Miller Function & Participation Scales

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April 14, 2017

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Purpose

The M-FUN measures a child’s fine, visual, and gross-motor skills and attempts to determine the impact of these skills on his or her participation in home and school activities.

Link to Instrument

Instrument Details

Acronym M-FUN

Area of Assessment

Occupational Performance
Processing Speed
Reasoning/Problem Solving
Self-efficacy
Social Relationships
Strength
Touch
Upper Extremity Function
Vestibular
Vision & Perception

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$466.00

Diagnosis/Conditions

Pediatric + Adolescent Rehabilitation

Non-Specific Patient Population

During the performance component of the assessment children complete fine motor, visual motor, and gross motor games. The participation component includes three observation checklists: Home, Classroom, and Test Observation Checklist.
Performance Component (Items and Scoring):
A) 15 games for ages 2.6 to 5.11 years
B) 16 games for ages 6.0- to 7.11 years
C) Each game aligns with a specific neurological ability and is scored from 0-2 or 0-3
D) The totals are added up for each game to get an overall score
Participation Component (Items and Scoring):
A) 46 items for the Classroom Observations Checklist
B) 65 items for the Home Observations Checklist
C) 25 items for the Task Observations Checklist
D) The items on the observation checklists are scored as “almost always successful,” “frequently successful,” “occasionally successful,” “seldom successful,” or “not observed”.
E) These ratings are then tallied to generate a score of: Average, Below Average, or Far Below Average.
For administration instructions, see the scoring manual.

Number of Items

15 games for ages 2.6 to 5.11 years

16 games for ages 6.0 to 7.11 years

46 items for the Classroom Observations Checklist

65 items for the Home Observations Checklist

25 items for the Task Observations Checklist

M-FUN Administration Directions
Record Form (for ages 2.6 to 3.11 or 4.0 to 7.11)
Workbook (for ages 2.6 to 3.11 or 4.0 to 7.11)
Origami templates
Large preschool-sized bright marker or highlighter with pointed tip
Ball, approximately tennis ball-sized
Stopwatch or watch or clock with a second hand
Child’s bank or an empty mixed-nuts can with lid, with a coin slot on the top of the bank or can, approximately 1 inch in length and 1/16 inch wide
Red felt-tipped pen; medium point
Child-sized scissors
18-inch string
#2 pencil
Colored modeling clay or soft therapeutic putty (shaped into four ping-pong-sized balls)
Two 8-ounce plastic glasses
Two to four napkins
Medium-sized metal spoon (table spoon)
Two terrycloth washcloths
Clear adhesive tape (¾ inch wide)
Masking tape (¾ inch wide)
Three 4x4 mats made from non-slip material
10 pennies
20-ounce bottle of water
Bite-sized snack crackers in a zip closure clear sandwich bag
Home, Classroom, or Test Observations Checklist
Pencil or pen

60 minutes

Required Training

Reading an Article/Manual

Children

2 - 12

years

Instrument Reviewers

Initially reviewed by University of Illinois at Chicago Master of Science in Occupational Therapy students Katherine Filippo, Lauren Greenblatt, and Janine Wilkin.

Body Part

Upper Extremity

ICF Domain

Body Structure
Body Function
Activity
Participation

Measurement Domain

Activities of Daily Living

Considerations

M-FUN scaled scores should always be integrated with other relevant information about the child’s abilities in a variety of settings, case history information, and information from a variety of sources, including the child’s family and teachers (Miller, 2006).

The M-FUN has been normed with children in the United States. This may have resulted in a cultural bias among the motor games and checklist questions (Miller, 2006; Rihtman & Parush, 2014).

