AP11 Psychological Assessment and Diagnostics I
Bender Gestalt Test
7th February 2024
Overview
Background
BGT: Materials and Test Structure
BGT: Utility
BGT: Administration
BGT: Scoring
BGT: Result Interpretation and Report Writing
Background
Gestalt
Gestalt is a German word that roughly means "configuration" or the way
things are put together to form a whole object.
Originated in work of Max Wertheimer -- response to structuralism
Holism
Principles and laws of perception
Lauretta Bender
1897-1987
Clinical neuropsychiatrist
1938- groundbreaking monograph- “A Visual Motor Gestalt Test and Its
Clinical Use”
Learning difficulties in school, suspected mental retardation
B.S. and M.A. in Biology
1923- accepted into medical school- lab technician for Dr Samuel
Orton; M.D. Neurology
1929- began work on Visual Motor Gestalt Test after serving as RA to
Adolph Meyer
Worked at Bellevue Hospital in NYC- 1930-56; double board
certification
History and Evolution of the BGT
Visual Motor Gestalt Test- Bender, 1938
Seen as extension of the clinical experience
9 figures printed on cards
Adaptation of Wertheimer’s figures to study the
Gestalt function
“...that function of the integrated organism whereby it responds to a
given constellation of stimuli as a whole. All integrative processes within
the nervous system occur in constellations, patterns, or gestalten. The
whole setting of the stimulus and the whole integrative state of the
organism determine the pattern of the response.”
(Bender, 1938)
History and Evolution of the BGT
Visual Motor Gestalt Test- Bender, 1938
1945 onwards- Hutt’s adaptations- Psychopathology Scale- reliable,
valid, valuable for personality assessment
1951- Pascal & Suttell’s scoring system- deviation-based. Became basis
for subsequent systems.
1960- Hutt and Briskin- 12 essential indicators of brain damage
1963- Koppitz- Developmental Bender Scoring System
1963- Canter’s Background Interference Procedure
1984- Lacks’ scoring for differentiating psychiatric patients with and
without organic brain dysfunction
1966- Modified Bender- Gestalt Test by deHirsch et al.
1989- Brannigan & Brunner- Qualitative Scoring System
BGT II
The Bender-Gestalt II measures visual-motor integration skills in
children and adults from 4 to 85+ years of age. It also provides an
assessment of memory for children and adults from 5 to 85+ years of
age. The development of the test was guided by over 60 years of
research on the original test, contemporary methods of test
construction, and current standards of educational and psychological
testing.
BGT II
Brannigan & Decker, 2003
Objectives of revision:
Extend measurement scale
Obtain large, representative norming sample that accurately
reflected development of visual-motor integration skills across large
segment of lifespan
Retain as many original items as possible.
Rasch analysis for item analysis -> adding new items while extending
utility of measurement scale
Normed on N=4,000 (US)
Expert validation
New features- recall procedure, observation form, motor and
perception tests, global scoring system
BGT: Materials and
Test Structure
Bender Gestalt II: Test Description
Bender Visual-Motor Gestalt Test, Second Edition (BGT II)
Consists of 16 Stimulus Cards and the Observation Form
Two supplemental tests- Motor Test and Perception Test
Non time-limited
Bender Gestalt II Materials: Stimulus Cards
Bender Gestalt II Materials: Observation Form
Notes name of test taker and examiner
Notes sex, handedness, paper orientation
Asks for reporting of physical observations (yes/no + open-
ended ‘other’)
Checklist format of test-taking observations
Bender Gestalt II Materials: Motor Test
Brief screening of specific motor abilities
Has one sample item and four test items
Each test item has three figures
Takes approximately 2 minutes to administer, with a maximum
of 4 minutes allowed for administration
Asks examinee to connect the dots using a line without lifting
the pencil, erasing or tilting the paper while drawing the lines
Bender Gestalt II Materials: Perception Test
Brief screening of specific perceptual abilities
Has 10 items
Takes approximately 2 minutes to administer, with a maximum
of 4 minutes allowed for administration
Asks examinee to circle of point to a design in each row that
best matches the design in the numbered box on the left
Bender Gestalt II Materials Required
16 BGT cards- arranged in ascending order face down, starting
from indicated card based on age
Table/writing pad
Observation form
Supplementary test sheets
10+ sheets of A4 paper
2 pencils
1 eraser
Stopwatch
Manual
Bender Gestalt II: Phases and Order
1. Copy Phase
2. Recall Phase
3. Supplemental Tests
a. Motor test
b. Perception test
BGT: Utility
What does the BGT assess?
