Motor Coordination Assessment Battery for Children with Autism Spectrum Disorder (BACMA)

Abstract

The Motor Coordination Assessment Battery for Children with Autism Spectrum Disorder (known natively as the Bateria de Avaliação da Coordenação Motora em Crianças com Transtorno do Espectro Autismo [BACMA]; Monteiro et al., 2023) is an evidence-based clinical and psychoeducational measurement instrument developed to evaluate fundamental motor skills and motor coordination deficits in pediatric populations diagnosed with Autism Spectrum Disorder (ASD). Grounded conceptually in the fundamental movement phase articulated by Gallahue and Ozmun’s motor development model, BACMA directly operationalizes the psychomotor competencies indispensable for adaptive functional independence, school-based engagement, and recreational physical activity. The battery was formulated by the Paralympic Sports Working and Research Group (GTP) in Brazil to address severe ecological and structural limitations inherent in standardized Western pediatric motor batteries—specifically the Körperkoordinations Test für Kinder (KTK), the Bruininks-Oseretsky Test of Motor Proficiency (BOT/TBO), and the Test of Gross Motor Development, Second Edition (TGMD-2)—which often impose cognitive, linguistic, or social-communicative demands that confound pure motor coordination measurement in neurodivergent cohorts.

BACMA comprises four distinct physical-performance subtests mapping to core motor domains: Locomotion, Manipulation, Balance (stability), and Jumping. The psychometric validation of the instrument involved experienced health and physical education professionals who each possessed more than two years of specialized clinical experience working with pediatric ASD populations. Psychometric analyses demonstrate exceptional measurement properties, including a Content Validity Index (CVI) of 0.99 (99% inter-expert consensus) and an extraordinarily high internal consistency coefficient (Cronbach’s alpha = 0.99). Administered in a structured Battery response format using direct observational performance metrics, BACMA equips multidisciplinary evaluators, physical therapists, occupational therapists, and adapted physical educators with a standardized, ecologically valid diagnostic and evaluative tool for pinpointing specific sensorimotor integration challenges and monitoring targeted neurorehabilitation interventions.

Keywords

Autism Spectrum Disorder, Motor Coordination, Psychomotor Performance, Fundamental Motor Skills, Locomotion, Manipulation, Dynamic Balance, Jumping, Motor Assessment Battery, Pediatric Neurodevelopment, Adapted Physical Education, Psychometrics

Authors

The BACMA test battery was designed, validated, and published by a specialized interdisciplinary research team affiliated with prominent Brazilian academic and clinical research institutions:

• Carlos Eduardo Lima Monteiro — Programa de Doutorado em Enfermagem e Biociências (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil. Corresponding Author: [email protected].
• Fabrizio di Masi — Departamento de Educação Física e Esporte, Universidade Federal Rural do Rio de Janeiro (UFRRJ), Seropédica, Rio de Janeiro, Brazil.
• Divaldo Martins de Souza — Departamento de Esporte, Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil.
• Darlan Tavares dos Santos — Programa de Doutorado em Enfermagem e Biociências (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
• Moisés Simão Santa Rosa de Sousa — Departamento de Esporte, Universidade do Estado do Pará (UEPA), Belém, Pará, Brazil.
• Estélio Henrique Martin Dantas — Programa de Doutorado em Enfermagem e Biociências (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.

Purpose

The primary purpose of the Motor Coordination Assessment Battery for Children with Autism Spectrum Disorder (BACMA) is to deliver a reliable, non-discriminatory, and developmentally grounded psychomotor assessment system tailored explicitly to the unique cognitive, communication, and behavioral characteristics of autistic children. While Autism Spectrum Disorder is conventionally classified in diagnostic manuals such as the DSM-5-TR by persistent socio-communicative deficits and restricted, repetitive patterns of behavior, modern developmental neuroscience confirms that gross and fine motor coordination impairments represent an extraordinarily prevalent cardinal feature of the autistic phenotype, affecting between 70% and 90% of autistic children.

