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Perceptual and Motor Skills

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Preschool Children: The DOI: 10.1177/00315125211025246
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Zurich Neuromotor
Assessment-2 and the
Movement Assessment
Battery for Children-2

Gerda van der Veer1 ,

Erica Kamphorst1,
Alexander Minnaert1, Marja Cantell1,
Tanja H. Kakebeeke2 , and
Suzanne Houwen1

Abstract
Comparing motor assessment tools that are available for young children is important
in order to select the most appropriate clinical and research tools. Hence, this study
compared motor performance assessed with the Zurich Neuromotor Assessment-2
(ZNA-2) to the Movement Assessment Battery for Children-2 (MABC-2). The
sample consisted of 169 children, aged 3–5 years (87 boys; 51%). We used
Pearson correlations to examine relationships between the ZNA-2 and MABC-2
component and total scores. In addition, Pearson correlations were performed

1
Inclusive and Special Needs Education Unit, Faculty of Behavioural and Social Sciences, University of
Groningen, Groningen, the Netherlands
2
Child Development Center, University Children’s Hospital Zürich, Zürich, Switzerland
Tanja Kakebeeke and Suzanne Houwen contributed equally to this work and should be considered co-last
authors.
Corresponding Author:
Suzanne Houwen, Inclusive and Special Needs Education Unit, Faculty of Behavioural and Social Sciences,
University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.
Email: [email protected]
2 Perceptual and Motor Skills 0(0)

between individual fine motor and balance items of the ZNA-2 and MABC-2. Results
were that the total scores of the ZNA-2 and MABC-2 correlated moderately
(r ¼.40, p < .001). Non-significant to moderate correlations were found between
components (r ¼ .00 to .47) and between individual items of fine motor skills
(r ¼.04 to .38) and balance (r ¼ .12 to .38). Thus, the ZNA-2 and MABC-2 measure
partly similar and partly different aspects of motor performance.

Keywords
Zurich Neuromotor Assessment-2, Movement Assessment Battery for Children-2,
motor skills, motor abilities, early childhood, psychometric properties

Introduction
Three to five-year old children experience a remarkable pace and extent of
development in their motor repertoire. The attainment of basic motor skills,
such as balance, locomotion, and object control, in this age period lays the
foundation for learning more complex motor skills needed for daily life and
physical activities (Gabbard, 2018; Piek et al., 2012). Practicing various motor
skills also contributes to the development of cognitive and social skills
(Diamond, 2007). More specifically, the expanding range of motor skills pro-
vides multiple opportunities for young children to engage in environmental
exploration, perceptual learning, and social interaction – skills that match child-
ren’s increasing need for autonomy (Oudgenoeg-Paz et al., 2015; Walle &
Campos, 2014). With the acknowledgement that motor skills are linked to
cognitive and social-emotional skills, the assessment of motor performance in
3–5-year-old children has gained importance (Piek et al., 2012).
There are several assessment tools available to examine motor performance
at the preschool age (Piek et al., 2012). One of the most frequently used tests by
health care professionals in Europe for this purpose in (young) children is the
Movement Assessment Battery for Children-2 (MABC-2; Henderson et al.,
2007). The MABC-2 is a validated and norm-referenced test to detect motor
coordination difficulties in children aged 3–16 years, and it has been recom-
mended for the detection of Developmental Coordination Disorder (Blank
et al., 2019). But the MABC-2 may be susceptible to ceiling effects for better
performers (French et al., 2018; Kok
stejn et al., 2018). Ceiling effects make a test
less suitable for assessing motor performance in typically developing children, as
differentiation between above average performers cannot be done (Cools et al.,
2009; de Niet et al., 2021). Some health care professionals may therefore use the
norm-referenced Zurich Neuromotor Assessment-2 (ZNA-2; Kakebeeke et al.,
2019). In contrast to the MABC-2, the ZNA-2 battery has been designed to
van der Veer et al. 3