What does the BGT assess?
Visuomotor abilities
Perceptual abilities
Motor abilities
Integration of perceptual and motor abilities
What can the BGT assess?
Visuomotor abilities
Perceptual abilities
Motor abilities
Integration of perceptual and motor abilities
Attentional abilities
Motivation
Neurological impairments
Developmental delays
Anything else?
What is the utility of the BGT?
Assess maturation of gestalt function
Check for developmental appropriateness and delays
Learning difficulty identification
Measure of organicity and brain damage
Differentiating psychopathology
Psychoeducational assessment; emotional indicators;
academic performance
Standardisation Sample
N= 4000
Ages 4-85+
Approximately equal percentages of females and
males
Included individuals with mental retardation, learning
disabilities, attention-deficit hyperactivity disorder,
Autism, and Alzheimer’s disease
Also included ‘gifted’ individuals
Racial and ethnic diversity
BGT: Administration
Administration: General
Prior to the start of the test ask the client to write sample/draw – gives
a rough assessment of examinee’ capacity to take the test.
Place stimulus cards facedown in correct order. Do not show design on
cards until administered.
Administer in well-lit area with a table and two chairs. Table should
have a smooth surface and be a comfortable height for the examinee.
Chair should allow examinee’s feel to comfortably reach the floor.
Where possible, examiner should be seated across from examinee.
Supply only one pencil and pone sheet of paper- paper vertically
positioned.
Administration: General
Begin test with appropriate card
Age 4 - 7years 11 months: Start at item 1, end at item 13
Ages 8 and older: Start at item 5, end at item 16
Show cards one at a time, aligning each displayed card with the top of
the drawing paper
After card administered, place on bottom of stack with number facing up
During administration- erasing and using more than one sheet of paper is
allowed. Turning or manipulating cards, drawing on back of paper,
doodling, and drawing nontest designs are not allowed.
Discouragement: “Do the best you can”
Asked where to start drawing: “Begin wherever you like”
Practice before administering
Administration: Copy Phase
Time the examinee, with stopwatch out of their sight.
Position the drawing paper on the table, centering it vertically in front of
examinee.
Say:
“I have a number of cards here. Each card has a different drawing on it. I will
show you the cards one at a time.
Use this pencil (give pencil) to copy the drawing from each card onto this sheet
of paper (pointing to drawing paper). Try to make your drawings look just like the
drawings on the card. There are no time limits, so take as much time as you need.
Do you have any questions? Here is the first card.”
Administration: Copy Phase
Turn over first card, align with top of the drawing paper, start timing.
Document observations.
Note time when completed drawing for each of the cards and total cards.
Label sheet ‘Copy Sheet” and indicate top of the page with arrow pointing up.
Then remove the paper from the table.
Administration: Recall Phase
Administer immediately after the Copy phase.
Present new sheet of paper - give instructions – begin timing.
“Now I want you to draw as many of the designs that I just showed you as you
can remember. Draw them on this new sheet of paper. Try to make your
drawings just like the ones on the cards that you saw earlier. There are no time
limits, so take as much time as you need. Do you have any questions? Begin.”
In observation form, mark the order of recall.
Stop when examinee says they cannot remember any more.
Stop timing if no recall after 2 minutes.
Mark this sheet as ‘recall sheet’ + upward pointing arrow
Use the Order of Recall boxes in the observation form to numerically label
designs in the order they were recalled and note your observations
Administration: Motor test
This test should be given after the recall phase.