Despite the ubiquitous presence of motor control deficits, existing general pediatric motor batteries present major ecological and psychometric limitations when deployed with neurodivergent individuals. Instruments like the TGMD-2 focus extensively on complex qualitative movement process checklists that require children to attend to elaborate verbal directions or mimic multi-stage demonstrator postures, inadvertently transforming motor evaluations into tests of receptive language, central coherence, or social imitation. Similarly, the KTK and BOT-2 demand sustained attention, tolerance for artificial laboratory-style apparatuses, and prolonged testing sessions that frequently induce sensory overload, anxiety, or task refusal in autistic participants. Consequently, clinical assessors frequently find themselves unable to determine whether an autistic child’s poor score reflects true neuromotor dysfunction or an inability to process multi-tiered verbal instructional constraints.

BACMA was formulated by the Paralympic Sports Working and Research Group (GTP) to resolve this assessment gap. Its specific purposes include:

• Direct Phenotypic Profiling: Systematically profiling a child’s motor competency across four core movement dimensions (Locomotion, Manipulation, Balance, and Jumping) without confounding motor performance with language comprehension deficits.
• Individualized Intervention Design: Supplying pediatric occupational therapists, physiotherapists, neurorehabilitation clinicians, and adapted physical educators with granular baseline performance metrics to construct targeted sensory-motor and psychomotor interventions.
• Longitudinal Progress Monitoring: Providing objective, standardized criteria to track motor development, functional autonomy, and adaptive movement gains over time in clinical, educational, and sports-training contexts.
• Epidemiological and Translational Research: Establishing an empirically validated measurement standard for clinical trials evaluating the motor efficacy of neurodevelopmental, psychomotor, and adapted sports interventions designed for autistic cohorts.

Psychological Construct

The core construct assessed by the BACMA is Pediatric Motor Coordination within the neurodevelopmental context of Autism Spectrum Disorder. Motor coordination is defined biomechanically and neurologically as the harmonious, spatio-temporally synchronized sequencing of muscular action patterns orchestrated by the central nervous system to execute goal-directed movements with efficiency, kinematic precision, and adaptive stability.

In children with neurotypical development, fundamental motor coordination matures along predictable developmental sequences, transitioning from rudimentary survival reflexes into fundamental movement patterns, which subsequently form the building blocks for specialized athletic, scholastic, and activities of daily living (ADL) competencies. However, neuroimaging and neurodevelopmental investigations have shown that autism is characterized by widespread disruptions in neural connectivity, particularly involving the fronto-striatal circuits, the motor cortex, the basal ganglia, and cerebellar architectures responsible for internal forward modeling, feedforward motor planning, and continuous sensorimotor feedback correction.

BACMA operationalizes this multidimensional construct across four distinct developmental sub-constructs:

1. Locomotion

The locomotion subscale evaluates the child’s neurological capacity to transport the center of body mass dynamically across space while coordinating alternating reciprocal limb movements. In autistic children, locomotive disruptions frequently manifest as atypical spatio-temporal gait metrics, reduced step-length consistency, reduced arm swing, asymmetric ground reaction forces, and toe-walking (equinus gait). The locomotion tasks in BACMA gauge fluid forward and multidirectional displacement, assessing how effectively the motor cortex and spinal central pattern generators synchronize lower-extremity propulsion while preserving postural orientation.

2. Manipulation

The manipulation subscale captures fine and gross upper-limb coordination required to control, project, arrest, or physically influence objects within the immediate environment. Successful manipulative performance necessitates precise visuo-motor coordination, predictive perceptual anticipation, distal grip modulation, and upper-extremity kinetic integration. Autistic children frequently demonstrate atypical fine motor control, manual dyspraxia, and impaired anticipation of interceptive kinetics. BACMA assesses manipulative competence by evaluating how effectively the child integrates sensory input to execute controlled object-handling patterns, a domain directly predictive of handwriting readiness, school tool use, and functional self-care.

3. Balance (Stability)

The balance subscale isolates static and dynamic equilibrium, reflecting the child’s capability to stabilize the body’s center of mass within the base of support against gravitational forces. Balance requires continuous multi-sensory re-weighting, integrating vestibular, visual, and proprioceptive inputs within the vestibular nuclei and cerebellum. Children with ASD frequently display pronounced postural sway, delayed muscular reflex activation to balance perturbations, and an over-reliance on visual anchoring to maintain postural stability. BACMA’s stability tasks isolate equilibrium control across dynamic and reduced bases of support, reflecting the core stability necessary for virtually all terrestrial physical maneuvers.

