WITHDRAWN: The Difference in Fine Motor Performance Between Saudi Boys and Girls in Preschool Age: A Pilot Study

doi:10.21203/rs.3.rs-2653093/v1

Background

Fine motor skills in form of grasping and visual motor integration are essential to social and emotional adaptation in preschool age, it may different in age and gender which affect the performance of the child in school.

Methods

Three hundred children aged three to six years old were recruited at public and private preschools in Riyadh, Saudi Arabia. The 150 boys and 150 girls were divided into three groups each by age: (1) three to four years, (2) four to five years and (3) five to six years. Fine motor skills were assessed one time using the grasping and visual-motor integration subtests of the Peabody Developmental Motor Scales, Second Edition (PDMS-2). The raw scores and age equivalences of the subtests were evaluated.

Results

There were no significant gender differences in the mean raw scores or age equivalence results on either set of subtests. The youngest group had significantly lower mean visual-motor integration, grasping and age equivalence scores than either of the other age groups (separately for boys and girls).

Conclusion

In a sample of Saudi preschool children, there were no significant gender differences in grasping or visual-motor integration fine motor skills, and age differences seemed to be developmentally appropriate

Fine motor skill

Grasping

Preschool

Visual-motor integration

Visual perception

Children begin to learn functional and manipulative object control and fine motor skills during early childhood. Fine motor skills are the movements of small body muscles to accomplish intricate tasks, including common daily activities, such as grasping objects, writing and fastening buttons on clothing. Many of these movements are basic, essential and usually engaged in as part of children’s everyday lives, and some of them might be milestones in development and functionality [1, 2, 3, 4, 5].

Fine motor skills generally require grasping, visual-motor integration (VMI) and eye-hand coordination. Grasping is the use of hand and finger muscles to perform a task or hold an object [6, 7], VMI is the interaction of visual skills, visual perception skills, and motor skills [8]. The coordination between visual perception and finger-hand movements using VMI and eye-hand coordination for smooth and efficient movement patterns is important to social and emotional adaptation in school [9, 10, 11, 12].

The importance of fine motor functioning to humans cannot be exaggerated. The cortical representation of the hands in the brain is large and strongly connected to children’s cognition [13]. Several factors influence the development of fine motor skills, such as central nervous system maturation, muscle strength and muscle tone. In addition, VMI skills, which rely on fine motor coordination, intact VMI abilities, motor inhibition, and sustained attention, have an influential role in shaping fine motor skills [14, 15]. Weak fine motor skills influence children’s cognitive learning and academic performance and lead to dysgraphia or poor handwriting, such as incorrect placement or size of letters and insufficient pencil grip, which influence motivation and self-esteem [16, 17, 18, 19, 20, 21, 22].

This study hypothesized gender differences in VMI and grasping skills among preschool children in Saudi Arabia. The development of children’s fine motor skills was previously found to be different by gender [23, 24, 25, 26, 27], with girls demonstrating manual dexterity at younger ages than boys [28, 29]. Among three to four year old children in Prague and central Bohemia, this study [30] found that fine motor skills in girls were better than among boys of the same age using the Movement Assessment Battery for Children, Second Edition (Age Band 1). On the other hand, other study [31] found no significant gender difference in fine motor skill development in West Virginia in the United States, but the sample size was marginally small and not randomly selected.

The main objective of the present study was to investigate gender differences in fine motor skills in a sample of preschool children specifically regarding grasping skills and VMI using the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Several previous studies have used the PDMS-2 to evaluate development, ranging from average motor development [32] to specific health conditions, such as cerebral palsy [33], low infant birth weight [34], and Autism spectrum disorder [35]. This study’s second objective was to determine the influence of age on fine motor performance within gender.

Study design:

This study was a non-experimental, prospective, analytical and descriptive investigation of the differences in fine motor skills between preschool girls and boys in Saudi Arabia.

Participants

The participants of this study were a convenience sample of 300 boys and girls ranging from three to six years old. The participants were randomly selected from public and private schools in Riyadh, Saudi Arabia. Children identified as having a cognitive, auditory, or visual defect, or with observed tightness or fixed deformities of the upper limbs were excluded. First, the 300 participants were categorized by gender: 150 boys and 150 girls. Each gender group were subdivided into three age groups: Group A: ages three or four years old; Group B: ages four or five years old; and Group C: ages five or six years old. Sample size calculation was performed prior to the study using G*POWER statistical software (version 3.1.9.2; Franz Faul, Universitat Kiel, Germany) [F tests- MANOVA: special effect and interaction, α = 0.05, β = 0.1, and effect size = 0.14] and revealed that the appropriate sample size for this study was N = 300.

