Scandinavian Journal of Occupational Therapy. 2014; Early Online, 1–12

ORIGINAL ARTICLE

Convergent validity of two motor skill tests used to assess school-age children

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HAYLEE LANE1 & TED BROWN2 1

Occupational Science and Therapy Program, School of Health and Social Development, Faculty of Health, Deakin University, Waterfront Campus, Geelong, Victoria, Australia, and 2Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia

Abstract Background: Motor skills allow children to interact with their surrounding environment, making the progression of competent motor skills crucial to development. The most common form of motor skill assessment is through the use of performance-based tests. Performance measures need to be both reliable and valid to ensure they are of high quality. Two examples of performance-based motor skill tests often used to assess children are the Bruininks-Oseretsky Test of Motor Proficiency – 2nd edition (BOT-2) and the Movement Assessment Battery for Children – 2nd edition (MABC-2). Aim: This study investigated the convergent validity between the BOT-2 and MABC-2 when completed by typically developing school-aged children aged 7–16 years. Method: A convenience sample of 50 children aged 7–16 years with no history of motor or intellectual impairments was recruited. Scores from the BOT-2 and MABC-2 were analysed using Spearman’s rho correlation. Results:The study found that the MABC-2 11- to 16-year-old group (age band 3) was significantly associated with the BOT-2; however, there were no significant relationships between the MABC-2 7- to 10-year-old group (age band 2) and the BOT-2. Conclusion: The MABC-2 and BOT-2 appear to assess associated motor skill abilities in children aged 11–16 years but not in children aged 7–10. This study adds to the body of convergent validity evidence regarding the MABC-2 and BOT-2.

Key words: performance-based assessment, paediatrics, motor skill performance, MABC-2, convergent validity, children, BOT-2

Introduction Paediatric occupational therapy focuses on children’s ability to engage in daily occupations. By assessing a child’s execution of skills and his/her performance patterns (1), occupational therapists can identify the differences between a child’s ability and the demands of the occupation (2). Many factors underpin a child’s ability to successfully complete his/her daily occupations including motor, sensory, social, affective, and cognitive skills. A common area of assessment and intervention in paediatric occupational therapy is

motor skill performance (3) and performance-based tests are the most common type of paediatric motor skill assessment (4-6). It is essential that motor skill assessments have documented evidence of validity and reliability. The aim of this study is to examine the convergent validity between two commonly used motor skill assessments, these being the BruininksOseretsky Test of Motor Proficiency – 2nd edition (BOT-2) (7), and the Movement Assessment Battery for Children – 2nd edition (MABC-2) (8) when completed by typically developing school-aged children aged 7–16 years.

Correspondence: Dr Ted Brown, PhD MSc MPA BSc OT (Hons) GCHPE OT(C) OTR, Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus, Building G, 4th floor, McMahons Road, PO Box 527, Frankston Victoria, 3199, Australia. Tel: +613 9904 4462. E-mail: [email protected]] (Received 10 March 2014; accepted 18 September 2014) ISSN 1103-8128 print/ISSN 1651-2014 online
2014 Informa Healthcare DOI: 10.3109/11038128.2014.969308

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H. Lane & T. Brown

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Motor skill performance and links to health, occupational performance, and well-being Motor skills can be defined as goal-directed patterns of movement that meet the requirements of a task and can be divided into areas of gross and fine motor skills (9). Gross motor skills include whole-body movements such as walking/jumping and involve larger muscle groups. Fine motor skills include in-hand manipulation and grasping objects, and involve the use of small muscles of the hand for controlled movements (7).The development and enhancement of proficient motor skills is a fundamental aspect of childhood as they allow children to interact with and explore their surrounding environment, and engage in daily occupations such as dressing, toileting, functional mobility, taking part in leisure pursuits, handwriting, and using technology (10-13). Motor skill performance has been shown to have implications in terms of a child’s occupational performance, health, and well-being (10,13). For example, studies have shown that children with poor motor skills can experience difficulties with self-care occupations (13), and educational occupations (14). As outlined in the International Classification of Functioning, Disability and Health (ICF) (15) framework, impairment of body functions and structures, such as motor function difficulties, may affect or limit a child’s participation in occupations or activities, in turn having an effect on their health and well-being. The negative impact of children’s motor function difficulties is supported by evidence (16). Typically, children with motor function difficulties have poor perceptions of their academic and athletic competence, their self-worth, and their physical appearance in comparison with their typically developing peers (13,16). In the absence of intervention, many of these difficulties can persist into adulthood and continue to interfere with performance in many aspects of community functioning (17). It is therefore important that valid and reliable instruments are used to assess children presenting with suspected motor skill performance difficulties (18). As both the BOT-2 and MABC-2 are used by therapists to measure motor skill performance, there is a need to determine how performance on these different assessments is associated (19). That is, there is a need for information concerning their convergent validity. There are two other reasons why investigating the convergent validity of the BOT-2 and MABC-2 is warranted. First, the MABC-2 was recently revised and some of the assessment items were changed. Hence comparing the revised version of the MABC-2 with the BOT-2 will provide valuable related psychometric information. Second, the

