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Motor Competence in Greek Adolescents Using Movement Assessment Battery for Children 2nd Edition: The Effect of Individual and Environmental Factors

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14 June 2026

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16 June 2026

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Abstract
Background/Objectives: The aims of the present study were (a) to identify motor difficulties in Greek adolescents attending secondary schools, (b) to assess motor difficul-ties related to gender, school grade, extracurricular organized physical activity, body mass index, handedness and type of school and (c) to compare anthropometric data among levels of motor difficulties. Methods: Adolescents’ (n = 742; Mage = 13.98 yrs.) motor difficulties were identified by the Movement Assessment Battery for Children–2nd Edition (MABC-2). Results: The results indicated that 1.5% of adolescents showed definite motor difficulties and 3.6% classified “at risk”. The ratio of motor difficulties between genders was about 1.5:1, with boys being more susceptible to being affected. Motor difficulties continue to exist in the secondary school grades in the same percentage, presented with left-handedness and lack of participation in physical activity. Motor difficulties prevalence existed in public and private schools in the same percentage, but no motor difficulties were detected in the music public school. Univariate analyses showed a higher body mass index in adolescents with definite motor difficulties compared to typically developed peers. Conclusions: In conclusion, motor difficulties continue to exist in adolescence and thus, individual and environmental factors should be taken into consideration during motor assessment procedures for more robust results.
Keywords: 
motor difficulties
;  
gender
;  
grade
;  
body mass index
;  
handedness
;  
physical activity
;  
obesity
Subject: 
Public Health and Healthcare  -   Public Health and Health Services

