care, health and development Child: Original Article bs_bs_banner
doi:10.1111/cch.12190
Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI): lessons from exploration of cultural variations in visual-motor integration performance of preschoolers C. Y. Lim,*† P. C. Tan,† C. Koh,‡ E. Koh,‡ H. Guo,‡ N. D. Yusoff,‡ C. Q. See‡ and T. Tan‡ *School of Rehabilitation Science, McMaster University, Ontario, Canada †Department of Child Development, KK Women’s and Children’s Hospital, Singapore, and ‡School of Health Sciences, Occupational Therapy, Nanyang Polytechnic, Singapore Accepted for publication 20 August 2014
Abstract
Keywords assessment, Beery, children, socio-cultural, visual-motor integration Correspondence: Chun Yi Lim, Department of Child Development, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Level 5 Women’s Tower, Singapore 229899 E-mail: [email protected]
© 2014 John Wiley & Sons Ltd
Background Visual-motor integration (VMI) is important in children’s development because it is associated with the performance of many functional skills. Deficits in VMI have been linked to difficulties in academic performance and functional tasks. Clinical assessment experience of occupational therapists in Singapore suggested that there is a potential difference between the VMI performance of Singaporean and American children. Cross-cultural studies also implied that culture has an influence on a child’s VMI performance, as it shapes the activities that a child participates in. The purpose of this study was to (1) explore if there was a difference between the VMI performance of Singaporean and American preschoolers, and (2) determine if there were ethnic differences in the VMI performance of Singaporean preschoolers. Methods The Beery-VMI, which was standardized in America, is commonly used by occupational therapists in Singapore to assess the VMI ability of children. We administered the Beery-VMI (fifth edition) full form test (excluding the supplemental tests) to 385 preschoolers (mean age = 63.3 months) from randomly selected schools in Singapore. We compared the scores of Singaporean preschoolers with those of the American standardization norms using the one-sample t-test. Scores of different ethnic groups among the Singapore population were also compared using a one-way ANOVA, followed by the Bonferroni post-hoc test. Results Singaporean preschoolers and the standardization sample of American children performed significantly differently in all age groups (P < 0.05). Among the Singapore population, the scores were also significantly different (P < 0.05) between the (i) Chinese and Malay and (ii) Chinese and Indians ethnic groups. Conclusion Preschoolers from different cultural and ethnic groups had different VMI performance. Certain cultural beliefs and practices may affect VMI performance. Clinicians should exercise caution when using an assessment in communities and cultures outside the ones on which it was standardized.
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Introduction Visual-motor integration (VMI) is defined as ‘the degree to which visual perception and finger-hand movements are well coordinated’ (Beery & Beery 2006, p. 12). VMI is important in children’s development because it is associated with the performance of many functional skills. It has been associated with self-care tasks and education-related activities such as handwriting, reading and mathematics (Schneck 2001; Sortor & Kulp 2003; Barnhardt et al. 2005; Kulp 2009). Level of VMI skills has also been correlated with school readiness and adjustments in preschoolers as well as their social-emotional functioning (Kurdek & Sinclair 2000; Bart et al. 2007). In addition, Weil and Amundson (1994) and Daly and colleagues (1997) found a significant relationship between VMI and handwriting readiness among preschoolers. Many children presenting with developmental delay, learning difficulties and neurological issues present with VMI difficulties (Kushki et al. 2011; Sutton et al. 2011; Case-Smith et al. 2013). The Beery-VMI (Beery & Beery 2006) is commonly used to assess VMI and academic-related difficulties among these children. Internationally, educators, psychologists and occupational therapists use it (Feder et al. 2000), including those in Singapore. Studies have investigated the differences in performance in Beery-VMI across cultures with mixed results (Mao 1995; Mao et al. 1999; Beery & Beery 2006). For example, Mao (1995) found that Taiwanese children had higher scores than the American normative sample. They suggested that there may be some biological influence or aspects of cultural practice such as writing Chinese characters or learning to use chopsticks that may have facilitated the development of VMI in Taiwanese children. Besides the Beery-VMI, other cross-cultural studies that used related motor assessments also found that children of different cultural background have different motor skills profile. Crowe and colleagues (1999) found that Native American children scored significantly lower than the normative sample in the fine motor component of the Peabody Developmental Motor Scales – second edition (PDMS-2). Chow and colleagues (2001) found that Hong Kong children scored higher in the manual dexterity sections of the Movement Assessment Battery for Children (MABC) while the American children scored higher in the gross motor sections. Evidently, children’s cultural upbringing may influence their motor skill development and clinicians should exercise caution when using motor skill measures that were standardized in another culture (Super & Harkness 1986). Clinical experiences of paediatric occupational therapists in Singapore suggested similar conclusions that the Beery-VMI, which is standardized in America, may not detect Singaporean
© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
children who present at the clinic as having functional difficulties related to VMI. Assessing children with a measure that is standardized in another culture can potentially lead to underor over-estimation of abilities (Mao et al. 1999). Overestimation may lead to delay in providing intervention and under-estimation may lead to unwarranted medical and educational attention and may cause unnecessary anxiety (Mao et al. 1999). These clinical impressions and concerns highlight the need to explore potential differences in the VMI abilities of Singaporean and American children. In addition, this study will determine if the Beery-VMI correctly reflects the VMI abilities of Singaporean children given their particular developmental experience and context. The purposes of this study were to (1) explore if there were differences between the VMI performance of Singaporean and American preschoolers; and (2) determine if there were ethnic differences in the VMI performance of Singaporean preschoolers.
Methods Sample – inclusion and exclusion criteria The sample includes Singapore citizens and Permanent Resident children born in 2005 attending Kindergarten One level, and aged 58–69 months. We chose this age as many children receiving early intervention are within this age group (Lian et al. 2012). Children were excluded from the study if (i) their parents or guardians signed the parental opt-out forms provided; and (ii) their teachers identified them with physical impairments (including uncorrectable visual deficits), or intellectual or developmental disabilities that would render them unable to comply with the assessment protocol or to complete the assessment. International schools were excluded because of the small number of Singaporean and Permanent Resident children in them.