assess the entire range of a child’s motor performance (i.e., from very poor to
very good) for children aged 3 - 18 years (Kakebeeke et al., 2019). Despite this
difference, unlike other motor tests, such as the Bruininks-Oseretsky Test of
Motor Proficiency Second Edition (Bruininks & Bruininks, 2005), the
K€orperkoordinationstest für Kinder (Kiphard & Schilling, 2007), and the Test
of Gross Motor Development-3 (Ulrich, 2013), the ZNA-2 and MABC-2 cover
both the assessment of fine and gross motor skills over the 3-5 year age range.
To permit practitioners and researchers to compare the test results of individual
3-5-year-old children who may have been evaluated with these two instruments,
or even the results of any child who might have been given one of these tools on
one instance and the other later, it is important to empirically compare and
establish performances on these two different motor assessment tools to better
understand how they may be related.
It is important to note that motor performance is a concept covering a variety
of terms (e.g., motor skills, motor abilities) used to describe goal-directed human
movement (Burton & Miller, 1998). Although all these different terms are relat-
ed, they describe conceptually distinct constructs. Motor skills can be seen as the
qualitative expression of a specific movement pattern (e.g., hop, catch), while
motor abilities can be viewed as general traits or capacities that underlie the
performance of a variety of motor skills (Burton & Miller, 1998). A similarity
between the ZNA-2 and MABC-2 is that they are both, to some extent, based on
the normative functional approach (Wilson, 2005); that is, they both yield a
quantitative measure (e.g., response time, proficiency rating, and accuracy
scores) that indicates performance level (norm-referenced), and both focus on
functional motor skills. In addition, the ZNA-2 also includes tasks representing
motor abilities (Kakebeeke et al., 2018), which reflect internal neurological and
neuromotor processes and thus provide information about the neurological
basis of a child’s motor functioning (Burton & Miller, 1998). Thus, the ZNA-
2 and MABC-2 may provide different information about a child’s motor per-
formance. Neither assessment tool necessarily claims to measure the same
aspects of motor performance; however, researchers often use each tool in an
attempt to answer similar clinical and research questions. Thus, there is a need
to determine how seemingly similar and/or different aspects of motor perfor-
mance included in the two assessment tools are or are not related (Logan et al.,
2014; Scheuer et al., 2019).
A study comparing an earlier version of the ZNA for young children (ZNA3-
5) with the MABC-2 revealed a rank correlation of .77 between the total scores
of the two tests, and rank correlations higher than .50 between their compo-
nents, making the tests seemingly comparable in their face validity (Kakebeeke
et al., 2016). In addition, components measuring different motor constructs
correlated within a range from .31-.52. Thus, some components measure similar
constructs, while others assess different aspects of motor performance. Given
the more recent development of an updated version of the ZNA, the ZNA-2, a
4 Perceptual and Motor Skills 0(0)

renewed comparison between the MABC-2 and this updated version of the
ZNA-2 is both necessary and timely. The aim of the present study was to
compare the motor performance of 3-5-year-old children on the ZNA-2 and
MABC-2.

Method
Participants
The participant sample for this study was drawn from a larger research project
‘MELLE’ (Motor skills, Executive functions, Language, and LEarning out-
comes in preschool children; see also Houwen et al., 2019), in which 3–5-year-
old children are being followed intensively through their development with
respect to their motor skills, executive functions, and language abilities. The
MELLE-study protocol received approval by the Ethics Review Committee of
the Department of Pedagogical and Educational Sciences, Faculty of
Behavioural and Social Sciences, University of Groningen, and parents of all
the child participants gave their written informed consent for data from their
children’s evaluations to be used in research, in accordance with the Declaration
of Helsinki.
From March 2016 to December 2018, a sample of 193 Dutch preschool
children was recruited from preschools, kindergartens, day-care centers, and
primary schools in the north of the Netherlands. Additionally, social media,
mouth-to-mouth recruitment, and flyers and posters in supermarkets, stores,
and playgrounds were used to recruit participants. Participant inclusion criteria
were: (a) aged between 36 and 72 months; (b) no signs of a medical condition
(e.g., heart disease), neurological disorder (e.g., cerebral palsy), or intellectual or
physical disability (e.g., club foot); (c) normal hearing and normal or corrected
to normal visual sight; (d) being able to follow test instructions; and (e) having
parents/caretakers with sufficient proficiency in written Dutch to be able to
complete the questionnaires. The inclusion criteria were checked by phone inter-
view. In addition, parents filled out a sociodemographic questionnaire. Twenty-
four children were excluded from the sample for unreliable assessments on
one or both motor tests due to refusal, lack of concentration, or lack of moti-
vation. The final sample consisted of 169 children (87 boys; 51%), aged 36 to 71
months old (M ¼ 50.8 months, SD ¼ 10.1 months). The group of 3-year-olds
consisted of 35 boys and 37 girls (age range 36 to 47 months), the group of
4-year-olds consisted of 30 boys and 24 girls (age range 48 to 59 months),
and the group of 5-year-olds consisted of 22 boys and 21 girls (age range 60
to 71 months).
van der Veer et al. 5

