title: Visual-motor integration, visual perception, and fine motor coordination in a population of children with high levels of Fetal Alcohol Spectrum Disorder.
abstract: BACKGROUND
  Visual-motor integration (VMI) skills are essential for successful academic performance, but to date no studies have assessed these skills in a population-based cohort of Australian Aboriginal children who, like many children in other remote, disadvantaged communities, consistently underperform academically. Furthermore, many children in remote areas of Australia have prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD), which are often associated with VMI deficits.
  
  
  METHODS
  VMI, visual perception, and fine motor coordination were assessed using The Beery-Buktenica Developmental Test of Visual-Motor Integration, including its associated subtests of Visual Perception and Fine Motor Coordination, in a cohort of predominantly Australian Aboriginal children (7.5-9.6 years, n=108) in remote Western Australia to explore whether PAE adversely affected test performance. Cohort results were reported, and comparisons made between children i) without PAE; ii) with PAE (no FASD); and iii) FASD. The prevalence of moderate (≤16th percentile) and severe (≤2nd percentile) impairment was established.
  
  
  RESULTS
  Mean VMI scores were 'below average' (M=87.8±9.6), and visual perception scores were 'average' (M=97.6±12.5), with no differences between groups. Few children had severe VMI impairment (1.9%), but moderate impairment rates were high (47.2%). Children with FASD had significantly lower fine motor coordination scores and higher moderate impairment rates (M=87.9±12.5; 66.7%) than children without PAE (M=95.1±10.7; 23.3%) and PAE (no FASD) (M=96.1±10.9; 15.4%).
  
  
  CONCLUSIONS
  Aboriginal children living in remote Western Australia have poor VMI skills regardless of PAE or FASD. Children with FASD additionally had fine motor coordination problems. VMI and fine motor coordination should be assessed in children with PAE, and included in FASD diagnostic assessments.
authors.affiliation: School of Public Health, Curtin University, Perth, Australia. Electronic address: robyndoney@gmail.com.
authors.forename: Robyn
authors.initials: R
authors.lastname: Doney
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; Poche Center for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia. Electronic address: blucas@georgeinstitute.org.au.
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Lucas
authors.affiliation: Telethon Kids Institute, University of Western Australia, Perth, Australia. Electronic address: rochelle.watkins@telethonkids.org.au.
authors.forename: Rochelle E
authors.initials: RE
authors.lastname: Watkins
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia. Electronic address: tracey.tsang@sydney.edu.au.
authors.forename: Tracey W
authors.initials: TW
authors.lastname: Tsang
authors.affiliation: School of Public Health, Curtin University, Perth, Australia; Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia. Electronic address: k.sauer@curtin.edu.au.
authors.forename: Kay
authors.initials: K
authors.lastname: Sauer
authors.affiliation: School of Public Health, Curtin University, Perth, Australia; Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia. Electronic address: p.howat@curtin.edu.au.
authors.forename: Peter
authors.initials: P
authors.lastname: Howat
authors.affiliation: The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia. Electronic address: jlatimer@georgeinstitute.org.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; Telethon Kids Institute, University of Western Australia, Perth, Australia. Electronic address: james.fitzpatrick@telethonkids.org.au.
authors.forename: James P
authors.initials: JP
authors.lastname: Fitzpatrick
authors.affiliation: Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia; University of Notre Dame, Broome, Australia. Electronic address: ceo@mwrc.com.au.
authors.forename: June
authors.initials: J
authors.lastname: Oscar
authors.affiliation: Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia. Electronic address: maureen.carter@nindilingarri.org.au.
authors.forename: Maureen
authors.initials: M
authors.lastname: Carter
authors.affiliation: Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; The Sydney Children's Hospitals Network (Westmead), Sydney, Australia. Electronic address: elizabeth.elliott@health.nsw.gov.au.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D002492:Central Nervous System Depressants; D002648:Child; D015331:Cohort Studies; D000431:Ethanol; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D018811:Maternal Exposure / Q000706:statistics & numerical data; D009048:Motor Skills; D019957:Motor Skills Disorders / Q000453:epidemiology / Q000503:physiopathology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D011597:Psychomotor Performance; D014796:Visual Perception; D014904:Western Australia / Q000453:epidemiology
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol
keywords: Fetal alcohol spectrum disorders; Indigenous population; Motor skills; Psychomotor performance; Visual motor