R E V I E W A R T I C L E

The Clinimetric Properties of

Performance-Based Gross Motor
Tests Used for Children With
Developmental Coordination
Disorder: A Systematic Review
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Leanne M. Slater, BPhty (Hons); Susan L. Hillier, PhD; Lauren R. Civetta, BPhty (Hons), Grad Dip Pub Hlth
Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia,
Australia

Purpose: Performance-based measures of gross motor skills are required for children with developmental
coordination disorder to quantify motor ability and objectify change. Information related to psychometrics,
clinical utility, feasibility, and client appropriateness and acceptability is needed so that clinicians and research-
ers are assured that they have chosen the most appropriate and robust tool. Methods: This review identified
performance-based measures of gross motor skills for this population, and the research evidence for their
clinimetric properties through a systematic literature search. Results: Seven measures met the inclusion criteria
and were appraised for their clinimetric properties. The Movement Assessment Battery for Children and the
Test for Gross Motor Development (second version) scored highest on appraisal. Conclusions: The 2 highest
scoring measures are recommended in the first instance for clinicians wishing to evaluate gross motor perfor-
mance in children with developmental coordination disorder. However, both measures require further testing
to increase confidence in their validity for this population. (Pediatr Phys Ther 2010;22:170 –179) Key words:
child, developmental coordination disorder, human movement system, motor skills disorders, outcome
measures, psychomotor performance, validation studies as topic

INTRODUCTION and psychological health factors to encompass the World

Historically, outcome measures were used primarily
to assess quality of care through numbers of morbidities,
mortalities, readmissions, and length of stay.1 More re-
cently, outcome measures have been developed to assess
health care interventions by measuring physical, social,
0898-5669/110/2202-0170
Pediatric Physical Therapy
Copyright © 2010 Section on Pediatrics of the American Physical
Therapy Association.
Correspondence: Susan L. Hillier, PhD, Centre for Allied Health Evi-
dence, School of Health Sciences, University of South Australia (City
East), GPO Box 2471, Adelaide, South Australia 5001, Australia
(susan.hillier@unisa.edu.au).
This systematic review was completed as partial fulfillment of the Bach-
elor of Physiotherapy with Honors by Leanne Slater (Nee Plummer) at the
University of South Australia.
DOI: 10.1097/PEP.0b013e3181dbeff0
Health Organization’s definition of health.1,2
Changes in funding models, management, and na-
tional health strategies have increased the importance of
implementing outcome measures to evaluate interventions
used in health care facilities.3,4 Health practitioners are in-
creasingly being pressured to use appropriate outcome
measures to assess patient’s progress and justify funding.4
This includes pediatric physiotherapy as children with sus-
pected developmental coordination disorder (DCD) are of-
ten referred for gross motor assessment and intervention.
DCD is a term used to describe children who exhibit
insufficient motor coordination skills in comparison with
that expected for their chronological age and intellect and
for which there are no attributable medical disorders.5 The
motor impairments (MIs) are at a level at which activities
of daily living and/or academic achievement are signifi-
cantly negatively affected.5 The prevalence of DCD is esti-
mated to range from 5% to 9% of school-age children.6,7

