Ann Appl Sport Sci 7(2): 03-12, 2019.

http://www.aassjournal.com; e-ISSN: 2322–4479; p-ISSN: 2476–4981. 10.29252/aassjournal.7.2.3

ORIGINAL ARTICLE

The Validity and Reliability of the Bruininks–Oseretsky Test of

Motor Proficiency, 2nd Edition Brief Form, in Preschool Children
1Eghbal Gharaei, 2Masoumeh Shojaei*, 2Afkham Daneshfar
1
Motor Behavior Department, Physical Education Faculty, Science and Research Branch, Islamic Azad
University, Tehran, Iran. 2Department of Motor Behavior, Faculty of Physical Education, Alzahra
University, Tehran, Iran.

Submitted 15 October 2017; Accepted in final form 31 December 2017.

ABSTRACT
Background. Evaluating motor skills and using an appropriate tool for the diagnosis and evaluation of motor
proficiency in preschool-aged children seems critical. Objectives. The purpose of this study was to evaluate the
validity, reliability, and sensitivity of the Bruininks–Oseretsky Test of Motor Proficiency, Second Edition Brief Form
(BOT-2 BF), in preschool children. Methods. A total of 306 preschool children (aged four to seven years) participated
in this study. To evaluate the validity of the test, the canonical correlation statistic method was used to calculate the
correlation between the subscales of this test and the Movement Assessment Battery for Children (MABC) test. To
evaluate the reliability by the time reliability method, 50 subjects were retested after an interval of two weeks. The
sensitivity analysis and receiver operating characteristic curve (ROC curve) tests were used to determine the ability to
diagnose a developmental coordination disorder (DCD). Results. The results of the canonical correlation analysis
showed that there is a significant linear relationship (p<0.001) between the BOT-2 and the MABC tests. The intra-
class correlation coefficient (ICC=0.80) was high for time reliability. The appropriate cutoff point was 13. At this
point, the area under the ROC curve was 0.91 for sensitivity and 0.93 for the characteristic, and in general, the area
under the curve was 0.97. Conclusion. According to the results of this study, it seems that the BOT-2 has an appropriate
validity and reliability as well as a high sensitivity and characteristic in preschool children, and can be used to evaluate
motor skills and diagnose children with DCD.

KEY WORDS: Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), Movement
Assessment Battery for Children (MABC), Sensitivity and Characteristic, Developmental Coordination Disorder
(DCD), Preschool Children.

INTRODUCTION
Inactive lifestyles and the decreasing obesity. Many studies have shown that children
frequency of motor activities in childhood have with problems in motor skills are more prone to
increased the incidence of obesity among children being overweight (2). They also have a higher
around the world; therefore, ignoring motor negative self-assessment (3), higher levels of
growth, especially the motor skills of children in depression and anxiety (3, 4), lower physical
early ages, leads to increased obesity and future activity levels (2, 5), and lower self-efficacy (6),
motor problems (1). All these are evidence that besides being weaker than their peers in terms of
motor proficiency in childhood is related to educational success (2). The ability to evaluate

*. Corresponding Author:
Masoumeh Shojaei, Associate Professor
Department of Motor Behavior, Faculty of Sport Sciences, Alzahra University, Po.Box: 1993893973, Deh Vanak St., Tehran, Iran.
E-mail: [email protected]
4 Validity and Reliability of the BOT-2

