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Research Article  |   May 2013
Norm Scores of the Box and Block Test for Children Ages 3–10 Years
Author Affiliations
  • Marjolein Jongbloed-Pereboom, MSc, is PhD Student, Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, Nijmegen 6500 HE, the Netherlands; M.Jongbloed-Pereboom@pwo.ru.nl
  • Maria W. G. Nijhuis-van der Sanden, PhD, is Full Professor in Allied Health Sciences, Pediatric Physical Therapy, Department of Rehabilitation, Scientific Institute for Quality of Healthcare, Nijmegen Medical Centre, Radboud University Nijmegen, Nijmegen, the Netherlands
  • Bert Steenbergen, PhD, is Full Professor of Perception and Action Problems, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
Article Information
Assessment Development and Testing / Neurologic Conditions / Pediatric Evaluation and Intervention / School-Based Practice / Children and Youth
Research Article   |   May 2013
Norm Scores of the Box and Block Test for Children Ages 3–10 Years
American Journal of Occupational Therapy, May/June 2013, Vol. 67, 312-318. doi:10.5014/ajot.2013.006643
American Journal of Occupational Therapy, May/June 2013, Vol. 67, 312-318. doi:10.5014/ajot.2013.006643
Abstract

This study provides new norm scores for the Box and Block Test for gross manual dexterity in children ages 3–10 yr. Two hundred fifteen Dutch children performed the Box and Block Test separately with each hand. We found an age effect for the scores; older children obtained higher scores than younger children. Concurrent validity was assessed by means of comparison with the manual dexterity subtests of the Movement Assessment Battery for Children–2; correlations were significant. Intraclass correlation coefficients for test–retest and interrater reliability measures were .85 and .99, respectively. The Box and Block Test is an easy, feasible, valid, and reliable measurement for gross manual dexterity in young children. The obtained norms can be used in clinical settings to compare the gross manual dexterity of atypically developing children with that of age-related peers and to evaluate efficacy of interventions. A larger international reference population is needed to increase generalizability.

The Box and Block Test is often used in clinical rehabilitation settings to provide an indication of gross manual dexterity. In recent years, it has increasingly been used to assess gross manual dexterity of the affected versus the nonaffected hand in children and young adolescents with unilateral cerebral palsy (CP; e.g., Arnould, Penta, & Thonnard, 2007; Crajé, van Elk, et al., 2010; Mutsaarts, Steenbergen, & Bekkering, 2006), to compare atypically developing children with age-related peers, and to assess the efficacy of intervention (Crajé, Aarts, Nijhuis-van der Sanden, & Steenbergen, 2010; Sung et al., 2005). The Box and Block Test is a simple test that can be administered quickly to assess gross manual dexterity; these facets make the test a valuable and suitable test for very young children.
More than 25 yr ago, Mathiowetz, Volland, Kashman, and Weber (1985)  published norm scores for the Box and Block Test for adults. In the same year, Mathiowetz, Federman, and Wiemer (1985)  also reported norm scores for children ages 6–19 yr. Although it is important to regularly renew norm scores, they have not been updated since 1985, and norm scores for preschool-age children have not been available. Although the lack of norm scores for young children does not necessarily obviate the use of this test to assess the functionality of both hands in clinical populations, a valid comparison with a norm group is valuable to compare functional capacity with that of typically developing children. For example, although differences between both hands in unilateral CP give insight regarding the level of impairment, norm scores can provide additional information on the functioning of the unimpaired hand compared with the gross manual dexterity of age-related peers.
Comparing scores of atypically and typically developing children is important in clinical practice, because doing so provides important information on the need for clinical intervention and may provide insight into the efficacy of rehabilitation programs. Moreover, standardized tests are much needed in rehabilitation programs for preschool children, particularly for children with unilateral CP. These children may benefit significantly from early intervention aimed at improvement of hand function (e.g., Aarts, Jongerius, Geerdink, van Limbeek, & Geurts, 2010).
Reliability and validity data for the Box and Block Test have been published for adult populations, and test–retest reliability was reported in 1961 for a sample of 7- to 9-yr-old children (Cromwell, 1976). Systematic study of reliability and concurrent validity of the Box and Block Test has not until now been performed with very young children.
Our aim in this study was to provide norms for the Box and Block Test with a large group of typically developing children, ages 3–10 yr. In addition, we examined the test’s concurrent validity by means of comparison with the recently standardized manual dexterity subtests of the Movement Assessment Battery for Children–2 (MABC–2; Henderson, Sugden, & Barnett, 2010). Finally, we investigated the test–retest reliability and interrater reliability of the test.
Method
Research Design
This study was an observational quantitative study aimed at establishing new developmental norms for children on the Box and Block Test. We also sought to establish concurrent validity, test–retest reliability, and interrater reliability. Parental informed consent was obtained for all participating children before the assessments. The study was approved by the local ethics committee.
Participants
Participants were children recruited from four primary schools and two playgroups in two regions in the Netherlands. These two regions were selected for convenience regarding logistics and contacts with the schools and playgroups but were representative of the general population on socioeconomic status and ethnicity. All children were between 3 and 10 yr old. Children were stratified by chronological age (eight groups from age 3 yr to 10 yr). The aim was to include a minimum of 20 children per age group (10 boys, 10 girls). Children with medical or behavioral problems were excluded from the study.
Instruments
Box and Block Test.