170 Slater et al Pediatric Physical Therapy

 Children with DCD form a heterogeneous group, and
individuals tend to be deficient in a variety of motor tasks.8
These children commonly withdraw from physical, aca-
demic, and social activities because of their motor deficits,
fear of failure, and peer criticism. Consequently, poor aca-
demic performance, low levels of perceived competence,
low self-esteem, deficient social skills, and reduced physi-
cal fitness and strength often ensue.8,9
Evidence suggests that without intervention, motor
deficits and problems associated with DCD are not always
outgrown in adolescence and can persist into adult-
hood.10 –12 Thus, appropriate outcome measures to help
monitor changes in gross motor development in response
to intervention are required. This will enable health prac-
titioners to manage individuals with DCD effectively and to
justify funding of intervention.
Gross motor skills can be measured through formal
and informal means.13 Informal assessments have no standard
procedure, are generally flexible, and can provide useful qual-
itative information, but they can be time-consuming and are
generally not suitable when comparing results across indi-
viduals.13 Examples include interviews and general/teacher
observations.13 Formal tests are standardized with strict
testing procedures and are used to diagnose, make intervention
decisions, and/or evaluate intervention.13 Performance-based
tests are a common type of formal measure used to assess
children’s gross motor skills.14 A performance-based gross
motor measure assesses a child’s ability in a variety of mo-
tor skill domains by determining the child’s performance
on a specific test administration.14
The quality and weighting of the information gained
from an outcome measure depends, in part, on the psycho-
metric properties of the test.15 The most trustworthy tools
have a strong level of measurement and established valid-
ity, reliability, and responsiveness in the population being
tested.1,15
All standardized tests provide a measure that is scaled.
One definition states that “a measurement is obtained by
applying a standard scale to variables, thus translating di-
rect observations or patient/proxy reports to a numerical
scoring system.”15 Therapists need to ensure that numbers
obtained from outcome measures are used in a valid and
meaningful way.15 A test that is valid accurately measures
the domain that it is intended to measure.16 Validity can be
demonstrated by showing that the measure correlates sig-
nificantly with another test that measures the same con-
structs (criterion validity, which can be assessed with con-
current or predictive validity), experts in the area agree
that the items in the test are representative of the whole
domain that the test claims to measure (content validity),
the test seems to test what it is meant to by using subjective
factors (face validity), and the test measures an abstract
concept or construct (construct validity).1,15–17 Acceptable
construct validity is demonstrated when the test identifies
a characteristic that it claims to measure within a popula-
tion that is known to have that characteristic (known
group method), by demonstrating that 2 tests that measure
the same construct correlate well (convergent validity),
Pediatric Physical Therapy
that 2 tests that do not measure the same construct do not
correlate well (discriminative validity), or by factor analy-
sis in which statistical analysis demonstrates that the items
on a test can be grouped to fit into related components or
factors.1,15–17
A test is reliable when it demonstrates that test scores
are stable over time (test-retest reliability) and with differ-
ent examiners (interrater reliability).1,15–17 A reliable test
will also have internal consistency, where the degree to
which test items all measure the same construct is ade-
quate.1,15 Finally, a test should at an appropriate level of
difficulty be able to demonstrate change (responsive-
ness) and be able to accurately discriminate a person
with a positive impairment (sensitivity) or no impair-
ment (specificity).1,15
A test that is viable clinically should be practical to
use. Tests that show excellent psychometric properties
may not be feasible due to complicated equipment require-
ments, long administration times, difficult application/
scoring systems, and/or difficulties with interpretation of
scores. Additionally, the measure needs to be acceptable
and meaningful to the patient/client. Thus, these clinimet-
ric factors also need to be taken into consideration when a
clinician selects an appropriate test.
There are several performance-based measures used
clinically and in research to investigate or monitor the mo-
tor coordination of children with DCD. However, it is im-
portant that decisions for the choice of one measure over
another are based on the principles outlined earlier. Nev-
ertheless, after an extensive search of the literature, no
reviews were identified that investigated this. Thus, to
identify performance-based measures of gross motor func-
tion and to determine the relative strength of these mea-
sures, we conducted secondary research. This was under-
taken using a systematic review and appraisal approach.
The aims were to systematically identify (1) performance-
based outcome measures that assess gross motor skills of
children with DCD, (2) literature reporting on the psycho-
metrics of the identified measures in the DCD population
and to evaluate the quality of these studies, and (3) the
most robust outcome measure based on evaluation of the
literature identified.
METHODS
Inclusion and Exclusion Criteria for Considering
Studies
Outcome measures were included in the review if they
met the following criteria: (1) a standardized performance-
based gross motor assessment suitable for children with
MIs consistent with DCD, (2) printed in English, (3) a test
that identified DCD and measured changes in gross motor
performance of children (for composite tests, at least 50%
of the overall suite must be gross motor), (4) for children
older than 4 years, and (5) the most recent version reported
in the published literature searched.
Measures of Gross Motor Skills for Children With DCD 171
 Studies were included if they (1) assessed psychomet-
ric properties of any of the measures that met the afore-
mentioned inclusion criteria, (2) were published in En-
glish in a peer-reviewed journal between January 1980 and
February 2008 (the date 1980 was chosen to exclude those
measures that do not reflect current thinking regarding
motor performance13), and (3) if participants were aged
between 4 and 16 years. Studies that used normative sam-
ples were included when relevant, for example, to gather
normative data or when the population was representa-
tional, and therefore included children with motor difficul-
ties. Such studies are clearly identified in the results. Stud-
ies were excluded if (1) the majority of participants had
been diagnosed with a disorder other than DCD or equiv-
alent DCD term (ie, cerebral palsy, Down syndrome, and
autism were excluded), (2) the performance-based assess-
ment was used as a criterion measure for a screening tool or
nonmotor performance-based test, or (3) the studies were
published before 1980 because it was thought that the in-
formation would pertain to a generation different from the
current child population and a different philosophical ap-
proach to motor skills.
Search Strategies
A systematic search of computer databases was used
to locate studies. The databases searched were MEDLINE,
AMED, Meditext, Ausport, Ausportmed, Humanities and
Social Science Collection, A⫹ Education, CINAHL, Aca-
demic Search Premier, SPORTdiscus, ERIC, Health Source:
Consumer Edition, Health Source: Nursing/Academic Edi-
tion, PsycINFO, Current Contents Connect, Blackwell
Synergy, Cochrane, PEDro, OTseeker, EMBASE, and Sco-
pus. Pearling of the reference lists of all retrieved studies
was also performed.
Three groups of search terms were used; outcome
measurement, DCD or associated terms, and psychometric
properties (separated by Booleans “OR” and “AND”). A full
list of search terms have been included in Table 1. The
search was conducted between February 4 and 8, 2008.
Critical Appraisal
Tool to Identify and Evaluate Measures. The Measure-
ment Critical Appraisal Tool (MCAT) was used to identify
and then evaluate the outcome measures in separate processes
(Table 2). This tool was modified to suit the needs of this
review from a version of the criteria developed by the United
Kingdom’s Clearing House on Health Outcomes.18
Tool to Appraise the Quality of Studies. The quality
scoring of the studies evaluating each measure was carried
out using a modified critical appraisal tool from the
NHMRC Handbook series.19 This tool is referred to as the
Quality Critical Appraisal Tool (QCAT) (a copy of the tool
can be obtained from the authors).
Data Extraction and Synthesis
Descriptive data on the clinimetrics and psychomet-
rics of outcome measures were extracted from the included
studies by the first reviewer and entered into separate
spreadsheets. Two reviewers then appraised all articles us-
ing both the MCAT and the QCAT tools. If disagreements
arose between scorers, then a third reviewer was available
to facilitate consensus. This was not necessary.
The outcome measures quality score (MCAT) was ob-
tained from summing scores for validity (3 points), reli-
ability (3 points), responsiveness (1 point), precision (1
point), client centeredness (2 points), and tester centered-
ness (2 points). Half scores were given if part of an item was

