Bender-Gestalt Research Articles

El sistema de calificación cualitativa para la Prueba Gestáltica de Bender – Modificada. Estudio preliminar de sus propiedades psicométricas

The present report describes the psychometric properties of the Qualitative Scoring System for the Modifi ed version of the Bender-Gestalt Test, in a 97 children’s group, that are going to enter to fi rst grade of elementary education in a public school of Lima. Our fi ndings report modest levels of reliability internal consistency and test-retest reliability, in comparison with the coeffi cients of the manual, but their potential range (due confi dence intervals) gets to high levels. The correlation with task orientation, fl uid intelligence and parental report of fi ne-motor behavior give support to the validity and utility of this new scoring system in the context of fi rst grade children’s assessment. We discuss the limits and relevance of this scoring system for the psychoeducational research and assessment

Risk Factor Frequency for Learning Disabilities in Low Socioeconomic Level Preschool Children in Mexico City

The objective was to identify the frequency of risk factors for Learning Disabilities (LD) in low socioeconomic level children in Mexico City. We studied children by means of: Wechsler, Bender-Gestalt, and Human drawing tests. Average age of male subjects was 5.6±0.9 years, while that of the female group was 5.4±0.5 years. In male subjects, average Total intelligence quotient (T-IQ) score was 98±12.2 while, in the female group, this was 99±12.2. On the Bender-Gestalt test, male subjects had a mental and visual-motor average age of <1 year under chronological age. Female subjects had a mental and visual-motor age 8-7 months under the norm. On the Human drawing test, in male and female subjects, the most frequent at-risk features comprised: self-isolation in 25% of subjects, shyness in 22.4%, and poor internal controls in 22%. In conclusion, we found a high at-risk factor frequency for LD in children of low socioeconomic strata. We highlight the importance of screening children before they attain school age.

Diffuse occipital hypometabolism on [18F]-FDG PET scans in patients with idiopathic REM sleep behavior disorder: Prodromal dementia with Lewy bodies?

Previous longitudinal studies have revealed that specific patterns on [(18) F]-fluoro-d-glucose (FDG) positron emission tomography (PET) scans in patients with amnesic mild cognitive impairment can predict Alzheimer's disease (AD). However, the significance of particular patterns on [(18) F]-FDG PET scans in prodromal patients with dementia with Lewy bodies (DLB) remains unclear. Based on the prevailing evidence that rapid eye movement (REM) sleep behavior disorder (RBD) often precedes the onset of DLB, [(18) F]-FDG PET scans of nine non-demented patients reporting recurrent nocturnal dream-enactment behavior in our memory clinic were compared with the normative database using three-dimensional stereotactic surface projection (3D-SSP) images. All patients underwent clinical and neuropsychological examinations as well as cardiac [(123) I]-metaiodobenzylguanidine ([(123) I]-MIBG) scintigraphy. Four patients were found to have diffuse areas of reduced cerebral metabolic rate of glucose (CMRglc), predominantly in the occipital lobe, which is the preferentially affected region in DLB patients. In contrast, five patients showed no such occipital hypometabolism; instead, these five patients showed hypometabolism in the left anterior cingulate gyrus (Broadmann area (BA) 24), right frontal lobe (BA 32) and right anterior temporal lobe (BA 38), which are the preferentially affected regions in Parkinson's disease rather than DLB. The extent of the reduction in CMRglc in the left occipital lobe was correlated with scores on the Bender Gestalt Test, which reflects visuospatial ability, but not with global cognitive measures. All patients showed reduced cardiac [(123) I]-MIBG levels, consistent with underlying Lewy body disease. These variations in [(18) F]-FDG PET scans raise the possibility that the specific pattern of CMRglc reduction may predict developing DLB in patients with idiopathic RBD. Further follow-up studies are needed, particularly on patients with diffuse occipital hypometabolism.

