Normalizing the Bender Visual-Motor Gestalt Test Among 6-10 Year-Old
This research is aimed at normalizing the visual-motor
Bender Gestalt Test among 1014 students (693 boys and 321 girls) that
focused on Koppit′z system for administration and scoring. Findings
indicated a test-retest reliability coefficient (after 4 weeks) of 0.81
(p≤0.001). There was a significant negative correlation between BGT
scores, Good enough-Harris Drawing Test (r = -0.36; N = 80) and Colored
Progressive Matrices Children Test (r = -0.41; N = 117). However, gender-related
differences were found to be significant (p≤0.0001); and males attained
higher error mean scores than their female counterparts. Also, age-related
differences were significant that is older children attained lower error
mean scores than younger children (8 and 7 year-old age-groups children).
The results showed perceptual performance improvement with students′
increasing age, especially for 9 and 10 years-old ones, which is consistent
with Koppit′z maturational hypothesis.
Developmentally, The Bender-Gestalt or Bender Visual-Motor Gestalt Test is
a popular research and pencil-drawing test that, historically, has been widely
used in the screening and assessment of neuropsychological impairment. The test
aims at identifying defects in an individuals visio-constructive ability,
which is considered a Gestalt function composed of biological imprints of sensory
reception, perception and motor action (Ghassemzadeh, 1988).
For more than six decades, this psychometric measure, developed by Bender
(1938) to identify brain-injured adults and to detect signs of emotional
disturbance, has been included as an integral part of psychological assessment
of cognitive functioning (Lacks, 1984).
The Bender-Gestalt Test (BGT) consists of nine cards each displaying an abstract
design. Bender (1938) adapted these stimulus designs from
those originally used by Wertheimer (1923) for his research
on visual perception (Kopiptz, 1975). Bender
(1938) saw her test as being particularly relevant to the assessment of
cognitive maturation and the diagnosis of organically based pathologic. When
administering the test, the examiner presents the cards one at a time to the
test-taker who is required to copy each design as accurately as possible. No
time limits are imposed. Standard administration requires the designs to be
copied on a blank unlined sheet of paper with an HB pencil (Bender,
1938). The individuals designs are then rated on their relative degree
of accuracy and overall integration. The final product is a reflection of the
original stimuli as modified by the test-takers, unique visual-motor ability.
For many years, the BGT has been an integral part of most neuropsychological
assessment batteries. It appears equally widely used by clinicians working with
adults as well as children (Bassa and Schlebusch, 1984;
Less-Haley et al., 1996; Rabin
et al., 2005). Surveys in the United States of America indicate that
the BGT continues to be ranked among the top ten assessment instruments of choice
among psychologists (Less-Haley et al., 1996).
The popularity of the BGT has historically been associated with its reputation
as an instrument with a wide variety of applications amongst diverse clinical
groups. However, for the first two decades following its inception, the BGT
was applied almost exclusively to adult population groups to diagnose a variety
of clinical disorders such as schizophrenia, aphasia and other neurological
syndromes (Bender, 1938; Kopiptz, 1975;
Lacks, 1984). Increased awareness of learning disabilities
among school-going childrens the 1960s and 1970s increased the need for
an inexpensive, brief, easy-to-administer screening tool. The BGT appeared particularly
well suited for this task (Gilger and Kaplan, 2001).
The BGT can be used in the screening of scholastic problems that may emerge
during the early stages of a childs education. Its particular value resides
in its ability to provide an indication of broad cognitive ability in children.
The maturational relationship between age and BGT performance indicated its
additional promise as a measure of cognitive development (Gilger
and Kaplan, 2001; Groth-Marnat, 2003; Kopiptz,
1975). The Bender Gestalt Test, or the Bender Visual-Motor Gestalt Test
(BVMG), is a psychological assessment instrument used to evaluate visual-motor
functioning and visual perception skills in both children and adults. BVMG scores
are used to identify possible organic brain damage and the degree of maturation
of the nervous system.