Sampling and stratification The population of children born in 2005 is 37 485 (ICA 2006). We used the formula n = N/1 + N(e)2 with a desired 95% confidence level and ±5 precision to calculate the sample size of 400 (Israel 2009). With an estimated dropout rate of 10%, the final sample size required is 440. In order to obtain a nationally representative sample, half the sample was obtained from schools under the largest preschool education service provider (A) and the remaining half taken from a combination of other preschool service providers (non-A). Non-A schools were further stratified into the five regions of Singapore to capture
Cultural variation in VMI performance of preschoolers
Table 1. Description and stratification of schools School type
Description
Singapore regions
School type ‘A’
Largest pre-school education service provider Combination of several smaller service providers
No regions considered
School type ‘non-A’
Broken down into 5 regions – North, North-east, East, West, Central
Table 2. Random sampling of schools School type
School type ‘A’ 18 4
School type ‘non-A’
Total No. of schools randomly selected Final No. of schools which participated in study Total No. of children opted out from study Total No. of booklets administered
90 (from all 5 regions) 14
20
9
216
184
Final sample size
400
participants of various socio-economic and educational backgrounds. See Table 1 for illustration. We conducted two rounds of random sampling which yielded a total of 18 A schools and 90 non-A schools, to which letters of invitation to participate in the study were sent. Non-A schools are privately owned and have fewer children so they were sampled more. Out of the 108 preschools, four A schools and 14 non-A schools responded to the invitation. Twenty-nine children declined to participate in the study, leaving a remaining sample of 400 participants. See Table 2 for illustration.
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properties (Beery & Beery 2006). Beery and Beery (2004) reported that the inter-rater reliability ranged from 0.92 to 0.98 and test–retest reliability correlation is 0.92 for a 2-week interval. Brown and colleagues (2009) and Mao and colleagues (1999) examined its construct validity using the Rasch Measurement Model and found overall scalability and unidimensionality. Concurrent validity was provided by correlation of VMI scores of children with their scores for Developmental Test of Visual Perception – second edition (DTVP-2) copying subscale (r = 0.75) and eye–hand co-ordination subscale (r = 0.65), Wide Range Achievement Visual-Motor Assessment Drawing Test (WRAVMA) (r = 0.52) and the Bender Gestalt Test (r = 0.29–0.93, median = 0.56) (Beery & Beery 2004). Other studies have proven its convergent validity (Brown et al. 2011; Sutton et al. 2011) and discriminant validity (Chang & Yu 2009). Beery and Beery (2006) claimed that the Beery-VMI is not culture bias based on their norming studies completed in 1981. They found no statistical differences between the Beery-VMI scores of children from different ethnic groups such as AfricanAmerican, Caucasian and Hispanic-American (Beery & Beery 2004). When compared with American children, Chinese children appeared to perform better on the Beery-VMI at early ages and Greek and Norwegian children performed less well (Beery & Beery 2006). Mixed conclusions were found for comparisons between African-American and Caucasian children (Beery & Beery 2006). No statistical differences were found on the BeeryVMI for Native American and non-Native American kindergarten children (Beery & Beery 2006).
Procedures Instrument For this study, we used the Beery-VMI (fifth edition) full form test, excluding the supplemental tests. The Beery-VMI (fifth edition) is a norm-referenced measure that was developed and standardized in America on five occasions since 1960 through studies involving over 11 000 children (Beery & Beery 2004). It was developed as an early screening tool to identify children who have not fully integrated their visual and motor abilities (Beery & Beery 2004). The adolescence and adult versions were developed subsequently. The paediatric version of the BeeryVMI (fifth edition) is for children/adolescence 2 years to 18 years 11 months and includes a sequence of 30 geometric shapes, arranged in a developmental sequence and to be copied or imitated by children using pencil and paper. The Beery-VMI is a widely used visual motor assessment because of its extensive and well-documented psychometric
Given that the study presents less than minimal risk to participants, we applied for wavier of informed consent to increase participation rate, and it was approved by SingHealth Centralised Institutional Review Board (Singapore). Parents were provided with an information sheet with an opt-out option form attached. They could fill in the opt-out option form if they would like to withdraw from the study. Prior to the actual administration, the principal investigator who had 15 years of experience in the paediatric field conducted group training for co-investigators on Beery-VMI administration. During training, we adhered to the Beery-VMI (fifth edition) manual guidelines and standardized the administration instructions, procedures, management of participants’ behaviours and the environmental layout to ensure consistency in administration. We also conducted an administration trial with 20 children from a kindergarten of convenience sample and refined the
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procedures after the trial. The standardized procedures were documented in a protocol, which investigators referred to during the administration phase. The actual administration sessions were conducted in school classrooms. During each administration session, two co-investigators were allocated four to five participants each. Participants were allowed to complete all the geometric forms found in the assessment booklet without regard to the number of mistakes they made in the process. Two co-investigators independently scored each set of booklets using standard measurement equipment and in accordance to the Beery-VMI (fifth edition) scoring criteria. Every item scored was compared between the two co-investigators. Any discrepancies in scores were discussed and agreed upon by consensus between the two co-investigators. The principal investigator randomly reviewed 175 booklet and any discrepancies in scores were discussed and agreed upon by consensus. Of the 400 booklets received, 391 were scored. Booklets filled in by children who required additional verbal instructions that were not in accordance to the Beery-VMI (fifth edition) standardized procedures were excluded (n = 9).
Data analysis We used the IBM SPSS 22.0 to perform the statistical analysis. Descriptive statistics were calculated to characterize the performance of the Singaporean sample on the Beery-VMI by age and ethnic groups. Normality and homogeneity of variances were tested to ensure that no assumptions were violated and appropriate statistical tests were used. To determine if there were differences between the standard score means of the Singaporean and USA samples for each age group, the one-sample t-test was used. In addition, Cohen’s d measure of effect size was calculated to examine the extent of difference. Effect sizes of 0.8 were interpreted as small, moderate and large, respectively (Cohen 1988). To determine if there was a difference between the standard score means of the various ethnic groups in Singapore, the one-way anova was used, followed by the Bonferroni post-hoc test to examine the differences between the ethnic groups. The significance level, α, was set at 0.05 for all statistical tests.
Results Sample characteristics Of the 391 booklets that were scored, six were rejected because of insufficient sample size in the 57 months group. This yielded a final sample size of 385 participants (mean = 63.3 months,
© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
Table 3. Demographic characteristics of sample Singapore 2005 birth cohort (ICA 2006)
Sample
Gender Boys Girls Ethnicity Chinese Malay Indian Others
n
Percentage
Percentage
198 187
51.4% 48.6%
51.6% 48.4%
275 59 37 14
71.4% 15.3% 9.6% 3.6%
64.9% 17.3% 9.8% 8%
N = 385.
SD = 3.4). As depicted in Table 3, the sample was closely representative of cohort statistics in terms of gender and ethnic groups (ICA 2006).
Comparison between Singaporean and American samples Participants were divided in six 2-month age groups in accordance with the format presented in the Beery-VMI (fifth edition) manual, and the means of their standard scores were calculated. The standard score mean of each age group was compared with the standard score population mean of the American sample (mean = 100, SD = 15) that was derived from the Beery-VMI (fifth edition) manual. Table 4 presents mean scores, standard deviations and results of comparison tests between the Singapore and American samples. The onesample t-test revealed that all age groups from the Singapore sample performed statistically differently (P < 0.05) from the American sample with the mean difference ranging from 15.6 to 20.7. Cohen’s d effect size ranged from 0.79 to 0.88, indicating that all age groups of the Singaporean sample scored higher to a moderate to large extent when compared with the American sample (Cohen 1988).
