Abstract
Background Mastery motivation is a precursor of future developmental outcomes. Evidence about whether toddlers with motor delay have lower mastery motivation is inconclusive.
Objective The purpose of this study was to examine differences between mental age–matched toddlers with and without motor delay on various mastery motivation indicators.
Design A mental age– and sex-matched case-control study was performed.
Methods Twenty-two children with motor delay, aged 23 to 47 months, and 22 children who were developing typically, aged 15 to 29 months, were recruited. Persistence and mastery pleasure were measured with behavioral tasks that were moderately challenging for each child and with maternal ratings using the Dimensions of Mastery Questionnaire (DMQ). The DMQ was rated by each child's mother based on her perception of her child's motivation. Two types of structured tasks (a puzzle and a cause-effect toy selected to be moderately challenging for each child) were administered in a laboratory setting and recorded on videos. Paired t tests or Wilcoxon signed rank tests were used to examine group differences in persistence and mastery pleasure (α=.007, 2-tailed).
Results Children with motor delay were rated lower on DMQ persistence than the typically developing group, but they did not show significantly lower persistence on the structured tasks. There were no significant differences in mastery pleasure between the 2 groups on either measure.
Limitations Large within-sample variability on the tasks and small sample size makes subgroup analysis (eg, different severities) difficult.
Conclusions Toddlers with motor delay did not show lower persistence and pleasure when given tasks that were moderately challenging; however, their mothers tended to view them as having lower motivation. Clinicians and parents should provide appropriately challenging tasks to increase children's success and motivation.
Mastery motivation is a predictor of future performance of daily activities1 and academic achievement2 for children with developmental disabilities. In addition, mastery motivation predicted future cognitive function better than standardized developmental quotients for young children who are developing typically.3 Pediatric physical therapists view motivation as a determinant of change in basic motor abilities for children with cerebral palsy.4 Therefore, mastery motivation is an essential element of development for children with disabilities.1,2,5
Mastery motivation is defined as a multifaceted, psychological force that stimulates the child's attempt to master tasks that are moderately challenging for him or her.6 Mastery motivation focuses more on persistence, the process or motivation to master the task, rather than the child's ability to solve it.7 The emphasis on moderately challenging tasks echos the concepts of the “match” and the “zone of proximal development” that could provide the highest degree of motivation. The match is the optimal level of incongruity between the organism's cognitive level and environmental demands.7 The zone of proximal development is the distance between a child's current developmental level and the potential level of development with environmental facilitators.8 Theoretically, higher levels of mastery motivation, through focused exploration in early life, will increase interactions with the environment and repetitive practice, which lead to better developmental outcomes for toddlers.9
In early life, motor delay is the first concern of parents and usually is detected earlier than delays in other developmental domains.10 Toddlers (24–36 months of age) are viewed as beginning to be more self-regulated in their production of outcomes11 and to perceive themselves as agents of action in behavioral-event contingencies.12 Therefore, it is important to understand the mastery motivation of toddlers with motor delay.
There are 3 domains of the mastery motivation construct: object, social, and gross motion. The object domain includes children's attempts to master toys, the social domain is children's attempts to interact effectively with others, and the gross motor domain focuses on children's attempts to master physical skills.13 Within each domain, there are 2 indicators: instrumental and expressive. The instrumental indicator is represented by persistence and the duration of task-directed behavior, and the expressive indicator is pleasure or positive affect during or immediately after task-directed behavior.13 Both the Dimensions of Mastery Questionnaire (DMQ) and structured mastery tasks for measuring mastery motivation have been commonly used and have acceptable psychometric properties.14,15 The DMQ is used to rate caregiver's perceptions of children's behavior in the 3 domains of mastery motivation.
The individualized structured tasks are behavioral assessments used to code children's object-oriented mastery motivation.13 The individualized method involves selecting the appropriate difficulty level from a set of similar tasks, such as puzzles, so that each child is given a task that is moderately difficult for him or her. Some studies have shown that children are more motivated by tasks that are moderately difficult for them.16,17 Most children persist less at tasks that are too difficult or too easy for them.
