Beery-Buktenica Developmental Test of Visual-Motor Integration

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Original Editor - Romy Hageman
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Purpose[edit | edit source]

The Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) is a gold standard measure designed to identify challenges related to the coordination of visual and motor skills in both children and adults[1][2]. Difficulties in this area can affect the learning ability of children[3][4][5], but can also be an early sign of dementia[6]. It is the most commonly used standardized test for testing the visual-motor integration[7][8] [9]and mainly employed in educational, medical, and research context[10]. The Beery VMI is a norm-referenced test that had been standardized through five extensive large-scale studies conducted in the USA[11].

The key objectives of using the Beery VMI include:

  • Early identification: Detecting visual-motor integration problems at an early age, allowing for timely intervention and support[12].
  • Intervention planning: Assisting in the development of targeted intervention plans for children with visual-motor integration problems.

The Beery VMI is composed of one central task: Visual-Motor Integration (VMI), and two additional tasks: Visual Perception (VP) and Motor Coordination (MC)[13][14]. The Visual Perception and Motor Coordination both gather more information concerning an individual's abilities in the event of a poor performance on the VMI.

The Beery VMI is a useful screening tool for writing[15]. Academic skills necessary for visual motor integration:

  • Gross motor skills
  • Fine motor skills
  • Visual Perception
  • Visuomotor development

Intended population[edit | edit source]

  • Target group: Individuals aged 2-100 years[1][10]
  • Children born preterm[16][17][18][19]
  • Children with Autism spectrum disorder (ASD)[7][20][21][22][23][24][25][26]
  • Children with traumatic brain injury[27]
  • Children with Brachial Plexus injury[26]
  • Children with Cerebral Palsy[26]
  • Children with Attention-Deficit/Hyperactivity Disorder (ADHD)[27]
  • Children with Developmental Coordination Disorder (DCD)[28]
  • Children with special needs[29]
  • Children with mild intellectual disability[30]
  • Children with Fetal Alcohol Spectrum Disorder (FADS)[31]
  • Children with Human Immunodeficiency Virus (HIV)[32]
  • Children with Sickle Cell Disease[33]
  • Children with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)[34]
  • Children with congenital heart disease[35]
  • Children with type 1 Diabetes[36]
  • Children with Cerebral Visual Impairment (CVI)[37]
  • Children with Strabismus with and without amblyopia[38]
  • Children with idiopathic infantile nystagmus[39]
  • Children with severe specific language impairment[40]
  • Children with speech sound problems[41]
  • Children and adults with Williams syndrome[42]
  • Children with Prader-Willi syndrome[43]
  • Children with 22q11 deletion syndrome[44][45][46]
  • Children with 3q29 deletion syndrome[47]
  • Children with obstructive sleep apnea syndrome[48]
  • Adults with obsessive-compulsive disorder[49]
  • Elderly with Alzheimer's disease[6]
  • Elderly with mild cognitive impairment[6]

Target examiner population[edit | edit source]

The Beery VMI can be used by[9][50][51][52][53]:

  • (Pediatric) Occupational therapists
  • (Pediatric) Physiotherapists
  • Educational Psychologists
  • Neuropsychologists
  • Educators

Technique[edit | edit source]

  • Administration time: Visual Motor Integration takes approximately 10-15 min. The supplemental Visual Perception (VP) and Motor Coordination (MC) tasks each take approximately 5 min[10].
  • It is crucial to adhere to the proper testing sequence: start with the Beery VMI, followed by Visual Perception, and finally Motor Coordination. This sequence is essential as the exposure of one test may influence the outcomes of another, and result in significantly affected norms[54].
  • Visual Motor Integration: the individual copies a series of geometric shapes in a developmental sequence using pen and paper. Children under the age of 5 start by mimicking the examiner's drawing tasks. The shapes start with simple line drawings and progress to more complex figures[55].
  • Visual Perception: this task assesses an individual's visual capabilities without involving the coordination of fine motor skills. For children below the age of 5, the initial steps involve pointing to various items, such as body parts and pictures from the manual. This is to gauge their ability to visually distinguish gross differences and objects. Older children and adults start by being presented with a set of visually similar figures, with one designated as the target. They must point to the item in the array that matches the target figure. The examiner records the responses, eliminating the need for fine motor control. The elapsed time is monitored from item 7, and the task ends after 3 minutes.
  • Motor Coordination: this task assesses fine motor skills independently of visual perceptual abilities. The initial three items can be evaluated based on prior observations by the examiner, considering factors whether the individual has grasped the pencil with the thumb and at least one finger. If succesful in these initial tasks, participants are given three practice items to learn how to connect dots and draw within specified borders. They are then directed to proceed with subsequent tasks within a 5-minute time limit. Starting and ending dots are provided, marking where the tracing should initiate and conclude for each line segment forming every geometric shape. This is done to reduce the perceptual demands of the task.