1. Introduction

Developmental Coordination Disorder (DCD) is a distinct neurodevelopmental disorder causing motor difficulties that interfere with daily living activities, academic performance, leisure, and play, without the existence of other neurological or pathological conditions. There are four definite criteria for DCD identification: “(A) acquisition and execution of coordinated motor skills is substantially below that expected given the individual’s chronological age and opportunity for skill learning and use. Difficulties are manifested as clumsiness as well as slowness and inaccuracy of performance of motor skills; (B) motor skills difficulties in Criterion A significantly and persistently interfere with activities of daily living appropriate to chronological age (e.g., self-care and self-maintenance) and impacts academic/school productivity, prevocational and vocational activities, leisure, and play; (C) onset of symptoms is in the early developmental period; and (D) motor skill difficulties are not better explained by intellectual disability or visual impairment and are not attributable to a neurological condition affecting movement” [1]. However, the diagnosis of DCD is a multi-dimensional procedure, including developmental and medical history, physical examination, school or workplace report, and individual assessment using psychometrically sound and culturally appropriate standardized tests, considering factors such as age and environment, for specific and personalized interventions designs [1,2]. The MABC-2 as a motor competence assessment, coupled with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria could identify DCD accurately and in detail, enabling beneficial interventions, in adolescents [3,4,5,6]. Thus, the diagnosis of DCD is crucial, as it is characterized by high prevalence among individuals, but it remains among the most unrecognized disorders, in medical and educational systems [7,8].
Although, the most prevalent estimate in children was suggested to be 5% to 6%, there is evidence that this estimation extends from 2% to 20% [1,9,10]. Recent studies in children and adolescents showed ambiguous results, from slightly higher [1,9,11] to very lower than previous prevalence values, in primary and secondary schools across cultures [12], as the strictness of selection criteria that were applied in the identification of motor difficulties, may have played a crucial role in epidemiological data [9]. Evidence showed that without timely intervention, motor difficulties due to DCD, persist in adolescence and even into adulthood, in a range of 50% - 70% of individuals diagnosed with DCD in childhood, with continuing problems in daily life, educational and work achievements, and physical and leisure activities. However, it is suggested that the impact of DCD will also vary depending on an individual’s personal resources (resilience, self-confidence) and the nature and extent of social support networks [9]. Although general motor performance improves with age in children with motor difficulties, the development of motor skills is not always linear, and this may be due to reduced participation in physical activity (PA) [13]. As evidence showed, balance, a critical factor in accurate and coordinated motor development, is impaired in children and adolescents with DCD, could affect and decrease their daily activities performance and PA participation. Future research should focus on factors that explain the different developmental motor patterns in children and adolescents with DCD [14,15,16].
Studies about gender prevalence of motor difficulties showed that DCD affects more boys than girls, in a range from 2:1 to 7:1 [1,9], although a boy-to-girl ratio of 1:2, in school age children (6-15 years old) was reported in a study from India indicating a higher prevalence in girls [12]. These results may be due to differences in underlying neurological systems between boys and girls [17]. However, study methods, diagnostic criteria, or cultural factors such as chances for learning and practicing motor skills, may affect gender differences in DCD prevalence [9,18].
In recent years, excessive body weight (overweight and obesity) has been associated with developmental disorders [19] and more specifically with DCD [20]. Excessive body weight as a child and adolescent may lead to an increased risk of obesity as an adult with related chronic diseases [21]. Motor difficulties were found to negatively affect mental and physical health like physical fitness and the development of obesity, and these consequences may be related to reduced levels of physical activity participation and increased levels of sedentary behavior [22,23,24]. As children and adolescents with motor difficulties were found to participate in physical and leisure activities inadequately, demonstrating higher body mass index, reduced cardiorespiratory fitness, strength, endurance, flexibility, balance, coordination, they are posed at a higher risk for obesity-related chronic diseases compared to peers with typical development [6,11,25,26,27,28,29,30,31,32,33,34]. Moreover, a recent meta-analysis showed that DCD is associated with obesity and overweight, and this association increases with age [20]. Recent research studies showed that children and adolescents with motor difficulties due to DCD, did not meet general recommendations for PA, lacking enjoyment from participation in organized sports and PA [33,35], while PA participation was found to impact motor skill performance, daily function, and well-being, positively [36]. It was stated that children and adolescents with motor difficulties due to DCD may avoid engagement in PA because they often experience low social status among peers e.g., being overlooked or chosen last for competitive games, resulting in reduced motor skill and physical fitness improvement due to lack of practice, which in turn limits participation in PA, further [37]. The activity deficit hypothesis and engagement in a negative cycle of inactivity could justify this assumption [35,38]. In addition, motor difficulties could anticipate reduced PA and enhanced sedentarism in adulthood highlighting that they continue from childhood to adolescence and adulthood communicating secondary negative health problems. Thus, this assumption stresses the need for assessment and identification of motor difficulties in childhood and adolescence [24].
Inconsistent handedness and left-handedness have been associated with DCD, but this association remains unclear [39,40]. The general assumption is that the prevalence of left-handedness is higher in individuals with DCD than in general population and is like the prevalence reported in children with other developmental disabilities [40]. This hypothesis supported by studies confirming a higher prevalence of left-handedness, unstable and mixed handedness, in school-aged children with DCD [39,41], although previous studies reported ambiguous results [42]. However, the relationship between DCD and handedness is unclear and it could be useful to investigate and identify potential differences and difficulties that may arise from hand preference in individuals with DCD, so that they can be appropriately addressed in adolescence and adulthood [40].
As DCD is an under-recognized and under-supported motor learning disorder and financing of individual therapy programs is limited, the school setting and even more physical education (PE) classes should be an excellent path to develop motor skills and promote PA participation in adolescents [7,43]. Secondary school students in Greece spend daily about 6 hours in schools. As school (microsystem) is one of the extrinsic factors or social environments that affects individual development, according to the bioecological model proposed by Bronfenbrenner [44], can be considered an essential environment for adolescent’s development [45,46]. It was also supported that biological (individual) and environmental factors and the relationships between them play an important role in motor development during childhood and adolescence [47]. As a result, it could be assumed that schools with structure and services that give amply experiences permit an optimal motor development [48]. Previous research from Spain and Greece showed that the private school environment affected positively motor development in preschoolers due to different organization and curriculum. Moreover, severe motor difficulties and lower scores on all dimensions of the MABC-2 test were more likely to be present in preschoolers, in public than in private schools, in Spain [49,50]. In Greece, public and private secondary schools follow the same curriculum policy with the same lessons and twice a week physical education classes, although private school are independent to offer extra curriculum sport, cultural, artistic activities etc. Public schools are financed exclusively by the state and all material and human resources depend on educational administration, whereas private schools have fees that are paid exclusively by families. Based on the competition in the high market, private schools tend to have better facilities, offer more sport participation in order to attract more students [45]. In addition, music secondary public schools in Greece follow a different curriculum based more on music classes, although physical education classes applied twice a week, as in typical public schools [51]. Evidence showed that simple music listening activities have brain benefits in typically and non-typically developed brains, highlighting the importance of musical practice as the perfect tool for neuro-education. Moreover, music training plays a privileged role compared to other activities (sports, visual arts, drama) in improving children’s executive functioning, as it depends on the integration of senses and motor skills like talking, walking, highlighting the relation between perception, cognition and action [52,53]. However, individuals with DCD must exert extra cognitive effort to master and perform everyday motor tasks and to organize themselves, their time and their equipment [54]. To the best of our knowledge, none of the previous research studies examined the prevalence of motor difficulties in adolescents from different types of schools.
It appears that motor coordination difficulties continue to exist in adolescence, interfering with daily living activities, academic performance, leisure, and play, with negative consequences in physical health [22,23,24]. In a preliminary study regarding parents’ reports, the need was stressed for improving diagnosis, increasing awareness and availability of services for DCD children and adolescents [33]. DCD remains among the most unrecognized disorders in educational systems [7,8] and individual assessment using standardized tests, should consider factors such as gender, age and environment, for specific and personalized interventions designs [1,2]. Moreover, according to Newell [47] individual and environmental factors and the relationship between them play an important role in motor development during childhood and adolescence [47]. Thus, these factors may influence the typical course of motor development in DCD. Gaining insight into factors such as age (school grade), gender, excessive body weight, handedness, PA participation, type of school and the prevalence of motor difficulties in adolescents, may help in developing targeted interventions to improve motor competence and promote PA, as schools play a crucial role in addressing the needs of children with DCD [7,43].
Thus, it was firstly hypothesized that the prevalence of motor difficulties in adolescents would be in line with official data, regarding scores in MABC-2. Secondly, it was hypothesized that adolescents would be differentiated in MABC-2 scores regarding their gender, secondary school grade (age), extracurricular organized PA participation, Body Mass Index (BMI), handedness and type of school. Finally, it was hypothesized that MABC-2 zones of motor difficulties would have an effect in BMI. Therefore, the main aim of the present study was to identify motor difficulties in Greek adolescents attending secondary schools. A secondary aim was to identify motor difficulties related to gender, secondary school grade (age), extracurricular organized PA participation, Body Mass Index (BMI), handedness and type of school. Finally, a third aim was to compare BMI among the three MABC-2 zones of motor difficulties.

