Association between parent-proxy-reported and child-self-reported perceptions of children’s motor competence and children’s performance-based motor skill abilities

Abstract

Background

When assessing motor skills, occupational therapists are encouraged to seek the perspectives of children and their parents to promote the delivery of client-centered care.

Aim

To investigate whether 9–12-year-old children’s views and their parents’ proxy views of the children’s motor skill competence and their performance on a standardized, performance-based assessment are associated.

Materials and methods

Thirty 9–12-year-old children completed the Perceived Motor Competence Questionnaire in Childhood (PMC-C) and the Pictorial Scale of Perceived Movement Skill Competence – version 2 (PMSC-2), while their parents completed the Movement Assessment Battery for Children–2nd Edition Checklist (MABC-2 Checklist). Children’s objective motor skills were measured by the Bruininks-Oseretsky Test of Motor Proficiency–2nd Edition (BOT-2). Spearman’s rho correlations were used to analyze the data.

Results

Significant associations were found between the BOT-2 total motor composite and the PMC-C. A significant association was found between the MABC-2 Checklist and the BOT-2 Strength and Agility composite, as well as the PMC-C total score.

Significance and conclusions

Occupational therapists are encouraged to include children and their parents in the therapeutic process to capture individual perspectives and deliver client-centered care.

Keywords:

• Client-centered
• fundamental movement skills
• locomotor
• object control
• paediatrics
• perception

Introduction

In paediatric settings, occupational therapists play an integral role in early identification, as well as primary and secondary prevention of developmental delays in children, including motor skill difficulties [1–6]. As such, occupational therapists are expected to use a client-centered, family-centered, and child-centred lens to facilitate a partnership between the professional, the client and his/her family. Family-centered care allows for the child or parent/caregiver to be included in the goal setting, and intervention, thereby providing the client with an active role in the occupational therapy process [7–9]. Given children and their parents contribute valuable knowledge about their occupations, utilizing a family-centered and child-centred approaches to practice in paediatrics settings allows the therapist to gain greater insight into the child’s interests, habits, values, roles, rituals, routines, temporal adaptation, motivation, and desires for therapy [10]. When these perspectives are adopted in therapy contexts, the family (including the child) has greater involvement in goal setting and intervention planning, ultimately maximizing the input the child has over his/her wellbeing [11]. Unfortunately, current evidence shows that there is a lack of congruence between theory and practice in which children’s perspectives are often overlooked by practitioners in motor skill assessment and intervention, thereby compromising the delivery of holistic care [12,13].

Children’s motor skills

Basic motor skills are integral to a child’s development and enable a child to interact with and learn from their external environment [14]. In turn, this interaction further contributes to the improved development of children’s motor skills and allows children to engage in everyday occupations [15,16]. Typically, motor skills are divided into fine and gross motor skills [17,18]. Fine motor skills include controlled movements of the hand, whereas gross motor skills or fundamental movement skills (FMS) are foundational skills learned at a young agthat enable participation in physical activity and occupations [19]. Specifically, FMS are defined as basic motor skills that combine to form more complex sport-related movements and these are divided into locomotor skills involving larger movements such as skipping and running and object control skills, which include the manipulation of an object such as a ball [20]. Fine motor skills are also important for school-readiness-based occupations (including cutting with scissors, holding a pencil or pen for copying purposes, or typing at a keyboard), activities of daily living (including doing up buttons and zippers, tying shoelaces, holding a spoon, grasping a toothbrush, or sorting through coins), and play-based activities (including catching, bouncing, and throwing a ball, sending a text message to a friend, putting pegs in a pegboard, throwing darts at a dartboard, holding cards in a when playing a card game, or completing a puzzle).

The development of both fine motor and gross motor skills is influenced by a range of factors and, as a result, children or parents may have differing perceptions of these skills [21]. Therefore, to comprehensively understand the value of children’s and parent’s perspectives in occupational therapy practice, it is important to know whether they can accurately perceive their motor skill competence. Perceived motor competence (PMC) is defined as a person’s ability to evaluate their actual motor ability [22,23]. In contrast, actual motor competence (AMC) is described as a person’s ability to perform a range of motor skills in a proficient manner [24,25].

Current literature provides evidence of a dynamic relationship between motor skills and occupational performance. Specifically, children who overestimate their motor skills capacity have increased participation in physical activity compared to those who accurately perceive their motor skill ability [26,27]. Similarly, higher PMC is associated with increases in motivation to participate in occupations [24,25]. As well as motivation, motor skills have been found to promote social well-being including heightening empathy and community participation, as well as improving attention skills and academic performance [28,29]. Given the vital role that motor skills play in cognitive, emotional, physical, and social development, early identification of and intervention for developmental delays by occupational therapists is essential [1–3]. A range of motor skill assessments are employed by occupational therapists to gain a comprehensive understanding of children’s and parents’ perceptions of children’s motor competence and children’s actual motor performance in everyday tasks [4–6].

