Research Paper

British Journal of Occupational Therapy

2017, Vol. 80(11) 660–667

Development and initial validation of the ! The Author(s) 2017

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Gilboa functional test (GIFT): A unique DOI: 10.1177/0308022617711670
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measure for preschool graphomotor screening

Yafit Gilboa

Abstract
Introduction: Fine motor and graphomotor skills are essential for children’s healthy development, as well as for successful
participation in everyday activities. The Gilboa functional test (GIFT) is a newly developed norm-referenced screening instrument
for use with children 3–6 years old. The aim of this study was to develop and validate the GIFT as a new measure for preschool
graphomotor screening.
Method: A community-based sample of 611 children aged 3–6 years was screened.
Findings: Content validity was established via a panel of experts. The GIFT demonstrated good test–retest (0.95) and inter-rater
reliability (0.94), demonstrating good concurrent validity in scores which significantly correlated with the Beery-VMI (r ¼ 0.32,
P < 0.05), the Beery-MC (r ¼ 0.33, P < 0.05), the ‘manual dexterity’ subcategory of the movement assessment battery for children
(r ¼ –0.364, P < 0.05) and the total score of the developmental coordination disorder questionnaire ’07 (DCDQ’07)/little DCDQ
(r ¼ 0.41, P < 0.01). A significant difference in total GIFT scoring was found between children from mainstream versus special
education preschools (t ¼ 3.99, P < 0.001).
Conclusion: The GIFT is a unique tool that measures performance skills based on preschool children’s everyday activities. It can be
used by paediatric occupational therapists as a first step for early identification of children potentially at risk for graphomotor/fine
motor developmental delay.

Keywords
Screening test, preschool activities, graphomotor, fine motor, developmental delay

Received: 8 December 2016; accepted: 25 April 2017

Introduction
Fine motor skills are essential for children’s healthy devel-
opment as well as for successful participation in everyday
activities (Chien et al., 2009). The lack of such skills can
have a negative effect on various fields of development in
daily life and in academic performance (Roebers et al.,
2014). In addition, prompt detection of difficulties in a
child’s fine motor and graphomotor development, along
with application of suitable therapeutic proceedings, can
prevent later development of greater difficulties in writing
(Matijević-Mikelić et al., 2011). Therefore, in light of the
importance of later successful integration into the educa-
tional system, identification of problems during preschool
appears to be crucial as the first step towards intervention.
Consequently, the information provided by a sound
assessment tool is of great importance (Chien et al., 2009).
A number of screening instruments are available for
identifying fine motor developmental delay in preschool
children (Rihtman et al., 2011; Shooman and
Rosenblum, 2014). The first alerts are mostly based on
reports from parents or teachers. However, in recent
years the viability and reliability of parent and educator
reports on child functioning have been widely debated
(Gudmundsson and Gretasson, 2009). Other available
screening instruments are based solely on a specific skill,
such as copying figures (Beery et al., 2010), leaving other
basic functional fine motor and graphomotor skills unad-
dressed. Still other assessment batteries use distinct fine
motor tasks such as pegboard subtests, which are evalu-
ated with regard to timed performance and movement
quality (Henderson et al., 2007) but without focusing on
functional preschool tasks. An additional tool, the Shore
handwriting screening for early handwriting development
(SHS), is a non-standardised observation checklist that
was developed without formal scoring criteria; it lacks evi-
dence on psychometric properties and does not have a
normative sample (Shore, 2003).
To address this situation, the objective of the current
study was to document the procedures involved in the
Lecturer in Occupational Therapy, School of Occupational Therapy, The
Hebrew University of Jerusalem, Jerusalem, Israel
Corresponding author:
Yafit Gilboa, School of Occupational Therapy, Faculty of Medicine, Hebrew
University of Jerusalem, Mount Scopus, Jerusalem, 91240, Israel.
Email: Yafit.gilboa@mail.huji.ac.il
Gilboa
development of the Gilboa functional test (GIFT), a new
screening tool to identify young children at risk for fine
motor and graphomotor developmental delay, and to
establish the tool’s reliability in its content, construct
and discriminant validity, as well as concurrent validity
against a set of existing standardised tests.
