go deeper into their learning while making connections across disciplines that matter to them. When your lessons and units are centered on a question it gives each student “voice and choice” about what matters to them about the topic and how they want to approach answering your question.

When teaching my methods classes at the University of Maine or when doing professional development with educators, I am far more worried about the question that drives a lesson instead of the content. When you tell the question you will ask your students about a topic, I have a better sense of what you are looking for from your students and where they might be able to take their learning. For example, think about the different learning outcomes for students based on these questions about the Civil Rights movement:

• What are the key events of the Civil Rights movement?
• What event of the Civil Rights era was the most crucial turning point of the Civil Rights movement?
• How are contemporary issues of race impacted by major events of the Civil Rights movement?

All these lessons could be titled “The Civil Rights Movement”, but the compelling question is what tells us what the students will learn, what overarching concepts (turning points, compare/contrast, continuity and change) will be addressed, and what skills they demonstrate. When preparing your lessons, look beyond your topic (Civil Rights movement) and think about a compelling question that students will WANT to explore that is presented in a way that allows some choice in WHAT they learn.

Educators are living in a golden age of access to primary sources, and we must take advantage of this. Every minute of every day, there are more historical documents being made digitally available in addition to almost instantaneous access to the most/all the voices of our modern world. What better gift for our classrooms than the ability to hear voices that span across perspective, place, and time? If you are building off the inquiry approach outlined above, then you need to provide students with appropriate resources that allow them to address your question in a way that is meaningful to them. This is done by expanding the different primary sources that they can use to address your question.

When presented with a handful of appropriate primary sources, student can “hear” the voices, but they are limited in the ways in which they can build their answer to your question. The more primary sources, the more perspectives that can be included and the more “choose your own adventure” paths that a student can take to get to their answer. You have a student that has an interest in women’s history? Let them explore “women of the Civil Rights movement”. What about students that have family ties to different historical places or regions? Can they learn more about the role a specific city had in the Civil Rights movement? Maybe they want to focus on church/religion or teenagers/schools, then let them! This is what actual historians do when they “do” history and we should not expect any less from our own students.

Assessments

Inquiry is great, but students still need to provide answers. (Which by the way, can be in the form of more questions! Inquiry is sooo awesome!) Primary sources are key to voice and choice as well as diverse perspectives, but there are still essential skills that need to be assessed. This means that we need to make sure that our assessments are authentic in relation to the use of primary sources in response to a question. I have met very few teachers that think primary sources are “bad” or disagree with students doing DBQs (document-based questions) in class. However, I do run into a good number of teachers that while they believe in these types of assessments, they default to multiple choice quizzes and fill in the blank work sheets more often than they would like. Of course, we know that these types of assessments are readily available and easy to grade, but it often leads to such a disconnect between what we want our students learning to do and what is being assessed.

It is worth noting that multiple choice quizzes CAN be used for authentic assessment, but you must keep in mind what is your goal for what you are trying to assess. Do you have students reading primary sources to identify diverse perspectives about a question? Then you can use multiple choice questions that ask students “which of the primary sources shows the perspective of a southern African American woman in the 1950s”? Your responses could still be A, B, C, or D, with the letters referring to primary sources (or excerpts of) would best answer this question. This would help student read primary sources to practice the sourcing skills essential.

Along the way to assessment, our instructional moves and pedagogical moves need to give students the opportunity to practice what they will eventually be assessed on. Understanding by Design researchers McTighe and Wiggins tells us about the final step that I feel is so often overlooked by educators. We talk about what we students to be able to do (learning targets, standards, outcomes) and what it looks like so that we can assess it (though as noted above, we sometimes miss the mark on the assessments too), but what about making sure that your daily instruction actually sets them up for success?

If you have reached this point in the IPAD framework, then having “disciplinary literacy” for a foundation is what will fill in the gaps in your daily lesson plan. You have your compelling question that drives student inquiry based on primary sources with an authentic assessment, so now it is time to make sure that your class has the students doing the things that you WANT them to do! Are you going to assess using a DBQ? Then well before they are writing a DBQ, they need to analyze those primary documents in support of a strong thesis. I have written before about all the ways to work on DBQ skills before the final DBQ because disciplinary literacy should be the engine that powers your class.

Our students live in a world where there is more information is available than they can process, so we need to help them refine the information at their disposal by teaching them how the professionals of their disciplines look at their world. DBQs are great for a lot of social studies to be “like a historian”, but disciplinary literacy is also the skills of geographers and economics. If your goal is students to dive deep into geography, then have them play with the tools of geography instead of memorizing countries and capitals. You want your students understanding supply chain interruptions? Then move their study of supply and demand charts beyond “widgets” on a worksheet. Have them engage in the development and marketing of a product that fills a current need and examine how different price points impact both the cost of production and customer demand.

In Conclusion

I don’t pretend to think that all of this is new to you. In fact, I hope that you are already familiar with all the four key components of the IPAD acronym and already using them on a regular basis in your classroom. By pulling all the pieces together, I was hoping to remind you of the power of these four pillars of quality social studies instruction. By providing the structure that I did, I hoped to give you a simple framework to look at your lesson each day. Just like so many kids in the recent decade, I want you to make sure that you start class by double checking that you have your IPAD for the day.

Get a free trial of Active Classroom to explore instructional resources that can be personalized and differentiated to fit your class

Joe Schmidt taught social studies at the high school level for nine years and worked three years as a K-12 Social Studies Teacher Leader in Madison, Wisconsin. He currently holds the position of Social Studies Specialist with the Maine Department of Education, and teaches an elementary social studies methods course at the University of Maine. He is a founder of​  Joe Schmidt Social Studies LLC. and was recently elected to the NCSS Board of Directors. He also serves on the iCivics National Educator Network, sat four years on the Teaching Tolerance advisory board, and works with a number of other organizations that advocate and work actively to improve social studies education.  Check out his upcoming book,  Civil Discourse: Classroom Conversations for Stronger Communities , available for pre-order now!

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Research Skills for Social Sciences and Sciences: Overview

• Search for Articles Tips for finding articles in Library Search, disciplinary databases, and online.
• Searching for Information Online, Canvas tutorial (45 minutes) Learn techniques and strategies for searching the internet and library databases.
• Take Notes for Research Learn effective ways of taking notes

Reading Scholarly Articles

• Reading for Research Video (37 minutes) This workshop recording introduces strategies for skimming and deep-reading scholarly articles.
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• How to Read A Scholarly Article for Sciences and Social Sciences video (45 minutes) Workshop recording. Learn about the four types of typical scholarly articles and strategies for reading and evaluating an empirical study.
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• Conducting a Literature Review video (53 minutes) Workshop recording
• Introduction to Data, Canvas tutorial (15 minutes) Learn to define data and the data lifecycle and identify developments and issues in how data is used in research.
• How To Think About Data video (25 minutes) Learn to define data and the data lifecycle, discuss big data, biases, and ethics, explore data resources, and consider strategies for searching and accessing data in this workshop recording.
• How to Think About Data slides Slides from the workshop.
• Databases with Datasets video (25 minutes) Presenters discuss business, social sciences and humanities databases, along with text mining and copyright considerations in this workshop recording.
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Empowering students to develop research skills

February 8, 2021

This post is republished from   Into Practice ,  a biweekly communication of Harvard’s  Office of the Vice Provost for Advances in Learning

Terence D. Capellini, Richard B Wolf Associate Professor of Human Evolutionary Biology, empowers students to grow as researchers in his Building the Human Body course through a comprehensive, course-long collaborative project that works to understand the changes in the genome that make the human skeleton unique. For instance, of the many types of projects, some focus on the genetic basis of why human beings walk on two legs. This integrative “Evo-Devo” project demands high levels of understanding of biology and genetics that students gain in the first half of class, which is then applied hands-on in the second half of class. Students work in teams of 2-3 to collect their own morphology data by measuring skeletons at the Harvard Museum of Natural History and leverage statistics to understand patterns in their data. They then collect and analyze DNA sequences from humans and other animals to identify the DNA changes that may encode morphology. Throughout this course, students go from sometimes having “limited experience in genetics and/or morphology” to conducting their own independent research. This project culminates in a team presentation and a final research paper.

The benefits: Students develop the methodological skills required to collect and analyze morphological data. Using the UCSC Genome browser  and other tools, students sharpen their analytical skills to visualize genomics data and pinpoint meaningful genetic changes. Conducting this work in teams means students develop collaborative skills that model academic biology labs outside class, and some student projects have contributed to published papers in the field. “Every year, I have one student, if not two, join my lab to work on projects developed from class to try to get them published.”

“The beauty of this class is that the students are asking a question that’s never been asked before and they’re actually collecting data to get at an answer.”

The challenges:  Capellini observes that the most common challenge faced by students in the course is when “they have a really terrific question they want to explore, but the necessary background information is simply lacking. It is simply amazing how little we do know about human development, despite its hundreds of years of study.” Sometimes, for instance, students want to learn about the evolution, development, and genetics of a certain body part, but it is still somewhat a mystery to the field. In these cases, the teaching team (including co-instructor Dr. Neil Roach) tries to find datasets that are maximally relevant to the questions the students want to explore. Capellini also notes that the work in his class is demanding and hard, just by the nature of the work, but students “always step up and perform” and the teaching team does their best to “make it fun” and ensure they nurture students’ curiosities and questions.

Takeaways and best practices

• Incorporate previous students’ work into the course. Capellini intentionally discusses findings from previous student groups in lectures. “They’re developing real findings and we share that when we explain the project for the next groups.” Capellini also invites students to share their own progress and findings as part of class discussion, which helps them participate as independent researchers and receive feedback from their peers.
• Assign groups intentionally.  Maintaining flexibility allows the teaching team to be more responsive to students’ various needs and interests. Capellini will often place graduate students by themselves to enhance their workload and give them training directly relevant to their future thesis work. Undergraduates are able to self-select into groups or can be assigned based on shared interests. “If two people are enthusiastic about examining the knee, for instance, we’ll match them together.”
• Consider using multiple types of assessments.  Capellini notes that exams and quizzes are administered in the first half of the course and scaffolded so that students can practice the skills they need to successfully apply course material in the final project. “Lots of the initial examples are hypothetical,” he explains, even grounded in fiction and pop culture references, “but [students] have to eventually apply the skills they learned in addressing the hypothetical example to their own real example and the data they generate” for the Evo-Devo project. This is coupled with a paper and a presentation treated like a conference talk.

Bottom line:  Capellini’s top advice for professors looking to help their own students grow as researchers is to ensure research projects are designed with intentionality and fully integrated into the syllabus. “You can’t simply tack it on at the end,” he underscores. “If you want this research project to be a substantive learning opportunity, it has to happen from Day 1.” That includes carving out time in class for students to work on it and make the connections they need to conduct research. “Listen to your students and learn about them personally” so you can tap into what they’re excited about. Have some fun in the course, and they’ll be motivated to do the work.

6 Skills Students Need to Succeed in Social Studies Classes

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In 2013, the National Council for the Social Studies ( NCSS ), published the College, Career, and Civic Life (C3) Framework for Social Studies State Standards also known as the  C3 Framework . The combined goal of implementing the C3 framework is to enhance the rigor of the social studies disciplines using the skills of critical thinking, problem-solving, and participation. 

The NCSS has stated that,

"The primary purpose of social studies is to help young people develop the ability to make informed and reasoned decisions for the public good as citizens of a culturally diverse, democratic society in an interdependent world."

In order to meet this purpose, the C3s Frameworks encourage student inquiry. The design of the frameworks is that an "Inquiry Arc" straddles all elements of the C3s. In every dimension, there is an inquiry, a seeking or request for truth, information, or knowledge. In economics, civics, history, and geography, there is required inquiry.

 Students must engage in a pursuit of knowledge through questions. They must first prepare their questions and plan their inquiries before they use the traditional tools of research. They must evaluate their sources and evidence before they communicate their conclusions or take informed action. There are specifics skills outlined below that can support the inquiry process.

Critical Analysis of Primary and Secondary Sources

As they have in the past, students need to recognize the difference between primary and secondary sources as evidence. However, a more important skill in this age of partisanship is the ability to evaluate sources.

The proliferation of  "fake news" websites and social media "bots" means that students must sharpen their ability to evaluate documents. The Stanford History Education Group (SHEG ) supports teachers with materials to help students "learn to think critically about what sources provide the best evidence to answer historical questions."

SHEG notes the difference between the teaching of social studies in the past compared to the context of today,

"Instead of memorizing historical facts, students evaluate the trustworthiness of multiple perspectives on historical issues and learn to make historical claims backed by documentary evidence."

Students at every grade level should have the critical reasoning skills necessary to understand the role that an author has in each of the sources, primary or secondary, and to recognize bias where it exists in any source.