2. Materials and Methods

2.1. Participants

Data were derived from 742 adolescents (367 boys; 49.5% and 375 girls; 50.5%) attending three typical public secondary schools, one public music school and one private secondary school, in an urban area of average socioeconomic status in Northern Greece. 47 (6.3%) of the adolescents attended 1st grade, 413 (55.7%) 2nd grade and 282 (38.0%) 3rd grade, aged M = 13.98 yrs. (SD = 0.74). Mean adolescents’ body height was 165.93 cm (SD = 8.70) and mean body weight was 56.79 kg (SD = 10.91). 292 (39.4%) of adolescents participated in extracurricular organized PA, mostly in team sports such as soccer, basketball, volleyball, handball and water polo (56.7%), while a 35% of them participated in individual sports such as swimming, track and field, martial arts and dancing activities, and a 8.3% in dual sports like tennis and badminton. 292 adolescents reported mean weekly frequency of participation in extracurricular organized sports 3.30 times/week (SD = .88) with mean 72.55 minutes per training session (SD = 22.64). In addition, 90.4% of the adolescents were reported as right-handed. Additionally, according to Table 1, 24% were classified as underweight, 67.3% as having healthy weight, while 7.6% and 1.1% as overweight and obese, respectively.

2.2. Materials

Movement Assessment Battery for Children - 2nd Edition (MABC-2) age band three (11 - 16 years) was used for adolescent’s assessment [4]. This motor test is designed to identify motor difficulties and assess motor competence in children and adolescents, while providing information and quality observations regarding motor development and effectiveness of motor intervention programs [4]. The 3rd age band of MABC-2 consists of eight test items divided into three categories: manual dexterity (turning pegs, triangle with nuts and bolts, drawing trail 3), ball skills (catching with one hand, throwing at wall target) and static and dynamic balance (two board balance, walking toe-to-heel backwards, zigzag hopping). A practice attempt and two official trials are given with the best to be evaluated. If the child/adolescent cannot complete the attempt properly it is classified as failed (F), if they refuse to perform it, as a refusal (R) and if they have inappropriate behavior during execution, as inappropriate (I).
According to the manual’s norms, raw scores derived from each test item are converted into age-adjusted item standard scores (SS) and component standard scores (CSS). The total standard score can be transformed into an age-adjusted percentile rank. The MABC-2 manual, according to a “traffic light system”, classifies children/adolescents who score ≤ 5th percentile (red zone – total test score up to and including 56) as having a significant motor difficulty, while those who score in the 6th -15th percentile (amber zone – between 57 and 67 inclusive) as being “at risk” of having a motor difficulty and requiring monitoring. Adolescents who score ≥ 16th percentile (green zone – any score above 67) do not have a motor difficulty [4]. Clinically, a cut-off score of ≤ 15th percentile to diagnose DCD is recommended, while a stricter cut-off score of ≤ 5th percentile is recommended for children ages 3–5 years [10].

2.3. Procedure and Design

The study was approved by the institutional research ethics committee (ERC-017/2023) before experiment was started and has been conducted in accordance with the principles set forth in the Helsinki Declaration. All parents or legal guardians of adolescents were informed about testing procedures, and corresponding written consent was obtained prior to participation. Also, the adolescents’ consent was obtained for their involvement and access to relevant information. Adolescents with a known history of intellectual, physical or emotional disability, as well as special educational needs, were excluded from the assessment. Prior to data collection, permission to conduct the study was granted from the school headmasters. The purpose of the study was explained to the participants; they were informed that their participation was voluntary and that their examination would remain confident. None of the participants denied participating in the data collection. A coding system was used to secure anonymity. A screening procedure using MABC-2 was performed to identify adolescents with motor difficulties. At this stage, adolescents were assessed individually in a specially equipped, quiet area and it was required about 20 minutes to complete the assessment.

2.4. Data Analysis

Categorical variables were presented as absolute frequencies (n) and relative frequencies (%), while the quantitative variables were presented either as means and standard deviations (followed the normal distribution). Frequency analyses were used to classify the prevalence of motor difficulties (definite, “at risk”, no difficulties) in all participants and to examine the prevalence of motor difficulties according to gender, grade (age), BMI, participation in extracurricular organized PA, handedness and type of school. Additionally, one-way Anova was used with Bonferroni adjustments to examine the effect of the three zones classification, according to “traffic light system” on anthropometric data. Moreover, univariate ANCOVA tests were used to examine effects among the three zones of motor difficulties in BMI with gender and extracurricular organized PA participation as covariates. The two-sided level of statistical significance was set equal to 0.05. To calculate the strength of the results, partial-eta-squared were applied (η2=0.01 small, η2=0.06 medium and η2=0.14 large) and Cohen’s f statistic for one-way analysis of variance (ANOVA) were used. The f values of 0.10, 0.25, and 0.40 represent small, medium, and large effect sizes, respectively [55]. The statistical processing and analysis of the survey data was performed using the statistical package SPSS, version 29.0.