Comparison between ethnic groups The Singapore sample comprised of four major ethnic groups, including Chinese, Malay, Indians and Others. Others include a small number of people from highly diverse ethnic backgrounds such as Eurasians, Caucasians, Filipinos, etc. The standard scores of the four ethnic groups are illustrated in Fig. 1. The one-way anova revealed that there is at least one group that is statistically different from one other group [F (3, 381) = 10.7, P = 0.001 < 0.05]. The Bonferroni method was used to
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Table 4. Results of comparison (t-values, P-values and Cohen’s d) between the Singapore and US (mean = 100, SD = 15) sample standard score means
of all six age groups on the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI)
Age group (n)
Mean ± SD
t-value
Degree of freedom
58–59 months (79) 60–61 months (58) 62–63 months (58) 64–65 months (70) 66–67 months (66) 68–69 months (54)
120.7 ± 11.4 119.5 ± 11.2 120.1 ± 11.3 115.6 ± 10.9 115.0 ± 11.6 113.7 ± 10.7
16.2* 13.2* 13.6* 12.1* 10.5* 9.45*
78 57 57 69 65 53
Mean difference 20.7 19.5 20.1 15.6 15.0 13.7
95% Confidence interval of the difference Lower
Upper
Cohen’s d
Effect size (r)
18.1 16.5 17.2 13.1 12.2 10.8
23.2 22.4 23.1 18.2 17.9 16.6
3.67 3.50 3.60 2.91 2.60 2.60
0.88 0.87 0.87 0.82 0.79 0.79
*P-value < 0.05.
Table 5. Results of comparison between standard score means (P-values) of the ethnic groups
Ethnic group (n)
Mean ± SD
Chinese (275)
119.4 ± 10.9
Malay (59)
111.1 ± 11.2
Indian (37)
113.7 ± 11.7
Others (14)
118.9 ± 12.1
95% Confidence Interval of the difference
Ethnicity group for comparison
Mean difference
P-value
Lower
Upper
Malay Indian Others Chinese Indian Others Chinese Malay Others Chinese Malay Indian
8.26* 5.65* 0.52 −8.26* −2.61 −7.74 −5.65* 2.61 −5.13 −0.52 7.73 5.13
0.001 0.022 1.000 0.001 1.000 0.113 0.022 1.000 0.836 1.000 0.113 0.836
4.06 0.53 −7.50 −12.5 −8.75 −16.4 −10.8 −3.53 −14.3 −8.54 −0.96 −4.05
12.5 10.8 8.54 −4.06 3.53 0.96 −0.53 8.75 4.05 7.50 16.4 14.3
*P-value < 0.05.
Indians (mean = 113.7, SD = 11.7), P = 0.001 < 0.05. The Chinese scored higher than the Indians with a mean difference of 5.65. The differences in the other groups were not statistically significant. Table 5 presents the mean standard scores, standard deviation and results of comparison between the ethnic groups.
Discussion Figure 1. Visual-motor integration performance standard scores of ethnic groups in Singapore.
further compare the VMI scores between each ethnic group. It was found that the difference in VMI standard scores between the Chinese (mean = 119.4, SD = 10.9) and the Malay (mean = 111.1, SD = 11.2) is statistically different, P = 0.001 < 0.05. The Chinese scored higher than the Malays with a mean difference of 8.26. There is also a significant difference between VMI standard scores of the Chinese (mean = 119.4, SD = 10.9) and
The purpose of this study was to explore cultural differences in the VMI performance of preschool children on the BeeryVMI. Results indicated that overall, the Singaporean preschoolers scored higher on the Beery-VMI when compared with the American standardization sample. VMI performance of the ethnic groups in Singapore also varied, with the Chinese scoring higher than the Malays and Indians. These results contrast with findings by Beery and Beery (2006) who stated that the Beery-VMI was essentially culture-free. The findings of this study suggested that preschoolers from different cultural and ethnic groups had different VMI performance. We will
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discuss this in the context of preschool education in Singapore and America and the cultural beliefs and practices of the ethnic groups in Singapore.
porean preschoolers have more opportunities to engage in tasks that require VMI and this may have innately enhanced their VMI performance.
Preschool education in Singapore and America
Cultural beliefs and practices of ethnic groups
Singapore is a meritocratic society that places emphasis on a person’s academic credentials (Tan 2008). The government places great emphasis on its education system, as Singapore lack natural resources and human resources are the main drive of its economy (Ng 2011). With the influence of the larger culture’s emphasis on achievement and success at school, Singaporean parents are likely to associate successful development of their children with academic success and value a head start in their education. Singaporean children start attending childcare and preschool centres as early as 2 years old (Low et al. 2010). These centres have a profound influence on their development, as they spend most of their growing years there (Sharpe 1998). In Singapore, the focus on preschool education is to prepare the children academically for primary school with emphasis on language, literacy, printing and numeracy skills (Sharpe 1998). As such, preschoolers begin holding writing tools at a young age and are often engaged in fine-motor and visual-motor tasks such as printing and colouring. Children are expected to be able to print and write sentences independently when they enter primary school at 7 years old. In contrast, the emphasis of America’s preschool education is on cognitive, health, social and emotional development through a play-based approach that encourages creativity (Ministry of Education 2006; Copple & Bredekamp 2009; Gordon & Browne 2013). It is believed that developing creativity encourages personal freedom and individuality, which is valued in the western culture (Wong 2008). Academic activities that involve printing and writing are considered skills learned through repetition, which is equivalent to rote learning that refutes the concept of creativity (Forman 2003). Therefore American preschoolers might participate less in repetitive fine-motor tasks such as writing and printing with more emphasis on oral language, self-expression and play. A cross-cultural study comparing the literacy programmes of preschools in Hong Kong and North America found that the North American teachers focused on the creativity and self-expression in story writing whereas the Hong Kong teachers focused on the accuracy of the print (Wong 2008). The study concluded that context could influence learning priorities. Singaporean preschoolers may have a higher VMI score compared with American preschoolers because of the differences in the priorities of their learning context. With more emphasis on academics and the mastery of writing skill, Singa-
Despite receiving preschool education in the same context, the Chinese in Singapore have a higher VMI score when compared with the Malays and Indians. Numerous cross-cultural studies found that Chinese children had better fine-motor and visualmotor skills when compared with European American children (Saeki et al. 1985; Mao 1995; Chow et al. 2001; Luo et al. 2007). The studies attributed this difference to the cultural beliefs and practices of the Chinese. The Chinese culture is deeply influenced by Confucianism, a philosophical system that developed from the teachings of Confucius, a Chinese philosopher (Lee 2010). One of the teachings of Confucianism is the importance of seeking knowledge for self-improvement and to bring glory to the family (Lee 2010). Confucius introduced meritocracy to the society in which people of any background could be a government official if they passed the national imperial examination (Lee 2010). This led to the Chinese beliefs that scholastic knowledge and hard work would lead to success in life (Li 2004; Lee 2010). These beliefs and practice of meritocracy continue to exist today in the Chinese culture, including the Chinese in Singapore (Li 2004). Chinese parents therefore believe that early introduction to literacy and printing would give their children a head start in life (Wang et al. 2002). In addition to gaining mastery in printing/writing skill and reinforcing knowledge acquisition, Chinese parents also believe that repeated practice in printing/writing nurtures discipline, perseverance and concentration, values that will empower their children to succeed in life (Wong 2008). With strong beliefs in its benefits, Singaporean Chinese parents would naturally provide their children with more opportunities to practice printing/writing and this may have facilitated their VMI performance. Certain practices in the Chinese culture may also influence VMI performance of Chinese preschoolers. Chinese characters are symbols that are logographic in nature, comprise of many strokes of different directions and are typically written on worksheet frames (Lai & Leung 2012). The writing of Chinese characters requires fine-motor skills – skills assessed by the BeeryVMI – to produce the strokes, and cognitive abilities to recall the sequence and spatial relationship of the patterns (Wong 2008). In comparison, English writing is predominantly linear and has fewer strokes. Therefore writing Chinese characters could provide more experiences for the development of VMI as compared with writing English characters. Other Chinese practices
© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
Cultural variation in VMI performance of preschoolers
such as learning to use the chopsticks and to recognize Chinese characters that are visually distinct as compared with English letters may contribute to the VMI performance of Chinese preschoolers (Mao 1995; Chow et al. 2001). Few studies have explored cross-cultural differences between ethnic groups in Singapore. A local study found that the Malay and Indian students in Singapore face more academic challenges and fewer of them pass the national examinations and pursue higher education, as compared with Chinese students (Yamashita 2002). The study suggested socio-economic factors as a reason for this discrepancy and recommended more research to determine other possible reasons. Quah (2004) compared parenting styles between the ethnic groups and concluded that parents of different ethnicity and educational levels had different parenting styles. Chinese parents were more authoritative and less affectionate as compared with Malay and Indian parents. This is supported by an international study (Rao et al. 2003) that compared the parenting styles between Chinese and Indian parents. The study found that Chinese parents used more authoritative practices, focused more on academic achievement and believed in teaching their children selfcontrol. Indian parents focused more on oral expression and self-expression of emotions and affections. These studies suggested that ethnicity influenced parenting beliefs and styles and this consequently influenced the opportunities that parents provide to their preschool children. Chinese parents might be stricter in ensuring that their children engage in academic tasks and printing/writing on a regular basis and this might have innately enhanced the Singaporean Chinese children’s academic and VMI performances.
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ordering as carried out by Brown and colleagues (2009). Clinicians in Singapore should not determine if a Singaporean child require intervention based solely on the interpretation of the Beery-VMI score using the American norms. If the Beery-VMI is to be used, it is recommended that other forms of assessments such as qualitative observations and reports of functional performance should be considered to provide a holistic view of the child’s ability to function in daily occupations (Missiuna & Pollock 1995; Goyen & Duff 2005). Clinicians who encounter children who perform well on the Beery-VMI American norms but have functional difficulties should refer to the results of this study, which will be made available to clinicians in Singapore. This will prevent overestimation of children’s abilities and delays in providing intervention.
Conclusion Preschoolers from different cultural and ethnic groups had variable VMI performance. Clinicians should therefore exercise caution when using an assessment that was standardized in another culture. There is also a need to take into account different ethnic groups when assessing a child and to be aware of the demands of handwriting for children in Singapore preschools. Lastly, results of this study contribute to the growing culture and child development literature. It suggests that culture potentially structures the types of activities in which children participate and the types of activities they participate in have potential implications on their developmental outcomes (Harkness et al. 2011).
Key messages Limitations of study and recommendations One limitation is that this study did not replicate Beery and Beery (2006)’s stratification method. This may result in sampling bias, as we only stratified the sample based on type of school. There was also lack of other demographic information beyond preschool, ethnicity and gender of the participants. Regression analysis of other demographic factors such as parental income and educational levels might provide further insights to the differences in VMI performance. This study only focused on one age group; future studies including children from other age groups could determine if the trend is similar for other age groups. Considering the apparent disparity in VMI performance between the Singaporean and American sample, it is recommended that construct validity of the Beery-VMI (fifth edition) be further researched in the Singaporean context. This includes re-establishing the differential item functioning and hierarchical
• Preschoolers from different cultural and ethnic groups had different VMI performance. • The Beery-VMI is not culture-free, contrary to the findings of Beery and Beery (2006). • Clinicians should exercise caution when using an assessment in communities and cultures outside the ones on which it was standardized.
Funding This study was conducted with funds from KK Women’s and Children’s Hospital, Department of Child Development, Singapore.
Conflict of interests All authors declare that they have no conflict of interests.
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Acknowledgements We thank Ms Corrine Hoo and Ms Chia Choon Yee from Nanyang Polytechnic for their advise on the methodology of this study. We also thank Dr Mary Law, Dr Peter Rosenbaum and Associate Professor Nancy Pollock from McMaster University; Dr Mary Khetani from Colorado State University and Dr Debra Cameron from University of Toronto for their review of and feedback on earlier drafts of this paper. Lastly, we thank all preschool teachers and children who supported and participated in this study.
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Schneck, C. M. (2001) Visual perception. In: Occupational Therapy for Children, 4th edn (ed. J. Case-Smith), pp. 382–412. Mosby, Sydney, Australia. Sharpe, P. J. (1998) Aspects of preschool education in Singapore. Early Child Development and Care, 144, 129–134. Sortor, J. M. & Kulp, M. T. (2003) Are the results of the Beery-Buktenica Developmental Test of Visual-Motor Integration and its subtests related to achievement test scores? Optometry and Vision Science, 80, 758–763. Super, C. M. & Harkness, S. (1986) The developmental niche: a conceptualization at the interface of child and culture. International Journal of Behavioral Development, 9, 545–569. Sutton, G. P., Barchard, K. A., Bello, D. T., Thaler, N. S., Ringdahl, E., Mayfield, J. & Allen, D. N. (2011) Beery-Buktenica Developmental Test of Visual-Motor Integration performance in children with traumatic brain injury and attention-deficit/hyperactivity disorder. Psychological Assessment, 23, 805–809. Tan, K. P. (2008) Meritocracy and elitism in a global city: ideological shifts in Singapore. International Political Science Review, 29, 7–27. Wang, X., Bernas, R. & Eberhard, P. (2002) Variations of maternal support to children’s early literacy development in Chinese and American Indian families: implications for early childhood educators. International Journal of Early Childhood, 34, 9–23. Weil, M. J. & Amundson, S. J. C. (1994) Relationship between visuomotor and handwriting skills of children in kindergarten. American Journal of Occupational Therapy, 48, 982–988. Wong, M. N. C. (2008) How preschool children learn in Hong Kong and Canada: a cross-cultural study. Early Years, 28, 115–133. Yamashita, M. (2002) Singapore education sector analysis: improvement and challenges in academic performance of four ethnic groups in Singapore. Paper presented at the Annual Meeting of the Comparative and International Education Society, Orlando. Florida. Available at: http://eric.ed.gov/?id=ED473030 (last accessed 21 February 2014).