Standard Error of Measurement (SEM)

Typically Developing Children: (Miller, 2006; n = 414 (for norm-referenced scores; for criterion-referenced scores, see below); age = [2.6 to 7.11])

The average SEMS were calculated by averaging the sum of the squared SEMs for each age group and obtaining the square root of the result)

Average SEM for Norm-Referenced Scores

Average SEM for Visual Motor (n = 414): 1.22
Average SEM for Fine Motor (n = 414): 0.98
Average SEM for Gross Motor (n = 414): 0.87

Average SEM for Criterion-Referenced Scores

Average SEM for Home Observations (n = 325): 5.23
Average SEM for Classroom Observations (n = 183): 4.72
Average SEM for Test Observations (n = 360): 2.13

Cut-Off Scores

Children Aged 2.6 to 7.11: (Miller, 2006)

If the cut-score was 1 standard deviation below the mean for the Visual Motor score, 89% of those with a visual motor delay were correctly identified as such by M-FUN, and 89% of those without visual motor delays were correctly identified as such (sensitivity = 0.89; specificity = 0.89)
If the cut-score was 1.5 standard deviations below the mean for the Visual Motor score, 92% of those with a visual motor delay were correctly identified as such by M-FUN, and 77% of those without visual motor delays were correctly identified as such (sensitivity = 0.72; specificity = 0.93)
If the cut-score was 2 standard deviations below the mean for the Visual Motor score, 100% of those with a visual motor delay were correctly identified as such by M-FUN, and 66% of those without visual motor delays were correctly identified as such (sensitivity = 0.49; specificity = 1.00)
If the cut-score was 1 standard deviation below the mean for the Fine Motor score, 78% of those with a fine motor delay were correctly identified as such by M-FUN, and 72% of those without fine motor delays were correctly identified as such (sensitivity = 0.69; specificity = 0.80)
If the cut-score was 1.5 standard deviations below the mean for the Fine Motor score, 88% of those with a fine motor delay were correctly identified as such by M-FUN, and 69% of those without fine motor delays were correctly identified as such (sensitivity = 0.58; specificity = 0.92)
If the cut-score was 2 standard deviations below the mean for the Fine Motor score, 96% of those with a fine motor delay were correctly identified as such by M-FUN, and 62% of those without fine motor delays were correctly identified as such (sensitivity = 0.38; specificity = 0.98)
If the cut-score was 1 standard deviation below the mean for the Gross Motor score, 83% of those with a gross motor delay were correctly identified as such by M-FUN, and 86% of those without gross motor delays were correctly identified as such (sensitivity = 0.87; specificity = 0.82)
If the cut-score was 1.5 standard deviations below the mean for the Gross Motor score, 88% of those with a gross motor delay were correctly identified as such by M-FUN, and 79% of those without gross motor delays were correctly identified as such (sensitivity = 0.77; specificity = 0.90)
If the cut-score was 2 standard deviations below the mean for the Gross Motor score, 95% of those with a gross motor delay were correctly identified as such by M-FUN, and 71% of those without gross motor delays were correctly identified as such (sensitivity = 0.60; specificity = 0.97)

Test/Retest Reliability

Typically Developing Children: (Miller, 2006; n = 28; age = [2.6, 7.11])

Excellent test-retest reliability for Visual Motor Test (ICC = 0.77)
Excellent test-retest reliability for Fine Motor Test (ICC = 0.82)
Excellent test-retest reliability for Gross Motor Test (ICC = 0.77)

Interrater/Intrarater Reliability

Children Ages 2.6 to 7.11 Years: (Miller, 2006; n = 29; age = [2.6, 7.11])

Excellent interrater reliability for Visual Motor Test (ICC = 0.91)
Excellent interrater reliability for Fine Motor Test (ICC = 0.93)

Excellent interrater reliability for Gross Motor Test (ICC = 0.91)

Internal Consistency

Children Identified as Having a Motor Delay: (Miller, 2006)

Excellent internal consistency for Visual Motor Test (Cronbach’s Alpha = 0.92)
Excellent internal consistency for Fine Motor Test (Cronbach’s Alpha = 0.93)
Excellent internal consistency for Gross Motor test (Cronbach’s Alpha = 0.96)

Typically Developing Children: (Miller, 2006; n = 414; age = [0.6, 7.11])