Interpreting Visual and Audio Sources

Information today is often presented visually in different formats. Digital programs allow visual data to be shared or reconfigured easily.

Students need to have the skills to read and to interpret information in multiple formats since data can be organized in different ways.

• Tables use numerals or non-numeral data that is set in vertical columns so that the data may be emphasized, compared, or contrasted.
• Graphs or charts are pictures used to make facts easier for a reader to understand. There are different types of graphs: bar graph, the line graph, pie charts, and the pictograph.  

The  Partnership for 21st Century Learning  recognizes that information for tables, graphs and charts can be collected digitally. 21st-century standards outline a series of student learning goals.

"To be effective in the 21st century, citizens and workers must be able to create, evaluate, and effectively utilize information, media, and technology."​​

This means that students need to develop the skills that allow them to learn in real-world 21st-century contexts. The increase in the amount of digital evidence available means students need to be trained to access and to evaluate this evidence before forming their own conclusions. 

For example, access to photographs has expanded. Photographs can be used as  evidence , and the National Archives offers a template worksheet to guide students learn in the use of images as evidence. In the same manner, information can also be gathered from audio and video recordings that students must be able to access and to evaluate before taking informed action.

Understanding Timelines

Timelines are a useful tool for students to connect the disparate bits of information that they learn in social studies classes. Sometimes students can lose perspective on how events fit together in history. For example, a student in a world history class needs to be conversant in the use of timelines to understand that the Russian Revolution was occurring at the same time that World War I was being fought.

Having students create timelines is an excellent way for them to apply their understanding. There are a number of educational software programs that are free for teachers to use:

• Timeglider : This software allows students the opportunity to create, collaborate, and publish zooming and panning interactive timelines. 
• Timetoast:  This software allows students to make a timeline in horizontal and list modes. Students can design timelines in ancient history to the far-off future.
• Sutori : This software allows students to make timelines and to examine sources through contrast and compare. 

Comparing and Contrasting Skills

  Comparing and contrasting in a response allows students to move beyond facts. Students must use their ability to synthesize information from different sources, so they need to strengthen their own critical judgment in order to determine how groups of ideas, people, texts, and facts are similar or different.

These skills are necessary to meet the critical standards of the C3 Frameworks in civics and history. For example, 

D2.Civ.14.6-8. Compare historical and contemporary means of changing societies, and promoting the common good. D2.His.17.6-8. Compare the central arguments in secondary works of history on related topics in multiple media.

In developing their compare and contrasting skills, students need to focus their attention on the critical attributes (features or characteristics) under investigation. For example, in comparing and contrasting the effectiveness of for-profit businesses with nonprofit organizations,  students should consider not only the critical attributes (e.g., the sources of funding, expenses for marketing) but also those factors that impact critical attributes such as employees or regulations.

Identifying critical attributes gives students the details needed to support positions. Once students have analyzed, for example, two readings in greater depth, they should be able to draw conclusions and take a position in a response based on the critical attributes. 

Cause and Effect

Students need to be able to understand and communicate cause and effect relationships in order to show not only what happened but why it happened in history. Students should understand that as they read a text or learn information they should look for keywords such as "thus", "because", and "therefore". 

The C3 Frameworks outline the importance of understanding cause and effect in Dimension 2 stating that,

"No historical event or development occurs in a vacuum; each one has prior conditions and causes, and each one has consequences."

Therefore, students need to have enough background information to be able to make informed guesses (causes)  about what could happen in the future (effects).

Maps are used throughout the social studies to help deliver spatial information in the most efficient way possible.

Students need to understand the type of map they are looking at and to be able to use the map conventions like keys, orientation, scale and more as outlined in  Basics of Map Reading .

 The shift in the C3s, however, is to move students from the low-level tasks of identification and application to the more sophisticated understanding where students “create maps and other graphic representations of both familiar and unfamiliar places.”

 In Dimension 2 of the C3s, creating maps is an essential skill. 

"Creating maps and other geographical representations is an essential and enduring part of seeking new geographic knowledge that is personally and socially useful and that can be applied in making decisions and solving problems."

Asking students to create maps allows them prompts new inquiries, especially for the patterns portrayed.

• National Council for the Social Studies (NCSS), The College, Career, and Civic Life (C3) Framework for Social Studies State Standards: Guidance for Enhancing the Rigor of K-12 Civics, Economics, Geography, and History (Silver Spring, MD: NCSS, 2013).  
• Questions for Each Level of Bloom's Taxonomy
• How Many Electoral Votes Does a Candidate Need to Win?
• Sample Report Card Comments for Social Studies
• How John Lewis' "March" Trilogy Can Teach Students About Civil Rights
• Idioms Used in Elections
• 10 Test Question Terms and What They Ask Students to Do
• Voting Rights Background for Students
• Multiple Literacies: Definition, Types, and Classroom Strategies
• Higher-Order Thinking Skills (HOTS) in Education
• Bloom's Taxonomy in the Classroom
• High School English Curricula Explained
• How Social Skills Can Lead to Academic Success
• How Depth of Knowledge Drives Learning and Assessment
• Elie Wiesel's Speech for Holocaust Units
• Critical Thinking in Reading and Composition
• Typical Course of Study for 9th Grade

• Our Mission

Inquiry-Based Tasks in Social Studies

Assignments that are bigger than a lesson and smaller than a unit are a good way to experiment with inquiry-based learning.

Many schools, both nationally and internationally, are adopting the College, Career, and Civic Life (C3) Framework for Social Studies State Standards . Some states, districts, and schools adopt the full framework and standards, and others adopt the general framework, but modify or create their own grade-level standards. An important element of the framework either way is something called the Inquiry Arc.

The Inquiry Arc comprises four dimensions : “one focused on questioning and inquiry; another on disciplinary knowledge and concepts relating to civics, economics, geography, and history; another on evaluating and using evidence; and a final one on communicating and taking action.” The basic idea is that students ask or are given compelling questions and then investigate those questions, evaluate and find evidence to answer them, and communicate their answers.

For example, middle school students might be given the question “Can disease change the world?” in order to spark their  exploration of the Black Death . Starting with questions such as “What was the Black Death?” and “How did the Black Death affect people in the 14th century?,” they explore geography and history by examining maps and other sources.

They then write an argumentative essay to answer the original question, using the sources they examined as evidence. As an extension, they might create a public service announcement on how to assess how effective their school or community is in preventing and controlling the spread of disease.

By default, inquiry is hardwired into the C3 framework and standards: In order to effectively implement the C3, you must engage students in inquiry practices.

The Inquiry Design Model for Tasks

The Black Death exercise is an example of an inquiry-based task that uses the Inquiry Design Model (IDM) developed by some of the key authors of the C3. They describe these tasks as “bigger than a lesson, smaller than a unit”—just right for teachers who want to implement inquiry-based learning but may not feel comfortable devoting a unit to it. IDM tasks include the following :

• A compelling question that is of interest to students and addresses issues found in one or more of the academic disciplines in social studies. It should provoke student thinking and align to curricular outcomes.
• Specific standards from the C3 framework.
• An activity to stage the question to elicit student inquiry.
• Supporting questions aligned to the compelling question. They are specific and content-based, and guide the students to be able to answer the compelling question.
• Formative assessments to check student knowledge of the content under the supporting questions. These can be short paragraphs, graphic organizers, or other traditional ways to assess student learning.
• Sources—usually primary sources—aligned to the supporting questions.
• A summative performance task that is argumentative in nature. Students must answer the compelling question using evidence to support their thinking.
• An option for students to take informed action in the world around them.

In an elementary example , students learn economics standards by investigating the compelling question “What choices do we make with our money?” They examine short readings and images, and write a short argument using these sources. They discuss the pros and cons of saving and spending, and have a chance to take informed action such as creating a poster listing ways families can save money.

There is also a version of IDM called a focused inquiry . A high school example has the compelling question “Did the attack on Pearl Harbor unify America?” Students answer a single supporting question and complete one performance task and then write short claim and counterclaim arguments. They then propose a revision to their textbook based on the sources explored in an extension assignment. This takes one or two class periods, versus five or six for the elementary school economics example.

What About Project-Based Learning?

Project-based learning (PBL) is also a great way to implement the C3 framework. PBL employs inquiry and includes elements that increase engagement, such as authenticity, high-quality public products, and voice and choice.

But there may be challenges to implementing the C3 framework through PBL. Teachers may not want to transform a full unit into PBL, or the unit may not be a great fit for PBL. In any case, an inquiry-based task like IDM has many of the essential elements of PBL : It assesses key knowledge and skills, has a challenging question, and requires inquiry. It also may allow students to do more public work if they take informed action through the extension assignment. It’s also possible to have an inquiry-based task within a PBL unit, as another way to assess student learning: If students are collaborating on the final PBL product, an inquiry-based task is an effective way for teachers to assess individual students’ understanding of the content and skills in the project.

Teachers need to use their professional judgment about what makes sense for student learning as they consider PBL and smaller inquiry-based tasks. Both can increase student engagement and be used to assess deeper learning.

• Study Protocol
• Open access
• Published: 13 May 2024

Enhancing Pragmatic Language skills for Young children with Social communication difficulties (E-PLAYS-2) trial: study protocol for a cluster-randomised controlled trial evaluating a computerised intervention to promote communicative development and collaborative skills in young children

• Suzanne Murphy 1 ,
• Kerry Bell 2 ,
• Erica Jane Cook 1 ,
• Sarah Crafter 3 ,
• Rosemary Davidson 1 ,
• Caroline Fairhurst 2 ,
• Kate Hicks 2 ,
• Victoria Joffe 4 ,
• David Messer 3 ,
• Lyn Robinson-Smith 2 ,
• Luke Strachan 2 ,
• David Torgerson 2 &
• Charlie Welch 2  

BMC Psychology volume  12 , Article number:  266 ( 2024 ) Cite this article

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A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The E-PLAYS-2 study will test an intervention (‘E-PLAYS’) aimed at supporting such children. E-PLAYS uses a dyadic computer game to develop collaborative and communication skills. Preliminary studies by the authors show that E-PLAYS can produce improvements in children with social communication difficulties on communication test scores and observed collaborative behaviours. The study described here is a definitive trial to test the effectiveness and cost-effectiveness of E-PLAYS delivered by teaching assistants in schools.

The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, delivered in primary schools, compared to care as usual. Cluster-randomisation will take place at school level to avoid contamination. The E-PLAYS intervention will be delivered by schools’ teaching assistants. Teachers will select suitable children (ages 5–7 years old) from their schools using guidelines provided by the research team. Assessments will include blinded language measures and observations (conducted by the research team), non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. A process evaluation will also include interviews with parents, children and teaching assistants, observations of intervention delivery and a survey of care as usual.

The primary analysis will compare pragmatic language scores for children who received the E-PLAYS intervention versus those who did not at 40 weeks post-randomisation. Secondary analyses will assess cost-effectiveness and a mixed methods process evaluation will provide richer data on the delivery of E-PLAYS.

The aim of this study is to undertake a final, definitive test of the effectiveness of E-PLAYS when delivered by teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. Should E-PLAYS prove to be effective at the end of this trial, we believe it is likely to be welcomed by schools, parents and children.

Trial registration

ISRCTN 17561417, registration date 19th December 2022.

Protocol version: v1.1 19th June 2023.

Peer Review reports

Children who have difficulties with social communication (also known as pragmatic language ability) experience problems with using language for social purposes. Whilst their knowledge of grammar and vocabulary may be adequate or even advanced, they struggle with communicative tasks such as appropriate use of greetings, conversational turn-taking, understanding non-literal language such as jokes, irony or sarcasm, social conventions such as politeness, taking the perspective of their listener and responding with relevant information [ 1 ].

'Social communication difficulties' (SCDs) or 'pragmatic language impairments' represent a continuously distributed trait in the population. This trait includes individuals at the extreme end who are diagnosed with autistic spectrum disorder and/or severe language disorders but also a much larger group who show milder, but still detrimental, communication difficulties [ 2 ].

Children with SCDs are commonly rejected and victimised by peers [ 3 , 4 ] and can be severely disruptive [ 5 , 6 , 7 ]. In groups, they fail to contribute appropriately, and are often ignored or dominated by peers [ 8 , 9 ]. Children with pragmatic language problems experience lower quality of life; in adulthood these individuals experience more mental health problems, lower academic achievement and make fewer friends [ 10 ]. Health economic evaluations have also been called for as healthcare costs have been shown to be 36% higher for children with language disorders at 4–5 years old [ 11 ].

These communication difficulties frequently cause troubled interactions with family, peers, teachers and the criminal justice system [ 12 , 13 ]. For primary school children of low socio-economic status, pragmatic language skills appear to be especially important [ 14 ].

