Mehwish Ambreen

Reg#416-FSS/MSCP/F14
Bender Gestalt
Test

Neuropsychological Testing
Scheme of Presentation

What is neuropsychological testing?

History
Introduction
Purpose
Precautions
Assumptions
Description
Administration
Scoring
Interpretation
1: Quantitative
2: Qualitative (Emotional Indicators)
Neuropsychological Testing

– Neuropsychological testing looks at two aspects:

i.) Functional integrity: Whether or not any particular specifiable function is intact
- Examples: short-term/long-term memory, attention, sensory discrimination,
motor strength
ii.) Localization: Whether or not any specific neuroanatomical region of the brain is
functionally intact
History

– A psychological test first developed by child neuropsychiatrist Lauretta Bender

in 1938.
– The test is used to evaluate "visual- motor maturity", to screen for
developmental disorders, or to assess neurological function or brain damage.
Introduction

– The test has been used as a screening device for brain damage.
– It measures perceptual motor skills, perceptual motor development, and gives
an indication of neurological intactness.
– It has been used as a personality test and a test of emotional problems.
– It is for the age of four and above.
Purpose

– The Bender Gestalt Test is used to evaluate

– visual maturity,
– visual motor integration skills,
– style of responding,
– reaction to frustration,
– ability to correct mistakes,
– planning and organizational skills, and motivation.
Continue…

– 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
drawn.
Assumptions

– One basic assumption behind BGT is that the manner in which the subject
perceive and approach their world parallels the way they approach the task of
reproducing the nine designs. Much of the validity research on BGT has
attempted to demonstrate that this parallel occur.
– For example: disoriented patients might rotate the designs, manic patients
might produce irregular sequences that reflect their impulsivity and attention
deficits, and the degree of anxiety the person is experiencing might influence
the size of the drawing.
Continue…

– Additional clinical information can be derived by observing anxious patients

who might erase and retrace their drawings. Similarly, compulsives might begin
their drawings by making extensive preliminary guidelines and often take three
to five minutes to complete each design.
– Thus, the Bender can be useful in revealing the general style and manner of
approach the individual takes toward his or her world.
Precautions

– The Bender Gestalt Test should not be administered to an individual with severe
visual impairment unless his or her vision has been adequately corrected with
eyeglasses.
– the test should not be given to an examinee with a severe motor impairment,
as the impairment would affect his or her ability to draw the geometric figures
correctly. The test scores might thereby be distorted.
Continue..

– The Bender Gestalt Test should never be used in isolation. When making a
diagnosis, results from the Bender Gestalt Test should be used in conjunction
with other medical, developmental, educational, psychological, and
neuropsychological information
– Should be used by clinically trained examinee
Description

– It is an individually administered pencil and paper test used to make a diagnosis

of brain injury.
– There are 9 geometric figures drawn in black. These figures are presented to
the examinee one at a time; then, the examinee is asked to copy the figure on a
blank sheet of paper.
– Examinees are allowed to erase, but cannot use any mechanical aids (such as
rulers)
– The average amount of time to complete the test is five to ten minutes
Administration

– The test is administered to each subject individually in a room free from

distracting stimuli.
– Administer test on a table seated across from the examinee if possible.
– Two Pencils with eraser, a white blank sheet of paper is needed.
– Supply one pencil and one sheet of paper(vertically in front of examine)
– Show the stimulus cards to the examinee one at a time (aligned with the top of
the drawing paper).
Continue…

– Examinee is shown stimulus cards with designs and asked to copy each of the
design on a sheet paper.
– Administer stimulus cards in the correct numeric sequence and do not allow
examinee to turn or manipulate them.
– Inconspicuously, measure how long the examinee takes to complete the items-
record time in minutes and seconds.
– Carefully note the examinees approach to each design.
Scoring
BGT scoring system-Quantitative

– Rotation
– Score if there is a rotation of 80-180 degrees.
– Including mirror imaging (image or object which is identical in the form of other
but with the structure reversed as in mirror.

– Note: Do not score if the client shifts the position of the card and paper then
draws image correctly.
– Rotation error is seen in all 9 cards.
Rotation
Overlapping Difficulty

– Difficulty in reproducing the portions of the figures that should overlap.

– Overlap is seen only in 6 and 7.
Overlapping
Simplification

– Score if the figure is drawn in the simplified and easier form.

– Circle for dots in figure 1
– Non-overlapping
– Joining parts of the same figure are more than 1/8 inch apart.
– Curves for angles.

– Score for all figures.

Simplification
Fragmentation

– Score if figure is broken up into parts destroying the gestalt or if the figure is
incomplete.
– Missing rows
– Less than 6 items in figure 1 and 2.

Score for all figures.

Fragmentation
Retrogression

– Substitution of a more primitive gestalt form than the stimulus.

– Loops for circles( if persistent)
– Dashes for Dots( if extreme and persistent)
– Triangle, square or rectangle for diamond or hexagon.

– Score for all figures except 4 and 6.

Retrogression
Perseveration

– There are two types of perseveration error.

1: Inappropriate substitution of the features of a preceding stimulus replacing
circle of figure 2 with dots of figure 1.
– Score only for figures 2, 3 and 5.
2: Intra-design perseveration or continuing to draw a figure beyond the limits.
Score only for figure 1,2 and 3.
Perseveration
Collision

– One figure is touching or overlapping to another figure.

– One figure is drawn with in ¼ inch or less of another figure but does not touch.

– Score for all figures.

Collision
Impotence

– Behavioral or verbal expression of inability to draw a figure correctly(often

accompanied by statements such as “ I know this drawing is not right but I just
cant make it right”
– Repetitious drawing or numerous erasures of figures with similar accuracies.