The advantages of individualized structured tasks are that they provide observable records of the child's behavior, the tasks are individually moderately challenging for each child, and there is less influence of social desirability. On the other hand, the advantages of the caregiver questionnaire are: it can measure more than one domain of mastery motivation in daily life, and it does not require much testing time or a standardized setting. Both assessments have value as measures of mastery motivation14 and have been used to examine the differences between children with and without developmental disabilities.
Testing procedures, children's age, and matching criteria probably influence the results of studies about differences in mastery motivation between children with and without motor delay.15 Most previous studies have shown that children with motor or cognitive impairments were perceived to be deficient in mastery motivation when it was rated by the caregiver.18–21 Therefore, we hypothesized that mastery motivation measured with the DMQ would be lower in children with motor delay than in children with typical development.
When mastery motivation was measured using behavioral assessments, deficits in children with developmental disabilities were not always found.18,20,22–25 Some studies of children (3–12 years of age) with motor impairments demonstrated that they had lower mastery motivation than matched children with typical development, but none of these studies used individualized task methods, so the tasks may have been more difficult for the children with motor delay.23–25 However, other studies demonstrated that children (6 months–15 years of age) with motor or mental delay had a motivation level similar to that of mental age–matched children with typical development.18,20,22 All of these studies measured mastery motivation with individualized behavioral assessments; thus, each child received tasks that were moderately challenging for him or her.18,20,22 We, therefore, hypothesized that there would be no difference in object mastery motivation measured with individualized behavioral assessment between toddlers with motor delay and mental age–matched toddlers with typical development.
The aim of this study was to investigate differences between toddlers with and without motor delay, but matched on mental age and sex, on both the instrumental and expressive aspects of mastery motivation using both the parent-completed questionnaire and behavioral task methods. This is the first study to examine group differences of Chinese toddlers' mastery motivation, using both the DMQ and individualized structured mastery tasks.
Method
Design
We conducted a mental age– and sex-matched case-control study to compare mastery motivation indicators between toddlers with and without motor delay.
Setting
The experiment took place in the laboratory of a physical therapy department of a university and was conducted by a pediatric physical therapist (first author) who had been trained by the original developer (Morgan) of the individualized mastery tasks26 and the DMQ.27
Participants
To calculate the sample size, we used the study by Blasco et al,28 which investigated differences in mastery behavior between children with cerebral palsy and children developing typically, as a reference. The mean difference between the 2 groups was 0.50, and the pooled standard deviation was 0.53. When we set the alpha level as .05 and power as .80, the estimated sample size was 22 for each group.29 A convenience sample of 22 Taiwanese children with motor delay was recruited from hospitals and clinics in the Taipei area.
The inclusion criteria for children with motor delay were: (1) aged from 24 months to 48 months; (2) have a physician's diagnosis related to motor delay, which included impaired sensorimotor function with nonprogressive disorders of the central nervous system or impaired neuromotor development; (3) have a motor developmental quotient less than 85 as measured by the diagnostic test of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT)30; (4) have a cognitive and fine motor developmental age of 15 months or older in order to have the skills to do the mastery tasks; (5) have a biological mother who was the primary caregiver of the child at least 4 hours daily; and (6) the mother's educational level was at least junior high school, with adequate reading level to fill out the questionnaire. The exclusion criteria were: (1) having an unstable health condition, such as progressive epilepsy, severe hearing disease, being hospitalized frequently, or receiving a surgical operation in the previous 6 months; (2) having a visual or auditory impairment; or (3) having a diagnosis of autistic spectrum or attention deficit hyperactivity disorder.
For each child with motor delay, we recruited a mental age– and sex-matched child who was developing typically from advertisements or well-baby clinics in a medical center. To select the matched child with typical development, we calculated the mental age of each child with motor delay first, then recruited one child with typical development whose chronological age was within 2 months of the mental age and was the same sex as the child with motor delay. Inclusion criteria for children who were developing typically were: (1) the whole test developmental quotient on the CDIIT was 85 or above,30 (2) had a biological mother who was the primary caregiver at least 4 hours daily, and (3) the mothers' educational level was at least junior high school.