3. Results

3.1. Prevalence of Motor Difficulties in Adolescents: Individual and Environmental Factors

Frequency analysis (N=742) showed that 1.5% of adolescents revealed significant motor difficulties (red zone) being below the 5th percentile (Standard Score up to and including 56), a 3.6% were ranked between the 5th and 15th percentile inclusive, thus classified “at risk” of having a motor difficulty (Standard Score between 57 and 67), (amber zone), while a 94.9% were above the 15th percentile (Standard Score above 67), (green zone) indicating no motor difficulties. Conclusively, the prevalence of motor difficulties according to a cut-off score of ≤ 15th percentile proposed for diagnosis was 5.1%. The results are depicted in Table 2 and show that difficulties appeared in all three motor domains, but adolescents with definite motor difficulties presented their difficulties in ball skills in a higher percentage, while adolescents “at risk” indicated a higher percentage in manual dexterity. In addition, regarding the occurrence of motor difficulties between genders boys are affected more in manual dexterity and balance than girls, while girls show difficulties in ball skills, in a higher percentage than boys. Moreover, regarding the gender ratio of definite motor difficulties prevalence was found to be 6 boys for 5 girls and “at risk” a ratio of 16 boys for 11 girls. Thus, the total ratio of motor difficulties was about 1.5:1 with boys being more susceptible to being affected by DCD. Table 3 demonstrates motor difficulties prevalence according to gender in all MABC-2 item scores.
Regarding the prevalence of motor difficulties between secondary school grades, the results are presented in Table 4 and show that motor difficulties continue to exist across ages in about the same percentage, in adolescents.
BMI-for-age was also categorized according to percentiles growth charts for boys and girls [4], and frequency analysis among zones of motor difficulties are shown in Table 5. Results showed that adolescents “at risk”, or with definite motor difficulties are at greater risk for overweight.

3.2. Anthropometric Variable Comparisons Among Zones of Motor Difficulties

Moreover, anthropometric data regarding zones of motor difficulties are presented in Table 6. One-way ANOVAs parametric analyses (Levenes’ tests of equality of variances < 0.05) among three zones of motor difficulties showed statistically significant differences only in BMI. Adjustments using Bonferroni corrections for post hoc analysis, as the number of comparisons was small [57], showed that the group of adolescents with definite motor difficulties (red zone) indicated higher BMI scores compared to adolescents with no motor difficulties (p<0.05).
Univariate (ANCOVA) results, using as covariates gender and extracurricular organized PA, revealed a significant zones of motor difficulties univariate effect [F708) = 4.02, p = 0.018, η2= 0.011], so it should be concluded that three different zones had a significant effect on BMI. Moreover, significant univariate effects were also revealed for both gender [F (1, 708) = 6.42, p = 0.011, η2 = 0.009] and extracurricular organized PA [F (1, 708) = 6.28, p = 0.012, η2 = 0.009] covariates, indicating that gender and PA participation had a significant effect on adolescents’ BMI. Follow-up ANOVA’s after Bonferroni adjustments indicated that adolescents in red zone (definite motor difficulties) had higher BMI scores compared to adolescents in green zone (no motor difficulties).
Cohen’s f effect sizes (ESs) for body height, body weight, age and BMI comparisons for the three zones (Anova’s) are presented in Table 6. The computations of ES were calculated according to Lenhard & Lenhard [58]. f values of 0.10, 0.25, and 0.40 represent small, medium, and large effect sizes, respectively [55] (Cohen, 1988). Results showed a small effect size for body height and body weight and a medium to large for BMI and age.
Regarding prevalence of motor difficulties among adolescents who participate in extracurricular organized PA the results are presented in Table 7, showing that adolescents had double prevalence of motor difficulties when they didn’t participate in extracurricular organized PA related to physically active peers.
Prevalence of motor difficulties between right- and left-handed adolescents are presented in Table 8 indicating that motor difficulties appear most in left- handed.
The prevalence of motor difficulties between the types of secondary schools, is presented in Table 9. It was found that although motor difficulties exist in typical secondary school settings in about the same percentages, in music school setting no motor difficulties were detected among adolescents.

