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Perceptions of Children's Motor Abilities by Children, Parents, and Teachers as Predictors of Children's Motor Skill Performance.

Abstract

This study investigated the links between children's motor performance using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), with the perceptions of children, parents, and teachers of children's motor skills. Fifty-five children (8-12 years of age) completed the Physical Self-Description Questionnaire (PSDQ) and the Self-Perception Profile for Children (SPPC). Parents completed the Developmental Profile III (DP-III) and the Developmental Coordination Disorder Questionnaire (DCDQ-P) while teachers completed the Developmental Coordination Disorder Questionnaire (DCDQ-T) and the Teacher's Rating Scale of Child's Actual Behavior (SPPC-T). Regression analysis found that the children, parents, and teachers subscale scores together represented 36.9% of the variance in the BOT-2 total motor composite score. Findings from this study support the top-down assessment approach in paediatric occupational therapy practice.

Key words

Assessment, psychomotor skills, self-report, students.

Reference

Lalor, A., & Brown, T. (2016). Perceptions of children's motor abilities by children, parents, and teachers as predictors of children's motor skill performance. New Zealand Journal of Occupational Therapy, 63 (2), 14-24.

Children acquire and refine their motor skills throughout their development. This enables them to participate in self-care, productivity, school, and play occupations, as well as assuming new roles and becoming independent within their daily living environments (Davis & Polatajko, 2006). Motor skills are the "qualitative expression of movement performance, or a specific class of goal-directed movement patterns" (Burton & Miller, 1998, p. 367) and are generally referred to as gross motor skills and fine motor skills. Gross motor skills enable large movements or actions like crawling, walking, running, climbing, swimming, throwing a ball, and riding a bicycle. Fine motor skills enable manipulations using one's hands such as grasping, pinching, holding, poking, hand writing, and cutting with scissors (Bee & Boyd, 2004; Sheridan, 1999). Occupational therapists work with children presenting with occupational performance problems related to poor motor skill performance. To provide evidence to support paediatric occupational therapists intervention, this study is designed to explore the relationships between actual motor performance and how it is perceived by children, parents, and teachers. Findings from study will assist clinicians in choosing appropriate assessment methods when working with children presenting with motor difficulties.

Literature Review

In addition to Developmental Coordination Disorder (DCD) which is specifically related to motor deficits, children with mental health (such as anxiety and depression), behavioural (such as Attention Deficit Hyperactive Disorder [ADHD]), learning disabilities, and developmental disorders (such as autism) frequently present with motor difficulties (Emck, Bosscher, Beek, & Doreleijers, 2009). The clinical (diagnostic) prevalence of children presenting with some form of motor disorder is in the region of 15-20% (Australian Institute of Health and Welfare [AIHW], 2004; AIHW, 2006; AIHW, 2012). If the average primary school classroom size is considered, these figures are significant. For instance, within a typical classroom of 24 to 30 children, there could potentially be four to six children presenting with some type of motor difficulty which could impact on their activities and participation in school, home and community environments (Anaby et al., 2013).

The impact of motor deficits on children and their families can be significant. For example, children with motor difficulties may require more time, assistance, or resources to complete daily functional tasks and occupations in comparison to their peers without motor difficulties (Cermak, Gubbay, & Larkin, 2002). This can disrupt family routines, increase parental stress, and place additional financial demands on family units (Cummins, Piek, & Dyck, 2005; Larkin & Summers, 2004; Payne, Ward, Turner, Taylor, & Bark, 2013). At school, children with motor difficulties are more likely to be excluded or ostracised by their peers in playground activities (Rose & Larkin, 2002) leading to social difficulties and isolation (Emck et al., 2009; May-Benson, Ingolia, & Koomar, 2002).

Motor performance is one domain that paediatric occupational therapists frequently assess since it is a primary skill that underpins occupational performance (Brown, Rodger, Brown, & Roever, 2005; Rodger, Brown, & Brown, 2005). One of the most widely used standardised motor skill tests is the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP; Bruininks, 1978) (Brown et al., 2005; Miller, Burtner, McMain, & Crowe, 2002; Rodger et al., 2005). A revised version of the BOTMP called the Bruininks-Oseretsky Test of Motor Proficiency--Second Edition (BOT-2) (Bruininks & Bruininks, 2005) was published in 2005. The BOTMP is an example of the bottom-up assessment approach, which focuses on performance components (Trombly & Radomski, 2002). The use of a standardised performance-based test provides the opportunity for children's motor skills to be compared with performance norms or criteria of age-equivalent peers (Barnett & Peters, 2004). The bottom-up approach to assessment focuses first on the body structure and function aspect of the International Classification of Functioning Disability and Health (ICF) (World Health Organisation [WHO], 2001). In contrast, the activity and participation level is typically addressed first when using a top-down approach to assessment.

Top-down assessments seek to obtain client perspectives, including children and their proxies such as parents and teachers to determine what is important and meaningful for the client (Weinstock-Zlotnick & Hinojosa, 2004). Research evidence has shown that school-aged children, around eight years of age, are reliable informants of their own health and therefore, have a right to provide input and be involved in the decisions about their health care (Dunn, Shields, Taylor, & Dodd, 2007; Riley, 2004; Sturgess, Rodger, & Ozanne, 2002). There is evidence to support the engagement of, and collaboration with, both parents and children when reporting information about the child's abilities (le Coq, Boeke, Bezemer, Colland, & van Eijk, 2000). Self-report measures are commonly used to understand client perceptions of their occupational performance issues. In this context, 'self-report' refers to clients and/or their caregivers/family members answering formal and informal questions and actively providing their perspectives on issues being assessed (Nielsen & Waehrens, 2015). Two examples of such self-report questionnaires that school age children can complete are the Physical Self-Description Questionnaire (PSDQ) (Marsh, Richards, Johnson, Roche, & Tremayne, 1994) and the Self-Perception Profile for Children (SPPC) (Harter, 1985a). The PSDQ and SPPC obtain information about children's perceptions of their physical and motor abilities (e.g., physical appearance, flexibility, endurance, coordination, health, esteem, sporting ability, social competence, athletic competence, behavioural conduct) which can underpin occupational performance abilities.