Children with language difficulties in the UK are served by NHS Speech and Language therapists and/or by schools’ own speech and language services and schools’ other provisions. However, services are stretched, particularly since the pandemic. Furthermore, schools and speech and language therapists have few rigorously tested interventions that they can use for SCDs. The most recently available surveys of usual care reported a ‘proliferation of locally-developed programmes based on clinical experience’ due to a lack of ‘strongly evidence-based programmes’ [ 15 , 16 ]. These findings were borne out by interviews with schools and speech and language therapists in our earlier work [ 17 ]. Activities typically include exercises on turn-taking, topic management, and conversational skills, sometimes with role-play or modelling. There is little evidence concerning the efficacy of these constituent activities [ 16 ]. Whilst the use of technology and gaming has been highlighted as a positive tool for facilitating communication and collaboration in children with social communication difficulties [ 18 , 19 ], its use is generally viewed as emerging rather than established [ 20 ].

E-PLAYS (Enhancing Pragmatic Language skills for Young children with Social communication difficulties) is a computer-based intervention that has been developed and piloted by our team.

Collaborative and team-building skills are recognised as vital to future adult employment and participation in society [ 21 ]. However, some of the most challenging contexts for children with social communication difficulties are precisely those requiring collaboration, such as joint problem-solving or creative free play [ 8 , 9 , 22 , 23 ]. E-PLAYS aims to facilitate and enhance children’s interactions by providing socio-cognitive scaffolding within a fun, cooperative computer game.

E-PLAYS supports communication based around naturalistic play with a peer and aims to embed learning in relevant contexts, thus promoting the generalisation of these social skills.

An earlier version of E-PLAYS (known as the Maze Game [ 9 , 23 ]) was tested on 32 children. Children receiving the intervention showed significant improvement by comparison to a control group on pragmatic language test scores. A recent feasibility study of E-PLAYS [ 17 ] with 50 children showed good response and completion rates, realistic recruitment and high acceptability by children and schools. These studies laid the groundwork for the present study which will conduct a randomised controlled trial of E-PLAYS seeking to establish its clinical- and cost-effectiveness.

Design and methods

The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, which is designed to improve pragmatic language skills in children with social communication difficulties, delivered in primary schools, compared to care as usual.

Trial design

The E-PLAYS-2 trial is a multi-centre, two-arm, cluster-randomised controlled trial with an internal pilot.

The trial will take place in state-funded mainstream primary schools and state-funded special primary schools in Bedfordshire, Hertfordshire and North London. Following slightly lower than anticipated recruitment during the internal pilot phase, primary schools in Buckinghamshire will also be recruited for the main trial.

Participants

Both the school and the children’s parents/carers must agree to take part before either may be included. Eligibility to take part will be ascertained using the following criteria.

School eligibility

Inclusion criteria:.

A state-funded infant or primary school or special needs school based in the target recruitment areas;

Exclusion criteria:

Independent, fee-paying schools;

Schools participating in other language and communication research/trials aimed at pupils in Year 1 and Year 2 (aged 5–7 years);

Schools who have previously used E-PLAYS;

Child participants

Teachers will use the Social Communication Behaviour Checklist [ 24 ] which comprises a short 5-item questionnaire to confirm or reject their selection for ‘Focal’ children. Similarly, teachers will use the Social Communication Behaviour Checklist to confirm the selected ‘Partner’ children do not meet the criteria for social communication difficulties (see ‘ Intervention ’ section for definitions of Focal and Partner children). Child recruitment will take place prior to school randomisation.

Child eligibility (Focal children)

Focal child eligibility criteria are as follows:

Children aged 5–7 years old;

Children who meet the criteria for social communication difficulties as determined by the Social Communication Behaviour Checklist [ 24 ];

Children whose parents/carers give consent for them to take part in the E-PLAYS-2 trial;

Children who have not used E-PLAYS before;

Children whose parents/carers are willing to complete relevant questionnaires;

Children who complete the key trial baseline assessments (assuming all other eligibility criteria are met);

Baseline and outcome data will be sought for all Focal children (subject to potential withdrawals from some or all aspects of follow-up data collection by participating schools or parents).

Child eligibility (Partner children)

Partner child eligibility criteria are as follows:

Children who do not meet the criteria for social communication difficulties as determined by the Social Communication Behaviour Checklist [ 24 ];

Children whose parent/carers give consent for them to take part in the E-PLAYS-2 trial.

Not all Partner children will complete assessments. We will randomly select one Partner child from each school to complete the Test of Pragmatic Skills (TPS) at baseline and follow-up assessments (see details of the TPS below). This will allow for a comparison of the outcomes in this subsample of typically-developing children between intervention (where the child will partner a participating child in E-PLAYS-2) and control schools (care as usual). Parents/carers of the Partner children will be asked to consent to the Partner child completing the TPS (although only one randomly selected participant in each school will complete these assessments as stated above).

Intervention

The E-PLAYS programme is designed for children with SCDs aged 5–7 years old (referred to hereafter as ‘Focal’ children). Using a computer game, E-PLAYS guides the Focal child through real-life conversational exchanges with a specific focus on (a) requesting optimally useful information (b) giving helpful directions and (c) asking for clarification. Each Focal child is matched with a ‘Partner’; a typically-developing child from the same year group.

Each E-PLAYS session uses the computer game which is designed for two players using interlinked laptops. There are ten weekly sessions of 30 min each; schools’ teaching assistants are trained to deliver and supervise all sessions. Five sessions are with the Focal child and the teaching assistant only, five are with the Focal and Partner child together supervised by the teaching assistant. Sessions with the classmate (Partner child) give the child an opportunity to practice newly-acquired skills and also to learn collaboration skills through joint problem-solving with a peer. E-PLAYS is web-based, enabling us to distribute E-PLAYS directly to schools. Teaching assistants will self-train using a comprehensive manual with online support. The E-PLAYS software automatically records the number of sessions along with date accessed and sends this data directly to the research team.

Recruitment

School recruitment.

Recruitment strategies include directly emailing schools based in the target recruitment areas, use of social media channels and working with contacts in relevant local authorities by providing them with recruitment materials to distribute at a local level. During initial contact, schools will be provided with an information sheet about the trial. Where schools express an interest in participating, a member of the research team will arrange a convenient time discuss the trial with an appropriate staff member (e.g., a Head Teacher or a Special Educational Needs Co-ordinator (SENCO)) in greater detail. Schools wishing to proceed will be required to sign a memorandum of understanding (MoU) agreeing to the expectations of the trial, and a Data Sharing Agreement (DSA) between the school and the research team.

School retention and withdrawal

Schools will receive £350 as a thank you for taking part in the trial. This will be paid in instalments by the University of Bedfordshire after key milestones have been reached (such as completion of mid-trial surveys).

Where a school indicates that they wish to withdraw from the study this will result in the full withdrawal of all participants and staff at this school. No further data will be collected. The school will inform the parents/carers that they have withdrawn.

Child recruitment

Once teachers have identified the children eligible to take part in the trial, the teacher will distribute paper information sheets and consent forms to their parents/carers. Translated versions will be offered for parents with English as an additional language (EAL). The participant information sheets will be supplied to schools by the research team, along with a simplified illustrated information sheet for children to read together with their parents/carers. The information sheets and consent forms will be tailored to Focal and Partner children. Schools will be asked to send a reminder to parents/carers if no response is received approximately two weeks after receipt of the original invitation pack. Completed consent forms are to be returned to the school for collection by the research team.

Child consent procedure

All parents will be given the option to speak to a member of the research team or to contact the Chief Investigator in the event of additional questions. Consent to enter the study will be sought from each participant only after a full explanation has been given, an information leaflet offered and time allowed for consideration.

Participation in the study will be entirely voluntary and written informed consent from parents/carers will be obtained before child baseline data is collected and randomisation is conducted. On the consent form, parents/carers will be requested to consent for their child’s school to provide data including child’s name, date of birth, gender, home postcode, ethnicity, religion/belief, English as an additional language (EAL), education, health and care plan (EHCP) status, help received from a Speech & Language Therapist and/or an Educational Psychologist and receipt of Pupil premium and/or free school meals (FSM, a proxy for deprivation) for the purposes of sample description and potentially for use as covariates in analyses. The consent form for Focal children will also request parent/carers to provide their educational qualifications, employment status, ethnicity and consent/commitment to complete the EQ-5D-Y (proxy version 1), CHU-9D, and resource use data questionnaires at specified time-points. Parents/carers will return completed consent forms to the school.

Child and parent/carer retention and withdrawal

At the end of the trial and following completion of all questionnaires, parents/carers of Focal children will receive a £15 voucher to offset any incidental expenses and in recognition of their participation.

All participants are free to withdraw at any time from either the intervention or follow-up data collection without giving reasons and without prejudicing further care. The Chief Investigator will preserve the confidentiality of participants taking part in the study and is registered under the Data Protection Act. If a child does not appear to want to take part at the time the E-PLAYS intervention is being delivered and/or assessments are taking place, their wishes will be respected. Where a parent/carer wishes to withdraw from the study, it will be clarified as to whether they wish their child to withdraw from the intervention or if they themselves wish to withdraw (i.e., stop completing outcome measures). Where withdrawal is only for the participating parent/carer, the child may continue to take part in all other aspects of the trial and follow-up data will continue to be collected when possible. If a Partner child withdraws, another child from the school will be recruited as a replacement for the purposes of intervention delivery.

Teaching assistant recruitment

All teaching assistants will be asked to provide information at baseline on their work training and experience. School staff will also be asked to complete a survey exploring usual care for children with social communication difficulties. A subset of teaching assistants will be asked to participate in interviews, observations and focus groups; for these a separate information sheet and consent form will be provided by the research team.

Teaching assistant retention and withdrawal

Where withdrawal is only for the teaching assistant, we will ask schools to replace them for the intervention period. Where a teaching assistant cannot be replaced, the study team will discuss the implications of this with affected participant(s) to establish if they wish to continue providing outcome data.

Randomisation

The trial will be cluster-randomised to prevent within-school contamination. Schools will be allocated to intervention or control group using minimisation based on geographical location and proportion of children with free school meals (a proxy for deprivation) by a trial statistician at York Trials Unit using dedicated software (MinimPY [ 25 ]). Randomisation will occur following baseline data collection. Schools will be informed of their allocation via email. Schools will be advised to tell the parents/carers of participating children the schools random allocation.

Children in schools allocated to the intervention group will receive E-PLAYS plus whatever constitutes care as usual in their school. Participating children in schools allocated to the control group will receive whatever constitutes care as usual in their school. ‘Care as usual’ is defined as the existing support routinely provided for a child with social communication difficulties from educational and health services.

Outcome measures

Outcome data will be provided by three different kinds of observers: blinded research assistants, parents/carers and teachers.

Blinding of outcome data collection

Research assistants will be blind to group allocations when collecting the quantitative outcome measures listed below. They will have received relevant training from the research team. All research assistants will have an enhanced Disclosure and Barring Service (DBS) check and undergo relevant safeguarding and data protection training. When a research assistant visits a school to administer the assessments, teachers and teaching assistants at the school will be reminded on every visit not to reveal allocation to the research assistants. Any instances of unblinding during the assessments will be recorded (using a bespoke unblinding form which will include information on who was unblinded, the source of unblinding, and the reason for unblinding) and the unblinded research assistant will be replaced with another research assistant who is blind. Research assistants will also collect qualitative data from schools; for this data, they will not be blinded. Hence, each school will be allocated both a blinded and unblinded research assistant.

Teachers and parents/carers will be requested to complete outcome measures for Focal children. Whilst blinded during the completion of these outcome measures at baseline, due to the nature of the intervention, it is not possible for them to be blinded at 15–20- or 35–40-weeks post-tests.

Primary outcome

The primary outcome is the Focal children’s pragmatic language ability measured using the validated Test of Pragmatic Skills (TPS [ 26 ]). This assessment will be administered by a blinded research assistant at baseline, and at 15–20- and 35–40-weeks post-randomisation. The measurement at 35–40 weeks will serve as the primary endpoint for the trial, with the 15–20-week measurement being a secondary outcome.

Secondary outcomes

The following secondary outcome measures will also be administered to Focal children by a blinded research assistant at baseline, 15–20 weeks, and 35–40 weeks post-randomisation.

Clinical Evaluation of Language Fundamentals-5 (CELF-5 [ 27 ])—Recalling Sentences and Following Directions subscales.

Expression, Reception and Recall of Narrative Instrument (ERRNI [ 24 ]) assesses the ability to relate, comprehend and remember information after a short delay.

Droodles Tasks and Communication Test [ 28 , 29 ].