4. Discussion

The present study aimed to identify motor difficulties in Greek adolescents attending secondary schools. Moreover, motor difficulties were examined regarding individual factors like gender, secondary school grade (age), body mass index (BMI), extracurricular organized PA, handedness and the type of school as an environmental factor. Another aim was to compare anthropometric variables (body height, bodyweight, BMI and age) among the three MABC-2 zones of motor difficulties.
According to the first hypothesis regarding the identification of motor difficulties in adolescents, the results of the present study indicated that 1.5% of adolescents revealed definite motor difficulties, whereas 3.6% classified “at risk” of having a motor difficulty. Adolescents with definite motor difficulties presented their difficulties mainly, in ball skills, while adolescents “at risk” indicated a higher prevalence in manual dexterity. These results are in line with the general estimations of 2% to 20% for motor difficulties, revealing a relatively low prevalence and close to the international standards reported for the disorder, in adolescents [59]. Previous research among younger school age children, in Greece, indicated that the prevalence of definite motor difficulties was lower 1.6% whereas about 10% was estimated as being “at risk” [60]. Moreover, the prevalence of motor difficulties in adolescents in the present study are like results in Europe data, as DCD estimate was about 2%, lower than in North America (6%), Brazil (11.6%) and Asia (4%) whereas they are higher than estimates in South India (0.8%), [12,59,61]. Ambiguous results, regarding DCD prevalence, may be due to different assessment tools, individual (age, gender) and environmental factors (type of school, sport participation) and thus they should be considered in DCD epidemiological data for more accurate interpretation [9]). However, the diagnosis of DCD is a multi-dimensional procedure, and should consider factors such as age and environment, for specific and personalized interventions designs [1,2].
According to the second hypothesis regarding the occurrence of motor difficulties between genders, results showed that boys were affected more by motor difficulties than girls, showing difficulties mainly in manual dexterity and balance, while girls showed mainly in ball skills. Moreover, regarding gender ratio of definite motor difficulties prevalence was found to be 6 boys to 5 girls and “at risk” a ratio of 16 boys to 11 girls. Thus, the total ratio of motor difficulties, in the present study, was about 1.5:1 with boys being more susceptible to being affected by DCD, in adolescence. These results are in accordance with the existing literature, which indicated that motor difficulties affect more boys than girls, in a ratio ranging from 2:1 to 7:1 [1,9,59], although there was evidence that girls indicated a higher prevalence compared to boys, in a study from India [12]. These findings highlight that gender differences in the prevalence of motor difficulties in children and adolescents may vary across populations, based on study methods, diagnostic criteria, or cultural factors [9], stressing the necessity of standardized assessment methods in DCD identification. Moreover, differences in underlying neurological systems (brain size and volume, density of gray matter, cerebral blood flow and thickness of the cortical areas) between boys and girls may also explain this unclear relationship [17,59,62]. Regarding motor domains, the results of the present study showed that motor difficulties in balance (static and dynamic) were more prevalent among boys over girls, agreeing to other studies which indicated that boys may experience greater postural control challenges [63], as it is a motor domain that individuals with DCD experience difficulties [16]. On the other hand, girls showed difficulties with ball skills as boys were found to be more proficient than girls in object control skills, such as throwing, catching, and kicking [64]. Thus, study methods, diagnostic criteria, or cultural factors such as chances for learning and practicing motor skills, may affect gender differences in adolescents with motor difficulties [9,18].
Regarding age, it was found that motor difficulties continue to exist in all three secondary school grades, in about the same percentage, in adolescents. Although general motor competence improves with age, in children with motor difficulties, this does not always occur, possibly due to their diminished participation in PA [13,64]. As evidence showed, balance is impaired in children and adolescents with DCD could affect and decrease their daily activities performance and thus PA participation impacting negatively motor competence. Future research should focus on factors that explain the different developmental motor patterns in adolescents with DCD [14,15,16] because adolescence represents a dynamic period of physical, psychosocial and highly individual development with the growth spurt leading to temporary reductions in motor competence (i.e., adolescent awkwardness), [3,64]. Age is the factor that depends on biological and neurological maturation of the child and their environment. Thus, the increasing variability in motor development with age would be explained with the interaction of maturation and environmental factors [65]. As age plays an important role in motor competence, in adolescence, it should be taken into consideration during motor assessment procedures in DCD [64].
The results of the present study indicated that adolescents had double the prevalence of motor difficulties when they didn’t participate in extracurricular organized PA related to physically active peers. These results are in line with general literature as individuals with DCD tend to avoid participation in physical and leisure activities, posing themselves at a higher risk for developing psychological and physiological deficits [25,34]. Moreover, as it was recently stated, children and adolescents with motor difficulties due to DCD, did not meet general recommendations for PA, lacking enjoyment from participation in organized sports and PA [33,66], and PA avoidance was found to impact motor skill performance, daily function, and well-being [36]. These findings could be justified by the activity deficit hypothesis and the engagement in a negative cycle of inactivity [35,38]. Children and adolescents with DCD may avoid engagement in PA, because they often experience low social status among peers, resulting in a further deterioration in motor competence and physical fitness due to lack of practice, which in turn limits more, their participation in PA [37]. This trend regarding reduced PA participation and enhanced sedentarism could continue in adulthood, highlighting that motor difficulties not only continue but transfer their secondary negative consequences, too. Thus, this assumption stresses the need not only for assessment and identification of motor difficulties in childhood and adolescence, but for assessment of PA behaviors for timely and physical activity-specific intervention application [24,66]. School settings should serve as a critical avenue, through various PE curricula, to increase motor competence in adolescents with and without motor difficulties [25,67].
It was assumed that there are positive interactions between motor competence and physical activity and negative interactions for weight status in adolescents [3]. Moreover, it was stated that excessive body weight as a child and adolescent put the individual to an increased risk of obesity as an adult with related chronic diseases [21]. The results of the present study showed that adolescents “at risk”, or with definite motor difficulties and thus with lower motor competence were at greater risk for having excessive body weight, as was interpreted by BMI. It was also indicated that the group of adolescents with very low motor competence indicated significant higher BMI scores compared to adolescents without motor difficulties. These results are in line with literature which stated that DCD is related to obesity and overweight, and this relationship increases with age [20]. This finding may be attributed to reduced levels of PA participation and increased levels of sedentary behavior among adolescents with DCD [22,23,24]. Taking into consideration these assumptions, coupled with the fact that motor difficulties and low motor competence continues to adulthood carrying excessive body weight and secondary negative health outcomes, it would be advisable that excessive body weight should also be evaluated when motor difficulties identified in adolescence, with caution to biological maturation, for more valid results [24].
Motor difficulties have been related to inconsistent handedness and left-handedness [40]. The results of the present study confirmed the above assumption indicating that low motor competence and motor difficulties appeared most in left- handed adolescents. Moreover, the present findings agree with studies conducted in younger school-age children with DCD [39,41,68], although there is evidence with ambiguous results [42]. Given that handedness relation with DCD has not identified clearly, it could be necessary that potential differences and difficulties that may arise from hand preference in DCD to be investigated, so interventions to take into consideration this relation in childhood and adolescence [40].
Schools could play an important role in improving development, motor competence and promoting PA participation, in adolescents with DCD, as this motor learning disorder is unknown and financial support for individual therapy programs is scarce [7,43,46]. The findings of the present study demonstrated that the prevalence of motor difficulties in typical secondary schools estimated at about the same percentage, both in public and private schools, whereas none of the adolescents in the music secondary school were detected with motor difficulties. The results of the present study are not in accordance with previous studies in preschoolers, which supported that private schools, due to its different structure, curriculum and services, give multiple experiences encouraging motor development, and indicating lower prevalence of motor difficulties [48,49,50]. The similar prevalence of motor difficulties in private and public schools, in our study, may be attributed to the fact that typical private and public secondary schools, in Greece, follow the same strict curriculum, except for optional extracurricular activities in private schools. Additionally, another explanation may be since our study engaged adolescents and not preschoolers who follow a more flexible school program [45]. Thus, our participants with motor difficulties, may have avoided PA by not choosing to engage in the extracurricular PA programs offered by their private school, as avoidance of PA related to motor difficulties is supported by literature [37,66]. In addition, the findings regarding the absence of motor difficulties in adolescents who attended the music secondary public school could be justified by the fact that music public schools follow a different curriculum based on music classes, students play musical instruments and participate in music performances [51]. Moreover, there is evidence that simple music listening activities have brain benefits in typically and non-typically developed brains. Additionally, music training is more effective compared to other activities like sports, in improving children’s executive functioning, a critical cognitive factor that is impaired in DCD individuals, who should exert greater effort than typically developed peers, in performing motor skills [52,53,54]. The prevalence of motor difficulties, or the evaluation of motor competence in different types of secondary schools as an environmental factor, could give valuable information for educational interventions, as it plays an important role in motor development during childhood and adolescence [47].

