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ADVANCED PROJECTIVE TECHNIQUES
Dr. Joy Tungol, Thursdays, 6:00-9:00 PM 2 nd^ Term, A.Y. 2022- 2023
Bender Visual-Motor Gestalt Test II
Reporters: Abrillo, Maria Angela C. Vayalamannil, Aneesh Overview ● Developed in 1938, “A Visual Motor Gestalt Test and Its Clinical Uses” by Lauretta Bender ● Gestalt function ○ Integrated ○ Biologically determined ○ Responds to stimuli as a whole ● The Bender-Gestalt II measures visual-motor integration skills in children and adults aged 4 to 85+ years. It also provides an assessment of memory for children and adults aged 5 to 85+ years. ● 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 ● One of the most frequently used instruments in psychological assessment history Materials ● set of stimulus cards ● observation form ● Motor and Perception tests ● Number 2 pencils with erasers ● Blank sheets of paper ● Timing device
Administration A. Before Testing ● Stimulus cards should be in order ● Area should be well-lit with tables and chairs ● Administer card numbers 1-13 only for children below 8 years old ● Administer card numbers 5-16 for 8 years old and up B. During ● Examinees: ○ May erase and/or use more than one sheet of paper ○ May not turn or manipulate the stimulus cards ○ May not use rulers or anything to guide the drawing ○ May not draw at the back of the paper nor doodle non-test designs ● If the examinee becomes discouraged during the test, you can say “Do the best you can.” ● If the examinee asks where to start drawing on the paper, you can say “Begin wherever you like.” C. Copy Phase Administration ● No time limit but record how long the examinee completes the items ● Say: “I have several cards here. Each card has a different drawing on it. I will show you the cards one at a time. Use the pencil to copy each drawing onto the paper. Try to make the drawings look the same as the drawings on the card. There are no time limits, so take as much time as you need. Do you have any questions? If none, here is the first card.” ● Only give additional paper if the examinee requests or no more space ● Record any behaviors such as tilting the paper, counting the number of dots or waves, etc. on the Observation Form D. Recall Phase Administration ● Given right after Copy phase ● Say: “Now, I want you to draw as many of the designs that I showed you as you can remember. Draw them on this new sheet of paper. Try to make you drawings just like the ones on the cards you saw earlier. There are no time limits, so you can take as much time as you need. Do you have questions?” ● Stop timing if: ○ Examinee completes all items ○ Doesn’t recall any more designs after approximately 2 minutes E. Bender Gestalt II Motor Test Administration ● Consists of a sample item and 4 test items with 3 figures per item ● Takes 2 to 4 minutes to administer ● Stop administration when the examinee completes all items or after 4 minutes
B. Scoring Supplemental Tests a. Criteria for Motor Test 1 Line touches both end points and does not leave the box. Line may touch the border but cannot go over it. 0 Line extends outside the box or does not touch both end-points Calculate by adding correct items for each figure. A total of 12 points is possible. b. Criteria for Perception Test 1 Correct 0 Incorrect Calculate by adding correct items for each figure. A total of 10 points is possible.
Theoretical basis of Bender Gestalt II Developmental maturation of drawing ability is an ongoing process that follows sequential stages, incorporating gross to fine-motor skills, visual imagery, and perceptual awareness and a developmental drawing tendency from vertical to horizontal movements, and finally from two dimensional to three-dimensional awareness. These stages are all part of the maturational process leading to the more intricate representations found within a mature representational drawing that become a complete gestalt or perceptual integration. If there is any deviation within this maturational process, it would lead to disintegration of the original representation or errors between drawing and its stimulus. Standardization and norming A. Standardization sample Based on a carefully designed, stratified, random plan that closely matched the U.S. 2000 census: ● 4,000 individuals from 4 to 85+ years of age ● Additional samples were collected for validity studies (e.g., individuals with mental retardation, learning disabilities, ADHD, autism, Alzheimer’s disease, and examinees identified as gifted) ● Data was collected over a 12-month period in 2001 through 2002 B. Normative specifications Utilizing U.S. 2000 census data, the Bender-Gestalt II normative sample was designed to be nationally representative and matched to percentages of the U.S. population for the following variables:
- Age: ○ 21 age groups differing in size and age, were defined ○ More refined age categories are used at the earliest and latest age groups because of a higher rate of change in scores due to age-related development or decline.