The Droodles Task and Communication Test are a series of tasks and puzzles testing children’s ability to evaluate the effects of ambiguous versus informative communications, a key skill targeted by E-PLAYS. The tests are embedded in play sessions with dolls and puppets and have previously been used for this age group.

The battery of assessments above will take approximately 50 min to administer per child at each data collection time-point. The children’s tests are mostly tasks presented as fun games to play and therefore not onerous for the children. These tests can be divided into two or more sessions as the children are very young and may tire.

The following secondary outcome measures (relating to health-related quality of life) will be completed by Focal children’s parents/carers at baseline, 15–20 weeks and 35–40 weeks post-randomisation:

Child Health Utility (CHU-9D), paediatric generic preference-based measure of quality of life. The CHU-9D includes specific dimensions on school and joining in with activities [ 30 , 31 ].

EQ-5D-Y (proxy version 1). This is a widely used standardised generic measure of health-related quality of life for younger children [ 32 ].

Resource use data: A bespoke questionnaire (developed for the E-PLAYS feasibility study [ 17 ]) will collect resource use data about healthcare, voluntary organisations and educational resources.

We anticipate that it will take parents/carers approximately 30 min to complete the questionnaires at each data collection time-point.

The following secondary outcome measures will be completed by the Focal children’s teacher at baseline, 15–20 weeks and 35–40 weeks post-randomisation; these measures are completed by the teachers without the child present:

Children’s Communication Checklist-2 (CCC-2[ 33 ]). CCC-2 is a standardised questionnaire of children’s communication impairment.

The Strengths and Difficulties Questionnaire (SDQ [ 34 ]). The SDQ is widely used as a mental health indicator with subscales assessing behavioural, emotional and peer problems.

We anticipate the questionnaires listed above will take teachers no longer than ten minutes per child to complete at each data collection time-point.

The following secondary outcome measures will be administered to a randomly selected subgroup of 88 Partner children (1 per school) in school by a research assistant at baseline, 15–20 weeks and 35- 40 weeks post-randomisation:

Partner children’s pragmatic language ability measured using the validated TPS [ 26 ].

Sample size calculations

We will recruit single- and multi-form entry schools. Pupils will be recruited from Years 1 and 2; assuming an average of two classes per year, based on our feasibility study [ 17 ] we expect to identify a mean of ten eligible Focal children per school, of which six will consent and be recruited. The intervention will be delivered to the participating children by teaching assistants and we expect an average of 1.5 teaching assistants per class.

In multi-form entry schools, we will have clustering of classes within year groups, but in one-form entry schools the levels of class and year will be equivalent. We consider that in multi-form entry schools the difference in clustering between class and year will be negligible so we shall ignore the level of class. Therefore, this cluster randomised trial assumes a three-level structure in that pupils (level 1) are nested within year group (level 2) nested within schools (level 3). Randomisation will take place at school-level. The year groups participating in this trial are consecutive (Years 1 and 2) so the difference between them will be minimal and the cluster effect of school will likely dominate the effect of class; therefore, we have not explicitly accounted for clustering at the class level in this sample size calculation. The largest influence within schools is likely to be between teaching assistants since these will be the ones delivering the intervention to the children; however, in most schools we expect that the ratio of teaching assistants to participating children will be approximately 1:1 so this level of clustering is eliminated. In the feasibility trial [ 17 ], the school-level ICC was small (< 0.01); here we have assumed a conservative ICC of 0.05 at the school-level to account for all levels of potential clustering.

In our feasibility trial the standard deviation (SD) of the primary outcome measure, the TPS [ 26 ], at baseline was 7.2 (95% CI 5.4 to 9.7) and the observed correlations between the TPS score at baseline and the scores at weeks 15–20 and 35–40, respectively, were 0.84 (95% CI 0.71 to 0.91) and 0.79 (95% CI 0.63 to 0.89). In the calculation for this trial we assume: a SD of 7, an ICC of 0.05 at the school-level, a mean cluster size of six (Focal children per school, at randomisation), 20% pupil level attrition at follow-up and a more conservative pre-post correlation of 0.6. To detect a difference in TPS score of 2 points (a third of a year’s progress based on the standardisation sample given in the TPS manual), with 90% power and a two-sided alpha of 5%, we would require 84 schools (504 focal children).

We will undertake an exploratory analysis to assess the potential impact of the intervention on Partner children’s (i.e., those who do not have social communication difficulties) pragmatic language skills. We will randomly select one Partner child from each school to complete the TPS [ 26 ] at baseline, at 15–20 weeks post-randomisation and at 35–40 weeks post-randomisation with a blinded, independent research assistant. This will allow for a comparison of the outcomes in these typically-developing children between intervention (where the child will partner a participating Focal child in E-PLAYS) and control schools (care as usual).

Since this is an exploratory analysis, we have planned the sample size of one typically-developing child from each school for logistical reasons. Collecting the TPS [ 26 ] from only one extra child per school will not substantially increase the time or burden to complete outcome measures. Assuming a SD of 7, a pre- post-test correlation of 0.6 and 20% attrition, a sample size of 84 children (one per school) will give 80% power to detect a difference of 3.9 points in the TPS [ 26 ]. We shall compare TPS [ 26 ] scores of the typically developing children.

For the 20 school clusters recruited as part of the internal pilot phase, the observed mean cluster size (at randomisation) was 4.55 participants per cluster, around 25% less than the anticipated six participants per cluster detailed in the previous section.

Following discussion with the funder, the total target number of school clusters was changed to 88. Assuming a mean cluster size (at randomisation) of 4.55 and keeping all assumptions the same as previously (e.g. \(\delta\) = 2, SD = 7, pre-post correlation = 0.6, school level intra-cluster correlation of 0.05 and 20% participant level attrition), 44 clusters per group would provide approximately 85.2% power for a two sided test of \({H}_{0}:\delta =0\) (where \(\delta\) is the difference in expected TPS score at 35–40 weeks).

As per the original proposal we will randomly select one Partner child per school to complete the primary outcome (TPS [ 26 ],) at baseline and 15–20- and 35–40-weeks post-randomisation. Under the same assumptions as before, a sample size of 88 children (one per school) will give 80% power to detect a difference of 3.4 points in the TPS [ 26 ].

Statistical analysis plan

Statistical analysis will primarily be conducted in Stata/MP v18 [ 35 ] or later, unless specified otherwise. All analyses will be conducted just once at the end of the trial follow-up period, according to precise specifications detailed in a Statistical Analysis Plan (SAP) that will be approved by the TMG and TSC prior to the end of follow-up. Any departures from the analysis plan will be reported and justified in the final trial reports and other relevant published articles.

The flow of clusters and participants through the study will be presented according to CONSORT guidance for cluster RCTs. Continuous characteristics will be summarised in terms of the available sample size, arithmetic mean, standard deviation, median, interquartile range, minimum and maximum. Categorical characteristics will be summarised in terms of frequencies and percentages.

For all between group comparisons, clusters and participants (both Focal and Partner) will be analysed as part of the groups to which they were randomised, regardless of subsequent engagement with the allocated treatment. All analyses estimating between group contrasts will include all participants with data available for the relevant outcome (unless explicitly stated otherwise in the SAP). Point estimates of contrasts between randomised groups will be reported together with appropriate 95% confidence intervals. Point and interval estimates will be reported on the scale of the original measurements (as well as the scale used for the analysis should these differ). P-values for statistical tests will be two-sided unless specified otherwise in the SAP.

Baseline data participants

Baseline data for the participating focal children will be summarised descriptively by randomised group and overall, according to the principles outlined above. Two sets of tables will be reported: one set including all randomised Focal children and another including just the subset of Focal children included in the primary analysis model. Baseline data for the participating Partner children will be summarised similarly in a separate set of tables. No formal comparison of baseline data between randomised groups will be undertaken (for either Focal or Partner children).

Primary outcome analysis (focal children)

The planned primary analysis model will include all available post-randomisation TPS [ 26 ] scores as outcomes, modelling these measurements using a linear mixed effect model. This model will include fixed effects for treatment group, time point, and their interaction, and will also condition on fixed effects for baseline TPS mean composite score, year group, child FSM status, geographical location of school, and school level random intercepts. Correlation between repeated measurements within participants will be modelled using an unstructured covariance matrix for the model residuals. Precise details of the terms included in the model will be provided in the SAP (including plans for dealing with any incomplete baseline covariate data). If the fit of the planned primary analysis model is reasonable (see below), then the fitted model will be used to estimate differences (Intervention – Control) in expected TPS scores at both post-randomisation time points, together with 95% confidence intervals and p-values for tests of H 0 : \(\delta\) = 0 (where \(\delta\) is the difference in expected score at the relevant time point).

The appropriateness of key model assumptions will be checked using diagnostic plots based on the standardised residuals from the fitted model. If these plots (or indeed other extra-data considerations) suggest the observed data show important departures from the assumptions of the planned analysis, then we will undertake semi-parametric analyses of the scores at each post-randomisation time point in isolation. This will be accomplished using cumulative probability models based on ordinal regression [ 36 ]. The ordinal regression models will include fixed effects for treatment group, baseline TPS [ 26 ] mean composite score, year group and child FSM status, and a random intercept for school.

Sensitivity analyses (Focal children)

Several additional planned analyses of the primary outcome will be undertaken to investigate the sensitivity of the results of the primary analysis to departures from the key statistical assumptions that underpin this analysis. In particular, we will investigate the impact that various alternative adjustment sets have on the results of the primary analysis, investigate the potential impacts of departures from the planned schedule of assessments, and undertake analyses of the primary outcome under different assumptions about any missing primary outcome data.

Principal stratum analyses (Focal children)

Participants allocated to the control group will not have access to the E-PLAYS intervention. Participants allocated to the intervention group will be offered the E-PLAYS intervention, but may not receive any sessions at all, or may receive only a proportion of the planned ten sessions (or potentially none of them).

We will estimate two different CACE estimands under different definitions of compliance: (1) The difference in expected TPS mean composite score at 35–40 weeks among participants that would complete at least one session of the E-PLAYS programme if they were randomised to E-PLAYS; (2) The difference in expected TPS mean composite score at 35–40 weeks among participants that would complete at least seven E-PLAYS sessions (70% of the programme) if they were randomised to E-PLAYS.

We will use instrumental variable estimators to estimate both of these principal stratum estimands. Specifically, we will use random allocation as an instrument for the relevant definitions of treatment receipt in each case, with estimation performed using a generalised two-stage least squares random effects estimator. These analyses will include the same baseline covariates as included in the primary analysis and random intercepts for school cluster. Point estimates of the two principal stratum estimands outlined above will be reported together with two-sided 95% confidence intervals and p-values for tests of H 0 : \(\delta\) = 0.

Secondary outcome analyses (Focal children)

Continuous secondary outcomes will be analysed similarly to the primary outcome, with the baseline TPS score replaced with the baseline score for the relevant outcome. Ordered categorical secondary outcomes will be analysed using appropriate ordinal regression models with similar fixed and random effects as included in the primary analysis.

Fidelity analysis

E-PLAYS software will record the content, duration and number of intervention sessions each child receives using a unique login ID. This monitoring data will be summarised as part of the process evaluation and used to estimate Complier Average Causal Effect (CACE) estimands (see above).

Primary outcome analysis (Partner children)

The TPS scores for Partner children will be analysed following a similar approach to the primary analysis but will not include random intercepts for school cluster (since there will be no replication at the participant at within cluster level) (Fig. 1 ).

Flow diagram of the E-PLAYS-2 recruitment, randomisation and data collection

Process evaluation

A mixed-methods process evaluation, following MRC recommendations for RCTs [ 37 ], will assess E-PLAYS' acceptability and fidelity of implementation, mechanism of impact, and examine contextual influences on implementation and outcomes. This evaluation will use quantitative and qualitative data across the school sample alongside observation, interview and focus group data from four purposively selected case study schools. Research assistants will conduct the interviews, observations and focus groups described below.

Case study schools

Eight intervention schools (four from the internal trial and a further four from the main trial) will be purposively sampled to act as case studies [ 38 ]. Schools will be profiled to include at least the following: one special needs and one mainstream school plus one school with high levels of deprivation and another with a high proportion of children with English as an additional language. These schools will be approached to be case studies before the E-PLAYS intervention is given to them and will continue to be observed throughout intervention delivery. The following assessments will take place with a subgroup of case study participants:

Structured observations of the children (Focal and Partner) and teaching assistants as they use E-PLAYS, based on an observation schedule developed for the E-PLAYS feasibility study ([ 17 ] mid-intervention);

Focus groups conducted with teaching assistants exploring their experiences of delivering E-PLAYS (end intervention);

Interviews with the children (Focal and Partner) with a card sorting task and visual analogue scale to give an indication of their liking of E-PLAYS (mid-intervention);

Structured interviews with parents exploring the extent to which children play computer games at home before and after the intervention and any changes to game-playing (baseline and 40-week follow-up);

In addition, a training questionnaire will be sent to all teaching assistants delivering E-PLAYS to obtain feedback on the training manual and online support. This survey will also include questions on the teaching assistants training and experience. A further survey will be sent to all participating schools based on our findings from the E-PLAYS feasibility study [ 17 ], asking about the content of usual care for children with SCD. We will also include 6–8 structured interviews with a subset of teaching assistants to further explore usual care provided. Surveys will be delivered via Qualtrics online survey software, with a paper version available on request. Written consent will be obtained from teaching assistants to participate in focus groups and interviews.