Instruments
Zurich Neuromotor Assessment Second Edition (ZNA-2). The ZNA-2
(Kakebeeke et al., 2019) is a standardized test that aims to describe the devel-
opment of neuromotor functioning in 3–18-year-old children. Motor skills and
motor abilities are quantitatively examined by measuring the following compo-
nents: fine motor skills (pegboard, bolts, and beads), pure motor skills (repet-
itive hand, foot, and finger movements, alternating hand and foot movements,
and sequential finger movements), static balance (one-leg stand with eyes open
and with eyes closed), and dynamic balance (jumping sidewards, chair-rise, and
standing long jump). All items are measured in seconds; only the long jump item
is measured in centimeters. Age- and gender-based standard scores (z-scores)
can be calculated for the components and the total score. Norm reference values
are available for Swiss children (Kakebeeke et al., 2018), and these were used to
calculate the motor performance of the study sample.
The ZNA-2 has shown moderate to good test-retest reliabilities for its com-
ponents, with ICC’s ranging from .67 to .84 in a sample of Swiss children aged
3–18 years. Intra-rater reliabilities were excellent with ICC’s of 1.00. Inter-rater
reliabilities were also excellent with ICC’s of .92 and higher. A factorial study on
the original ZNA, of which the item groupings of the ZNA-2 are based, showed
good factorial validity (Rousson & Gasser, 2004). A comparison study between
the ZNA 3-5 (an earlier version of the ZNA for young children) and the MABC-
2 supported convergent validity (Kakebeeke et al., 2016). Discriminant validity
has not yet been investigated.
Movement Assessment Battery for Children Second Edition (MABC-2). The
MABC-2 (Dutch version; Henderson et al., 2010) is a norm-referenced test that
aims to detect motor impairment in children aged 3–16 years. It consists of three
age bands, which have specific scoring and task variations. Age band 1 (3–6
years) was used in the present study. The MABC-2 includes eight tasks mea-
suring three components: manual dexterity (‘Posting coins’, ‘Threading beads’,
and ‘Drawing trail’), aiming and catching (‘Catching a bean bag’ and ‘Throwing
a beanbag onto a mat’), and balance (‘One-leg stand’, ‘Walking heels raised’,
and ‘Jumping on mats’). The posting coins, threading beads and one-leg stand
tasks are measured in seconds. Catching a beanbag, throwing a beanbag onto a
mat, walking heels raised, and jumping on mats are measured in number of
successful jumps. The drawing trail task is measured in number of errors. Age-
based standard scores (range 1–19, M ¼ 10, SD ¼ 3) and percentile scores can be
calculated for the three components and for a total score. The MABC-2 has
been normed for Dutch children. The psychometric properties of age band 1 of
the MABC-2 suggest that it is a valid and reliable measure to be used in pre-
schoolers (Ellinoudis et al., 2011; Psotta & Brom, 2016; Smits-Engelsman et al.,
2011). A comparison study between age band 1 of the MABC-2 and the
6 Perceptual and Motor Skills 0(0)

Peabody Developmental Motor Scales–2 supported convergent validity in pre-

school children (Hua et al., 2013). To our knowledge, discriminant validity of
age band 1 of the MABC-2 has not been investigated yet.

Procedure
Test administrators were graduate students from Pedagogical and Educational
Sciences, Psychology or Human Movement Sciences and were all trained inten-
sively to ensure reliable test results. The training process consisted of reading
test manuals, practicing on each other with the tests, administering two video-
taped practice assessments which were evaluated during group sessions, and
scoring the performance of the children during the practice assessments.
Students were provided individual feedback on their practice assessments,
and, above and beyond, had to pass their training before administering any
formal assessments.
The data necessary for this study were gathered in two sessions, each lasting
up to 90–120 minutes; in the first session, the children performed the MABC-2-
NL, and in the second session, the ZNA-2. Next to the ZNA-2 and MABC-2,
children completed a battery of cognitive and language tests as part of the
MELLE-project. The assessments were videotaped for scoring purposes.
Children received stickers after every task as encouragement. When necessary,
short individually tailored breaks were used to maintain motivation and atten-
tion. When testing was completed children were given a small gift (<2 euro) and
a certificate for their participation in the MELLE-project. Parents received a
report of their child’s test results. Participant data were coded and stored using a
personalized study identifier to ensure confidentiality.