Measures
DMQ.
The DMQ contains 45 items, with each item rated on a 5-point Likert scale from 1 (“not typical at all”) to 5 (“very typical”).27,31 Our team translated the DMQ version 17.0 for children aged 1.5 to 5 years into Chinese, and the back translation was approved by the test developer (Morgan).27 Instrumental aspects of mastery motivation are assessed on 4 subscales: object-oriented persistence (eg, explores all parts of an object or toy), gross motor persistence (eg, tries to do well in physical activities even when they are difficult to perform), social persistence with adults (eg, tries to get adults to understand), and social persistence with children (eg, tries to get included when children play). There also are 2 subscales for assessing the expressive aspect of mastery motivation, including mastery pleasure (eg, smiles broadly after finishing something) and negative reaction to failure (eg, cries or fusses after failing at something he or she tried hard to do).
In addition, the general competence subscale of the DMQ, which reflects the child's ability rather than motivation, was included. The score of each subscale is the average of the items in the subscale. Therefore, the score range of each subscale is from 1 to 5. Total persistence was calculated by averaging the scores of the 4 instrumental subscales. Except for the negative reaction subscale, a higher score indicates higher mastery motivation. The DMQ has acceptable internal consistency (α>.7).15,31 Its convergent validity with structured tasks is moderate in children with Down syndrome (r=.42).2 Validity of the DMQ also was demonstrated by distinct differences in mastery motivation between infants at low and high risk for developmental delay.31 In addition, the DMQ showed moderate stability in children who were developing typically from 2 to 3 years of age.32
Individualized structured mastery tasks.
Two sets of individualized structured mastery tasks for 15- to 36-month-old children, developed by Morgan et al,26 were conducted to observe object-oriented mastery motivation behaviors. In the present study, task materials were modified somewhat so that they could be used for children up to 48 months of age. Two types of tasks were used: 6 puzzles and 3 cause-effect toys that varied in difficulty levels from easy for a 15-month-old child who is developing typically to difficult for 3.5-year-old. One specific puzzle and one cause-effect toy were coded for each child as moderately challenging (ie, not too easy and not too difficult), based on testing procedures suggested by Morgan et al26 and used by Hauser-Cram22 and Gilmore et al.33 The appropriate difficulty level of each mastery task was estimated initially from the child's mental age on the CDIIT and was determined by the performance of that child during behavior assessment. The criterion for moderate challenge was the child successfully completed at least one part of the task, but did not finish all parts of the task within first 2 minutes.26 Once a moderately challenging task was identified, the examiner let the child continue with that level for up to 4 minutes.
In the present study, 2 variables of instrumental mastery motivation during structured mastery tasks were: task persistence and continuity of task engagement. Task persistence was calculated by the number of 5-second intervals (0–48) in which the child showed mostly task-directed behavior (eg, trying to fit a puzzle piece). Continuity of task engagement was defined as the maximal duration of continuous task-directed behavior (0–240 seconds).34 Mastery pleasure was the expressive motivation variable on the structured mastery tasks. It was calculated from the number of 5-second intervals (0–48) in which the child showed positive facial expressions, vocalizations, or gestures during or immediately after task-directed behavior. Structured mastery tasks had acceptable psychometric properties, including interrater reliability (kappa=.80–.89), in this study and in other studies.19,22,33
CDIIT.
This inventory is a diagnostic developmental test. It was standardized on a normative sample of 3,703 Taiwanese children, aged 3 to 72 months, for the 5 developmental domains (cognition, language, motor, social, and self-help). The developmental ages and developmental quotients of all domains are obtained according to norms.35 A developmental quotient of less than 85 (1 standard deviation below the mean of the norm) was used to indicate some developmental delay in this study. The CDIIT has acceptable psychometric properties, including test-retest reliability,35 construct validity, and concurrent validity.30,35–38
Procedure
Mothers and children were invited to the laboratory during a wakeful time period for the child for about 90 minutes. After a warm-up period (with interesting toys other than the testing materials to make the child feel comfortable), the child was tested with the CDIIT. The mental age of each child was calculated immediately after this test and used for choosing the initial difficulty level for the later structured mastery tasks. After a 5-minute rest, a parent-child interaction observation was conducted, but not reported here. After another 5-minute break, the child was tested using the individualized structured mastery task method, and at the same time, the mother filled out the DMQ in the same room with her back facing the child.