Process evaluation analyses

Qualitative data will be (with written consent) audio-recorded, transcribed verbatim and managed using NVivo11 software. A six-step reflexive thematic analysis approach [ 39 ] will be used to report the experiences, meanings, and reality of participants. Two experienced qualitative researchers will independently code a subsample of transcripts where initial codes will be compared, discussed, and agreed on prior to coding on all other interviews. Codes will be generated both from the topics explored in the interview guides and iteratively from the data to attain both the facilitators and challenges of the intervention. Interim themes will then be discussed, refined, and agreed by two researchers and the research team. Detailed analysis of each theme will be presented with illustrative anonymised quotes used to illustrate themes arising from the data. Individual interview and focus group data will be analysed both separately, followed by a cross-synthesis, to identify and map overarching themes related to experiences of the intervention. Comparative analysis across the case study schools will also be conducted to explore the impact of the intervention and examine experiences across different school contexts.

Economic evaluation

The costing approach will be undertaken primarily from the perspective of the National Health Service (NHS) but will also consider the perspective of both Social and Education Services. The economic evaluation will assess the cost-effectiveness of E-PLAYS compared with usual care. Individual participant data from the trial will be used to evaluate resource use, costs, health and social outcomes associated with the intervention and will be collected over the follow-up period of the trial.

The primary economic outcome will be the difference in costs and the difference in quality-adjusted life years gained by receiving E-PLAYS using an intention-to-treat approach. Costs and outcome data for the economic analysis will be collected prospectively during the trial using proxy-reported questionnaires at baseline and at each follow-up.

The primary analysis will be conducted using the CHU-9D [ 30 , 31 ] which is a paediatric generic preference-based measure of quality of life that includes specific dimensions on school and joining in with activities and allows for the calculation of QALYs [ 31 ]. To ensure comparability with similar interventions, a secondary analysis will be conducted using the EQ-5D-Y [ 32 ]. Both instruments will be collected from proxies at baseline and at each follow-up. Mean within-trial costs and benefits will be calculated using regression methods adjusting for baseline covariates as well as any correlation between costs and utility. Multiple imputation methods will be used to deal with missing data if appropriate. Uncertainty will be described using confidence intervals and cost effectiveness acceptability curves (CEACs). A range of sensitivity analyses will be conducted to test the robustness of the results under different scenarios.

The bespoke resource use questionnaire developed for the feasibility trial of EPLAYs will be used. Healthcare resource use will be presented for both arms in terms of mean value, standard deviation and mean difference (with 95% confidence interval) between the groups. The cost of the intervention will be estimated according to treatment and resource use costs. Treatment costs will include staff, equipment and software costs. Unit costs will be derived from established national costing sources such as NHS Reference Costs and PSSRU Unit costs of health and social care. Unit costs will be multiplied by resource use to obtain a total cost for each patient (pupil).

The cost of delivering E-PLAYs was estimated in the feasibility trial. To confirm this, a costing exercise will be undertaken taking a bottom-up approach to identify and place a value on the constituent parts of the intervention delivery, e.g., staff and training costs, to estimate total cost both in monetary terms and time required including that of existing school staff.

The results of the trial will provide an estimate of the relative effect of E-PLAYs compared with usual care for the time horizon of the trial. However, there is potential for the impact of the intervention to extend far beyond what is measurable during the trial period, for instance, long-term educational outcomes and future criminal activity/anti-social behaviour. We will consider existing models that link the shorter-term outcomes of the trial, for example behavioural problems as measured by the SDQ, to longer term outcomes. One potential such model is the Dartington model [ 40 ] which could be used as the basis for linking short term outcomes to longer term educational attainment, future criminal activity and labour market productivity, though there are possibly other models available. We will use any identified models to examine the likely additional costs and benefits of the intervention over the longer term. As with the within trial analysis, health and educational effects will be presented separately and the potential values of the outcomes will be explored for both sectors. A discount rate of 3.5% will be applied for costs and outcomes.

Data management

Data collection, management and verification.

The five primary sources of quantitative data for this trial are:

Data collected by research assistants during school visits at baseline, 15–20 weeks and 35–40 weeks. The TPS and ERRNI will be audio recorded, with these recording being subsequently scored, and the relevant data entered into the REDCap database. All of the other Research Assistant completed measures (CELF-5, Droodles and Communication Test) will be entered into the REDCap database after testing.

Data collected from the teachers of participating focal children at baseline, 15–20 weeks and 35–40 weeks (CCC-2 and SDQ). These data will be collected via online Qualtrics surveys sent directly to teachers of participating focal children.

Data collected from the parents of participating focal children at baseline, 15–20 weeks and 35–40 weeks. Parent/household demographic data (e.g. parent/carer employment, parent/carer ethnicity etc.) are collected as part of the paper consent forms completed by parents of participating focal children. These forms are returned to the research team who enter these into the REDCap database. Parent completed data for the economic evaluation (i.e. EQ-5D-Y, CHU-9D and resource use) will be collected electronically (via direct entry into the trial REDCap database), or via paper questionnaires (which are subsequently returned to the trial team and entered into the trial database)

Data collected directly from the schools of participating children at baseline (provided for both focal and partner children). These data (e.g. age, gender, ethnicity etc.) are entered into password protected spreadsheets by school staff (one for each school). These are then securely shared with the research team.

Data collected by research assistants during intervention fidelity assessments.

Monitoring data: E-PLAYS-2 software will record the content, duration and number of intervention sessions each child receives using a unique login ID. Access to the E-PLAYS information is password protected and will be accessed on University computers with Bitlocker Windows security. Data within the E-PLAYS software is anonymised.

Most of the quantitative trial data will be stored and managed using REDCap (Research Electronic Data Capture). REDCap is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources [ 41 , 42 ]. Data provided by teachers (CCC-2 and SDQ responses at baseline, 15–20 weeks, and 35–40 weeks) will be collected using a bespoke Qualtrics questionnaire [ 43 ] created by the research team at YTU. Data provided by schools via password protected Excel spreadsheets will serve as the raw data for these variables.

Validation of the quantitative data will be implemented as part of the REDCap and Qualtrics systems, so that data will be checked at the point of data entry. The validation rules implemented as part of the REDCap system were reviewed and agreed by the trial statistician and health economist prior to the start of data entry. The trial statistician and health economist have permissions to download the data stored in REDCap, saving these exports to secure password protected servers managed by YTU. Electronic datasets from the Qualtrics survey will be accessed directly from the Qualtrics software by the trial statistician, with these again being saved locally to YTU managed servers. Electronic datasets (.xlsx format) completed by schools will be stored in a central location accessible by the research team at YTU (including the trial statistician and health economist).

All quantitative data (REDCap, Qualtrics and school completed data stored on YTU servers) will be imported into statistical software (precise details reported in any outputs/reports). Further checks to investigate the consistency and completeness of the data will be undertaken. Any anomalies identified during these processes will be documented and resolved in accordance with the procedures outlined in YTU SOP S02: Statistical Quality Control. Any changes to the analysis data will be detailed in an assumptions log as described in YTU SOP S02: Statistical Quality Control.

There will also be qualitative data from interviews, surveys and structured observations in the form of audio recordings. Recordings will be securely transferred to the transcription company via a secure file transfer service. Audio recordings will be deleted once anonymised transcriptions have been received by the research team.

Access to Data

The final anonymised trial dataset will be available to all trial team members/investigators if a formal request describing their plans is approved by the Trial Management Group. To ensure confidentiality, data dispersed to trial team members will be blinded of any identifying participant information. Appropriate anonymised datasets will be made available in a public repository, such as the UK Data Archive. Any participants that do not have explicit consent in place for publicly sharing anonymised data will have their data removed from any publicly available datasets.

Data protection

The University of York will be the Data Controller who also processes data. Data subjects are the participants in the evaluation, which includes children in participating schools, their parents/carers and staff members in participating schools. Personal data will be processed under Article 6 (1) (e) ( Processing necessary for the performance of a task carried out in the public interest ) and Special Category data under Article 9 (2) (j) ( Processing necessary for … scientific … research purposes) of the General Data Protection Regulation (GDPR; 2018). Any sharing of data between research team institutions will be made explicit in all participant information sheets and will be based on the procedures given in relevant Data Sharing Agreements. The study consent form will include optional statements affirming agreement with sharing anonymised data.

Potential participants of the trial will be informed about the research via an information sheet sent on behalf of the research team by Schools to parents/carers/children/staff. Parents/carers willing for their child to participate will provide written informed consent. Paper consent forms will be securely transported and stored in a locked filing cabinet at the University of Bedfordshire. A unique trial identification number (Trial/Child ID) will be generated for each participant. Data sharing agreements will be put in place with participating Schools before data transfer.

Recordings comprising audio-recordings from focus groups and interviews will be removed/deleted from audio-recorders by research assistants and stored on an encrypted flash drive (memory stick) before being transferred to university laptops compliant with university security regulations. Recordings will be securely transferred to the transcription company via a secure file transfer service. Audio recordings will be deleted once anonymised transcriptions have been received.

The dataset for statistical analysis will hold pseudonymised data. No Schools, staff members, or children will be identifiable in the report or dissemination of any results. Electronic data and paper documents including identifiable personal child data will be securely archived and disposed of by the research team five years after the end of the study (2029). Identifiable personal data about adult data subjects (e.g., parents/carers, school staff) will be kept for five years after the end of the study (2029). Pseudonymised electronic data and paper documents will be kept indefinitely.

Ethics and regulatory considerations

Ethical approval for the trial has been received from University of Bedfordshire, institute for Health Research Ethics Committee.

The proposed study will be conducted in accordance with ICH Good Clinical Practice guidelines.

A Memorandum of Understanding signed by schools will cover the requirements of the trial.

Data Sharing Agreements (DSAs) will be signed by the University of Bedfordshire and each participating school.

Ethical amendments and reporting.

Substantial amendments will require approval by both NIHR in the first instance, and where necessary the Institute for Health Research ethics committee. All correspondence with the ethics committee and NIHR will be retained in the Trial Master File (TMF). Any changes relevant to schools will be communicated in writing at the earliest opportunity following approval.

Trial monitoring

Protocol amendments.

Protocol amendments will be approved by the Chief Investigator, sponsor, Trial Steering Committee and funder and then submitted to the ethics committee (if necessary).

Protocol compliance and breaches

Accidental protocol deviations will be documented on the relevant forms and reported to the CI.

Trial management group

The Trial Management Group (TMG) will be the decision-making body who will be responsible for the day-to-day running and management of the trial. The TMG will comprise the Chief Investigator, the co-applicants, the trial manager and other key members of the research team. The Trial Management Group will meet at least monthly.

Trial steering committee

A Trial Steering Committee (TSC) will be established to govern the conduct of this study. This committee will function in accordance with YTU SOPs. The TSC will be led by an independent chair, a senior academic with relevant expertise and will comprise 75% independent members (as per NIHR’s definition https://www.nihr.ac.uk/documents/research-governance-guidelines/12154 ). The TSC will meet approximately every 6 months from the start of the trial.

Advisory group (Public and Patient Involvement)

An advisory group will input into the trial and advise on matters such as recruiting a diverse sample, producing an accessible Participant Information Sheet and other relevant participant-facing study documents, support for teaching assistants and dissemination of our findings to participants and the public. The advisory group will comprise a mix of parents of children with SCD, teachers, speech and language therapists and relevant charity representatives. All members of the advisory group will be supported by a dedicated research team member. They will plan activities such as the preparation of information sheets and newsletters and other promotion of E-PLAYS. The dedicated research team member will provide feedback on these activities and their impact and will plan to distribute and promote E-PLAYS nationally if it is found to be effective at the end of the study.

Adverse events and safeguarding

Serious adverse events (saes) and adverse events (aes).

Due to the nature of participant involvement no serious adverse events or adverse events that are unexpected and related are anticipated. However, the study team will monitor adverse events throughout the study.

Expected Events

This is a low-risk study and the trial team has not identified any adverse events that could be related to the intervention, therefore this will be determined on a case by case basis by the Chief Investigator. It is expected that there may be unrelated incidents of hospitalisations, illnesses, disabling/incapacitating/life-threatening conditions, other common illnesses and rarely deaths in the study population.