Bender-Gestalt Test correlates of prognosis in Unipolar Depression

The Bender-Gestalt test (B-G test) was administered to examine its prognostic implications in an Ethiopian sample with unipolar depression. Total 30 patients with moderate level of depression were included in study and their time taken was compared against the performance on the B-G test. Finally, a significant difference was found between time taken and Z-scores of the test supporting the prognostic value of this test in unipolar depression. KEY WORDS: Unipolar depression; B-G test; Prognosis

Evaluación de la confiabilidad del Sistema Cualitativo de Calificación para la versión modificada del Test Gestáltico de Bender

El presente estudio busca obtener evidencias de confiabilidad para el Sistema Cualitativo de Calificación (Brannigan y Brunner, 2002) aplicado al Test Gestáltico de Bender – Modificado. Los participantes fueron 86 niños, divididos en dos grupos de edad preescolar y escolar; y tres estudiantes que calificaron los diseños en ambos grupos. Los análisis se efectuaron a nivel del puntaje total y del ítem. Los resultados señalan de buenos niveles de confiabilidad intercalificadores y consistencia interna en el grupo de preescolares, mientras que estos niveles fueron más bajos en el grupo de escolares. Estas diferencias establecen la relación entre estos dos aspectos del error de medición, y el énfasis en un adecuado entrenamiento de medidas que requieren el juicio del examinador. Discutimos nuestros resultados considerando la potencial utilidad de esta relativa nueva versión del test Gestáltico de Bender para la práctica clínica y de investigación.

Visual-motor and executive functions in children born preterm: The Bender Visual Motor Gestalt Test revisited

Visual-motor development and executive functions were investigated with the Bender Test at age 5½ years in 175 children born preterm and 125 full-term controls, within the longitudinal Stockholm Neonatal Project. Assessment also included WPPSI-R and NEPSY neuropsychological battery for ages 4-7 (Korkman, 1990). Bender protocols were scored according to Brannigan & Decker (2003), Koppitz (1963) and a complementary neuropsychological scoring system (ABC), aimed at executive functions and developed for this study. Bender results by all three scoring systems were strongly related to overall cognitive level (Performance IQ), in both groups. The preterm group displayed inferior visual-motor skills compared to controls also when controlling for IQ. The largest group differences were found on the ABC scoring, which shared unique variance with NEPSY tests of executive function. Multiple regression analyses showed that hyperactive behavior and inattention increased the risk for visual-motor deficits in children born preterm, whereas no added risk was seen among hyperactive term children. Gender differences favoring girls were strongest within the preterm group, presumably reflecting the specific vulnerability of preterm boys. The results indicate that preterm children develop a different neurobehavioral organization from children born at term, and that the Bender test with a neuropsychological scoring is a useful tool in developmental screening around school start.

Differential Functioning of Bender Visual-Motor Gestalt Test Items

Differential Item Functioning (DIF) refers to items that do not function the same way for comparable members of different groups. The present study focuses on analyzing and classifying sex-related differential item functioning in the Bender Visual-Motor Gestalt Test. Subjects were 1,052 children attending public schools (513 boys, 539 girls, ages 6-10 years). The protocols were scored using the Bender Graduated Scoring System, which evaluates only the distortion criterion using the Rasch logistic response model. The scoring system fit the Rasch model, although two items were found to be biased by sex. When analyzing differential functioning of items for boys and girls separately, the number of differentially functioning items was equal.

Psychogenetics of Turner syndrome: an investigation of 28 subjects and respective controls using the Bender test and Piagetian scales