The GIFT is a specially developed screening instrument
for preschool children 3–6 years old, designed to be used
by paediatric occupational therapists. The GIFT captures
real-life graphomotor skills performance in a childhood
educational setting, thus providing information about
the children’s ability to function within the context of
their natural environments.
Method
The GIFT includes five fine motor/graphomotor skill
items, which are rated by numeric evaluation. These five
items together cover a representative range of fine motor/
graphomotor skills that all children may exhibit at
preschool. They include: copying basic geometric figures;
colouring within lines; cutting with scissors; drawing a
person and writing the child’s first name. Based on the
normal development of these five activities (Case-Smith,
2015), the GIFT consists of three forms adapted for
the following age groups (years:months): 3–3:11, 4–4:11
and 5–6.
Phase 1: Development of the GIFT
Two steps were completed in the GIFT development pro-
cess: (a) selection of the activities that were representative
of childhood occupations at preschool and could elicit
children’s most appropriate fine motor/graphomotor per-
formance across different age levels; and (b) construction
of rating scales for each activity in each age group, fol-
lowed by scoring of a sample group of children to generate
a preliminary version.
Selection of the fine motor/graphomotor activities. Four cri-
teria were developed to assist with the selection of the
activities. They needed to: (a) be representative of
common childhood activities that require fine motor/
graphomotor skills; (b) present age-appropriate activities
for children aged 3–6 years; and (c) be easily observed in
the natural environment while placing minimal demands
on language and perception.
The selection of the activities was also based on two
source groups: (a) the core curricula for preschool educa-
tion in pre-reading and pre-writing that were published by
the Israeli Ministry of Education (Israeli Ministry of
Education, 2007) and by the US Department of
Education, as detailed for example by the state of New
Jersey (New Jersey State Department of Education,
2014); (b) a review of the current occupational therapy
literature on activities for assessing graphomotor func-
tions and dysfunctions in preschool children.
The existing literature described developmental grapho-
motor skills which were assessed by six main tasks: (a)
661
writing the child’s first name (Pontart et al., 2013;
Puranik and Lonigan, 2012; Shore, 2003); (b) drawing
(Matijević-Mikelić et al., 2011; Shooman and Rosenblum,
2014); (c) copying geometric figures (Pontart et al., 2013;
Rosenblum, 2006); (d) colouring of objects (Rosenblum,
2006; Shooman and Rosenblum, 2014; Shore, 2003; Stich
et al., 2014); (e) drawing lines inside of tracks (Henderson
et al., 2007; Stich et al., 2014); and (f) connecting dot
patterns or line segments drawn in grids of points (Stich
et al., 2014).
Content validity, initial version. A panel of six paediatric
occupational therapists who were experts in preschool
education assessed content validity. The panel evaluated
the suitability of these six tasks to the GIFT based on the
three criteria that were previously described. As a result of
the experts’ feedback, the activities were then reduced to
the first four, because the last two tasks were not repre-
sentative of a common childhood activity. Moreover,
based on the experts’ recommendation, along with the
above-cited curricula for preschool education (Israeli
Ministry of Education, 2007; New Jersey State
Department of Education, 2014) and a review of the lit-
erature (Rosenblum, 2006; Shore, 2003; Wilson et al.,
2009), one preschool fine motor activity was added: cut-
ting with scissors.
Construction and testing of the rating scale. Each item was
broken down into multiple components, with specific cri-
teria for scoring based on the international classification of
functioning, disability, and health – children and youth
version (ICF-CY) by the World Health Organization
(World Health Organization, 2007). In the first three
items of the GIFT, the examiner assesses the activities’
level of production in the tasks, with the effectiveness of
performance assessed by the relevant body function com-
ponents. In the last two items, the examiner assesses only
the execution of the activities. All body function compo-
nents were chosen based on performance analyses that
deEne how the selected tasks may be performed at each
age range, according to existing developmental rating
scales (Maxwell, 2010; Shore, 2003). The scoring criteria
were adjusted to three different base protocols for the
three age groups:
1. Copying nine basic geometric forms. The geometric figures
appeared in developmental order (Beery et al., 2010). The
score for the activity performance was based on the
number of recognisable graphic reproductions (0–9). In
addition, the score for the body function components
was given in a point rating scale (0–3), relating to the con-
sistency and efficiency of the pencil grip of the dominant
hand, and use of the non-dominant hand.