BOT-2 is a detailed motor skill assessment that often takes more time to administer compared with the MABC-2, which is designed as a motor skills screening test. Determining whether the MABC-2 is correlated with the BOT-2 would provide helpful information in terms of the potential demands made on children being assessed and the time taken to complete motor skill assessments (e.g. the MABC-2 takes less time to administer and hence places fewer demands on the child being assessed and the therapist administering and scoring the test). Convergent validity Convergent validity indicates that two measures that are believed to be related will yield similar results (20). Exploring the convergent validity between these motor skill assessments answers the question of whether the motor skill tests are measuring similar motor skill constructs. In order to determine correlation coefficients and the relationship between ordinal level variables, non-parametric statistics are used. Non-parametric tests have been developed specifically for use with ordinal scales and data (21). Many clinical measurements such as motor skill assessments, including the BOT-2 and MABC-2, are based on an ordinal scale. The aim of this study was to investigate the convergent validity of the BOT-2 and MABC-2 when completed by typically developing school-aged children aged 7–16 years. Three research questions were posed: (1) Does the BOT-2 total motor composite significantly correlate with the MABC-2 total test score when completed by typically developing school age children aged 7–16 years? (2) Do the BOT-2 fine motor skill composite scales and the four fine motor subscales significantly correlate with the MABC-2 fine motor skill subtest when completed by typically developing school-age children aged 7–16 years? (3) Do the BOT-2 gross motor skill composite scales and the four gross motor subscales significantly correlate with the MABC-2 gross motor skill subtests when completed by typically developing school-age children aged 7–16 years? Material and methods Participants A sample of 50 typically developing children was recruited for this study from regional Victoria, Australia. The inclusion criteria included (a) typically developing children aged 7–16 years, (b) children

Convergent validity of motor skill assessments

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with a working knowledge of the English language, (c) children attending a mainstream school, and (d) children who had consent provided by their parent/ guardian to take part in the study. If a child presented with a known history of developmental, intellectual, neurological, medical, or learning problems based on a parent-report screening questionnaire, they were excluded from the study. The age range of 7–16 years was selected to correspond with the two age bands of the MABC-2. Of the 70 consent forms originally distributed to parents/caregivers, 50 were returned that met the inclusion criteria (71.4% response rate). Instrumentation Parent demographic questionnaire. A parent demographic questionnaire was created as a screening tool for the purpose of this study. The purpose of this questionnaire was to determine whether potential participants met the inclusion criteria for the study and had any known health, learning, or developmental problems (based on parent report). The questionnaire was also used to collect basic information one ach child. The questionnaire included 16 items related to the child (e.g. gender, age, school, languages spoken, history of health, learning or developmental problems). Parents were instructed to complete each item of the questionnaire by circling or writing a response. Bruininks-Oseretsky Test of Motor Proficiency – Second Edition (BOT-2). The BOT-2 (7) measures an array of motor skills in children from 4 to 21 years of age. It uses a composite structure organized around the muscle groups and limbs involved in the movements. There are four motor-area composites including Fine Manual Control, Manual Coordination, Body Coordination, and Strength and Agility. Each composite comprises two subscales, with between five and nine items in each. The subscales include Fine Motor Precision, Fine Motor Integration, Manual Dexterity, Upper Limb Coordination, Bilateral Coordination, Balance, Running Speed and Agility, and Strength (7). The Fine Manual Control composite includes the Fine Motor Precision and Fine Motor Integration subscales; the Manual Coordination composite includes the Manual Dexterity and Upper Limb Coordination subscales; the Body Coordination composite includes the Bilateral Coordination and Balance subscales; and the Strength and Agility composite includes the Running Speed and Agility and Strength subscales. The BOT-2 was chosen for this study as it is one of the most widely used performance-based measures (4,17) and has norms for the age group of children included in this study (7). The BOT-2

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standardization scores are based on normative data collected from a sample of 1520 children and adolescents aged from 4 to 21 years from 239 sites in 38 states of the United States (7). The BOT-2 manual provides evidence of the reliability and validity of the assessment tool (7,10,22-25). Internal consistency data reported in the BOT-2 manual states that reliability coefficients range from high 0.70s to low 0.80s for the eight subtests, from high 0.80s to low 0.90s for the motor composites, and sit in the mid 0.90s for the total motor composite (7). Test–retest reliability has been established based on a sample of 134 children where mean correlation coefficients ranged from 0.69 to low 0.70s for the subtests, from 0.77 to low 0.80s for the motor composite areas, and from midto-high 0.80s for the Total Motor Composite (7). Cools et al. (10) also reported that good inter-rater reliability for the BOT-2 has been demonstrated with Pearson’s correlation coefficients ranging from 0.92 to 0.99. The content validity of the BOT-2 was established through the development of test content, analysis of item fit, and evidence that the BOT-2 discriminates between different clinical groups and typically developing children (7). The BOT-2 manual also reports evidence of construct validity as variations in tests scores according to age and gender are reported to be consistent with research on motor development (7). Criterion validity of the BOT-2 has also been established through comparisons with other motor skill assessments. For example, when compared with the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP; the previous version of the BOT-2), correlations with the BOT-2 are between 0.45 and 0.73 for subtest and composite scores, and strong correlations exist for the total motor composite score and the BOTMP total score (7).