Several studies examined whether children's overall motor performance are correlated with children, parents' and teachers' self-reports of motor skill constructs (Barnett, Morgan, van Beurden, & Beard, 2008; Robinson, 2010). Brown (2012) and Kennedy, Brown and Chien (2012) compared the BOT-2 (Bruininks & Bruininks, 2005) total motor composite score with the child-reported PSDQ using two different samples of Australian children (n = 93, 8-12 years old, Mean Age = 10.3 years, SD = 1.4 years; and n = 38, Mean Age = 10 years 2 month, SD = 1 year 4 months, respectively). Both Brown (2012) and Kennedy et al. (2012) reported significant correlations between the BOT-2 total motor composite score with the PSDQ subscales of Global Physical Activity, Sports Competence, and Endurance. Brown (2012) also reported significant correlations between the BOT-2 total motor composite score and the PSDQ subscales of Health, Coordination, Strength and Esteem, however Kennedy et al. (2012) did not report similar findings. On the other hand, Kennedy et al. (2012) obtained significant correlations between the BOT-2 total motor composite score and the PSDQ Body Fat subscale, which Brown (2012) did not find.

LeGear et al. (2012) examined the relationship between perceptions of competence of 260 children in their first year of school and their motor skill proficiency. Children's perceptions of their physical competence were assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children while their motor skills were measured using the Test of Gross Motor Development-2. Correlations between children's perceived physical competence and object control skills (r = 0.14, p < .05) and locomotor skills (r = 0.31, p < .01) were modest, but statistically significant. "This finding suggests that children in kindergarten are already beginning to make self-judgments; and that affording opportunities to help them become and feel physically competent needs to occur early in their school, or preschool, life" (LeGear et al., 2012, p. 29).

Vedul-Kjelsas, Sigmundsson, Stensdotter, and Haga (2012) compared children's overall motor performance using the Movement Assessment Battery for Children, Second Edition (MABC-2) (Henderson, Sugden, & Barnett, 2007) with the child-reported SPPC (translated Norwegian version) using a sample of sixth grade children (n = 82, Mean Age = 11.42 years) in Norway. They found that children's overall motor performance was significantly correlated with the SPPC Social Acceptance, Athletic Competence, Physical Appearance, and Global Self Worth subscales. The significant correlations between the MABC-2 total score and the SPPC Athletic Competence subscale is consistent with the significant correlations between BOT-2 total composite score and the PSDQ Sports Competence and Endurance subscales; and the significant correlations between motor performance and the SPPC Social Acceptance subscale construct was consistent with findings that children with DCD are often teased and excluded by peers in school settings (Rose & Larkin, 2002). The significant correlation found between the MABC-2 assessed motor performance and the SPPC Global Self Worth subscale was in contrast with findings in a previous study (Shields, Loy, Murdoch, Taylor, & Todd, 2007) where children's self-worth did not appear to be negatively impacted by the children's physical disability.

Mixed results have been reported when comparing children's actual motor performance as measured by standardised performance-based tests and parents' perspectives using self-report questionnaires. With a sample of 38 children aged 8-12 years, Kennedy et al. (2012) compared parent-report using the MABC-2 Checklist and the BOT-2 total motor composite score and found a significant correlation (Spearman's rho = .40, p < 0.05) between the two sets of scores. The MABC-2 Checklist can be completed by classroom and special education teachers to identify motor difficulties a child may be presenting with under different conditions (such as when the child and environment are either stable or moving). Lane and Brown (2015) reported a non-significant correlation between the total scores of the MABC-2 (age band 2; 7-10-year-old group) and the BOT-2 using a sample of 50 children aged 7-16 years, however the BOT-2 was significantly correlated with the MABC-2 11-16-year-old group (age band 3). It is important to note that the MABC-2 and BOT-2 are both performance-based motor skill assessments. It is likely that the differences in the age groups of the two studies contributed to the differences in results. In the clinical group of children diagnosed with DCD, parent-report scale scores using the Developmental Coordination Disorder Questionnaire (DCDQ) correlated significantly with the Movement Assessment Battery for Children (MABC) performance test scores (Henderson & Sugden, 1992). The MABC is an earlier edition of the currently used MABC-2.

Teachers often refer children with motor difficulties for occupational therapy services (Miller et al., 2001). Toftegaard-Stoeckel, Groenfeldt and Andersen (2010) evaluated children's actual motor performance with the perceptions of a group of teachers. The teachers' evaluation of children's motor performance was measured by the three-item supplement to the Social Skills Rating System Questionnaire (Gresham & Elliott, 1990) and children's motor performance was measured by the German gross motor mobility test referred to as the Korperkoordinationstest Fur Kinder (Schilling, 2000). Toftegaard-Stoeckel et al. (2010) reported a significant correlation between the teachers' scoring of their perceptions of the children's motor skills and the outcomes of the children's performances on the German motor skills test (Spearman's rho = .31, p < 0.05, n = 646).