Statistical Analysis
Data were analyzed using SPSS version 25.0. Descriptive statistics (frequencies,
means, and standard deviations) were calculated to characterize the motor per-
formance of the sample on all ZNA-2 and MABC-2 components and total
scores. The rate of missing test data varied from 0% (age and gender) to
52.1% (ZNA-2 total score) (see Online Appendix A for a more detailed over-
view of the missing values per variable). Little’s MCAR test indicated that the
missing values of the motor components and total scores (Little’s MCAR test: v2
(156) ¼ 177.634, p ¼ .113) as well as the missing values of the individual items
(Little’s MCAR test: v2 (488) ¼ 484.113, p ¼ .541) were missing on a completely
random basis. To account for potential bias resulting from missing data and to
increase statistical power, we performed multiple imputation with full condi-
tional specification. Multiple imputation is a sophisticated and flexible routine
for handling missing data. Several studies have shown that accuracy and reli-
ability of multiple imputation is attainable, even with substantial proportions of
van der Veer et al. 7

missing data (Graham & Schafer, 1999; Madley-Dowd et al., 2019). Regarding
relationships between components of the ZNA-2 and MABC-2, we performed
multiple imputation using the components and total scores as both predictors
and variables to be imputed. Age and gender were used as predictors.
Information of individual items were used so as to be able to impute more
reliably by constructing variables of the mean of individual items per compo-
nent. Regarding relationships between individual items of fine motor skills and
balance of both motor tests, the following MABC-2 items were imputed and
used as predictors: ‘Posting coins dominant (d) hand’, ‘Posting coins nondomi-
nant (nd) hand’, ‘Threading beads’, ‘Drawing trail’, ‘One-leg stand’, ‘Walking
heels raised’, and ‘Jumping on mats’. The following ZNA-2 items were imputed
and used as predictors: ‘Pegboard (d)’, ‘Pegboard (nd)’, ‘Bolts (d)’, ‘Bolts (nd)’,
‘Beads’, static balance component, ‘Jumping sidewards’, ‘Chair-rise’, and
‘Standing long jump’. The aiming and catching items of the MABC-2, the
pure motor items of the ZNA-2, age, and gender, were used as predictors.
For both imputation models, twenty multiple imputed data sets were created.
All subsequent analyses were conducted on each imputed data set individually,
and the results were pooled.
The degree of association between the ZNA-2 and MABC-2 components and
total scores was assessed by bivariate Pearson correlation analyses. Next, we
analyzed the relationship between the ZNA-2 and MABC-2 more in-depth by
performing bivariate Pearson correlation analyses between individual items of
components with theoretically similar motor constructs (i.e., fine motor and
balance items). Based on Kakebeeke et al. (2016), we expected mostly moderate
(>.30) to strong (>.50) effect sizes. An a priori power analysis (G*Power
Version 3.1.9.2; Faul et al., 2009) revealed that our sample size of 160 was
sufficient to detect correlations as low as .20 (with a power of .80 and alpha
level of .05). Examination of histograms of all imputed data sets showed that the
assumption of normality was not violated. In addition, no serious violations of
linearity and outliers were observed when boxplots and scatterplots of all imput-
ed data sets were analyzed.

Results
Descriptive
An overview of the descriptive data for the components, total scores, and indi-
vidual test items of the ZNA-2 and MABC-2 is provided in Table 1 (see Online
Appendix B for a more detailed overview of these test characteristics per par-
ticipant age). Cohen’s d analysis showed that the original and pooled means of
the components, total scores, and individual items were similar for the whole
sample, except for the component pure motor skills of the ZNA-2, which dif-
fered weakly. For 3-year-old children, there were small differences between the
8 Perceptual and Motor Skills 0(0)

Table 1. Descriptives on the ZNA-2 and the MABC-2.