Piagetian scales and the Bender visual motor gestalt test (BT) were applied to 28 subjects with universal 45,X Turner syndrome (TS), and their respective controls, in order to investigate their cognitive performance. Dermatoglyphics were also analyzed to obtain clues concerning embryological changes that may have appeared during development of the nervous system and could be associated with cognitive performance of TS patients. Dermatoglyphic pattern distribution was similar to that reported in previous studies of TS individuals: ulnar loops in the digital patterns and finger ridge, a-b, and A'-d counts were more frequent, while arch and whorl patterns were less frequent compared to controls. However, we did not find higher frequencies of hypothenar pattern, maximum atd angle, and ulnarity index in our TS subjects, unlike other investigations. Furthermore, we found significant differences between TS and control T line index values. The BT scores were also lower in probands, as has been previously reported, revealing a neurocognitive deficit of visual motor perception in TS individuals, which could be due to an absence of, or deficiency in, cerebral hemispheric lateralization. However, TS subjects seemed to improve their performance on BT with age. Cognitive performance of the TS subjects was not significantly different from that of controls, confirming a previous study in which TS performance was found to be similar to that of the normal Brazilian population. There were significant correlations between BT scores and Piagetian scale levels with dermatoglyphic parameters. This association could be explained by changes in the common ectodermal origin of the epidermis and the central nervous system. TS subjects seem to succeed in compensating their spatial impairments in adapting their cognitive and social contacts. We concluded that genetic counseling should consider cognitive and psychosocial difficulties presented by TS subjects, providing appropriate treatment and orientation for them and their families.

A comparison of clinical and nonclinical groups of children on the Bender-Gestalt and Draw a Person Tests

The present study compared a clinical and a control sample of Turkish children on the Bender Gestalt and Draw A Person tests. 44 of the children from a clinic sample were compared to 44 children from a matched nonclinical school sample The tests were scored according to the Koppitz criteria. ANOVA comparisons showed differences on the Bender Gestalt test, and the HFD. The two groups did not differ on the number of Emotional Indicators. Correct classification of the children in the clinical groups based on the presence of Emotional Indicators was accurate only in 56% of the cases.

Neuropsychological Assessment of Adult Patients with Shunted Hydrocephalus

This study is planned to determine the neurocognitive difficulties of hydrocephalic adults. THE RESEARCH GROUP CONTAINED HEALTHY ADULTS (CONTROL GROUP, N : 15), and hydrocephalic adults (n : 15). Hydrocephalic group consisted of patients with idiopathic aquaduct stenosis and post-meningitis hydrocephalus. All patients were followed with shunted hydrocephalus and not gone to shunt revision during last two years. They were chosen from either asymptomatic or had only minor symptoms without motor and sensorineural deficit. A neuropsychological test battery (Raven Standart Progressive Matrices, Bender-Gestalt Test, Cancellation Test, Clock Drawing Test, Facial Recognition Test, Line Orientation Test, Serial Digit Learning Test, Stroop Color Word Interference Test-TBAG Form, Verbal Fluency Test, Verbal Fluency Test, Visual-Aural Digit Span Test-B) was applied to all groups. Neuropsychological assessment of hydrocephalic patients demonstrated that they had poor performance on visual, semantic and working memory, visuoconstructive and frontal functions, reading, attention, motor coordination and executive function of parietal lobe which related with complex and perseverative behaviour. Eventually, these patients had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results. This prospective study showed that adult patients with hydrocephalus have serious neuropsychological problems which might be directly caused by the hydrocephalus; and these problems may cause serious adaptive difficulties in their social, cultural, behavioral and academic life.

Comparison of the Bender Gestalt-II and VMI-V in Samples of Typical Children and Children with High-Functioning Autism Spectrum Disorders

The visual-motor skills of 60 children with high-functioning autism spectrum disorders (HFASDs) and 46 typically developing children were assessed using the Bender Visual-Motor Gestalt Test— Second Edition (BG-II) and Beery-Buktenica Developmental Test of Visual-Motor Integration, Fifth Edition (VMI-V). Within-group comparisons yielded substantive mean differences between the BG-II Copy score and VMI-V composite,Visual Perception and Motor Coordination sections of the VMI-V, and Copy and Recall sections of the BG-II, in both samples. Between-groups differences were assessed in a subsample of 27 participants from each group matched on age, gender, ethnicity, and parent education. After statistically controlling for IQ, the HFASD group scored significantly lower than the typically developing group on the two scores from each test with greater motor involvement. Intratest and intertest correlations were similar across the two samples. Correlations between the BG-II Copy score and VMI-V composite were .55 for the HFASD and .48 for the typically developing sample.