This study aimed to examine the association between the perceptions of children, parents, and classroom teachers of children's motor skills and children's motor skill performance as measured by the BOT-2 overall motor composite score; and to investigate whether the perceptions of children, parents, and teachers about children's motor skills were significant predictors of children's motor skill performance.

The following research questions were posed:

1) Is there a significant association between the perceptions of children's motor skills as reported by children, parents and teachers and typically developing children's motor skill performance as indicated by the total motor composite score of the BOT-2?

2) Are the perceptions of children, parents, and teachers about typically developing children's motor skills significant predictors of a child's actual motor skill performance as measured by the BOT-2 total motor composite score?

Methods

A cross-sectional, quantitative study design was used.

Participants.

Parents and children across the Melbourne metropolitan region, Victoria, Australia were recruited through convenience and snowball sampling methods. Parents were provided with an explanatory statement for themselves and their children's classroom teacher and were asked to sign a consent form if they were interested in their child and themselves taking part. The explanatory statement outlined that participation in the study was completely voluntary. Consent was obtained from all classroom teachers of children whose parents agreed to participate in the study. Some parents and children who consented suggested the names of other additional participants via word of mouth. Both boys and girls who attended state, private, or Catholic schools were recruited for the study.

The inclusion criteria were: the child was aged between exactly eight years and 12 years 11 months; attending primary school on a full-time basis; did not have any known physical, neurological, learning, psychosocial, or intellectual disabilities; had a working knowledge of the English language; had written informed consent from their parent(s), and provided his/her own verbal consent to participate. Parents of children fitting the inclusion criteria also needed to provide consent for themselves and their child and had to have a working knowledge of the English language. Teachers of children whose parents consented to take part in the study also needed to provide consent to participate in the study and have a working knowledge of the English language. They also had to be the main classroom teacher of the child involved in the study.

Demographic information was obtained via parents' report regarding the child's age, gender, school attended and whether they had any known physical, neurological, learning, psychosocial, or intellectual disabilities. This was designed to assist the researcher in confirming participants' eligibility for the project based on the established inclusion/exclusion criteria. The children completed the Physical Self-Description Questionnaire (PSDQ) (Marsh et al., 1994) and the Self-Perception Profile for Children (SPPC) (Harter, 1985a); parents completed the Developmental Profile III (DP-III) (Alpern, 2006), and the Developmental Coordination Disorder Questionnaire (DCDQ-P) (Wilson et al., 2000); and classroom teachers completed the Developmental Coordination Disorder Questionnaire (DCDQ-T) and the Teacher's Rating Scale of Child's Actual Behaviour (SPPC-T) (Harter, 1985b). All children completed the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) (Bruininks & Bruininks, 2005). Details of the BOT-2, PSDQ, SPPC, DP-III, DCDQ, and SPPC-T are reported in Table 1.

Data entry, management & analysis.

Demographic and raw scale scores for each participant were entered into the Statistical Package for the Social Sciences[R], Version 15.0 for Windows[R] (SPSS Inc., 2007) for analysis. Accuracy of the data entry procedure was ensured through re-entry and cross-checking of 10% of the data. Descriptive statistics (mean and standard deviation), Spearman's rho correlation coefficients, and a multiple linear regression equation were calculated. The BOT-2 total composite score was the dependent (criterion) variable for the regression analysis. Independent variables for the regression were identified from the Spearman's rho correlations. Only those independent variables that significantly correlated with the BOT-2 total composite score were used in the regression modelling. Preliminary analyses were performed to ensure no violation of multicollinearity was evident.

Procedures

Initial interest for recruitment of participants was sought through word of mouth and via email to the researchers' colleagues. Additional participants were recruited through referral by parents of children who had already consented. Parents and their school-aged children were mailed a plain language explanatory statement, consent form, and demographic forms to assist with determining whether they met the inclusion and exclusion criteria for the study, and a reply paid envelope to return the documents should they consent to participate. Upon receipt of consent forms and demographic information from parents, an appointment was arranged to assess the child. Consent was obtained for 55 school-aged children (eight to 12 years), their parents, and their teachers to partake in the study.

At the appointment, verbal assent was obtained from the child prior to administering the BOT-2. Parents were provided with a questionnaire package (including DCDQP, DP-III, PSDQ, SPPC and SPPC-T), a plain language explanatory statement and consent form for the child's classroom teacher, and two reply paid envelopes for the parent and teacher to return questionnaires to the researchers. Teachers were not contacted directly by the researchers at any stage, however, they were able to contact the researchers if they had any questions or concerns. In some cases a reminder phone call was made to parents to improve response rate. Each self-report questionnaire and performance-based assessment was scored by the researchers in accordance with the test manual instructions for each scale. The first author conducted the assessments with the children. The administration and scoring instructions outlined in the test manuals of the BOT-2, PSDQ, SPPC, DP-III, DCDQ, and SPPC-T were reviewed by the authors before completing the assessments with participants.

Ethical issues and considerations

Ethics approval for this study was obtained from the Standing Committee on Ethics in Research involving Humans (SCERH), Monash University. Data were de-identified and analysed on a group basis to protect the privacy and confidentiality of participants.

Results

Twenty-eight girls and 27 boys (aged eight to 12 years) from state, Catholic, and private schools from Melbourne metropolitan region were recruited for this study (see Table 2). This age range of the participants was within the recommended age bands of each of the scales used. The children who participated in the study had a mean age of 10.04 years (SD=1.39). The average age for girls included in the study was 9.79 years (SD=1.37) and the average age for boys was slighter older being 10.30 years (SD=1.38). Each age level for children was relatively similar in size except for 10 year olds who accounted for nearly one third of the overall sample size. Therefore there is a higher proportion of participants within grades three to six than grades two and seven.