Gross manual dexterity was tested with the Box and Block Test (Mathiowetz, Federman, & Wiemer, 1985; Mathiowetz, Volland, et al., 1985). Test materials included a box measuring 53.7 cm × 25.4 cm × 8.5 cm, divided into two equal compartments by a 15.2-cm-high partition, with one compartment filled with 150 colored cubes of 2.5 cm per side. Concurrent validity of the Box and Block Test in adults with neuromuscular disorders is r = .86 for the General Aptitude Test Battery and .91 for the Minnesota Rate of Manipulation test (Cromwell, 1976). Cromwell (1976)  reported test–retest reliability of r = .84 for typically developing children and r = .96 for adults with neuromuscular disorders, and Mathiowetz, Volland, et al. (1985)  reported interrater reliability in healthy adults of r = .99.
Movement Assessment Battery for Children–2.
The Dutch version of the MABC–2 (Henderson et al., 2010) assesses fine manual dexterity and was recently standardized and validated for children ages 3–16 (Henderson et al., 2010). Three subtests measure fine manual dexterity: Subtest 1 measures goal-directed movements for both hands separately (ages 3–6, Posting Coins; ages 7–10, Placing Pegs), Subtest 2 measures bimanual performance (ages 3–6, Threading Beads; ages 7–10, Threading Lace), and Subtest 3 measures the ability to draw between two lines (ages 3–6, Drawing Trail 1; ages 7–10, Drawing Trail 2). Subtests 1 and 2 are velocity tasks, and Subtest 3 is an accuracy task. The MABC–2 has a mean standard score of 10 with a standard deviation (SD) of 3 for both the subtest and the total scores (Henderson et al., 2010). Test–retest reliability of the MABC–2 was r = .80. Concurrent validity was r = .58 for the second edition of the Bruininks-Oseretsky Test of Motor Proficiency, r = .57 for the second edition of the Peabody Developmental Motor Scales, and r = .62 for the Körperskoordinations Test für Kinder (Henderson et al., 2010).
Procedure
Children performed the Box and Block Test and the MABC–2 at different stations in an empty classroom. Both testing stations were occupied by one of the trained test assistants. Each child sat on suitable, height-adjustable furniture, so that the child sat comfortably and the forearms rested on the table. The chairs were positioned facing the wall of the classroom so children could not watch each other. The Box and Block Test and MABC–2 were administered in a counterbalanced order; half of the children first performed the Box and Block Test, and half of the children first performed the MABC–2 subtests.
For the Box and Block Test, the blocks were located in one compartment at the onset of the test, and participants were asked to move as many blocks as possible with one hand to the other compartment in 60 s. Participants were instructed to grasp one block at a time, transport it over the partition, and subsequently release it in the other compartment. The test was preceded by a 15-s practice period. Both hands were tested separately, always starting with the dominant hand. The dominant hand was determined by asking the participants to draw a puppet on paper. The hand that was used to perform this task was denoted as the dominant hand. The number of blocks transferred in 60 s was the outcome score of the test, resulting in a score for the dominant hand and for the nondominant hand.
We administered all three subtests of the MABC–2 according to the instructions in the manual. The MABC–2 subtests consisted of two attempts (including two attempts per hand for Posting Coins and Placing Pegs). The raw score of the best attempt was converted into a standard score using the tables in the Dutch manual. Moreover, a total manual dexterity standard score was calculated according to the MABC–2 manual (Henderson et al., 2010).
Concurrent Validity.
We used the MABC–2 (Henderson et al., 2010) to assess the concurrent validity of the Box and Block Test.
Reliability.
We determined the test–retest reliability of the Box and Block Test by readministering the test after 1 wk to a subgroup of 22 children. These 22 children participated in a different study and were tested independently on a separate occasion. They performed only the Box and Block Test. These assessments were videotaped for offline analysis. Interrater reliability was determined by comparing scores obtained by the test assistant on the first assessment with the scores obtained by the first author (Marjolein Jongbloed-Pereboom), who scored the first assessments offline by video.
Data Collection
All data were collected between October 2010 and April 2011 by the first author and five test assistants with a background in physical therapy, movement science, or special education. The test assistants received training and supervision in assessing the Box and Block Test from the first author.
Data Analysis
Differences between boys and girls and between right- and left-handed children on the Box and Block Test and the MABC–2 were tested with independent t tests. The effect of age on the Box and Block Test was examined with a one-way analysis of variance (ANOVA). Post hoc tests of differences between age groups were performed using least significant difference analyses.
Concurrent validity of the Box and Block Test with the MABC–2 raw scores was analyzed with either Pearson or Spearman correlation coefficients, depending on normal distribution of the data. Test–retest reliability and interrater reliability were analyzed with the intraclass correlation coefficient (ICC). ICCs between .41 and .60 were considered moderate; between .61 and .80, substantial; and between .81 and 1.00, excellent, according to the guidelines provided by Landis and Koch (1977) . For test–retest reliability, differences between the first and second administration of the Box and Block Test were analyzed with a paired samples t test.
Results
Of the 371 children invited, parents of 248 participants gave written permission for their children to participate. Several children were not present at school on the day of testing, yielding a total of 236 participants. Of this group, 17 children were excluded for medical reasons (hemiplegia, hypermobility, broken arm or deformity of the hand, epilepsy, asthma, metabolic syndrome), behavioral problems (autism spectrum disorders, attention deficit disorders), or both. Data from 4 additional children age 3 yr were excluded because these children were unable to follow and understand the instructions of the Box and Block Test properly. The final total sample size was 215. Table 1 shows the number of children per age group, subdivided into boys and girls.
Table 1.
Results of the Box and Block Test
Results of the Box and Block Test×
Age, yrNBoysGirlsBox and Block Score, Dominant Handa
Box and Block Score, Nondominant Handa
MeanSDRangeMeanSDRange
3159624.27.415–3922.86.612–35
42291335.77.316–4534.18.811–49
523131040.66.727–5638.75.821–47
62781944.77.028–5744.26.630–53
739192050.35.241–6448.74.442–58
831121955.47.039–6753.96.341–71
926121456.46.845–7155.55.846–71
1032191356.46.542–6856.25.541–64
Total215101114
Table Footer NoteNote. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.