Neuropsychologic Impairment in Children With Rolandic Epilepsy

Although patients with benign childhood epilepsy with centrotemporal spikes exhibit normal intelligence, they frequently display neuropsychologic abnormalities. Thirty-five patients with rolandic epilepsy were included in this study. They were divided into three subgroups. Group I comprised patients with rolandic focus who were not receiving treatment. Group II comprised patients with rolandic focus who were receiving treatment. Group III comprised patients who demonstrated improved foci and were not receiving treatment. The control group comprised 16 children who were similar to patients in terms of age, sex, and sociocultural level. All children underwent standardized neuropsychologic testing, including the Wechsler Intelligence Scale for Children-Revised subtests, Bender Gestalt Test, Stroop Test, Visual Aural Digit Span, Reading and Writing Performance, and Dichotic Listening Test. Patients exhibited significantly impaired visuomotor and reading ability and attention to verbal stimuli compared with control subjects. Reading disability persisted in patients in remission from seizures and epileptic discharges. Contrary to the presumed benign nature of rolandic epilepsy, this disorder may cause learning disabilities. Therefore, patients must be followed longitudinally to identify any learning problems.

Evaluation of Visual Motor Perception in Children with Developmental Articulation and Phonological Disorders

The aim of this study is to compare the visual-motor perceptual skills of children who have a developmental articulation and phonological disorder, with children who do not have such disorders. A group of 21 children between the ages 5:6 and 9:1 yr. (13 boys, 8 girls) was compared to a control group of 21 children matched on sex, age, and socioeconomic level using the Bender Visual-Motor Gestalt Test. Children with disorders had significantly more Bender errors.

Relationship of Bender Gestalt Developmental Scores and Human Drawing Developmental Scores in a Sample of Turkish Preschool Children

The Bender Gestalt test and Human Drawings are frequently utilized tests in assessing school readiness in children. This study was a pilot attempt to evaluate these two tests in a Turkish sample as they relate to first grade behaviour as measured by teacher ratings. One hundred and five children were evaluated at the end of kindergarten using the Bender Gestalt test and Draw A Person Test. The Koppitz (1968, 1975) system was utilized in the scoring of both tests. The children were followed-up and teacher ratings on three academic dimensions and three behavioural dimensions were obtained at the end of the first grade. Significant correlations were obtained between the Bender Gestalt and Human Drawings of the children and teacher ratings of academic achievement and behavioural adaptation at the end of first grade. It appears that the Bender Gestalt test performance at the end of kindergarten is strongly correlated with teacher observations at the end of first grade. Although the relationship between Human Drawing scores and teacher ratings of academic behaviour was not as strong, a relationship was observed between teacher ratings of peer relations and conduct and these scores.

Utility of the Bender Visual-Motor Gestalt Test—Second Edition in the Assessment of Attention-Deficit/Hyperactivity Disorder'

This study examined the use of the Bender Visual-Motor Gestalt Test-Second Edition (BGT-II) with children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Previous research has examined the relationship of ADHD and visual-motor functioning based on overall developmental scores or specific emotional indicators. Although several studies have examined the relationship of the previous edition of the BGT-II and ADHD symptoms, psychometric issues associated with the original edition limit the validity of the results. The current study examined the utility of the BGT-II in the assessment of behaviors associated with ADHD. A group of 62 subjects diagnosed with ADHD (M=11 yr., 5 mo.; 45 male, 17 female) was compared to a control group of 62 subjects randomly selected from the BGT-II standardization data (M=11 yr., 6 mo; 33 male, 29 female). Several hypotheses were made regarding how areas of deficit, e.g., self-regulation, planning, working memory, and motor control, were expected to manifest in BGT-II performance. With IQ controlled, subjects with ADHD performed more poorly on the BGT-II than subjects with no known disorders; however, the effect size was small (eta(p)=.07). Emotional indicators intended to assess symptoms of ADHD did not demonstrate diagnostic utility.

