Introduction: The Bender-Gestalt II
Richard Ruth, PhD
Former Member, Board of Directors
American Orthopsychiatric Association
Like most psychologists of my generation, the Bender Gestalt Test is my equivalent of a stethoscope. Developmentally, it is the first test I learned; in my rituals of practice, it is generally where I begin. It is both valued tool and valued symbol. A young man's life once was saved because my Bender gave the first hint he had copper poisoning. I teach assessment to graduate students in clinical psychology. Invariably, as students get a sense of what the Bender can do, the test itself takes them far beyond any words of mine, teaching them something integral about the nature of their science and their clinical craft.
Lauretta Bender developed her test working on the wards of Bellevue, some fifty years before I worked there. The test grew out of her deep encounters with the lives of her patients and the vital life of her own scientific mind. Crossing disciplinary boundaries and asking questions that challenged essential "truths" of practice in her time, Bender took both science and practice, interlinked, in new directions. In this context it is not surprising that she was an Ortho member, or that her involvement in this interdisciplinary organization helped lead this neurologist to shape the profession of clinical psychology.
The American Orthopsychiatric Association owes a great debt to Lauretta Bender. She assigned the copyright for her original test to us, a legacy that helps sustain us both intellectually and economically.
Times change, and tests change -- in both cases, not always for the better. Psychologists have much more sophisticated assessment tools today, but sophistication does not always equate with wisdom. So when the impending revision of the Bender was announced, many clinicians met the news with some ambivalence. Would something of value be destroyed?
I believe that Lauretta Bender would be proud of the Bender-II. The revised test, still simple and still elegant, is affordable (no small virtue), psychometrically sound and robust, and still among the most useful and powerful of tools for clinical psychologists, school psychologists, and neuropsychologists around the world. Among its virtues are that, like Bender herself, it both respects clinical observations and thinking and is structured to facilitate science shaping a diagnostician's thoughts.
The Board of the American Orthopsychiatric Association and the Editor of this journal warmly encouraged the commissioning of this special article on the Bender-II. Our thanks to the authors for their superb work on this important new assessment instrument, which honors this Association's past and advances and extends our deepest values -- that it is when engaged, rigorous science meets engaged, reflective practice, across the boundaries of guilds, that the transformation of human lives begins.
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American Journal of Orthopsychiatry January 2006 Vol. 76, No. 1, 10-12 |
The Bender-Gestalt II
Gary G. Brannigan
Department of Psychology, University of New York-Plattsburgh
Scott L. Decker
College of Education, Georgia State University
ABSTRACT
In 2003, the Bender-Gestalt II was published. In the present article, the revision process is described, and major changes to the test are discussed. These changes include additional designs, a memory (recall) phase, Motor and Perception supplementary tests, a detailed observation form, a global scoring system, and a large, nationally representative normative base. Directions for future research are also provided.
Keywords: Bender-Gestalt, visual-motor, memory
“mainstay in the assessment battery … as an assessment tool in appraisal of intelligence … as a screening technique for neuropsychological dysfunction, a clinical tool for sampling visual-motor proficiency, and as a standard projective technique in the assessment of personality.” (p. 1272)
According to
Schilder (2003), Lauretta Bender experienced learning problems herself and struggled during her early school years. However, over time, her academic performance improved markedly. She graduated as the valedictorian of her high school class and went on to earn a bachelor's degree in biology and a master's in pathology from the University of Chicago. She then entered the medical school at the University of Iowa. It was there that she worked with Samuel Orton and determined that a dyslexic condition had contributed to her early learning problems. Following her medical training in neurology, she began work on the Visual Motor Gestalt Test.
Intrigued by
Wertheimer's (1923) studies of the gestalt theory of perception,
Bender (1938) adapted nine of his configurations and transformed the technique from a visual-verbal one to a visual-motor one. After years of experimentation, her groundbreaking monograph
A Visual Motor Gestalt Test and Its Clinical Use was published by the American Orthopsychiatric Association (AOA) in 1938. In this work, she provided clinicians with an elaborate scoring system and normative data on the maturation of visual-motor gestalt functioning as well as detailed descriptions of the performance of individuals with various organic and functional pathological conditions (e.g., organic brain disorder, schizophrenia, psychoneuroses). In the most comprehensive review of the early research on the Bender-Gestalt Test,
Tolor and Schulberg (1963) praised Bender's work and noted its tremendous impact on research and clinical practice.
Although there have been many significant research accomplishments over the years, we only focus on the research threads that link the Bender-Gestalt Test to the Bender-Gestalt II.
Bender (1938) operated under the assumption “that the visual gestalt function is a fundamental function associated with language ability and closely associated with various functions of intelligence such as visual perception, manual motor ability, memory, temporal and spatial concepts and organization” (p. 112). As such, she used the test to study the “gestalt function in … different organic and functional nervous and mental disorders” (p. 4).