Note. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.×
Table Footer NoteaNumber of blocks transferred in 60 s.
Number of blocks transferred in 60 s.×
Table 1.
Results of the Box and Block Test
Results of the Box and Block Test×
Age, yrNBoysGirlsBox and Block Score, Dominant Handa
Box and Block Score, Nondominant Handa
MeanSDRangeMeanSDRange
3159624.27.415–3922.86.612–35
42291335.77.316–4534.18.811–49
523131040.66.727–5638.75.821–47
62781944.77.028–5744.26.630–53
739192050.35.241–6448.74.442–58
831121955.47.039–6753.96.341–71
926121456.46.845–7155.55.846–71
1032191356.46.542–6856.25.541–64
Total215101114
Table Footer NoteNote. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.
Note. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.×
Table Footer NoteaNumber of blocks transferred in 60 s.
Number of blocks transferred in 60 s.×
×
Of the 215 children, 86% showed a right-hand preference, which corresponds to the percentage of right-handed individuals in the general population (Perelle & Ehrman, 1994). Results for the Box and Block Test are shown in Table 1 and Figure 1. Results were not statistically significantly different for boys and girls or for right- and left-handed children. The one-way ANOVA revealed an age effect for the dominant hand, F(7, 207) = 62.56, p < .001, r = .82, and for the nondominant hand, F(7, 207) = 77.07, p < .001, r = .85. Older children transferred significantly more blocks in 60 s than younger children. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-old children. In these age groups, the older children transferred significantly more blocks than the younger children (see Table 1 and Figure 1). Between ages 8 and 10, this age effect was no longer observed; the scores did not differ significantly at these ages. The age effect is also depicted in Figure 1.
Figure 1.
Results of the Box and Block Test.
Note. Error bars represent 95% confidence intervals.
Figure 1.
Results of the Box and Block Test.
Note. Error bars represent 95% confidence intervals.
×
Of our sample of 215 children, 193 children were assessed with the MABC–2; the 22 children who took part in the reliability analyses were not. Results of the MABC–2 manual dexterity scores are shown in Table 2. Independent t tests revealed that boys scored significantly lower than girls on the total standard score, t(189) = 0.52, p < .001, r = .04, and on the subtest standard scores: Subtest 1 (Posting Coins or Placing Pegs), t(189) = 0.61, p < .05, r = .04; Subtest 2 (Threading Beads or Threading Lace), t(191) = 5.75, p < .001, r = .38; and Subtest 3 (Drawing Trail), t(191) = 13.77, p < .001, r = .71. In the Dutch norm group, girls also scored better than boys on the manual dexterity tasks of the MABC–2 (Henderson et al., 2010). The mean manual dexterity standard score was slightly higher in our sample than in the Dutch norm group, t(190) = 5.017, p < .001, r = .34, but the distribution of scores in our sample was not significantly different from the Dutch norm group (analyzed with χ2).
Table 2.
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores×
Age, YrTotal
Boys
Girls
MeanSDMeanSDMeanSD
3
 MD Total10.82.99.72.712.52.3
 Posting Coins10.72.010.42.111.22.0
 Threading Beads10.53.09.33.112.22.1
 Drawing Trail 110.11.89.61.911.01.4
4
 MD Total10.32.69.12.711.22.4
 Posting Coins10.82.210.32.311.12.1
 Threading Beads9.52.28.31.810.32.1
 Drawing Trail 110.51.710.02.210.91.3
5
 MD Totala9.52.09.01.510.32.6
 Posting Coinsa9.52.69.02.610.12.6
 Threading Beads10.02.49.32.510.92.1
 Drawing Trail 110.21.210.31.210.01.2
6
 MD Total10.72.510.02.611.02.5
 Posting Coins9.12.98.92.59.23.2
 Threading Beads11.42.310.72.911.71.9
 Drawing Trail 111.00.210.90.411.00.0
7
 MD Totala11.42.810.42.412.22.9
 Placing Pegsa11.42.210.82.211.92.2
 Threading Lace11.31.910.71.811.81.8
 Drawing Trail 29.72.59.32.410.22.6
8
 MD Total11.32.99.53.412.62.9
 Placing Pegs10.72.69.03.111.81.5
 Threading Lace11.01.810.12.211.61.0
 Drawing Trail 210.62.29.72.811.31.4
9
 MD Total11.23.010.23.312.42.4
 Placing Pegs11.22.011.12.311.31.7
 Threading Lace10.82.410.32.711.42.1
 Drawing Trail 210.13.18.83.711.61.4
10
 MD Total11.92.311.32.412.91.5
 Placing Pegs11.92.411.42.212.82.4
 Threading Lace11.32.111.22.411.51.3
 Drawing Trail 210.51.910.22.411.00.0
Total
 MD Total11.02.710.02.711.92.4
 Subtest 110.82.510.32.511.22.5
 Subtest 210.82.310.22.511.41.8
 Subtest 310.32.09.82.410.81.5
Table Footer NoteNote. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.
Note. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.×
Table Footer NoteaScores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).
Scores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).×
Table 2.