Most developmental measures of function or ability that yield a performance
age, like the BGT, can only be meaningfully interpreted when a childs
chronological age is taken into consideration. Kopiptz developed age-related
norms for the BGT in 1963. These norms were based on a sample of white American
middle-class children from Kindergarten to forth grade. A realization of the
effects of culture on BGT performance was reflected in her 1974 revision of
these norms, which included minority groups such as African-Americans and Hispanics
(Kopiptz, 1963, 1975).
Numerous studies focusing on the applicability and use of the BGT amongst children
have focused on the relationship between BGT performance and socio-cultural
background. The effects of demographic variables such as intelligence, education
and psychological factors on BGT performance has been widely documented (Goldstein
and Britt, 1994; Yousefi, 1992; Kopiptz,
1975; Rajabi, 1997; Rajabi et
al., 1999; Parush et al., 2000). Studies
conducted on American children have indicated significantly better performance
by white middle-class children than by their Native American and African-American
counterparts, who were all from disadvantaged backgrounds (Kopiptz,
1975). Results obtained in a study on Sierra Leone children revealed poorer
performance for the investigated sample when compared to Kpppitz norms (Karr,
1982). Studies conducted by Ghassemzadeh (1988),
Yousefi et al. (1992), Rajabi (1997), Rajabi
et al. (1999), Alilo (1993) and Poorsharifi
et al. (1997) reveal a pattern of possible cognitive maturation reflected
in Kopiptz findings which suggests that visual-motor ability is a cognitive
entity represented by improved BGT performance with increases in chronological
age. However, copying figures requires fine motor skills, the ability to discriminate
between visual stimuli, the capacity to integrate visual skills with motor skills
and the ability to shift attention from the original design to what is being
Yousefi (1992) normative study among 1600 students ranging
from 6 to 10 years and 11 month of age in Shiraz indicated that with increasing
age their the error means decreased in BGT. Also, he found that there were no
significant gender-related differences in the BGT performance among Shiraz sample.
Shapiro and Simpson (1995) by Kopiptz scoring system
for the Bender-Gestalt Test in a sample (N = 87) of behaviorally and emotionally
disturbed adolescents showed that age was modestly related to Kopiptz developmental
scores, an indication that visual-motor skills continue to develop beyond age
11. The current research suggested that visual-motor development is not maturational
complete by age 11 years, 11 months (Bolen et al.,
1992). Results of Decker (2008) suggest that visual-motor
ability has a rapid maturation lasting into middle adolescence, steadily
decreases through adulthood and rapidly declines in later age ranges.
These results provide evidence against earlier research conclusions
that suggested visual-motor ability development ends in late childhood
and remain steady across the life span. Alilo (1993)
in another normative study on 7 to 10 year-old school children in Tabriz revealed
the same results. Poorsharifi et al. (1997) in
a normative study on a sample of children (N = 1008) aged 6 years and 6 month
to 11 years and 6 month showed that with age increase in children, their means
of errors decreased in BGT. In another study, Rajabi (1997)
compared the 6 to 8 year old students BGT performance in elementary schools
(398 boys and 181 girls) in Busher city. Results of indicated that significant
gender-related differences in the maturational patterns of males and females
as well as students across the three age groups. Rajabi
et al. (1999) in a normative study on 6.5 to 10.6 year-old school
children in Zahedan (452 males and 417 females) demonstrated that with the students
age increase their performance in the BGT improved too. They found no significant
gender-related difference in BGT performance in the Zahedan, Iran sample.
Here, the present research was designed to examine the maturation level
of children going 6 to 10 upon the ability of reproduction of the Bender
Gestalt Test figures and attainment of BGT norms for Iranian students.
We proposed to answer two main questions: Are there significant differences
between 6 to 10 year old students on reproduction of the Bender Visual-Motor
Gestalt Test patterns? And are there differences between male and female
students on reproduction of the Bender Visual-Motor Gestalt Test patterns?