Original Pooled

n M SD n M SD Effect size

ZNA-2
Individual items
Pegboard (d) 163 .18 .98 169 .17 0.99 .00
Pegboard (nd) 162 .04 1.14 169 .03 1.16 .01
Bolts (d) 163 .75 1.04 169 .76 1.05 .01
Bolts (nd) 160 .56 1.01 169 .56 1.02 .00
Beads 165 .21 1.02 169 .21 1.02 .00
Repetitive foot (d)a 162 .33 1.28
Repetitive foot (nd)a 160 .39 1.36
Alternating foot (d)a 159 .16 1.06
Alternating foot (nd)a 159 .03 .96
Repetitive hand (d)a 162 .70 1.52
Repetitive hand (nd)a 157 .70 1.40
Alternating hand (d)a 158 .37 1.12
Alternating hand (nd)a 158 .31 1.25
Repetitive fingers (d)a 160 .40 1.57
Repetitive fingers (nd)a 159 .31 1.57
Sequential fingers (d)a 149 .30 1.05
Sequential fingers (nd)a 147 .24 1.01
Jump sideways 153 .05 .74 169 .05 0.75 .00
Chair rise 155 .46 1.34 169 .42 1.37 .03
Long jump 152 .11 1.27 169 .12 1.29 .01
Components
Fine motor skills 148 .55 1.01 169 .49 1.01 .06
Pure motor skills 114 .26 1.36 169 .45 .96 .20
Static balance 153 .38 1.06 169 .37 1.11 .01
Dynamic balance 128 .31 1.10 169 .31 1.18 .00
Total score 81 .26 1.04 169 .23 1.04 .03
MABC-2
Individual items
Posting coins (d) 167 10.63 2.56 169 10.63 2.56 .00
Posting coins (nd) 165 10.58 2.46 169 10.55 2.47 .01
Beads 166 10.17 2.42 169 10.17 2.43 .00
Drawing trail 168 9.21 2.48 169 9.20 2.49 .00
Catching a bean baga 164 8.31 2.35
Throwing a bean baga 162 9.75 3.06
One-leg stand 166 9.66 3.03 169 9.66 2.36 .00
Walking on toes 167 10.63 2.56 169 10.63 3.07 .00
Jumping on mats 165 10.58 2.46 169 10.55 3.04 .01
(continued)
van der Veer et al. 9

Table 1. Continued.
Original Pooled

n M SD n M SD Effect size

Components
Manual dexterity 164 10.11 2.85 169 10.07 2.85 .01
Aiming & catching 165 9.87 3.00 169 9.90 2.98 .01
Balance 159 8.99 3.06 169 9.02 3.07 .01
Total score 152 9.70 3.25 169 9.66 3.16 .01
Note. aPooled descriptives are not available for these items, because they were not multiply imputed. d:
dominant hand; nd: nondominant hand.

original and pooled means of the individual item ‘Jumping sidewards’. For
5-year-olds, there were small differences between the original and pooled
means of the component static balance of the ZNA-2 and the ZNA-2 total
score. There were no differences between the original and pooled means for
children aged four years.

The Relationship Between Components and Total Scores of the ZNA-2 and
MABC-2
Table 2 illustrates the bivariate correlations between the ZNA-2 and MABC-2
components and total scores. The total scores correlated moderately with each
other (r ¼ .40, p < .001). On component level, the highest correlations were
observed between the fine motor skills component of the ZNA-2 and the
manual dexterity component of the MABC-2 (r ¼ .47, p < .001), and between
the static balance component of the ZNA-2 and the balance component of the
MABC-2 (r ¼ .35, p < .001). The manual dexterity component of the MABC-2
correlated weakly to moderately with the other components and total score of
the ZNA-2 (r ¼ .18 to .37), with the exception of dynamic balance. The balance
component of the MABC-2 correlated weakly to moderately with all ZNA-2
components and the total score (r ¼ .17 to .39). There were no significant corre-
lations between the aiming and catching components of the MABC-2 and the
ZNA-2 components.

The Relationship Between Individual Fine and Balance Items of the ZNA-2
and MABC-2
From Table 3 it is clear that mainly weak to moderate correlations were found
between fine motor items of the ZNA-2 and MABC-2. The highest correlations
were observed between ‘Pegboard (nd)’ and ‘Posting coins (nd)’ (r ¼ .41,
p < .001), between both beads items (r ¼ .38, p < .001), between ‘Pegboard (d)’
10 Perceptual and Motor Skills 0(0)

Table 2. Pearson Correlations Between the ZNA-2 and the MABC-2 Subtests and Total
Scores.

MABC-2

Manual Aiming and MABC-2 total

ZNA-2 dexterity catching Balance score

Fine motor skills .47** .15 .24** .41**

Pure motor skills .18* .00 .20* .16*
Static balance .22** .13 .35** .34**
Dynamic balance .06 .04 .17* .12
ZNA-2 total score .37** .11 .39** .40**
Note. *p < .05; **p < .01.

Table 3. Pearson Correlations Between Fine Motor Items of the ZNA-2 and MABC-2.