4. Jumping

The jumping subscale functions as a specialized gross-motor metric integrating explosive neuromuscular power, bilateral lower-limb co-activation, and complex mid-flight aerial orientation followed by eccentric landing absorption. Jumping requires rapid stretch-shortening muscular cycles, symmetric bilateral propulsion, dynamic mid-air trunk control, and adequate anticipatory postural adjustments (APAs) upon ground contact. Autistic children frequently exhibit difficulties with bilateral motor integration and temporal sequencing, resulting in asymmetric takeoff, failure of simultaneous foot departure, or biomechanically stiff, uncoordinated impact absorption. Isolating jumping as a dedicated subscale provides deep insight into lower-body bilateral coordination and proprioceptive-vestibular integration.

Theoretical Framework

The architectural foundation of BACMA is rooted in the Motor Development Theory of David L. Gallahue and John C. Ozmun (2013), specifically their globally recognized Triangulated Hourglass Model of motor development. Under this theoretical paradigm, human motor development is conceptualized as an ongoing phase-based process governed by an interaction between individual biological hereditary factors and environmental affordances.

The Fundamental Movement Phase

Gallahue and Ozmun delineate four distinct phases of motor development across the human lifespan:

1. The Reflexive Movement Phase (in utero through infancy)
2. The Rudimentary Movement Phase (birth to age two)
3. The Fundamental Movement Phase (roughly ages two to seven years)
4. The Specialized Movement Phase (later childhood through adulthood)

The Fundamental Movement Phase represents the critical developmental window during which children explore, combine, and refine the primary movement patterns of their bodies. Gallahue and Ozmun divide fundamental movements into three primary categories: Locomotor skills (e.g., walking, running, hopping, leaping), Manipulative skills (e.g., throwing, catching, striking, kicking), and Stability/Balance skills (e.g., static balance, dynamic balance, axial twisting, landing). BACMA operationalizes Gallahue’s triad by preserving Locomotion, Manipulation, and Balance as fundamental pillars, while creating a distinct evaluative category for Jumping due to its unique diagnostic capacity to detect bilateral coordination, lower-body explosive power, and impact-absorption deficits common in pediatric neurodevelopmental conditions.

Dynamic Systems Theory and Newell’s Constraints Model

Complementing Gallahue’s foundational structural taxonomy, the conceptual design of BACMA incorporates Karl Newell’s Constraints Model within Dynamic Systems Theory of motor control. Dynamic systems theory posits that coordinated movement is not simply hard-wired by a central cognitive motor program, but rather emerges spontaneously through self-organization among three interacting classes of constraints:

• Organismic / Individual Constraints: The structural and functional characteristics of the child (e.g., muscle tone, proprioceptive acuity, cerebellar connectivity, vestibular sensitivity, attention span).
• Environmental Constraints: Physical surroundings (e.g., surface stability, ambient lighting, sensory noise) and socio-cultural demands.
• Task Constraints: The specific goals, operational rules, spatial boundaries, and physical equipment defining a given motor challenge.

Traditional motor batteries frequently superimpose complex task constraints (e.g., intricate verbal rules, verbal analogies, rapid multi-stage memory recall) onto neurodivergent children. Under Newell’s model, when task constraints exceed an autistic child’s receptive processing capacity, movement breakdown occurs not because of structural motor deficits alone, but because the systemic coordination cannot self-organize under conflicting constraints. BACMA consciously minimizes extrinsic cognitive, verbal, and sensory task constraints. By simplifying administrative prompts and optimizing physical task clarity, BACMA isolates the child’s true organismic motor capabilities, establishing an authentic psychomotor portrait of motor coordination.

Validity

The psychometric development of the BACMA was conducted following rigorous scientific test construction standards, prioritizing ecological and content validity for neurodevelopmental applications.

Content Validity and Expert Judge Consensus

The primary validation study for BACMA (Monteiro et al., 2023) established high content validity using an expert panel methodology. The panel consisted of certified, practicing health and education professionals—comprising physical educators, physical therapists, occupational therapists, and psychomotor specialists—each possessing over two years of documented clinical and educational experience delivering direct interventions to children diagnosed with Autism Spectrum Disorder in Brazil.