TABLE 1
Search Terms Used

Outcome Measures Terms DCD and Alternate Terms Psychometric Terms

Basic Gross Motor Assessment (BGMA) DCD Psychometrica
Basic Motor Ability Test Revised (BMAT-R) Minimal motor dysfunction (MMD) Valida
Bruininks-Oseretsky Test of Motor Proficiency Deficits in attention or motor control and Reliaba
(BOTMP) perception (DAMPS) Responsivea
Cratty’s 6 Category Gross Motor Tests (Cratty) Minimal cerebral dysfunction (MCD) Sensitia
McCarron Assessment of Neuromuscular Minimal brain dysfunction Specifica
Development (MAND) Developmental (dys)praxia Feasibila
Movement Assessment Battery for Children (M-ABC) Motor (dys)praxia Accuraa
Neuro Sensory Motor Developmental Assessment Clumsy kida Scalaba
(NSMDA) Clumsy childa Dimensionaa
Ohio State University Scale of Intra-Gross Motor Perceptual motor dysfunction Factor analysisa
Assessment (OS-SIGMA) Motor skills disordera
Peabody Developmental Motor Scale (PDMS) Sensory integration dysfunction
Sensory Integration Praxis Test (SIPT) Motor
Southern Californian Sensory Integration Test
(SCSIT)
Test of Gross Motor Development (TGMD)
Test of Motor Proficiency (TMP)
Searched separately: Zurich Neuromotor Assessment
(ZNA)
Abbreviation: DCD, developmental coordination disorder.
a
Appropriate truncations were used for specific databases.