2. Colouring within three shapes. The shapes were presented
in developmental order from straight lines to curved
shapes, and from large to small shapes (Schneck, 2005);
they involve three shapes: a rectangle, a triangle and a
heart. The score for the activity (0–4) was given for the
number of shapes that were coloured completely and
662
precisely (the edge within the lines). The score for body
function components was given by the same criteria
described in task 1.
3. Cutting three shapes with scissors. The tasks were pre-
sented in a developmental sequence, from the simple act
of cutting accurately (along a line), to change of direction
at corners (a square), to a continuous cutting task around
a shape with no direction change (a circle) (SpringEeld,
1998). The score for the activity (0–4) was based on the
effectiveness (rhythm and appropriate cutting strategies)
and the accuracy of the performance. The body function
component’s score (0–3 points) evaluated the functional
prehension of the scissors with the dominant hand and
appropriate strategies for holding the paper with the
non-preferred hand.
4. Writing the child’s first name. This subtest was applied to
only two of the three protocols (ages 4–5 and 5–6 years).
From around age 4 years, children begin to use letters that
can be distinguished in the Hebrew or Latin alphabets
(Puranik and Lonigan, 2012). The tasks were chosen as
representative of a developmental continuum for pre-
writing (Case-Smith, 2015; Israeli Ministry of Education,
2007) from copying their name (ages 4–4:11) to writing their
name (ages 5–6). The score for the activity ranged from 0 to
3 points, depending on specific writing features present or
absent in children’s name-writing. The scale addressed the
components of accuracy, organisation and legibility in
placement, order, size and spacing of the letters.
5. Drawing a person. Children were asked to draw a person
on a white A4-sized sheet of paper. The score for the activ-
ity in this task depended on the number of recognisable
organs that were drawn. The maximum number of body
parts according to each age group (3, 8 and 12 parts,
respectively) was based on previous developmental tests
(Miller, 2006; Shore, 2003).
A final score was computed by summing up all five test
items. Within the proposed rating scale, a higher score
indicates better performance; the maximum possible
total raw scores were 20, 35 and 40 for age groups
3–3:11, 4–4:11, 5–6, respectively. The total scores were
converted into percentiles which enabled comparisons
between the different versions. Diagnostic results were
Table 1. Distribution of the total participant sample across different age groups and age characteristics of the participating children in
the reliability and validity study.
Age group Gender N (%) Cultural background N (%)
(years:months)
N (% of Average Modern
sample) age (SD) Boys Girls UO Jews Jews
3–3:11 3.45 (.31) 70 (44) 89 (56) 39 (24) 121 (76)
159 (26)
4–4:11 4.53 (.27) 152 (58) 110 (42) 121 (46) 126 (48)
262 (43)
5–5:11 5.47 (.33) 118 (62) 72 (38) 96 (50) 94 (50)
190 (31)
SD: standard deviation; UO: Ultra-Orthodox.
British Journal of Occupational Therapy 80(11)
classified into ‘normal’ (>1 standard deviation (SD)
below the mean) and ‘follow-up’ (<1 SD below the mean).
Phase 2: Content validity, final version
After establishing the final research version, 33 experts
(paediatric occupational therapists) were recruited who
did not take part in the first stage (100% were women,
averaging 11.25  7.14 years of experience). Each occupa-
tional therapist reviewed the GIFT as a whole as well as
the individual items comprising it, and rated each for its
relevance to graphomotor screening for each particular
age group. The degree of relevance was rated on a
5-point Likert-type scale (1 ¼ not at all relevant and
5 ¼ extremely relevant). The content validity for each
item (Polit and Beck, 2006) was determined by taking
the number of experts giving a rating of 4 or 5, divided
by the total number of experts (range 74–97%,
mean 90%).