Data Reduction and Analysis
Mangold INTERACT software (Mangold International and Thought Technology Ltd, Arnstorf, Germany)39 was used to code the toddler's most prevalent behavior during every 5-second interval of the 4-minute video recording of each mastery task. The interrater reliability between the tester and another experienced rater was acceptable (puzzle task: kappa=.81; cause-effect task: kappa=.85) when coding 10 videos separately.
The variables were examined for normality and analyzed using SPSS version 17.0 software (SPSS Inc, Chicago, Illinois). Descriptive statistics were used to present basic information about the children, their families, and the scores on the study measures. For comparison of the differences between the 2 groups, Wilcoxon signed rank tests were used for ordinal variables, and paired t tests were used for continuous variables with normal distribution. For paired t tests, effect sizes (ESs) were calculated as d=mean difference in 2 paired groups/standard deviation of the paired differences. For Wilcoxon tests, an r ES was calculated as
Results
Group Characteristics
The descriptive data for the children with motor delay and typical development are reported in Table 1. In addition to motor delay, 13 children had a medical diagnosis of: cerebral palsy (n=4), Down syndrome (n=2), Williams syndrome (n=1), microcephalus (n=1), failure to thrive (n=1), and other genetic disease (n=4). Although there were significant differences in developmental quotients between the 2 groups, there were no differences in developmental age on the domains of the CDIIT, except for the social domain (Tab. 1). For the children with motor delay, the numbers of children with different severity levels of motor and cognitive delay were: borderline (6 motor/12 cognitive), mild (4 motor/3 cognitive), moderate (8 motor/7 cognitive), and severe (4 motor/0 cognitive). The distribution of social economic status levels of families were 7%, 61%, 25%, and 7% for levels I to IV, respectively. Level I represents the highest social economic status, level III represents middle class, and level IV represents lower middle class.41 Thus, the social economic status of the participants was heavily middle class or higher (93%). There were no group differences in social economic status (z=0.47, P=.64, using the Wilcoxon test).
Characteristics of the Children With Motor Delay (n=22) and Without Motor Delay (n=22)a
Group Differences on Instrumental Aspects of Mastery Motivation
The results of comparisons between the motor delay and typical development groups on the DMQ subscales are shown in Table 2. The children with motor delay were rated significantly lower on all 4 DMQ persistence scales and total persistence than the children who were developing typically (t=−8.30 to −3.65, P<.001; paired t tests). The gross motor persistence of the motor delay group was rated much lower than the typical development group, with a very large ES (ie, 1.77).
Comparison of Mental Age–Matched Children With and Without Motor Delay on the Subscales of the Dimensions of Mastery Questionnairea
However, no significant differences existed between the medians of the motor delay and typical development groups on task persistence or continuity of task engagement on the 2 types of mastery tasks (z=0.47–0.89, P=.38–.64; Wilcoxon test; Tab. 3). The ESs of the 4 indicators of persistence at mastery tasks were small, and the medians were slightly higher for the motor delay group.
Comparison of Mental Age–Matched Children With and Without Motor Delay on the Individualized Mastery Tasksa
Group Differences on Expressive Aspects of Mastery Motivation
Neither the DMQ nor the 2 structured mastery tasks revealed significant differences at the preset alpha level of .007 in mastery pleasure between children with and without motor delay (t=−2.55, P=.02 for the DMQ in Tab. 2; z=0.12, P=.90 for puzzles and z=0.13, P=.90 for cause-effect tasks in Tab. 3). The ES (d=0.54) could be considered medium for the DMQ mastery pleasure ratings, but the ES (r=.03) for task pleasure were very small.