MATERIALS AND METHODS
Participants: The participants were elementary schools students
in grades 1 to 5 (N = 1014) within the age range of 6 to 10 (321 females
and 693 males) and the study was conducted in 2003. They were selected
randomly from 15 elementary schools in Busher city, the Busher Province,
Instrument: The Bender Gestalt Test was administrated to students
individually based on Kopiptz (1963, 1975) instructions. In this
system, 30 cases are scored that its 5 case to form A and B and
the total scores range from 0 to 30 varieties. Also, there are four types
of errors main including: distortion, rotation, integration and perseveration.
The average time to complete the Bender Gestalt Test for children was
7 min and 41 sec. In addition, in present study the higher score suggested
that child is likely to have maturational problems.
According to Yousefi (1992), for an 8 to 10 week interval
and Poorsharifi et al. (1997), for a 4 to 6-week
interval, test-retest reliabilities on the Bender-Gestalt Test on 60 and 100
students has been 0.77 and 0.89 (p<0.001), respectively. The Bender-Gestalt
Test by test-retest reliability method during 3 to 4 months intervals among
60 and 80 students were 0.52, 0.81 (p≤0.01), respectively (Rajabi
et al., 1999; Rajabi, 1997). Fuller
and Vance (1995) the Modified of the Bender-Gestalt Test administered to
48 kindergartners and first grades by a licensed psychologist. The 48 test protocols
were scored independently by two psychologists using the qualitative scoring
system. The sets of scores were significantly correlated. In the present study,
the test-retest reliability coefficient over an interval of 4 weeks was 0.81
The validity coefficients of BGT with the Good enough-Harris Drawing Test (80
students) and with Colored Progressive Matrices Children Test (117 students)
were -0.36 and -0.41 (p≤0.01), respectively in the present study. All tests
coefficients were significant statistically. In addition to the above mentioned
tests, we consider the age of the participants as construct validity indication,
that is, the older children in the test have the fewer mistakes. However, with
age increase their frequency of their errors decreases again (Fig.
The means and standard deviations for the BGT scores are reported for
the entire sample and for males and females at each age level in Table
As shown in Table 1, the means for the lower age groups
were higher, for instance, the mean difference between the age groups
of 6 and 7 was greater than that of the age groups of 7 and 8 years. The
difference between the means for 8, 9 and 10 year old groups was very
subtle. Also, the mean error score obtained was higher for males than
females in age levels. At all ages females appeared to mature about than
males in visual-motor perception. Specifically, statistically significant
differences across genders were found in age groups 6 (t = 2.05, p≤0.05),
8 (t = 2.02, p≤0.05) and the total sample (t = 2.76, p≤0.01). The
differences in age groups 7 (t = 1.20, p = 0.231), 9 (t = 1.78, p = 0.076)
and 10 (t = 1.15, p = 0.249) across genders were not significant.
||Mean and standard deviation for the BGT for 6-11 years
children (n = 1014)
|N: Size of sample, M: Mean and SD: Standard Deviation.
||Standardization scores of the bender gestalt test among
6-10 year old children
||Mean scores of normative sample for the developmental
Bender scoring system for children
As shown in Fig. 1, the BWMG means decrease steadily
between the ages of 6 to 8, thus reflecting the effect of maturation on
visual-motor integration. After these age levels, the difference between
the age groups diminishes. For children younger than 8 years old the BGT
is useful for identification of both immature and bright youngsters.
As shown in Table 2, children with error score lower
than in BGT in the five age-groups have higher IQ s than children with
higher errors. Also, as the age of children increases and increase in
error scores in BGT, the IQ (non-verbal intelligence) decreases. Further,
children with lower ages and lower errors compared with older children
benefit higher cognitive maturation.
||Results of Scheffe test for the errors of performance
by the five age groups
|*p = 0.0001
ANOVA (F4, 1013=97.25, p≤0.0001) indicates that there are significant
differences between the means of age groups 6 to 10 years in copying the
BGT patterns (Table 3).