Instruments:

Peabody developmental motor scale-2 (PDMS-2) [36]:

Many previous studies have confirmed the PDMS-2 as a valid and reliable instrument for evaluating fine motor performance (high inter-rater reliability (0.97–0.99 in subtests) and test-retest reliability depending on the age group (r = 0.73–0.96) [7, 21, 36]. It is a standard instrument mostly used to assess child development from birth to six years. It has two domain scores (gross motor performance and fine motor performance) based on the results of six subtests (locomotion, stationary, object manipulation, reflexes, VMI, and grasping). All tasks are age appropriate and intended to reflect the average maturation of the human motor system during early development. This study used the fine motor performance subtests to assess the participants’ grasping and VMI skills.

Grasping. The grasping assessment was designed for children aged birth to 54 months (4.5 years). It aims to determine children’s abilities to use their hands and fingers. First, the child holds an object with one hand and, then, the child engages in activities with the object that include the controlled usage of the fingers of both hands. Altogether, there are 26 objects.

VMI. This subtest is intended to assess children’s abilities to coordinate and use their visual perception abilities to perform eye-hand coordination tasks (e.g. copying designs and building with blocks). It consists of 72 items targeted at children aged birth to 72 months (six years).

Procedures:

The participants were tested from February 2021 to September 2022. A physiotherapist individually tested each participant in a quiet location at the participant’s school. Each grasping or VMI assessment lasted between 30 and 40 minutes. First, personal information about the participant (name, age and gender) was obtained and the testing date was recorded. The participant’s chronological age was calculated by subtracting the birth date from the testing date. The chronological age of the child was calculated in months. Second, the physiotherapist recorded each child’s raw grasping score, VMI score and the age equivalence of each subtest. The raw scores were recorded and, then, converted to the age equivalence of each subtest.

Raw Scores:

The raw scores were the summed number of points that the participants earned on the subtests (i.e., participants received zero, one or two points as scores for each of the 26 grasping items and for each of the 72 VMI items). Because the fine motor difficulty levels for the items varied by subtest, the raw scores were treated as having little clinical value. To decrease the testing time, entry points, basal levels, and ceiling levels were used for all tests. The entry points were marked on each subtest as determined by observation to indicate to the physiotherapist when testing on an item should begin.

Because all the subtests took a relatively long time for young children to complete, three guidelines were used for their selection based on the participant’s age: (1) the entry point, which indicates the appropriate age for executing a given task (the age when 75% of the standardized sample successfully completed that task) so that testing would begin with items on which a given participant was expected to succeed; (2) the basal level, which involves the last of three consecutive items scored ‘2’ before the participant received another score; and (3) the ceiling level, which was identified when the participant scored zero on three consecutive items.

The scoring criterion was a three-point scale devised by the researchers. Participants who refused to attempt the task or the attempt indicated that the skill was not present received a zero, participants whose execution of the task was within but did not completely meet the item dominance criteria were given one point, and participants were given two points when the performance met the criteria of mastery.

Age Equivalents:

Age equivalence was based on the content of the subtest. Age equivalence scores were conveyed to parents to let them known whether their children’s scores on the subtests were similar to or different from other children of similar chronological ages.

Statistical Analysis:

Descriptive statistics were generated and independent samples t-tests were calculated to test the differences between the boys and girls in the three age groups. The Shapiro-Wilk test was used to check the normality of the distributions of all variables. The homogeneity between groups was assessed using Levene’s Test for Homogeneity of Variances. A two-way Multiple Analysis of Variance (MANOVA) test examined the relationships between age and gender on grasping and VMI subtest scores. Post-hoc tests used the Bonferroni correction to counteract the problem of multiple comparisons. The statistical significance cut-off level was set at p < 0.05, and SPSS (version 22 for Windows) was used to perform all statistical procedures.

The means and standard deviations of the participants’ scores are shown in Table 1 for each of the age groups by gender. There was no significant gender difference in mean age in years or in the mean chronological age in months in any age group (p > 0.05).