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores×
Age, YrTotal
Boys
Girls
MeanSDMeanSDMeanSD
3
 MD Total10.82.99.72.712.52.3
 Posting Coins10.72.010.42.111.22.0
 Threading Beads10.53.09.33.112.22.1
 Drawing Trail 110.11.89.61.911.01.4
4
 MD Total10.32.69.12.711.22.4
 Posting Coins10.82.210.32.311.12.1
 Threading Beads9.52.28.31.810.32.1
 Drawing Trail 110.51.710.02.210.91.3
5
 MD Totala9.52.09.01.510.32.6
 Posting Coinsa9.52.69.02.610.12.6
 Threading Beads10.02.49.32.510.92.1
 Drawing Trail 110.21.210.31.210.01.2
6
 MD Total10.72.510.02.611.02.5
 Posting Coins9.12.98.92.59.23.2
 Threading Beads11.42.310.72.911.71.9
 Drawing Trail 111.00.210.90.411.00.0
7
 MD Totala11.42.810.42.412.22.9
 Placing Pegsa11.42.210.82.211.92.2
 Threading Lace11.31.910.71.811.81.8
 Drawing Trail 29.72.59.32.410.22.6
8
 MD Total11.32.99.53.412.62.9
 Placing Pegs10.72.69.03.111.81.5
 Threading Lace11.01.810.12.211.61.0
 Drawing Trail 210.62.29.72.811.31.4
9
 MD Total11.23.010.23.312.42.4
 Placing Pegs11.22.011.12.311.31.7
 Threading Lace10.82.410.32.711.42.1
 Drawing Trail 210.13.18.83.711.61.4
10
 MD Total11.92.311.32.412.91.5
 Placing Pegs11.92.411.42.212.82.4
 Threading Lace11.32.111.22.411.51.3
 Drawing Trail 210.51.910.22.411.00.0
Total
 MD Total11.02.710.02.711.92.4
 Subtest 110.82.510.32.511.22.5
 Subtest 210.82.310.22.511.41.8
 Subtest 310.32.09.82.410.81.5
Table Footer NoteNote. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.
Note. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.×
Table Footer NoteaScores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).
Scores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).×
×
We tested the concurrent validity of the Box and Block Test by correlating the right- and left-hand scores on it with the raw scores on the MABC–2 manual dexterity subtests. As shown in Table 3, each subtest raw score correlated with the Box and Block Test. As expected, more blocks transported on the Box and Block Test in 60 s was statistically significantly related to better performance (faster or fewer errors) on the MABC–2 subtests. The standard scores of the subtests and the total manual dexterity standard score of the MABC–2 were divided into a group with typical scores (defined as standard score >7) and a group with at-risk scores (defined as standard score of ≤7, <1 SD).
Table 3.
Correlations of the Box and Block Test and MABC–2 Raw Scores
Correlations of the Box and Block Test and MABC–2 Raw Scores×
MABC–2Box and Block Score
Dominant HandNondominant Hand
Age Band 1, 3–6 yr
Posting Coins
 Ages 3 and 4
  Best hand−.643**−.635**
  Other hand−.642**−.681**
 Ages 5 and 6
  Best hand−.628**−.625**
  Other hand−.553**−.610**
Threading Beads
  Ages 3 and 4−.717**−.499**
 Ages 5 and 6−.400*−.450*
Drawing Trail 1a−.646**−.702**
Age Band 2, 7–10 yr
Placing Pegs
  Best handa−.436**−.458**
 Other hand−.389**−.479**
Threading Lace−.379**−.428**
Drawing Trail 2a−.249*−.282*
Table Footer NoteNote. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.
Note. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.×
Table Footer NoteaRaw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.
Raw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.×
Table Footer Note*p < .01. **p < .001.
p < .01. **p < .001.×
Table 3.
Correlations of the Box and Block Test and MABC–2 Raw Scores
Correlations of the Box and Block Test and MABC–2 Raw Scores×
MABC–2Box and Block Score
Dominant HandNondominant Hand
Age Band 1, 3–6 yr
Posting Coins
 Ages 3 and 4
  Best hand−.643**−.635**
  Other hand−.642**−.681**
 Ages 5 and 6
  Best hand−.628**−.625**
  Other hand−.553**−.610**
Threading Beads
  Ages 3 and 4−.717**−.499**
 Ages 5 and 6−.400*−.450*
Drawing Trail 1a−.646**−.702**
Age Band 2, 7–10 yr
Placing Pegs
  Best handa−.436**−.458**
 Other hand−.389**−.479**
Threading Lace−.379**−.428**
Drawing Trail 2a−.249*−.282*
Table Footer NoteNote. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.
Note. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.×
Table Footer NoteaRaw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.
Raw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.×
Table Footer Note*p < .01. **p < .001.
p < .01. **p < .001.×
×
Box and Block scores were compared for the two groups. For Subtest 1, the at-risk group scored significantly lower on the Box and Block test with both their dominant and nondominant hands, t(189) = 3.262, p < .01, r = .23, and t(189) = 2.672, p < .01, r = .19, respectively. For Subtest 2, the results were similar, t(191) = 4.062, p < .001, r = .28, and t(191) = 3.187, p < .01, r = .22, respectively. For the third subtest, Drawing Trail, we found no differences in Box and Block scores for the at-risk and typical-score groups.
For the total manual dexterity score, we found small but significant differences. Again, the at-risk group scored lower on the Box and Block test with both their dominant and nondominant hands, t(189) = 2.597, p < .05, r = .19, and t(189) = 2.514, p < .05, r = .18, respectively.
For test–retest reliability of the Box and Block test, the ICC was .85. The scores on the second assessment were about four blocks higher than the scores on the first assessment for both the dominant hand (Assessment 1: mean [M] = 47.45, SD = 6.33; Assessment 2: M = 51.59, SD = 7.32) and the nondominant hand (Assessment 1: M = 47.05, SD = 8.44; Assessment 2: M = 51.50, SD = 6.56), and this difference was statistically significant: dominant hand, t(21) = −3.90, p < .01, r = .65, and nondominant hand, t(21) = −3.82, p < .01, r = .64. For interrater reliability, the ICC was .99.
Discussion
This study provides normative data for the Box and Block Test for young children ages 3–10. Our results showed a significant age effect for performance on the Box and Block test. Older children transferred significantly more blocks in 60 s than younger children. This increase was most pronounced between ages 3 and 8, whereas between ages 8 and 10, the effect was not significant. Scores remained relatively stable at these ages.
