Influence of a Parent-mediated mHealth Motor Skill Intervention on Preschool Children's Motor Skills and Cognitive Function (COSMIC)

The proposed study uses a mHealth application "app" to help parents teach their preschool-age child motor skill (FMS) activities in the home environment. This app guides families to participate in 10-min activity breaks, 7 days/week for 12 weeks and the app includes weekly instructional lessons, peer modeling videos, behavioral scaffolding, and structured activities. This study builds on prior work by assessing whether improvements in FMS generalize to cognitive domains, including executive function skills such as working memory, attention, and inhibitory control. By examining both motor and cognitive outcomes, the project will provide essential evidence on whether enhanced FMS uniquely contributes to cognitive development. Based on findings from the proposed study, there may be a need to develop additional modules that address diverse needs of children or that contribute to broader, multifaceted improvement in both motor competence and cognitive function. Findings will inform the potential of technology-based motor skill interventions to support broader aspects of child development in diverse populations, guiding future practice and policy in education, health, and early intervention.

Study Overview

• Status: Not yet recruiting
• Conditions: Motor Skills; Healthy; Executive Function
• Intervention / Treatment: Behavioral: COSMIC

Detailed Description

This quasi-experimental study aims to examine how the PLAY app influences cognitive function (attention, working memory, inhibition, and cognitive flexibility) in preschool-age children. This study will include a 12-week intervention that encompasses 3 assessments across 6 months; measurements will be taken before (pre-; Month 0) and after (post-; Month 3) the home-based intervention and 3 months later (retention; Month 6) to examine the sustained effects of the program.

Utilizing the PLAY app, parents will deliver the intervention in the home to their preschool-age child (3-5 yrs). Parents will access weekly instructional lessons, peer modeling videos, and activity breaks to deliver 12 hrs of structured FMS instruction time to their child over a 3-month period. The PLAY app program comprised of 12-minute segments of varied activities that children perform, called "activity breaks" (12-min activity breaks, 5 days/week for 12 weeks) Each week parent-child dyads will work on one featured FMS (e.g., jumping) and will complete short bouts of activity that include a one-minute warm-up, 10 minutes of FMS practice, and then a one-minute cool down. During the FMS practice, parents will help their child practice this skill through a series of developmentally appropriate activities that aim to incrementally increase their child's performance through continued practice. Parents monitor time of each activity through an embedded timer in the app and have short (5-20 second) video clips of young children completing each activity for reference. Videos can also serve as a peer model for children to emulate movements. At the end of each "activity break" (i.e., daily 12-minute bout of FMS practice), parents will indicate they completed the daily practice and will receive a badge that shows up in the child's app profile to serve as a motivator.

Behavioral scaffolding and social cognitive theory inform the intervention and target 6 developmentally appropriate FMS through short activities parents and children can participate in together. Behavioral scaffolding is a cognitive learning approach to problem-solving that allows children to master skills just beyond their current inability and is effective in helping parents assist children in attaining behavior goals. According to social cognitive theory, for modeling to elicit behavior change effectively, the child must undergo a process involving attention, retention, reproduction, and motivation. Attention is garnered through the app via videos of peers (modeled and narrated by children), with auditory and visual stimuli to enhance arousal/engagement. Retention is reinforced through multiple exposures to the video segments and push notifications (SMS text message) to parents to reinforce strategies to facilitate their child's engagement, including FMS practice. Reproduction is elicited via the child producing the modeled activities. Motivation is encouraged intrinsically through perceived competence and extrinsically via encouragement from in-app rewards.

All communication (outside of assessment visits) occurs in the app and is built to accommodate families with limited data. Reminders are sent via push notifications and scheduled with the parents to support compliance with the program. An in-app reinforcement schedule uses the principles of shaping to promote continued motivation.

Participants The researchers will employ rolling recruitment through preexisting contacts with childcare centers and the utilization of technology and social media ads. The study will recruit 35 parent-child dyads to participate in the proposed study. Inclusion criteria: Children will be included if they are 3-5 years of age at the time of enrollment. Exclusion criteria: Child exclusion criteria: Physical or cognitive disability that parent feels will preclude participation in activity breaks or assessments; FMS being too high at baseline (i.e., TGMD-3 rating of "Superior" or "Gifted/Advanced") to eliminate potential participants to avoid a ceiling effect, which would limit the ability to detect improvement from intervention. Parent exclusion criteria: No parental access to a smartphone, tablet or computer; physical limitation that impairs modeling of activities; parent cannot read and understand English.