Bender's (1938) scoring system evaluated the overall quality of each design on a scale that ranged from 1 to 5 on one design through 1 to 7 on others. She provided detailed descriptions of each point on the scale for each design. On Design 6, for example, a score of 1 was given for an inhibited scribble, a score of 4 was given for two wavy lines crossing at right angles, and a score of 6 was given for perfection. Although her scoring system did not withstand the test of time, she still advocated the use of global scoring systems over error-based systems, which she felt oversimplified the processes involved and failed to do justice to the test.
One of the earliest global scoring systems to emerge was developed by Keogh and Smith in
1961. Their scoring system involved rating each design on a 5-point scale on the basis of the overall quality of the production. A score of 1 would be given when a figure was unrecognizable, and a score of 5 would be given when all parts of the figure were present and recognizable. Although the system generated some research, the authors never provided normative data.
The second scoring system was developed by
deHirsch, Jansky, and Langford (1966), in collaboration with Bender. They also modified the test by eliminating three of the more difficult designs to match their research interest in preschool screening. The scoring system used a single global inspection procedure that yielded a pass or fail for each design. The system evaluated the essentials of the gestalt and the degree of differentiation of each design. In 1972, Jansky and deHirsch further simplified and refined the scoring system by providing specific guidelines for scoring each design to determine whether a pass or fail should be given. On Design 6, for example, “lines should cross at or near the center, but need not be wavy” (p. 151) for a pass.
The work of these early researchers served as the basis for the development of a more elaborate series of studies beginning in the 1980s.
Brannigan and Brunner (1989,
1996,
2002), like
Bender (1938), believed that a global approach to scoring provided the most accurate assessment of visual-motor functioning. They refined and extended the early research in formulating the Qualitative Scoring System. Using the same six designs (A, 1, 2, 4, 6 and 8) as had
deHirsch et al. (1966) and
Jansky and deHirsch (1972), they devised a 6-point scoring system for greater differentiation in scoring each design. Scoring ranged from 0 (random drawing, scribbling, having no concept of the design) to 3 (all major elements present and recognizable with only minor distortions) to 5 (accurate representation). Extensive normative data were provided for children aged 4 years 6 months to 8 years 5 months.
The Bender Visual-Motor Gestalt Test—Second Edition (Bender-Gestalt II;
Brannigan & Decker, 2003) is an extension of this early research in two fundamental ways. First, it is a modified version of the original test. Second, it uses a quality-based method of scoring. As we discuss, though, there are a number of other significant developments and refinements in the revision. (See
Brannigan, Decker, & Madsen, 2004, for a detailed comparison of the Bender-Gestalt Test and the Bender-Gestalt II.)
The Revision
The decision to revise the Bender-Gestalt Test was made years before the work actually was initiated. The AOA, which owned the copyright to the Bender-Gestalt Test, was interested in revising the test. Ernie Hermann of AOA and John Wasserman of Riverside Publishing were instrumental in finalizing an agreement to transfer copyright to Riverside Publishing as well as in developing a preliminary blueprint for the revision. A large advisory panel, which included Lauretta Bender's son Peter Schilder, was established to provide input on the revision and monitor its progress.
The process of revising the test proved to be exciting and challenging. The large group of advisors, with different theoretical orientations, provided a wealth of ideas. Agreement did not always come easily. In the end, though, four guidelines emerged:
- Keep the original nine designs, but increase the number of designs in the test.
- Include a memory (recall) procedure.
- Compare both deviation- and quality-based scoring systems.
- Obtain a large, nationally representative sample.
To extend the measurement scale at both the lower and the higher end, the researchers generated many potential designs. Expert judges rated these designs to determine appropriateness of difficulty and how well they fit with the original test designs. Sixteen new designs were retained for further consideration (6 at the lower end and 10 at the higher end of the scale of difficulty). Following a pilot study, which used an item-response analysis to evaluate the designs, 7 designs (4 easier, 3 more difficult) were selected for inclusion in the Bender-Gestalt II.
The Bender-Gestalt II is composed of 16 designs, broken into two separate tests: 13 designs (original 9 and 4 easier) for individuals below age 8, and 12 designs (original 9 and 3 more difficult) for individuals aged 8 and older.
The addition of a memory (recall) procedure was based on previous research studies that suggested that the inclusion of a memory (recall) procedure would be useful in a variety of clinical applications. Additionally, numerous testimonies from clinicians revealed that a recall procedure was frequently added to the testing procedure, but because normative information was scarce, it was subjectively interpreted. The utility of the recall procedure comes from the measurement of related yet different cognitive processes involved in nonverbal recall of information. Because each individual must initially copy the designs, exposure to the items is ensured, and inattention during exposure is reduced. This procedure compliments verbal recall procedures, which are frequently measured in psychological test batteries.