Phase 3: Analysis of GIFT validity and reliability
Participants. We included 611 Israeli preschoolers (340
boys and 271 girls) aged 3–6 years (mean age 4 years
and 5 months, SD 8.10 months) for the norm development
of the GIFT. Ninety-one of the children were included in
the inter-rater and test–retest reliability components of the
study, and 150 children were included in the concurrent
validity segments. The participants were from diverse cul-
tural and educational backgrounds and were recruited
through social media advertisements and word of
mouth. Exclusion criteria: children with a known neuro-
logical condition. Table 1 shows the demographic infor-
mation on the participants.
Instruments
The Beery–Buktenica developmental test of visual-motor
integration (6th ed.) (Beery et al., 2010). This well
researched and commonly used standardised test was
used to measure visual-motor integration (VMI), visual
perception (VP) and motor coordination (MC). In the
Educational
Concurrent
General Special Reliability validity
Muslims education education study (N ¼ 91) (N ¼ 150)
155 (97.5) 4 (2.5) 40 41
15 (6) 240 (91.6) 22 (8.4) 23 64
168 (88.4) 22 (11.6) 28 45
Gilboa
VMI subtest, children were asked to copy 24 geometric
figures, starting with simple figures and ending with
more complex ones. In the VP subtest, the same 24 geo-
metric forms were presented. For each form, an identical
form had to be chosen among others that looked nearly
but not exactly the same. In the MC subtest, the child
‘traced’ each form by connecting the dots within the pro-
vided paths. The scoring procedure was based on the
number of correct forms completed. The subtests were
scored, and raw scores were converted into standardised
scores (mean 100, SD 15).
The developmental coordination disorder questionnaire
’07 (DCDQ’07) (Wilson et al., 2009) and the Hebrew version
of the little DCDQ (LDCDQ) (Rihtman et al., 2011). The
DCDQ’07 and the LDCDQ are valid and reliable
parent-report identification tools used to screen for the
presence of motor impairments in children between the
ages of 5 and 15 years, and in preschoolers aged 3–5
years, respectively. The questionnaires ask parents to com-
pare their child’s performance in everyday tasks with that
of their typically developing peers. The questionnaires
contain 15 items each, which rate the degree of children’s
coordination on a 5-point scale in three sub-categories:
control during movement, fine motor handwriting and
general coordination. Higher scores (maximum 75) indi-
cate better motor coordination. The DCDQ has good
internal consistency, and a Chinese-translated version of
the DCDQ’07 revealed a test–retest correlation of r ¼ 0.94
(Hua et al., 2015). Strong construct validity has been
reported for the DCDQ’07, with developmental coordin-
ation disorder (DCD) and suspect DCD groups scoring
significantly lower compared with a non-DCD group
(Wilson et al., 2009). Significant correlations between the
total scores on the DCDQ’07, the original movement
assessment battery for children and the Beery–Buktenica
developmental test of visual-motor integration have been
reported (respectively r ¼ –0.55 and r ¼ 0.42), suggesting
concurrent validity (Wilson et al., 2009).
The movement assessment battery for children (MABC)
(Henderson and Sugdin, 1992). The MABC is a standar-
dised, individually administered test widely used for
objective evaluation of motor functioning of children 4–
12 years of age. The test includes eight items that are
assessed along the following sub-scales: manual dexterity
(MD), aiming and catching, and balance. Summing up the
item scores for each subtest provides a sub-scale raw score.
Sub-scale scores can be added together to give a total
score. The total score on the MABC, as well as the sub-
scale scores and item scores, are converted into standar-
dised scores that reflect the child’s level of performance in
comparison with the norm.
Procedures
The ethics committees of the University of Haifa and of
the Hebrew University of Jerusalem approved this study.