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doi:10.1111/cch.12190
Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI): lessons from exploration of cultural variations in visual-motor integration performance of preschoolers C. Y. Lim,*† P. C. Tan,† C. Koh,‡ E. Koh,‡ H. Guo,‡ N. D. Yusoff,‡ C. Q. See‡ and T. Tan‡ *School of Rehabilitation Science, McMaster University, Ontario, Canada †Department of Child Development, KK Women’s and Children’s Hospital, Singapore, and ‡School of Health Sciences, Occupational Therapy, Nanyang Polytechnic, Singapore Accepted for publication 20 August 2014
Abstract
Keywords assessment, Beery, children, socio-cultural, visual-motor integration Correspondence: Chun Yi Lim, Department of Child Development, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Level 5 Women’s Tower, Singapore 229899 E-mail: [email protected]
© 2014 John Wiley & Sons Ltd
Background Visual-motor integration (VMI) is important in children’s development because it is associated with the performance of many functional skills. Deficits in VMI have been linked to difficulties in academic performance and functional tasks. Clinical assessment experience of occupational therapists in Singapore suggested that there is a potential difference between the VMI performance of Singaporean and American children. Cross-cultural studies also implied that culture has an influence on a child’s VMI performance, as it shapes the activities that a child participates in. The purpose of this study was to (1) explore if there was a difference between the VMI performance of Singaporean and American preschoolers, and (2) determine if there were ethnic differences in the VMI performance of Singaporean preschoolers. Methods The Beery-VMI, which was standardized in America, is commonly used by occupational therapists in Singapore to assess the VMI ability of children. We administered the Beery-VMI (fifth edition) full form test (excluding the supplemental tests) to 385 preschoolers (mean age = 63.3 months) from randomly selected schools in Singapore. We compared the scores of Singaporean preschoolers with those of the American standardization norms using the one-sample t-test. Scores of different ethnic groups among the Singapore population were also compared using a one-way ANOVA, followed by the Bonferroni post-hoc test. Results Singaporean preschoolers and the standardization sample of American children performed significantly differently in all age groups (P < 0.05). Among the Singapore population, the scores were also significantly different (P < 0.05) between the (i) Chinese and Malay and (ii) Chinese and Indians ethnic groups. Conclusion Preschoolers from different cultural and ethnic groups had different VMI performance. Certain cultural beliefs and practices may affect VMI performance. Clinicians should exercise caution when using an assessment in communities and cultures outside the ones on which it was standardized.
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Introduction Visual-motor integration (VMI) is defined as ‘the degree to which visual perception and finger-hand movements are well coordinated’ (Beery & Beery 2006, p. 12). VMI is important in children’s development because it is associated with the performance of many functional skills. It has been associated with self-care tasks and education-related activities such as handwriting, reading and mathematics (Schneck 2001; Sortor & Kulp 2003; Barnhardt et al. 2005; Kulp 2009). Level of VMI skills has also been correlated with school readiness and adjustments in preschoolers as well as their social-emotional functioning (Kurdek & Sinclair 2000; Bart et al. 2007). In addition, Weil and Amundson (1994) and Daly and colleagues (1997) found a significant relationship between VMI and handwriting readiness among preschoolers. Many children presenting with developmental delay, learning difficulties and neurological issues present with VMI difficulties (Kushki et al. 2011; Sutton et al. 2011; Case-Smith et al. 2013). The Beery-VMI (Beery & Beery 2006) is commonly used to assess VMI and academic-related difficulties among these children. Internationally, educators, psychologists and occupational therapists use it (Feder et al. 2000), including those in Singapore. Studies have investigated the differences in performance in Beery-VMI across cultures with mixed results (Mao 1995; Mao et al. 1999; Beery & Beery 2006). For example, Mao (1995) found that Taiwanese children had higher scores than the American normative sample. They suggested that there may be some biological influence or aspects of cultural practice such as writing Chinese characters or learning to use chopsticks that may have facilitated the development of VMI in Taiwanese children. Besides the Beery-VMI, other cross-cultural studies that used related motor assessments also found that children of different cultural background have different motor skills profile. Crowe and colleagues (1999) found that Native American children scored significantly lower than the normative sample in the fine motor component of the Peabody Developmental Motor Scales – second edition (PDMS-2). Chow and colleagues (2001) found that Hong Kong children scored higher in the manual dexterity sections of the Movement Assessment Battery for Children (MABC) while the American children scored higher in the gross motor sections. Evidently, children’s cultural upbringing may influence their motor skill development and clinicians should exercise caution when using motor skill measures that were standardized in another culture (Super & Harkness 1986). Clinical experiences of paediatric occupational therapists in Singapore suggested similar conclusions that the Beery-VMI, which is standardized in America, may not detect Singaporean
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children who present at the clinic as having functional difficulties related to VMI. Assessing children with a measure that is standardized in another culture can potentially lead to underor over-estimation of abilities (Mao et al. 1999). Overestimation may lead to delay in providing intervention and under-estimation may lead to unwarranted medical and educational attention and may cause unnecessary anxiety (Mao et al. 1999). These clinical impressions and concerns highlight the need to explore potential differences in the VMI abilities of Singaporean and American children. In addition, this study will determine if the Beery-VMI correctly reflects the VMI abilities of Singaporean children given their particular developmental experience and context. The purposes of this study were to (1) explore if there were differences between the VMI performance of Singaporean and American preschoolers; and (2) determine if there were ethnic differences in the VMI performance of Singaporean preschoolers.
Methods Sample – inclusion and exclusion criteria The sample includes Singapore citizens and Permanent Resident children born in 2005 attending Kindergarten One level, and aged 58–69 months. We chose this age as many children receiving early intervention are within this age group (Lian et al. 2012). Children were excluded from the study if (i) their parents or guardians signed the parental opt-out forms provided; and (ii) their teachers identified them with physical impairments (including uncorrectable visual deficits), or intellectual or developmental disabilities that would render them unable to comply with the assessment protocol or to complete the assessment. International schools were excluded because of the small number of Singaporean and Permanent Resident children in them.
