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Child: care, health and development

Original Article doi:10.1111/cch.12190

Beery-Buktenica Developmental Test of

Visual-Motor Integration (Beery-VMI): lessons from
exploration of cultural variations in visual-motor
integration performance of preschoolers
C. Y. Lim,*† P. C. Tan,† C. Koh,‡ E. Koh,‡ H. Guo,‡ N. D. Yusoff,‡ C. Q. See‡ and T. Tan‡
*School of Rehabilitation Science, McMaster University, Ontario, Canada
†Department of Child Development, KK Women’s and Children’s Hospital, Singapore, and
‡School of Health Sciences, Occupational Therapy, Nanyang Polytechnic, Singapore
Accepted for publication 20 August 2014
Keywords skills. Deficits in VMI have been linked to difficulties in academic performance and functional tasks.
assessment, Beery,
children, socio- Clinical assessment experience of occupational therapists in Singapore suggested that there is a
cultural, visual-motor potential difference between the VMI performance of Singaporean and American children. Cross-
integration
cultural studies also implied that culture has an influence on a child’s VMI performance, as it shapes
Correspondence: Chun
the activities that a child participates in.The purpose of this study was to (1) explore if there was a
Yi Lim, Department of difference between the VMI performance of Singaporean and American preschoolers, and (2)
Child Development, KK
determine if there were ethnic differences in the VMI performance of Singaporean preschoolers.
Women’s and
Children’s Methods The Beery-VMI, which was standardized in America, is commonly used by occupational
Hospital, 100 Bukit
therapists in Singapore to assess the VMI ability of children.We administered the Beery-VMI (fifth
Timah
Road, Level 5 Women’s edition) full form test (excluding the supplemental tests) to 385 preschoolers (mean age = 63.3
Tower, Singapore months) from randomly selected schools in Singapore.We compared the scores of Singaporean
229899
E-mail: preschoolers with those of the American standardization norms using the one-sample t-test. Scores of
lim.chun.yi@kkh.com.s different ethnic groups among the Singapore population were also compared using a one-way ANOVA,
g
followed by the Bonferroni post-hoc test.
Abstract
Results Singaporean preschoolers and the standardization sample of American children performed
Background
significantly differently in all age groups (P < 0.05). Among the Singapore population, the scores were
Visual-motor
integration (VMI) is also significantly different (P < 0.05) between the (i) Chinese and Malay and (ii) Chinese and Indians

important in ethnic groups.

children’s Conclusion Preschoolers from different cultural and ethnic groups had different VMI
development performance. Certain cultural beliefs and practices may affect VMI performance. Clinicians should
because it is exercise caution when using an assessment in communities and cultures outside the ones on which it
associated with the was standardized.
performance of
many functional

