An ICF-informed comparison of fine motor assessment measures

BACKGROUND: Fine-motor difficulties are associated with adverse educational, physical and socioemotional outcomes. Multiple tools are used to assess these difficulties. The International Classification of Functioning, Disability and Health (ICF) distinguishes body function, activity and participation as separate domains requiring measurement. We examined whether scores from measures sampling these domains align sufficiently for the tools to be treated as interchangeable. METHODS: Data were collected across four groups: (i)a whole-school sample(n = 415); (ii)a nested subsample with teacher-identified handwriting difficulties(n = 91; not independent of the whole school sample); (iii)a multi-school sample with teacher-identified handwriting difficulties(n = 172); and (iv)a clinical sample referred for occupational-therapy assessment(n = 33). Measures included the relevant fine-motor subscales of the Movement Assessment Battery for Children, Clinical Kinematic Assessment Tool, DCD Questionnaire, Detailed Assessment of Speed of Handwriting, and Beery-Buktenica Developmental Test of Visual-Motor Integration. Correlation and linear regression quantified observed-score associations and shared variance. Principal component analysis was used as exploratory data reduction. RESULTS: Cross-tool associations were generally small, if significant. Regression models showed that any given tool predicted only a small proportion of variance in scores on the remaining tools (approximately 1-22 %). Principal component analyses consistently yielded multiple components, with scores from different tools often represented on different components. CONCLUSION: Measures commonly described as assessing fine-motor skills were not sufficiently aligned to be treated as interchangeable, consistent with the tools sampling different combinations of ICF domains and task demands. An ICF-informed assessment battery may provide a more useful basis for characterising need and planning targeted support than reliance on a single score.