Related Events

An event is defined as ‘related’ if the event was due to the administration of any research procedure. The relatedness of an event will be reviewed by the Chief Investigator and the Trial Steering Committee. An ‘unexpected event’ is defined as a type of event not listed in the protocol as an expected occurrence.

Reporting of adverse events

Details of any SAEs or AEs reported to the study team by the participants will be considered by the Chief Investigator and the trial team. All AEs/SAEs will be recorded and reported to the Sponsor immediately upon knowledge of the event or as soon as is practicably possible to do so, and the Trial Steering Group and Trial Management Group at the next scheduled meetings. Any SAE which is unexpected and related will be reported immediately upon knowledge of the event or as soon as is practicably possible to do so to the Sponsor and Trial Steering Committee and will be reported to the Research Ethics Committee within fifteen days of the unexpected and related SAE being reported.

Child safeguarding issue

In the very rare circumstance where a child safeguarding issue is suspected, for example during data collection, a set procedure will be followed, including contacting Chief Investigator Dr Suzanne Murphy. The child’s school and parents/carers will then be informed accordingly. Both the school’s and the University of Bedfordshire’s usual safeguarding policy will then be followed. A SOP will be written to detail these arrangements.

Dissemination policy

On completion of the trial, the data will be analysed and a Final Trial Report will be prepared for NIHR and submitted after ratification by the TSC. We will publish the trial results in peer-reviewed journals irrespective of the findings. NIHR will be acknowledged as the funders in all publications. Participants will be provided with a report of the findings written in a style accessible for lay people, which will be accessible via schools. We will also provide on-going reports through our website as the trial progresses.

In order to disseminate E-PLAYS to professionals, we will offer workshops with the Royal College of Speech and Language Therapists and the children’s communication charity Speech and Language UK: Changing Young Lives. We will also publicise through National Association of Professionals concerned with Language Impaired Children (NAPLIC), Autistica, the National Autistic Society and the Communication Trust Consortium. We will also apply to have E-PLAYS registered on websites listing and reviewing evidence-based language interventions e.g., Education Endowment Foundation, the Learning Foundation. Special Educational Needs and Disabilities (SEND) teams in local authorities and CCGs are likely to be responsive to efforts to distribute a cost-free product. Should E-PLAYS prove to be effective at the end of this trial, distribution and implementation could start at once as it is a web-based intervention.

The E-PLAYS-2 trial aims to definitively test the effectiveness and cost-effectiveness of the E-PLAYS programme for children with social communication difficulties (SCDs). Should E-PLAYS prove to be effective, it will be offered as one of few evidence-based interventions available to schools and speech and language therapists.

Educationalists have long advocated computerised approaches as having considerable advantages for children with SCD. In spite of this, technological approaches have rarely been used and are widely seen as a missed opportunity [ 19 , 44 ]. There is a lack of interventions for children with social communication difficulties, and language therapies as a whole have attracted little research funding (Bishop, 2010). However, with the recent COVID pandemic, the importance of IT devices and internet connectivity to schools has taken centre-stage. There have been calls to provide schools with more and better IT equipment to which the Government has responded with a £1bn package [72]. This recent recognition of the importance of technology for schools together with increased training and interest of school staff means that we believe they are likely to be receptive to computerised interventions.

Sample selection

Wieckowski and White [ 20 ] in their extensive review of technological interventions for children with social communication impairments, commented that the focus in this field has been overwhelmingly on children with autism spectrum disorder (ASD); very few studies have evaluated technology use for the broader group of children with social communication difficulties. Furthermore, reviews have reported that participants who are male, white, and from professional-class backgrounds tend to be over-represented in ASD studies [ 45 ] and that it is likely that those who are most socially disadvantaged access speech and language therapy (SLT) services the least [ 46 ].

The E-PLAYS trial will aim to recruit as wide a variety of children with social communication difficulties as possible and will not limit the sample to those with an ASD diagnosis and/or in receipt of SLT service support. Teachers select the children in their class that they believe would benefit from E-PLAYS using a short questionnaire; this selection process aims to replicate conditions in the real-world in which schools are unlikely to have the resources to undertake a detailed assessment.

Study strengths and limitations

As far as we are aware, this is one of few major trials investigating an intervention targeting social communication difficulties in young children. A major strength of the study is that we will use a blinded outcome measure to assess children’s language pre- and post-test. Pragmatic language skills are difficult to assess as they manifest only during dynamic social interaction, therefore, testing with standardised questionnaires may not be appropriate [ 47 ]. In spite of this, much social communication literature is based on non-blinded parent-, teacher- or clinician-report [ 48 ]. To address this limitation, we are using measures administered by independent, blinded outcome assessors; the TPS and CELF-5 subscales administered by blinded research assistants. We will also collect parent and teacher reports for comparison with other studies.

Another strength of the study is that we will be able to obtain a precise measure of the number and timing of E-PLAYS sessions delivered for fidelity purposes as this will be automatically recorded by the software. This is preferable to alternative methods such as asking teaching assistants to record sessions or keep a diary. This reporting will be supplemented with live observations to paint a detailed picture of intervention delivery.

A limitation of the study is that it is impossible to blind participants, parents and teachers due to the nature of the intervention. However, the primary outcome measure, the TPS, is administered by blinded research assistants and the trial statisticians remain blinded to mitigate any impacts.

Against a backdrop in 2020 and 2021 where children’s socialisation with peers, communication skills and peer relations have suffered and the most deprived individuals have been hit the hardest, E-PLAYS is particularly timely. Its aim is to develop children’s social and collaborative skills by making novel use of technology; we believe it is likely to be welcomed by schools, parents and children.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

Adverse event

Complier Average Causal Effect

Cost-Effectiveness Acceptability Curve

Children’s Communication Checklist

Clinical Evaluation of Language Fundamentals-5

Child Health Utility questionnaire

Chief Investigator

Consolidated Standards of Reporting Trials

Case Report Form

Data Sharing Agreement

English as an Additional Language

Education, Health and Care Plan (outlining special educational needs)

Expression, Reception and Recall of Narrative Instrument

Enhancing Pragmatic Language skills for Young children with Social communication difficulties (2)

European Quality of Life-5 Dimension

Free School Meals

Good Clinical Practice

General Data Protection Regulation

International Standard Randomised Controlled Trials Number

Intra-Cluster Correlation

Intention To Treat

Multi-academy trust

Medical Research Council

Memorandum of Understanding

National Health Service

National Institute for Health Research

Participant Information Sheet

Personal Social Services Research Unit

Quality-Adjusted Life Years

Research Assistant

Randomised Control Trial

Serious Adverse event

Social communication difficulties

Standard Deviation

Special Educational Needs and Disability

Special Educational Needs Co-ordinator

Strengths and Difficulties Questionnaire

Standard Operating Procedure

Teaching Assistant

Trial Master File

Trial Management Group

Test of Pragmatic Skills

Trial Steering Committee

United Kingdom

York Trials Unit

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Acknowledgements

Our grateful thanks to Robin Allen of Robin Allen (consulting) Ltd, games developer for the E-PLAYS computer game and to Professor Chloe Marshall of University College, London, chair of the Trial Steering Committee.

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The sponsor is the University of Bedfordshire, the sponsor’s representative is Professor Gurch Randhawa.

This project is funded by the National institute for Health Research (NIHR) Public Health Research programme (award number NIHR131745). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders do not play a role in study design, data collection, analysis, or reporting.

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SM is the Chief Investigator and developed the E-PLAYS intervention and drafted the initial protocol for the E-PLAYS-2 study. LRS, KB and KH made substantial amendments to the protocol in particular data management, trial monitoring and trial delivery. CF, CW and LS were responsible for the design of the statistical analysis sections of the protocol, KB was responsible for design of the health economic component of the trial. DM and VJ contributed to outcome measures and recruitment sections, DT provided advice on trial management, SC, EC and RD were responsible for the process evaluation sections. All authors read and approved the final manuscript.

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Ethical approval for the study was granted by the University of Bedfordshire’s Institute for Health Research Ethics Committee on 23rd February 2022 (Reference IHREC971). Written consent to participate will be obtained from all participating parents/carers and school staff. Parents/carers will provide written consent on behalf of their participating children.

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Murphy, S., Bell, K., Cook, E.J. et al. Enhancing Pragmatic Language skills for Young children with Social communication difficulties (E-PLAYS-2) trial: study protocol for a cluster-randomised controlled trial evaluating a computerised intervention to promote communicative development and collaborative skills in young children. BMC Psychol 12 , 266 (2024). https://doi.org/10.1186/s40359-024-01749-y

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A novel dance intervention program for children and adolescents with developmental disabilities: a pilot randomized control trial

• Jeffrey T. Anderson 1 , 4 ,
• Christina Toolan 2 ,
• Emily Coker 3 ,
• Hannah Singer 1 , 4 ,
• Derek Pham 1 ,
• Nicholas Jackson 1 ,
• Catherine Lord 1 , 4 &
• Rujuta B. Wilson 1 , 4  

BMC Sports Science, Medicine and Rehabilitation volume  16 , Article number:  109 ( 2024 ) Cite this article

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Metrics details

Organized physical activity programs have been shown to provide wide benefits to participants, though there are relatively few studies examining the impact of these programs for individuals with developmental disabilities. This pilot study was conducted to determine the feasibility and impact of an undergraduate-led dance intervention program for children and adolescents with developmental disabilities. We evaluated the impact of the dance program on motor ability and social skills.

The study design was a waitlist control clinical trial in which participants were randomized to active and control groups. Eligible participants included male and female children and adolescents between the ages of 4 and 17 years with neurodevelopmental disabilities. The Motor Assessment Battery for Children Checklist and the Social Responsiveness Scale were used to assess change in motor and social skills, respectively. After gathering baseline data, the active group completed 1 h of online dance classes per week for 10 weeks, while the control group entered a 10-week waiting period. All participants then returned for a follow-up visit. Pre- and post-intervention data were analyzed using linear mixed-effects modeling adjusting for age and class attendance with subject random intercept.

We recruited and randomized 43 participants with neurodevelopmental disabilities (mean age = 8.63, SD = 2.98), of which 30 participated in dance classes. The attendance rate was 82.6% for the active group and 61.7% for the control group. The active group demonstrated a significant improvement in motor skills in an unpredictable environment, as indicated on the Motor Assessment Battery for Children Checklist ( n  = 21, p  = 0.05). We also observed positive trends in social skills that did not reach significance.

Conclusions

Our results indicate that it is feasible to develop and implement a fully digital dance intervention program for individuals with developmental disabilities. Further, we find that change in motor skills can be detected after just 10 h of low-intensity participation. However, a lack of significant change in social skills coupled with limitations in study implementation suggests further research is needed to determine the full impact of this dance program.

Trial Registration

ClinicalTrials.gov Protocol Registration System: Protocol ID 20-001680-AM-00005, registered 17/2/2021 – Retrospectively Registered, https://clinicaltrials.gov/study/NCT04762290 .

Peer Review reports

Organized physical activity (OPA), which is structured physical activity led by a coach or instructor, has wide benefits for physical health and wellbeing. It is well established that routine physical activity reduces risk for multiple chronic conditions and improves health outcomes [ 1 ]. Physical activity is also associated with the formation of fundamental motor skills in early childhood, highlighting its importance for motor development [ 2 ]. The World Health Organization echoed the importance of daily physical activity for children and adolescents to strengthen muscles and reduce sedentary behavior [ 3 ]. In addition, physical activity may provide benefits to the psychological wellbeing of adolescents through strengthening cognitive function networks in the brain [ 4 ]. Importantly, not all types of physical activity provide the same array of benefits; this distinction, however, has not yet been thoroughly explored. One study which investigated the relationship between structured and unstructured physical activity found that structured physical activity with guided opportunities for practice proved to be the most beneficial for motor skill development [ 5 ]. Similarly, structured indoor and outdoor activities have been shown to reduce the yearly increase of body mass index for developing children. Researchers have found a smaller increase in BMI during what is described as the adiposity rebound period of childhood for children who participate in these activities compared to those who do not [ 6 ]. These findings illustrate that within the broader context of physical activity, participation in OPA is a particularly effective way for children and adolescents to improve their physical health and wellbeing.