Some children were siblings from the same family. All children completed the BOT-2. Some teachers did not return the questionnaires despite efforts to contact them; however each child had at least two self-report questionnaires completed (usually by the parents). Therefore not all children had a complete data set. For the set of scales completed by the children's parents, only one father completed the scales, the rest were completed by the children's mother. Results for all participants were included in the analysis.

Participant raw score results

Child

The overall BOT-2 mean standard score for all 55 participants was 50.71 (SD = 7.52). The SPPC and PSDQ had overall means of 99.90 (SD = 12.41) and 53.83 (SD = 6.05) respectively. The SPPC subscale mean raw scores ranged from 19.16 (SD = 3.45) to 21.37 (SD = 2.59) while the PSDQ subscale mean raw scores ranged from 4.38 (SD = 1.09) to 5.40 (SD = 0.49) (see Table 3).

Parents

The DP-III had an overall mean of 170.82 (SD = 6.31) and the DCDQ-P an overall mean of 71.33 (SD = 9.76) (see Table 3). The DP-III subscale mean raw scores ranged from 32.51 (SD = 1.49) to 36.59 (SD = 1.71) and the DCDQ-P subscale mean raw scores ranged from 13.27 (SD = 2.16) to 25.96 (SD = 3.69).

Teachers

The DCDQ-T and SPPC-T had overall mean scores of 67.45 (SD = 10.92) and 49.73 (SD = 6.70) respectively (see Table 3). The DCDQ-T subscale mean raw scores ranged from 13.10 (SD =2.55) to 24.31 (SD = 5.78) while the SPPC-T subscale mean raw scores ranged from 8.80 (SD = 2.19) to 10.61 (SD = 1.71).

Correlation results

The BOT-2 total motor composite scale score was significantly correlated with the SPPC subscales of Scholastic Competence (.30, p < .05) and Athletic Competence (.40, p < .01); the PSDQ subscales of Coordination (.31, p < .05), Sports Competence (.41, p < .01), and Endurance (.56, p < .01); the DP-III Physical subscale (.36, p < .05); and the SPPC-T Athletic Competence subscale (.30, p < .05). The overall BOT-2 motor composite score was not significantly correlated with any of the DCDQ-P or DCDQ-T subscale scores (see Table 4).

Regression analysis results

The BOT-2 total motor composite scale score was the dependent variable in the regression analysis. The independent variables for the regression analysis were any of the SPPC, PSDQ, DP-III, SPPC-T, DCDQ-P, and DCDQ-T subscale scores that were significantly correlated with the BOT-2 total motor composite score. The following subscales were significantly correlated with BOT-2 total motor composite score: the child self-report PSDQ Endurance, Sports Competence, and Coordination subscales; the child self-report SPPC Scholastic Competence and Athletic Competence subscales; the parent-report DP-III Physical subscale; and the teacher-report SPPC-T Athletic Competence subscale (see Table 5).

Table 5 reports the unstandardised regression coefficients (B) and unstandardised regression coefficients standard error (SE B), the standardised regression coefficients ([beta]), the semi-partial correlations ([sr.sub.i.sup.2]), the significance (p), [R.sup.2], and adjusted [R.sup.2] results. The overall regression model accounted for 36.9% of the BOT-2 total motor skill composite scale score as the dependent variable. The PSDQ Endurance subscale made the strongest unique contribution to BOT-2 total motor skill composite scale score representing 14.2% of the 36.9% total variance of the dependent variable.

Discussion

A number of significant correlations were found between the BOT-2 total motor composite scale and the self-report questionnaires completed by the children, parents and classroom teachers. These scales included: the PSDQ Endurance, Sports Competence, and Coordination subscales; the SPPC Scholastic Competence and Athletic Competence subscales; the DP-III Physical subscale; and the SPPC-T Athletic Competence subscale. Regression analysis indicated that 36.9% of the variance in the BOT-2 total motor skill composite scale was predicted by the above identified correlations. These subscales in the self-report questionnaires were predominantly gross motor in nature, with the exception of the SPPC Scholastic Competence subscale. This suggests that children themselves, parents of children, and classroom teachers of the children were able to report about the gross motor skills of school-age children with some accuracy or at a minimum were able to provide some useful additional information.

Correlations between self-report scale scores and the motor performance of children

Brown (2012) and Kennedy et al. (2012) also reported significant correlations between the BOT-2 total composite motor score and the PSDQ Sports Competence and Endurance subscales using samples of Australian children. In the current study, the PSDQ Endurance subscale made the strongest unique contribution to BOT-2 total motor composite score (14.2% of the 36.9% total variance; p < .01). This is consistent with the findings reported by Wu, Lin, Li, Tsai, and Cairney (2010) involving a group of Taiwanese children (n = 41) with DCD and a group of health typically developing children. They found that the children with DCD had significantly lower levels of cardiopulmonary fitness and endurance compared to their typically developing age-mates. Similarly, using the MABC and SPPC with 67 Norwegian children, Vedul-Kjelsas et al. (2012) reported a significant correlation between the MABC total score and the SPPC Athletic Competence subscale score.

A significant correlation was not obtained between the SPPC Social Acceptance subscale and the BOT-2 total motor composite score in the current study. In contrast, Rose, Larkin and Berger (1997) and Vedul-Kjelsas et al. (2012) reported that children's poor motor performance was associated with significantly lower social acceptance as measured by the SPPC. One reason for this may be the fact that only typically developing children were recruited for this study. Using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children to assess kindergarten-age children's perceptions of their physical competence and the Test of Gross Motor Development-2 to assess their gross motor skills, LeGear et al. (2012) found that significant correlations existed between children's perceived physical competence and their object control skills and locomotor skills.