A convenient sampling method was used: recruitment of
663
participants through word of mouth. All parents of par-
ticipants signed an informed consent form approving their
child’s participation. While their children were being
tested, the parents were asked to fill out a demographic
questionnaire and the DCDQ’07 or the LDCDQ (accord-
ing to the child’s age). The testing was administered indi-
vidually in a standardised sequence. The administration of
the GIFT took approximately 20 minutes; for children
who participated in the validation research, test adminis-
tration took approximately 45 minutes.
For the inter-rater reliability study, three examiners
independently assessed the performance of the GIFT test
by watching video recordings at normal speed. Regarding
the test–retest reliability study, the initial and the second
assessments were done by the same examiner, over an
interval of 1–2 weeks.
Statistical analysis
Score distributions of the GIFT were assessed using
descriptive statistics (mean, SD, range). The percentages
of individuals with the lowest and highest levels of partici-
pation were recorded. The GIFT’s final scores in the three
versions were analysed using Z-standard scoring. A t-test
was conducted to compare the performance of the boys
versus girls on the GIFT. Correlations between the
GIFT’s final score and age, and the mother’s years of edu-
cation, were examined using Pearson analysis.
Inter-rater reliability between two examiners, along
with the test–retest and concurrent validity, were exam-
ined using Pearson correlation analysis. Welch’s t-test
for unequal variances was used to determine differences
between the regular and special education groups with
regard to the GIFT’s score. Homogeneity of variance
was not assumed, due to the unequal sample sizes. In
this study, a P value less than 0.05 was set as the minimum
threshold for statistical signiEcance.
Results
Screening results and construct validity
The mean and SD scores of the GIFT, as well as the per-
centages of individuals with the lowest and highest scores
for each age group, are presented in Table 2. The results of
the GIFT did not demonstrate ceiling or floor effects,
which are considered to be present if more than 15% of
Table 2. Descriptive information and floor/ceiling effects of the
GIFT for each age group.
Possible GIFT total score % Worst % Best
Age group score possible possible
(years:months) range Mean SD score score
3–3:11 (N ¼ 159) 0–20 12.76 4.76 0.7 2.6
4–4:11 (N ¼ 262) 0–35 26.95 5.67 0.0 4.6
5–5:11 (N ¼ 190) 0–40 31.76 5.89 0.0 4.8
GIFT: Gilboa functional test; SD: standard deviation.
664 British Journal of Occupational Therapy 80(11)

respondents achieved the highest or lowest possible scores subscales of the DCDQ’07/LDCDQ and the MD sub-
(Terwee et al., 2007). scale of the MABC (see Table 4).
A significant performance difference was found
between the genders (girls scored higher). In addition, sig- Discriminant validity. The group difference in the GIFT’s
nificant correlations were obtained between age and the total score based on educational background characteris-
final scores of the GIFT (see Table 3). No significant cor- tics was analysed for discriminant validity using the
relation was obtained between the final score of the GIFT known-groups technique. A significant difference in total
and the mother’s years of education (r ¼ 0.042, P ¼ 0.649). GIFT scores was found between children from main-
stream preschools and children from special education
Inter-rater and test–retest reliability. Based on the Pearson preschools (t ¼ 3.99, P < 0.001). Children learning in the
correlation, the final inter-rater reliability score was 0.95. general education system had significantly higher total
With respect to test–retest, the total scores between the scores relative to the children learning in special education.
two repeated assessments exhibited a strong level of cor-
relation (r ¼ 0.94, P < 0.01).
Discussion
Concurrent validity. Significant correlations were found This study described the initial stages of the development
between the total scores of the GIFT and those obtained and validation process of the GIFT, a screening test
with the VMI and MC subtests, the total score and all the designed for the identiEcation of children aged 3–6 years
suspected of having fine motor and graphomotor develop-
mental delay in natural environments. The GIFT,
designed to be child friendly, uses common childhood
Table 3. Gender effect in the performance of the GIFT and activities that require fine motor/graphomotor skills
correlations with age. which can be observed in preschool classes. Although
the GIFT is still undergoing research, the result of the
GIFT total score current study indicates that the psychometric qualities of
Age group Correlations
(years:months) Boys (SD) Girls (SD) t with age the GIFT appear to be sound, with neither ceiling nor
floor effects (Terwee et al., 2007).