– Score for all figures.

Impotence
Closure Difficulty

– Slight separation or overlap.

– Contact at wrong place.
– Reworking at joining parts of figure.

– Score only for figure A, 4, 7 and 8.

Closure Difficulty
Motor In-coordination

– Irregular, tremor lines, heavy pressure.

– Behavioral observations are important to score it.
– Surface of working should be smooth.

– Score for all figures.

Motor In-coordination
Angulation Difficulty

– Severe difficulty in producing angle of figure.

– Whole figure turned 45-80 degree.
– Half figure angulation.

– Score only for 2 and 3.

Angulation Difficulty
cohesion

– Isolated decrease or increase in size of figure (within and between figure)

– Score for all figures.

cohesion
Emotional indicators for children

– Not all youngsters with poor developmental BGT scores necessarily have
emotional problems, nor do all children with emotional indicators on their BGT
records inevitably show malfunctioning immaturity in the visual motor area.
(koppitz, 1975)
– Koppitz has listed 12 emotional indicators.
1: confused Order

– Poor planning, difficulty organizing information, and possible mental confusion.

– Associated with learning disabled children of 8-10 years of age and with acting
out.
– 2: Large size
– Tendency toward acting out
3:Box around Design

– Impulsive tendencies with weak inner control in which external limits are
needed to control behavior.
– 4: Expansion
– Impulsive, acting out behavior especially for older children who also have
neurological impairment.
5: Fine line

– Shyness, timidity, withdrawal.

6: careless Overwork(or heavily reinforced line)

– Impulsive, aggressive behavior consistent with children who act out , overt
hostility.
– However careful reworking and erasure also might suggest high intelligence and
good achievement.
7: Second Attempts

– Aggressiveness
– Impulsiveness, anxiety, indicates awareness that the first attempt is incorrect,
yet individuals do not have sufficient inner control to correct the original.
8:Small size
– Constriction, withdrawal, anxiety ad timidity
9: Wavy Line

– Lack of stability in motor coordination, expresses emotional instability.

10: Dashes For Circles
– Impulsiveness, aggressiveness,
– In young children a lack of intrest or attention, suggests a preoccupation with
personal difficulties to the extent that children may attempt to avoid tasks
presented to them.
11: Increased Size

– Poor frustration tolerance.

12: Elaboration(spontaneous additions to design)
Intense fears, anxieties.
Preoccupation with inner thoughts.
Emotional Indicators Adults

– 1: Perseveration
– Rigid cognitive set, as might be found in compulsive personalities.
– Poor ego control and impaired reality testing.
– Difficulty with planning and poor concentration.
2: Rotation

– A severe degree of dysfunction, possibly psychosis.

– Oppositional tendencies.
– Poor attention with a limited capacity for new learning.
– Disorientation
– Like Perseveration, Rotation are more frequent among organics. Sometimes,
organics and non organics can be distinguished. Since, even with questioning,
organics are often unaware of their errors and have difficulty altering the
degree of rotation when requested to do so.
3: Overlap

– Insecurity and compulsive self doubt.

– Potential for aggressive acting out.

– 4: Elaboration or Doodling( spontaneous addition of lines, loops,

curves and doodles)
– Extreme preoccupation with inner needs.
– Intense anxiety and difficulty concentrating.
5: Simplification

– Possibly negativism and low tolerance to frustration.

– Impulsivity and possible malingering.

6: Closure Difficulty
Anxiety
Hesitancy and self doubt, with difficulty completing tasks. Relationships are often
seen as difficult and provoke anxiety.
Aggressive acting out behavior.
7: Confused sequence

– Strong feelings of anxiety.

– Disorientation, poor comprehension, and impaired judgement.
– Arrangements that are scattered suggest acting out tendencies.
– Consistent with manic state.
8: Fragmentation
Poor abstracting and synthesizing ability.
9: Concretism

– Usually suggest brain damage but may also indicate regressive state.
– Difficulty with abstract thinking.
10: Added angles
Poor visual motor coordination.
Insecurity and hesitancy.
Further difficulty with angles include an increase in width, suggesting problems
with controlling affect and a decrease in width suggested a constricted decreased
effective response.
11: Omission

– Difficulty in synthesizing and integrating.

– Disturbance in coordinated motor acts.
– Disrupted ego functions to the extent that the person cannot work with the
more complex aspects of the design.
12: Expansion
Insufficient emotional control.
Impulsivity
Perhaps consistent with an antisocial personality, grandiose expensiveness to
compensate for underlying feelings of self doubt and inadequacy.
13: Reduced in size

– Feelings of Inadequacy.
– Insecurity
– Tendency to Withdraw
– Size Distortions may indicate anxiety.
14: Rigid Methodological Arrangement
Rigidity and meticulousness.
Possible in an attempt to create a sense of security due to underlying feelings of
vulnerability and inadequacy.
14: Constricted Compressed
Arrangement
– Depression
– With feelings of insecurity and inferiority.

Koppitz(1975) recommended using three or more indicators as the cut off for
inferring emotional difficulties. She reports that more than 50% of children with
three indicators were emotionally disturbed, and 80% with four or more indicators
had serious emotional problems.
Results

– 3 0r fewer errors indicate absence of brain impairment.

– 4 errors is a border line score.
– 5 or 6 errors provide some evidence of brain impairment.
Clinically impaired child Bender
Gestalt Test
Reporting

– The Bender gestalt test has been administered. Total score was 7. It shows client
might have severe brain impairment. Emotional indicators shown that the
client has the traits of impulsiveness, aggressiveness, shyness, timidity and
withdrawal.
Clinically impaired Adult BGT