There was no significant correlations between the BOT-2 composite motor performance score and the SPPC Global Self Worth subscale. This is consistent with results reported by Vedul-Kjelsas et al. (2012). This finding supports previous claims that the self-worth of children with a disability does not suffer, despite recognising that they are less competent in completing certain tasks, compared to typically developing children (Shields et al., 2007).

A significant correlation between the SPPC Scholastic Competence subscale and the BOT-2 total motor composite score was achieved. This is consistent with findings reported by Rose et al. (1997), but in contrast to those reported by Vedul-Kjelsas et al. (2012). Rose et al. (1997) determined that the significant correlations between the above two variables were mostly contributed by the female participant group and not the male sample group in the study. This may explain the differences in results as Rose et al. (1997) recruited a sample of participants that had more girls than boys (200 girls and 180 boys). In the current study, an approximate equal number of boys and girls (28 girls and 27 boys) were recruited, while the sample for the Vedul-Kjelsas et al. (2012) included more boys than girls (39 and 28 respectively).

Child reports using the PSDQ and SPPC, both had a number of subscales (three and two respectively) that were significantly correlated (Spearman's rho coefficients ranging from .30 to .56) with the BOT-2 total motor composite score. In contrast, both parent- and teacher- report scales had one subscale each that significantly correlated with the BOT-2 total motor composite score. The difference in the number of significant correlations between the child, parent, and teacher self-report scales suggests that children 8-12 years of age are able to report reliably about their gross motor abilities (e.g., Athletic Competence, Coordination, Sports Competence, and Endurance). Also, it indicates that helpful information can also be obtained via parent and teacher proxy reporting about children's motor skills as well.

The BOT-2 total motor composite score did not correlate significantly with the total score of any of the self-report questionnaires used. In contrast, Brown (2012) reported a significant correlation (Spearman's rho = .30, p < 0.05) between the BOT-2 total motor composite score and the PSDQ total score. The lack of significant correlations may be explained by the scope of the self-report questionnaires used. For example, the SPPC is a measure of a child's global self-worth while the PSDQ is a measurement of a child's physical self-concept. The PSDQ also incorporates a variety of constructs other than motor skills, such as Physical Appearance and Esteem, which may partially explain the lack of significant correlations that were found between the BOT-2 total motor composite score and the SPPC and PSDQ total scores.

On the other hand, one would expect the DCDQ, the only self-report questionnaire used in this study that only measured motor skills, would correlate significantly with the BOT-2 total motor composite score. However, no significant correlations were found between the DCDQ total scores for either of the versions completed by the children's parents or the classroom teacher and the BOT-2 total motor composite score. This may be due to the inherent limitations of the DCDQ. Firstly, the sensitivity of DCDQ was noted to be low (28.9%) when used with some sample groups (Shoemaker et al., 2006), including children without moderate or severe motor impairments (Loh, Piek & Barrett, 2009). Secondly, the DCDQ measures daily functioning resulting from motor deficits rather than the motor deficits themselves and its correlation with the MABC, although significant, was small (r = -0.26, p = 0.002 for 8-12 year olds, n = 140; r = -.024, p = 0.001, 4-8 year olds, n = 182) as reported by Wilson et al. (2000).

There was only one significant correlation between the BOT-2 total motor composite score and the teachers' self-report scales, namely the SPPC-T Athletic Competence subscale. This suggests that teachers' perceptions of children's athletic competence may be well suited for identifying potential concerns with their motor skills. This is consistent with the significant correlations reported by Toftegaard-Stoeckel et al. (2010) between children's gross motor mobility test and teachers' self-report. In addition, Miller et al. (2001) reported that 50-85% of children with clumsy motor behaviours had been referred to occupational therapy services by the time they reached Grade 3 in Southwestern Ontario, Canada indicating that teachers in this context were skilled and knowledgeable about identifying children who required additional services. Similar data was not available for Australian contexts. This may help explain why the teacher-report using DCDQ did not correlate significantly with the BOT-2 total motor composite score.

Self-reported perceptions of children's motor skill abilities by children, parents and teachers as predictors of children's motor skill performance

Toftegaard-Stoeckel et al. (2010) reported that parental perceptions of low motor performance of their children was the strongest predictor of children's actual low motor performance. However they did not use a standardised self-report questionnaire with proven reliability and validity, which impacted on the robustness of their results. In comparison, all the self-report questionnaires used in this study have proven reliability and validity, which adds to the confidence that can be placed on the findings reported. It was found that the children's self-report PSDQ Endurance subscale, instead of parent-report, was the most significant predictor of children's actual motor performance, accounting for 14.2% of the 36.9% total variance.

In a study by Kennedy, Brown, and Stagnitti (2013) involving a sample of 38 children and parents recruited from Victoria, Australia, children completed the PSDQ and parents completed the MABC-2 Checklist. Additionally, the children's motor skill performance was assessed using the BOT-2. This study identified two predictive relationships based on the parents' perspectives. The total score of the MABC-2 Checklist was determined "to be a significant predictor of the BOT-2 Manual Coordination motor composite score, accounting for 8.35% of its variance, and the BOT-2 Strength and Agility motor composite score, accounting for 11.6% of its variance" (Kennedy, Brown, & Stagnitti, 2013, p. 45). No predictive relationships were found between the children's self-report PSDQ perspectives and the BOT-2 composite scores. This is in contrast to the results of the current study where it was the child-reported PSDQ Endurance subscale that was the largest unique contributor to the children's actual motor performance on the BOT-2.