172 Slater et al Pediatric Physical Therapy

 TABLE 2
Measurement Critical Appraisal Tool
Full name of outcome measure:
Abbreviated name:
Designer of outcome measure:
1. Purpose: Does it have a specific
aim to measure gross motor
performance in motor impaired
children? What is it?
2. Background: Is the design
performance based and for
fundamental motor skills?
3. Population: Does the test
measure motor performance in
children older than 4 years?
What ages have been studied?
4. Pathology: Does the test measure
motor performance of children
with DCD?
5. Number of items: Number of test
items/subscales. Is the gross
motor performance ⱖ50% of the
score?
6. Score system: Does the score
system rate performance? State
scoring system.
7. Equipment requirements
8. Time required to perform
9. Description: Are the tests
adequately described?
10. Normative data/scores: Are
norms provided?
11. Validity: Have 3 types of validity
been established? ie, criterion,
face/content, construct/factor
analysis.
12. Reliability: Have 3 types of
reliability been established? ie,
internal consistency, test-retest
reliability, interrater reliability.
13. Responsiveness: Sensitivity,
specificity, and floor/ceiling
effects?
14. Precision: Is the precision of the
outcome measure sound?
15. Client centeredness
Appropriateness: Is the test
appropriate? ie, meaningful to
the patient/parent.
Acceptability: Is the test
acceptable to the client? ie, time,
activities carried out.
16. Tester centeredness
Utility: Has the measure got
adequate interpretability,
acceptability, and relevance?
Feasibility: Ease of administration
and process?
Total score
Abbreviations: DCD, developmental coordination disorder; N, no;
Y, yes.
achieved (maximum score of 12; Table 2). Acceptable sta-
tistical analysis and results for each metric were defined a
priori to determine whether each criterion was met posi-
tively (available from authors).
Risk of bias (quality scoring using the QCAT) was
determined using 3 defined areas including selection, anal-
Pediatric Physical Therapy
ysis, and measurement bias. Three points were allocated to
each area based on set criteria (Table 3). The scores from
each area were summed to give a total risk of bias score, the
scores were categorized as follows: low risk of bias, score 7
to 9; moderate risk of bias, score 5 to 6; and high risk of
Continue? Y/N
bias, score 3 to 4 (maximum score of 9). Individual studies
were scored and reasoning was reported descriptively.
Continue? Y/N
RESULTS
Identification of Outcome Measures
Continue? Y/N
The preliminary search resulted in the identifica-
tion of 26 potential assessments that measured motor
skills of children. Through consultation with 2 experi-
Continue? Y/N
enced pediatric physiotherapists, 13 outcome measures
met the 5 outcome measure inclusion criteria listed ear-
Continue? Y/N lier, and the other 13 were excluded as they clearly were
not designed for children with DCD, were not gross
motor performance tests, or were a previous version of
Continue? Y/N an included measure. If there was any disagreement
about whether the outcome measure should be ex-
cluded, the assessment name was still included in the
search to be evaluated more thoroughly using the
Y/N/not stated MCAT. A full list of the 26 measures, with reasons for
exclusion, is available from the authors.
Y/N/not stated After the evaluation on the MCAT, a further 7 mea-
Y/N/not stated sures were excluded. The Sensory Integration and Praxis
Score __/3 Test and its predecessor the Southern California Sensory
Integration Test were excluded because total composite
scores were less than 50% gross motor based.20 The Test of
Y/N/not stated
Score __/3
Motor Proficiency was also excluded because it was only
used as a screening test.21 No studies meeting the inclusion
criteria were retrieved to evaluate the psychometrics of the
Y/N/not stated Ohio State University Scale of Intra-Gross Motor Assess-
Score __/1
ment, Neurosensory Motor Developmental Assessment,
Y/N/not stated Basic Motor Ability Test Revised, or the Cratty 6 Category
Score __/1 Gross Motor Tests. An additional outcome measure, the Zu-
Y/N/not stated rich Neuromotor Assessment (ZNA), was identified during
Score __/2
the pearling process and met the criteria for inclusion.
All the outcome measures reviewed represent the most
recent versions available in the current literature, with the
exception of the Movement Assessment Battery for Children
(M-ABC), which has recently been updated in 2007. After
Y/N/not stated
Score __/2
consultation with 2 experts in pediatric physiotherapy, it was
decided that a 12-month period was not sufficient for the
distribution, use, and testing of the M-ABC-2, and, therefore,
the first version was evaluated. Thus, a total of 7 gross motor
measures were identified: the Basic Gross Motor Assessment
__/12
(BGMA), Bruininks-Oseretsky Test, 2nd ed. (BOT-2),
M-ABC, the McCarron Assessment of Neuromuscular Devel-
opment (MAND), Peabody Developmental Motor Scale, 2nd
ed. (PDMS-2), the Test of Gross Motor Development, 2nd ed.
(TGMD-2), and the ZNA. Table 4 outlines the reviewed clin-
ical properties of the test.
Identification of Literature Reporting on the Psy-
chometrics of the Identified Measures in the DCD Pop-
ulation and Evaluation of the Quality of These Evalua-
tive Studies. The number of studies identified, the
Measures of Gross Motor Skills for Children With DCD 173
 TABLE 3
Risk of Bias Scoring

Score of Bias Selection Bias Analysis/Statistical Bias Measurement/Assessment Bias

3: Low risk of Population is truly random Analysis conforms to acceptable methodology. Assessors are blinded
bias (where appropriate) and/or Specific definitions and acceptable values (where appropriate),
targeting motor impairment (ascertained from referenced literature) trained/experienced, reliability
children (where appropriate) were attributed to each area in sections 11–16 tested.
OR age-matched controls. of the MCAT. A full description of these
definitions can be obtained from the author.
2: Moderate risk Sample is one of convenience but Analysis is not conventional but plausible. 1–2 of the criteria above are not met.
of bias representation has been
established.
1: High risk of Sample is one of total convenience Analysis is descriptive or incorrect. None of the above criteria are met.
bias and only applicable to that
setting (eg, a clinic sample).
Abbreviation: MCAT, Measurement Critical Appraisal Tool.
The scores from each tool were summed to give a total risk of bias score, the scores were categorized into the following: low risk of bias, score 7–9;
moderate risk of bias, score 5– 6; and high risk of bias, score 3– 4 (maximum score of 9).

