Cultural Context Matters: Development of South African Reference Values for the Movement Assessment Battery for Children–second edition (Ages 6–12 Years)

BACKGROUND: The Movement Assessment Battery for Children, Second Edition (MABC‑2), is widely used internationally to identify motor coordination difficulties. However, reliance on "imported" Western European norms for score interpretation in culturally and socio‑economically diverse contexts remains a significant challenge. This study aimed to quantify the magnitude of normative divergence and to establish contextually representative benchmarks, using a large sample of South African children as a model for local norm development. METHODS: Local reference values were developed using anonymized data from 2064 South African children aged 6-12 years, stratified by socioeconomic level and sex. Raw scores were converted to scaled scores to generate percentile ranks and age‑band cut‑off values. Comparative analyses examined differences in score distributions between the imported Dutch/Flemish norms and the newly derived local reference values. RESULTS: All MABC‑2 items showed statistically significant differences between imported and locally derived reference values (p < 0.001), with item‑level effect sizes (Hedges' g) ranging from 0.49 to 2.12. Applying the Dutch/Flemish norms to this cohort resulted in 29% of children scoring below the 5th percentile, compared with the expected 5% under the local normative distribution. CONCLUSIONS: These findings demonstrate that motor performance benchmarks are not globally interchangeable. Reliance on imported norms leads to substantial shifts in classification rates, increasing the risk of over‑identification of motor difficulties in non‑Western contexts. Establishing local reference values provides a more equitable framework for clinical interpretation and supports the need for culturally and contextually appropriate motor assessment practices worldwide.