Approaches to motor skills assessment

Previous literature has clearly illustrated the multidimensional nature of motor skills and motor skill perception. As such, to comprehensively understand children’s motor skills, there are two main types of assessments which are typically either objective, performance-based instruments, or self-report/proxy-report scales [12]. Objective, performance-based instruments assess children’s motor skill abilities using standardized, norm-based tests where prescribed tasks are used to assess children’s fine and gross motor skills. These types of motor skill instruments are commonly referred to as bottom-up or performance-based assessments and are body function and structure-focussed [16]. In contrast, self-report/proxy-report scales are often referred to as top-down assessments or self-report/proxy reports [7,18]. Top-down assessments are more aligned with therapists using client-centered, family-centered, and child-centred practice approaches with children and families.

Top-down assessments include the client’s perspectives, thereby offering a unique insight into a client’s participation and engagement in activities such as play, self-care, sleep, social participation, and education [16,18]. Examples of these assessments in occupational therapy include child-reports, teacher-proxy-reports, and parent proxy reports. The Pictorial Scale of Perceived Movement Skill Competence [30], Physical Self-Description Questionnaire (PSDQ) [31], and the Movement Assessment Battery for Children–2nd edition (MABC-2) Checklist [32] are the most common top-down motor skills assessments used in paediatric settings. While top-down assessments provide context to a child’s motor skill performance, they rely on the child having adequate levels of intellectual capacity, maturity, and insights to understand and respond to items in an informed manner [16,17]. In fact, evidence suggests a lack of congruence exists between various types of top-down assessments, with parent-proxy-reports, and child-reports producing varied results [18–21].

Bottom-up or performance-based motor skill scales are typically standardized and norm-referenced and are used to evaluate a child’s motor skills in quantifiable terms [22]. These tools are employed when a therapist wishes to elucidate the underlying skills that may be contributing to a child’s poor performance of tasks or occupations [21]. The Bruininks-Oseretsky Test of Motor Proficiency–2nd edition (BOT-2) [33], Peabody Developmental Motor Scales-2^nd edition (PDMS-2) [34], Test of Gross Motor Development–2nd Edition (TGMD-2) [35], and the MABC-2 [32] are the most frequently used bottom-up assessments in paediatric settings [28]. However, while these approaches reduce the risk of bias, they are limited by their inability to provide daily living context details relevant to a child’s skill performance and lack of client-centeredness [12].

Another issue related to the use of bottom-up focused paediatric assessments is the issue of ecological validity which refers to how generalizable study findings are to the real world, such as environments or settings typical of everyday life [36–38]. The ecological validity of standardized motor skill measures denotes to what extent do the test items in the BOT-2, PDMS-2, TGMD-2, or MABC-2 reflect the fine and gross motor skills that children need to engage in play, self-care, and educational-related activities in real-life contexts. For example, a study by Vinçon et al. [39] found that several of the fine and gross motor skill categories assessed by a German version of the BOT-2 were not relevant to daily activities undertaken by children.

Children’s PMC vs children’s AMC

Current literature has predominantly found either a lack of association or a low to moderate association between children’s perceived and actual motor skill competence. Specifically, one study found no relationship between children’s AMC and PMC in 6–7-year- old children [25]. Similarly, an Irish study including 5–11-year-old participants found that both boys and girls overestimated their motor competence [40]. These findings were mirrored in an Australian study of 8-12-year-olds which found few significant associations between children’s AMC and PMC [20]. In contrast, another study found that low PMC was directly aligned with poor AMC, suggesting that children of 4–7 years of age can predict their motor skill performance accurately [41]. Studies that evaluated associations between children’s perceptions and actual motor skills for object control skills and locomotor skills found that children’s perceptions of object control skills were more accurate than those of their locomotor skills [42]. Specifically, boys were found to have a higher perception of object control skills compared to girls [40]. Similarly, many cross-sectional studies reported that girls were more likely to underestimate their motor competence than boys [23, 29, 43]. Therefore, given previous studies lack consistency in their findings, additional research is needed in this area.

Parent-proxy perceptions versus children’s AMC

The empirical literature currently lacks insight into the relationship between children’s motor skills when assessed by child reports and parent-proxy-reports. However, studies that evaluated the relationship between children’s motor skills as reported by parents and performance-based assessments produced mixed results. Many studies found moderate associations between parent-proxy-report scales and children’s objective performance of FMS, suggesting that parents are a valuable source of information about their child’s motor skill capacity [17,20,43–45]. Interestingly, one study found parents could more accurately perceive their child’s object control skills than locomotor skills [20]. In contrast, other studies have reported no association between children- and parent-proxy-reported motor skills for subscales of strength, endurance, and sport [21]. The lack of clear results on this topic demonstrates the need for further investigation.