Comparing the scores of the 6- to 10-yr-old children in our study with the norm scores of children in the Mathiowetz, Federman, and Wiemer (1985)  study, children in the 1985 study scored higher on the Box and Block Test than our participants. Specifically, 6- to 9-yr-olds in Mathiowetz, Federman, and Wiemer’s (1985)  study transferred approximately 10% more blocks than the children in our study. An interesting finding was that the 7- to 9-yr-old children in the 1961 study reported in Cromwell (1976)  scored even higher than the children in the 1985 study. This difference again amounted to approximately 10% more blocks transferred in the 1961 study. These collective findings emphasize the need to regularly update norm scores and may suggest that manual performance in children has deteriorated over the past 50 yr. If so, the reason is unknown, but differences may be ascribed to small procedural differences; regional, socioeconomic, and cultural differences between the three studies; or even the less active lifestyle of children today (Boreham & Riddoch, 2001; Dollman, Norton, & Norton, 2005).
We assessed concurrent validity by means of correlation analysis between scores on the Box and Block Test and subtests of the MABC–2. These correlations were substantial for the unimanual task of the MABC–2 (Subtest 1) in the younger children, although the coefficients were lower than those for adults (Cromwell, 1976). A likely explanation for this result is that the tests used to assess validity in Cromwell’s (1976)  study required more gross manual manipulation (assessed with the Minnesota Rate of Manipulation Test, among others). The Box and Block Test merely measures gross manual performance, whereas Subtest 1 of the MABC–2 includes fine manual performance. However, we chose to validate the scores on the Box and Block test with the MABC–2 because this test had recent norm scores for children age 3 yr and older.
The correlations between the Box and Block score and the other two subtests of the MABC–2 were moderate but significant. Even for these more complex manual tasks, a high correlation remains for the more basic gross manual dexterity scores of the Box and Block Test. Moreover, children with scores on the MABC–2 <1 SD on Subtest 1 or 2 or total manual dexterity score scored lower on the Box and Block Test than children with a typical score on the MABC–2 Subtest 1 and 2 (≥1 SD). We did not find this difference for Subtest 3, possibly because of the substantial difference between the gross manual movement of the Box and Block Test and the writing movement required in Subtest 3 of the MABC–2, which requires fine motor dexterity.
Reliability of the Box and Block Test in our group of children was high. Interrater reliability was outstanding, as was also reported for adults (Cromwell, 1976). Test–retest reliability was also good. However, in the test–retest reliability study, performance on the second assessment was significantly better than on the first assessment. This effect was not reported for adults, although the time period between assessments was longer. In younger children, we found an apparent small but significant practice effect and an overall age effect. These differences between assessments were similar for all children, as reflected in the high ICC. These findings are important to keep in mind when administering the Box and Block Test multiple times—for example, when using it to evaluate therapeutic effects. In the 1961 study, test–retest reliability ranged from .78 to .92 for children ages 7–9 yr (reported in Cromwell, 1976). These results are similar to our findings, but the amount of time between the two assessments was not reported (Cromwell, 1976). To correct for the practice effect and to make sure children understand instructions correctly, we suggest asking the children to perform the test twice in a short time frame and reporting the highest score as the Box and Block Test score. Although this procedure would have some consequences for the provided norm data, in this way, as is common practice with the MABC–2, one would get a better idea of the child’s capabilities.
Limitations and Future Research
This study has several limitations. First, the results for the 3-yr-old children should be interpreted with caution. At this age, not all children were able to complete the Box and Block Test reliably. Some had difficulty following instructions and sustaining attention to perform the task. We therefore excluded the scores of the 3-yr-old children who were clearly unable to complete the Box and Block Test correctly (4 of 19 children, hence a little more than 20%). These findings emphasize the importance of giving clear instructions and motivating preschool children to complete the test correctly. If children cannot follow instructions properly, it is necessary to interpret test results with caution or reassess the child at a later point in time, which is a general guideline in many tests for young children.
A second limitation concerns the applicability of these normative data to other populations of children. The children in our study lived in two regions of the Netherlands that were representative of the general Dutch population. Increasing the number of participating children by including more regions and by sampling more detailed information about ethnicity and intelligence or socioeconomic status and extending assessments to other countries could increase generalizability in future studies. Moreover, it would be interesting to compare the normative data with data gathered in clinical populations and investigate whether differences in developmental patterns exist between typically and atypically developing children.
Implications for Occupational Therapy Practice
The results of this study have the following implications for occupational therapy practice:
  • This study provides normative data on the Box and Block Test for young children ages 3–10 yr.

  • The Box and Block Test is valid and reliable for measuring gross manual dexterity in a fast and easy way in young Dutch children.

  • These newly developed norms make it possible to compare gross manual dexterity of clinical populations of preschool- and school-age children with that of typically developing Dutch children; however, more international reference data are needed.

Conclusion
This study, combined with the previous studies of Mathiowetz, Federman, and Wiemer (1985)  and Mathiowetz, Volland, et al. (1985), provides normative scores for the Box and Block Test that allow its use to reliably and validly assess gross manual dexterity in typically developing children and adults, from age 2 yr to age 75 or older. Moreover, these scores can be used for comparison with atypically developing children, such as children with unilateral CP. Comparing scores for the nonaffected hand of children with unilateral CP with the norms of typically developing age-matched children provides useful information about motor problems and may aid in determining therapeutic efficacy. However, because we tested only Dutch children, sampling (international) reference populations is important. The Box and Block Test is a very simple test to administer in a therapeutic or research setting. The test duration is short; it takes approximately 3 min to carry out. This facet of the test, combined with the results of this study, make the Box and Block Test appropriate for evaluating manual dexterity in young children.