TABLE 4
Clinical Properties of Outcome Measures

Outcome Equipment Time for

Measure Age Number of Test Items Score Interpretability Provided Administration
BGMA22 51⁄2–121⁄2 y 8 items ⱖ7 y Raw score converted to percentile ⻫ Not stated
51⁄2 items ⬍7 y or normative score.
BOT-223 4–21 y 53 items (LF) Raw score converted to scale score ⻫ 40–60 min (LF)
13 items (SF) and standard score (complicated 15–20 mins (SF)
conversion system).
M-ABC24 4–12 y 32 items (8 for each age Raw score converted to Impairment ⻫ 20–40 min
group) score and into percentile
(simple conversions).
MAND25 31⁄2 y to 10 items Scores converted to a scaled score, ⻫ Not stated
young adult neuromuscular index, and factor
scores: specific to test
(complicated scoring and
interpretation).
PDMS-226 0–5 y, 11mo 241 items divided into Raw scores converted into Approximately 1⁄2 45–60 min
age-expected fields percentile, age equivalent, and purchased
standardized scores (complicated separately
scoring/conversions).
TGMD-227 3–10 y 12 items Raw scores converted to standard All equipment 15–20 min
score and converted to a gross purchased
motor quotient score and separately
percentile rank.
ZNA28 5–18 y 15 items Conversion of scores via computer ⻫ ⬃20 min
program, raw scores converted to
Z-score and percentile.
Abbreviations: BGMA, Basic Gross Motor Assessment; BOT-2, Bruininks-Oseretsky Test, 2nd ed.; LF, long form; MABC-2, Movement Assessment
Battery for Children; MAND, McCarron Assessment of Neuromuscular Development; PDMS-2, Peabody Developmental Motor Scale, 2nd ed.; SF, short
form; TGMD-2, Test of Gross Motor Development, 2nd ed.; ZNA, Zurich Neuromotor Assessment.
The symbol ⻫ represents equipment provided with kit except for consumables, that is, stopwatch, tape. Note that time given for administration does
not include set up or scoring time. All of the measures have adequate description of items in their manuals.

duplicates, and the studies excluded during the search
procedure are summarized in the Figure 1. Six manuals
meeting the inclusion criteria were identified in the lit-
erature, and 5 were obtained from 2 experienced pedi-
atric physiotherapists. The sixth manual for the ZNA
was not obtained; however, the authors were contacted
and subsequently referred researchers to studies already
acquired. The BGMA manual was written in 1979, and
thus was excluded.
The quality of the studies (risk of bias) was evaluated
using the QCAT. The number of studies for each measure,
QCAT score ranges, and mean total quality scores with
standard deviation for each measure are summarized in
Table 5. All studies, except 1, were at a low to moderate risk
for bias in their reporting. The 1 study scoring poorly was
a descriptive report of concurrent validity between the M-
ABC and a balance test. The main methodologic problems
identified that increased chances of bias in studies were

174 Slater et al Pediatric Physical Therapy

 Fig. 1. Flow chart of search results.

TABLE 5
Quality Scores From QCAT on Studies for Each Outcome Measure

Reviewed Outcome Measures

BGMA BOT-2 M-ABC MAND PDMS-2 TGMD-2 ZNA All Scores
Number of studies 1 1a,b 25c 3 3c 3 4 38
Score ranges N/A 7–9 3–9 7–8 7–8 5–8 5–8 3–9
Mean (SD) 7 (N/A) 8 (1.41) 7.28 (1.1) 7.33 (0.58) 7.67 (0.58) 6.33 (1.53) 6.75 (1.26) 7.2 (1.1)
Abbreviations: BGMA, Basic Gross Motor Assessment; BOT-2, Bruininks-Oseretsky Test, 2nd ed.; MABC-2, Movement Assessment Battery for
Children; MAND, McCarron Assessment of Neuromuscular Development; N/A, not applicable; PDMS-2, Peabody Developmental Motor Scale, 2nd ed.;
QCAT, Quality Critical Appraisal Tool; TGMD-2, Test of Gross Motor Development, 2nd ed.; ZNA, Zurich Neuromotor Assessment.
a
Two parts of one study scored separately.
b
One study reports on that specific outcome measure and another reviewed outcome measure.
c
Two studies report on that specific outcome measure and another reviewed outcome measure.

