Adam’s Forward Bend Test in Singapore: School Screening Explained

If your daughter came home from school with a note about her spine, this page explains what was measured, what the number means, and what happens next. Singapore has screened schoolchildren for scoliosis since 1982, and the test used is the one described below.

Written for parents in Singapore · Medically reviewed by Dr. Kevin Lau, D.C., M.H.N. · Updated 27 August 2026

Why your child was screened at school

Scoliosis screening has been part of Singapore’s school health programme since 1982 and runs through the Health Promotion Board. It is not a private initiative or an optional extra — it is built into the annual school health screening that every primary and secondary school takes part in.

Under the current published programme, scoliosis screening is carried out for girls in Primary 5 and Primary 6. The reason is timing rather than sex alone: adolescent idiopathic scoliosis tends to appear and progress during the growth spurt, and that spurt arrives earlier in girls. Screening at the point where curves are most likely to start is what makes early detection possible at all.

The examination itself is brief. It is done by female doctors or nurses in a private enclosed cubicle, students are briefed in advance, and the child is examined standing and then bending forward. What the examiner is looking for is asymmetry — one side of the back sitting higher than the other as the child bends.

The scale of the programme is worth knowing, because it is what the current screening levels are built on. A review by the Health Promotion Board’s own Student Health Centre screened 93,626 female students aged 9 to 13 and found prevalence rising sharply with age: 0.27% at age 9, 0.64% at 10, 1.58% at 11, 2.22% at 12 and 2.49% at 13. That gradient is why annual screening was recommended from age 10 onwards rather than starting later.

What the school actually measures

Singapore’s school screening does not stop at looking. Examiners measure the Angle of Trunk Rotation, or ATR, using a scoliometer — a small instrument laid across the back while the child is bent forward. It reports, in degrees, how far the trunk is rotated at that point on the spine.

This distinction matters more than most parents are told. ATR is a surface measurement of rotation. The Cobb angle — the number that appears in a specialist’s report and determines whether bracing or surgery is discussed — is measured on an X-ray and cannot be obtained from the back at all. The two are related, but one is not a substitute for the other. A scoliometer can never report a Cobb angle.

What ATR does well is flag which children need a closer look. That is precisely what a screening test is for.

Singapore refers at 5°, not 7°

This is the single most important local difference on this page, and it is where international advice and Singapore practice part company.

Much of the published guidance you will find online treats 7° as the point at which a child should be referred for professional assessment. Singapore’s school programme has historically used a lower bar: students measuring ATR of 5° or more were referred on to the Student Health Centre for second-tier screening. A lower threshold means more children are sent for a closer look, and fewer progressing curves are missed early.

If you are measuring at home and you get a reading in the 5° to 6° band, the practical implication in Singapore is that this is not a “wait and see” number. It is the band at which the national programme would already be acting.

What happens after a Student Health Centre referral

A referral is not a diagnosis and it is not the start of treatment. It is a second, more careful measurement.

1. Second-tier screening. The child is re-measured at the Student Health Centre. Many children measured once at school do not measure the same way again — posture, technique and the child’s position all shift the number.
2. Imaging, if the reading holds. Where the repeat measurement remains at or above the referral threshold, a postero-anterior radiograph of the spine is taken. This is the point at which a Cobb angle can first be established.
3. Specialist assessment where indicated. Depending on the Cobb angle, the child’s age and how much growth remains, the family may be referred to a paediatric orthopaedic or spine service.
4. Monitoring, in most cases. Most children who are screened positive do not go on to need bracing or surgery. Observation over time is the usual outcome.

Waiting between these steps is normal and is often the hardest part for parents. It is also the stage at which measuring at home has the most value — not to second-guess the clinician, but to have a consistent record of whether anything is changing while you wait.

How to perform the test at home

The technique below is the same one used in school screening. It is simple to perform and easy to do badly, so the detail matters.

1. Position. Have your child stand with feet together, knees straight, and clothing removed from the back or changed for a swimsuit top.
2. Bend. Ask them to bend forward from the waist with arms hanging loose and palms together, until the upper back is roughly horizontal.
3. Look first. View from behind at the level of the back. You are looking for one side sitting higher than the other — a rib hump in the upper back, or a fullness in the lower back.
4. Measure. Rest the scoliometer, or a phone running a scoliometer app, gently across the back at the highest point of asymmetry. Do not press.
5. Work down the spine. Move from the upper back to the lower back and record the largest reading you find, along with where on the back you found it.
6. Keep conditions the same. Same person measuring, same time of day, same technique. Comparability is what makes a series of readings useful.