Excellent internal consistency for Visual Motor Test (Cronbach’s Alpha = 0.85)

Excellent internal consistency for Fine Motor Test (Cronbach’s Alpha = 0.90)

Excellent internal consistency for Gross Motor Test (Cronbach’s Alpha = 0.92)

Excellent internal consistency for Home Observations Checklist (Cronbach’s Alpha=.95)

Excellent internal consistency for Classroom Observations Checklist (Cronbach’s Alpha = 0.96)

Excellent internal consistency for Test Observations Checklist (Cronbach’s Alpha = 0.96)

Children Identified as Having a Motor Delay: (Miller, 2006)

Excellent internal consistency for Visual Motor Test (Cronbach’s Alpha = 0.92)

Excellent internal consistency for Fine Motor Test (Cronbach’s Alpha = 0.93)
Excellent internal consistency for Gross Motor Test (Cronbach’s Alpha = 0.96)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

Children Aged 2.6 to 7.11 Years: (Miller, 2006; n = 15; mean age = 3.7)

Excellent correlation between the M-FUN Fine Motor scaled scores and the Miller Assessment of Preschoolers (MAP) total score (r = 0.83)
Excellent correlation between the M-FUN Visual Motor scaled scores and the MAP total score (r = 0.62)
Adequate correlation between the M-FUN Gross Motor scaled scores and the MAP total score (r = 0.42)

Children Aged 4.6 to 6.6 Years: (Diemand & Case-Smith, 2013; n = 40; Age = [4.6, 6.6]; 20 children were receiving occupational therapy services)

Excellent correlation between the total scaled score for visual motor subscale of the Developmental Test of Visual Perception, Second Edition (DTVP-2) and the visual motor subscale of the M-FUN (r = 0.87)
Excellent correlation between the raw scores for the DTVP-2 and the M-FUN (r = 0.835)
Excellent, Adequate, and Poor correlation of M-FUN subtest raw scores and DTVP-2 subtest raw scores (see table below for breakdown of each subtest)

Subtest	Eye-Hand Coordination (DTVP-2)	Copying (DTVP-2)	Spatial Relations (DTVP-2)	Visual Motor Speed (DTVP-2)
Amazing Mazes (M-FUN)	Excellent (r = 0.708)	Adequate (r = 0.592)	Adequate (r = 0.544)	Adequate (r = 0.438)
Race Car (M-FUN)	Adequate (r = 0.464)	Adequate (r = 0.574)	Adequate (r = 0.448)	Excellent (r = 0.643)
Hidden Forks (M-FUN)	Adequate (r = 0.545)	Adequate (r = 0.524)	Adequate (r = 0.443)	Adequate (r = 0.418)
Find the Puppies (M-FUN)	Adequate (r = 0.535)	Adequate (r = 0.468)	Adequate (r = 0.463)	Poor (r = 0.302)
Draw a Kid (M-FUN)	Adequate (r = 0.489	Excellent (r = 0.690)	Excellent (r = 0.610)	Adequate (r = 0.584)
Writing (M-FUN)	Adequate (r = 0.539)	Excellent (r = 0.685)	Excellent (r = 0.659)	Excellent (r = 0.638)
Go Fishing (M-FUN)	Excellent (r = 0.621)	Adequate (r = 0.589)	Adequate (r = 0.557)	Adequate (r = 0.543)
Visual Motor Behavior (M-FUN)	Excellent (r = 0.762)	Adequate (r = 0.572)	Adequate (r = 0.566)	Adequate (r = 0.422)

Children Aged 2.6 to 7.11 Years: (Rihtman & Parush, 2014; n = 267; mean age = 59.21 months; Israel sample)

