Comparing Motor Abilities Using a Standardized Clinical Assessment (BOT-2) and Parent Report Questionnaires (MABC-2 and DCDQ) in Children with Autism Spectrum Disorder (ASD)

Background:  

Autism Spectrum Disorder (ASD) is a multisystem disorder characterized by impairments in social communication skills and the presence of restricted and repetitive behaviors (American Psychiatric Association, 2013). Additional comorbidities include gross-motor (GM) and fine-motor (FM) impairments as well as cognitive/behavioral impairments (Srinivasan & Bhat, 2013). Invariably, there are discrepancies between parent and clinician estimates about the level of functioning of children with ASD. A comparison of motor functioning using parent and clinical estimates could highlight the gap in the understanding of functional capacities of children with ASD between the two stakeholders.

Objectives:  

We aimed to compare parent and clinician perspectives regarding functional performance within the FM and GM domains in children with ASD using parent questionnaires and standardized clinical assessments.

Methods:

Thirty-seven children with ASD aged between 5 and 12 years participated in this study. We administered various FM and GM subtests from the Bruininks-Oseretsky Test of Motor Proficiency- 2^nd Edition (BOT-2) and report the FM and GM composite performance. Parents of the participating children completed two motor questionnaires - Movement Assessment Battery for Children-2 (MABC-2) and Developmental Coordination Disability Questionnaire. Both questionnaires provide normative data on overall motor delays. Significant motor delays were scores below the 15^th-18^th percentile depending on the measure.

Results:  

Based on BOT-2 data, 50% of the ASD sample had significant FM delays and 59.1% of the ASD sample had significant GM delays. Based on MABC-2 data, 75% of the ASD sample scored in the red zone (i.e.; below the 15^th percentile) in terms of FM & GM performance. Based on DCDQ data, 84% of the ASD sample met criteria for a Developmental Coordination Disorder (DCD).

Correlations between BOT-2, MABC, and DCDQ indicated that both gross (r=0.78) and fine motor (r=0.61) scores of MABC-2 strongly correlated with those of DCDQ. However, both MABC-2 and DCDQ scores did not correlate with BOT-2 scores across GM and FM domains.

We also analyzed the percent of parents that agreed with the clinician’s estimate of FM and GM delays. In general, 55% of the parents completely agreed and 18% of the parents partially agreed with the clinician’s assessment of FM and GM delays in the ASD sample. In contrast, 27% of the parents disagreed and either overestimated or underestimated the motor skill performance of their children.

Conclusions:  

A subset of parents’ did not accurately assess their children’s abilities as they were clearly off compared to clinician estimates. Parents of children with ASD are perhaps more concerned about their child’s social skills and they may not pay enough attention to their motor skills. Strong correlation between the MABC and DCDQ confirms that parental perception of their children’s motor function remains constant. Secondly, the skills assessed in the parent questionnaires are more functional in nature than the standard activities of BOT-2. Clinical measures such as the BOT-2 may not adequately assess motor functioning required for completing activities of daily living. Clinicians need to consider the use effective functional assessments to better evaluate functional motor performance of children with ASD.