Time duration – 4 minutes. Stop when client completes all items or after 4
minutes.
1 sample item + 4 test items. Read directions out loud.
Ask examinee to attempt the sample item. Demonstrate it if necessary –point to
the largest item in Item 1 – ‘Now you try it.’
Not allowed to:
Lift pencil.
Tilt the paper.
Erase.
If necessary, point to the next numbered item and repeat the instructions.
Continue this procedure until the examinee has completed all items or the
maximum time limit has expired.
Administration: Perception test
This test should be given after the motor test.
Has 10 items.
Time duration – 4 minutes. Stop when client completes all items or after 4 minutes.
Say:
“Look at this picture (design in the first box). There is another picture that
looks just like it in this row (show which row). Circle/point to the picture that
looks like this one.”
If needed, provide assistance for item 1. Point to each item in the row and say:
“Which one of these pictures looks like this one? (Point again to the design in the
box).”
If there is difficulty holding a pencil, allow pointing and you circle/mark. If >30
seconds to respond to any item, say “Let’s try the next one”. Write S next to any
skipped items.
AP11 Psychological Assessment and Diagnostics I
Bender Gestalt Test
Scoring and Interpretation
8th February 2024
BGT: Scoring
C.B. is a 6 years 3 month old girl. She was recently pulled up by her class teacher
for attacking a classmate. The school has asked the parents to get certain
psychological tests conducted to determine if any developmental or intellectual
deficits exist. Along with other tests, you administer the Bender Gestalt II, and
obtain the attached protocol from the child for
the copy phase.
Scan the QR code below to access C.B.’s protocol. How would you
score this? What would be your criteria for scoring the protocol?
BGT II Scoring: Global Scoring System
by Brannigan & Decker, 2003
Global Scoring System- simplified adaptation of Brannigan * Brunner’s
Qualitative Scoring System
Evaluated overall representation of each item on 5-point rating scale (0 to 4)
Yields individual score for each item and total score for test
Range of scores for those aged 4-8: 0-52
Range of scores for those aged 8+: 0-48
Criteria for scoring
0= No resemblance, random drawing, scribbling, lack of design
1= Slight -- vague resemblance
2= Some -- moderate resemblance
3= Strong -- close resemblance, accurate reproduction
4= Nearly perfect
BGT II Scoring: Global Scoring System
by Brannigan & Decker, 2003
Scoring examples are provided in Appendix F. These are not exhaustive and
show examples of designs drawn at the lowest range of each category.
Points should be given when a drawing is equal to or better than the examples.
When in doubt, assign the lower score.
At the end of this procedure, you will have-
Total raw score for copy phase
Total raw score for recall phase
BGT II Scoring: Global Scoring System
by Brannigan & Decker, 2003
Convert raw scores to standard scores (M=100, SD=15), percentiles and T
scores
Go to Table A (finding standard scores)
See page corresponding to examinee’s age
Locate total raw score obtained on the test
Look at corresponding standard score (separately for copy and recall)
Go to Table B
Locate the standard score (separately for copy and recall)
Look at corresponding T scores, percentil ranks and classification category
BGT II Scoring: Scoring Motor Test
Each correct item scored 1 point
Each incorrect item scored 0 points
Total score = 12
Go to Table C1
Locate examinee’s age
Look for raw score
Identify corresponding percentile rank
Enter in record form
BGT II Scoring: Scoring Perception Test
Each correct item scored 1 point
Each incorrect item scored 0 points
Total score = 10
Go to Table C2
Locate examinee’s age
Look for raw score
Identify corresponding percentile rank
Enter in record form
Types of Scoring Systems
Global Deviation
Brannigan and Brunner’s Hutt’s Psychopathology Scale
(1989) qualitative scoring (1977)
system Koppitz’s Developmental Bender
Brannigan and Decker’s (2003) Scoring System (1963, 1975)
global scoring system Lacks’ Scoring System (1984,
1999)
etc.