3–3:11 11.38 (4.72) 13.85 (4.57) 3.25** 0.54**
The gender differences seen in the GIFT are consistent
(N ¼ 159)
with previous findings relating to other screening instru-
4–4:11 25.16 (5.79) 29.47 (4.40) 6.51** 0.30**
(N ¼ 262) ments such as the little DCDQ, the ages and stages ques-
5–5:11 30.17 (6.26) 34.39 (4.04) 5.07** 0.36** tionnaire (ASQ), and the systematic screening of
(N ¼ 190) handwriting difficulties (SOS). In all the population-
based samples, it was observed that girls tended to score
GIFT: Gilboa functional test; SD: standard deviation.
higher (Rivard et al., 2014; Wilson et al., 2015). This fur-
**Significant at the 0.01 level.
ther supports the development of gender-specific cut-off
scores for the GIFT.
Fine motor and graphomotor skills develop dramatic-
ally during childhood. This is especially true between the
Table 4. Pearson correlation coefficient values between the GIFT ages of 2–6 years (Beery et al., 2010; Case-Smith, 2015).
and the Beery, DCDQ’07 and MABC subtests. Therefore, the correlations with age reinforce the con-
GIFT total struct validity of the GIFT as a developmental test for
score graphomotor and fine motor abilities. However, this
Beery (N ¼ 60) VMI 0.32*
result also supports the division of the cut-off scores into
MC 0.33*
smaller units of 4–6 months.
VP 0.16
The mother’s years of education are a single acceptable
DCDQ’07 þ little Control during movement 0.28*
measure of socioeconomic status (Mayson et al., 2009).
DCDQ (N ¼ 60) The GIFT result is in line with previous results, which
Fine motor handwriting 0.27*
found no significant differences in motor scores among
General coordination 0.31*
infants with mothers of different levels of education
Total score 0.41**
(Mayson et al., 2009).
MABC (N ¼ 30) Manual dexterity –0.36*
Aiming and catching 0.04
The inter-rater reliability was determined to be good,
Balance 0.08
indicating consistent agreement between different raters.
Total score 0.04
However, all the raters in our study were third-year occu-
pational therapy students with the same level of clinical
GIFT: Gilboa functional test; VMI: visual motor integration; MC: motor experience. Previous studies have reported that rater
coordination; VP: visual perception; DCDQ’07: developmental coordin- experience might affect the reliability of observational
ation disorder questionnaire ’07; MABC: movement assessment battery
for children. instruments (Chien et al., 2010; Cusick et al., 2005).
**Correlation is significant at the 0.01 level (two-tailed). Therefore, future studies should re-examine the inter-
*Correlation is significant at the 0.05 level (two-tailed). rater reliability using raters with a more diverse range of
Gilboa
professional experience and background. On the other
hand, the study results exhibited satisfactory test–retest
reliability, indicating that the graphomotor skills rated
by the same rater were relatively stable over time.
The results of the correlational analyses between the
GIFT and the two observational tools, the Beery and
the MABC, reinforced the concurrent validity of the
GIFT. The GIFT is significantly correlated with the
Beery VMI and MC subtests, and the MD subscale of
the MABC. The GIFT did not correlate significantly
with the Beery-VP or with the ball skills and balance sub-
scales of the MABC. These results support the validity of
the GIFT as a screening tool to detect fine motor and
graphomotor deficits in particular; the test was not
designed to measure visual-perceptual and/or gross
motor components.
The DCDQ’07/LDCDQ total score and the three sub-
scales (control during movement, fine motor handwriting
and general coordination) were correlated significantly
with the total score of the GIFT. These results are in
line with previous results that correlated the total score
and the subscale of the LDCDQ with the MD subscale
of the MABC, and with the VMI and MC subtests of the
Beery. All correlations were significant, with one exception
(Wilson et al., 2015).