motor skills in childhood is critical and important. studies dealing with different cultures (10, 11).
In order to carry out motor programs and support Only a few studies have used this test to evaluate
children with specific needs in a large the motor skills of preschool children, and their
community, the importance of collecting findings are not sufficient evidence for use in
information about skill levels and recognizing the preschool children and children with motor
strengths and weaknesses of these programs is felt disorders.
now more than ever. As reported by the Disease The BOT-2 test is a norm-referenced test
Control Centers in the United States, due to the whose most important reason for implementation
decreased motor activities in the United States, is to evaluate motor proficiency in children and
Europe, Latin America, Asia, and other countries, adolescents, as well as to use it in the screening
6% of children between the ages of four and 12 process (9). This test is applicable and purpose-
years are obese. Therefore, ignoring the motor oriented, and is used to measure motor skills in
development and motor skills of children in early individuals aged four to 21 years. It is often used
age could lead to increased obesity and future by therapists and pediatricians specializing in
motor skill problems (1). All this is evidence that motor disorders, as well as by sports teachers, to
motor proficiency in childhood is associated with evaluate the motor development and diagnose
obesity. DCD in childhood in different countries (2, 12-
One of the most important measures in 15).
examining the development of motor skills in Many studies focus on the validity and
children is the precise evaluation of these skills. reliability of this test in evaluating children's motor
Evaluating motor skills in childhood, especially skills and diagnosing children with DCD.
during preschool age, seems necessary for several However, there is a discrepancy between studies in
reasons (7, 8). First, motion is an integral part of using this test. Schulz et al. (2011) showed on 379
life in infancy and childhood during which subjects aged 8–17 years that the correlation
children seek to discover their surroundings (8). between the MABC and BOT-2 tests was
Besides, studying motor development in moderate to high (r=0.61) (9). Moreover, Croce,
childhood is an essential prerequisite for Horvat, and McCarthy (2001), in their study on the
understanding their overall growth (7). In age group of 5–12 years, reported the correlation
addition, designing and planning for the between MABC and BOT-2 as 0.6–0.9 (16).
development of appropriate motor skills depends Another study showed that the correlation between
on the diagnosis and correct evaluation as well as MABC and BOT-2 in the age group of 4–10 years
the child's level of development in these skills (8). is 0.84. These results indicate that not only does the
To this end, several tests are designed in different correlation between these tests result in their use in
fields. Some examples are: Movement clinical conditions, but that the convergence
Assessment Battery for Children (MABC); validity of these tests is also confirmed for
Peabody Development Scales (PDMS); Korper evaluating motor proficiency and abilities (9).
Coordination test fur Kinder (KTK); Test of Research on five-year-old children has shown that
Gross Motor Development (TGMD); a number of BOTMP brief form items are not very
Maastrichtse Motoriek Test (MMT); Bruininks– reliable (17). In another study, the brief form of
Oseretsky Test of Motor Proficiency, Second BOTMP was compared with its long form. The
Edition (BOT-2); and McCarron Assessment of study included 114 five-year-old children. Their
Neuromuscular Development (MAND). These results showed that the BOTMP-SF test has a low
are used to diagnose children with DCD as well sensitivity and low negative predictive value
as to evaluate the children’s motor development. compared to its long form (BOTMP-LF). So it is
Among these tests, the American Psychiatric not suitable for five-year-olds or for the diagnosis
Association (APA) has addressed the BOT-2, of children with a motor coordination disorder
MABC, and MAND tests as important tests for (18). This is while Beitel and Mead (1982) support
diagnosing children with DCD (9). the ability of this test to evaluate the motor
Some studies have shown that the Bruininks– proficiency of three- to five-year-old children (19).
Oseretsky test of motor proficiency—Short Form Venetsanou et al. (2009), in their evaluation of 380
(BOTMP-SF) has an appropriate reliability and children aged four to six years, showed that the
validity for evaluating motor skills in childhood; BOT-2 test has a high validity (15). Spironello et
but the use of this test is rejected in some other al. (2010), in their study on 340 children aged 11
 Validity and Reliability of the BOT-2 5

