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The Bruininks-Oseretsky Test of Motor Proficiency-Short Form is reliable in children living in remote Australian Aboriginal communities

Barbara R Lucas1234*, Jane Latimer26, Robyn Doney5, Manuela L Ferreira26, Roger Adams7, Genevieve Hawkes8, James P Fitzpatrick26, Marmingee Hand9, June Oscar109, Maureen Carter11 and Elizabeth J Elliott11226

Author Affiliations

1 Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, NSW 2145, Australia

2 The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, Missenden Rd, Sydney 2050, Australia

3 Poche Centre for Indigenous Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia

4 Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia

5 School of Public Health, Curtin University of Technology, Perth, Australia

6 Sydney Medical School, University of Sydney, Sydney, Australia

7 School of Physiotherapy, University of Sydney, Sydney, Australia

8 Western Australia Country Health Services, Derby, Australia

9 University of Notre Dame, Broome, Australia

10 Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Australia

11 Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia

12 The Sydney Children’s Hospital Networks (Westmead), Westmead, Australia

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BMC Pediatrics 2013, 13:135  doi:10.1186/1471-2431-13-135

Published: 6 September 2013



The Lililwan Project is the first population-based study to determine Fetal Alcohol Spectrum Disorders (FASD) prevalence in Australia and was conducted in the remote Fitzroy Valley in North Western Australia. The diagnostic process for FASD requires accurate assessment of gross and fine motor functioning using standardised cut-offs for impairment. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) is a norm-referenced assessment of motor function used worldwide and in FASD clinics in North America. It is available in a Complete Form with 53 items or a Short Form with 14 items. Its reliability in measuring motor performance in children exposed to alcohol in utero or living in remote Australian Aboriginal communities is unknown.


A prospective inter-rater and test-retest reliability study was conducted using the BOT-2 Short Form. A convenience sample of children (n = 30) aged 7 to 9 years participating in the Lililwan Project cohort (n = 108) study, completed the reliability study. Over 50% of mothers of Lililwan Project children drank alcohol during pregnancy. Two raters simultaneously scoring each child determined inter-rater reliability. Test-retest reliability was determined by assessing each child on a second occasion using predominantly the same rater. Reliability was analysed by calculating Intra-Class correlation Coefficients, ICC(2,1), Percentage Exact Agreement (PEA) and Percentage Close Agreement (PCA) and measures of Minimal Detectable Change (MDC) were calculated.


Thirty Aboriginal children (18 male, 12 female: mean age 8.8 years) were assessed at eight remote Fitzroy Valley communities. The inter-rater reliability for the BOT-2 Short Form score sheet outcomes ranged from 0.88 (95%CI, 0.77 – 0.94) to 0.92 (95%CI, 0.84 – 0.96) indicating excellent reliability. The test-retest reliability (median interval between tests being 45.5 days) for the BOT-2 Short Form score sheet outcomes ranged from 0.62 (95%CI, 0.34 – 0.80) to 0.73 (95%CI, 0.50 – 0.86) indicating fair to good reliability. The raw score MDC was 6.12.


The BOT-2 Short Form has acceptable reliability for use in remote Australian Aboriginal communities and will be useful in determining motor deficits in children exposed to alcohol prenatally. This is the first known study evaluating the reliability of the BOT-2 Short Form, either in the context of assessment for FASD or in Aboriginal children.

Fetal alcohol spectrum disorders; Fetal alcohol syndrome (FAS); Alcohol related neurodevelopmental disorder; Australian Aborigine; Maternal use of alcohol; School-aged children; Reproducibility of results; Culture; Motor skills; Child development