Table 1

Age of subjects of the study age groups.
	Girls	Boys
	x̄±SD	x̄±SD	MD	t- value	p- value
Age (years)
Group A	3.65 ± 0.2	3.62 ± 0.18	0.03	0.3	0.76*
Group B	4.6 ± 0.24	4.68 ± 0.16	-0.08	-0.84	0.4*
Group C	5.48 ± 0.34	5.59 ± 0.26	-0.11	-0.99	0.33*
Chronological age (months)
Group A	43.8 ± 2.44	43.44 ± 2.18	0.36	0.33	0.74*
Group B	55.27 ± 3.1	56.13 ± 2.11	-0.86	-0.78	0.44*
Group C	65.81 ± 4.13	67.18 ± 3.25	-1.37	-1.04	0.3*
x̄, Mean; SD, Standard deviation; MD, Mean difference; p-value, Level of significance;
*Non-significant.

Gender differences in grasping raw scores and age equivalence

Table 2 and Fig. 1 indicate no significant gender differences in the association between grasping raw scores and age equivalence (p > 0.05) or in the association between VMI and age equivalence (p > 0.05). However, there was a statistically significant relationship between age and the VMI and grasping subtests (F = 20.02, p = 0.0001), and there was a significant main effect of gender on VMI and grasping subtests (F = 2.65, p = 0.04). There was no significant interaction effect of age and gender (F = 0.55, p = 0.81).

Table 2

Mean row score and age equivalent of grasping and visual motor integration subsets of boys and girls.
	Boys	Girls
	x̄±SD	x̄±SD	MD	t- value	p- value
Grasping
Row score	50.21 ± 2.14	49.54 ± 2.45	0.67	1.25	0.21*
Age equivalent	60 ± 11.54	57.24 ± 11.87	2.76	1.01	0.31*
Visual motor integration
Row score	137.51 ± 8.14	135.48 ± 7.78	2.03	1.09	0.27*
Age equivalent	64.1 ± 11.03	61.24 ± 11.41	2.86	1.09	0.27*
x̄, *Mean; SD, Standard deviation; MD, Mean difference; p-value, Level of significance; Non significant.**

Age group differences and gender differences in grasping subtests

There was a significantly lower grasping raw score and age equivalence in Group A compared to Groups B and C for the girls and the boys (p = 0.0001), but there was no significant difference between Groups B and C (p > 0.05) (Table 3 and Fig. 2). There was no significant gender difference in grasping raw score or age equivalence in all three age groups (p > 0.05) (Table 3 and Fig. 2).

Table 3. Mean row score and age equivalent of grasping subsets of boys and girls of different age groups:

Grasping	Group A	Group B	Group C	p-value
Grasping	\(\overline{\mathbf{{\rm X}}}\)±SD	\(\overline{\mathbf{{\rm X}}}\)±SD	\(\overline{\mathbf{{\rm X}}}\)±SD	A vs B	A vs C	B vs C
*Row score*
Girls	47.4 ± 1.83	51.18 ± 1.16	51.31 ± 0.94	0.0001**	0.0001**	1*
Boys	46.77 ± 1.85	50.75 ± 2.41	50.93 ± 1.28	0.0001**	0.0001**	0.16*
MD	0.63	1.43	0.38
	p = 0.4*	p = 0. 3*	p = 0.51*
*Age equivalent*
Girls	45.7 ± 7.18	64.81 ± 8.6	65.62 ± 7.25	0.0001**	0.0001**	1*
Boys	44.88 ± 7.44	58.58 ± 11.6	63.18 ± 8.91	0.002**	0.0001**	0.5*
MD	0.82	6.23	2.44
	p = 0.83*	p = 0.08*	p = 0.42*

\(\overline{\mathbf{{\rm X}}}\), Mean; SD, Standard deviation; MD, Mean difference; p-value, Level of significance; * Non-significant;

** Significant

Age group differences and gender differences in visual motor integration subtests

There was a significantly lower visual motor integration raw score and age equivalence in Group A compared to Groups B and C for the girls and the boys (p = 0.0001), but there was no significant difference between Groups B and C (p > 0.05) (Table 4 and Fig. 3). There was no significant gender difference in visual motor integration raw score or age equivalence in all three age groups (p > 0.05) (Table 4 and Fig. 3).