- Sex ○ The Bender-Gestalt II standardization included approximately equal percentages of males and females for each age group except for ages 60 and above where differences in sex also occur in the census 60 – 69 à Females (55.5) and Males (44.5) 70 – 79 à Females (61.0) and Males (39.0) 80+ à Females (66.0) and Males (34.0).
- Race/Ethnicity (including Hispanic origin): Examinees’ racial and ethnic origins were identified on the consent forms by the examinees or their parents or legal guardians: ○ American Indian or Alaskan Native, Asian, Native Hawaiian, or other Pacific Islander ○ Black or African American ○ White ○ Hispanic ○ Multiple ethnicities (classified as ―Other)
- Geographic Region: (Northeast, Midwest, South, and West)
- Socioeconomic Level (Educational Attainment) ○ Adults: levels measured by years of education completed
e. Autism and Alzheimer Autism :Examinees included in this category were required to exhibit a documented developmental disability that significantly and adversely affected verbal and nonverbal communication and social interaction as they relate to educational or occupational performance Alzheimer’s Disease : Examinees were independently diagnosed prior to testing. Diagnosis was primarily based on DSM-IV-TR 294.1x criteria f. Giftedness For inclusion in the Giftedness category, examinees were required to provide documentation for both of the following criteria: ● Performance on an individually administered IQ test with a score of more than two SDs above the mean ( > 130, M = 100, and SD = 15) ● Official designation by a local, county, or state education agency that the individual is qualified for gifted/talented school services Technical Properties: Reliability and validity ● It provides stable, consistent measures ● Test-retest reliability over a 2 - 3 week interval was .85 (range .80-.88) for the copy phase and .83 (range .80-.86) for the recall phase ● Split-half procedures indicated the overall validity was .91 and the standard error of measurement was 4.55. ● Evidence of moderate to high interrater consistency for trained scorers. Rater agreement for the copy phase (.90) and .96 for the recall phase. ● Moderate correlations with other measures support its construct validity. ● Discriminatory validity as it can discriminate populations with brain damage from those without brain damage. Bender is better used as an indicator for gross neurological damage. Its diagnostic accuracy is questioned. Shaughnessy (2018) claimed that Bender-2 is a quick, and reliable dependent test that will at least provide some information as to recovery from head injury or concussion and will provide a way in which clinicians can monitor progress and recovery. Guidelines for Interpretation Before the interpretation, our assumption is that when the clients take the test and perform well they must have adequate fine motor coordination and the ability to make accurate perceptual discriminations. They must then integrate this into the actual reproduction of the design. If there are errors, what do they suggest? Poor motor coordination, difficulties actually perceiving the design, problems executing the drawing itself, or difficulties integrating the perception and motor requirements. Difficulties with poor performance – result of delays in visuomotor abilities, brain dysfunction, emotional disturbance, or a combination of all these factors. (Note: bender performance is only minimally influenced by cultural or processing speed).
Take care of the following in the interpretation of the protocol: Test scores can be quantitatively interpreted according to the standardized norms. For a quantitative interpretation, follow the global scoring Scale.