Movement Assessment Battery for Children Second Edition (MABC-2). The MABC-2 (8) is designed to measure and identify impairments in motor performance of children and adolescents from three to 16 years of age. It is a revision of the Movement Assessment Battery for Children (MABC) (26). The MABC-2 comprises two parts, the Performance Test and the Parent Checklist. The Performance Test includes three motor skill areas of Manual Dexterity, Aiming and Catching, and Balance. Manual Dexterity is the ability to use hands with skill and coordination. Aiming and Catching involves a complex combination of both gross and fine motor movements. Balance looks at the skill of maintaining upright and steady in a state of equilibrium. The MABC-2 is split into three age-bands (ABs), AB1: 3–6 years, AB2: 7–10 years, and AB3: 11–16 years

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(8). Each AB is composed of eight items that fall under the three skill areas. The MABC-2 takes approximately 50 minutes to set up, administer, and score (8). Norms are provided for each AB (27) and are based on normative data collected from a sample of 1172 children and adolescents aged 3–16 years from 12 geographical locations within the United Kingdom (8). Henderson et al. (8) assumed that the reliability and validity information reported for the (MABC) (26) is generalizable to the MABC-2. Although the MABC and MABC-2 may measure the same motor skill constructs, the MABC-2 has four added items, combined multiple age bands, and extended its age range (8). This therefore makes it a different instrument that needs to have its own specific measurement properties measured and reported (27). This is, in part, why it was chosen for this study. Limited information on reliability is reported in the MABC-2 manual (27-29). However, some preliminary reliability details for the MABC-2 Performance Test, based on the results of several studies completed by other investigators that involved experimental versions of AB1 and AB3, are reported. Visser and Jongmans (30) report test–retest results for Age Band 1 assessment tasks for a group of 55 three-year-old children from the Netherlands. Pearson Product Moment correlation results ranged from 0.49 to 0.70. Chow et al. (31) evaluated inter-rater and test–retest reliability of an experimental version of the 11:0–16:11 year Age Band 3 assessment tasks (with instructions and scoring criteria translated into Chinese) with a sample of 31 adolescents. Intra-class correlation (ICC) coefficients for interrater reliability varied from 0.92 to 1.00 while test– retest coefficients varied from 0.62 to 0.92. In another study involving 64 young adults, Faber and Nijhuis (32) examined the intra-rater and inter-rater reliability of a total score calculated for the Age Band 3 tasks originally used by Chow et al. (2002). The ICC coefficients were 0.79 (intra-rater) and 0.79 (inter-rater). Test–retest reliability of the MABC-2 has been established (8). Henderson et al. (8) reported a test–retest study involving 20 three-year-old children. Pearson Product Moment correlations ranged from 0.86 to 0.91 for the three Manual Dexterity tasks while the Aiming and Catching and Balance tasks were less reliable with coefficients of 0.48 and 0.68. The test authors suggested that the test–retest reliability problems lie with younger children, aged between 3 and 4 years. In another study completed by the test authors, the test–retest reliability of the whole test involving all three ABs was completed. Sixty children, 20 from each AB, were included. Using the standard scores for the three test sections

(Manual Dexterity, Aiming and Catching, and Balance) as well as the total test score, the Pearson Product Moment Correlations were 0.77, 0.84, 0.73, and 0.80 respectively (8). In a study examining the internal consistency and responsiveness of the MABC-2 when used with children with Developmental Coordination Disorder, internal consistency of the total test score was deemed to be excellent (0.90) (24). At this stage, evidence regarding the validity of the MABC-2 version is limited (27,29). Content validity of the MABC-2 was established by input of an expert panel. According to the test manual, the expert panel was unanimous that the Performance Test contents/ items were representative of the motor domain it was intended to evaluate. The test manual reports that face validity has been established by feedback obtained from a wide range of professionals who have used the MABC including psychologists, therapists, educational professionals, and physicians. The test manual reported section and total test standard score correlations as evidence of the three MABC-2 sections evaluating related but distinct motor skill abilities. The Manual Dexterity section was correlated with the Aiming and Catching section (0.26), Balance section (0.36), and MABC-2 Total Test Score (0.76). The Aiming and Catching section was correlated with the Balance section (0.25), and the total test score (0.65). The Balance section was correlated with the total test score (0.73). This provides evidence that the three MABC-2 sections are measuring related but discrete skills and “the fact that each component correlates well with the Total Test Score is reassuring” [(8) p. 142]. Evidence of criterion-related validity of the MABC-2 was reported in the form of three studies in the test manual. First, enlisting a sample of 31 Cypriot children (33), the relationship was examined between MABC-2 Manual Dexterity section items and the children’s performance on the Good enough and Harris Draw-a-Man Test (34). Correlations with the Posting Coins and Drawing Trail items and the Draw-a-Man test were 0.66. The preliminary results of a second study completed by the test authors involving a small sample of 20 children who were initially assessed with the MABC and were reassessed using the MABC-2 (8). The MABC-2 was able to indicate that the children continued to have ongoing motor skill difficulties. The third study reported the results of 25 boys diagnosed with Asperger’s Syndrome who were assessed by the MABC-2 (35). The MABC-2 total scores indicated that the majority of the boys (21/25) had impaired motor skills. The test authors purported that this is evidence of the MABC-2’s discriminative validity. No evidence of

Convergent validity of motor skill assessments the MABC-2’s convergent validity was reported in its test manual.