Despite OPA’s known benefits, much of the research around OPA focuses on typically developing children. Comparatively fewer studies investigated the benefits of OPA programs for children with neurodevelopmental disabilities (NDD), despite the fact that these children often face greater barriers to participation in physical activity. NDD, as defined in the Diagnostic and Statistical Manual, 5th edition, refers to a group of conditions including autism, attention deficit/hyperactivity disorder (ADHD), and cerebral palsy, that often emerge before grade school and are characterized by developmental deficits in personal, social, academic, or occupational domains [ 7 ]. Furthermore, it is not uncommon for children and adolescents to be diagnosed with more than one NDD [ 8 ]. Literature has shown that adolescents with NDDs are less likely to engage in OPA than neurotypical peers [ 9 , 10 , 11 ]. It is well known that individuals with NDDs often have difficulties in physical movement and mobility. In autistic patients, this can include as praxis, object manipulation, and postural stability [ 12 ], while cerebral palsy is characterized by high muscle tone and missed motor milestones. Motor challenges also have broad negative impacts on adaptive function and quality of life. Adolescents with cerebral palsy have reported higher physical quality of life, social quality of life, and overall happiness when able to be more physically active [ 13 ]. Likewise, motor difficulties in autism are negatively correlated with social skills [ 14 ]. This is significant because social challenges can lead to further barriers, including negative social interactions with peers [ 15 ] and higher feelings of loneliness [ 16 ].

In addition, there is a lack of programs led by physical education coaches with the training and knowledge to adapt the program to individual needs. Limited education for coaches regarding disability has a significant impact on the number of available and adequately trained coaches, and may negatively affect disabled individuals’ participation in sports and other forms of physical activity [ 17 ]. Semi-structured interviews with coaches of autistic athletes have shown that the coach-athlete relationship is a particularly important theme, suggesting that adapting teaching styles according to the experience of autistic individuals is an effective coaching strategy [ 18 ]. While research into this topic is sparse, these findings offer evidence that encouraging coaches to adopt adaptive teaching styles may reduce barriers to participating in physical activity programs for individuals with NDDs.

There are several examples of physical activity programs which have been successfully implemented for individuals with NDDs and have shown benefits across domains. Previous research has shown that following participation in group OPA programs, autistic children had improved overall motor skills, including aiming, catching, and balance, as well as improved social communication and social motivation [ 19 , 20 ]. Another review of movement interventions for children with intellectual disabilities found improvements in fundamental motor skills and balance [ 21 ]. Researchers have also explored dance-based OPA programs as interventions for children with NDDs, and found techniques such as mirroring and exploratory movement to benefit social and communication skills, motor skills, and behavioral domains [ 22 , 23 ]. The success of these programs demonstrates the need to further reduce the barriers individuals with NDDs face by developing and evaluating new OPA programs that are adapted for their needs.

To address this gap, we established an organized dance intervention program called the Expressive Movement Initiative (EMI) at the University of California, Los Angeles (UCLA). The course model was designed to achieve meaningful participation for each dancer by creating an adaptable framework which acknowledges individual needs. To achieve that goal, each dancer was paired individually with an undergraduate buddy who had been trained about NDDs, inclusive language, neurodiversity, and adaptive dance and movement teaching styles. Using a strength-based approach [ 18 , 24 ], this framework ensured that each dancer had the support of an individual who was equipped to support their needs. Furthermore, the use of student buddies to carry out the program greatly increased the feasibility of maintaining one-to-one pairings which in turn provided adequate support for participants and increased opportunities for meaningful social interactions. A document detailing the structure of the dance classes and the protocol for the study at the time of this publication can be found on the clinicaltrials.gov website ( https://clinicaltrials.gov/study/NCT04762290?tab=history&a=3 ). Here we present interim analysis of our study protocol. We choose to present interim analysis due to impacts of the COVID-19 global pandemic on the delivery of the intervention and participant retention. Our goals are to present [ 1 ] the feasibility of developing and implementing the EMI program, and [ 2 ] the results of two of our standardized outcome measures that were not affected by data attrition. This includes one primary outcome measure – the Motor Assessment Battery for Children Checklist (mABC-C), and one secondary outcome measure – the Social Responsiveness Scale (SRS). Other measures described in our study protocol are not presented due to attrition that resulted in incomplete datasets and will be presented when the full sample is collected and complete. We hypothesized that participants would show improvements in motor and social skills following participation in this program as indicated by the mABC-C and SRS, respectively.

Our study design and research methods were reviewed and approved by the University of California, Los Angeles Institutional Review Board (IRB#20-001680). Due to the age of the participant population and/or diagnoses that affect cognitive abilities, a legally authorized representative of all participants provided written informed consent for their data to be used in related research.

Participants

Eligible participants were between the ages of 4 and 17 with a diagnosed NDD from a healthcare provider, which was reported by parents during eligibility screening. Exclusion criteria was previous participation in EMI dance classes. There were no exclusion criteria related to the degree of intellectual/physical disability or co-occurring health conditions. Participants living in the United States were recruited for this study through flyers and social media listings. Interested families contacted the study team directly and all prospective participants were screened until recruitment goals were met. In instances where parents reported more than one diagnosed NDD, e.g., autism and co-occurring ADHD, or a NDD with a co-occurring condition that falls into a different diagnostic category, e.g., anxiety, this information was recorded onto the participant ID key by a researcher at study entry. Furthermore, parents were asked to report racial and ethnic affiliation.

All potential participants were screened in January and February of 2021. Pre-testing took place from February 15, 2021 to March 5, 2021 and follow-up visits occurred from May 2, 2021 to May 9, 2021. The trial, which was originally planned to conclude in March 2024, was interrupted after one year to perform an interim analysis on the data collected during the COVID-19 pandemic. This decision was made in order to perform a feasibility assessment and adjust the study protocol to include direct in-person measures upon resuming the trial.

Intervention design

The intervention was designed as a longitudinal waitlist-control study in which participants were randomized into active and control groups using permuted block randomization with a 2:1 active to control randomization scheme. Study data were collected and managed using Research Electronic Data Capture (REDCap) hosted at UCLA [ 25 ]. REDCap is a secure, web-based software platform designed to support data capture for research studies, providing (1) an intuitive interface for validated data capture; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for data integration and interoperability with external sources. REDCap was also used to complete the randomization, with the allocation sequence being generated by author six and participants being enrolled by author eight. The randomization list was concealed by REDCap, with the assignment group only being known once an intervention group was assigned. Additionally, participants were stratified by language level (complex speech, phrased speech, or minimally verbal) in order to ensure an even distribution of baseline communication skills. The treatment period was 10 weeks with weekly 1-hour classes. The active and control group completed pre and post intervention surveys online via Zoom in an interview format. Whereas participants were aware of which group they had been placed in, assessments were conducted by trained research staff who were blinded to assignment group. The control group was offered participation in the dance classes after the post-intervention data collection (Fig.  1 ).

Graphical representation of the longitudinal study design. The timeline for study events as they relate to the dance intervention

The EMI dance intervention classes were carried out by trained undergraduate students. Each session consisted of an artistic director to lead the class and buddies that were paired 1:1 to each participant. Buddies received training around NDD, accessible language, and how to adapt their teaching for their buddy. This training included attending speaker presentations and reviewing weekly feedback provided by a class instructor. Due to the COVID-19 pandemic, all classes were held virtually on Zoom. To ensure the quality of virtual instruction, artistic directors and buddies received training in adapting movements for Zoom delivery. Additionally, artistic directors provided buddies with written feedback on a weekly basis to provide strategies for adjusting teaching styles to their dancer.

The structure of each class could take one of two forms, group class or buddy class, which alternated each week. Dancers started each group class with a warm up consisting of stretches and other movements, followed by an “across the floors” exercise which involved more exaggerated movement. Across the floor movements were commonly based in ballet techniques, such as “relevé walks”, “step, prep, passé,” and “reach chassé.” A short break was incorporated into every class to encourage hydration and resting. After the break, the instructor taught a short choreography to the dancers, which would first be practiced at a pace best for the participant before being paired with music. To close out group time, a musical game was played. These games would require dancers to follow a particular objective, such as balance a tissue on their head while dancing, or follow instructions embedded within a song, such as the hokey-pokey. Following this, dancers were sent into Zoom breakout rooms for a few minutes to work with their buddies. Upon their return, they were given the opportunity to share what they did with their buddy and engage in a cooldown before ending class. A visual representation of a typical group class can be seen in Fig.  2 .

Buddy classes began with a warm up and an across the floors series similar to group class. However, after this point they would be sent directly into breakout rooms with their buddies for the remainder of class, which usually lasted 40–45 min. Class plans would provide buddies with objectives to accomplish during their one-on-one session, such as play a musical game or come up with specific dance skills to practice. This structure allowed dancers to receive more individualized attention and work on learned movement skills. Much like group classes, buddy classes ended with dancers coming back to the main room, sharing what they did with their buddy, and engaging in a cooldown activity.

Group Class Agenda. The typical order of activities that occur during group class. During buddy class, dancers would spend additional time with their buddy in lieu of learning new choreography or playing a game

Measures used pre- and post-intervention

Social Skills : Social skills were assessed through parent responses to the Social Responsiveness Scale 2nd edition (SRS-2) [ 26 ]. The SRS-2 is a continuous measure of social behaviors that is normed and validated for use across the lifespan in autistic individuals as well as non-autistic individuals who may show various impairments. It captures behaviors related to 5 subscales: (a) social awareness, (b) social cognition, (c) social communication, (d) social motivation, and (e) restricted interested and repetitive behavior. The instrument contains 65 items that took parents approximately 15 min to complete.

Motor Function. Motor function was assessed via parent responses to the Movement Assessment Battery for Children Checklist (mABC-C) [ 27 ]. This checklist is intended to be completed by a teacher or parent and contains questions pertaining to a variety of motor tasks. The mABC-C contains 30 items, which took parents approximately 10 min to complete. It is validated for use in children ages 5 through 12 with or without motor challenges as a screening tool for Developmental Coordination Disorder (DCD) [ 28 , 29 ]. The instrument yields a total motor score, wherein a higher score indicates worse motor skills as more characteristics meet criteria for DCD. The mABC-C is associated with a direct assessment battery, the Movement Assessment Battery for Children –second edition (mABC-2), which is commonly used as a tool for assessing children with suspected motor skill impairment [ 30 ]. As we were unable to conduct in-person visits due to the COVID-19 pandemic, the mABC-C was used to target relevant motor domains.

Statistical analysis

The primary analysis was intention-to-treat and included all randomly assigned participants who completed the mABC-C and the SRS in at least one study visit. Dance class attendance rate was calculated independently for the active and control groups. Linear mixed-effects modeling adjusted for age and class attendance with subject random intercept was used to evaluate the change in motor function and social skill scores after undergoing EMI dance classes. Between group differences in change over time were assessed using a group-by-time interaction term. All statistical significance was determined using a two-sided alpha level less than 0.05, and all analyses were conducted using R Version 4.2.1 [ 31 ].

A total of 43 participants were recruited and randomized for this study, of which 61 percent were male. Speech level in this sample ranged from non-speaking to fully-verbal. All participants had a diagnosed NDD, with a majority of participants having a diagnosis of autism (Table 1 ). A summary of parental racial and ethnic affiliation can be seen in Table 2 .

Out of the 43 participants who were allocated to an intervention group, 36 completed the mABC-C and SRS at baseline (n active = 21, n control = 15) and 26 participants completed them at follow-up (n active = 14, n control = 12). 30 participants received the allocated intervention (Fig.  3 ). On average, participants in the active group had an attendance rate of 82.6% while participants in the control group had an attendance rate of 61.7%. There was only one protocol deviation for a participant in the active group. This participant was lost to follow-up and did not provide post-assessment data. However, they re-engaged the study team and were given the opportunity to participate in the dance classes with the control group. The pre-assessment data for this participant is included in the intention-to-treat analysis and they have been counted as not having received the allocated intervention.

Participant Flow Diagram. Figure  3 Shows the number of participants that were screened, randomized, and ultimately included in the analysis. A power analysis was performed on the full sample size projected over the multi-year study. No power analysis was performed on the sample reported in this interim analysis

There was no significant change in either the active group ( n  = 21, p  = 0.11) or the control group ( n  = 15, p  = 0.82) on the mABC-C total score, although the active group showed a positive trend. The active group displayed a significant improvement on the “movement in an unpredictable environment” domain of the mABC-C ( n  = 21, p  = 0.05), while the control group did not show any significant change in this domain ( n  = 15, p  = 0.64). A summary of the data can be seen in Table  3 .

Across the domains of the SRS, the active group demonstrated positive trends for improvement in social communication and social motivation, neither of which were significant. We did not observe any notable changes in social awareness, social cognition, or restricted interest and repetitive behavior for the active group. There were no significant changes across any of the domains nor the total score of the SRS for the control group (Fig.  4 ).