- Raw scores for copy and recall phase are converted into scaled scores and percentiles (Mean=100, SD=15). The standard score can range from 40- 160
- For example, a score of 85 (standard Score) means the client scored 1 standard deviation below the norm or at the 16th^ percentile when compared with his or her age-related peers. SS (M=100; SD=15) T Scores M= SD= 10 Percentile Ranks Confidence intervals 90% 95% Classification 85 40 15.87 79 - 93 78 - 94 Low Average As per the manual scores in the lower 25th^ percentile signal the need for further evaluation. A score in the bottom 2% of the population (2nd^ percentile, SS of 70) is considered to be in the “impaired” range. These scores need to be interpreted while considering the person’s history, demographics, and level of functioning. For example, if a student has been functioning near the top of the class but who then begins to have academic difficulties and has a Bender - 2 scores at the 20th^ Percentile (SS 87), may suggest a deteriorating condition. But if a student with marginal academic record, low-average intelligence, who also has a Bender-2 score at the 20th^ Percentile may be merely reflecting overall low-average abilities. This way of interpreting will give us a general sense of the person’s scores on Bender-2 (low scores represent a person’s visuo-motor abilities. Three major areas to consider in expanding on the meaning of the person’s score
- Distinguish between perceptual versus motor difficulties
- Consider the meaning of design construction versus visual memory
- Differentiate among developmental delays, brain dysfunction, and emotional disturbance. Perceptual v/s Motor Difficulties A poor performance on Bender-2 is due to perceptual versus motor difficulties. How do you interpret? We must carefully consider the relevant behavioural observations about the client’s approach to the test and qualitative features of the drawings (client’s level of confidence,
Other factors that might influence: situations that might encourage faking, chronic schizophrenia, older age, history of substance abuse. There are also the following possible reasons for poor performance: ● Visual problems ● Physiological limitations associated with illness, injury, fatigue or muscular weakness ● Physically disabling conditions such as low birthweight, cerebral palsy, or sickle cell anemia ● Environmental stresses. ● Impulsiveness ● Inadequate motivation ● Emotional problems ● Mental retardation ● Social or cultural deprivation ● Limited experience Sometimes the presence and severity of different types of errors, along with relevant behavioral observations can be used to form a tentative hypothesis concerning the client’s functioning. Why? Because there can be some qualitative differences in the performance of a client with lesions in different brain areas. Right-hemisphere lesions Likely to make errors related to visuospatial abilities (rotations, asymmetry, fragmentation, unrecognizable drawings, unjoined lines) Left-hemisphere lesions Often make drawings that are shaky (line tremors), and smaller in size, with rounded corners and missing parts (oversimplification) Gary Groth-Marnat (2016) observes that Bender-2 is generally sensitive in identifying people with right-hemisphere difficulties. Clients who have primary difficulty with incorrect rotations in their reproductions of the designs suggest mirror reversals involved with other tasks, such as reading. Clients with difficulty in sequencing could be suggested by a poorly arranged sequence in the reproduction of the bender-
A useful interpretive strategy – note and compare scores on other relevant tests (if people do poorly on bender-2, they are expected to do poorly on the Weschler Block design subtest.) It is useful because it enables the practitioner to observe the deficits of the clients clearly. A client with perceptual difficulty distorts and misperceives the design. The client who experiences the difficulty is indicative of the presence of a right parietal lesion. Some clients understand the task, and
perceive it correctly but experience difficulty completing it. This dissociation between intent and doing it is known as constructional dyspraxia. Due to CNS complications, clients may compensate for visuomotor difficulties. In this case, the bender-2 reproductions might be relatively accurate. This compensation is particularly likely if an injury is not extensive, there was premorbid above-average intelligence, the location of the lesion is not too critical, and the injury is not recent. A clinician can detect a possible presence of a brain damage by becoming aware of the possible compensatory mechanisms as listed by Koppitz(1975): ● Excessive length of time for completion ● “Anchoring” designs by placing a finger on them as they attempt to reproduce them ● Reproducing a design from memory after first glancing at it ● Checking and rechecking the number of dots yet still being uncertain regarding the correct number that should be included ● Rotating either the sheet of paper or the Bender–2 card itself as an aid in reproducing the design ● Designs that are quickly