years, showed that the correlation between the two validity and reliability of these tests differs from
tests of BOTMP-SF and MABC is moderate to country to country. The validity and reliability of
low. Their results showed that the children who a test is not inherent; thus, it cannot be applied in
were diagnosed with DCD by the BOTMP-SF test, different cultures and environments (25). Since
had lower physical activity levels and higher BMI, the tests used to evaluate the motor skills are
and were more overweight. In this study, MABC influenced by these factors (26, 27), and given
was reported to be more suitable for screening (20). that the mother tongue can also influence the
Cairney et al. (2009) compared BOT-2 and MABC major motor skills in preschool children; the need
tests in the diagnosis of children with DCD. They for a highly reliable, valid, sensitive, and
concluded that the BOTMP-SF is not a good characteristic test is necessary for the evaluation
alternative to MABC in diagnosing children with of motor skills and diagnosis of children with
DCD, and further research is needed on the DCD in the country.
sensitivity and characteristic of this test (2). Previous studies compared the BOT-2 test
McIntyre et al. (2017) compared the McCarron with other motor developmental tests, and used
Assessment of Neuromuscular Development each of the various forms of this test (BOT-2,
(MAND) and BOT-2 in 91 youth aged 21 years. BOTMP-SF, and BOTMP-LF) for validity and
They concluded that there is a difference between reliability. But there are still differences in the
the two tests in diagnosing adults with motor validity and reliability, as well as the sensitivity
weakness and DCD. They considered a standard and characteristics of the test. Furthermore, due to
deviation below the mean as a motor weakness. the effect of cultural and environmental
The results showed that there is a low correlation conditions on determining the validity of the test,
between the two tests (r=0.37). The percentage of many questions about the correct use of these tests
agreement between the two tests was 85% in have remained unanswered among researchers
identifying healthy subjects. This was while the and further studies are required. Since the
percentage of agreement for identifying people reliability and validity of a specific test in a
with motor weakness was reported at 44%. Their community with specific environmental and
results showed that the BOT-2 test doubled the cultural characteristics cannot guarantee its use in
subjects with motor weakness compared to the other communities, the purpose of this study was
McCarron test (13.2% vs. 6.6%) (21). Wuang and to examine the validity and reliability of the BOT-
Su (2009) evaluated the reliability and 2 test in preschool children of Tehran.
responsiveness of the BOT-2 test, and their results
showed that this test has good reliability with a MATERIALS AND METHODS
high characteristic and low sensitivity (22). Lucas Participants. This research was descriptive.
et al. (2013) showed that the BOT-2 test has a high The statistical population of this study comprised
reliability in children with alcoholic fetal all preschool children in Tehran (aged four to
syndrome and can be used for people with a motor seven years) enrolled in kindergartens and
disorder or weakness (23). Finally, they stated that preschools in 22 areas of Tehran. A random
evaluating the sensitivity and characteristic of selection of 306 healthy children aged four to
these tests was critical to further ensure the ability seven years (164 girls and 142 boys) was carried
of these two tools to evaluate motor proficiency out. The sampling was a random cluster class. All
and diagnose DCD (23). Lam (2011) evaluated the the participants took part in the study by obtaining
validity of the BOT-2 test’s major skills and finally consent from their parents. The MABC and BOT-
concluded that the five major skills of the tests 2 brief form tests were used to evaluate the motor
(running speed and agility, balance, bilateral skills of the children.
coordination, strength, and coordination of the Apparatus and task. The BOT-2 test is
upper body) has a high validity in preschool appropriate for measuring a wide range of motor
children (24). skills in individuals aged four to 21 years. The
Therefore, considering the importance of simultaneous validity of this test with the BOTMP-
human motor development at preschool age, the SF test was 0.88, and its reliability in the three age
need for a valid and appropriate test for evaluating domains of four to 21 years was reported as 0.81 to
motor skills in this age range, and the existence of 0.90 (27). The BOT-2 included 12 items that
cultural and environmental differences, one of the measure eight subscales. The subscales of this test
largest challenges for the researchers is that the measure fine motor precision, fine motor integrity,
6 Validity and Reliability of the BOT-2