Brown and Lane (2014) investigated whether the parent-report MABC-2 Checklist was predictive of the BOT-2 Fine Manual Control composite, the BOT-2 Manual Coordination composite, and the BOT-2 Short Form total scale score. In the first regression model, "the MABC-2 Checklist explained 5.9% of the total variance of the BOT-2 Fine Manual Control construct (beta = .28, p < .05)" (Brown & Lane, 2014, p. 377). The second regression model results indicated the MABC-2 Checklist accounted for 6.9% of the variance of the BOT-2 Manual Coordination composite (beta = .30, p < .05). "The third regression model included the BOT-2 Short Form total as the dependent variable and the MABC-2 Checklist as the independent variable. This model did not reach statistical significance overall (p = .07)" (Brown & Lane, 2014, p. 377). Again, this contrasts the results of the current study where the children's self-reported PSDQ Endurance subscale was a significant predictor of children's overall motor skill abilities.

Implications for Occupational Therapy Practice

The study findings suggest that children from 8-12 years not only can provide reliable information about their motor abilities, but their perceptions are more predictive than those of their parents and teachers. This supports the use of child-centred top-down approaches to motor performance assessment in paediatric occupational therapy. The study results support the idea of client-centred occupational therapy and provides evidence that clients can be invaluable informants about themselves (Law, 1998; Wilkins, Pollock, Rochon, Law, 2001). However, paediatric occupational therapists need to be conversant with both the bottom-up and top-down approaches to assessment and correctly select what are the most appropriate assessment methods to use in a particular context (Brown & Chien, 2010; Weinstock-Zlotnick & Hinojosa, 2004).

Limitations and Recommendations for Future Research

The current study is limited in its scope due to its sample size, the convenience sampling method used, and the inclusion of only typically developing children in its participant group. Another potential limitation is the issue of social-desirability biased reporting by parents and teachers (Fisher & Katz, 2005) whereby children's motor deficits are under-reported so as not to reflect badly on their parental and teaching abilities. The impact of gender on the children's motor skill performance scores on the BOT-2 were not accounted for and this is an acknowledged limitation. A final limitation is the fact that the data in this study was generated from participants who resided in one specific geographical region hence this will limit the generalisability of the study findings.

Future research can further the current study by including a larger number of children who are randomly selected, including children who have a known disability, including children from a larger geographic area, and by recruiting a sample that is more representative of the local population. In addition, all but one parent who completed the parent-report scales was the mother of the child. This identifies a possible alternative research study whereby both parents are asked to complete self-report questionnaires independently of each other about their perceptions of their child's motor skills. Furthermore, the self-report assessment tools used in this study may not have been sensitive enough or sufficiently robust to obtain all the details of children's, parent's, and teacher's perceptions of the children's motor skills. However, all of the scales used in the study did have documented evidence reliability and validity and had been used previously in Australian contexts. Finally, future research designs could benefit from adopting a qualitative research methods approach to elicit the perspectives from children, parents and teachers based on key informant interviews or focus groups.

Conclusion

The current study investigated the relationship between self-report questionnaires (child, parent and teacher) and a performance-based assessment of children's motor skills (the BOT-2 total motor composite scale). A number of significant correlations have been obtained and regression analysis indicated that 36.9% of the variance in the BOT-2 total motor composite scale was accounted for by the child, parent, and teacher self-report scales about their perceptions of the children's motor skill performance. The PSDQ Endurance subscale made the strongest unique contribution to BOT-2 total motor composite scale (14.2% of the 36.9% total variance). Findings from this study support the top-down assessment approach in paediatric occupational therapy practice and indicate that children as young as eight years of age can provide valuable insights about their motor skill abilities.

Acknowledgements

The authors would like to acknowledge the participants who volunteered to take part in this study.

Key points:

* It is recommended that occupational therapists utilise a variety of approaches when assessing the motor skills of children including the perspectives of children, parents and classroom teachers;

* It appears that the self-report questionnaires completed by children, parents and teachers about the children's motor skills are associated with and predictive of children's motor skill performance on standardarised, performance-based motor skill tests such as the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2).

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Corresponding author:

Aislinn Lalor, BOT (Hons, Doctoral Student) Department of Occupational Therapy School of Primary Health Care Monash University Australia

Email: aislinn.lalor@monash.edu

Ted Brown PhD, MSc, MPA, BScOT (Hons), OT(C), OTR Associate Professor Department of Occupational Therapy School of Primary Health Care Monash University
Table 1. Instrument details.

Category                 BOT-2

Author(s)                Bruininks, R. H., and
                         Bruininks, B. D.


Year Published           2005
Type of Test             Performance based
Location Developed       United States
Purpose                  To assist diagnosis of motor
                         impairment; aid development
                         and evaluation of individual
                         motor training programs
Age (y:m)                4:0 to 21:11

Number of Items          8 subscales: Fine Motor
and Subtests             Precision (7 items), Fine Motor
                         Integration (8 items), Manual
                         Dexterity (5 items), Bilateral
                         Coordination (7 items),
                         Balance (9 items), Running
                         Speed and Agility (5 items),
                         Upper-Limb Coordination
                         (7 items), and Strength (5
                         items) within 4 motor-area
                         composites: Fine Manual
                         Control, Manual Coordination,
                         Body Coordination, and
                         Strength and Agility
Time to complete         40 to 60 minutes
Reliability              Inter-rater reliability (r = 0.77
& Validity               to 0.97) and test-retest
                         reliability (r = 0.86) (Wiart
                         & Darrah, 2001).










