Análise psicométrica dos itens da Avaliação da Coordenação e Destreza Motora ( ACOORDEM) em crianças de 4 anos

Abstract

The motor development process is characterized by constant changes in motor behavior or in the way we learn and control movements. Two important aspects of motor development are coordination and dexterity. Although coordination is a natural result of the developmental process and practice, there are children who have difficulty performing coordinated and dexterous movements. Often these difficulties are related to some neurological deficit or even due to a psychological factor. However there are cases where the motor difficulty occurs in isolation, without an specific cause that could explain this behavior. In such cases the diagnosis of Developmental Coordination Disorder (DCD) might apply as it refers to discrete motor deficit, but that impacts the child´s school, family and social life. Currently, there are several tools for detecting this disorder. However, they were created abroad, have high cost and do not have normative data for Brazilian children. Aiming to contribute to facilitate the identification of motor problems such as DCD, in 2001 Brazilian researchers began to create the Avaliação da Coordenação e Destreza Motora ACOORDEM (Assessment of Motor Coordination and Dexterity) for children 4-8 years old, composed of items to assess aspects of motor development and functional performance that are relevant for school performance and social participation. The ACOORDEM is in validation process and children 6-8 years old have been assessed. The present study continues ACOORDEM´s validation process for children 4 years and aims are to: investigate test -retest reliability, verify if there are significant differences on item performance related to gender and type of school that might influence the validity of the test´s scores, establish preliminary standards for motor performance for 4 years old Brazilian children and describe the patterns of grip pencil during ACOORDEM´s handwriting tasks. The study included 80 children from public and private schools in Belo Horizonte. The children were divided into two groups with equal representation of gender (female/male) and type of school (public/private). Parents who agreed to participate signed the consent form and answered ACOORDEM´s parents questionnaires, the DCDQ-Little and a socioeconomic questionnaire. Then the children were assessed on the premises their own school. A cognitive test was used to rule out possible cognitive deficits, and two motor tests (ACOORDEM and MABC-2). During ACOORDEM´s handwriting tasks the children's hands were photographed to document the grip pencil pattern. Teachers were also asked to complete ACOORDEM´s teacher questionnaire. For test-retest reliability verification, ACOORDEM was reapplied in 10 children, including the questionnaires for parents and teachers. Few significant differences were found in the performance of ACOORDEM´s items when compared by gender and type of school, which suggests that the process of standardization of the test can proceed with a single normative table for age, without differentiation by gender or type of school, which should be confirmed with the test´s total validation sample. The questionnaires for parents and teachers seem appropriate to assess the motor performance of the children at home and school, but the low test-retest reliability of several the items in the parents questionnaire indicates the need to adjust and reduce the number of items. The test-retest reliability of ACOORDEM´s quantitative items was satisfactory, since few of them did not show good reliability. However, the qualitative items need to be reviewed, with the establishment of cutoff scores or the deletion of some items, to prevent 4 years old children to do activities above their level of development. In general the results are consistent with previous work with children 6-8 years of age, showing that the test was well accepted by the children, has acceptable psychometric qualities, however, some items need adjustment or to be eliminated for 4 years old children, reducing the length of the test.