and impulsively drawn and then corrected with extreme difficulty ● Expressions of dissatisfaction with the poorly reproduced designs followed by repeated efforts to correct them. Note : while screening for neuropsychological impairment using bender-2, it is important to be aware of the many indicators for CNS problems that are also indicators for emotional disturbance. We need other tests to make a differential diagnosis. Bender-2 is not a stand-alone test. Insight : You might ask why there is a tendency in some clients the need to compensate. The basic assumption of Gestalt about human nature is that “individuals have the capacity to self- regulate when they are aware of what is happening in and around them.” Compensation is a mechanism to self-regulate in managing life around them with the awareness that they have a damage to the brain. Other Interpretation guidelines in testing children with learning disabilities as found by Koppitz (1975): During testing such children may manifest ● hesitancy (asking the sharpen the pencil, talking about other topics, drawing other objects) ● impulsivity (e.g., dashing of drawings without taking time to analyze the drawings) ● compulsivity (e.g., constantly checking and rechecking details) ● insecurity and anxiety (e.g., continually seeking reassurance and encouragement) The behaviour of the examinee is sometimes as important as the test response itself. In explaining the personality characteristics of the client, it is important to examine the aspects of an examinee’s work method. This can be understood in the following three categories based on the detailed
Confused order: Designs are scattered arbitrarily on paper without sequence or order Associated with poor planning, and inability to organize material. It may be related to mental confusion, particularly in older individuals or brighter children. Wavy Line: two or more abrupt changes in the direction of the line of dots or circles of design 6 or design 7. Associated with instability in motor coordination and in personality. It may reflection emotional instability resulting from poor coordination and poor integrative capacity, or it may reflect poor motor control due to tenseness in a person with serious emotional disturbances. It may come about from organic factors, from emotional attitudes, or both. Dashes for circles (design 7): substitution of dots for circles is acceptable. It has been associated with impulsivity and with lack of interest or attention. It is found among individuals who are preoccupied with their problems or who try to avoid doing what they are required to do Progressive increase in Size (Design 6,7, or 8): dots and circles increase progressively in size until the last ones are at least three times as large as the first one. It is associated with low frustration toleration and explosiveness. Because very young children normally tend to have a lower frustration tolerance. The diagnostic implications on this deviation increase as individuals age and is less significant in 5 year olds. Large Size: one or more designs are drawn one third larger in both directions than design on stimulus card. It is associated with acting out behavior and externalizing disorders. Small size: one or more designs are drawn half as large as the design on the stimulus card (eg., Designs 5 & 9). Associated with anxiety, withdrawal, constriction, and timidity. Fine lines: pencil line is so thin that it requires effort to see the completed design Associated with timidity, shyness, and withdrawal.
Overworked, reinforced lines: total design or part of it is redrawn or reinforced with heavy, impulsive lines. Associated with impulsiveness and aggressiveness. It occurs frequently among acting out children. Second attempt: drawing of design or part of it is spontaneously abandoned before or after it has been completed, and a new drawing of the design is made. Associated with impulsiveness and anxiety. It occurs among those who are aware that their drawing of a design is incorrect but who are too impulsive and lacking in inner control to correct the drawing by erasing and carefully redrawing the part that was incorrect. Expansion: two or more sheets of paper are used to complete the drawings of all the bender designs. Associated with impulsiveness and acting out behaviour. This seems to occur normally among preschool children. For children older than age 6, Koppitz found it to occur almost exclusively on the Bender records or emotionally disturbed youngsters with neurological impairment. Box around design: a box is drawn around one or more designs after the design has been copied. Associated with the attempt to control impulsivity, but commonly denotes a lack of internal behavioral controls coupled with a desire for limits and controls to be placed on one’s behavior. Spontaneous elaboration or additions to design: two or more designs are joined or combined to create a different, often bizarre design. These are rare and occur exclusively on the drawings of individuals who are overwhelmed by fears and anxieties or who are principally preoccupied with their own thought and feelings.