What the test cannot tell you

Being straight with parents about the limits of this test is part of using it responsibly.

• It measures rotation, not curvature. A child can have a measurable curve on X-ray with relatively little surface rotation, and the reverse is also true.
• It does not produce a Cobb angle, and no app or scoliometer can convert one into the other reliably.
• It does not distinguish idiopathic scoliosis from other causes of trunk asymmetry, including leg length difference or simple postural habit.
• Readings vary between people taking them. This is why the same person should do every measurement in a home series.
• A normal reading is reassuring at that moment. It is not a guarantee about the next twelve months, which is why screening is repeated annually during growth.

When to seek review in Singapore

Seek professional assessment if any of the following applies:

• A home reading reaches 5° or more, which is the level at which the national school programme refers.
• Readings are climbing across measurements, particularly a rise of around 5°.
• You can see uneven shoulders, one shoulder blade standing out, an uneven waistline, or a visible rib hump on forward bending.
• Your child is in or approaching the growth spurt and has a family history of scoliosis.
• There is back pain that wakes your child at night, or any numbness or weakness — these are not typical of adolescent idiopathic scoliosis and need prompt review.

In practice, most families start at a polyclinic or with their family doctor, who can refer on to a paediatric orthopaedic or spine service. If your child was screened at school and referred, follow that pathway rather than starting a parallel one — the Student Health Centre appointment already exists in the system.

If your child missed screening, has left the screened year groups, or you have simply noticed something yourself, you do not need a school referral to ask for an assessment.

Frequently asked questions

My daughter was referred after school screening. Does she have scoliosis?

Not necessarily, and most referred children do not. A referral means one measurement crossed the threshold and a second, more careful look is warranted. Many readings do not repeat at the same level, and of those that do, most curves are mild and are monitored rather than treated.

Why are only girls screened in Primary 5 and 6?

Adolescent idiopathic scoliosis usually appears and progresses during the growth spurt, which arrives earlier in girls, and it is both more common and more likely to progress in girls. Health Promotion Board data showed prevalence in girls rising from 0.27% at age 9 to 2.49% at age 13, which is what set the screening years. Boys can develop scoliosis too — see below.

I have read that 7° is the referral threshold, but Singapore uses 5°. Which should I follow?

Both figures are real; they reflect different trade-offs. A 5° threshold refers more children and misses fewer curves; a 7° threshold refers fewer children and accepts more risk of missing one. If you are in Singapore, use 5° as your prompt to seek assessment, because that is what the local programme acts on.

My son was not screened. Should I check him myself?

Yes, if you have any concern. Scoliosis is less common in boys and less likely to progress, but it does occur, and boys are not covered in the same way by the current primary school programme. The home technique on this page is identical regardless of sex.

Can I measure at home while waiting for the Student Health Centre appointment?

Yes, and a consistent record is genuinely useful to bring along. Measure the same way each time and note the date, the reading and where on the back you took it. Do not use home readings to decide whether to keep the appointment.

Does the app measure the Cobb angle?

No. It measures the Angle of Trunk Rotation on the surface of the back. The Cobb angle is measured on an X-ray by a clinician and is the diagnostic measurement for scoliosis. No app can convert one into the other.

Do I need a referral to see a specialist in Singapore?

For public specialist care a referral from a polyclinic or family doctor is the usual route, and it affects subsidy. If your child has already been referred through school screening, that pathway is in place — follow it rather than starting a second one.

Sources. Programme details from the Health Promotion Board’s published school health screening information (HealthHub, Health Screening for Primary School). Prevalence figures, the 1982 programme start, the scoliometer-based method and the 5° referral threshold are from Yong F, Wong HK, Chow KY. Prevalence of adolescent idiopathic scoliosis among female school children in Singapore. Ann Acad Med Singap. 2009;38(12):1056–63, retrieved via PubMed (PMID 20052440) — a Health Promotion Board Student Health Centre study of 93,626 female students. Screening practice and thresholds can change; confirm current arrangements with your child’s school or the Health Promotion Board. Cited research assessed screening methods, not any specific application. Results vary between individuals.