Scoring: Hutt (1969, 1977)
19-factor preliminary scale of psychopathology- 1960
Drawing from Hutt and Briskin (1960) factors
Each factor from 1960 system was assigned a linear scaled score ‘weighted’ for
increasingly distorted reproductions of stimulus designs
Psychopathology from normal (relatively small amount) to extreme (psychotic)
Scoring incremental and linear. Higher scores = more pathology.
1977- revision with enhanced psychometric properties -- 6 levels of
psychopathology differentiated -- normals, outpatient neurotics, inpatient
neurotics, outpatient schziophrenics, chronic schizophrenics.
Current scale- 17 factors, each scored on scale from 0-10 with 1 factor scored
between 1-3.25
Errors in 3 categories: Factors related to organisation, factors related to changes in
gestalt, factors related to distortions in gestalt
Scoring: Hutt (1969, 1977)
Factors related to organisation Factors related to distortions of the gestalt
Sequence in placement of designs Perceptual rotation
Position of the first drawing Retrogression
Simplification
Use of space
Fragmentation
Collision Overlapping difficulty
Shift in position of the paper Elaboration or doodling
Factors related to change in gestalt Perseveration
Closure difficulty Redrawing of the total figure
Crossing difficulty
Curvature difficulty
Changes in angulation
Scoring: Koppitz (1963, 1975)
Well-established psychometric properties
Developmental score = sum of 30 possible errors
For children between 5-10: Most effective system
Errors in 4 categories: Distortion of shape, rotation, integration and perseveration
Higher score = poorer performance
Scoring: Koppitz’s Emotional
Indicators (1963, 1975)
Confused order
Dashes for circles
Large size
Fine line
Second attempt
Box around design
Wavy line
Small size
Progressive increase in size
Overworked or reinforced lines
Expansion
Spontaneous elaboration or addition to a design
Scoring: Lacks (1984, 1999)
12 errors
Screening for organicity
Score presence of error, not severity
Single appearance of error enough to mark
Score conservatively
Present column- 1 if present even for each figure
Scoring: Lacks (1984, 1999)
Rotation- –rotation (80-180 degrees) in reproduction of the entire drawing while
the card stimulus and test paper are in normal positions.
Overlapping difficulty- Difficult reproducing portions of figures that should overlap
-- omission or simplification only at point of overlap or marked sketching or
overworking only at point of overlap or distortion at point of overlap or wrong point
of overlap or failure to overlap.
Simplification- If figure draw in easier form that is not more primitive from
maturational view
Fragmentation- Entire figure broken up into parts destroying gestalt or incomplete
Retrogression- Substitution of more primitive gestalt
Perseveration: Two types (carryover/intradesign)
Scoring: Lacks (1984, 1999)
Collision/collision tendency: drawn within 1/4 inch or touching or overlapping
Impotence- Expression of inability to draw, unsuccessful attempts to correct,
numerous erasures
Closure difficulty- Difficulty in getting joining parts of figure together or getting
adjacent parts of figure to touch.
Motor incoordination- Irregular lines, heavy pressure.
Angulation difficulty- Severe difficulty reproducing angulation.
Cohesion- Isolated increase or decrease in size of figures. Score very
conservatively.
BGT: Interpretation of Results
and Report Writing
Interpretation: General Principles
Corroborate test information with history of client, other test findings, test
taking behaviours.
Combine quantitative (GSS) and qualitative (behavioural observations)
approaches to scoring.
If relevant to concerns presented, include in the qualitative findings
observations from deviation score systems such as Koppitz’s emotional
indicators for children or Lacks’ system.
In addition to commenting on visuospatial and visuomotor skills (copy phase)
and memory difficulties (recall phase), you can comment on frustration
tolerance, motivation, etc.