Acknowledgments
We thank Marga Huntelaar, Monique Hermanns, Roos Schoonderbeek, Angèle Peeters, Mandy Bentvelsen, and the HAN University of Applied Sciences for their help in collecting the data. We also thank all children and their parents, the schools, and playgroups who participated in this study.
References
Aarts, P. B., Jongerius, P. H., Geerdink, Y. A., van Limbeek, J., & Geurts, A. C. (2010). Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: A randomized controlled trial. Neurorehabilitation and Neural Repair, 24, 509–518. http://dx.doi.org/10.1177/1545968309359767 [Article] [PubMed]
Aarts, P. B., Jongerius, P. H., Geerdink, Y. A., van Limbeek, J., & Geurts, A. C. (2010). Effectiveness of modified constraint-induced movement therapy in children with unilateral spastic cerebral palsy: A randomized controlled trial. Neurorehabilitation and Neural Repair, 24, 509–518. http://dx.doi.org/10.1177/1545968309359767 [Article] [PubMed]×
Arnould, C., Penta, M., & Thonnard, J. L. (2007). Hand impairments and their relationship with manual ability in children with cerebral palsy. Journal of Rehabilitation Medicine, 39, 708–714. http://dx.doi.org/10.2340/16501977-0111 [Article] [PubMed]
Arnould, C., Penta, M., & Thonnard, J. L. (2007). Hand impairments and their relationship with manual ability in children with cerebral palsy. Journal of Rehabilitation Medicine, 39, 708–714. http://dx.doi.org/10.2340/16501977-0111 [Article] [PubMed]×
Boreham, C., & Riddoch, C. (2001). The physical activity, fitness and health of children. Journal of Sports Sciences, 19, 915–929. http://dx.doi.org/10.1080/026404101317108426 [Article] [PubMed]
Boreham, C., & Riddoch, C. (2001). The physical activity, fitness and health of children. Journal of Sports Sciences, 19, 915–929. http://dx.doi.org/10.1080/026404101317108426 [Article] [PubMed]×
Crajé, C., Aarts, P., Nijhuis-van der Sanden, M., & Steenbergen, B. (2010). Action planning in typically and atypically developing children (unilateral cerebral palsy). Research in Developmental Disabilities, 31, 1039–1046. http://dx.doi.org/10.1016/j.ridd.2010.04.007 [Article] [PubMed]
Crajé, C., Aarts, P., Nijhuis-van der Sanden, M., & Steenbergen, B. (2010). Action planning in typically and atypically developing children (unilateral cerebral palsy). Research in Developmental Disabilities, 31, 1039–1046. http://dx.doi.org/10.1016/j.ridd.2010.04.007 [Article] [PubMed]×
Crajé, C., van Elk, M., Beeren, M., van Schie, H. T., Bekkering, H., & Steenbergen, B. (2010). Compromised motor planning and motor imagery in right hemiparetic cerebral palsy. Research in Developmental Disabilities, 31, 1313–1322. http://dx.doi.org/10.1016/j.ridd.2010.07.010 [Article] [PubMed]
Crajé, C., van Elk, M., Beeren, M., van Schie, H. T., Bekkering, H., & Steenbergen, B. (2010). Compromised motor planning and motor imagery in right hemiparetic cerebral palsy. Research in Developmental Disabilities, 31, 1313–1322. http://dx.doi.org/10.1016/j.ridd.2010.07.010 [Article] [PubMed]×
Cromwell, F. S. (1976). Occupational therapist’s manual for basic skill assessment: Primary prevocational evaluation. Altadena, CA: Fair Oaks.
Cromwell, F. S. (1976). Occupational therapist’s manual for basic skill assessment: Primary prevocational evaluation. Altadena, CA: Fair Oaks.×
Dollman, J., Norton, K., & Norton, L. (2005). Evidence for secular trends in children’s physical activity behaviour. British Journal of Sports Medicine, 39, 892–897; discussion 897. http://dx.doi.org/10.1136/bjsm.2004.016675 [Article] [PubMed]
Dollman, J., Norton, K., & Norton, L. (2005). Evidence for secular trends in children’s physical activity behaviour. British Journal of Sports Medicine, 39, 892–897; discussion 897. http://dx.doi.org/10.1136/bjsm.2004.016675 [Article] [PubMed]×
Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2010). Movement Assessment Battery for Children, second edition (Dutch Trans., B. Smits-Engelsman). Amsterdam, the Netherlands: Pearson Assessments.