The selection of what is now called the Global Scoring System resulted from the interaction of experts in a variety of fields (e.g., psychology, medicine, statistics), trial and error, and pilot studies. The Global Scoring System evaluates the representation of each design on the basis of its overall quality using a 5-point (0 to 4) rating scale. The scoring system yields an individual score for each design and total scores for the Copy and Recall phases of the test. Initially, several objective and subjective scoring systems were used to score the standardization data and protocols from numerous clinical samples. The scoring systems were compared on a number of criteria, including reliability, validity, and ease of use. This research was communicated in newsletters and presentations to advisors and consultants throughout the revision. After the evidence was analyzed, it was clear that the Global Scoring System had advantages over the other systems. It was shown to be reliable, valid, and especially sensitive to clinical conditions that involved disturbances in visual-motor functioning.
The acquisition of a large, representative normative sample was the most significant part of the revision. This normative base was especially important because such factors as age and development are crucial to the interpretation of scores. The normative sample for the Bender-Gestalt II is the largest and most comprehensive in the history of the test. In addition to its size, it is stratified to closely match the U.S. 2000 Census.
Validity studies were also conducted on the normative sample as well as individuals with mental retardation, learning disabilities, attention-deficit/hyperactivity disorder, autism, Alzheimer's disease, and special talents. In addition to these major changes, the Bender-Gestalt II includes Motor and Perception supplementary tests to help detect specific problems in these areas separate from the integration processes that are required for performance on the Bender-Gestalt II. The information provided by these tests, in conjunction with the Bender-Gestalt II, should aid differential diagnosis.
The last enhancement is the addition of an observation form. On this form, examiners can check lists to determine whether sensory or motor factors and/or test-taking behaviors might have influenced test performance. They can also record any design-copying behavior that may have clinical relevance.
Research Directions
Twenty-five years ago,
Tolor and Brannigan (1980) stressed the need for research on the Bender-Gestalt Test to proceed in several directions. Although some significant advancements have been made (for examples, see review in
Brannigan & Brunner, 2002), the publication of the Bender-Gestalt II will, we hope, stimulate further research in the following areas:
- diagnosing organic pathology,
- predicting school learning problems, and
- assessing personality dynamics and psychopathology.
With the innovations in the revision, the Bender-Gestalt II has become a more dynamic assessment tool. Research in these areas should stress its role in various phases of the assessment process (i.e., from screening to comprehensive evaluation) and its contributions, along with other tests, to differential diagnosis. We hope many others will join us in this endeavor.
References
Bender, L. (1938). A visual motor gestalt test and its clinical use (Research Monograph No. 3). New York: American Orthopsychiatric Association.
Brannigan, G. G., & Brunner, N. A. (1989). The Modified Version of the Bender-Gestalt Test for Preschool and Primary School Children. Brandon, VT: Clinical Psychology.
Brannigan, G. G., & Brunner, N. A. (1996). The Modified Version of the Bender-Gestalt Test for Preschool and Primary School Children—Revised. Brandon, VT: Clinical Psychology.
Brannigan, G. G., & Brunner, N. A. (2002). Guide to the qualitative scoring system for the Modified Version of the Bender-Gestalt Test. Springfield, IL: Thomas.
Brannigan, G. G., & Decker, S. L. (2003). Bender Visual-Motor Gestalt Test (2nd ed.). Itasca, IL: Riverside Publishing.
Brannigan, G. G., Decker, S. L., & Madsen, D. H. (2004). Innovative features of the Bender-Gestalt II and expanded guidelines for the use of the global scoring system (Bender Visual-Motor Gestalt Test, 2nd ed., Assessment Service Bulletin No. 1). Itasca, IL: Riverside Publishing.
deHirsch, K., Jansky, J. J., & Langford, W. S. (1966). Predicting reading failure. New York: Harper and Row.
Jansky, J. J., & deHirsch, K. (1972). Preventing reading failure: Prediction, diagnosis, intervention. New York: Harper and Row.
Keogh, B. K., & Smith, C. E. (1961). Group techniques and proposed scoring system for the Bender-Gestalt Test with children. Journal of Clinical Psychology, 17, 122-125.
Lacks, P. (1999). Bender-Gestalt screening for brain dysfunction (2nd ed.). New York: Wiley.
Piotrowski, C. (1995). A review of the clinical and research use of the Bender-Gestalt Test. Perceptual and Motor Skills, 81, 1272-1274.
Schilder, P. (2003). Lauretta Bender: A pioneer in the fields of gestalt psychology and neuropsychology. In G. G. Brannigan & S. L. Decker, (Eds.), Bender Visual-Motor Gestalt Test (2nd ed., pp. vi-vii). Itasca, IL: Riverside.
Tolor, A., & Brannigan, G. G. (1980). Research and clinical applications of the Bender-Gestalt Test. Springfield, IL: Thomas.
Tolor, A., & Schulberg, H. C. (1963). An evaluation of the Bender-Gestalt Test. Springfield, IL: Thomas.
Wertheimer, M. (1923). Studies in the theory of Gestalt psychology. Psychologische Forschung, 4, 301-350.
Correspondence concerning this article should be addressed to Gary G. Brannigan, Department of Psychology, Plattsburgh State University of New York Plattsburgh, NY 12901