Accuracy of motor assessment in the diagnosis of fetal alcohol spectrum disorder

Abstract

Background To evaluate the accuracy of motor assessment tools listed in Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan (Canadian Guideline) for the purpose of fetal alcohol spectrum disorder (FASD) diagnosis. Specifically, we aimed to determine: 1) diagnostic accuracy of motor assessment tools and subtests; 2) accuracy of multiple subtests versus total scores; and 3) accuracy of alternate cut-offs. Methods Cross-sectional diagnostic study of 63 children aged 6–17 years. Diagnostic accuracy and alternate cut-offs were calculated for the Movement Assessment Battery for Children, 2nd edition (MABC-2), Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition Short Form (BOT-2SF) and Beery-Buktenica Developmental Test of Visual Motor Integration, 6th edition (BeeryVMI-6). Results The MABC-2 total motor score was more sensitive (0.30; 95% CI 0.17–0.46; p < 0.01) to motor impairment in the presence of FASD than the BOT-2SF (0.02; 95% CI 0.00–0.12) at the 2nd percentile (−2SD). The MABC-2 total motor score was more accurate than any combination of subtest scores. The Motor Coordination subtest of the BeeryVMI-6 (BeeryMC) at the 5th percentile (− 1.5SD) (sensitivity 0.68, specificity 0.90) was the most accurate subtest. Conclusions The BOT-2SF was an inaccurate assessment tool for FASD diagnosis. The MABC-2 total motor score was the most accurate using current guidelines, though its sensitivity was still low. Further investigation into inclusion of single subtests and/or using a less conservative cut-off in the Canadian Guideline is warranted.

Motor skills and intelligence in children with fetal alcohol spectrum disorder

“…We conducted secondary analysis of an existing clinical database previously used for research. 8 The database was created using historical data obtained by patient file review. A cross-sectional design was used, with all data collected at the same point in time for individual children.…”

“…5 There is a growing body of research on the health and social implications of FASD, highlighting the importance of early and accurate diagnosis. 5 Fine and gross motor skill deficits are well documented in children with FASD, [6][7][8] yet motor testing is not routinely conducted during FASD diagnostic assessments. The prevalence of severe fine motor and gross motor impairments among children diagnosed with FASD is estimated to be 51% and 37% respectively.…”

“…Fine motor skills support independence in self‐care tasks such as dressing, eating, brushing hair, and cleaning teeth; academic skills including handwriting, drawing, and using scissors; and participation in play and social activities. Therefore a severe fine motor impairment can adversely affect a child’s ability to meet daily activity demands 8 . Children with FASD can present with deficits in gross motor skills including balance, coordination, and ball skills 9 .…”

“…Fine and gross motor skill deficits are well documented in children with FASD, 6–8 yet motor testing is not routinely conducted during FASD diagnostic assessments. The prevalence of severe fine motor and gross motor impairments among children diagnosed with FASD is estimated to be 51% and 37% respectively 8 .…”

“…Fine and gross motor skill deficits are well documented in children with FASD, 6–8 yet motor testing is not routinely conducted during FASD diagnostic assessments. The prevalence of severe fine motor and gross motor impairments among children diagnosed with FASD is estimated to be 51% and 37% respectively 8 . Fine motor skills support independence in self‐care tasks such as dressing, eating, brushing hair, and cleaning teeth; academic skills including handwriting, drawing, and using scissors; and participation in play and social activities.…”