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Procedures In the context of this study, only the latter two agebands of the MABC-2 (i.e. AB2: 7–10 years, and AB3: 11–16 years) were included in the convergent validity study. The first MABC-2 age band, AB1: 3– 6 years, was not included for two reasons. First, this was an unfunded study and including the younger MABC-2 age band would have greatly added to the cost of data collection. Second, the authors of the study deemed it was important for the participants themselves to be able to provide verbal assent to take part in the study, after their parents/caregivers provided formal consent. Developmentally it was determined that participants three to six years of age were not able to provide verbal assent. Therefore, for ethical reasons, it was also decided by the authors only to enrol children who fell into the latter two agebands of the MABC-2 (in other words children who were 7–16 years of age. Ethical approval was obtained from the Deakin University Human Ethics Advisory Group (Approval No.: HEAG-H 11_ 2013). Ethical approval was also obtained from the Victorian Department of Education and Early Childhood Development Strategy and Review Group (Approval No. 2013_001880). Participants took part in the study on a voluntary basis. As the participants were not old enough to provide informed consent, permission was sought from the parents/caregivers of the children. Participants were recruited from two primary and two secondary schools in regional Victoria. Participant information letters and consent forms were sent home with students who were aged 7–16 years. In total, 70 letters and consent forms were distributed by classroom teachers. Fifty consent forms signed by children’s parents/caregivers were returned to the classroom teachers. The teachers forwarded the returned consent forms to the researchers. The participant’s parents/caregivers were informed of how the confidentiality of their personal information would be handled in the contents of participant information letters that were distributed. Details of how the study data would be stored and used as well as the ability of participants taking part in the study to withdraw without reprisal was also reported. Participants were also informed of the study aims, and the anticipated benefits and the potential risks were also detailed in the participant information letters sent home to parents/caregivers. Given that the participants were children who were under the age of 18 years, parental/caregiver consent was initially obtained. Verbal assent was also obtained from the

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children who took part in the study. The researchers ensured that participating children understood the information and could provide informed assent by using language that was suitable for their developmental ages and also reminded the children that they were able to stop at any time without negative consequences. The researchers also asked the children a minimum of three times during the course of the data collection whether they wished to take a break or discontinue taking part in the study. It took children approximately 70–80 minutes to complete both the BOT-2 and MABC-2. Sessions were mostly completed within the children’s home environment during school holidays at a time negotiated with the parent or guardian. The sessions took place in a quiet area of the home to minimize distractions and extraneous influences. Where space was inappropriate, some items (e.g. shuttle run, throwing a ball at a target) were also completed in undercover yard areas. All children were provided with two rest breaks during the completion of the BOT-2 and MABC-2. After each session was completed, the two motor skill tests were scored and the data were coded to maintain the confidentiality of the participants. Data were entered and stored on a database that was password protected. The BOT-2 and MABC-2 score results were provided to parents/caregivers of the children in the form of a written letter. Parents/caregivers were provided with the option of contacting the researchers if they had any questions about their children’s performance scores. Also, parents were provided with the opportunity to request the contact details of two publicly funded and two private agencies that could provide follow-up for their children if needed. The first author received a four-hour training session in the administration and scoring of the BOT-2 and MABC-2. The first author also reviewed the BOT-2 and MABC-2 test manuals to ensure they were administered in a consistent manner. The first author also observed four sessions of the BOT-2 and MABC-2 being administered to children by an experienced occupational therapist who had 15 years of professional practice in paediatrics. The first author then completed the data collection for the study by administering the BOT-2 and MABC-2 to the 50 participants. Data analysis All data obtained from the parent demographic questionnaires, BOT-2, and MABC-2 raw scores were entered into the Statistical Package for Social Sciences (SPSS) version 21.0 (36). As the data collected from the parent demographic questionnaires, BOT-2, and