Measures (Measured at 0, 3, and 6 months)

1. Executive function skills will be assessed using the Head, Toes, Knees, and Shoulders - Revised (HTKS-R) task. The HTKS-R task measures executive function skills (attention, working memory, and inhibitory control) and behavioral self-regulation in young children aged 4-8 yrs and takes 6 minutes to complete. HTKS-R has been validated in the study's target population. Attention, working memory, inhibitory control, and additional components of cognition will also be assessed using the NIH ToolBox. The NIH Toolbox Early Childhood Cognition Battery is recommended for ages 3-6 yrs old. This test battery offers five (5) subtests that measure various components of cognitive function including cognitive flexibility, attention, inhibitory control, episodic memory, processing speed, and nonverbal and visual reasoning.
2. FMS will be assessed using the TGMD-3, a criterion- and norm-referenced assessment to measure 13 FMS in children aged 3-10 yrs. This is considered the gold-standard assessment for FMS in this age group. Assessments will be led and recorded by a trained staff member and coded by trained research assistants blinded to the study. mPI Webster established reliability and validity for the TGMD-3.
3. Parent Implementation Fidelity [Potential Covariate] will be assessed as the percentage of instructional videos watched by the parent, and the percentage of possible activity breaks marked as completed. This outcome may be used to determine the dose-response effect of the PLAY app.
4. Physical activity [Potential Covariate] will be assessed using an ActiGraph GT3X-BT accelerometer worn for 7-days on the right hip at all times except sleeping, swimming, and bathing. The validity and reliability of accelerometers have been well established in preschoolers, and our team has extensive experience using accelerometry in preschoolers. Accelerometers will be initialized to 15-sec epochs, and established cut-points will be used to estimate time spent in activity intensity levels of light, moderate, and vigorous.
5. Height and weight will be assessed using standard procedures. BMI (kg•m-2) will be calculated as body mass (kg) divided by height (m) squared, then percentiles and z-scores derived from age- and sex-specific normative values.

• Study Type: Interventional
• Enrollment (Estimated): 35
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Kip Webster, PhD; Phone Number: 865-974-3752; Email: kipwebster@utk.edu
• Study Contact Backup: Name: Dawn Coe, PhD; Phone Number: 865-974-0294; Email: dcoe@utk.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Children will be included if they are 3-5 years of age at the time of enrollment and their accompanying parents (Age 18 or above).

Exclusion Criteria:

• Child exclusion criteria: Physical or cognitive disability that parent feels will preclude participation in activity breaks or assessments (physical activity or gross motor skill activities).

Parent exclusion criteria: No parental access to a smartphone, tablet or computer; physical limitation that impairs modeling of activities; parent cannot read and understand English.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: COSMIC; mHealth intervention

Behavioral: COSMIC; Parents will deliver the FMS intervention at home to their preschool-age child (3-5 yrs). Each day, Parents will access weekly instructional lessons, peer modeling videos and activity breaks to deliver approximately 12 hrs of structured FMS instruction time to their child over a 3-month period. The Mission PLAY app program is comprised of 10-minute segments of varied activities that children perform, called "activity breaks" (10-min activity breaks, 7 days/week for 12 weeks) Each week parent-child dyads will work on one featured FMS (e.g., jumping) and will complete short bouts of activity that include a one-minute warm-up, 8 minutes of FMS practice, and one-minute cool down. During the FMS practice, parents will help their child practice this skill through a series of developmentally appropriate activities that aim to incrementally increase their child's performance through continued practice.; Other Names: PLAY App

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in executive functioning skills based on COSMIC intervention	Heads, Toes, Knees, and Shoulders - Revised, Attention, working memory, inhibitory control	Measured at three time points: enrollment (Week 0), end of intervention (Week 12), and 12-week retention (Week 24)
Change in motor skills based on COSMIC intervention	Actual and perceived motor skills assessed by the Test of Gross Motor Development - 3rd edition and Perceived Movement Skill Competence assessment	Measured at three time points: enrollment (Week 0), end of intervention (Week 12), and 12-week retention (Week 24)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parent implementation fidelity using the COSMIC app	The percentage of instructional videos watched by the parent, and the percentage of possible activity breaks marked as completed	Measured throughout the duration of the intervention (12 weeks)
Changes in habitual physical activity based on engagement with COSMIC app	Assessed using an ActiGraph GT3X-BT accelerometer worn for 7-days on the right hip at all times except sleeping, swimming, and bathing	Measured at three time points: enrollment (Week 0), end of intervention (Week 12), and 12-week retention (Week 24)

Collaborators and Investigators

• Sponsor: University of Tennessee
• Collaborators: Woodcock Institute for the Advancement of Neurocognitive Research and Applied Practice

Study record dates

Study Major Dates

• Study Start (Estimated): June 30, 2026
• Primary Completion (Estimated): June 30, 2027
• Study Completion (Estimated): June 30, 2027

Study Registration Dates

• First Submitted: June 25, 2026
• First Submitted That Met QC Criteria: June 25, 2026
• First Posted (Actual): July 2, 2026

Study Record Updates

• Last Update Posted (Actual): July 2, 2026
• Last Update Submitted That Met QC Criteria: June 25, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: preschool; mHealth; executive function; motor skill; parent-mediated
• Additional Relevant MeSH Terms: Cosmic composite resin
• Other Study ID Numbers: STUDY00000124

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No