5. Conclusions

In summary, the findings of the present study indicated that the identification of motor difficulties assessing motor competence with a standardized test confirmed the prevalence in previous studies indicating a percentage close to the lower estimate reported for children and adolescents (1.5% definite and 3.6% “at risk”), with a ratio 1.5:1 with boys being more susceptible to motor difficulties prevalence [59]. Moreover, individual and environmental factors were found to play an important role in prevalence of motor difficulties in adolescents, indicating that gender, age, PA participation, BMI, handedness and type of secondary school should be taken in consideration during motor assessment procedures, in order efficient PA educational interventions to be designed in school settings, as environment and individual factors play an important role in motor development [25,47,64]. Although the present study was conducted in secondary schools in an urban area of average socioeconomic status, in Northern Greece, could be considered representative for this area, as most of the secondary schools participated. Furthermore, motor difficulties screening was performed by a single valid motor competence test. As DCD is a multidimensional procedure, future research should focus on this direction. Finally, individual and environmental factors were examined in relation to the prevalence of motor difficulties, so future research should examine them more thoroughly highlighting their relationships and their causal effects. In conclusion, our results suggest that by considering potential risk factors when screening motor difficulties by assessing motor competence, the adolescents should be assessed more holistically for robust results, allowing the development of targeted motor interventions based on each adolescent’s specific strengths and weaknesses.

Author Contributions

For research articles with several authors, a short paragraph specifying their individual contributions must be provided. The following statements should be used “Conceptualization, E.K. and M.K.; methodology, E.K. and M.K.; software, E.K. and M.K.; validation, E.K. and M.K.; formal analysis, E.K. and M.K.; investigation, E.K. and M.K.; resources, E.K. and M.K.; data curation, E.K. and M.K.; writing—original draft preparation, E.K. and M.K.; writing—review and editing, E.K. and M.K.; visualization, E.K. and M.K. All authors have read and agreed to the published version of the manuscript.”.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Research Committee of Aristotle University of Thessaloniki, Greece (ERC-017/2023, 13 April 2024).