Sampling and stratification The population of children born in 2005 is 37 485 (ICA 2006). We used the formula n = N/1 + N(e)2 with a desired 95% confidence level and ±5 precision to calculate the sample size of 400 (Israel 2009). With an estimated dropout rate of 10%, the final sample size required is 440. In order to obtain a nationally representative sample, half the sample was obtained from schools under the largest preschool education service provider (A) and the remaining half taken from a combination of other preschool service providers (non-A). Non-A schools were further stratified into the five regions of Singapore to capture
Cultural variation in VMI performance of preschoolers
Table 1. Description and stratification of schools School type
Description
Singapore regions
School type ‘A’
Largest pre-school education service provider Combination of several smaller service providers
No regions considered
School type ‘non-A’
Broken down into 5 regions – North, North-east, East, West, Central
Table 2. Random sampling of schools School type
School type ‘A’ 18 4
School type ‘non-A’
Total No. of schools randomly selected Final No. of schools which participated in study Total No. of children opted out from study Total No. of booklets administered
90 (from all 5 regions) 14
20
9
216
184
Final sample size
400
participants of various socio-economic and educational backgrounds. See Table 1 for illustration. We conducted two rounds of random sampling which yielded a total of 18 A schools and 90 non-A schools, to which letters of invitation to participate in the study were sent. Non-A schools are privately owned and have fewer children so they were sampled more. Out of the 108 preschools, four A schools and 14 non-A schools responded to the invitation. Twenty-nine children declined to participate in the study, leaving a remaining sample of 400 participants. See Table 2 for illustration.
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properties (Beery & Beery 2006). Beery and Beery (2004) reported that the inter-rater reliability ranged from 0.92 to 0.98 and test–retest reliability correlation is 0.92 for a 2-week interval. Brown and colleagues (2009) and Mao and colleagues (1999) examined its construct validity using the Rasch Measurement Model and found overall scalability and unidimensionality. Concurrent validity was provided by correlation of VMI scores of children with their scores for Developmental Test of Visual Perception – second edition (DTVP-2) copying subscale (r = 0.75) and eye–hand co-ordination subscale (r = 0.65), Wide Range Achievement Visual-Motor Assessment Drawing Test (WRAVMA) (r = 0.52) and the Bender Gestalt Test (r = 0.29–0.93, median = 0.56) (Beery & Beery 2004). Other studies have proven its convergent validity (Brown et al. 2011; Sutton et al. 2011) and discriminant validity (Chang & Yu 2009). Beery and Beery (2006) claimed that the Beery-VMI is not culture bias based on their norming studies completed in 1981. They found no statistical differences between the Beery-VMI scores of children from different ethnic groups such as AfricanAmerican, Caucasian and Hispanic-American (Beery & Beery 2004). When compared with American children, Chinese children appeared to perform better on the Beery-VMI at early ages and Greek and Norwegian children performed less well (Beery & Beery 2006). Mixed conclusions were found for comparisons between African-American and Caucasian children (Beery & Beery 2006). No statistical differences were found on the BeeryVMI for Native American and non-Native American kindergarten children (Beery & Beery 2006).
Procedures Instrument For this study, we used the Beery-VMI (fifth edition) full form test, excluding the supplemental tests. The Beery-VMI (fifth edition) is a norm-referenced measure that was developed and standardized in America on five occasions since 1960 through studies involving over 11 000 children (Beery & Beery 2004). It was developed as an early screening tool to identify children who have not fully integrated their visual and motor abilities (Beery & Beery 2004). The adolescence and adult versions were developed subsequently. The paediatric version of the BeeryVMI (fifth edition) is for children/adolescence 2 years to 18 years 11 months and includes a sequence of 30 geometric shapes, arranged in a developmental sequence and to be copied or imitated by children using pencil and paper. The Beery-VMI is a widely used visual motor assessment because of its extensive and well-documented psychometric
Given that the study presents less than minimal risk to participants, we applied for wavier of informed consent to increase participation rate, and it was approved by SingHealth Centralised Institutional Review Board (Singapore). Parents were provided with an information sheet with an opt-out option form attached. They could fill in the opt-out option form if they would like to withdraw from the study. Prior to the actual administration, the principal investigator who had 15 years of experience in the paediatric field conducted group training for co-investigators on Beery-VMI administration. During training, we adhered to the Beery-VMI (fifth edition) manual guidelines and standardized the administration instructions, procedures, management of participants’ behaviours and the environmental layout to ensure consistency in administration. We also conducted an administration trial with 20 children from a kindergarten of convenience sample and refined the
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procedures after the trial. The standardized procedures were documented in a protocol, which investigators referred to during the administration phase. The actual administration sessions were conducted in school classrooms. During each administration session, two co-investigators were allocated four to five participants each. Participants were allowed to complete all the geometric forms found in the assessment booklet without regard to the number of mistakes they made in the process. Two co-investigators independently scored each set of booklets using standard measurement equipment and in accordance to the Beery-VMI (fifth edition) scoring criteria. Every item scored was compared between the two co-investigators. Any discrepancies in scores were discussed and agreed upon by consensus between the two co-investigators. The principal investigator randomly reviewed 175 booklet and any discrepancies in scores were discussed and agreed upon by consensus. Of the 400 booklets received, 391 were scored. Booklets filled in by children who required additional verbal instructions that were not in accordance to the Beery-VMI (fifth edition) standardized procedures were excluded (n = 9).
Data analysis We used the IBM SPSS 22.0 to perform the statistical analysis. Descriptive statistics were calculated to characterize the performance of the Singaporean sample on the Beery-VMI by age and ethnic groups. Normality and homogeneity of variances were tested to ensure that no assumptions were violated and appropriate statistical tests were used. To determine if there were differences between the standard score means of the Singaporean and USA samples for each age group, the one-sample t-test was used. In addition, Cohen’s d measure of effect size was calculated to examine the extent of difference. Effect sizes of 0.8 were interpreted as small, moderate and large, respectively (Cohen 1988). To determine if there was a difference between the standard score means of the various ethnic groups in Singapore, the one-way anova was used, followed by the Bonferroni post-hoc test to examine the differences between the ethnic groups. The significance level, α, was set at 0.05 for all statistical tests.
Results Sample characteristics Of the 391 booklets that were scored, six were rejected because of insufficient sample size in the 57 months group. This yielded a final sample size of 385 participants (mean = 63.3 months,
© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
Table 3. Demographic characteristics of sample Singapore 2005 birth cohort (ICA 2006)
Sample
Gender Boys Girls Ethnicity Chinese Malay Indian Others
n
Percentage
Percentage
198 187
51.4% 48.6%
51.6% 48.4%
275 59 37 14
71.4% 15.3% 9.6% 3.6%
64.9% 17.3% 9.8% 8%
N = 385.