Individual and Mean Scores for mABC-C and SRS Subscales. Figure  4   Individual scores (grayscale) and means calculated using linear mixed-effects modeling (color) are plotted for subscales of the mABC-C and the SRS. The social communication and social motivation subscales of the SRS are displayed to visualize the change in scores

The aim of this pilot study was to investigate the feasibility and impact of a novel movement-based dance intervention program for children and adolescents with NDD. Consistent with our hypothesis, we found that children in the active group showed a statistically significant improvement in movement in dynamic environments, as measured by the mABC-C, and we observed a trend of improvements in social skills on the SRS.

We measured movement skills that are related to movement in dynamic environments, which are targeted through the EMI program activities. Examples of dynamic movement activities include self-care/classroom skills, ball skills, and PE/recreational skills. Examples of specific items covered in this section of the mABC-C include, “moves body in time with music or other people,” “keeps time to a musical beat by clapping hands or tapping feet,” and, “maintains balance when frequent adjustments are required.” This type of movement occurs in a dance class setting in which students are learning how to express themselves using movement through space and time. As such, the expressive movement component of EMI likely accounts for the improvements to movement in dynamic environments. This finding is in line with other movement-based intervention studies which have found similar results on the mABC-2 when assessing the impact of their program on motor skills [ 20 ]. Motor skills are integral to many developmental and behavioral domains because they influence how one interacts with their environment. Namely, better motor skills could enhance or improve opportunities to participate in peer interactions by allowing for participation in a broader range of activities, such as sports or active games. Better motor skills may also lead to an increase in active behavior and exercise, which has benefits for social wellbeing, mental health, and cognitive benefits, including a reduction in sedentary behavior [ 32 ]. Importantly, improvements in motor skills reported in this study resulted from a relatively low-intensity program that put minimal burden on participating families. One hour of class per week in an online setting offers a more accessible option for families compared to other interventions, as it does not require transportation for participation. Thus, our findings are promising for the viability of OPA programs for children and adolescents with NDDs.

Changes in social skills were characterized by positive trends for social communication and social motivation that were not statistically significant. Participants were given opportunities for social engagement through one-to-one pairings with buddies, which were reinforced by weeks dedicating greater amount of time to buddy interactions. During group time, the instructor also frequently encouraged participants to verbally share their thoughts or experiences, such as their favorite song or what they did during buddy time. These social interactions likely account for the positive trend in social skills noted on the SRS. This result also mirrors similar works that have investigated the impact of OPA on social skills, which have yielded a mix of significant and non-significant results [ 19 ]. As will be further discussed in study limitations, several factors such as small sample size and heterogeneity of the participant sample may have impacted our ability to measure significant change in these areas. Considering the impact that negative social interactions can have on individuals with NDD [ 15 ], future research is warranted to investigate the impact of OPA programs on social skills and subsequent changes in quality of life. For example, it is possible that positive social interactions during OPA programs increase both one’s motivation to interact with peers and the effectiveness of the communication, which in turn could reduce feelings of loneliness [ 16 ].

One strength of the present study was the enrollment of individuals with varying NDDs and co-occurring diagnoses, which served to increase the generalizability of the program. Across participants of EMI, there were diagnoses of autism, ADHD, cerebral palsy, genetic syndromes, and other disabilities. As participants included males and females between the ages of 4 and 17 with no prerequisite for dancing ability, it follows that a wide range of children and adolescents with a diagnosed NDD can benefit from the presented program. This flexibility could be attributed to the training given to buddies, which emphasized adaptable teaching for the specific needs of each student. Furthermore, the decision to use a student-supported structure for class instruction increases the accessibility of the program by allowing for one-to-one pairings between buddies and dancers while remaining cost-free to families who participate.

We acknowledge that there were also several limitations in our implementation, which should be considered when interpreting the results. As a pilot study, our sample size was small and may have limited our ability to identify all effects. Furthermore, the heterogeneity of our participant sample, while positive for the reach and impact of the EMI program, may have constrained our ability to measure significant results related to social communication and social motivation. The reliance on parent reported diagnoses rather than medical records or clinical assessments is another potential limitation. In addition, the quality of our data was affected by a high amount of attrition in the second half of the study, which led to missing data. These factors could lead to a degree of sampling bias in our study population, although it is likely that global changes in the pandemic played a significant role in engagement levels, in part due to a shift back to in-person social, educational, and leisure activities after a prolonged period of these activities being restricted. Several families who did not complete the study reported that they wanted to travel or have their child return to other programs that had been on a hiatus during the pandemic. Indeed, class attendance rate, which was roughly 80% for the active group when COVID-19 restrictions remained in effect, dropped to nearly 60% for the control group after many restrictions were lifted. Finally, it was necessary for our protocol to be transitioned to fully remote due to the pandemic, which did not allow us to conduct direct measures of participants in person. Direct assessment of more detailed motor skills and social skills may have allowed us to detect changes secondary to participation in the dance intervention. Despite opportunities for one-on-one engagement, the program’s effects on social engagement may have also been attenuated due to the online format of the classes.

In this pilot study, we demonstrate the feasibility of developing and implementing an online dance intervention for individuals with NDDs. Furthermore, this intervention shows benefits in motor skills after a 10-week period with a dose of 1 h per week. Moving forward, we are utilizing direct standardized and quantitative measures of motor skills and social communication to further examine the impact of this dance intervention. Future studies will include an IQ assessment to understand whether this differentially affects the results of the intervention. Future work could also assess the impact of EMI participation on teachers and buddies in order to provide further insight into the efficacy of this approach. Our preliminary results support the growing body of research that OPA is a promising intervention for motor skills among children and adolescents with NDDs.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Full details of the trial protocol version that is reported in this paper can be found on the ClinicalTrials.gov Protocol Registration System, available at https://clinicaltrials.gov/study/NCT04762290?tab=history&a=3 .

Abbreviations

Attention deficit/hyperactivity disorder

Autism Intervention Research Network on Physical Health

Expressive Movement Initiative

Health Services and Resources Administration

Movement Assessment Battery for Children Checklist

Movement Assessment Battery for Children – second edition

Developmental coordination disorder

Neurodevelopmental disability

Organized physical activity

Social Responsiveness Scale

University of California, Los Angeles

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Acknowledgements

We acknowledge the Expressive Movement Initiative group at UCLA for their invaluable role as organizers and teachers of the dance program used in this research. We also acknowledge the Autism Intervention Research network on Physical health (AIR-P) for supporting this project.

This study was funded by the Health Resources and Services Administration (HRSA) (Grant NO.: UT2MC39440). The funding agency did not play a role in the design of the study, the collection, analysis, and interpretation of the data, nor in the writing of this manuscript. Additional funding support was received from the Department of Health and Human Services, Administration for Community Living (Grant NO.: 90DDUC0129) and the National Institute of Child Health and Human Development (Grant NO.: K23HD099275).

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Jeffrey T. Anderson, Hannah Singer, Derek Pham, Nicholas Jackson, Catherine Lord & Rujuta B. Wilson

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Stanford School of Medicine, Stanford, CA, USA

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Contributions

JA entered and interpreted data collected during the study and drafted the manuscript. CT and HS assisted with the collection of data and data entry. EC made significant contributions to the design of the dance intervention and the randomized control trial. NJ generated the allocation sequence for randomization. DP and NJ conducted the statistical analysis for the study and advised on interpreting and reporting results. CL advised on the study design and data collection methods. RW oversaw the design and implantation of the study, the analysis and interpretation of the results, and was a major contributor in writing the manuscript. All authors read and approved the final version of this manuscript.

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Correspondence to Rujuta B. Wilson .

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Anderson, J.T., Toolan, C., Coker, E. et al. A novel dance intervention program for children and adolescents with developmental disabilities: a pilot randomized control trial. BMC Sports Sci Med Rehabil 16 , 109 (2024). https://doi.org/10.1186/s13102-024-00897-3

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For many students coming to McGill from across Canada and other countries around the globe, one of the many advantages of pursuing a degree at McGill is that students are immersed in Montreal’s unique bilingual culture.

McGill’s French Language Centre is one of the university’s best assets in promoting learning opportunities for students in any academic program throughout the university with its course offerings of credited and non-credited courses that encompass writing and oral communication.

Students from McGill’s various professional schools, such as the School of Social Work, and the Faculty of Medicine and Health Sciences, turn to the FLC for crucial French language training that will benefit them not only during their time at McGill but beyond when they leave to pursue professional careers in Quebec.

Beginner Level Courses for All McGill Students 

For students across academic disciplines, from the Faculty of Arts to the Faculty of Engineering, the FLC offers placement tests to ascertain a student’s level of comprehension and skill in the French language and offers 5 different levels of courses, which follows the Common European Framework of Reference for Languages, a global standard for grading language proficiency. The levels on offer range from level A1, absolute beginner, to level C1, which is a full command of the language.

Alida Soucé has been a Faculty Lecturer at the French Language Centre for close to ten years now, and, along with the Centre's other instructors, is responsible for creating, coordinating, and teaching beginner level French courses at the FLC. Alida currently coordinates and teaches the near beginner course, FRSL 103 and the elementary French course, FRSL 206/207.

“These courses are built and based on research in applied didactics,” says Alida. “Most of our instructors are constantly reflecting on improving course offerings so that students have access to the most innovative academic courses in the field of French as a Second Language.”

Living and learning in a bilingual city such as Montreal gives students the opportunity to use their newly acquired French skills in a multitude of settings on and off campus.

“We equip students with solid, academic French courses that are centered in a Montreal context” says Alida. “Thanks to our exceptional setting in Quebec, the courses we teach can help students whose goal is to become bilingual.”

“We also organize many extracurricular activities in which students can further strengthen the skills we teach in the classroom,” says Alida.

The FLC organizes a series of cultural outings such as a historical and cultural tour of popular Montreal neighborhoods like the Mile End and Old Montreal, and events such as a French Improv Night, conversation workshops and a series focusing on French in the workplace, all of which give students the opportunity to develop their oral skills in informal settings with other students enrolled in FLC courses.

Alida prides herself on being able to offer her students a personalized approach to learning and her courses are often filled with a strong sense of community.

In some anonymous student feedback received by Alida, many students attest to the excellent learning environments they experienced in her classroom.

“It’s always been one of my goals to speak French, and it’s in part why I moved to Montreal,” says one student who took a FLC course this winter. “My anxiety always got in the way, and it wasn’t until [Alida’s] class that I was able to work through that productively, something I'll be taking with me when I move to London this fall and continue working towards fluency.”

Another student noted how thankful they were for the extra time Alida devoted to providing detailed feedback on tests and writing/oral practice. “[Alida’s] encouragement and support [inspired] me to keep participating and improving my French skills in my daily life.”

Teaching French for Specific Purposes 

Ariel Mercado came to McGill with over 20 years of experience teaching French and English as a second language in Spain. It was in Spain that Ariel developed his interest in teaching language for a specific purpose, such as teaching English and French for the tourism industry and in the healthcare sector.

Ariel later moved to Quebec to pursue his studies, and it was during his PhD in Linguistics that Ariel’s interest in healthcare and languages solidified.

Working closely with the administration of the FLC, Ariel created French courses for health sciences and social work , which are offered during both Fall and Winter semesters, as well as a May intensive course. The courses are designed to give written and oral communication skills to students from a variety of disciplines in the health and social work sectors, as well as French skills for students studying dietetics and nutrition.

These courses are offered through a partnership with Dialogue McGill, which is funded by Health Canada under the Action Plan for Official Languages, which aimed to “build and maintain the capacity of bilingual health and social services professionals in Quebec.”

“My focus in these courses is especially oral communication with patients, with caregivers and with other professionals, and to prepare students for that,” says Ariel. “Writing skills are also important- students have to know how to write a chart for another professional or in layman’s terms for the patient.”

The Centre works closely with the Professional Schools Committee, which includes representatives from the various McGill schools in healthcare. The courses are formulated with the feedback of doctors, social workers and dieticians so that the courses are tailored to specific skills and requirements students will encounter in their future professions.

“We have around two meetings per semester in which I participate,” says Ariel. “I have had ideas for courses from these meetings. For example, they tell me we need our students to know how to write a chart in French, I ask for material that they can share (without personal identification details) so that the examples we give students are accurate and can be adapted to their learning levels and needs.”

Focusing on real tasks that they will have in their professional lives is an important objective in Ariel’s courses. In order to pass the courses and to be able to work in their respective fields in Québec, students must pass the French exam for their discipline which is designed and administered by the Office Québécois de la langue française ( OQLF).

“I know the OQLF exam very well and I try to integrate in-class activities for the exam,” says Ariel. Ariel runs around 2 or 3 dedicated workshops to prepare his students for the OQLF exam.

“I tell students that this or that in-class activity is similar to a section of the OQLF exam so they know what to prepare for,” says Ariel.

To learn more about course offerings at the FLC and its event programming, you can consult their website and follow them on Facebook .

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