hand agility, bilateral coordination, balance, speed MABC test, and their scores were recorded. Given
and agility, upper limb coordination, and strength. the instructions for each test, the examiner
In general, these eight measured subscales include provided the required guidelines so as to
the four motor domains of manipulation control, familiarize the subject with the manner of
hand coordination, body coordination, and strength performing the task. To evaluate the simultaneous
and agility (27). validity of the two MABC and BOT-2 tests, 30
The MABC test was designed by Henderson subjects were selected who were evaluated by both
and Sugden (1992) with the goal of studying the tests. To evaluate the time reliability, 50 subjects
motor developmental efficiency and delay in were tested with a BOT-2 test two weeks later.
children and adolescents. The children’s motor Data analysis. The reliability of the BOT-2 test
evaluation test has a high validity and time was calculated using time reliability with an interval
reliability, and the reliability of the evaluators was of two weeks. To calculate the validity of BOT-2 by
0.77 and 0.98, respectively. The full set of this test the convergence method, the canonical correlation
consists of 32 tasks divided into four groups. Each between BOT-2 and MABC was calculated (9). An
group contains eight items that come from three effective and well-known method for evaluating a
subscales: manipulation skills (three items), ball laboratory test, whose results are variable in a
skills (two items), and balance skills (three items), ranking or quantitative scale, is to use a ROC curve.
wherein each item is adjusted with regard to the The ROC curve is a graph that is obtained by
age group (28). This test was standardized in Iran dividing the sensitivity (real positive value) by the
in 2015 by Badami et al. (29). false positive value. In this method, the area under
Procedure. At first, five areas of Tehran were the graph represents the diagnosis power of a test.
determined from the north, west, east, south, and Hence, the more a curve tends to the left of the
center of the city. Then two kindergartens and two graph, the greater will be its accuracy and it will be
preschool centers were randomly selected from each closer to the ideal (area of one) (30); therefore, in
area. Finally from the 20 kindergartens and order to evaluate the sensitivity and characteristic of
preschool centers, 306 children were randomly the BOT-2 test in agreement with the MABC test,
selected. After selecting the subjects, parental this study used the ROC curve. Recently, it has been
consent was taken to examine the subjects. Then all found that these curves have remarkable uses in
the test items of MABC and BOT-2 were performed medical decision-making. The SPSS.21 software
on all participants and their scores were recorded in was used to analyze the data.
the notebook for each test. Every item that was not
understandable to a child was explained and RESULTS
performed by the examiner, for as long as it took for In investigating the convergence validity of
the item to be understood by the child. Each test the BOT-2 test, the statistic test of canonical
performance lasted 15 minutes for each subject. correlation was used, so as to calculate the score
Each child first performed the BOT-2 test and then correlation of the subscales of this test and the
the MABC test after 30 minutes. The items for both MABC test. The results of the correlation analysis
the tests were performed by all the children. showed that there is a significant linear
To evaluate the sensitivity and characteristic of relationship for the correlation between these two
the BOT-2 test, 30 children whose scores in the sets of variables (Table 1).
MABC test were below the 15th percentile were The crossing factor loads of the BOT-2 test
selected as children with a potential to have DCD; subscales and the MABC test were high factor
and 30 subjects who had high scores were placed loads with their counterpart test linear
in the other group (as healthy individuals) (3). relationship, which indicates a high correlation
Then, the BOT-2 test was performed again on the between these two tests (Table 2 and 3).
30 subjects who gained high and low scores in the

Table 1. Canonical correlations between BOT-2 and MABC tests.

Linear Special Wilkes Num Denom
Correlation F Significance
relationship value statistics D.F D.F
1 0.885 3.62 0.191 3.56 24 110.81 <0.001
2 0.297 0.097 0.882 0.36 14 78.00 0.982
3 0.179 0.033 0.968 0.221 6 40.00 0.968
 Validity and Reliability of the BOT-2 7

Table 2. Counterpart factor loads of the test subscales of the BOT-2 brief form
variable First Linear Relationship
fine motor precision 0.832
fine motor integrity 0.826
hand agility 0.769
upper limb coordination 0.642
bilateral coordination 0.613
balance 0.526
speed and agility 0.611
strength 0.627

Table 3. Crossing factor loads of the MABC tests subscales

variable First Linear Relationship
manipulation skills -0.732
ball skills -0.662
balance skills -0.791

To investigate the reliability of the brief form that the intra-class correlation factor is 0.80 for
of the BOT-2 test, the intra-class correlation the time reliability (Table 4).
coefficient was used, where the results showed

Table 4. Class correlation coefficient of the BOT-2 test

95% confidence interval F Test
Intra-class
Lower Upper Value of Degree of Degree of Significance
correlation
bound bound F freedom 1 freedom 2
0.809 0.685 0.888 9.49 48 48 <0.001