MABC-2

ZNA-2 Posting coins (d) Posting coins (nd) Beads Drawing trail

Pegboard (d) .32** .29** .27** .12

Pegboard (nd) .28** .41** .30** .14
Bolts (d) .19* .19** .14 .04
Bolts (nd) .24** .28** .22** .10
Beads .24** .27** .38** .16*
Note. d: dominant hand; nd: nondominant hand. *p < .05; **p < .01.

and ‘Posting coins (d)’ (r ¼ .32, p < .001), and between ‘Pegboard (nd)’ and
‘Beads’ of the MABC-2 (r ¼ .30, p < .001). The lowest correlations were detected
between the ‘Drawing trail’ and the ZNA-2 fine motor items (r ¼ .04 to .16).
Table 4 shows the correlations between the individual balance items of the
ZNA-2 and MABC-2. The highest correlation was found between ‘One-leg
stand’ of the ZNA-2 and the ‘One-leg stand’ of the MABC-2 (r ¼ .38,
p < .001). Weak correlations were observed between ‘One-leg stand’ of the
ZNA-2 and ‘Walking on toes’ of the MABC-2 (r ¼ .21, p ¼ .009) and between
‘Jumping sideways’ of the ZNA-2 and ‘One-leg stand’ of the MABC-2 (r ¼ .23,
p ¼ .003). No significant correlations were found between the other balance
items.

Discussion
The aim of this study was to compare the measured motor performance of 3–5-
year-old children on the ZNA-2 and MABC-2. In general, we found a moderate
van der Veer et al. 11

Table 4. Pearson Correlations Between Balance Items of the ZNA-2 and MABC-2.

MABC-2

ZNA-2 One-leg stand Walking on toes Jumping on mats

Static balance .38** .21** .05

Jumping sideways .23** .03 .15
Chair rise .03 .01 .10
Standing long jump .09 .13 .12
Note. *p < .05; **p < .01.

relationship between the total scores of the ZNA-2 and MABC-2. Relationships
between motor skill components of the ZNA-2 and MABC-2 varied from non-
significant to moderate. As expected, the relationships between pure motor skills
of the ZNA-2, measuring motor abilities, and the MABC-2 components, mea-
suring motor skills, were non-significant to weak.
Our findings differed from Kakebeeke et al. (2016) in which the ZNA3-5 (an
earlier version of the ZNA for young children) was compared to the MABC-2.
Kakebeeke et al. (2016) showed higher correlations between components and
total scores of the ZNA3-5 and MABC-2 (correlation between total scores .77)
than the current study (correlation between total scores .40). Furthermore,
Kakebeeke et al. (2016) found moderate-to-strong relationships between the
components, while we found weak-to-moderate relationships. In line with
Kakebeeke et al. (2016), relationships between the aiming and catching compo-
nent of the MABC-2 and the ZNA-2 components were lowest. In a practical
hindsight, the Swiss and Dutch studies took place in two different settings, at
childcare center vs. at home, thus providing a different context for the assess-
ments, yet there does not seem to be any simple explanation for the different
correlation results. Perhaps future studies comparing motor tests in young chil-
dren, such as the ZNA-2 and MABC-2, could include several levels of analysis
incorporating task analysis with the context and child factors (such as executive
functioning and temperament).
Examining in more detail the relationships between individual items of the
components that intend to measure similar underlying motor constructs, the
strength of the relationships between individual item seem to depend on
the similarity of the test items. The relationships between similar items of
both tests (i.e., beads and one-leg stand items) were moderate, while the relation-
ships between seemingly different items (e.g., ‘Drawing trail’ of the MABC-2
with the fine motor items of the ZNA-2) were non-significant to weak. Thus our
findings indicate that the ZNA-2 and MABC-2 measure motor performance in
partly similar and partly different ways, revealing partly different underlying
motor constructs in these two measures.
12 Perceptual and Motor Skills 0(0)