Table 4

Mean row score and age equivalent of visual motor integration of boys and girls of different age groups:
Visual motor integration	Group A	Group B	Group C	p-value
Visual motor integration	\(\overline{\mathbf{{\rm X}}}\)±SD	\(\overline{\mathbf{{\rm X}}}\)±SD	\(\overline{\mathbf{{\rm X}}}\)±SD	A vs B	A vs C	B vs C
Row score
Girls	125.8 ± 6.47	141.27 ± 2.14	142.25 ± 2.3	0.0001**	0.0001**	1*
Boys	123.88 ± 5.23	138.25 ± 3.57	139.93 ± 3.67	0.0001**	0.0001**	0.8*
MD	0.63	1.43	0.38
	p = 0.29*	p = 0.07*	p = 0.1*
Age equivalent
Girls	48.5 ± 9.77	69.6 3 ± 2.06	70.06 ± 3.04	0.0001**	0.0001**	1*
Boys	45.33 ± 8	65 ± 6.36	67.37 ± 6.83	0.002**	0.0001**	0.97*
MD	3.17	4.63	2.69
	p = 0.27*	p = 0.08*	p = 0.23*
\(\overline{\mathbf{{\rm X}}}\), *Mean; SD, Standard deviation; MD, Mean difference; p-value, Level of significance; Non-significant; Significant.

The purpose of this study was to examine differences in fine motor skill performance between preschool boys and girls in Saudi Arabia. To the best of our knowledge, no previous studies on these differences have been conducted in Saudi preschools. The results indicated no significant differences between boys and girls in grasping or VMI. During the assessments, the researchers observed that the grasping skills were similar, but VMI was slightly better, in girls than boys.

Other factors might have influenced the children’s performance, such as environmental, socio-cultural and biological factors that are important to fine motor performance, specifically neurological maturation [23, 30, 37, 38]. Furthermore, attention and concentration in preschool education is equally focused on boys and girls during classroom time and activity time. Most Saudi preschools now have gender mixed classes with various activities that require girls and boys to cooperate and work together. This approach might influence the ways that boys and girls perceive and respond to their school environments. Furthermore, social media usage and parent groups have become common, and parents are more aware of and educated about the effects of childcare and play activities on their children.

Although this study found no significant gender difference in fine motor performance, there was a significant difference between the age groups. Significant differences between Group A (3 to 4 years) and Group B (4 to 5 years) were found for girls and for boys, but there was no significant difference between Group B (4 to 5 years) and Group C (5 to 6 years) for either gender. In addition, fine motor skills were better in Group A and Group B than Group C, but the developmental level of Group B was the same as that of Group C.

Regarding the significant differences between Group A and Group B, these outcomes might be attributable to the increase in social activities that children experience with their peers between three and five years old. At about age three, which was the young limit of Group A, children tend to be shy and just beginning to adapt to the preschool social environment; however, by the time children are about four years old (the lower age limit of Group B), they tend to be more socially active and comfortable. In addition, the children in Group A apparently were more interested in playing and becoming accustomed to their new environment.

Formal preschool teaching in Saudi Arabia using teaching tools and classroom activities begins at ages four to five years (Group B). As the children use these tools and engage in the structured activities, their fine motor skills improve. Regarding tools that promote fine motor skills, most of the Group A children’s parents were uncomfortable with their children’s use of some tools, such as scissors. The Group B children had freer access to these tools and used them relatively often.

The Saudi culture has an essential role in fine motor skill development. In East Asian countries, children are taught to use chopsticks as young as two years old, which enhances their fine motor skills to performance levels higher than those of children in Western countries [39]. Saudi children’s development also is influenced by culture, but these influences differ depending on the family background and environment, which are quite varied in Saudi Arabia.

This study found no significant differences between Groups B and C, which might be explained by the similarities of effects of using various technologies on the children’s fine motor performance. The children currently spend most of their time engaged in screen-based activities, such as video games and playing with graphics (drawing) tablets or smartphones, which likely reduces the time they spend in other activities, such as playing cards, with wooden blocks and so on. Furthermore, regular fine motor skills’ tasks, such as tying shoelaces or buttoning shirts, are less commonly performed because of modern devices, such as zippers and Velcro™ fastenings. The opportunities for gaining fine motor skills are decreasing because of these technological and cultural changes [40, 41].