Gaps in the current literature

Recent literature has encouraged the use of a combination of top-down and bottom-up assessments in children to provide further evidence on the accuracy of children’s and parents’ perceptions of children’s motor skills [25]. Indeed, the low levels of concordance between current studies exemplify the need for future research to consolidate the relationship between child- and parent-proxy-reported motor skills and actual motor skill competence. Additionally, the present lack of literature exploring the accuracy of parent-proxy perspectives of children’s motor skills highlights the opportunity to provide further insight on the topic.

Given that therapists are mandated to include families/caregivers in goal setting and intervention planning [46], a study on this topic is essential to further our understanding of how accurately parents and children can perceive children’s motor skills. Having a clearer understanding of this relationship will facilitate better therapeutic outcomes for families and provide a means for the efficacy of motor skill therapy programs to be formally evaluated [47]. Finally, this study is being performed after the COVID-19 global pandemic, where 9–12-year-olds from Melbourne, Victoria, Australia experienced multiple lockdowns over a two-year period (i.e. 2020–2021). As a result, their PMC and AMC may have been impacted and this study is an opportunity to provide new insights into children’s motor skill abilities following the pandemic. Therefore, the research project aims to investigate whether 9–12-year-old children’s views and their parents’ proxy-reported views of the children’s motor skill competence and their performance on a standardized, performance-based assessment are associated. The two research questions posed are:

1. Are parent-proxy-reported and child-reported perceptions of the children’s motor skill abilities associated with the child’s performance on a standardized motor-skill assessment?

2. Are parent-proxy-reported and child-reported perceptions of the children’s motor skill abilities associated with each other?

Methodology

Design

A quantitative cross-sectional design was used in this study. This design was chosen as it allows for the investigation of variables that are present in a population at a single time point [48]. Ethical approval for the study was received from the Monash University Human Research Ethics Committee (MUHREC) (ID: 30685, date of approval: 17/12/2021) and the Victorian Department of Education and Training (approval number: 2022_004527, date of approval: 17/01/2022).

Participants

A sample of 30 9-12-year-old children and their parents were recruited in Melbourne, Victoria, Australia. Using convenience and snowball sampling, participants were recruited from one public primary school and through the authors’ informal networks. Children were eligible to participate if they provided informed assent, were 9-12-years old, and could read in English at grade four level. Children were excluded if they had a known history (based on parent-proxy-report) of psychosocial, developmental, learning, intellectual or physical disabilities, or had previously received support from any allied health professional services. The rationale for excluding children with a known physical, developmental or intellectual disability was to examine the association between children’s self-reported and parents’ proxy-reported perceptions of the children’s motor skill abilities. There was the potential that children with known physical, developmental or intellectual disabilities might not have had the necessary cognitive or reflective skills to be able to answer self-report scales. Additionally, parents were eligible if they provided informed consent and could read in English. After reading the respective explanatory statements, children who wished to participate in the study provided written assent and parents who wished to participate provided written consent.

Instrumentation

Demographic survey and screening tool

The demographic survey was used to collect information about the child and his/her parent prior to participating in the study and took 5-10 min to complete. This ensured potential participants aligned with the inclusion and exclusion criteria and provided information about participant characteristics. The demographic survey has been used in 10 previous studies and has adequate face and content validity.

Bruininks-Oseretsky Test of Motor Proficiency–2nd edition (BOT-2)

The BOT-2 is a norm-referenced standardized assessment of fine and gross motor skills used for children between four and 21 years of age that takes 45–60 min to complete. The BOT-2 is divided into four composites [33]. These include ‘fine manual control’, ‘manual coordination’, ‘body coordination’, and ‘strength and agility’, and these are further divided into subtests which each contains between five to eight items: ‘fine motor precision’ (7 items), ‘fine motor integration’ (8 items), ‘manual dexterity’ (5 items), ‘bilateral coordination’ (7 items), ‘balance’ (9 items), ‘running speed and agility’ (5 items), ‘upper limb coordination’ (7 items), and ‘strength’ (5 items) [33]. Each item is scored on an ordinal scale and the total score is compared to a normative sample [49]. In the current study, combined norms were used to analyze girls’ and boys’ performances simultaneously. The BOT-2 has good content validity [50], good inter-rater and test-retest reliability (ICC ≥ 0.96), as well as excellent internal consistency (Cronbach α ≥ 0.86) [51,52].