The low to modest relationships found between the ZNA-2 and MABC-2,
despite some items that seemed similar at face value, may be explained by dif-
ferent task demands imposed on the child. Stemming from the theory of con-
straints, the production of movement is influenced by characteristics of the
individual, the environment, and the task (Adolph & Hoch, 2019; Newell,
1986). Derived from this theory, differences in task demands were considered
to be a reason why the associations were modest between items that at first sight
seemed comparable. For example, both tests contain a manual dexterity task
that included beads. The ‘Beads’ item of the ZNA-2 includes small round beads
that need to be strung onto a thin thread. The beads are lying randomly in a
hollow of the pegboard. After practice, in the test phase the child has one
attempt to string five beads onto the thread as fast as possible. The
‘Threading beads’ item of the MABC-2 includes square beads and a thicker
thread than in the ZNA-2. In addition, the setup is different from the ZNA-2
for which the beads are lying in a row and cannot easily roll off; and, after
practice, in the ZNA-2 test phase the child has two attempts to string six beads
onto the thread as quickly as possible. In sum, the disparities in the task
demands of individual test items may cause some of the differences in motor
performance, and subsequently, may explain modest associations.
Interestingly, differences in task demands also exist between the balance
items. In the ‘One-leg stand’ of the MABC-2, the child is wearing gym shoes;
but, in the ZNA-2, the child is not. In addition, in the ZNA-2 the child is
requested to stand on one leg with eyes closed; whereas, in the MABC-2, the
child is only asked to stand on one leg with eyes open. The ‘Chair-rise’ and
‘Jumping sidewards’ tasks from the ZNA-2 involve continuous movements in
which a time element plays a role (Kakebeeke et al., 2019). ‘Walking on toes’ in
the MABC-2 is a task that should be performed as accurately as possible with-
out a time requirement and can thus be performed as slowly as needed. In the
‘Jumping on mats’ task from the MABC-2, 3- and 4-year-old children are
allowed to complete the jumps in a discontinuous manner, and they can
adjust their standing position on the mats (Henderson et al., 2007). Therefore,
the performance on the balance tasks of the MABC-2 may be less dynamic than
the dynamic balance tasks of the ZNA-2. Apart from all the above differences in
test items and demands posed on the children, there are some parts of both tests
for which there is no equivalent in the other test. Pencil skills and ball skills are
only included in the MABC-2. The performance on these items are highly
dependent on experience and practice (Hardy et al., 2012). Pure motor skills
are only assessed with the ZNA-2 with the intention of examining the matura-
tional state of the nervous system. Pure motor skills are skills that are not easily
modified by experience or practice and are relatively stable across the lifespan
(Burton & Miller, 1998; Cincotta & Ziemann, 2008; Mayston et al., 1999). Our
results confirmed the notion that each assessment includes components that are
unique for it and that are aimed at measuring specific motor constructs. In
van der Veer et al. 13

practice, although there is an overlap between the ZNA-2 and MABC-2, clini-
cians should choose a test or specific test components that targets the purpose of
the assessment and provides the most useful information for that purpose.
The modest relationships found between the ZNA-2 and MABC-2 may also
be partially explained by the large intra-individual variability in motor devel-
opment, especially in early childhood (Adolph et al., 2015; Piek et al., 2012). In
addition, early childhood is characterized by ordinary day-to-day variations in
behavior, motivation, and attention that impact motor performance (Payne &
Isaacs, 2016). Because of behavioral and performance instability, it is important
not to base diagnostic conclusions in young children on assessment at one single
time point, but to assess motor functioning at multiple times in order to examine
the temporal stability of a young child’s developmental motor problems (Blank
et al., 2019; Eldred & Darrah, 2010).
The modest relationships we found between the ZNA-2 and MABC-2 may
also be partially due to the internal structure of one or both of these motor tests.
Although we were not able to examine the internal structure of the tests due to
our small sample size, both a three-factor structure (Psotta & Brom, 2016) and a
one-factor structure of the MABC-2 (Okuda et al., 2019; Schulz et al., 2011; van
der Veer et al., 2020) seem viable in preschool children. Furthermore, the factor
structure of the original ZNA has been supported by Rousson and Gasser
(2004). The ZNA-2 is likely to have a similar factorial structure, because the
ZNA-2 is closely based on the original ZNA. Thou our findings may be con-
sidered together with the original ZNA factor structure. As such, we are confi-
dent that our study provides at least partial information on the relationship
between both tests. Nevertheless, we cannot fully rule-out the possibility that
our findings are limited to the performance profiles of the current sample.