Other studies that have reported gender differences have proposed that the development in the left hemisphere of the brain and brain region is high during the first six years, which might relate to differences in fine motor skills, social cognition, and language acquisition between girls and boys. In support, the development and structure of the brain are different by gender during infancy [30, 42]. Boys aged three to four years old might need more time than girls of the same age to develop fine motor skills because of different gender-specific rhythms in brain maturation [30, 43]. Last, girls and boys tend to have different interests related to fine motor skills; for example, girls tend to be more interested than boys are in creating art and playing with small objects, whereas boys tend to be more interested than girls are in gross motor activities, such as playing with balls, cars, and dynamic activities.

This study had some limitations that influenced the results. First, the sample size was small and, to be able to generalize about gender differences in fine motor performance, a bigger sample is needed. A problem with the group comparisons was that the testing rooms were different across the schools. It is important that future studies prepare an appropriate testing room where each child is individually tested to avoid loss of attention and concentration.

In conclusion, this study found no significant differences between preschool Saudi girls and boys in fine motor performance using the PDMS-2, but there was a significant difference between the group of children aged three to four years old and the group of children aged four to five years old for both genders. However, there were no significant age differences between the group aged four to five years and the group aged five to six years for either the boys or the girls compared to the normal rate of development.

Recommendation:

Based on this study’s results, we recommend that researchers and future studies investigate fine motor performance for children with various medical conditions, such as cerebral palsy or children diagnosed within the Autistic spectrum. Fine motor skills also might differ by socioeconomic status because social class might influence children’s learning experiences.

Ethical Approval

All the ethical consideration was fulfilled before conducting the study. The study was conducted after obtaining ethical approval from the IRB institutional review board, Princess Nourah bint Abdulrahman University (KSA:H-01-R-059). All methods were performed in accordance with the relevant guidelines and regulations. The parents of all the children were provided with a written informed consent form to sign regarding their willingness to participate in the study. The procedures and purposes of the study were described in detail to the mothers before they voluntarily agreed to have their children participate. The parents were told that their children would be assigned to a gender group and one of the three age groups for their gender. They participated in a brief structured interview to collect demographic information about their children and assess the inclusion and exclusion criteria. All parents were assured of the confidentiality of their information.

Competing interests

Not applicable

Authors' contributions

Alrifaei S., Alnutifi A., and Almutiri R. identified the participatnts. Alrifaei S., Alnutifi A., and Almutiri R. got required ethical approvals. Aleidi J., Almutairi R., Alrifaei S., Alnutifi A., Almutiri R. and Alsakhawi R. S. assessed the participants. Alsakhawi R. S., Aleidi J. and Almutairi R. collected the data and analyzed it. Alsakhawi R. S., Aleidi J. and Almutairi R. wrote the main manuscript text with the interpretation of the study.