© 2014 John Wiley & Sons Ltd 213

214 C.Y. Lim et al.
Introduction colleagues (1997) found a significant relationship between VMI and handwriting readiness among
preschoolers.
Visual-motor
Many children presenting with developmental delay, learning difficulties and neurological issues
integration (VMI) is
present with VMI difficulties (Kushki et al. 2011; Sutton et al. 2011; Case-Smith et al. 2013). The
defined as ‘the
Beery-VMI (Beery & Beery 2006) is commonly used to assess VMI and academic-related difficulties
degree to which
among these children. Internationally, educators, psychologists and occupational therapists use it (Feder
visual perception
et al. 2000), including those in Singapore. Studies have investigated the differences in performance in
and finger-hand
Beery-VMI across cultures with mixed results (Mao 1995; Mao et al. 1999; Beery & Beery 2006). For
movements are well
example, Mao (1995) found that Taiwanese children had higher scores than the American normative
coordinated’ (Beery
sample. They suggested that there may be some biological influence or aspects of cultural practice such
& Beery 2006, p.
as writing Chinese characters or learning to use chopsticks that may have facilitated the development of
12). VMI is
VMI in Taiwanese children. Besides the Beery-VMI, other cross-cultural studies that used related motor
important in
assessments also found that children of different cultural background have different motor skills profile.
children’s
Crowe and colleagues (1999) found that Native American children scored significantly lower than the
development
normative sample in the fine motor component of the Peabody Developmental Motor Scales – second
because it is
edition (PDMS-2). Chow and colleagues (2001) found that Hong Kong children scored higher in the
associated with the
manual dexterity sections of the Movement Assessment Battery for Children (MABC) while the
performance of
American children scored higher in the gross motor sections. Evidently, children’s cultural upbringing
many functional
may influence their motor skill development and clinicians should exercise caution when using motor
skills. It has been
skill measures that were standardized in another culture (Super & Harkness 1986).
associated with self-
Clinical experiences of paediatric occupational therapists in Singapore suggested similar conclusions
care tasks and
that the Beery-VMI, which is standardized in America, may not detect Singaporean children who
education-related
present at the clinic as having functional difficulties related to VMI. Assessing children with a measure
activities such as
that is standardized in another culture can potentially lead to underor over-estimation of abilities (Mao
handwriting, reading
et al. 1999). Overestimation may lead to delay in providing intervention and under-estimation may lead
and mathematics
to unwarranted medical and educational attention and may cause unnecessary anxiety (Mao et al. 1999).
(Schneck 2001;
These clinical impressions and concerns highlight the need to explore potential differences in the VMI
Sortor & Kulp 2003;
abilities of Singaporean and American children. In addition, this study will determine if the Beery-VMI
Barnhardt et al.
correctly reflects the VMI abilities of Singaporean children given their particular developmental
2005; Kulp
experience and context.
2009).Level of VMI
The purposes of this study were to (1) explore if there were differences between the VMI
skills has also been
performance of Singaporean and American preschoolers; and (2) determine if there were ethnic
correlated with
differences in the VMI performance of Singaporean preschoolers.
school readiness and
adjustments in
preschoolers as well Methods
as their social-
emotional Sample – inclusion and exclusion criteria
functioning (Kurdek
The sample includes Singapore citizens and Permanent Resident children born in 2005 attending
& Sinclair 2000;
Kindergarten One level, and aged 58–69 months. We chose this age as many children receiving early
Bart et al. 2007). In
intervention are within this age group (Lian et al. 2012).Children were excluded from the study if (i)
addition, Weil and
their parents or guardians signed the parental opt-out forms provided; and (ii) their teachers identified
Amundson (1994)
them with physical impairments (including uncorrectable visual deficits), or intellectual or
and Daly and
developmental disabilities that would render them unable to comply with the assessment protocol or
to complete the assessment. International schools were excluded because of the small number of
Singaporean and Permanent Resident children in them.

© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
 Cultural variation in VMI performance of preschoolers 215
Sampling and School type Combination of several Broken down into 5 regions – smaller
stratification ‘non-A’ service providers North, North-east, East,
West, Central
The population of
children born in
2005 is 37 485 Table 2. Random sampling of schools
(ICA 2006). We School
used the formula School type type‘A’ School type‘non-A’

n = N/1 + N(e)2 Total No. of schools randomly selected 18 90 (from all 5 regions)