Henderson, S. E., Sugden, D. A., & Barnett, A. L. (2010). Movement Assessment Battery for Children, second edition (Dutch Trans., B. Smits-Engelsman). Amsterdam, the Netherlands: Pearson Assessments.×
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174. http://dx.doi.org/10.2307/2529310 [Article] [PubMed]
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174. http://dx.doi.org/10.2307/2529310 [Article] [PubMed]×
Mathiowetz, V., Federman, S., & Wiemer, D. (1985). Box and Block Test of manual dexterity: Norms for 6-19 year olds. Canadian Journal of Occupational Therapy, 52, 241–245. [Article]
Mathiowetz, V., Federman, S., & Wiemer, D. (1985). Box and Block Test of manual dexterity: Norms for 6-19 year olds. Canadian Journal of Occupational Therapy, 52, 241–245. [Article] ×
Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (1985). Adult norms for the Box and Block Test of manual dexterity. American Journal of Occupational Therapy, 39, 386–391. http://dx.doi.org/10.5014/ajot.39.6.386 [Article] [PubMed]
Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (1985). Adult norms for the Box and Block Test of manual dexterity. American Journal of Occupational Therapy, 39, 386–391. http://dx.doi.org/10.5014/ajot.39.6.386 [Article] [PubMed]×
Mutsaarts, M., Steenbergen, B., & Bekkering, H. (2006). Anticipatory planning deficits and task context effects in hemiparetic cerebral palsy. Experimental Brain Research, 172, 151–162. http://dx.doi.org/10.1007/s00221-005-0327-0 [Article] [PubMed]
Mutsaarts, M., Steenbergen, B., & Bekkering, H. (2006). Anticipatory planning deficits and task context effects in hemiparetic cerebral palsy. Experimental Brain Research, 172, 151–162. http://dx.doi.org/10.1007/s00221-005-0327-0 [Article] [PubMed]×
Perelle, I. B., & Ehrman, L. (1994). An international study of human handedness: The data. Behavior Genetics, 24, 217–227. http://dx.doi.org/10.1007/BF01067189 [Article] [PubMed]
Perelle, I. B., & Ehrman, L. (1994). An international study of human handedness: The data. Behavior Genetics, 24, 217–227. http://dx.doi.org/10.1007/BF01067189 [Article] [PubMed]×
Sung, I. Y., Ryu, J. S., Pyun, S. B., Yoo, S. D., Song, W. H., & Park, M. J. (2005). Efficacy of forced-use therapy in hemiplegic cerebral palsy. Archives of Physical Medicine and Rehabilitation, 86, 2195–2198. http://dx.doi.org/10.1016/j.apmr.2005.05.007 [Article] [PubMed]
Sung, I. Y., Ryu, J. S., Pyun, S. B., Yoo, S. D., Song, W. H., & Park, M. J. (2005). Efficacy of forced-use therapy in hemiplegic cerebral palsy. Archives of Physical Medicine and Rehabilitation, 86, 2195–2198. http://dx.doi.org/10.1016/j.apmr.2005.05.007 [Article] [PubMed]×
Figure 1.
Results of the Box and Block Test.
Note. Error bars represent 95% confidence intervals.
Figure 1.
Results of the Box and Block Test.
Note. Error bars represent 95% confidence intervals.
×
Table 1.
Results of the Box and Block Test
Results of the Box and Block Test×
Age, yrNBoysGirlsBox and Block Score, Dominant Handa
Box and Block Score, Nondominant Handa
MeanSDRangeMeanSDRange
3159624.27.415–3922.86.612–35
42291335.77.316–4534.18.811–49
523131040.66.727–5638.75.821–47
62781944.77.028–5744.26.630–53
739192050.35.241–6448.74.442–58
831121955.47.039–6753.96.341–71
926121456.46.845–7155.55.846–71
1032191356.46.542–6856.25.541–64
Total215101114
Table Footer NoteNote. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.
Note. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.×
Table Footer NoteaNumber of blocks transferred in 60 s.
Number of blocks transferred in 60 s.×
Table 1.
Results of the Box and Block Test
Results of the Box and Block Test×
Age, yrNBoysGirlsBox and Block Score, Dominant Handa
Box and Block Score, Nondominant Handa
MeanSDRangeMeanSDRange
3159624.27.415–3922.86.612–35
42291335.77.316–4534.18.811–49
523131040.66.727–5638.75.821–47
62781944.77.028–5744.26.630–53
739192050.35.241–6448.74.442–58
831121955.47.039–6753.96.341–71
926121456.46.845–7155.55.846–71
1032191356.46.542–6856.25.541–64
Total215101114
Table Footer NoteNote. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.
Note. Post hoc analysis revealed significant age effects for both dominant and nondominant hand scores in all age categories between 3- and 8-yr-olds: 3-yr-olds vs. 4-yr-olds, p < .001 for the dominant and nondominant hands; 4-yr-olds vs. 5-yr-olds, p < .05 for both hands; 5-yr-olds vs. 6-yr-olds, p < .05 and p < .01 for the dominant and nondominant hands, respectively; 6-yr-olds vs. 7-yr-olds, p < .01 for both hands; 7-yr-olds vs. 8-yr-olds, p < .01 for both hands. SD = standard deviation.×
Table Footer NoteaNumber of blocks transferred in 60 s.
Number of blocks transferred in 60 s.×
×
Table 2.
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores×
Age, YrTotal
Boys
Girls
MeanSDMeanSDMeanSD
3
 MD Total10.82.99.72.712.52.3
 Posting Coins10.72.010.42.111.22.0
 Threading Beads10.53.09.33.112.22.1
 Drawing Trail 110.11.89.61.911.01.4
4
 MD Total10.32.69.12.711.22.4
 Posting Coins10.82.210.32.311.12.1
 Threading Beads9.52.28.31.810.32.1
 Drawing Trail 110.51.710.02.210.91.3
5
 MD Totala9.52.09.01.510.32.6
 Posting Coinsa9.52.69.02.610.12.6
 Threading Beads10.02.49.32.510.92.1
 Drawing Trail 110.21.210.31.210.01.2
6
 MD Total10.72.510.02.611.02.5
 Posting Coins9.12.98.92.59.23.2
 Threading Beads11.42.310.72.911.71.9
 Drawing Trail 111.00.210.90.411.00.0
7
 MD Totala11.42.810.42.412.22.9
 Placing Pegsa11.42.210.82.211.92.2
 Threading Lace11.31.910.71.811.81.8
 Drawing Trail 29.72.59.32.410.22.6
8
 MD Total11.32.99.53.412.62.9
 Placing Pegs10.72.69.03.111.81.5
 Threading Lace11.01.810.12.211.61.0
 Drawing Trail 210.62.29.72.811.31.4
9
 MD Total11.23.010.23.312.42.4
 Placing Pegs11.22.011.12.311.31.7
 Threading Lace10.82.410.32.711.42.1
 Drawing Trail 210.13.18.83.711.61.4
10
 MD Total11.92.311.32.412.91.5
 Placing Pegs11.92.411.42.212.82.4
 Threading Lace11.32.111.22.411.51.3
 Drawing Trail 210.51.910.22.411.00.0
Total
 MD Total11.02.710.02.711.92.4
 Subtest 110.82.510.32.511.22.5
 Subtest 210.82.310.22.511.41.8
 Subtest 310.32.09.82.410.81.5
Table Footer NoteNote. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.
