Have children's manual dexterity skills changed in the past 40 years? A cross-sectional observational norm comparison study.
Tami L Konieczny, Nellie P Butler, Lynne Allen-Taylor and 3 others
Children aged 7 to 18 scored 9.1 to 21.1 blocks fewer than the 1985 norms (males) and 11.8 to 18.9 fewer (females).
The 1985 norms likely overestimate dexterity deficits. Updated norms or a different test are needed.
Key findings
1In every sex-and-age group, the current sample scored significantly lower than the 1985 BBT norms. Males placed 9.1 to 21.1 fewer blocks in 60 seconds depending on age; females placed 11.8 to 18.9 fewer.
2The observed score differences exceed the BBT minimum clinically important difference of 5.29 to 6.46 blocks, a value established in children with unilateral cerebral palsy rather than typically developing children.
3The authors conclude the 1985 norms likely overestimate the prevalence of dexterity deficits in children tested today, and that updated norms or assessments with more recent normative data would reduce unnecessary referrals.
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What it does not show
Subgroup sizes were small (4 to 21 per sex-by-age-by-handedness group), so the precision of the comparison is limited and the study was not designed to establish new norms. No 6-year-olds or 19-year-olds were included, so the comparison does not cover the full 6-to-19 age range of the 1985 norms. This was a secondary analysis from a CMDT validation study, not a study designed to re-norm the BBT. The minimum clinically important difference cited (5.29 to 6.46 blocks) was established in children with unilateral cerebral palsy, not typically developing children. Volunteer bias is possible, though recruitment drew from a socioeconomically diverse urban and suburban community and families received compensation.
Declared interests
The authors declare no known competing financial interests or personal relationships that could have influenced the work.
The easy way to misread this
Do not read this as proof that children's manual dexterity has declined over 40 years. The study compares one cross-section of 181 children to 1985 norms with subgroup sizes of 4 to 21. The difference could reflect changes in testing conditions, population, or practice rather than a true loss of skill. The authors themselves note this was a secondary analysis not designed to establish new norms.
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