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MABC-2 were in ordinal form, non-parametric statistics were used (20). To allow the analyses to be consistent, raw scores were analysed. Spearman’s rho correlations were calculated for each research question to explore the relationship between the BOT-2 and MABC-2 scores. Correlations were deemed significant when p < 0.05. Where significant correlations were identified by the analysis, the strength of each association was labelled based on correlations coefficients between 0 and 0.25 having a low level relationship, 0.25 and 0.50 having a fair relationship, 0.50 and 0.75 having a moderate to good relationship, and above 0.75 having a good to excellent relationship (20). Results Participants Due to the MABC-2 having separate age band (AB) assessments (Henderson et al., 2007), the sample was

also divided into two age bands to correspond with the ages of AB2 (7–10 years) and AB3 (11–16 years). AB2 comprised 25 children (50% of the total sample), 14 females (56% of AB2) and 11 males (44% of AB2). Participants varied in age from 7 years to 10 years 11 months with a mean age of 8 years 11 months (SD = 1 year, 1 month). Grade distribution of the AB2 sample was as follows: grade one: 2 (8%), grade two: 6 (24%), grade three: 7 (28%), grade four: 6 (24%), and grade five: 4 (16%). The girls varied in age from 7 years to 10 years 11 months with a mean age of 9 years (SD = 1 year, 4 months). The boys varied in age from 7 years 8 months to 10 years 6 months with a mean age of 8 years 9 months (SD = 9 months). AB3 comprised 25 children (50% of the total sample), 11 females (44% of AB3) and 14 males (56% of AB3). Participants varied in age from 11 years to 16 years 11 months with a mean age of 13 years 4 months (SD = 1 year 8 months). Grade distribution of the AB3 sample was as follows: grade five: 2 (8%),

Table I. AB2 (7–10 years of age) participant raw scores (n = 25). Percentiles Score

Mean (SD)

Median

Range

25

50

75

BOT-2 Eight subtests Fine motor precision

36.48 (2.57)

37

31–40

36.00

37.00

38.50

Fine motor integration

36.64 (2.18)

37

30–39

36.00

37.00

38.00

32.6 (4.92)

32

23–42

28.50

32.00

36.00

Upper-limb coordination

33.08 (4.03)

34

24–39

30.50

34.00

36.00

Bilateral coordination

22.72 (1.49)

23

20–24

22.00

23.00

24.00

Manual dexterity

Balance

34.04 (2.07)

34

31–37

32.00

34.00

35.00

Running speed & agility

38.40 (3.79)

39

33–47

35.50

39.00

41.50

27.4 (6.00)

26

18–39

23.00

26.00

32.00

Fine manual control

73.12 (3.56)

74

66–78

70.50

74.00

75.50

Manual coordination

65.68 (7.39)

67

52–78

58.50

67.00

73.00

Body coordination

56.76 (2.15)

57

51–61

55.00

57.00

58.50

Strength & agility

40.44 (6.95)

41

25–54

37.00

41.00

43.50

236.00 (14.43)

241

229–290

246.50

264.00

276.50

73.64 (5.80)

72

66–85

69.00

72.00

78.50

Strength Four composite areas

Total motor composite Total short form MABC-2 performance Test Three component areas Manual dexterity

33.44 (5.77)

34

21–42

28.00

34.00

37.50

Aiming & catching

19.60 (3.16)

19

14–26

17.00

19.00

22.00

Balance

32.72 (3.41)

32

26–39

30.50

32.00

36.00

Total test score

85.76 (8.22)

88

66–102

80.00

88.00

91.00

Notes: AB = age band; SD = standard deviation; BOT-2 = Bruininks-Oseretsky Test of Motor Proficiency–Second Edition; MABC-2 = Movement Assessment Battery for Children–Second Edition.

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Convergent validity of motor skill assessments Table II. AB3 (11–16 years of age) participant raw scores (n = 25). Percentiles Score

Mean (SD)

Median

Range

25

50

75

BOT-2

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Eight subtests Fine motor precision

39.64 (1.80)

41

35–41

38.00

41.00

41.00

Fine motor integration

38.12 (2.42)

39

31–40

37.50

39.00

40.00

Manual dexterity

37.20 (3.24)

38

29–42

35.00

38.00

39.50

Upper-limb coordination

37.40 (1.53)

38

32–39

37.00

38.00

38.50

Bilateral coordination

23.76 (.83)

24

20–24

24.00

24.00

24.00

Balance

35.80 (1.15)

36

34–37

35.00

36.00

37.00

Running speed & Agility

42.80 (4.31)

44

32–49

39.50

44.00

46.00

Strength

33.04 (4.51)

33

26–40

29.00

33.00

37.50

Fine manual control

77.76 (3.53)

79

69–81

76.50

79.00

81.00

Manual coordination

74.60 (3.58)

75

67–81

72.00

75.00

77.50

Body coordination

59.56 (1.66)

60

54–61

59.00

60.00

61.00

Four composite areas

Strength & agility

38.00 (6.95)

37

23–50

33.50

37.00

43.50

249.92 (12.60)

252

218–266

241.50

252.00

261.00

78.24 (5.24)

77

65–85

75.00

77.00

83.00

Manual dexterity

30.24 (5.47)

31

17–38

26.00

31.00

34.00

Aiming & catching

25.72 (4.01)

27

17–32

22.50

27.00

28.00

Balance

34.24(2.60)

36

29–36

31.00

36.00

36.00

Total test score

90.20(9.01)

92

70–104

85.50

92.00

96.50

Total motor composite Total short form MABC-2 performance Test Three component areas

Notes: AB = age band; SD = standard deviation; BOT-2 = Bruininks-Oseretsky Test of Motor Proficiency–Second Edition; MABC-2 = Movement Assessment Battery for Children–Second Edition.