Excellent correlation between the raw score of the M-FUN (Hebrew Version) Visual Motor test and the raw score of the Beery-Buktenica Developmental Test of Visual-Motor Integration, Fifth Edition Beery Visual-Motor Integration test (r = 0.83)
Excellent correlation between the raw score of the M-FUN (Hebrew Version) Visual Motor test and the raw score of the Beery Visual Perception test (r = 0.62)
Excellent correlation between the raw score of the M-FUN (Hebrew Version) Visual Motor test and the raw score of the Beery Motor Coordination test (r = 0.72)
Adequate correlation between the raw score of the M-FUN (Hebrew Version) Fine Motor test and the raw score of the Beery Visual-Motor Integration test (r = 0.59)
Adequate correlation between the raw score of the M-FUN (Hebrew Version) Fine Motor test and the raw score of the Beery Visual Perception test (r = 0.54)
Adequate correlation between the raw score of the M-FUN (Hebrew Version) Fine Motor test and the raw score of the Beery Motor Coordination test (r = 0.50)
Excellent correlation between the raw score of the M-FUN (Hebrew Version) Gross Motor test and the raw score of the Beery Visual Motor Integration test (r = 0.62)
Adequate correlation between the raw score of the M-FUN (Hebrew Version) Gross Motor test and the raw score of the Beery Visual Perception test (r = 0.44)
Adequate correlation between the raw score of the M-FUN (Hebrew Version) Gross Motor test and the raw score of the Beery Motor Coordination test (r = 0.43)

Construct Validity

Convergent Validity:

Children Aged 2.6 to 7.11 Years: (Rihtman & Parush, 2014, n = 30; mean age = 59.21 months; Israel sample)

Excellent construct validity between the Visual Motor Test raw scores and child’s age (r = 0.85)
Excellent construct validity between the Fine Motor Test raw scores and child’s age (r = 0.66)
Excellent construct validity between the Gross Motor Test raw scores and child’s age (r = 0.77)
Poor construct validity between the Home Observation Checklist score and child’s age (r = 0.30)
Poor construct validity between the Classroom Observation Checklist score and child’s age (r = 0.23)
Poor construct validity between the Test Observation Checklist score and child’s age (r = 0.18)

M-FUN for Ages 2.6 to 3.11 Years

Adequate construct validity for Visual Motor Test (r = 0.57)
Adequate construct validity for Fine Motor Test (r = 0.40)
Adequate construct validity Gross Motor Test (r = 0.52)

M-FUN for Ages 4.0 to 7.11 Years

Excellent construct validity for Visual Motor Test (r = 0.79)
Excellent construct validity for Fine Motor Test (r = 0.68)
Excellent construct validity for Gross Motor Test (r = 0.78)

Content Validity

M-FUN is based on the model from the ICF and AOTA's OT Practice Framework (World Health Organization, 2001; American Occupational Therapy Association, 2002; Miller, 2006).
6 focus groups were held in California, Massachusetts, New York, and Pennsylvania in 2003. Participants collaborated, indicating that M-FUN needed to be a measure of functional abilities rather than developmental milestones (Miller, 2006).
Experts established the importance of combining subjective parent and teacher ratings with standardized measures (Miller, 2006).
5 experts evaluated blueprint for the test and initial draft of test items and experts were consulted to review the developmental skills that would be assessed in games (Miller, 2006).

Bibliography

Diemand, S. & Case-Smith, J. (2013). Validity of the Miller Function and Participation Scales. The Journal of Occupational Therapy: Schools and Early Intervention, 6(3), 203-212. https://doi.org/10.1080/19411243.2013.850937

Miller, L. J. (2006) Miller Function & Participation Scales: Examiner’s Manual. San Antonio, Texas: PsychCorp Harcourt Assessment.

Rihtman, T. & Parush, S. (2014). Suitability of the Miller Function and Participation Scales (M-FUN) for use with Israeli children. The American Journal of Occupational Therapy, 68(1), e1-e12. https://doi.org/10.5014/ajot.2014.008573

Spirtos, M. (2008). The Miller Function and Participation Scales, M-FUNPS: A critical appraisal. The Irish Journal of Occupational Therapy, 36(2), 24-27.

World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Author: Genova.

American Occupational Therapy Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56(6), 609-639.