Category            PSDQ                      SPPC & SPPC-T

Author(s)           Marsh, H.W., Richards,    Harter, S.
                    G.E., Johnson, S.,
                    Roche, L., and
                    Tremayne, P.
Year Published      1994                      1985
Type of Test        Self-report               Self-report
Location Developed  Australia                 United States
Purpose             To measure perceived      To ascertain child's and
                    physical self-concept     teacher's perceptions
                                              of the child's
                                              competencies.
Age (y:m)           School-age to             8:0 to 15:11
                    adulthood
Number of Items     11 subscales with 70      6 domains with
and Subtests        items: Strength; Body     36 and 15 items
                    Fat; Physical Activity;   respectively: Scholastic
                    Endurance/Fitness;        Competence; Social
                    Sports Competence;        Acceptance; Athletic
                    Coordination; Health;     Competance;
                    Appearance; Flexibility;  Physical Appearance;
                    General Physical          Behvioural Conduct;
                    Self-Concept; and,        and, Global
                    Self-Esteem               Self-Worth*




Time to complete    20 minutes                10 minutes
Reliability         Good test-retest          Good internal
& Validity          reliability and overall   consistency, test-retest
                    reliability, construct    stability, internal
                    validity, cross-cultural  reliability (r = 0.71
                    validity, convergent      to 0.86), construct
                    and discriminant          and convergent
                    validity reported         validity (Kaneko
                    (Marsh, 1996a, 1996b,     & Okamura, 2005; Muris,
                    1997; Marsh et al.,       Meesters, & Fijen,
                    1994; Marsh, Tomas        2003; Van den Bergh
                    Marco, & Hulya Apcy,      & Marcoen,1999)
                    2002; Schipke & Freund,
                    2012)

Category            DCDQ-P & DCDQ-T          DP-III

Author(s)           Wilson, B.N., Kaplan,    Alpern, G. D.
                    B.J., Crawford, S.G.,
                    Campbell, A., and
                    Dewey, D.
Year Published      2000                     2007
Type of Test        Self-report              Self-report
Location Developed  Canada                   United States
Purpose             Designed to distinguish  To screen and
                    those children with      identify possible
                    motor issues from        developmental delay in
                    those without.           children.
Age (y:m)           8:0 to 14:11             0:0 to 12:11

Number of Items     4 subtests with 17       5 developmental
and Subtests        items: Movement          subscales: Physical
                    Control; Fine Motor/     (35 items), Adaptive
                    Handwriting; Gross       Behaviour (37 items),
                    Motor/ Planning; and,    Social-Emotional
                    General Coordination     (36 items), Cognitive
                    (Barnett & Peters,       (38 items), and
                    2004)                    Communication (34
                                             items)





Time to complete    10 minutes               20 to 40 minutes
Reliability         High internal            Strong internal
& Validity          consistency, content,    consistency and
                    construct and            test-retest reliability,
                    concurrent validity      proven construct
                    with specificity of 71%  and discriminant
                    and sensitivity of 86%   validity (Alpern, 2006;
                    (Barnett & Peters,       Hebbeler & Gerlach-Downie,
                    2004; Crawford,          2002; Quay & Steele,
                    Wilson, & Dewey, 2001;   1998)
                    Green et al., 2005;
                    Wilson et al., 2000)



Note. SPPC = Self-Perception Profile for Children; SPPC-T = Teacher's
Rating Scale of Child's Actual Behaviour; DCDQ / DCDQ-T = Developmental
Coordination Disorder Questionnaire (Teacher Version);
DP-3 = Developmental Profile III.

Table 2. Demographic data for children included in the study (n=55)

Demographic      Male    Female  Total   Percentage of
Variable         (n=27)  (n=28)  Sample  Total Sample (%)

Age
 8                4       6      10      18.18
 9                3       6       9      16.36
10                8       9      17      30.91
11                5       2       7      12.73
12                7       5      12      21.82
Grade
 2                1       3       4       7.27
 3                5       4       9      16.36
 4                5      11      16      29.09
 5                7       2       9      16.36
 6                4       7      11      20.00
 7                5      11       6      10.92
School Attended
 State           11      16      27      49.09
 Catholic        11      10      21      38.18
 Private          5      22       7      12.73

Table 3. Mean Scores, Standard Deviation and Score Range of BOT-2,
SPPC, PSDQ, DP-III, DCDQ, and SPCC-T