Discussion
The key finding of this study was that toddlers with motor delay had behavioral levels of persistence and pleasure in object mastery motivation similar to those of mental age–matched children with typical development when they were given tasks that were moderately difficult for them individually. Possible reasons for the key finding are discussed below, along with suggestions for clinical practice. Likewise, reasons for the finding that mothers of toddlers with motor delay rated their children as having lower motivation for mastery are discussed below.
Differences in Object Persistence Between Behavioral Assessments and Maternal Ratings
Although children with motor delay were rated lower by their mothers on all of the persistence aspects of mastery motivation, they did not differ on the behavioral mastery tasks. Therefore, our hypotheses about the instrumental aspects of mastery motivation were supported. The results are similar to those of 3 studies of children with Down syndrome18–20 in that the motor delay group was rated lower on the DMQ instrumental subscales than the typical development group, but had similar levels of persistence tested by object mastery tasks. There are several possible reasons that there seem to be differences in object persistence between observational assessments from the structured tasks and maternal ratings from the DMQ.
The lack of group differences on the structured mastery tasks could be because the individualized method is a more effective way to control for differences in cognitive competence and thus provides a better measure of mastery motivation than the maternal rating. In the present study, there were no significant group differences in cognitive developmental ages on the CDIIT (t=0.78, P=.44), in the difficulty levels of the structured mastery tasks (z=0.72–1.00, P=.32–.47), or in the competence scores on the puzzle and cause-effect tasks (t=−0.08 to 0.21, P=.84–.94) between the motor delay and typical development groups. Thus, the 2 groups were well matched on mental competence, as well as the difficulty level of the structured tasks used in this study.
Although the DMQ scores represent children's mastery motivation over time in natural settings, they were based on parental perceptions. Note that the typical development group was rated much higher on the DMQ general competence subscale than the motor delay group (t=−11.13, P<.001, ES=2.37). In the present study, there were significant Pearson correlations between scores on the DMQ general competence subscale and scores on the DMQ total persistence subscale in the motor delay group (r=.54, P=.009) and in the typical development group (r=.52, P=.013). These correlations imply that mothers seem to rate their children's motivation based on their children's competence level.
Another reason that mothers of children with motor delay might have rated their children as having low motivation is that some DMQ items seem to imply that the rated tasks were quite difficult. Thus, it is likely parents assume that difficult or hard tasks are more than moderately challenging.15 However, the structured mastery task method provides tasks that are moderately difficult for the individual child.7 Thus, the structured tasks probably provide measures closer to the definition of mastery motivation, which focuses on motivation to solve problems that are moderately challenging.6
In the current study, there were no significant correlations of object mastery motivation between the DMQ and the structured tasks in the motor delay and typical development groups (r=.12–.24, P=.28–.61). The results indicate that these 2 measures assess different aspects of mastery motivation: parental perception of motivation in everyday life and observations of mastery behavior in a structured setting.
Group Differences in Expressive Mastery Motivation
Regarding the expressive aspect of mastery motivation, a main finding of this study was there was no significant difference between mental age–matched children with and without motor delay, using both mastery tasks and the DMQ. Thus, the hypotheses related to expressive mastery motivation were partially supported. Furthermore, the difference in mastery pleasure scores on the 2 types of tasks between the 2 groups was very small (ie, ES=0.03). Thus, nonsignificance of mastery pleasure in mastery tasks is not likely due to lack of power or small samples. The results of the present study are similar to the findings of 2 previous studies19,22 and are inconsistent with the findings of 3 other studies that were not mental age–matched case-control studies.15,21,34 In the present study, children expressed somewhat more positive affect while doing cause-effect tasks than puzzle tasks, perhaps because they are more sensitive to the contingency between action and outcomes in the cause-effect tasks. Although the present study did not reveal significant group difference at the preset alpha level of .007 in DMQ mastery pleasure, the difference approached significance with P=.02, and the ES was 0.54. Therefore, mothers of toddlers with motor delay tended to rate their children as lower on positive affect while doing tasks.