with a desired Final No. of schools which participated in 4 14

study
95% confidence
Total No. of children opted out from study 20 9
level and ±5
precision to Total No. of booklets administered 216 184
calculate the Final sample size 400
sample size of 400
(Israel 2009). participants of various socio-economic and educational backgrounds. See Table 1 for illustration.
With an estimated We conducted two rounds of random sampling which yielded a total of 18 A schools and 90 non-A
dropout rate of schools, to which letters of invitation to participate in the study were sent. Non-A schools are
10%, the final privately owned and have fewer children so they were sampled more. Out of the 108 preschools, four
sample size A schools and 14 non-A schools responded to the invitation. Twenty-nine children declined to
required is 440. In participate in the study,leaving a remaining sample of 400 participants. See Table 2 for illustration.
order to obtain a
nationally Instrument
representative
sample, half the For this study, we used the Beery-VMI (fifth edition) full form test, excluding the supplemental tests.
sample was The Beery-VMI (fifth edition) is a norm-referenced measure that was developed and standardized in
obtained from America on five occasions since 1960 through studies involving over 11 000 children (Beery &
schools under the Beery 2004). It was developed as an early screening tool to identify children who have not fully
largest preschool integrated their visual and motor abilities (Beery & Beery 2004). The adolescence and adult versions
education service were developed subsequently. The paediatric version of the BeeryVMI (fifth edition) is for
provider (A) and children/adolescence 2 years to 18 years 11 months and includes a sequence of 30 geometric shapes,
the remaining half arranged in a developmental sequence and to be copied or imitated by children using pencil and
taken from a paper.
combination of The Beery-VMI is a widely used visual motor assessment because of its extensive and well-
other preschool documented psychometric properties (Beery & Beery 2006). Beery and Beery (2004) reported that
service providers the inter-rater reliability ranged from 0.92 to 0.98 and test–retest reliability correlation is 0.92 for a 2-
(non-A). Non-A week interval. Brown and colleagues (2009) and Mao and colleagues (1999) examined its construct
schools were validity using the Rasch Measurement Model and found overall scalability and unidimensionality.
further stratified Concurrent validity was provided by correlation of VMI scores of children with their scores for
into the five Developmental Test of Visual Perception – second edition (DTVP-2) copying subscale (r = 0.75) and
regions of eye–hand co-ordination subscale (r = 0.65), Wide Range Achievement Visual-Motor Assessment
Singapore to Drawing Test (WRAVMA) (r = 0.52) and the
capture Bender Gestalt Test (r = 0.29–0.93, median = 0.56) (Beery & Beery 2004). Other studies have proven
Table 1. Description its convergent validity (Brown et al. 2011; Sutton et al. 2011) and discriminant validity (Chang & Yu
and stratification of
2009).
schools
School type Description
Beery and Beery (2006) claimed that the Beery-VMI is not culture bias based on their norming
studies completed in 1981. They found no statistical differences between the Beery-VMI scores of
School type ‘A’ Largest pre-school
children
education from different ethnic groups such as AfricanAmerican, Caucasian and Hispanic-American
service provider
(Beery & Beery 2004). When compared with American children, Chinese children appeared to perform

© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
216 C.Y. Lim et al.
better on the Beery- withdraw from the study. Prior to the actual administration, the principal investigator who had 15 years
VMI at early ages of experience in the paediatric field conducted group training for co-investigators on Beery-VMI
and Greek and administration. During training, we adhered to the Beery-VMI (fifth edition) manual guidelines and
Norwegian children standardized the administration instructions, procedures, management of participants’ behaviours and
performed less well the environmental layout to ensure consistency in administration. We also conducted an administration
(Beery & Beery trial with 20 children from a kindergarten of convenience sample and refined the procedures after the
2006). Mixed trial. The standardized procedures were
conclusions were documented in a protocol, which investigators referred to during the administration phase.The actual
found for administration sessions were conducted in school classrooms.During each administration session, two
comparisons co-investigators were allocated four to five participants each. Participants were allowed to complete all
between African- the geometric forms found in the assessment booklet without regard to the number of mistakes they
American and made in the process. Two co-investigators independently scored each set of booklets using standard
Caucasian children measurement equipment and in accordance to the Beery-VMI (fifth edition) scoring criteria. Every item
(Beery & Beery scored was compared between the two co-investigators. Any discrepancies in scores were discussed and
2006). No statistical agreed upon by consensus between the two co-investigators. The principal investigator randomly
differences were reviewed 175 booklet and any discrepancies in scores were discussed and agreed upon by consensus.Of
found on the the 400 booklets received, 391 were scored. Booklets filled in by children who required additional
BeeryVMI for verbal instructions that were not in accordance to the Beery-VMI (fifth edition) standardized procedures
Native American were excluded (n = 9).
and non-Native
American
Data analysis
kindergarten
children (Beery & We used the IBM SPSS 22.0 to perform the statistical analysis. Descriptive statistics were calculated to
Beery 2006). characterize the performance of the Singaporean sample on the Beery-VMI by age and ethnic groups.
Normality and homogeneity of variances were tested to ensure that no assumptions were violated and
appropriate statistical tests were used. To determine if there were differences between the standard score
Procedures
means of the Singaporean and USA samples for each age group, the one-sample t-test was used. In
Given that the study addition, Cohen’s d measure of effect size was calculated to examine the extent of difference. Effect
presents less than sizes of <0.5, 0.5–0.8 and >0.8 were interpreted as small, moderate and large, respectively (Cohen
minimal risk to 1988). To determine if there was a difference between the standard score means of the various ethnic
participants, we groups in Singapore, the one-way anova was used, followed by the Bonferroni post-hoc test to examine
applied for wavier of the differences between the ethnic groups. The significance level, α, was set at
informed consent to 0.05 for all statistical tests.
increase
participation rate,
and it was approved Results
by SingHealth
Centralised
Sample characteristics
Institutional Review Of the 391 booklets that were scored, six were rejected because of insufficient sample size in the 57
Board (Singapore). months group. This yielded a final sample size of 385 participants (mean = 63.3 months,
Parents were Table 3. Demographic characteristics of sample
provided with an
information sheet Singapore 2005 birth cohort
with an opt-out Sample (ICA 2006)

option form n Percentage Percentage

attached. They could Gender

fill in the opt-out
Boys 198 51.4% 51.6%
option form if they Girls 187 48.6% 48.4%
would like to Ethnicity

© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
 Cultural variation in VMI performance of preschoolers 217
Chinese 275 scores were calculated. The standard score mean of each age group was compared with the standard
Malay 59
Indian 37
score population mean of the American sample (mean = 100, SD = 15) that was derived from the
Others 14 Beery-VMI (fifth edition) manual. Table 4 presents mean scores, standard deviations and results of
comparison tests between the Singapore and American samples. The onesample t-test revealed that all
N= 385. age groups from the Singapore sample performed statistically differently (P < 0.05) from the
American sample with the mean difference ranging from 15.6 to 20.7. Cohen’s d effect size ranged
from 0.79 to 0.88, indicating that all age groups of the Singaporean sample scored higher to a
moderate to large extent when compared with the American sample (Cohen 1988).
SD = 3.4). As
depicted in Table
3, the sample was Comparison between ethnic groups
closely The Singapore sample comprised of four major ethnic groups, including Chinese, Malay, Indians and
representative of Others. Others include a small number of people from highly diverse ethnic backgrounds such as
cohort statistics in Eurasians, Caucasians, Filipinos, etc. The standard scores of the four ethnic groups are illustrated in
terms of gender Fig. 1.
and ethnic groups
The one-way anova revealed that there is at least one group that is statistically different from one
Table 4. Results of comparison (t-values, P-values and Cohen’s d) between the Singapore and US (mean = 100, SD = 15) sample standard score means
Ethnic group (n) Mean ± SD for comparison difference P-value Lower Upper
of all six age groups on the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI)
Chinese (275) 119.4 ± 10.9 Malay 8.26* 0.001 4.06 12.5
95% Confidence interval of the difference
Indian 5.65* 0.022 0.53 10.8
Degree Mean Effect
Age group (n) Mean ± SD t-value of freedom Others
difference Lower 0.52 Upper
1.000 −7.50 Cohen’s d size (r)8.54
58–59 months (79) 120.7 ± 11.4 16.2* 78 20.7 18.1 23.2 3.67 0.88
Malay (59)
60–61 months (58) 119.5 ± 11.2 111.1 ± 11.2
13.2* 57 Chinese
19.5 16.5 −8.26* 0.001
22.4 −12.5 3.50 0.87 −4.06
62–63 months (58) 120.1 ± 11.3 13.6* 57 Indian
20.1 17.2 −2.61 1.000
23.1 −8.753.60 0.87 3.53
64–65 months (70) 115.6 ± 10.9 12.1* 69 15.6 13.1 18.2 2.91 0.82
Others −7.74 0.113 −16.4 0.96
66–67 months (66) 115.0 ± 11.6 10.5* 65 15.0 12.2 17.9 2.60 0.79
68–69 months (54)
Indian (37)
113.7 ± 10.7 9.45* 53
113.7 ± 11.7 13.7
Chinese 10.8 −5.65* 16.6
0.022 −10.8 2.60 0.79 −0.53
*P-value < 0.05. Table Malay 2.61 1.000 −3.53 8.75
5. Results of co
Others −5.13 0.836 −14.3 4.05

