Have children's manual dexterity skills changed in the past 40 years? A cross-sectional observational norm comparison study

Tami L Konieczny ¹, Nellie P Butler ², Lynne Allen-Taylor ³

⁰Department of Occupational Therapy, Division of Rehabilitation, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists +

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November 18, 2025

View abstract on PubMed

Summary

Children

Area Of Science

Pediatric medicine
Neuroscience
Occupational therapy

Background

Established norms for the Box and Block Test (BBT) in children were from 1985 and 2013.
Evidence suggests potential changes in children's hand use over 40 years necessitate updated normative data.

Purpose Of The Study

To compare current pediatric performance on the BBT against the 1985 normative data.
To investigate potential declines in children's manual dexterity over time.

Main Methods

Secondary analysis of a cross-sectional observational study.
Participants (N=181, ages 7-18) completed one trial of the BBT with each hand.
Performance (blocks placed in 60 seconds) was compared to 1985 norms using one-sample t-tests.

Main Results

Children's mean BBT performance was statistically significantly lower than 1985 norms across all groups.
The deficit ranged from 9.1 to 31.3 fewer blocks placed in 60 seconds.
Nonoverlapping 95% confidence intervals and t-test results confirmed the decline.

Conclusions

Findings suggest a significant decline in children's manual dexterity over the past 40 years.
The 1985 BBT norms may no longer be accurate for current pediatric populations.
Clinicians should consider these findings when interpreting BBT results for children.

Keywords:

Box and Block Test Manual dexterity Motor development Normative data Pediatrics