Task Specificity of Structured Mastery Tasks
We further analyzed the relationships of object mastery motivation in the 2 types of structured mastery tasks in the motor delay and typical development groups. There were no significant Spearman correlations of task persistence between puzzle and cause-effect tasks in either group (r=−.08 to .25, P=.26–.74). Such task specificity in mastery motivation in children with and without delay also was found by Gilmore et al19 and Glenn et al.20 Because no individualized gross motor mastery motivation tasks are available at the current time, we do not know how the children with motor delay would have performed on such tasks or how scores on them would relate to the fine motor, object-oriented tasks used in current study. Individualized gross motor mastery tasks are needed for future examination of differences in the motivation of children with and without motor delay.
Clinical Application
The results of this study demonstrated that children with motor delay had levels of persistence and pleasure similar to those of their mental age–matched peers when presented with tasks that were appropriately challenging for them. Therefore, therapists could take advantage of this mastery drive and should present the optimal challenge during intervention.
There are several ways for clinicians to choose optimal challenge or adjust the motor task difficulty. The task selection principles in the individualized structured mastery tasks described in the “Method” section of this article could be used to identify moderately challenging tasks for each child. Using the norm of developmental tests to know the mean age required for each task could help to choose a moderately difficult task for each child.42 Clinicians also can adjust task difficulty through task requirement analysis and modification,43 such as modifying the amount and type of feedback, modifying practice conditions or context,44 and modifying tasks based on Gentile's taxonomy.45 The latter approach allows therapists to adjust the difficulty of a motor task by, for example, requiring whole body motion or not; the child could be asked to kick a ball in a static standing position or while running. Another example of such an adjustment of difficulty level would be asking the child to walk either carrying a cup of water or not.
For parents' education, therapists can teach the differences between ability and motivation and the importance of mastery motivation for development. Therapists also can instruct parents to use the “one-step ahead” approach46 to encourage children's autonomy, to offer cognitively stimulating activities and a variety of toys or activities in various settings, and to give emotional support.8 The concept of the one-step ahead approach is similar to Vygotsky's zone of proximal development, in which adults provide appropriate and necessary assistance to help the child to attain the next level of performance.46 Clinicians also can instruct parents how to observe and support children's mastery attempts and to be sensitive to the child's needs and respond appropriately.8,47
Limitations
Some limitations of this study were: (1) there was sample homogeneity because most participants in this study had middle to upper middle social economic status; (2) large within-sample variability on the tasks and small sample size made subgroup analysis, such as comparing different age or severity groups, impossible; and (3) some children might have been influenced by the unfamiliar structured environment, even after the warm-up.
Conclusions
This was the first study to examine the difference between mental age–matched toddlers with and without motor delay on both instrumental and expressive aspects of mastery motivation, using both the DMQ and individualized structured mastery tasks. The findings of this study illustrated that toddlers with motor delay did not show lower motivation compared with mental age–matched children with typical development when given tasks that were moderately difficult for them. However, mothers of toddlers with motor delay tended to view their children as having low motivation for mastering difficult tasks. To enhance mastery motivation in clinical populations, it is important to provide tasks with appropriate difficulty level for the individual child. It also may be necessary to educate parents about how to observe and support children's motivated behavior. In addition, therapists can teach parents to see and celebrate their child's strengths rather than focus on the child's difference from the typical.
Footnotes
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Ms Wang, Dr Hwang, and Ms Liao provided concept/idea/research design and data analysis. All authors provided writing. Ms Wang and Dr Hwang provided data collection. Ms Liao provided project management, fund procurement, study participants, facilities/equipment, and institutional liaisons. Dr Morgan and Ms Liao provided consultation (including review of manuscript before submission). The authors thank all of the participating children and their parents. They also thank the Pitotech Company for providing a trial version of the Mangold INTERACT software used for data analysis.
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The study was approved by the Human Subjects Review Committee of National Taiwan University Hospital, Taipei, Taiwan.
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This study was supported, in part, by Grant NSC 96-2314-B-002-074-MY3 awarded by the National Science Council, Taiwan (Republic of China).
- Received February 21, 2012.
- Accepted September 4, 2012.
- © 2013 American Physical Therapy Association
References
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