Scoring[edit | edit source]

The manual offers scoring guidelines and examples for all three tasks.

  • In the case of the VMI items, the examiner may apply various measurements and angles to determine a score. However, a general guideline for all tasks is ''if in doubt, score the item as passed''. The examiner manually scores from zero (no shape resemblance) to one (shape resemblance)[55].
  • For Visual Perception, one point is given for each correct item based on the individual's initial response.
  • In Motor Coordination, one point is awarded for each item where pencil marks are present between all dots and within the specified borders. There are specific additional rules for items 27 and 30.
  • Raw scores on the Beery VMI can range from 1 to 27, with a higher score reflecting a better performance[1]. Raw scores can be converted into norm scores, which are adjusted for age.
  • Poor performance on the Beery VMI is associated with difficulties in spatial organization of written text and maths[3]. The cut-off percentile for the Beery VMI, utilized in research concerning Developmental Coordination Disorder (DCD), varies based on the specific study and the studied population. Some studies propose a cut-off below the 25th percentile[1][56][57]to identify below-average motor performance. This treshold is higher than the 15th and 16th percentile cut-offs used in research to indicate severe difficulties with motor coordination affecting daily life[58][59].
  • By using the standard scores of individual sub-tests, individuals can be categorized into five categories: Well above average (scores between 130-145), Above average (scores between 115-130), Average (scores between 85-115), Below average (scores between 70-85) and Well below average (scores below 70).

Norm values[edit | edit source]

Cultural nuances, educational practices, and environmental factors can shape the way children engage with visual and motor tasks. Therefore, having norm values that are specific to a particular country ensures a more accurate and relevant assessment of visual-motor integration skills in the respective population. There is no significant difference in the VMI scores between boys and girls[60]. Practitioners should be careful when applying an evaluation in communities and cultural settings different to the ones on which it was originally standardized[11].

There are norm values for the following countries:

Evidence[edit | edit source]

The psychometric properties of the Beery VMI are:

  • Excellent test-retest reliability (0.84-0.88)[1][13][65]
  • Interrater reliability of (0.90-0.98)[1][13][65]. The Interrater reliability may be significantly affected by the extent of training and experience that the scores possess[10][66][67][68][69].
  • Internal consistency (0.81-0.82)[1][13]
  • The Beery VMI stands out in terms of psychometric properties among other instruments assessing writing readiness[70].
  • The Beery VMI has strong construct validity based on the construction of test items and strong predictive validity regarding academic outcomes[71].
  • The Beery VMI demonstrates moderate concurrent validity when compared to the Copying subtest of the Developmental Test of Visual Perception - 2nd edition[72] and the Wide Range Assessment of Visual-Motor Abilities[73], with correlation coefficients of 0.75 and 0.52 respectively[1].
  • The Beery VMI is considered to be a culture-free assessment tool by some researchers[74][75][76][77], but there is also evidence that it is not a culture- and ethnic-free assessment tool[11].
  • The Beery VMI is not sensitive in detecting change in visual-motor integration[52][78], so it should not be used as an outcome measure for assessing changes after a handwriting intervention[14][21][79][80][81][82][83].
  • The Beery VMI can serve as a valuable tool for evaluating changes over time in pediatric clinical vision studies. Its applicability spans a broad age range, with norms provided for ages 2 years through adulthood. This enables consistent longitudinal assessments using the same instrument from toddlerhood through adulthood[65].

The scoring can be time consuming, and the results can be influenced by the examiner's subjectivity and bias. This can potentially impact the sensitivity of the Beery VMI[13].

References[edit | edit source]

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