Funding

Nonfinancial benefits have been received

Losse, A., Henderson, S.E., Elliman, D., Hall, D., Knight, E. & Jongmans, M. Clumsiness in children—do they grow out of it? A 10-year follow-up study. DEV MED CHILD NEUROL. 33(1) (1991) 55–68. doi: 10.1111/dmcn.1991.33.issue-1.
Cantell, M.H., Smyth, M.M. & Ahonen, T.P. Clumsiness in adolescence: educational and motor outcomes of motor delay detected at five years old. Adapt Phys Activ Q. 11(2), 115–130, (1994). DOI: 10.1123/apaq.11.2.115.
Exner, C.E. Evaluation and interventions to develop hand skills. Occupational therapy for children (6th ed.). St. Louis: Mosb. (2010).
Landa, R.J., Gross, A.L., Stuart, E.A. & Bauman, M. Latent class analysis of early developmental trajectory in baby siblings of children with autism. J CHILD PSYCHOL PSYC.: 53(9), 986–996 (2012). doi:10.1111/j.1469-7610.2012.02558.x
Choi, B., Leech, K.A., Tager-Flusberg, H.& Nelson, C.A. Development of fine motor skills is associated with expressive language outcomes in infants at high and low risk for autism spectrum disorder. J NEURODEV DISORD. 10(1) (2018). doi:10.1186/s11689-018-9231-3.
MacKenzie, C.L. & Iberall, T. Advances in psychology, Vol. 104. The grasping hand. Amsterdam, Netherlands: North-Holland/Elsevier Science Publishers. (1994).
Hartingsveldt, M.J., Cup, E.H. & Oostendorp, R.A. Reliability and validity of the fine motor scale of the Peabody Developmental Motor Scales – 2. OCCUP THER INT.12(1), 1–13 (2005). doi:10.1002/oti.11.
Exner, C.E. Development of hand skill. Occupational therapy for children (4th ed.) St. Louis: Mosby. (2001).
Watson, T.S. & Skinner, C.H. Encyclopedia of school psychology. New York: Kluwer Academic/Plenum. (2004).
Crawford, J.D., Medendorp, W.P. & Marotta, J.J. Spatial transformations for eye-hand coordination. J. Neurophysiol. 92, 10–19 (2004). doi:10.1152/jn.00117.2004.
Sanghavi, R. & Kelkar, R. Visual-motor integration and learning-disabled children. Indian J Physiother Occup Ther. 37(2); 33–35 (2005).
Bart, O., Hajami, D. & Bar-Haim, Y. Predicting school adjustment from motor abilities in kindergarten. Infant Child Dev.: 16(6), 597–615 (2007). doi:10.1002/icd.514.
Comuk-Balci, N., Bayoglu, B., Tekindal, A., Kerem-Gunel, M. & Anlar, B. Screening preschool children for fine motor skills: environmental influence. J. Phys. Ther.28(3), 1026–1031(2016).
Schultz, R.T., Carter, A.S., Gladstone, M., Scahill, L., Leckman, J.F., Peterson, B.P. et al., Visual-Motor integration functioning in children with Tourette syndrome. Neuropsychology. 12(1):134–145 (1998).
Memisevic, H. & Hadzic, S. Development of Fine Motor Coordination and Visual-Motor Integration in Preschool Children. JSER.14(1–2) (2013). doi:10.2478/v10215-011-0032-4.
Simner, M.L. Printing Errors in Kindergarten and the Prediction of Academic Performance. J. Learn. Disabil. 15(3), 155–159 (1982). doi:10.1177/002221948201500306.
Levine, M.D. Developmental variation and learning disorders. Cambridge: Educators Publ. Service. (1987).
Cermak, S.A. & Henderson, A. The efficacy of sensory integration procedures. Sensory Integration Quarterly.: 18(1), 1–5 (1990).
Karlsdottir, R. & Stefansson, T. Problems in developing functional handwriting. Percept Mot Skills.: 94, 623–662 (2002).
Grissmer, D., Grimm, K.J., Aiyer, S.M., Murrah, W.M. & Steele, J.S. Fine motor skills and early comprehension of the world: Two new school readiness indicators. Dev Psychol. 46(5):1008 (2010). https://doi.org/10.1037/a0020104.
Lin, Y., Chao, Y., Wu, S., Lin, H., Hsu, C., Hsu, H. et al. Comprehension of handwriting development: Pen-grip kinetics in handwriting tasks and its relation to fine motor skills among school-age children. Aust. Occup. Ther. J.. 64(5), 369–380 (2017). doi:10.1111/1440-1630.12393.
Mokobane, M., Pillay, B.J. & Meyer, A.M. Fine motor deficits and attention deficit hyperactivity disorder in primary school children. S Afr J Psychol. 25, 1–5 (2019). doi:10.4102/sajpsychiatry.v25i0.1232.
Thomas, J. & French, K. Gender differences across age in motor performance: a meta- analysis, Journal of Psychol Bull. 98(2), 260–282 (1985). doi:10.1037/00332909982260.
Mathiowetz, V., Wiemer, D.M. & Federman, S.M. Grip and Pinch Strength: Norms for 6- to 19-Year-Olds. Am. J. Occup. Ther.. 40, 705–711 (1986). doi:10.5014/ajot.40.10.705.
Largo, R., Caflisch, J., Hug, F., Muggli, K., Molnar, A. & Molinari, L. Neuromotor development from 5 to 18 years. Part 2: Associated movements. DEV MED CHILD NEUROL. 43. 444–453 (2001).