mparison between standard score means (P-values) of the ethnic groups

Others (14) 118.9 ± 12.1 Chinese −0.52 1.000 −8.54 7.50
95% Confidence Interval of the difference
Malay 7.73 0.113 −0.96 16.4
Ethnicity group Mean
(ICA 2006). Indian 5.13 0.836 −4.05 14.3

other group [F (3, 381) =

Comparison
between
Singaporean and 10.7, P = 0.001 < 0.05]. The Bonferroni method was used to
American samples *P-value < 0.05.

Participants were
divided in six 2-
month age groups
in accordance
with the format
presented in the
Beery-VMI (fifth
edition) manual,
and the means of
their standard Figure 1. Visual-motor integration performance standard scores of ethnic groups in Singapore.

© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
218 C.Y. Lim et al.
further compare Discussion
the VMI scores
The purpose of this study was to explore cultural differences in the VMI performance of preschool
between each
children on the BeeryVMI. Results indicated that overall, the Singaporean preschoolers scored higher
ethnic group. It
on the Beery-VMI when compared with the American standardization sample. VMI performance of the
was found that the
ethnic groups in Singapore also varied, with the Chinese scoring higher than the Malays and Indians.
difference in VMI
These results contrast with findings by Beery and Beery (2006) who stated that the Beery-VMI was
standard scores
essentially culture-free. The findings of this study suggested that preschoolers from different cultural
between the
and ethnic groups had different VMI performance. We will discuss this in the context of preschool
Chinese (mean =
education in Singapore and America and the cultural beliefs and practices of the ethnic groups in
119.4, SD = 10.9) Singapore.
and the Malay
(mean = 111.1,
SD = 11.2) is Preschool education in Singapore and America
statistically Singapore is a meritocratic society that places emphasis on a person’s academic credentials (Tan 2008).
different, P = The government places great emphasis on its education system, as Singapore lack natural resources and
0.001 < 0.05. The human resources are the main drive of its economy (Ng 2011). With the influence of the larger culture’s
Chinese scored emphasis on achievement and success at school, Singaporean parents are likely to associate successful
higher than the development of their children with academic success and value a head start in their education.
Malays with a Singaporean children start attending childcare and preschool centres as early as 2 years old (Low et al.
mean difference 2010). These centres have a profound influence on their development, as they spend most of their
of 8.26. There is growing years there (Sharpe 1998). In Singapore, the focus on preschool education is to prepare the
also a significant children academically for primary school with emphasis on language, literacy, printing and numeracy
difference skills (Sharpe 1998). As such, preschoolers begin holding writing tools at a young age and are often
between VMI engaged in fine-motor and visual-motor tasks such as printing and colouring. Children are expected to
standard scores of be able to print and write sentences independently when they enter primary school at 7 years old.
the Chinese (mean In contrast, the emphasis of America’s preschool education is on cognitive,health,social and
= 119.4, SD = emotional development through a play-based approach that encourages creativity (Ministry of
10.9) and Indians Education 2006; Copple & Bredekamp 2009; Gordon & Browne 2013). It is believed that developing
(mean = 113.7, creativity encourages personal freedom and individuality, which is valued in the western culture (Wong
SD = 11.7), P = 2008). Academic activities that involve printing and writing are considered skills learned through
0.001 < 0.05. The repetition, which is equivalent to rote learning that refutes the concept of creativity (Forman 2003).
Chinese scored Therefore American preschoolers might participate less in repetitive fine-motor tasks such as writing
higher than the and printing with more emphasis on oral language, self-expression and play. A cross-cultural study
Indians with a comparing the literacy programmes of preschools in Hong Kong and North America found that the
mean difference North American teachers focused on the creativity and self-expression in story writing whereas the
of 5.65. The Hong Kong teachers focused on the accuracy of the print (Wong 2008). The study concluded that
differences in the context could influence learning priorities. Singaporean preschoolers may have a higher VMI score
other groups were compared with American preschoolers because of the differences in the priorities of their learning
not statistically context. With more emphasis on academics and the mastery of writing skill, Singaporean preschoolers
significant. Table have more opportunities to engage in tasks that require VMI and this may have innately enhanced their
5 presents the VMI performance.
mean standard
scores, standard Cultural beliefs and practices of ethnic groups
deviation and
Despite receiving preschool education in the same context, the Chinese in Singapore have a higher
results of
VMI score when compared with the Malays and Indians. Numerous cross-cultural studies found that
comparison
Chinese children had better fine-motor and visualmotor skills when compared with European
between the
American children (Saeki et al. 1985; Mao 1995; Chow et al. 2001; Luo et al. 2007). The studies
ethnic groups.
attributed this difference to the cultural beliefs and practices of the Chinese. The Chinese culture is

© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
 Cultural variation in VMI performance of preschoolers 219
deeply influenced believe that early introduction to literacy and printing would give their children a head start in life
by Confucianism, (Wang et al. 2002). In addition to gaining mastery in printing/writing skill and reinforcing knowledge
a philosophical acquisition, Chinese parents also believe that repeated practice in printing/writing nurtures discipline,
system that perseverance and concentration,values that will empower their children to succeed in life (Wong
developed from 2008). With strong beliefs in its benefits, Singaporean Chinese parents would naturally provide their
the teachings of children with more opportunities to practice printing/writing and this may have facilitated their VMI
Confucius, a performance.
Chinese Certain practices in the Chinese culture may also influence VMI performance of Chinese
philosopher (Lee preschoolers. Chinese characters are symbols that are logographic in nature, comprise of many strokes
2010). One of the of different directions and are typically written on worksheet frames (Lai & Leung 2012). The writing
teachings of of Chinese characters requires fine-motor skills – skills assessed by the BeeryVMI – to produce the
Confucianism is strokes,and cognitive abilities to recall the sequence and spatial relationship of the patterns (Wong
the importance of 2008). In comparison, English writing is predominantly linear and has fewer strokes. Therefore
seeking writing Chinese characters could provide more experiences for the development of VMI as compared
knowledge for with writing English characters. Other Chinese practices such as learning to use the chopsticks and to
self-improvement recognize Chinese characters that are visually distinct as compared with English letters may
and to bring glory contribute to the VMI performance of Chinese preschoolers (Mao 1995; Chow et al. 2001).
to the family (Lee Few studies have explored cross-cultural differences between ethnic groups in Singapore. A local
2010). Confucius study found that the Malay and Indian students in Singapore face more academic challenges and
introduced fewer of them pass the national examinations and pursue higher education, as compared with Chinese
meritocracy to the students (Yamashita 2002). The study suggested socio-economic factors as a reason for this
society in which discrepancy and recommended more research to determine other possible reasons.Quah (2004)
people of any compared parenting styles between the ethnic groups and concluded that parents of different ethnicity
background could and educational levels had different parenting styles. Chinese parents were more authoritative and
be a government less affectionate as compared with Malay and Indian parents. This is supported by an international
official if they study (Rao et al. 2003) that compared the parenting styles between Chinese and Indian parents. The
passed the study found that Chinese parents used more authoritative practices, focused more on academic
national imperial achievement and believed in teaching their children selfcontrol. Indian parents focused more on oral
examination (Lee expression and self-expression of emotions and affections. These studies suggested that ethnicity
2010). This led to influenced parenting beliefs and styles and this consequently influenced the opportunities that parents
the Chinese provide to their preschool children. Chinese parents might be stricter in ensuring that their children
beliefs that engage in academic tasks and printing/writing on a regular basis and this might have innately
scholastic enhanced the Singaporean Chinese children’s academic and VMI performances.
knowledge and
hard work would
Limitations of study and recommendations
lead to success in
life (Li 2004; Lee OnelimitationisthatthisstudydidnotreplicateBeeryandBeery (2006)’s stratification method.This may
2010). These result in sampling bias, as we only stratified the sample based on type of school. There was also lack
beliefs and of other demographic information beyond preschool, ethnicity and gender of the participants.
practice of Regression analysis of other demographic factors such as parental income and educational levels
meritocracy might provide further insights to the differences inVMI performance.This study only focused on one
continue to exist age group; future studies including children from other age groups could determine if the trend is
today in the similar for other age groups.Considering the apparent disparity inVMI performance between the
Chinese culture, Singaporean and American sample, it is recommended that construct validity of the Beery-VMI (fifth
including the edition) be further researched in the Singaporean context. This includes re-establishing the
Chinese in differential item functioning and hierarchical ordering as carried out by Brown and colleagues (2009).
Singapore (Li Clinicians in Singapore should not determine if a Singaporean child require intervention based solely
2004).Chinese on the interpretation of the Beery-VMIscoreusingtheAmericannorms.If theBeery-VMIis to be used, it
parents therefore is recommended that other forms of assessments such as qualitative observations and reports of

© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
220 C.Y. Lim et al.
functional groups when assessing a child and to be aware of the demands of handwriting for children in Singapore
performance preschools. Lastly, results of this study contribute to the growing culture and child development
should be literature.It suggests that culture potentially structures the types of activities in which children
considered to participate and the types of activities they participate in have potential implications on their
provide a holistic developmental outcomes (Harkness et al. 2011).
view of the
child’s ability to
function in daily Key messages
occupations
• Preschoolers from different cultural and ethnic groups haddifferent VMI performance.
(Missiuna &
• The Beery-VMI is not culture-free, contrary to the find-ings of Beery and Beery (2006).
Pollock 1995;
• Clinicians should exercise caution when using an assess-ment in communities and cultures outside
Goyen & Duff
the ones on which it was standardized.
2005). Clinicians
who encounter
children who Funding
perform well on This study was conducted with funds from KK Women’s and Children’s Hospital, Department of Child
the Beery-VMI Development, Singapore.
American norms
but have Conflict of interests
functional All authors declare that they have no conflict of interests.
difficulties should
Acknowledgements
refer to the results
of this study, WethankMsCorrineHooandMsChiaChoonYeefromNanyang Polytechnic for their advise on the
which will be methodology of this study. We also thank Dr Mary Law, Dr Peter Rosenbaum and Associate
made available to ProfessorNancyPollockfromMcMasterUniversity;DrMaryKhetani from Colorado State University and
clinicians in Dr Debra Cameron from University of Toronto for their review of and feedback on earlier drafts of this
Singapore. paper. Lastly, we thank all preschool teachers and children who supported and participated in this study.
Thiswillpreventov
erestimationof
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