Data Availability Statement

The data presented in this study are available on request from the corresponding author due to privacy reasons.

Acknowledgments

The authors appreciate the willingness and collaboration of the head of the school, teachers, parents and adolescents, and research assistants who were involved in the study. They all consented to the acknowledgement.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
MABC-2 Movement Assessment Battery for Children 2nd Edition
DCD Developmental Coordination Disorder
DSM-5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
PA Physical Activity
PE Physical Education
BMI Body Mass Index
SS Standard Score
CSS Component Standard Score

References

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Table 1. BMI categorization for children and adolescents between age 2-20 (The Centers for Disease Control and Prevention (CDC, 2024).
Table 1. BMI categorization for children and adolescents between age 2-20 (The Centers for Disease Control and Prevention (CDC, 2024).
Category Percentile Range
Underweight <5%
Healthy weight 5% - 85%
At risk of overweight 85% - 95%
Overweight >95%
Note. BMI-for-age was categorized according to percentiles growth charts for boys and girls [56].
Table 2. Prevalence of motor difficulties using MABC-2, in adolescents.
Table 2. Prevalence of motor difficulties using MABC-2, in adolescents.
Movement ABC-2
Zones of Motor Difficulty-
“Traffic Light System”		 Movement ABC-2 (N=742)
Total Manual Dexterity
 Aiming/ Catching Static / Dynamic Balance
n (%) n (%) n (%) n (%)
No motor difficulties
(green zone)		 704 (94.9%) 670 (90.3%) 659 (88.8%) 711 (95.8%)
“At risk” (amber zone) 27 (3.6%) 52 (7.0%) 38 (5.1%) 19 (2.6%)
Definite motor difficulties (red zone) 11 (1.5%) 20 (2.7%) 45 (6.1%) 12 (1.6%)
Note. N = 742, n = the number and % is the respective percentage of adolescents, classified in the three zones of motor difficulties, according to MABC-2 scores in manual dexterity, aiming and catching, static/dynamic balance, and total test score [4].
Table 3. Prevalence of motor difficulties using MABC-2, in adolescents according to gender.
Table 3. Prevalence of motor difficulties using MABC-2, in adolescents according to gender.
M ABC-2
Zones of Motor Difficulty-“Traffic Light System”		 Movement ABC-2 (N=742; 367 boys - 375 girls)
Total
n (%)		 Manual Dexterity
n (%)		 Aiming/Catching n (%)
Static/Dynamic Balance
n (%)
Boys Girls Boys Girls Boys Girls Boys Girls
No motor difficulties
(green zone)		 345
(94%)		 359
(95.7%)		 320
(87.3%)		 350
(93.3%)		 347
(94.5%)		 312
(83.2%)		 344
(93.7%)		 367
(97.8%)
“At risk”
(amber zone)		 16
(4.4%)		 11
(2.9%)		 29
(7.9%)		 23
(6.1%)		 12
(3.3%)		 26
(6.9%)		 15
(4.1%)		 4
(1.1%)
Definite motor difficulties
(red zone)		 6
(1.6%)		 5
(1.4%)		 18
(4.8%)		 2
(0.6%)		 8
(2.2%)		 37
(9.9%)		 8
(2.2%)		 4
(1.1%)
Note. N=742; 367 boys and 375 girls, n = the number and % is the respective percentage of adolescents, classified in the three zones of motor difficulties according to Movement ABC-2 scores in manual dexterity, aiming and catching, static/dynamic balance, and total test score in boys and girls [4].
Table 4. Prevalence of motor difficulties using MABC-2 in adolescents, among secondary school grades.
Table 4. Prevalence of motor difficulties using MABC-2 in adolescents, among secondary school grades.
Movement ABC-2 Zones of Motor Difficulty
“Traffic Light System”		 Secondary School Grades
1st Grade
n1 = 47
(Mage = 12.64
± 0.46)		 2nd Grade
n2 = 413
(Mage = 13.65
± 0.42)		 3rd Grade
n3 = 282
(Mage = 14.70
± 0.44)
n (%) n (%) n (%)
No motor difficulties
(green zone)		 44 (93.6%) 392 (94.9%) 268 (95%)
“At risk”
(amber zone)		 2 (4.3%) 18 (4.4%) 7 (2.5%)
Definite motor difficulties
(red zone)		 1 (2.1%) 3 (0.7%) 7 (2.5%)
Note. N=742; n1 = 47 (1st grade), n2 =413 (2nd grade), n3 =282 (3rd grade), n = the number and % is the respective percentage of adolescents, classified in the three zones of motor difficulties, according to Movement ABC-2 total test score, among the 3 secondary school grades (Henderson et al., 2007) [4].
Table 5. BMI classification (CDC, 2024), according to prevalence of motor difficulties using MABC-2 in adolescents.
Table 5. BMI classification (CDC, 2024), according to prevalence of motor difficulties using MABC-2 in adolescents.
BMI classification (CDC, 2024)
 Movement ABC-2
Zones of Motor Difficulty-“Traffic Light System”
No motor difficulties
(green zone)
ng=704		 “At risk” (amber zone)
na=27		 Definite motor difficulties (red zone)
nr=11
n (%) n (%) n (%)
Underweight 14 (2%) 1 (3.7%) 0 (0%)
Healthy Weight 514 (73%) 17 (63%) 5 (45.4%)