grade six: 6 (24%), grade seven: 4 (16%), grade eight: 7 (28%), grade nine: 1 (4%), grade 10: 4 (16%), and grade 12: 1 (4%). The girls varied in age from 11 years 6 months to 16 years 2 months with a mean age of 13 years (SD = 1 year 7 months). The boys varied in age from 11 years to 16 years 11 months with a mean age of 13 years, 1 month (SD = 1 year 9 months). Motor skill test scores Descriptive statistics for the two measures are reported in Table I for AB2 and Table II for AB3. No significant correlation was found between the BOT-2 Total Motor Composite and the AB2 MABC-2 Total Test Score. However, a positive strong correlation was found between the BOT-2 Total Motor Composite and the AB3 MABC-2 Total Test Score (rho = 0.80, p < 0.01). There were no significant correlations identified between the MABC-2 fine motor skill subtest and

the BOT-2 two fine motor skill composite scales or the four fine motor subscales for the 7- to 10-year-old age band (AB2; Table III). Table III illustrates that the BOT-2 Fine Motor Integration subscale and the Fine Manual Control composite scale were not significantly correlated with the AB3 MABC-2 fine motor skill subtest. However, several other significant correlations were identified between the fine motor components of the MABC-2 and the BOT-2. The MABC-2 Manual Dexterity Component was found to be positively and moderately correlated with BOT-2 Fine Motor Precision (rho = 0.61, p < 0.01) and Manual Dexterity (rho = 0.59, p < 0.01) subscales, and to have a positive and fair relationship with the BOT-2 Manual Coordination Composite scale (rho = 0.44, p < 0.05); and, the MABC-2 Aiming and Catching Component was found to be moderately correlated with the BOT-2 Upper-limb Coordination subscale (rho = 0.63, p < 0.01). The gross motor components of the BOT-2 were not significantly correlated with the gross motor

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Table III. Spearman’s rho correlations between the BOT-2 fine motor components and the MABC-2 fine motor components. MABC-2 AB2 (7–10 year olds; n = 25)

MABC-2 AB3 (11–16 years olds; n = 25)

Manual dexterity component

Aiming & catching component

Manual dexterity component

–0.09

–0.15

0.61**

0.13

Fine motor integration

0.30

–0.13

0.03

0.06

Manual dexterity

0.03

–0.01

0.59**

0.12

–0.05

0.17

Fine manual control

0.09

–0.15

0.34

0.09

Manual coordination

–0.02

0.13

0.44*

0.38

Variable

Aiming & catching component

BOT-2 Subscales Fine motor precision

Upper-limb coordination

–0.06

0.63**

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Composite scales

Notes: AB = age band; BOT-2 = Bruininks-Oseretsky Test of Motor Proficiency–Second Edition; MABC-2 = Movement Assessment Battery for Children–Second Edition; AB2 = age band 2 (7–10 year olds); AB3 = age band 3 (11- to 16-year-olds). *Significant at the 0.05 level. **Significant at the 0.01 level.

components of the AB2 MABC-2 assessment (Table IV). Table IV displays several significant correlations that were found between the gross motor components of the BOT-2 and AB3 MABC-2 assessment. The MABC-2 Balance component was found to have a positive and fair correlation with the BOT-2 Strength and Agility composite (rho = 0.45, p > 0.05) and the Running Speed and Agility subscale (rho = 0.45, p > 0.05). The MABC-2 Balance component also had a positive moderate correlation with the BOT-2 Strength subscale (rho = 0.51, p > 0.05); and, the MABC-2 Aiming and Catching component was found to be positively and fairly correlated with the BOT-2

Strength and Agility composite scale and the strength subscale with coefficients both having correlations of rho = 0.44 (p > 0.05). Discussion The Spearman’s rho correlation analyses indicated that no significant correlation existed between the BOT-2 total motor composite and the AB2 MABC-2 total test score. However, a strong positive correlation in the good to excellent range was found between the BOT-2 total motor composite and the AB3 MABC-2 total test score (rho = 0.80, p < 0.01).

Table IV. Spearman’s rho correlations between the BOT-2 gross motor components and the MABC-2 gross motor components. MABC-2 AB2 (7- to 10-year-olds; n = 25)

Variable

Balance component

Aiming & catching component

MABC-2 AB3 (11- to 16-year-olds; n = 25) Balance component

Aiming & catching component

BOT-2 Subscales –0.10

–0.08

0.15

0.26

Balance

0.11

0.35

0.31

0.01

Running speed & agility

0.14

0.14

0.45*

0.25

Strength

0.37

–0.10

0.51*

0.44*

Body coordination

0.13

0.17

0.29

0.03

Strength & agility

0.32

0.17

0.45*

0.44*

Bilateral coordination

Composite scales

Notes: AB = age band; BOT-2 = Bruininks-Oseretsky Test of Motor Proficiency–Second Edition; MABC-2 = Movement Assessment Battery for Children–Second Edition; AB2 = age band 2 (7- to 10-year-olds); AB3 = Age band 3 (11- to 16-year-olds). *Significant at the 0.05 level. **Significant at the 0.01 level.