Content validity was evaluated quantitatively across criteria of theoretical relevance, developmental appropriateness, visual clarity, task feasibility, and non-discrimination. The battery demonstrated an exceptional Content Validity Index (CVI) of 0.99 (reflecting a 99% overall agreement rate among expert judges). This level of expert consensus confirms that the four operationalized test domains (Locomotion, Manipulation, Balance, and Jumping) thoroughly cover the fundamental motor coordination construct while maintaining optimal clinical utility for autistic children.

Comparative and Construct Validity Rationale

During the developmental phase, the Paralympic Sports Working and Research Group (GTP) performed comparative structural analyses against three universally established pediatric motor assessments:

• Körperkoordinationstest für Kinder (KTK): While highly standardized, the KTK focuses strictly on non-sports gross body balance and coordination (walking backward along balance beams, hopping on one leg across foam obstacles, lateral jumping, moving across wooden platforms), entirely omitting manipulative ball skills and requiring specialized mechanical equipment that can provoke behavioral apprehension in autistic children.
• Bruininks-Oseretsky Test of Motor Proficiency (BOT-2 / TBO): Although comprehensive across gross and fine motor domains, the BOT-2 is notoriously lengthy (taking 45 to 60 minutes for the complete battery), involves complex instructional protocols, and has severe administrative ceiling/floor challenges when administered to non-verbal or minimally verbal autistic individuals.
• Test of Gross Motor Development, Second Edition (TGMD-2): The TGMD-2 evaluates qualitative process criteria for fundamental gross motor skills. However, its heavy reliance on immediate observational imitation of a live visual demonstration poses construct-irrelevant variance for autistic children experiencing imitation apraxia or impaired mirror neuron functioning.

By purposefully synthesizing the primary functional advantages of these classical batteries and discarding their confounding cognitive and sensory barriers, BACMA achieves superior ecological construct validity for the targeted clinical group.

Reliability

The reliability of the BACMA test battery has been empirically verified through rigorous internal consistency assessment. In psychometrics, high reliability ensures that an assessment yields stable, internally cohesive, and repeatable measurements, minimizing measurement error attributable to test design or environmental fluctuations.

Internal Consistency

In the psychometric evaluation conducted by Monteiro et al. (2023), the BACMA battery demonstrated internal consistency with a calculated Cronbach’s alpha (α) of 0.99. A reliability coefficient of this magnitude confirms extreme covariance among the evaluated motor domains, indicating that the subtests within Locomotion, Manipulation, Balance, and Jumping converge uniformly upon the overarching latent construct of general motor coordination.

Inter-Rater and Test-Retest Considerations

Because the validation cohort comprised experienced clinical evaluators specializing in ASD, inter-rater reliability was bolstered by standardizing administrative routines, observational criteria, and performance scoring parameters. In pediatric autism assessments, test-retest reliability can often be compromised by endogenous state fluctuations in the child (e.g., changes in sensory processing sensitivity, emotional regulation, medication schedules, or environmental novelty). BACMA addresses these sources of observational instability by employing direct, objective performance-based metrics that allow examiners to capture reproducible motor scores across distinct evaluative sessions.

Factor Analysis

Within the initial validation study published by Monteiro et al. (2023), formal empirical data from Exploratory Factor Analysis (EFA) or Confirmatory Factor Analysis (CFA)—such as explicit orthogonal/oblique factor loading matrices, eigenvalues, Kaiser-Meyer-Olkin (KMO) measures of sampling adequacy, Bartlett’s test of sphericity, or structural equation modeling fit indices (e.g., CFI, TLI, RMSEA, SRMR)—were not explicitly reported in the primary index publication.

Theoretical Latent Dimensionality

Although empirical numerical factor loading matrices await secondary large-scale clinical trials, the theoretical latent structure of BACMA is conceptualized as an oblique four-factor first-order model subsumed under a single higher-order general motor coordination construct:

• Factor 1: Locomotor Efficiency — Accounting for variance in reciprocal lower-extremity cyclic patterns and dynamic spatial propulsion.
• Factor 2: Upper-Limb Manipulative Control — Accounting for variance in distal visuo-motor coordination, grip modulation, and projectile kinetic control.
• Factor 3: Postural Equilibrium & Stability — Accounting for variance in the maintenance of static and dynamic center-of-mass equilibrium under vestibular/proprioceptive control.
• Factor 4: Bilateral Explosive Coordination (Jumping) — Accounting for variance in symmetric bilateral lower-body power generation, flight stabilization, and eccentric ground absorption.