For the diagnosis ability of this test, the that this test is approved to evaluate the motor
sensitivity and characteristic of the BOT-2 test proficiency of preschool children. The results
and the MABC test was dealt with. In Fig. 1, the regarding the sensitivity and characteristics of the
ROC curves of these two tests are given. The test support the screening for preschool children.
results show that the best cutoff point at 13 was The reliability results of this tool showed that the
obtained with the best balance between sensitivity scores of this test have a high reliability for
and characteristic as 0.91 and 0.93, respectively. children aged four to seven years.
The area under the curve (AUC=0.97) was 0.97 Regarding the simultaneous validity, the result
and, as expected, the BOT-2 test has an of this study supported the simultaneous validity of
appropriate sensitivity and characteristic (Fig. 1). the BOT-2 and MABC tests for children aged four
to seven years in Tehran. The results are consistent
DISCUSSION with the results of the studies by Lam (2011),
Vinçon et al. (2017), Venetsanou et al. (2009),
The purpose of this study was to evaluate the
validity and reliability of the BOT-2 test in Schulz et al. (2011), Crawford et al. (2001), and
preschool children. In order to use this test in the Lucas et al. (2013) also obtained a high correlation
screening process, the sensitivity and between the MABC and BOT-2 tests (9, 14, 15, 23,
characteristics of the test were evaluated as well. 24, 31). The results of this study contradicted the
To evaluate validity, the BOT-2 test was results of McIntyre et al. (2017), Spironello et al.
compared with the MABC test. In summary, the (2010), and Cairney et al. (2009) which showed
results of this study in the context of the that the consistency (r=0.50) between the BOT-2
simultaneous validity of the BOT-2 test showed and MABC tests was low (2, 20, 21). A possible
8 Validity and Reliability of the BOT-2

reason for the difference in results in this study vis- taking the ball in the BOT-2 test, children did not
à-vis the previous studies may be the type of test perform well. However, studies have shown that
used, methodology differences, and the methods children perform well in the ball and taking skills
used in the studies. Previous studies have in European countries. The results obtained
suggested that a suitable statistical method is an support the influence of cultural differences in
important factor for evaluating the validity of a tool developmental tests (32). Venetsanou et al. (2009)
(20). However, the MABC test has been compared compared age groups and showed that differences
for the long form of BOTMP (28). But in this between age groups were significant, and these
study, the comparison of the brief form of BOT-2 supported the validity of this test (15). Their
with the MABC test was considered. While a findings are also consistent with the results of Lam
number of studies reported low to moderate et al. (2003) who with a larger age range that
correlation between the two tests (28, 31) and showed that BOTMP-SF has a good validity in the
stated that, as both tests evaluate different aspects age range of four to six years (24). Numerous
of motor skills, at best, the correlation between studies have compared the simultaneous validity of
these two tests can be moderate (28); but in this the MABC and BOT-2 tests (14-16, 18). They
study, a high correlation was found between the stated that although the purpose of these two tests
subscales of both tests. One of the advantages of is different, a moderate correlation exists in most
the MABC and BOT-2 test in clinical observations studies between the two tests. The simultaneous
is that before evaluating motor skills, all items are validity results of both tests were satisfactory; so a
generalized for the children to ensure that they significant correlation was obtained between the
have properly understood the correct total score and the scores of the BOT-2 and MABC
implementation of the item (2). In some items, test subscales.
such as taking a sandbag in the MABC test and

ROC Curve 10 / AUC=0.97

1
The real positive value (sensitivity)

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

The false positive value (characteristic 1)

Figure 1. ROC curve for sensitivity and characteristic of the BOT-2 test.

Regarding the validity of the tool, it should be re-evaluated; that is because the motor skills of
noted that the validity of a tool in a country or a preschool children may be influenced by factors
community may not be appropriate for another such as nutrition, lifestyle, exercise, and physical
country or community, and its validity should be activity, since all these differ in other countries
 Validity and Reliability of the BOT-2 9