Scale                             N (*)  Mean    SD     Score Range

BOT-2
 Fine Motor Precision Subtest     55      37.49   2.99   28-41
 Fine Motor Integration Subtest   55      38.07   2.32   32-40
Fine Manual Control Composite     55      53.24   7.14   38-69
 Manual Dexterity Subtest         55      30.95   4.04   21-39
 Upper Limb Coordination
 Subtest                          55      32.78   4.10   18-38
Manual Coordination Composite     55      48.53   9.00    6-66
 Bilateral Coordination Subtest   55      21.89   2.10   16-24
 Balance Subtest                  55      32.80   2.17   25-37
Body Coordination Composite       55      47.89   7.87   36-68
 Running Speed and Agility
 Subtest                          55      36.27   2.94   28-45
 Strength Subtest                 55      25.75   4.30   16-35
Strength and Agility Composite    55      53.07   7.42   27-65
SPPC
 Scholastic Competence            51      19.29   3.39   11-24
 Social Acceptance                51      19.39   3.36   10-24
 Athletic Competence              51      19.16   3.45   11-24
 Physical Appearance              51      20.24   3.19   10-24
 Behavioural Conduct              51      19.61   3.59   11-24
 Global Self Worth                51      21.37   2.59   15-24
Overall scale score               51      99.90  12.41   72-120
PSDQ
 Health                           51       4.69   0.75    2-6
 Coordination                     51       4.93   0.78    3-6
 Body Fat                         51       5.28   1.21    1-6
 Physical Appearance              51       4.88   1.03    2-6
 Sports Competence                51       4.85   0.98    2-6
 Appearance                       51       4.63   0.74    2-6
 Strength                         51       4.67   0.92    2-6
 Flexibility                      51       4.68   0.90    3-6
 Global Physlca                   51       5.23   0.79    3-6
 Endurance                        51       4.38   1.09    2-6
 Esteem                           51       5.40   0.49    4-6
Overall scale score               51      53.83   6.05   37-63
DP-MI
 Physlca                          49      34.37   1.67   25-35
 Adaptive Behaviour               49      34.49   2.20   29-37
 Social Emotlona                  49      32.86   1.97   28-36
 Cognitive                        49      36.59   1.71   29-38
 Communication                    49      32.51   1.49   28-34
Overall scale score               49     170.82   6.31  153-180
DCDQ-P (parent completed
version)
 Movement Contro                  52      25.96   3.70   14-30
 Fine Motor                       52      16.60   3.57    7-20
 Gross Motor                      52      15.50   3.06    6-20
 General Coordination             52      13.27   2.17    5-15
Overall scale score               52      71.33   9.76   33-85
DCDQ-T (teacher completed
version)
 Movement Contro                  49      24.31   5.78    8-30
 Fine Motor                       49      15.88   3.74    6-20
 Gross Motor                      49      14.16   2.79    9-20
 General Coordination             49      13.10   2.55    4-15
Overall scale score               49      67.45  10.92   32-84
SPPC-T
 Scholastic Competence            51      10.06   2.12    3-12
 Social Acceptance                51      10.10   2.00    4-12
 Athletic Competence              51       8.80   2.19    3-12
 Physical Appearance              51      10.16   1.55    6-12
 Behavioural Conduct              51      10.61   1.71    5-12
Overall scale score               51      49.73   6.70   26-60

Note. (*) = Number of questionnaires completed by child participants;
SD = Standard Deviation; BOT-2 = Bruininks-Oseretsky Test of Motor
Proficiency, Second Edition; SPPC = Self-Perception Profile for
Children; PSDQ = Physical Self-Description Questionnaire; DP-III =
Developmental Profile III; DCDQ-P = Developmental Coordination Disorder
Questionnaire (parent completed version); DCDQ-T = Developmental
Coordination Disorder Questionnaire (teacher completed version); SPPC-T
= Teacher's Rating Scale of Child's Actual Behavior.

Table 4. Significant Spearman rho correlations between the BOT-2
overall score and self-report questionnaires SPPC, PSDQ, DP-3 and
SPPC-T (n=55)

Self-Report       Subscales of Self-Report      Spearman rho
Questionnaire     Questionnaires                correlation
                                                coefficients with
                                                BOT-2 total score

SPPC              Athletic Competence           .40 (**)
                  Scholastic Competence         .30 (**)
PSDQ              Coordination                  .31 (*)
                  Sports Competence             .41 (**)
                  Endurance                     .56 (**)
DP-III            Physical                      .36 (*)
SPPC-T            Athletic Competence           .30 (*)

Note. BOT-2 = Bruininks-Oseretsky Test of Motor Proficiency, Second
Edition; SPPC = Self-Perception Profile for Children; PSDQ = Physical
Self-Description Questionnaire; DP-3 = Developmental Profile 3; DCDQ =
Developmental Coordination Disorder Questionnaire; SPPC-T = Teacher's
Rating Scale of Child's Actual Behaviour; (**) = Correlation is
significant at the p< 0.01 level; (*) = Correlation is significant at
the p< 0.05 level.

Table 5. Summary of Standard Regression Analysis for Independent
Variables predicting Bruininks-Oseretsky Test of Motor Proficiency,
Second Edition, Overall composite score (Dependent Variable; n=55)

Variable                      B       SE B    [beta]  p     [sri.sup.2]

SPPC Athletic Competence      .026    .459    .012    .96   .366
SPPC Scholastic Competence    .376    .344    .169    .28   .673
PSDQ Coordination           -2.686   1.943   -.279    .18   .397
PSDQ Sports Competence       -.414   1.626   -.054    .80   .362
PSDQ Endurance               4.320   1.457    .625    .01   .364
DP-III Physical               .581    .745    .129    .44   .594
SPPC-T Athletic Competence    .297    .601    .087    .62   .529

Note. [R.sup.2] = .369; Adjusted [R.sup.2] = .256; B = unstandardised
regression coefficients; SE B = unstandardised regression coefficients
standard error; [beta] = standardised regression coefficients;
[sri.sup.2] = semi-partial correlations indicate the unique variance
predicted by the independent variable; p = significance; BOT-2 =
Bruininks-Oseretsky Test of Motor Proficiency, Second Edition; SPPC =
Self-Perception Profile for Children; PSDQ = Physical Self-Description
Questionnaire; DP-III = Developmental Profile III; SPPC-T = Teacher's
Rating Scale of Child's Actual Behavior.
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Title Annotation:Feature article
Author:Lalor, Aislinn; Brown, Ted
Publication:New Zealand Journal of Occupational Therapy
Geographic Code:8AUST
Date:Sep 1, 2016
Words:9401
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