Pictorial Scale of Perceived Movement Skill Competence – version 2 (PMSC-2)

The first version of the PMSC was a self-report pictorial measure that assessed 4–8-year-old children’s perceptions of their competence when engaged in FMS [25,30,53,54]. Its items were based on the 12 FMS assessed by the TGMD-2 [22]. The second version of the PMSC (PMSC-2) [20,55] assesses children’s perceived motor skill competence using 13 pictographic tasks that mirror the 13 FMS assessed in the TGMD version 3 (TGMD-3) [56,57]. Specifically, the PMSC-2 is composed of six locomotor skills and seven object control skill items. Given the TGMD-3 is standardized for children aged 3 to 10 years 11 months [56,57], the PMSC-2 was deemed appropriate for use for children aged 9–12 years in the current study. It takes 15–20 min to complete and includes six locomotor skills and seven object control skills.

For the locomotor subscale, the score range is 6–24 and for the object control subscale, the score ranges are 7–28 [20,55]. Upon completion of the assessment, children are given a score from 13–52, where 52 represents the highest perceived competence and 13 represents the lowest perceived competence [20,55]. The PMSC-2 has evidence of construct validity and good internal consistency (Cronbach α ≥ 0.60) [55]. Additionally, test-retest reliability was reported when the PMSC-2 was conducted at two time points 7–12 days apart (ICC = 0.86) [55]. In a more recent study, with an Australian sample parents/guardians of 100 children aged 7–9 years completed a proxy-parent version of the PMSC-2, the internal consistency for the 13 FMS items was Cronbach α = 0.92, for the six-item locomotor items was Cronbach α = 0.90, and for the seven locomotor items was Cronbach α = 0.94 [20].

The PMSC-2 contains two pictures of a child performing each skill, one depicting good performance of the skill and the other depicting poor performance of the skill. The child is required to choose the picture that is most similar to how they would perform that skill (i.e. ‘this child is pretty good at running, this child is not that good at running, which is more like you?’) [20]. If the child chooses the competent picture, they are asked if they are ‘really good at’ (score of four) or ‘pretty good at’ (score of three) performing the skill. In contrast, if the child chooses the not competent picture, they are asked if they are ‘not that good at’ (score of one) or ‘sort of good at’ (score of two) performing the skill [55].

Perceived Motor Competence Questionnaire in Childhood (PMC-C)

The PMC-C is a self-report measure that assesses 7-13-year-old children’s perceived FMS competence and takes 10 min to complete [58]. It was developed in Germany and contains 24 items which assess four locomotor and four object control skills, each comprising three items. The locomotor skills include running (e.g. ‘I am a good sprinter’), hopping (e.g. ‘I can hop on one leg very well’), jumping (e.g. ‘I am good at jumping forwards with both legs’), and leaping (e.g. ‘I am good at leaping alternating with both legs’) [58]. The object control skills include kicking (e.g. ‘I am good at kicking a ball at a target’), bouncing (e.g. ‘I can bounce a ball very well’), throwing (e.g. ‘I am good at throwing a ball far’), and catching (e.g. ‘I can catch a ball well’) [58].

Given the PMC-C was originally developed in Germany and was going to be completed by Australian participants, it was reviewed by three paediatric occupational therapists who each had 10 or more years of clinical experience regarding the phrasing of its items and relevancy to children’s motor skills. All three of the therapists did not recommend any changes to the wording or contents of the PMC-C thus providing evidence of its face validity and cross-cultural utility.

Each skill is scored on a four-point Likert scale which includes the items: strongly disagree, disagree, agree, and strongly agree. The total score is calculated by summing the subscales. The maximum possible score on this scale is 96, which indicates the highest perception of motor skill ability. The PMC-C has good construct validity, as well as good internal consistency, for locomotor skills (Cronbach α = 0.78-0.88) and object control (Cronbach α = 0.73–0.89) [58,59].

Movement Assessment Battery for Children–2nd edition Checklist (MABC-2 Checklist)

The MABC-2 Checklist is a norm-referenced assessment comprising three sections that can be completed by a child’s parent/caregiver, teacher or other professional who are familiar with a children’s daily motor skills [32]. Section A assesses children’s motor skills in non-changing or predictable environments, while Section B assesses a child’s motor skills in changing, unpredictable environments [32]. Each of these sections has 15 items which are scored on a four-point Likert scale where 0 means the child performs the skill very well, and 3 means they did not perform the action close to how it is typically performed [32]. In contrast, Section C has 13 items and allows for a qualitative explanation of the child’s motor performance as reported in Sections A and B [32,60].