Pediatric Physical Therapy Measures of Gross Motor Skills for Children With DCD 175
lack of information on tester training and/or blinding and
subject recruitment methods. Additionally, many subjects
represented samples of convenience and not true represen-
tations of the DCD/child populations, thus reducing the
generalizability of the results.
Critical Appraisal of Psychometrics of Each
Identified Outcome Measure
Using the MCAT, relevant data on the psychometrics
of the outcome measures were extracted from the 33 arti-
cles and 5 manuals. Information on the psychometrics of
each outcome measure is outlined briefly here. The mea-
surement critical appraisal scores and types of validity, re-
liability, and responsiveness established are summarized
for each outcome measure in Table 6. Information on the
population in which validity and reliability were estab-
lished and user/tester centeredness of individual outcome
measures are also summarized in Table 6. For further de-
tails, contact the authors. Note that normative data were
provided adequately for all outcome measures.
Validity of Measures
Construct validity of the BGMA was demonstrated
through factor analysis, all but 1 item loaded onto 7 factors;
however, the BGMA has only 8 tasks, suggesting each item
measures a different construct.22 The BOT-2 has moderate
to excellent concurrent validity correlations with the
PDMS-2 and BOT of Motor Proficiency and adequate con-
tent and construct validity demonstrated via item and fac-
tor analysis and goodness of fit tests, respectively.23 Con-
current validity correlation coefficients on the M-ABC with
other motor tests were moderate to excellent (r ⫽ 0.50 –
1.00) in more than 50% of 13 studies, with 10 of the studies
of children with DCD/MI.24,29 – 40 The lowest correlation co-
efficients obtained between the M-ABC and other motor
tests occurred when the subjects had DCD and/or learning
disabilities.33,35,38 Lower correlations also occurred when
the M-ABC scores were compared with very specific tests
measuring multiple constructs of a particular skill.31,32,37,40
The PDMS-2 and MAND also have moderate to excel-
lent concurrent validity (r ⱖ 0.50) with other similar mo-
tor measures in studies with DCD/MI.30,36,41 Additionally,
the PDMS-2 has moderate to good concurrent validity cor-
relations coefficients with gross motor subtests (r ⫽ 0.63–
0.75) in typical populations23,26 and adequate results on
factor analysis and goodness of fit tests to support its con-
struct validity.26 However, for gross motor components,
the MAND only correlated to a fair degree (r ⬍ 0.50) with
specific motor tests.25,42 In a single study, the TGMD-2
showed support for its concurrent/predictive validity with
fair to good correlation coefficients on its subtests and total
scores with a similar motor test27 (locomotion r ⫽ 0.63 and
object control r ⫽ 0.41, total scores r ⫽ 0.63). The
TGMD-2 also has acceptable content validity (through ra-
tionale, item analyses and discriminative tests) and con-
struct validity (through factor analysis).27,43,44
176 Slater et al
Reliability and Responsiveness of Measures
The BGMA has good to excellent test-retest reliability
and interrater reliability (r ⫽ 0.97 and 0.99, respectively) in
small samples (n ⫽ 48 and n ⫽ 10, respectively).22 The BOT-2
also has demonstrated good to excellent (r ⬎ 0.80) test-retest
and interrater reliability correlations.23 Correlations for
the test-retest24,34,45– 47 and interrater reliability46 – 49 on
total scores of M-ABC are consistently good to excellent
(r ⫽ 0.72– 0.95) in children developing typically and
children with MI. The internal consistency of the M-ABC
was investigated in a single study that showed the items
measured different constructs.50 The M-ABC total scores
are reportedly adequately responsive to change45,51 and
sensitive45,51; however, subtest and individual item scores
have only moderate to low responsiveness to change.51
The PDMS-2 has demonstrated good internal consis-
tency and excellent (r ⫽ 0.89) interrater reliability correla-
tions.26,41 The TGMD-2 reportedly has excellent internal
consistency and interrater reliability27(r ⫽ 0.98). However,
for interrater reliability, raters used previously scored proto-
cols and thus only summed and converted scores. Test-retest
reliability correlations of the TGMD-2 were good to excellent27
(r ⫽ 0.84–0.96). The ZNA test-retest reliability correlations for
timed performance scores were good to moderate28,52–54 (r ⫽
0.65) but only fair for scores based on accessory move-
ments28,52–54 (r ⫽ 0.45). Inter- and intrarater reliability correla-
tions overall were moderate to excellent for the ZNA; however,
some very low correlations (⬍0.1) were obtained on some items
with accessory movement scores.28,52–54
DISCUSSION
The search strategies identified several performance-
based outcome measures that assess gross motor skills of chil-
dren with DCD. The critical appraisal process has also indi-
cated which tests are the most robust psychometrically and
clinically. The studies identified that investigated outcome
measures were nearly all at a low to moderate risk of bias, and
thus the results could be considered of acceptable quality.
The M-ABC and TGMD-2 scored equally on overall
psychometric and clinical quality ratings. The M-ABC
scored well due to demonstrations of adequate sensitivity
and because it was the only measure to demonstrate re-
sponsiveness to change. The M-ABC has also had its psy-
chometric qualities tested the most of all the measures in
the DCD population. Additionally, the M-ABC is quick to
set up, administer, and score and requires minimal train-
ing, making it a viable tool clinically. The suitability of the
M-ABC’s US normative data has also been investigated for
other cultural groups in a number of studies.39,49,55–59 The
M-ABC, however, requires further support for its validity,
which should be considered when choosing tests. The M-
ABC also seems to have less stable concurrent validity
when testing children with DCD and learning disabilities.
The TGMD-2 has demonstrated good psychometric
qualities27; however, it is important to note that the inves-
tigations were only from the manual and were conducted
in children who are typically developing; thus, results have
Pediatric Physical Therapy
 TABLE 6
Scores on Outcome Measures From the Measure Critical Appraisal Tool
User Centeredness Tester Centeredness
Validity Achieved (Population in Reliability Achieved
Test Brackets) (Population in Brackets) Responsiveness Precision Appropriate Acceptable Feasibility Utility MCAT (/12)