Interpretation: Global Scoring System
Standard Score Classification
145-160 Extremely high
130-144 Very high
120-129 High
110-119 High Average
90-109 Average
Interpretation: Global Scoring System
Standard Score Classification
80-89 Low Average
70-79 Low
50-69 Very Low
40-54 Extremely low
Interpretation: Hutt, 1969, 1977
19-factor preliminary scale of psychopathology- 1960
Drawing from Hutt and Briskin (1960) factors
Each factor from 1960 system was assigned a linear scaled score ‘weighted’ for
increasingly distorted reproductions of stimulus designs
Psychopathology from normal (relatively small amount) to extreme (psychotic)
Scoring incremental and linear. Higher scores = more pathology.
Validation based on individuals presumed to differ on a priori levels of assessed
psychopathology. Comparison between normal college students, outpatient adult
psychoneurotics, and hospitalised, heterogeneously diagnosed schizophrenic
patients.
1977- revision with enhanced psychometric properties -- 6 levels of
psychopathology differentiated -- normals, outpatient neurotics, inpatient
neurotics, outpatient schziophrenics, chronic schizophrenics.
Current scale- 17 factors, each scored on scale from 0-10 and 1 factor scored
between 1-3.25
Interpretation: Hutt, 1969, 1977
Factors related to organisation Factors related to distortions of the gestalt
Sequence in placement of designs Perceptual rotation
Position of the first drawing Retrogression
Simplification
Use of space
Fragmentation
Collision Overlapping difficulty
Shift in position of the paper Elaboration or doodling
Factors related to change in gestalt Perseveration
Closure difficulty Redrawing of the total figure
Crossing difficulty
Curvature difficulty
Changes in angulation
Interpretation: Koppitz (1963, 1975)
Poor performance =/= poor visual skills or poor motor skills
Poor performance = poor perceptual-motor integration
Mode of working on the task, planning and organisational strategies as key to
critically assessing performance and suggestive of personality characteristics and
learned attitudes rather than maturational skills -> Development of Emotional
Indices (12)
Children with emotional disturbances hypothesised to reveal significantly more
errors not attributable to visual-motor immaturity than their normal peers.
Suggested that disturbed children draw more to satisfy their own needs than to
comply with the task demands.
Hence, emotional indices are independent of visual-motor integration ability and
help differentiated normal and maladjusted children.
Revised list in 1975 with 2 rare emotional indices
Total incidence of emotional indices related to seriousness of emotional
disturbances.
Interpretation: Koppitz (1963, 1975)
Confused order- poor planning + organisation. More in LD protocols than acting
out.
Dashes for circles- impulsivity + lack of interest
Large size- Acting out behaviour
Fine line- Withdrawal
Second attempt- Impulsivity and anxiety
Box around design- Attempt to control impulsivity, poor self-control
Wavy line- Poor motor coordination, emotional instability
Small size- Anxiety, withdrawn behaviour, shyness
Progressive increase in size- Poor frustration tolerance, explosiveness
Overworked or reinforced lines- Impulsivity, acting out, aggressiveness
Expansion- Impulsivity, acting out; exclusively emotionally disturbed/IDD
Spontaneous elaboration or addition to a design- overwhelmed by fear or anxiety
or totally preoccupied in own thoughts
Interpretation: Lacks (1984, 1999)
Generally, 3 or fewer errors indicates an absence of visuoconstructive deficits or
brain impairment;
4 errors is a borderline score;
And 5 or 6 errors provide some evidence for brain impairment.
The greater the number of errors, the greater the evidence for some type of brain
impairment.
Strong evidence with 7 or 8 errors and very strong evidence with 9 to 12 errors.
Five or more errors is serious, but not if the subject is lazy, impulsive, unmotivated,
or uncooperative.
Report Writing
Demographic details
Reason for referral
Brief history
Test-taking behaviour and observations
Tests conducted
Results
Overall test score (tabulate raw, standard, t scores, PRs, category for copy, recall,
motor, perception)
Item-wise scores- actual figure, figure drawn, score obtained, areas of concern (if any)
Interpretation
Overall test score
Test-taking behaviours
Interpretation of errors
Summary
Recommendations