The ranges of medium correlations were similar to
those reported in the literature on other screening ques-
tionnaires, such as the children activity scales (Rosenblum,
2006), the DCDQ and the results of the MABC (Wilson
et al., 2000).
In the current study, the GIFT score allowed for dif-
ferentiation between typically developing children and
children with special educational needs, thus confirming
discriminant validity. This result is in line with previous
studies which showed that children with special educa-
tional needs had significantly more borderline and definite
motor problems than the normative sample (Vuijk et al.,
2010; Westendorp et al., 2011).
Limitations and future research
Assessment of the clinical validity of any measure occurs
over time, with the continued use of a test across a variety
of sample groups (Wilson et al., 2000). This will also be true
for the GIFT. Further studies are required to confirm con-
clusively the GIFT’s reliability and validity. In this case a
convenient sample was recruited; a more rigorous recruit-
ment strategy could be used to select participants in a
random manner. In addition, future studies should investi-
gate the predictive validity of the instrument with measures
of motor and overall development, as well as other assess-
ments that measure participation by children. Such studies
may lead to further improvements of the GIFT in fulfilling
its purpose of identifying young children at risk for fine
motor and graphomotor developmental delay.
When screening a large number of children, a two-step
procedure is suggested (Peersman et al., 2012). In the Erst
step, teachers are asked to assess the general motor ability
of their pupils by means of a global checklist or
665
observation scale. Those children who are rated below
average for their age are subsequently screened by a stan-
dardised observational test; the GIFT has potential value
in this procedural step. However, its usability by preschool
teachers needs to be determined before the GIFT can be
promoted for this purpose.
Finally, when interpreting the results of the GIFT,
especially in relation to a child’s graphomotor develop-
mental level, it is important to take into account that the
test does not include certain areas of a preschooler’s devel-
opment such as gross motor perception and language.
Conclusion
The results of the current study indicate that as a norm-
referenced test, the GIFT is succinct, valid and reliable,
showing acceptably high indices of test–retest reliability
and inter-rater reliability. Satisfactory indices of content,
discriminant, construct and concurrent validity were
found, indicating that the items comprising the tool suc-
cessfully reflect the constellation of fine motor/graphomo-
tor development in preschool children.
The Endings of this study have several important
implications for occupational therapy practice. The
GIFT is designed as a quick, practical, easy to admin-
ister, norm-referenced observational screening tool that
can be implemented in the educational setting. It can be
used by occupational therapists for the early identifica-
tion of children potentially at risk for fine motor/
graphomotor developmental delay, and as a valuable
supplement to regularly used standardised measures of
gross motor skills used in paediatric practices. The
GIFT provides the clinicians with timely information
about a child’s fine motor/graphomotor difficulties,
which may be interfering with participation in preschool
activities. This information can assist the clinicians in
determining both the type of evaluations to use and
the goals of therapy.
Key findings
. The GIFT is a new norm-reference screening tool for
use with preschool children.
. The GIFT has high indices of reliability and satisfac-
tory indices of content, construct concurrent and dis-
criminant validity.
What the study has added
. This study presents the GIFT, a unique screening tool
that measures performance skills based on preschool
children’s everyday activities that can be used as a
first step for early identification.
Acknowledgements
The author would like to thank the staff of ‘Achiya – Learn That You
Can’ for the inspiration and the encouragement to develop the tool.
666
In addition, the author would like to thank her students in the School
of Occupational Therapy at Mivhar College in Bnei-Brak, the
University of Haifa and the Hebrew University of Jerusalem, for
the data collection. She would also like to thank the linguistic editors,
Mrs Hannah Weiss and Mr Andrew Goldstein.
Research ethics
This study was approved by the ethics committee of the University of
Haifa no. 12/200 (2012) and no. 224/14 (2014) and the Hebrew
University of Jerusalem no. 07022016 (2016). All parents of partici-
pants provided written informed consent.
Declaration of conflicting interests
The author confirms that there is no conflict of interest.
Funding
This research received no specific grant support from any funding
agency in the public, commercial, or not-for-profit sectors.
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