Movement Assessment Battery for Children, Second edition (MABC-2) Article Summary of Johnston 2019
2019 Johnston Article
FASD is an umbrella term for various neurodevelopmental and motor impairments that negatively affect activities of daily living due to an over-exposure of alcohol to a child during pregnancy. “The Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan” (Canadian Guideline) is the gold standard for diagnosing Fetal Alcohol Syndrome Disorder (FASD). When following this guideline, FASD can be diagnosed with evidence of prenatal alcohol exposure (PAE) and 3 or more neuro-developmental domains that include: motor skills, neuroanatomy/neurophysiology; cognition; language; academic achievement; memory; attention; executive function; affect regulation; adaptive behavior; social skills; or social communication. The Canadian Guideline provides various assessment tools that physical and occupational therapists can utilize when assessing gross motor, fine motor and visual-motor skill of the child in question. They include the following: Movement Assessment Battery for Children, Second edition (MABC-2), the Beery-Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition (BeeryVMI-6), the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) and the Rey Complex Figure Test (RCFT). For the confirmation of motor impairment, it is unclear which standardized motor assessment is the most accurate. Therefore, the purpose of this article was to “clarify diagnostic criteria regarding motor impairment in FASD”.
The patient population that was focused on in this study was children aged 6-17 years. The inclusion criteria also called for a confirmed PAE, impairment of 3 or more of the neuro-developmental domains mentioned above, no other genetic/neurological diagnoses, and English speaking participants (n=63). This study evaluated the MABC-2 (total score) and its three subtests (manual dexterity, aiming and catching, and balance), the BeeryVMI-6 and its subtest (motor coordination), and the BOT-2SF. The evaluation of functional motor abilities came from reports from the parent or caregiver. By clinicians of the Pediatric Specialty Clinic, the data was collected and de-identified by assigning each participant a number. The study found that agreement between raters was 98% and when discrepancies arose, they were each discussed to reach consensus. In order to determine diagnostic accuracy from each assessment, both data from children with FASD and PAE without FASD were utilized.
According to the Canadian Guideline, motor impairment is considered significant for FASD if the scores fall -2SD, therefore the sensitivity and specificity of each motor assessment was calculated at that standard deviation. The results of this study suggest that this standard deviation cutoff was too restrictive, since the diagnostic accuracy improved using -1.5SD as the cutoff score. As for the assessment tools, this study found that the sensitivity of the BOT-2SF was extremely low; therefore the suggestion and use of this assessment tool should be questioned. While the BeeryVMI-6 identified 16% of children with FASD with a severe motor impairment, MABC-2 was found to have the highest accuracy, identifying 30% of children.
While this study supports that the Canadian Guideline can lead to a more accurate diagnosis of FASD when prioritizing specific assessment tools like the MABC-2, the percentages were still low. Therefore, to continue identifying ways to increase the accuracy, I am in agreement with their conclusion that further investigation is called for regarding the following: standard deviation criteria and subtests that were not included in this study. As for the limitations with this study, they were concerned with how various inclusion criteria were collected. For instance, the mothers reported PAE retrospectively and the functional motor abilities of the children were reported through observation versus a standardized assessment tool.
2 responses to “Movement Assessment Battery for Children, Second edition (MABC-2) Article Summary of Johnston 2019”
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Hi Megan! I think you did a really good job of summarizing this article. I am a little curious to how accurate the data is that was collected from the parents/caregivers of the child. Maybe there could have been bias when the parents reported the data on the child. I feel that more information could have been collected if a PT or OT collected this data by observing the child themselves. I agree with you that an assessment tool could have been a better objective description of this data.
Thank you Kelly! I completely agree.
I found it a little confusing that this article, which focused on evaluating the accuracy, specificity, and sensitivity of standardized motor assessments, did not require a standardized/ objective assessment as a means for data collection of functional motor ability. The authors did state that this was one of the study’s limitations, however they did not explain their reasoning why unfortunately.