and cultures (24). Another issue that should be To evaluate the reliability of the test, the time
noted in the discussion of the validity of the reliability method was used. High correlation was
developmental tests is that one should not be obtained in the time reliability between the test
limited to a single approach in evaluating validity; and retest. These findings suggest that the BOT-2
instead, different methods should be used to test has good consistency. In general, the findings
ensure the validity of a tool (simultaneous support the improved post-test performance, and
validity, structural validity, formal validity). they also state that in the age range of four to
Therefore, a test has high validity when it has a seven years, the test has consistency in
high correlation with a similar test, and has high measurements even after an interval of a few
sensitivity, characteristic, and predictive value weeks. Many studies have examined the
(33). The results of this study showed that when reliability of internal consistency, time reliability,
the five low percentile scores in the MABC test and the reliability of the examiner of BOT-2. The
were diagnosed as DCD cases, they were obtained results support the high reliability of this
consistent with the 15 percentile of BOT-2. test and are consistent with the results of this
Therefore, according to the objectives of both study (12, 21, 27). The results of this study
these tests, it is clear that there is a high regarding the reliability of the total test score were
correlation between the short form of BOT-2 and consistent with the results of Moore, Reeve, and
MABC. The most important possible reason for Boan (1986); nevertheless, their research showed
this high correlation in the two tests is the that some subscales had a low correlation with the
similarity between the BOT-2 and MABC test total score and did not have proper reliability (17).
items. By looking at the items in both tests, it can It should be noted that in their study, the brief
be seen that the three items of threading squares, form of BOTMP was used. The intra-class
walking on a straight line, and route map are quite correlation coefficient for time reliability in the
similar between the two tests. Spironello et al. total score of BOT-2 was found to be 0.57 to 1.
(2009) showed that the correlation between the These values indicate the suitable reliability of
two BOT-2 and MABC tests was moderate this test. The time reliability in some subscales
(r=0.5) (20). However, when the cutoff point of and motor areas is low for some age groups and
15 was considered, the percentage of consistency this can be a limitation to scoring for the therapist.
between the two tests was high. Previous studies The results of this research were consistent with
(12, 20) also state that if MABC is accessible, the results of Lucas et al. (2013). They also stated
then BOTMP should not be used to evaluate and that BOT-2 has an appropriate validity and
diagnose DCD. However, the results obtained in reliability to evaluate the children’s motor
this study, as well as the similarity of the two tests proficiency (23). The results of this study were
for some items, show that this test can be used to inconsistent with the results of Venetsanou et al
diagnose DCD in children aged four to seven (15); the probable cause of this inconsistency
years. between the two studies may be the difference in
Another important point in motor the type of test used; for example, in the study of
development tests is the sensitivity to the Venetsanou et al, the long form of BOTMP test
environment. Billy and Welry (1989) state that was used to evaluate the reliability (15). While
among all the unique characteristics of children's supporting the reliability of BOT-2 test in
motor development tests, it is crucial that the test evaluating the motor proficiency in children with
be valid in terms of environment—that is, it Prader–Willi syndrome, White et al. (2012)
should be sensitive to the child's environment and concluded that a number of important factors such
the place of implementation. This is because the as attention, motivation, diagnosis ability, and
biological validity of a test not only increases the weather conditions play a constructive role in the
level of confidence of the examiner but also reliability of a tool (33). One of the most
maximizes the accuracy of the collected important reasons for the disagreement regarding
information (15). However, most kindergartens the reliability of this tool can be the time
and preschool centers in Iran do not have considered between testing and re-testing. With a
sufficient space for children’s activities. Hence, quick look at recent research on the reliability of
this could be a limitation in the evaluation and use motor development tests, it can be stated that the
of the BOT-2 test. longer the time interval, the lower is the
10 Validity and Reliability of the BOT-2