SD = 3.4). As depicted in Table 3, the sample was closely representative of cohort statistics in terms of gender and ethnic groups (ICA 2006).
Comparison between Singaporean and American samples Participants were divided in six 2-month age groups in accordance with the format presented in the Beery-VMI (fifth edition) manual, and the means of their standard scores were calculated. The standard score mean of each age group was compared with the standard score population mean of the American sample (mean = 100, SD = 15) that was derived from the Beery-VMI (fifth edition) manual. Table 4 presents mean scores, standard deviations and results of comparison tests between the Singapore and American samples. The onesample t-test revealed that all age groups from the Singapore sample performed statistically differently (P < 0.05) from the American sample with the mean difference ranging from 15.6 to 20.7. Cohen’s d effect size ranged from 0.79 to 0.88, indicating that all age groups of the Singaporean sample scored higher to a moderate to large extent when compared with the American sample (Cohen 1988).
Comparison between ethnic groups The Singapore sample comprised of four major ethnic groups, including Chinese, Malay, Indians and Others. Others include a small number of people from highly diverse ethnic backgrounds such as Eurasians, Caucasians, Filipinos, etc. The standard scores of the four ethnic groups are illustrated in Fig. 1. The one-way anova revealed that there is at least one group that is statistically different from one other group [F (3, 381) = 10.7, P = 0.001 < 0.05]. The Bonferroni method was used to
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Table 4. Results of comparison (t-values, P-values and Cohen’s d) between the Singapore and US (mean = 100, SD = 15) sample standard score means
of all six age groups on the Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI)
Age group (n)
Mean ± SD
t-value
Degree of freedom
58–59 months (79) 60–61 months (58) 62–63 months (58) 64–65 months (70) 66–67 months (66) 68–69 months (54)
120.7 ± 11.4 119.5 ± 11.2 120.1 ± 11.3 115.6 ± 10.9 115.0 ± 11.6 113.7 ± 10.7
16.2* 13.2* 13.6* 12.1* 10.5* 9.45*
78 57 57 69 65 53
Mean difference 20.7 19.5 20.1 15.6 15.0 13.7
95% Confidence interval of the difference Lower
Upper
Cohen’s d
Effect size (r)
18.1 16.5 17.2 13.1 12.2 10.8
23.2 22.4 23.1 18.2 17.9 16.6
3.67 3.50 3.60 2.91 2.60 2.60
0.88 0.87 0.87 0.82 0.79 0.79
*P-value < 0.05.
Table 5. Results of comparison between standard score means (P-values) of the ethnic groups
Ethnic group (n)
Mean ± SD
Chinese (275)
119.4 ± 10.9
Malay (59)
111.1 ± 11.2
Indian (37)
113.7 ± 11.7
Others (14)
118.9 ± 12.1
95% Confidence Interval of the difference
Ethnicity group for comparison
Mean difference
P-value
Lower
Upper
Malay Indian Others Chinese Indian Others Chinese Malay Others Chinese Malay Indian
8.26* 5.65* 0.52 −8.26* −2.61 −7.74 −5.65* 2.61 −5.13 −0.52 7.73 5.13
0.001 0.022 1.000 0.001 1.000 0.113 0.022 1.000 0.836 1.000 0.113 0.836
4.06 0.53 −7.50 −12.5 −8.75 −16.4 −10.8 −3.53 −14.3 −8.54 −0.96 −4.05
12.5 10.8 8.54 −4.06 3.53 0.96 −0.53 8.75 4.05 7.50 16.4 14.3
*P-value < 0.05.
Indians (mean = 113.7, SD = 11.7), P = 0.001 < 0.05. The Chinese scored higher than the Indians with a mean difference of 5.65. The differences in the other groups were not statistically significant. Table 5 presents the mean standard scores, standard deviation and results of comparison between the ethnic groups.
Discussion Figure 1. Visual-motor integration performance standard scores of ethnic groups in Singapore.
further compare the VMI scores between each ethnic group. It was found that the difference in VMI standard scores between the Chinese (mean = 119.4, SD = 10.9) and the Malay (mean = 111.1, SD = 11.2) is statistically different, P = 0.001 < 0.05. The Chinese scored higher than the Malays with a mean difference of 8.26. There is also a significant difference between VMI standard scores of the Chinese (mean = 119.4, SD = 10.9) and
The purpose of this study was to explore cultural differences in the VMI performance of preschool children on the BeeryVMI. Results indicated that overall, the Singaporean preschoolers scored higher on the Beery-VMI when compared with the American standardization sample. VMI performance of the ethnic groups in Singapore also varied, with the Chinese scoring higher than the Malays and Indians. These results contrast with findings by Beery and Beery (2006) who stated that the Beery-VMI was essentially culture-free. The findings of this study suggested that preschoolers from different cultural and ethnic groups had different VMI performance. We will
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218 C.Y. Lim et al.
discuss this in the context of preschool education in Singapore and America and the cultural beliefs and practices of the ethnic groups in Singapore.
porean preschoolers have more opportunities to engage in tasks that require VMI and this may have innately enhanced their VMI performance.