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Convergent validity of motor skill assessments This indicates that the overall motor skills assessed by the BOT-2 and the AB3 MABC-2 are significantly associated. No significant correlations were found when comparing the fine and gross motor components of the AB2 MABC-2. However, consistent with the total score results from research question one, significant positive correlations were found when comparing the fine and gross motor components of the AB3 MABC-2. hese results are also consistent with other studies completed to compare the BOT-2 scores with other theoretically related measures (37-39). The Spearman’s rho correlation analysis results indicated that several significant correlations in the fair to moderate range were identified between the fine motor components of the BOT-2 and AB3 MABC-2. Specifically, there were three significant moderate- to good-level correlations between the BOT-2 and AB3 MABC-2 fine motor subscales and one significant fair-level correlation between the BOT-2 fine motor composite scale and one of the AB3 MABC-2 fine motor subscales. Similarly there were three significant fair-level correlations between the BOT-2 and AB3 MABC-2 gross motor subscales and two significant fair-level correlations between the BOT-2 gross motor composite scale and one of the AB3 MABC-2 gross motor subscales. Overall, the degree of strength of the correlations between the BOT-2 and AB3 MABC-2 appears to be stronger in the area of fine motor skills than of gross motor skills. The fact that the correlations are in the moderate to good range indicates that the fine motor components of the BOT-2 and AB3 MABC-2 appear to be assessing similar fine motor constructs in children. A study examining the relationship between the BOT-2 and the Peabody Developmental Motor Scales, Second Edition (PDMS-2) (37) that included 38 children aged 4–5 years found there was a moderate to strong positive correlation between the two measures: (i) PDMS-2 Total Motor Quotient and BOT-2 Total Motor Composite scale, rho = 0.73, p < 0. 05; (ii) PDMS-2 Fine Motor Quotient and BOT-2 Fine Manual Coordination scale, rho = 0.51, p < 0. 05; (iii) PDMS-2 Gross Motor Quotient and BOT-2 Body Coordination subscale, rho = 0.65, p < 0. 05; and (iv) PDMS-2 Gross Motor Quotient and BOT-2 Strength and Agility subscale, rho = 0.75, p < 0.05. The findings reported by Folio and Fewell (37) are both similar to and contrasting with the current study in that there were BOT-2 had more significant correlations with the AB3 MABC-2, but many fewer with the AB2 MABC-2. The other similarity is that in this study the BOT-2 total motor composite was positively correlated with the AB3 MABC-2 total test score. In other words, the

9

BOT-2 was significantly correlated with the PDMS-2 Total Motor Quotient as reported by Folio and Fewell (37) and the AB3 MABC-2 total test score. Van Hartingsveldt et al. (38) examined the convergent validity of the Fine Motor Scale of the Peabody Developmental Motor Scales–Second Edition (PDMSFM-2) with the fine motor section of the Movement Assessment Battery for Children (M-ABC).The correlation between the PDMS-FM-2 and the M-ABC was = 0.69 (p < 0.002) (38). It should be noted that the sample for this study included two groups of 18 children between the ages of 4 and 5 years with and without mild fine motor problems. This study is different from the current study in that the participants were younger and half of them exhibited fine motor problems. However, the findings are comparable to the current study where there were significant positive correlations between the fine motor components of the AB3 MABC-2 and BOT-2. In a study by Deitz et al. (39) involving 56 children between the ages of 4 and 13 years, the BOT-2 was correlated with the Test of Visual Motor Skills – Revised (TVMS-R) (40). The strength of the association between the BOT-2 Fine Motor Integration subscale and the TVMS-R visual motor skills composite scores was 0.74 (p < 0.05), a statistically significant moderately high-level correlation coefficient. In conjunction with these studies, the results from this present study demonstrate that the scores of the children on the subscales and composites of the BOT-2 were correlated to scores of children on other measures of motor performance that in fact should theoretically be related, thus providing evidence for the convergent validity of the BOT-2 (39). There have also been studies that compared the MABC-2 scores with other theoretically related motor skill assessments. For example, Logan and Robinson (19) completed a study involving a sample of 32 children aged 3–6 years, comparing the MABC-2 with the Test of Gross Motor Development–2 (TGMD-2) (41). Logan and Robinson found significant low- to moderate-level correlations between the subscales of the TGMB-2 and the MABC-2 AB1 ranging from 0.13 to 0.40 (p < 0.05) (19). Other studies reported in the MABC-2 manual are unpublished manuscripts. Therefore, further studies with the use of the MABC-2 across multiple/all age bands and other assessment tools need to be completed to add to the validity knowledge of the tool. Comparison between the MABC-2 age bands In this study, positive significant correlations were found between the MABC-2 total test score, MABC-2 AB3 fine motor and gross motor components, the BOT-2 fine motor and gross motor