The Scheffe test for between group differences of the frequency errors
frequency among five aged groups in the BGT is presented in Table
Based on Table 3, significant differences were observed
between the BWMG means for 6-7; 6-8; 6-9; 6-10; 7-8, 7-9; 7-10; 8-9 and
8-10 year-old groups (p≤0.0001), but no significant differences between
the BWMG mean for 9 and 10 year-old groups were found. These findings
indicate that copying quality among older students is better than younger
The BGT was described by Bender (1938) and Kopiptz
(1963, 1975) as a maturational test, which implies
a close relationship between the age level and the ability to perceive, process
and reproduce designs assessed for normalizing purpose in the present study.
Present findings showed the BG test is a reliable and valid instrument for differentiation
of perceptual-motor integration for normal children during 9 year-old which
are consistent with those found by Kopiptz, Yousefi (1992),
Rajabi (1997), Rajabi et al.
(1999), Poorsharifi et al. (1997), Fuller
and Vance (1995), Brannigan et al. (1995)
and Rossini and Kaspar (1987).
Findings supported and confirmed answers to study objection and questions.
As noted earlier, Wertheimer (1923) had used designs
originally in order to demonstrate the principles of Gestalt psychology as related
to perception and Bender adopted these figures as a visual-motor test. He pointed
out four levels in case copying figures that included: motor skill, tactual-kinesthetic
tracing, visual perception and motor-perception integration (Buros
and Krisen, 1978).
However, the effect of maturation on the protocol reproduction has to be explained
within a neuropsychological framework. The BGT has been an integral part of
most neuropsychological assessment batteries. It appears equally widely used
by clinicians working with adults as well as children (Bassa
and Schlebusch, 1984; Less-Haley et al., 1996;
Rabin et al., 2005). Gilger
and Kaplan (2001) and Groth-Marnat (2003) indicated
the maturational relationship between age and BGT performance. Bender
(1938) argued that copying Gestalt designs reflected maturational level
of visual-motor perception and this process has a close relationship with language
ability, intellectual functions and intelligence in younger children. This ability
involves visual perception, temporal and spatial integration, organization and
reproduction. Finding of Shapiro and Simpson (1995) showed
that age was modestly related to Kopiptz developmental scores, an indication
that visual-motor skills continue to develop beyond age 11. Bolen
et al. (1992) indicated that visual-motor development is not maturational
complete by age 11 years, 11 months. Decker (2008) suggested
that visual-motor ability has a rapid maturation lasting into middle
adolescence, steadily decreases through adulthood and rapidly declines
in later age ranges. According to Joseph (1982),
a very fundamental change happens at 7 to 10 in terms of neurodynamics of language
and thought. As Evans (1973, adopted by Ghassemadeh, 1988)
stated, this stage is roughly the same as that Piaget calls as the concrete
operational stages. However, visual motor perception is an activity integration
which consists of visual perception and motor expression. On the other hand,
these two functions are immature in children. In addition,
Piaget (1969) pointed out that the child needs to have time, if he is to
do her motor activities and this development of motor-perceptual activities
by is doing system and age role playing in this skill.
Here, we demonstrated significant gender-related differences in age groups
6, 8 and the total sample in BGT and females had lower rate of errors than males.
This is inconsistent with earlier findings for gender-related differences in
the BGT (Rajabi et al., 1999; Rajabi,
1997; Kopiptz, 1975). Also, it can be seen that the
BGT mean scores for males and females decrease between the ages 6 to 8 steadily
and thus reflecting the effect of maturation on visual-motor perception (Kopiptz,
1963, 1975; Rajabi, 1997;
Rajabi et al., 1999; Yousefi, 1992; Alilo,
1993; Poorsharifi et al., 1997).
Since, the participants in this research were only limited to groups
with one-year range, we further investigation is needed to test this question
for 6-month interval of age groups in our culture. Finally, Kopiptz
scoring system is both replicable to Iranian normal children protocols.
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