Limitations and Directions for Further Research

A few study limitations should be addressed when considering these results.
Despite rigorous attempts to provide the best possible test administration for
young children, these data contained quite a few missing values, mostly preva-
lent in the components of pure motor skills and dynamic balance on the ZNA-2.
It is commonly known that assessing preschoolers is challenging, due to fluctu-
ations in their behavior, attention, motivation and mood (Malina, 2004;
Williams et al., 2019). The amount of missing data decreased with age, suggest-
ing that the tasks are feasible in this age range but might need some extra
attention and/or modification in test administration for the youngest in this
age group. It is difficult to draw a conclusion on how the missing data might
have affected the outcomes. A second limitation is that the instruments were
administered on two different days. Although the interval between the MABC-2
and ZNA-2 was generally short, this time gap may have reduced measured
agreement as a result of ordinary day-to-day variations in young children’s
14 Perceptual and Motor Skills 0(0)

behavior and motor performance, as already mentioned above. Third, like in

many other studies where children have been recruited from the community
(e.g., Hoskens et al., 2018; Houwen et al., 2017), the sample was not fully rep-
resentative with respect to the parents’ educational level. The sample consisted
mainly of children with highly educated mothers. Fourth, our sample of young
children did not include children with a formal diagnosis of Developmental
Coordination Disorder (DCD). Due to the large intra-individual variability in
early motor development (Darrah et al., 2009) and the lack of stability of (mild)
motor coordination difficulties at a young age (Houwen et al., 2021; van
Waelvelde et al., 2010), DCD is difficult to identify before the age of five
years (Blank et al., 2019). Therefore, the European Academy of Childhood
Disability does not recommend diagnosis of DCD before the age of five years
(Blank et al., 2019). Finally, the small sample size did not allow analysis of the
internal structures of the ZNA-2 and MABC-2. Subsequently, we could not
examine if or how the internal structures of either or both of these motor
tests might affect their relationship. Future research is recommended to examine
the internal structures of both motor tests.

Conclusion
Although both the ZNA-2 and MABC-2 focus on the general concept of motor
performance, our findings indicate that they measure distinct aspects of motor
performance. Accordingly, the ZNA-2 and MABC-2 may provide different and
complementary information regarding a child’s motor performance. A relevant
fact in this context is that the ZNA-2 and MABC-2 partly use similar motor
tasks as test items, with differences arising only in contextual details such as in
the ‘One-leg stand’. In addition, they assess similar skills with different motor
tasks, such as the ‘Bolts’ task of the ZNA-2 and the ‘Drawing trail’ of the
MABC-2 both measuring fine motor performance. Therefore, practitioners
and researchers should be aware of the distinct differences in content and out-
come measurements of these tools. In practice, this means that when the aim is
to assess particular motor skills such as ball skills, then the MABC-2 is a good
understandable choice. As a test, it enables the examiner to track intervention
effects at motor skills, such as aiming and catching (Heus et al., 2020). As the
ZNA-2 is less dependent on practice and is also focused on the development of
motor abilities (Kakebeeke et al., 2021), the ZNA-2 may detect different chil-
dren as having motor coordination difficulties than the MABC-2. Lastly, for
some populations, such as young children at risk of motor difficulties, a careful
task analysis may be an essential step in disentangling the everyday variability of
motor performance from variability rising from neurological causes. Such infor-
mation is imperative in early assessment procedures and for well-targeted and
efficient intervention contents.
van der Veer et al. 15

Acknowledgements
The authors would like to thank all families for their participation in this study. A special
thank you to Aziz Chaouch, MSc and Dr. J.R. van Ginkel for sharing their statistical
expertise. The authors also would like to express gratitude to the research assistants and
students who contributed to the data collection.

Authors’ Contributions
GV was responsible for the data collection, conducted the analysis, and wrote and edited
the manuscript. EK was responsible for the data collection and contributed to the anal-
ysis and reviewing the manuscript. AM, MC, TK, and SH supervised the study, and
contributed to the writing and reviewing of the manuscript. All authors contributed to
the article and approved the submitted version.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

ORCID iDs
Gerda van der Veer https://orcid.org/0000-0002-6824-2191
Tanja Kakebeeke https://orcid.org/0000-0001-7590-1477

Supplemental Material
Supplementary material for this article is available online.

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Author Biographies
Gerda van der Veer, MSc is a PhD candidate at the Inclusive and Special Needs Education Unit at
the University of Groningen.

Erica Kamphorst, MSc is a PhD candidate at the Inclusive and Special Needs Education Unit at the
University of Groningen.

Prof. Dr. Alexander Minnaert, is a Full Professor at the Inclusive and Special Needs Education Unit
at the University of Groningen.

Dr. Marja Cantell, works as Assistant Professor at the Inclusive and Special Needs Education Unit
at the University of Groningen.

Tanja Kakebeeke, PhD, is Adjunct Professor in Neurophysiology at the Child Development Center,
University Children’s Hospital Zurich.

Dr. Suzanne Houwen, is an Associate Professor at the Inclusive and Special Needs Education Unit at
the University of Groningen.