Future psychometric field trials involving larger pediatric sample sizes across the autism spectrum (stratified across levels 1, 2, and 3 of support needs) are recommended to conduct structural equation modeling (SEM) to confirm this four-factor latent topography and assess measurement invariance across chronological age cohorts and biological sexes.

Instrument / Measurement Tool

The BACMA is structured as an observational, performance-based clinical test battery. The operational parameters of the measurement tool are summarized below:

• Test Type: Original physical performance test battery / direct observational motor assessment.
• Format: Multi-component battery protocol consisting of physical tasks administered across standardized floor setups.
• Core Assessment Domains: Four distinct subtests:
  1. Locomotion
  2. Manipulation
  3. Balance
  4. Jumping
• Authentic Response Scale: Battery (structured multi-subtest observational performance trials scored via standardized quantitative and qualitative criteria).
• Target Population: Evaluated by trained Health and Education Professionals (pediatric physical therapists, occupational therapists, adapted physical educators, psychomotor specialists) who possess clinical experience (minimum 2 years) caring for children diagnosed with Autism Spectrum Disorder (ASD).
• Language Available: Portuguese (Original instrument developed in Brazil).
• Administration Setting: Spacious, non-distracting gymnasium, physical therapy clinic, or gross motor laboratory with low ambient sensory noise, non-slip flooring, and marked physical boundary lines.
• Scoring Mechanism: Tasks within each subtest generate objective performance data (e.g., successful completions, kinematic stability points, trials cleared) combined to form domain-specific subscale totals and an overarching composite motor coordination quotient.

Permissions & Fee and Test Year

• Test Year of Publication: 2023
• Commercial Availability: No. BACMA was designed within a public academic and doctoral research framework and is not commercially marketed as a proprietary retail product.
• Assessment Fee: No fee is required for non-commercial academic, clinical, or educational research usage.
• Permissions & Access Protocol: To obtain the full administrative test manual, specific physical task performance sheets, operational scoring rubrics, and protocol guidelines, researchers and clinical practitioners must contact the primary corresponding author directly:

Carlos Eduardo Lima Monteiro
Programa de Doutorado em Enfermagem e Biociências (PPgEnfBio), Universidade Federal do Estado do Rio de Janeiro (UNIRIO)
Avenida Pasteur, Bairro Urca, Caixa Postal 296, Rio de Janeiro / RJ, Brazil, CEP: 22290-250
E-mail: [email protected]

References

• Gallahue, D. L., & Ozmun, J. C. (2013). Compreendendo o Desenvolvimento Motor: Bebês, Crianças, Adolescentes e Adultos (7th ed.). AMGH Editora.
• Gorla, J. I., Duarte, E., Rodrigues, J. L., & Carminato, P. R. (2014). Coordenação motora de crianças com deficiência visual: Avaliação através do teste KTK. Revista Brasileira de Ciências do Esporte, 36(1), 143–156. https://doi.org/10.1590/S0101-32892014000100010
• Melo, F. D., Rodrigues, J. L., & Gorla, J. I. (2018). Validade do TGMD-2 em crianças com deficiência intelectual. Revista Brasileira de Educação Física e Esporte, 32(4), 579–587. https://doi.org/10.11606/1807-5509201800040579
• Monteiro, C. E. L., di Masi, F., de Souza, D. M., dos Santos, D. T., de Sousa, M. S. S. R., & Dantas, E. H. M. (2023). Criação e determinação da validade de uma bateria de teste para coordenação motora em crianças com autismo [Creation and determination of the validity of a test battery for motor coordination in children with autism]. Motricidade, 19(3). https://doi.org/10.6063/motricidade.31057
• Moreira, M. E. C., Rocha, C. F., & Mello, M. T. (2008). Teste de Proficiência Motora de Bruininks-Oseretsky (TBO): Aplicação em contexto brasileiro. Cadernos de Pós-Graduação em Distúrbios do Desenvolvimento, 8(1), 35–44.
• Newell, K. M. (1986). Constraints on the development of coordination. In M. G. Wade & H. T. A. Whiting (Eds.), Motor Development in Children: Aspects of Coordination and Control (pp. 341–360). Martinus Nijhoff Publishers. https://doi.org/10.1007/978-94-009-4460-2_19

Items of the Scale