reliability. One of the reasons for this in early age sensitivity and characteristic factor of BOT-2, and
is the rapid development and growth of children. emphasized the sensitivity and characteristic of
Hence, the interval between testing and retesting this test. Given the contradiction in evaluating the
should be short in early ages (23). These may be sensitivity and characteristic of the BOT-2 test,
the possible reasons for the inconsistency of this further research is needed in this regard, and it
study with the previous studies. One of the should be compared with other motor
important factors that can affect the reliability of development tests. That is because previous
the study is the interval between the two tests. studies have used different forms of this test with
Evaluating other methods of the tool reliability other tests. One of the most important issues
was one of the limitations of this study. If other regarding the results obtained in this study is that
reliability methods are evaluated, reliability can in the absence of a standard test and MABC for
be ensured with greater certainty. These results the DCD, BOT-2 can be used, and both the
support the use of the test in the effective MABC and BOT-2 tests (27, 31) can be used to
evaluation of interventional motor programs and identify children with DCD. Considering the
allow researchers to initially evaluate children by importance of the cultural environment and its
this tool. The reliability and test-retest results effect on children's motor development, there are
showed that the overall scores of the subjects in some concerns about using this test for screening
the first session significantly increased compared and it has to be implemented in the screening with
to the first session. care. Finally, given the limitation of the present
Another case examined in this study was the study, with regard to the cases mentioned in the
evaluation of the sensitivity and characteristic of American Health Association on identifying
the BOT-2 test so that it could be used in the children, we are satisfied with just the MABC and
screening process for identifying children with BOT-2 tests, although factors such as academic
DCD. Previous studies have stated that as long as success, weakness in routine activities, and
the sensitivity and characteristic of the BOT-2 test cognitive and perceptual–motor problems should
is not examined, it cannot be expressed that this be considered in evaluating children with DCD.
test is suitable for screening (2). The high The consistency between the two tests is high, but
correlation of these two tests can be a reason for we should note that the modified versions of both
the high characteristic of the BOT-2 test. The tests should be considered with other
results of this study showed that the BOT-2 test developmental tests. The other limitation of this
has the ability to identify and screen children with study was the low age of children, since only
DCD. In other words, when the lowest five children aged four to seven years were examined.
percentage scores of BOT-2 are used to diagnose Furthermore, because of the high amount of time
DCD, then the consistency with MABC and the spent on both tests (MABC and BOT-2), the low
low score of five percentile are suitable and number of samples was another limitation of this
acceptable. study. Therefore, it is suggested that a larger age
The results for the characteristic were range be evaluated in future studies and include
consistent with the results of Venetsanou et al. children of school age. Although in this study the
(15) and Wuang and Su (22); however, their sensitivity and characteristic of this test are
results were contradictory in terms of sensitivity. appropriate, it is recommended that in future
They stated that the BOT-2 and BOTMP-SF tests studies this test be compared with other
had a high characteristic and low sensitivity developmental tests for older children. It is also
compared to BOTMP-LF (15, 22). McIntyre et al. suggested that teachers and experts in motor
(2017) showed that when the BOT-2 test was development use this test in schools,
compared to the MAND test in adults, the former kindergartens, and preschool centers to evaluate
had high sensitivity; so people with motor major and fine motor skills, as well as to identify
weakness were diagnosed twice as frequently as children with DCD. Because of the limitations of
with the MAND test (21). The results obtained in reliability in some subscales and age groups,
this study were opposed to the results of Cairney therapists should be aware of the use of this test
et al. (2009) who stated that BOTMP-SF could in determining motor levels in some areas of
not be a good alternative to MABC (2). In motor development.
general, previous studies were sensitive to the
 Validity and Reliability of the BOT-2 11

CONCLUSION in determining motor levels in some areas of

In summary, the results of this research on the motor development.
simultaneous validity of the BOT-2 test showed
that the test was approved to evaluate the motor
proficiency of preschool children. Also, the APPLICABLE REMARKS
results of the study on tool reliability were
acceptable and showed that this tool has a good  The BOT-2 has appropriate validity
reliability in preschool-age children. The results and reliability as well as high
of the study supported the sensitivity and sensitivity and characteristic in
characteristic of the test for screening preschool- preschool children.
age children. Hence, this test can be used to screen  The teachers and mentors can use the
both children of preschool-age and older children.
BOT-2 test to evaluate and screen
Future research should examine the validity
children aged four to seven years.
and reliability of this test, as well as its sensitivity
and characteristic in older ages. It is also  The BOT-2 can be used to evaluate
suggested that teachers and experts in motor motor skills and diagnose children
development use this test in schools, with DCD.
kindergartens, and preschool centers to evaluate
major and fine motor skills, as well as to identify  In addition to educational and
children with DCD. Because of the limitations of intelligence tests, the BOT-2 test
reliability in some subscales and age groups, could be used to evaluate children’s
therapists should be aware of the use of this test major and fine skills.

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