Preschool education in Singapore and America
Cultural beliefs and practices of ethnic groups
Singapore is a meritocratic society that places emphasis on a person’s academic credentials (Tan 2008). The government places great emphasis on its education system, as Singapore lack natural resources and human resources are the main drive of its economy (Ng 2011). With the influence of the larger culture’s emphasis on achievement and success at school, Singaporean parents are likely to associate successful development of their children with academic success and value a head start in their education. Singaporean children start attending childcare and preschool centres as early as 2 years old (Low et al. 2010). These centres have a profound influence on their development, as they spend most of their growing years there (Sharpe 1998). In Singapore, the focus on preschool education is to prepare the children academically for primary school with emphasis on language, literacy, printing and numeracy skills (Sharpe 1998). As such, preschoolers begin holding writing tools at a young age and are often engaged in fine-motor and visual-motor tasks such as printing and colouring. Children are expected to be able to print and write sentences independently when they enter primary school at 7 years old. In contrast, the emphasis of America’s preschool education is on cognitive, health, social and emotional development through a play-based approach that encourages creativity (Ministry of Education 2006; Copple & Bredekamp 2009; Gordon & Browne 2013). It is believed that developing creativity encourages personal freedom and individuality, which is valued in the western culture (Wong 2008). Academic activities that involve printing and writing are considered skills learned through repetition, which is equivalent to rote learning that refutes the concept of creativity (Forman 2003). Therefore American preschoolers might participate less in repetitive fine-motor tasks such as writing and printing with more emphasis on oral language, self-expression and play. A cross-cultural study comparing the literacy programmes of preschools in Hong Kong and North America found that the North American teachers focused on the creativity and self-expression in story writing whereas the Hong Kong teachers focused on the accuracy of the print (Wong 2008). The study concluded that context could influence learning priorities. Singaporean preschoolers may have a higher VMI score compared with American preschoolers because of the differences in the priorities of their learning context. With more emphasis on academics and the mastery of writing skill, Singa-
Despite receiving preschool education in the same context, the Chinese in Singapore have a higher VMI score when compared with the Malays and Indians. Numerous cross-cultural studies found that Chinese children had better fine-motor and visualmotor skills when compared with European American children (Saeki et al. 1985; Mao 1995; Chow et al. 2001; Luo et al. 2007). The studies attributed this difference to the cultural beliefs and practices of the Chinese. The Chinese culture is deeply influenced by Confucianism, a philosophical system that developed from the teachings of Confucius, a Chinese philosopher (Lee 2010). One of the teachings of Confucianism is the importance of seeking knowledge for self-improvement and to bring glory to the family (Lee 2010). Confucius introduced meritocracy to the society in which people of any background could be a government official if they passed the national imperial examination (Lee 2010). This led to the Chinese beliefs that scholastic knowledge and hard work would lead to success in life (Li 2004; Lee 2010). These beliefs and practice of meritocracy continue to exist today in the Chinese culture, including the Chinese in Singapore (Li 2004). Chinese parents therefore believe that early introduction to literacy and printing would give their children a head start in life (Wang et al. 2002). In addition to gaining mastery in printing/writing skill and reinforcing knowledge acquisition, Chinese parents also believe that repeated practice in printing/writing nurtures discipline, perseverance and concentration, values that will empower their children to succeed in life (Wong 2008). With strong beliefs in its benefits, Singaporean Chinese parents would naturally provide their children with more opportunities to practice printing/writing and this may have facilitated their VMI performance. Certain practices in the Chinese culture may also influence VMI performance of Chinese preschoolers. Chinese characters are symbols that are logographic in nature, comprise of many strokes of different directions and are typically written on worksheet frames (Lai & Leung 2012). The writing of Chinese characters requires fine-motor skills – skills assessed by the BeeryVMI – to produce the strokes, and cognitive abilities to recall the sequence and spatial relationship of the patterns (Wong 2008). In comparison, English writing is predominantly linear and has fewer strokes. Therefore writing Chinese characters could provide more experiences for the development of VMI as compared with writing English characters. Other Chinese practices
© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
Cultural variation in VMI performance of preschoolers
such as learning to use the chopsticks and to recognize Chinese characters that are visually distinct as compared with English letters may contribute to the VMI performance of Chinese preschoolers (Mao 1995; Chow et al. 2001). Few studies have explored cross-cultural differences between ethnic groups in Singapore. A local study found that the Malay and Indian students in Singapore face more academic challenges and fewer of them pass the national examinations and pursue higher education, as compared with Chinese students (Yamashita 2002). The study suggested socio-economic factors as a reason for this discrepancy and recommended more research to determine other possible reasons. Quah (2004) compared parenting styles between the ethnic groups and concluded that parents of different ethnicity and educational levels had different parenting styles. Chinese parents were more authoritative and less affectionate as compared with Malay and Indian parents. This is supported by an international study (Rao et al. 2003) that compared the parenting styles between Chinese and Indian parents. The study found that Chinese parents used more authoritative practices, focused more on academic achievement and believed in teaching their children selfcontrol. Indian parents focused more on oral expression and self-expression of emotions and affections. These studies suggested that ethnicity influenced parenting beliefs and styles and this consequently influenced the opportunities that parents provide to their preschool children. Chinese parents might be stricter in ensuring that their children engage in academic tasks and printing/writing on a regular basis and this might have innately enhanced the Singaporean Chinese children’s academic and VMI performances.
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ordering as carried out by Brown and colleagues (2009). Clinicians in Singapore should not determine if a Singaporean child require intervention based solely on the interpretation of the Beery-VMI score using the American norms. If the Beery-VMI is to be used, it is recommended that other forms of assessments such as qualitative observations and reports of functional performance should be considered to provide a holistic view of the child’s ability to function in daily occupations (Missiuna & Pollock 1995; Goyen & Duff 2005). Clinicians who encounter children who perform well on the Beery-VMI American norms but have functional difficulties should refer to the results of this study, which will be made available to clinicians in Singapore. This will prevent overestimation of children’s abilities and delays in providing intervention.
Conclusion Preschoolers from different cultural and ethnic groups had variable VMI performance. Clinicians should therefore exercise caution when using an assessment that was standardized in another culture. There is also a need to take into account different ethnic groups when assessing a child and to be aware of the demands of handwriting for children in Singapore preschools. Lastly, results of this study contribute to the growing culture and child development literature. It suggests that culture potentially structures the types of activities in which children participate and the types of activities they participate in have potential implications on their developmental outcomes (Harkness et al. 2011).
Key messages Limitations of study and recommendations One limitation is that this study did not replicate Beery and Beery (2006)’s stratification method. This may result in sampling bias, as we only stratified the sample based on type of school. There was also lack of other demographic information beyond preschool, ethnicity and gender of the participants. Regression analysis of other demographic factors such as parental income and educational levels might provide further insights to the differences in VMI performance. This study only focused on one age group; future studies including children from other age groups could determine if the trend is similar for other age groups. Considering the apparent disparity in VMI performance between the Singaporean and American sample, it is recommended that construct validity of the Beery-VMI (fifth edition) be further researched in the Singaporean context. This includes re-establishing the differential item functioning and hierarchical
• Preschoolers from different cultural and ethnic groups had different VMI performance. • The Beery-VMI is not culture-free, contrary to the findings of Beery and Beery (2006). • Clinicians should exercise caution when using an assessment in communities and cultures outside the ones on which it was standardized.
Funding This study was conducted with funds from KK Women’s and Children’s Hospital, Department of Child Development, Singapore.
Conflict of interests All authors declare that they have no conflict of interests.
© 2014 John Wiley & Sons Ltd, Child: care, health and development, 41, 2, 213–221
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Acknowledgements We thank Ms Corrine Hoo and Ms Chia Choon Yee from Nanyang Polytechnic for their advise on the methodology of this study. We also thank Dr Mary Law, Dr Peter Rosenbaum and Associate Professor Nancy Pollock from McMaster University; Dr Mary Khetani from Colorado State University and Dr Debra Cameron from University of Toronto for their review of and feedback on earlier drafts of this paper. Lastly, we thank all preschool teachers and children who supported and participated in this study.
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