BGMA Content (partially: expert opinion Internal consistency (all
⻫ 22 ⻫ 22 ⻫ 22 Partial: time admin 22 Partial: scoring 9
only)22 norms)22 difficulties22
Construct (all norms 7–12 y)22 Test-retest (special ed and

Pediatric Physical Therapy

phys ed: age unknown)22
Interrater (referred for MI, age
unknown)22
BOT-2 Criterion (general population Internal consistency
⻫23 ⻫23 Partial: long admin23 Partial: training⫹ long Partial: scoring 91⁄2
6–24 y)23 (representative sample)23 admin23 difficulties23
Content (all norms, 4–21 y)23 Test-retest (gen pop, 4–21 y)23
Construct (DCD and general Interrater (gen pop, 4–21 y)23
population 4–12 y)23
M-ABC Criterion (DCD and general Internal consistency (gen pop ⻫ (DCD, 4 ⫺8 y)45,51 ⻫24 ⻫24 ⻫24 ⻫24,30 ⻫24,30,47 101⁄2
population 4–12 y)24,29–40 in 4 y)41
Construct partial, known group Test-retest (4–8 ys DCD, 8–12
methods only (MI, 4 y)24 y gen pop)24,34,45–47
Interrater (MI, 4–12 y)46–49
MAND Criterion (MI, 4–10 y and norms 7 None Partial: (MI sensitivity ⻫25 Partial: interpret Partial: task probs, ? time Partial: training⫹ ? time Partial: scoring 7
y)25,36,42 only)25 probs25 admin25 admin25 difficulties25
Content (gen pop, 7 y)25
Construct (gen pop, 7 y only)25
PDMS-2 Criterion (part norms, gen pop Internal consistency (all
⻫26 ⻫26 Partial: long admin26 Partial: training⫹26,30 Partial: scoring 81⁄2
and MI, 4–5 y)23,26,30,41 norms)26 difficulties26,30
Content (all norms, 4–5 y)26 Interrater (at risk for MI only
Construct (norms and phys in 4 y)41
disable 4–5 y)26
TGMD-2 Criterion (gen pop elementary Internal consistency (all
⻫27 ⻫27 ⻫27 ⻫27 ⻫27 101⁄2
school)27 norms)27
Content (all norms)27 Test-retest (gen pop and
children attending a special
program 3–10 y)27
Construct (all norms)27,43,44 Interrater; partial: previous
scored sheets (part norms
3–10 y)27
ZNA None reported, content seems to Test-retest (gen pop,
⻫28 ⻫28,52–54 ⻫28,52–54 Partial: training⫹28 Partial: scoring 7
be based on previous tests 7–10 y)28,52–54 difficulties28
Interrater (gen pop,
6–12 y)28,52–54
Intrarater (gen pop,
6–12 y)28,52–54