Note. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.×
Table Footer NoteaScores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).
Scores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).×
Table 2.
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores
Means and Standard Deviations of the MABC–2 Manual Dexterity Scores×
Age, YrTotal
Boys
Girls
MeanSDMeanSDMeanSD
3
 MD Total10.82.99.72.712.52.3
 Posting Coins10.72.010.42.111.22.0
 Threading Beads10.53.09.33.112.22.1
 Drawing Trail 110.11.89.61.911.01.4
4
 MD Total10.32.69.12.711.22.4
 Posting Coins10.82.210.32.311.12.1
 Threading Beads9.52.28.31.810.32.1
 Drawing Trail 110.51.710.02.210.91.3
5
 MD Totala9.52.09.01.510.32.6
 Posting Coinsa9.52.69.02.610.12.6
 Threading Beads10.02.49.32.510.92.1
 Drawing Trail 110.21.210.31.210.01.2
6
 MD Total10.72.510.02.611.02.5
 Posting Coins9.12.98.92.59.23.2
 Threading Beads11.42.310.72.911.71.9
 Drawing Trail 111.00.210.90.411.00.0
7
 MD Totala11.42.810.42.412.22.9
 Placing Pegsa11.42.210.82.211.92.2
 Threading Lace11.31.910.71.811.81.8
 Drawing Trail 29.72.59.32.410.22.6
8
 MD Total11.32.99.53.412.62.9
 Placing Pegs10.72.69.03.111.81.5
 Threading Lace11.01.810.12.211.61.0
 Drawing Trail 210.62.29.72.811.31.4
9
 MD Total11.23.010.23.312.42.4
 Placing Pegs11.22.011.12.311.31.7
 Threading Lace10.82.410.32.711.42.1
 Drawing Trail 210.13.18.83.711.61.4
10
 MD Total11.92.311.32.412.91.5
 Placing Pegs11.92.411.42.212.82.4
 Threading Lace11.32.111.22.411.51.3
 Drawing Trail 210.51.910.22.411.00.0
Total
 MD Total11.02.710.02.711.92.4
 Subtest 110.82.510.32.511.22.5
 Subtest 210.82.310.22.511.41.8
 Subtest 310.32.09.82.410.81.5
Table Footer NoteNote. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.
Note. MABC–2 = Movement Assessment Battery for Children–2; MD Total = Manual Dexterity Total standard score; SD = standard deviation; Subtest 1 = Posting Coins or Placing Pegs, Subtest 2 = Threading Beads or Threading Lace, Subtest 3 = Drawing Trail 1 or Drawing Trail 2.×
Table Footer NoteaScores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).
Scores for MD Total and Subtest 1 were missing for 1 girl (age 5) and 1 boy (age 7).×
×
Table 3.
Correlations of the Box and Block Test and MABC–2 Raw Scores
Correlations of the Box and Block Test and MABC–2 Raw Scores×
MABC–2Box and Block Score
Dominant HandNondominant Hand
Age Band 1, 3–6 yr
Posting Coins
 Ages 3 and 4
  Best hand−.643**−.635**
  Other hand−.642**−.681**
 Ages 5 and 6
  Best hand−.628**−.625**
  Other hand−.553**−.610**
Threading Beads
  Ages 3 and 4−.717**−.499**
 Ages 5 and 6−.400*−.450*
Drawing Trail 1a−.646**−.702**
Age Band 2, 7–10 yr
Placing Pegs
  Best handa−.436**−.458**
 Other hand−.389**−.479**
Threading Lace−.379**−.428**
Drawing Trail 2a−.249*−.282*
Table Footer NoteNote. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.
Note. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.×
Table Footer NoteaRaw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.
Raw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.×
Table Footer Note*p < .01. **p < .001.
p < .01. **p < .001.×
Table 3.
Correlations of the Box and Block Test and MABC–2 Raw Scores
Correlations of the Box and Block Test and MABC–2 Raw Scores×
MABC–2Box and Block Score
Dominant HandNondominant Hand
Age Band 1, 3–6 yr
Posting Coins
 Ages 3 and 4
  Best hand−.643**−.635**
  Other hand−.642**−.681**
 Ages 5 and 6
  Best hand−.628**−.625**
  Other hand−.553**−.610**
Threading Beads
  Ages 3 and 4−.717**−.499**
 Ages 5 and 6−.400*−.450*
Drawing Trail 1a−.646**−.702**
Age Band 2, 7–10 yr
Placing Pegs
  Best handa−.436**−.458**
 Other hand−.389**−.479**
Threading Lace−.379**−.428**
Drawing Trail 2a−.249*−.282*
Table Footer NoteNote. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.
Note. For Age Band 1, the subtests Posting Coins and Threading Beads were divided into scores of the youngest children (those ages 3 and 4 yr) and the scores of the children ages 5 and 6 yr because the number of coins posted and the number of threaded beads differed between these age groups. MABC–2 = Movement Assessment Battery for Children–2.×
Table Footer NoteaRaw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.
Raw scores for the subtests Drawing Trail 1 and 2 and for Age Band 2 Placing Pegs best hand were nonnormally distributed and therefore tested with Spearman’s correlation coefficient.×
Table Footer Note*p < .01. **p < .001.
p < .01. **p < .001.×
×