A total score out of 30 is reached by summing the items together, where the highest score represents poorer performance. The MABC-2 Checklist has excellent internal consistency (Cronbach α = 0.95) [61], and acceptable test-retest reliability (ICC >0.75) [19]. Additionally, the MABC-2 Checklist has fair concurrent validity, with significant correlations being found between parent’s proxy reported scores on the DCDQ (r=-0.36) and the MABC-2 Checklist (r= −0.38), as well as good construct validity [61]. It should be noted that most studies that have reported psychometric results about the MABC-2 Checklist have included teachers as respondents [62–64] but there are several that have included parents as respondents [65–67]. For example, Ke et al. [65] reported that when correlating the scores from parent and teacher completed versions of the MABC-2 Checklist with children’s test performance scores on the MABC-2, that parents’ ratings were more closely correlated with the MABC-2 subscale scores compared to teacher scores.

Procedure

One public primary school in metropolitan Melbourne, Victoria, Australia was approached to participate in the study. After receiving written consent from the school principal, information packages were distributed to grade four, five, and six classes. Parents and children who wished to participate were asked to return the signed consent and demographic forms to the researchers in a sealed envelope via the child’s classroom teacher. Nine children and their parents provided written consent. Twenty-one participants were later recruited using snowball sampling methods and completed the demographic questionnaire and consent forms using a Qualtrics survey. The first 30 children and parents who provided consent fitted the inclusion criteria and were therefore included in the study.

Data collection for children was split into two sessions that occurred one to two weeks apart (one for the completion of the BOT-2, and one for the child to complete the self-report scales). The BOT-2 was administered by the first author in a one-on-one format. The first author received training to administer the BOT-2, watched the instructional video available from the publisher on how to administer and score the BOT-2 items, and was observed by an occupational therapist with 10 years’ experience in paediatric assessments prior to the start of data collection. The self-report scales were administered in the second session either individually or in groups of two children. These sessions occurred on school grounds (for participants recruited from the primary school) or in a public setting (for participants recruited via snowball sampling). On average, it took each child 14 min to complete both self-reports and 51 min to complete the BOT-2. Parents completed the MABC-2 Parent Checklist online via a Qualtrics survey. A complete dataset was obtained for the study therefore the researchers did not have to deal with any missing data.

Analysis

The Statistical Package for Social Science (SPSS) version 28.0 (SPSS Inc., Chicago, IL) was used to analyze the data. Descriptive statistics were used to present demographic data and scale data. Spearman’s rho correlation was performed to determine the association between parent-proxy/child-reported motor skills and children’s performance-based motor skills.

Results

Participant demographics

A total of 30 children and 30 parents participated in the study. The child sample comprised more female participants (n = 19, 63.3%) than male participants (n = 11, 36.7%) (see Table 1). The children’s ages ranged from 9.0 years to 12.0 years with a mean age of 10.57 years (SD = 1.05). Most participants were in fourth grade (n = 12, 40%). The parent participant group was composed of 26 females (86.7%) and 4 males (13.3%) (see Table 1). Of the 115 people approached to participate in the study, 34 provided informed consent (response rate = 9.6%) and four participants were lost to follow-up. The response rate was 26.1%.

Table 1. Demographic characteristics (n = 30).

Sample characteristics	n (%)
Child’s gender identity
Male	11 (36.7)
Female	19 (63.3)
Non-binary/other	0 (0.0)
Child’s year level at school
Grade 4	12 (40)
Grade 5	8 (26.7)
Grade 6	8 (26.7)
Grade 7	2 (6.7)
Melbourne, Victoria suburb
South-Eastern suburbs	20 (66.7)
Inner suburbs	9 (30)
Eastern suburbs	1 (3.3)
Type of School Attended
State public	23 (76.7)
Catholic	4 (13.3)
Private	3 (10)
Number of siblings
0 siblings	4 (13.3)
1 sibling	16 (53.3)
2 siblings	4 (13.3)
3 siblings	6 (20)
Child’s first language
English	28 (93.3)
English and other language	2 (6.7)
Parents’ gender identity
Male	4 (13.3)
Female	26 (86.7)
Non-binary/other	0 (0.0)
Parents’ language
English only	23 (76.7)
English and other language	7 (23.3)

Descriptive statistics of motor skill assessments

Table 2 presents descriptive statistics, including the mean, standard deviation, range, and quartiles for raw scale data from the PMSC-2, PMC-C, BOT-2, and MABC-2 Checklist.

Table 2. Descriptive statistics of motor skill assessments (n = 30).