Brito, G.N. & Santos-Morales, T.R. Developmental norms for the Gardner Steadiness Test and the Purdue Pegboard: a study with children of a metropolitan school in Brazil. BRAZ J MED BIOL RES. 35(8), 931–949 (2002). doi:10.1590/S0100-879X2002000800011.
Largo, R.H., Joachim, F.F. & Valentin, R. Neuromotor development from kindergarten age to adolescence: Developmental course and variability. Swiss medical weekly. 133(13–14), 193–199 (2003). doi:2003/13/smw-09883.
Junaid, K.A. & Fellowes, S. Gender Differences in the Attainment of Motor Skills on the Movement Assessment Battery for Children. PHYS OCCUP THER PEDI. 26(1–2), 5–11 (2006). doi:10.1080/J006v26n01_02.
Giagazoglou, P., Kabitsis, N., Kokaridas, D., Zaragas, C., Katartz,i E. & Kabitsis, C. The movement assessment battery in Greek preschoolers: The impact of age, gender, birth order, and physical activity on motor outcome. Res Dev Disabil. 32(6), 2577–2582 (2011). doi:10.1016/j.ridd.2011.06.020.
Kokštejn, J., Musálek, M. & Tufano, J.J. Are sex differences in fundamental motor skills uniform throughout the entire preschool period? PLOS ONE. 12(4), e0176556 (2017). doi:10.1371/journal.pone.0176556.
Pennington, K.R. Gender Differences in Gross and Fine Motor Abilities in Preschool Aged Children in West Virginia. Theses, Dissertations and Capstones. 783 (2002).
Saraiva, L., Rodrigues, L.P., Cordovil, R. & Barreiros, J. Motor profile of Portuguese preschool children on the Peabody Developmental Motor Scales-2: A cross-cultural study. Res Dev Disabil. 34(6), 1966–1973 (2013). doi:10.1016/j.ridd.2013.03.010.
Lin, K.C., Chen, H.F., Chen, C.L., Wang, T.N., Wu, C.Y., Hsieh, Y.W. et al. Validity, responsive-ness, minimal detectable change, and minimal clinically important change of the Pediatric Motor Activity Log inchildren with cerebral palsy. Res Dev Disabil. 33, 570–577 (2012).
Tavasoli, A., Azimi, P. & Montazari, A. Reliability and Validity of the Peabody Developmental Motor Scales-Second Edition for Assessing Motor Development of Low Birth Weight Preterm Infants. Pediatr. Neurol. 51(4), 522–526 (2014). doi:10.1016/j.pediatrneurol.2014.06.010.
Bremer, E., Balogh, R. & Lloyd, M. Effectiveness of a fundamental motor skill intervention for 4-year-old children with autism spectrum disorder: A pilot study. Autism. 19(8), 980–991 (2015). doi: 10.1177/1362361314557548.
Folio, M. & Fewell, R. Peabody Developmental Motor Scales – Second Edition (PDMS-2): Examiner’s manual. Austin. (2000).
Cools, W., De Martelaer, K., Samaey, C. & Andries, C. Movement skill assessment of typically developing preschool children: a review of seven movement skill assessment tool. Journal of Sport Sci Med. 8(2), 154–168 (2009).
Venetsanou, F. & Kambas, A. Environmental Factors Affecting Preschoolers' Motor Development. Early Child. Educ. J. 37(4), 319–327 (2010).
Chui, M.M., Ng, A.M., Fong, A.K., Lin, L.S. & Ng, M.W. Differences in the Fine Motor Performance of Children in Hong Kong and the United States on the Bruininks-Oseretsky Test of Motor Proficiency. HONG KONG J OCCUP TH. 17(1), 1–9 (2007). doi:10.1016/s1569-1861(07)70002-5.
Missiuna, C. Children with developmental coordination disorder: at home and in the classroom., Hamilton: Child Dev Res. (1999).
Summers, J., Larkin, D. & Dewey, D. What Impact does Developmental Coordination Disorder have on Daily Routines? Int J Dev Disabil, Development and Education.55(2), 131–141 (2008).
Piek, J., Gasson, N., Barrett, N. & Case, I. Limb and gender difference in the development of coordination in early infancy. Journal of Hum Mov Sci. 21(5–6), 621–639 (2002).
Hanlon, H., Thatcher, R. & Cline, M. Gender differences in the development of EEG coherence in normal children. Journal of Dev Neuropsychol.16(3), 479–506 (1999).

No competing interests reported.

WITHDRAWN: The Difference in Fine Motor Performance Between Saudi Boys and Girls in Preschool Age: A Pilot Study

Status:

Version 1

Editorial Note

Abstract

Background

Methods

Results

Conclusion

Figures

Introduction

Methodology

Study design:

Participants

Instruments:

Procedures:

Raw Scores:

Age Equivalents:

Statistical Analysis:

Results

Gender differences in grasping raw scores and age equivalence

Age group differences and gender differences in grasping subtests

Age group differences and gender differences in visual motor integration subtests

Discussion

Recommendation:

Declarations

References

Additional Declarations

Status:

Version 1