Abbreviations: BGMA, Basic Gross Motor Assessment; BOT-2, Bruininks-Oseretsky Test, 2nd ed.; DCD, developmental coordination disorder; MABC-2, Movement Assessment Battery for Children; MAND,
McCarron Assessment of Neuromuscular Development; MI, motor impaired; PDMS-2, Peabody Developmental Motor Scale, 2nd ed.; TGMD-2, Test of Gross Motor Development, 2nd ed.; ZNA, Zurich neuromotor
assessment.
Gen pop indicates the general population (representing typical children or unspecified group of children); phys disable, physically disabled; all norms, the entire sample used to establish normative data; part
norms, part of sample used to establish normative data; special ed and phys ed, special education and/or special physical education classes; interpret probs, interpretation problems from test scores for patients;
long admin, long administration time of the testing procedures; task probs, some tasks do not seem to be important for children; and training⫹, large amount of extra training required to use test efficiently. The
symbol ⻫ represents adequately achieved in the area;
, did not adequately achieve in the area; and ?, unknown. Note: All the measures had normative data for their entire age groups and used ordinal
measurements.

Measures of Gross Motor Skills for Children With DCD 177

not yet been demonstrated to be as pertinent for children
with DCD. Additionally, the reliability between raters ad-
ministering/scoring performance of children on the
TGMD-2 is unreported. The TGMD-2 is reasonably quick
to set up and administer, with acceptable additional train-
ing requirements for administration and scoring.27 Both
these tests give standardized scores that are easily ex-
plained to the patient/parent, and both have items that
children would find acceptable and relevant.24,27
The BOT-2 scored third and also demonstrated ac-
ceptable psychometric qualities, but only 1 study on each
psychometric area has been performed, and most were on
children who are typically developing.23 The BOT-2 has
been reported to have a confusing scoring system and
markedly lengthy administration, scoring, and preparation
times.60 However, once calculated, the score can be con-
veyed to the patient adequately.60
The BGMA was ranked fourth in terms of psychomet-
ric and clinical quality. Although there is only a single
small study investigating the psychometric qualities of
BGMA, this test requires minimal equipment and set up
and administration time.22 Additionally, the raw score is
simply converted into an easy-to-understand percentile.13
However, the BGMA study lacked some methodological
rigor as ages were not specified for some areas and sample
sizes were small; thus, these factors should be noted if
considering this test.
The PDMS-2 was fifth on rankings of overall psycho-
metric and clinical quality. Although it has adequate psy-
chometric properties in children who are typically devel-
oping (except for test-retest reliability), its user and tester
centeredness have been criticized.30 The PDMS-2 has been
reported to require extensive training; additionally, it has a
long administration time and purportedly can be difficult
to administer and score.26,30 Furthermore, the PDMS-2 also
lacked sensitivity in identifying/monitoring children with
minor motor dysfunctions.30
The MAND and ZNA were the equal lowest scoring
measures. This is partially due to the ZNA lacking formal-
ized validity and the MAND lacking reliability in children.
In addition, the MAND scored lower because of some un-
usual test items along with the extended training time and
difficulties with interpretation of the scores.25 The MAND
studies were also largely carried out on a small sample of
7-year-old children with typical development, thus caution
should be practiced if generalizing these results to other
age groups. The MAND, however, has demonstrated ade-
quate sensitivity in identifying MI in 4- to 5-year-old chil-
dren.36 The ZNA is currently lacking in psychometric rigor.
Investigations into its reliability involved a small sample
size of typical children and some items showed question-
able correlations on interrater and test-retest reliability, the
same reliability results are published in 4 separate publica-
tions.28,52–54 The ZNA also scored lower on its tester cen-
teredness due to difficulties with scoring accessory move-
ments and the extended training required.28,52–54
178 Slater et al
Summary and Implications for Research and
Clinical Practice
Overall, none of the outcome measures identified
scored perfectly; all had redeeming factors along with their
flaws. When choosing the most appropriate test, it is im-
portant for a clinician or researcher to consider not only
which psychometric properties have been demonstrated
adequately but also what population and age group have
been investigated. Additionally, the practicality of the clin-
ical qualities of a test should be taken into account when
selecting an assessment for a particular patient.
We recommend that the M-ABC and the TGMD-2
should be considered for assessing the gross motor perfor-
mance of children with DCD in the first instance, but also
recommend further studies be conducted to clarify the psy-
chometric qualities of these tests. Specifically, the M-ABC
needs further evidence of its validity, and the TGMD-2
requires psychometric testing with children with DCD to
enable stronger justification for use in this population.
ACKNOWLEDGMENTS
The completion of this review in its current form was
only possible through the support and assistance of Liz
Pridham, Emily Ward, and Auburn McIntyre.
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Measures of Gross Motor Skills for Children With DCD 179