BOT-2	Mean	SD	Range	Q1 (25)	Q2 (50)	Q3 (75)
Subscale raw scores
Fine Motor Precision	38.7	2.5	12	38.8	39	40
Fine Motor Integration	36.4	2.2	10	35.8	37	38
Manual Dexterity	32.2	4.8	19	30	32	35.5
Upper Limb Coordination	34.2	4.2	14	29	36	37
Bilateral Coordination	23.4	0.8	3	23	24	24
Balance	34.5	2.4	11	33.8	35	36
Running Speed and Agility	41.2	4.3	19	38.8	40.5	44.5
Strength	27.8	4.9	18	51.8	58	64.5
Standard scores
Fine Manual Control	50.8	6.6	23	45.5	50.5	57
Manual Coordination	52.3	10.6	46	46.5	49.5	57.8
Body Coordination	55.4	7	26	50	55	62
Strength and Agility	59.2	8.6	34	51.8	58	64.5
MABC2 Checklist
Section A total score	1.7	2.8	11	0	0	2
Section B total score	3.8	4.9	21	0	1.5	5.8
Total score	5.6	7.6	33	0.8	2	8
PMC-C
Locomotor subscale total score	3	0.3	2.2	2.5	3	3.2
Object Control subscale total score	3.2	0.4	1.7	3.0	3.2	3.4
Total score	3.1	0.4	1.8	2.8	3.1	3.4
PMSC-2
Total score	42.3	4.3	15	39.3	43	45

Notes: BOT-2 : Bruininks-Oseretsky test of motor proficiency–2nd edition; MABC2 Checklist:movement assessment battery for children checklist–2nd edition; PMC-C:perceived motor competence questionnaire in childhood; PMSC-2 : perceived motor skill competence questionnaire version 2; SD:standard deviation; Q1 : 25th quartile; Q2 : 50th quartile; Q3:  75th quartile.

Correlation results

To evaluate the relationship between parents’ proxy-reported and children’s perceived motor skills and children’s actual motor skills, as well as the relationship between parents’ proxy-reported and children’s perceptions of children’s motor skills, Spearman’s rho correlations were performed. The results of the analysis are displayed in Table 3. For this study, a p-value less than 0.05 is considered statistically significant [45].

Table 3. Spearman rho correlations between variables (n = 30).

		Fine Motor Precision raw score	Fine Motor Integration raw score	Fine Manual Control composite score	Manual Dexterity raw score	Upper Limb coordination raw score	Manual Coordination composite score	Bilateral Coordination raw score	Balance raw score	Body Coordination composite score	Running Speed and Agility raw score	Strength raw score	Strength and Agility composite score	Total motor composite scale score	MABC-2 Checklist total score
PMC-C total score	ρ	0.193	−0.036	0.071	0.407*	0.539**	0.443*	0.135	0.016	−0.027	0.493**	0.450*	0.488**	0.374*	−0.480**
	p-value	0.306	0.850	0.710	0.026	0.002	0.014	0.475	0.933	0.889	0.006	0.013	0.006	0.042	0.007
PMC-C Object Control total score	ρ	0.114	−0.004	0.031	0.381*	0.640**	0.496**	0.224	0.058	0.190	0.343	0.360	0.306	0.361*	−0.431*
	p-value	0.548	0.984	0.872	0.038	<0.001	0.005	0.235	0.761	0.315	0.063	0.051	0.099	0.050	0.017
PMC-C Locomotor total score	ρ	0.352	−0.076	0.136	0.352	0.264	0.291	0.091	0.004	−0.134	0.551**	0.484**	0.579**	0.345	−0.462*
	p-value	0.056	0.688	0.475	0.056	0.159	0.119	0.633	0.985	0.481	0.002	0.007	<0.001	0.062	0.010
PMSC-2 total score	ρ	0.183	0.128	0.059	0.334	0.383*	0.325	0.151	0.058	0.224	0.402*	0.322	0.245	0.292	−0.293
	p-value	0.333	0.499	0.756	0.071	0.037	0.080	0.427	0.762	0.233	0.028	0.083	0.193	0.117	0.116
MABC-2 Checklist total score	ρ	−0.250	0.028	−0.030	−0.286	−0.301	−0.143	−0.333	0.024	−0.190	−0.352	−0.493**	−0.477**	−0.320	1.000
	p-value	0.182	0.884	0.874	0.126	0.106	0.450	0.072	0.900	0.315	0.057	0.006	0.008	0.085

Notes: BOT-2 : Bruininks-Oseretsky test of motor proficiency–2nd edition; MABC2 Checklist:movement assessment battery for children checklist–2nd edition; PMC-C:perceived motor competence questionnaire in Childhood; PMSC-2 : perceived motor skill competence questionnaire – version 2; ρ:Spearman rho correlation coefficient; **Correlation is significant at the 0.01 level; *Correlation is significant at the 0.05 level.

Correlations between the BOT-2 total motor composite and child-self report and parent-proxy-report motor scales

The BOT-2 total motor composite was significantly correlated with the PMC-C total score (ρ = 0.488, p < 0.05) and the PMC-C Object Control subscale score (ρ = 0.361, p < 0.05). No significant relationship was found between the BOT-2 and the PMSC-2 total score. Similarly, no significant correlation was found between the MABC2 Checklist total score and BOT-2 total motor composite scores.