“At risk” for Overweight 133 (18.9%) 5 (18.5%) 3 (27.3%)
Overweight 43 (6.1%) 4 (14.8%) 3 (27.3%)
Note. N=742; ng = 704 (number of adolescents in green zone), na= 27 (number of adolescents in amber zone), nr= 11 (number of adolescents in red zone), n = the number and % is the respective percentage of adolescents, classified in the three zones of motor difficulties according to MABC-2 total test score, among BMI classification [4,56].
Table 6. Anthropometric data comparisons (one-way ANOVAs) for adolescents among zones of motor difficulties according to MABC-2.
Table 6. Anthropometric data comparisons (one-way ANOVAs) for adolescents among zones of motor difficulties according to MABC-2.
Anthropometric variables Zones of motor difficulties
No motor difficulties (green zone)
(ng= 704)		 “At risk”
(amber zone)
(na=27)		 Definite motor difficulties
(red zone)
(nr=11)		 F(2,739) p f
Mean (SD) Mean (SD) Mean (SD)
Body Weight (kg) 56.70 (10.80) 56.62 (12.08) 63.00 (14.66) 1.64 0.19 0.239
Body Height (cm) 166.01(8.61) 164.04 (10.95) 164.70 (8.92) 0.70 0.49 0.092
BMI (kg/m2) 20.49 (2.90) 20.92 (3.47) 23.09 (4.09) 4.07 0.01* 0.361
Age (years) 13.98 (0.74) 13.96 (0.94) 14.43 (0.65) 2.02 0.13 0.257
Note. SD= Standard deviation. Parametric test: ANOVA (Analysis of Variance) between zones of motor difficulty. ng = 704 (number of adolescents in green zone), na= 27 (number of adolescents in amber zone), nr= 11 (number of adolescents in red zone); F (2,739) = F Anovas measure with degrees of freedom, p = level of significance (p<0.05). An asterisk (*) denotes a significant effect. Cohen’s f was used as effect size measures for ANOVAs. f values of 0.10, 0.25, and 0.40 represent small, medium, and large effect sizes, respectively.
Table 7. Extracurricular organized PA participation in adolescents among zones of motor difficulties according to MABC-2.
Table 7. Extracurricular organized PA participation in adolescents among zones of motor difficulties according to MABC-2.
Extracurricular Organized PA Participation Movement ABC-2
Zones of Motor Difficulty - “Traffic Light System”
No motor difficulties
(green zone)
ng=704		 “At risk” (amber zone)
na=27		 Definite motor difficulties (red zone)
nr=11
n (%) n (%) n (%)
PA Participation
Npa =292		 279 (39.6%) 9 (33.3%) 4 (36.4%)
no PA Participation
Nnpa = 450		 425 (60.4%) 18 (66.7%) 7 (63.6%)
Note. N=742; Npa =292 (number of adolescents participated in extracurricular organized PA), Nnpa = 450 (number of adolescents not participated in extracurricular organized PA), n = the number and % is the respective percentage of adolescents, classified in the three zones of motor difficulties according to Movement ABC-2 total test score, between participation and no participation in extracurricular organized PA [4].
Table 8. Prevalence of motor difficulties using MABC-2 in adolescents, according to preferred hand.
Table 8. Prevalence of motor difficulties using MABC-2 in adolescents, according to preferred hand.
Movement ABC-2
Zones of Motor Difficulty-“Traffic Light System”		 Right-handed
(Nr = 671)		 Left-handed
(Nl = 71)
n (%) n (%)
No motor difficulties
(green zone)		 638 (95.1%) 66 (93%)
“At risk” (amber zone) 22 (3.3%) 5 (7%)
Definite motor difficulties (red zone) 11 (1.6%) 0 (0.0%)
Note. N=742; Nr =67 (number of right-handed adolescents), Nl= 71 (number of left-handed adolescents), n = the number and % is the respective percentage of adolescents, classified in the three zones of motor difficulties according to MABC-2 total test score, between right-and left-handed [4].
Table 9. Prevalence of motor difficulties using MABC-2 in adolescents, according to type of school.
Table 9. Prevalence of motor difficulties using MABC-2 in adolescents, according to type of school.
Type of Secondary Schools
Movement ABC-2
Zones of Motor Difficulty - “Traffic Light System”		 Public
Secondary schools
Npub=576		 Private
secondary school
Npriv=76		 Public
secondary music school
Nmus=90
n (%) n (%) n (%)
No motor difficulties
(green zone)		 533 (92.53) 70 (92.10) 90 (100)
“At risk”
(amber zone)		 33 (5.72) 4 (5.26) 0 (0.0)
Definite motor difficulties
(red zone)		 10 (1.73) 2 (2.63) 0 (0.0)
Note. N=742; Npub=576 (number of adolescents in public secondary schools), Npriv=76 (number of adolescents in the private secondary school), Nmus=90 (number of adolescents in the public secondary music school), n = the number and % is the respective percentage of adolescents, classified in the three zones of motor difficulties according to Movement ABC-2 total test score, among the type of secondary school [4].
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