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components, and the BOT-2 total motor composite. However, similar results were not found with the younger MABC-2 age band (that is, AB2). As the items of the MABC-2 are age dependent and require children indifferent age ranges to complete different motor skill assessment tasks, this may be one possible explanation for the lack of consistency in the correlation results between the two MABC-2 age bands and the BOT-2. The motor skill abilities able to be performed by children at different age levels could account for the lack of significant correlation between the BOT-2 and MABC-2 AB2. Motor skill development of children aged 7– 10 years (the age range covered by the MABC-2 AB2) includes good fine motor manipulation and dexterity for crafts and construction with small objects. It also includes bilateral coordination for building complex structures and motor planning and precision to complete drawings and puzzles (2). Gross motor skills, in the same 7–10 age level, include the ability to run with speed and endurance, jump, hop, and skip, to successfully throw a ball a reasonable distance, and to be able to catch a ball with accuracy (2). Development during the 11–16 year age range (the age range covered by the MABC-2 AB3) is an intense period of physical and physiological maturation (42). This process of growth and muscle development increases a child’s overall strength for physical activities and leads to overall improvement in motor performance including better coordination and endurance (42). It is during these ages that children usually refine and become attuned to their movements and motor skill patterns (43). Performing a new task initially may cause some misjudgment but once a child becomes familiar with a task, problems in executing this task successfully are not expected (43). This could be one primary reason to explain the difference between the results comparing the two age bands, as children in AB3 have a greater ability to take on and successfully complete a new task (43), compared with children in the age range of AB2. The difference between the two age bands could also be due to the motor skill assessment items included in the MABC-2 AB3 being more closely linked to the items of the BOT-2 when compared with the motor skill assessment tasks included as part of the MABC-2 AB2. The MABC-2 tasks are focused on specific aspects of a particular motor skill, whereas the BOT-2 has more items addressing a wider range of tasks involving that motor ability, providing the child with greater opportunities to demonstrate his/her competence in the different motor construct areas. Between the ages of 7 and 11 years, the large muscles of children’s bodies are considerably more developed than their smaller muscles (44). The ability

to initiate and complete a motor pattern with the arrival of a moving object, referred to as ‘coincidence-anticipation timing’, also improves and further develops from the age of 7 to 18 years. These developmental factors may affect the relationship between these two assessment tools when children are aged 7–10 years, as at this age children are still developing and refining their motor skills, thus contributing to their overall motor performance abilities. As Logan and Robinson (19) discuss, the differences between the two age bands may also be due to the fact that as children become older it is possible that the assessments are capable of more strongly discriminating between the different motor constructs that each assessment measures. Study limitations and future research Due to the small sample of children with typical development recruited from one geographical area, the ability to generalize the findings is limited. Another limitation is that participants were recruited for the study via convenience sampling, therefore parents who gave consent for their children to participate in the study may have been biased. This recruitment issue could have taken the form of volunteer bias or selection bias since parents/caregivers gave consent for their children to take part in the study. Individuals who volunteer are not likely to be representative of the general population thereby impacting on the generalizability of the study results. It was not possible to investigate the extent of the influence of this type of these types of bias since it was not ethical practice to compare the group of children whose parents did not provide consent with those who did. Another type of bias that could have been present is information bias. The parents of the children who provided consent may have had some prior knowledge of children’s motor skills or motor skill assessment. Therefore this may have influenced their choice to provide permission to enrol their children in the study. One other type of bias that might have been present given that the BOT-2 and MABC-2 are performance-based motor skill tests is response bias. Since the children participating in the study were aware that they were being assessed given the nature of the specific fine and gross motor skill tasks they were asked to complete, their behaviour, responses, and motor skill performance might have been different compared with a non-assessment context. Another limitation of the study is that the some of the Spearman rho correlation coefficient results obtained in the study were in the fair to moderate range. This increases the chance of a Type 1 error occurring.

Convergent validity of motor skill assessments This study also only covered two out of the three MABC-2 age bands. It would be beneficial for future studies to use larger sample sizes and also include the first age band assessment of the MABC-2, to explore how this is associated with the BOT-2. It would be of value to purposefully include children with a known disability or impairment to determine whether the results of this study are consistent for other groups of children.

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Conclusion This study has provided some insights into the relationships between motor skill constructs measured by the BOT-2 and MABC-2. While existing research has explored the differences between the BOT-2 and other assessment tools, research correlating the MABC-2 to other assessment tools has been limited. The finding that the MABC-2 AB3 was significantly correlated with the BOT-2, a well-established motor skills test, adds to the body of concurrent validity evidence for this instrument. Knowing that performance on different assessments is linked is important in occupational therapy practice as it allows for comparison of results, generalization of findings, and measuring the effectiveness of interventions (19). It is also notable that the fine and gross motor subscales of the MABC-2 AB2 did not correlate with the BOT-2 subscales. For practicing clinicians, this implies that they could use the BOT-2 and MABC-2 AB3 interchangeably but that this is not so for the MABC-2 AB2. It also demonstrates that the BOT-2 and MABC-2 AB3 appear to measure similar motor skill constructs while the BOT-2 and MABC-2 AB2 do not.

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Acknowledgements The authors wish to sincerely thank the children and parents who participated in this study. Without their invaluable assistance and input, this study would not have been possible. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

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