Correlations between the BOT-2 Manual Coordination and child self-report and parent-proxy-report motor scales

The BOT-2 motor composite Manual Coordination was significantly associated with the PMC-C Object Control subscale score (ρ = 0.496, p < 0.01), and the PMC-C total score (ρ = 0.443, p < 0.05). However, no significant correlation was found to exist between the Manual Coordination motor composite and the PMSC-2 total score, PMC-C Locomotor subscale score, or MABC-2 Checklist total score.

Correlations between the BOT-2 Strength and Agility and child-self report and parent-proxy-report motor scales

A strong significant correlation was found between the MABC-2 Checklist total score and the BOT-2 motor composite Strength and Agility (ρ= −0.477, p < 0.01). The Strength and Agility BOT-2 motor composite was also highly significantly associated with the PMC-C total score (ρ = 0.488, p < 0.01) and the PMC-C Locomotor subscale (ρ = 0.579, p < 0.01). No significant association existed between the Strength and Agility motor composite and the PMC-C Object Control subscale, or the PMSC-2 total score.

Correlations between the BOT-2 Fine Manual Control and Body Coordination and child-self report and parent-proxy-report motor scales

The BOT-2 Fine Manual Control motor composite was not significantly correlated with any of the child self-report or parent-poxy-report scales. Additionally, the BOT-2 Body Coordination motor composite was not significantly correlated with any of the child self-report or parent-poxy-report scales.

Correlations between MABC-2 Checklist and child-reported motor skills

The MABC-2 Checklist was found to be significantly correlated with the PMC-C, including the PMC-C total score (ρ = 0.48, p < 0.01), the PMC-C Object Control subscale score (ρ= −0.431, p < 0.05), and the PMC-C Locomotor subscale score (ρ= −0.462, p < 0.05). No significant relationship was found to exist between the MABC-2 Checklist total score and the PMSC-2 total score.

Discussion

Relationship between parents’ proxy-reported and children’s self-reported perceptions of motor skills and children’s actual motor skill performance

Overall, the correlations between children’s PMC and AMC found in this study were moderate. Indeed, significant positive associations were found between the BOT-2 total motor composite score and the PMC-C total score, as well as the PMC-C Object Control subscale score. This means that the child participants could accurately perceive their gross motor skills and, specifically, their object control skills. While no studies to date have evaluated the relationship between PMC and AMC using the BOT-2 and PMC-C, a systematic review by De Meester and colleagues [22] also concluded a low-to-moderate association exists between children’s PMC and AMC. Additionally, two cross-sectional studies by Barnett et al. [30] and Liong and colleagues [68] came to the same conclusions, using the TGMD-2 [35] and the Pictorial Scale of Perceived Competence and Social Acceptance [69] and the TGMD-2 and PMSC [54], respectively. Similar to the current study, Estevan and colleagues [43], using the TGMD-3 and PMSC-2 in their investigation, found a weak positive association between children’s perceived and actual motor performance of object control skills. The ability of children to perceive their gross motor skills, specifically object control skills, more accurately than their fine motor skills has been linked to children paying closer attention to movements that contribute to achievements in sport (e.g. scoring a goal) [20]. Additionally, gross motor skills are more frequently performed in key developmental stages of early childhood. As such, they may provide more holistic somatosensory and visual feedback when compared to fine motor skills.

A positive significant association was also found between both the PMC-C total score and the PMC-C Object Control subscale score and the BOT-2 Manual Coordination motor composite. The current study also produced significant associations between the BOT-2 Strength and Agility motor composite and the PMC-C total score, as well as the PMC-C locomotor subscale score. The strong correlations between the BOT-2 motor composites and both the PMC-C Object Control and Locomotor subscales suggest that children in this study were more accurate in their perceptions of gross motor skills than fine motor skills. Gross motor skills not only act as foundational skills for participating in sport activities during middle childhood, but are largely used during play-based occupations and are associated with higher levels of physical activity, emotional awareness, and cognitive development [40]. An awareness of children’s perception of these skills is a valuable finding for therapists as it provides additional contextual information on the way children execute essential movement skills, in ways that may not be highlighted when independently using performance-based assessments (like the BOT-2 or the TGMD-3) [12].

In the current study, no significant association between the PMSC-2 and the BOT-2 composite scales was found. While studies by both Pesce and colleagues [29] and Morano et al. [26] reported a low or lack of association between children’s PMC and AMC, no study to our knowledge has performed correlational analyses using the BOT-2 and PMSC-2. While Bolger and colleagues [40] reported that a lack of correlation between children’s AMC and PMC can result from the child reporting on their subjective experiences of enjoyment and effort, rather than their more objective-in-nature AMC, others suggest that a lack of alignment between the two scales may have decreased the number of significant correlations produced [25]. The same scenario may explain the absence of significant associations between the BOT-2 fine motor composite subscales and all the proxy reports used in the current study.

Parents’ proxy-reported perspectives measured by the MABC-2 Checklist total score were negatively associated with the BOT-2 Strength and Agility subscale. A similar study investigated the relationship between parental proxy-reported perceptions of children’s motor skills and children’s actual motor skill performance using the MABC-2 Checklist, BOT-2, and Physical Self-Description Questionnaire (PSDQ) [21]. This study found a positive significant association between childrens’ perceived and actual strength and agility, suggesting that parents can provide accurate insight into their children’s strength ability. However, the same source proposed that parents were limited in their ability to accurately report strength-related motor tasks such as speed, endurance, and flexibility [21]. This aligns with the current study’s finding that the MABC-2 Checklist did not correlate with any other BOT-2 motor composites. Herein, parents may be able to provide unique insight into children’s strength, which can be complimented by children’s knowledge of their FMS performance. Therefore, both parents and children should be included as active agents and information sources in the assessment and therapy process to ensure that multiple perspectives into a child’s motor skill patterns are considered.

Relationship between parent-proxy-reported motor skills and child self-reported motor skills

In the current study the MABC-2 Checklist was significantly associated with the PMC-C total score, and both the PMC-C Object Control and PMC-C Locomotor subscales. However, no significant correlation was found between the MABC-2 Checklist and the PMSC-2. Although this suggests that children’s self-reported and parents’ proxy-reported perceptions are low-to-moderately associated, to the authors’ knowledge no study to date has evaluated the association between the PMC-C and the MABC-2 Checklist. Those that have investigated the association between parents’ proxy-reported motor competence and child-reported motor competence have found little to no relationship between the two, suggesting that children are more likely to overestimate their motor performance than their parents [21]. While this differs with the findings of the current study, it reinforces the concept that solely including the parent or child in the assessment and information-gathering process is insufficient to capture all relevant information about children’s motor skills for therapy planning and provision.

Limitations

While a strength of this study is its use of standardized assessment tools, it is limited by the small sample size and convenience sampling method which compromises the generalizability of results. Additionally, the use of the PMSC-2 and PMC-C as child-report scales may have contributed to social desirability bias. The study was also limited by its low number of male parent participants and the recruitment of participants from one geographical region. However, the study was strengthened by using both subjective and objective assessment tools which uphold client-centered values. Regarding the use of the PMSC-2, its use was originally designed for use with children ages 4 to 8 years, and this could be considered a limitation in the context of the current study since the child participants had a mean age of 10.57 years (SD = 1.05). A final limitation that is noted is that the PMC-C was originally developed in Germany but was completed by Australian participants. However, during administration of the PMC-C with its pictorial representations of motor skills with participants, no issues of its use in a cross-cultural context were noted by the researchers.

Future research recommendations

The use of a stratified sampling technique is recommended in future research to ensure participants’ age, gender, and geographical location are evenly represented. Future research using the PMC-C in cross-cultural populations and clinical settings is also important to reinforce the findings of the current study. Finally, a mixed-methods study on the topic would provide interesting new insight into both parent-proxy-reported and child self-report motor skill perspectives.

Professional implications

The findings suggest that children and their parents can accurately report as proxies on varying components of the child’s motor skill performance which are likely to provide unique and useful contextual information about the child’s AMC. In this context, a combination of performance-based and proxy-reports will likely provide the most accurate insights into children’s motor skill capacities. Including both family members in the therapy assessment and data collection process is encouraged to provide a more holistic report of both fine and gross motor skills that may not be captured by using the scales individually.

Conclusion

This study investigated the association between children’s self-reported and parents’ proxy-reported perceptions of children’s motor skills and children’s performance-based motor skill performance. Overall, children’s self-reported perspectives of their gross motor skills as measured by the PMC-C were significantly associated with their actual motor performance when measured using the BOT-2. In contrast, the PMSC-2 did not correlate with any other scale used in the study. The results suggest that children and parents both provide unique perspectives into children’s motor skill competence and, as such, they should be included in the occupational therapy process to support the delivery of client-centered as well as family-centered care.

Authors’ contributions

TB and M-LY conceived and designed the methodology for the study and selected the data collection tools. AH obtained institutional ethics approval, collected the data, and performed the data analysis. AH drafted the manuscript with critical input, reviewing, and editing from TB and M-LY. All authors approved the version of the manuscript to be published.

Acknowledgements

The authors wish to thank the participating school principals for their time and collaboration with the researchers which allowed for participant recruitment. The researchers would also like to express their gratitude to the children and parents for volunteering to participate in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

There was no direct funding for the study.