Association between prenatal exposure to methylmercury and visuospatial ability at 10.7 years in the seychelles child development study

The Seychelles Child Development Study was designed to test the hypothesis that prenatal exposure to MeHg from maternal consumption of a diet high in fish is detrimental to child neurodevelopment. To date, no consistent pattern of adverse associations between prenatal exposure and children's development has appeared. In a comprehensive review of developmental studies involving MeHg, a panel of experts recommended a more consistent use of the same endpoints across studies to facilitate comparisons. Both the SCDS and the Faeroe Islands studies administered the Bender Visual Motor Gestalt Test. However, the method of test administration and scoring used was different. We repeated the test on the SCDS Main Study children (mean age 10.7 years) using the same testing and scoring procedure reported by the Faeroe studies to obtain Copying Task and Reproduction Task scores. We found no association between prenatal MeHg exposure and Copying Task scores which was reported from the Faeroese study. However, our analysis did show a significant adverse association between MeHg and Reproduction Task scores with all the data ( p = 0.04), but not when the single outlier was removed ( p = 0.07). In a population whose exposure to MeHg is from fish consumption, we continue to find no consistent adverse association between MeHg and visual motor coordination.

Psychometric Properties of the Bender Gestalt Test Using Lacks' Version of the Hutt-Briskin Scoring System

Criterion-referenced (Livingston r) and norm-referenced (Gilmer-Feldt r and Coefficient Alpha) techniques were used to calculate the internal consistency reliability of the Bender-Gestalt Test (BGT) Total Score using the 12-item Lacks system of scoring. Livingston's r was found to be .825 for the Lacks BGT cutoff score of 5. The Gilmer-Feldt and alpha coefficients for the Lacks Total Score was found to be .644 and .626, respectively. An item analysis showed that most of the BGT items (9 out of 12) were within established criteria for item difficulty, however, 7 items were found to be poor discriminators. The interscorer reliabilities based on three scorers, two scorers, and a single scorer was found to be .895, .852, and .740, respectively. Due to the low reliabilities and several inherent flaws that were identified with the Lacks scoring system, the authors recommend that users of the BGT consider alternative objective scoring systems.

Turkish Children's Bender-Gestalt Test Performance: A Pilot Study and Preliminary Norms

The present study was undertaken to provide preliminary data for norms on the Bender-Gestalt Test for 253 children ages 5 yr., 5 mo. to 11 yr., 10 mo. in Turkey. The Koppitz Developmental Scoring System gave mean error scores of 4.2 ( SD = 3.3) for girls and 3.6 ( SD = 3.0) for boys. The mean error scores obtained by all age groups are presented and compared with other cross-cultural data. These scores decreased across age groups, supporting Bender's maturational hypothesis of the test. The present sample performed at a higher developmental level than the Koppitz normative sample for the 5- and 6-year age groups, while means for other age groups were similar to the original U.S. norms. That this pattern is supported in other cross-cultural studies is discussed as well as the importance of developing local norms for visual spatial tests.

Evaluation of the effect of methylphenidate by computed tomography, electroencephalography, neuropsychological tests, and clinical symptoms in children with attention-deficit/hyperactivity disorder: A prospective cohort study

Background: Stimulant drugs are the most commonly used treatments for attention-deficit/hyperactivity disorder (ADHD), although the mechanism of action of these drugs is still not entirely understood. Objective: The aim of this study was to investigate the effects of the psychostimulant drug methylphenidate (MPH) on regional cerebral blood flow (rCBF), electrical activity of the brain, and clinical symptoms in children with ADHD using single-photon emission computed tomography (SPECT), electroencephalography (EEG), and neuropsychological tests. Methods: In this prospective cohort study, pediatric outpatients received MPH for 3 months at a mean dose of 1 mg/kg · d (range, 0.5–1.5 mg/kg · d). They were then administered the Wechsler Intelligence Scale for Children-Revised, the Bender Visual-Motor Gestalt Test (BGT), EEG, and SPECT of the brain. The parents and/or teacher of each child were asked to complete the Conners' Parent Rating Scale (CPRS), the Conners' Teacher Rating Scale (CTRS), and the Turgay Diagnostic and Statistical Manual of Mental Disorders Fourth Edition-based Child and Adolescent Behavior Disorders Screening and Rating Scale (T- DSM-IV-S). All of the evaluations were performed at baseline and after 3 months of MPH treatment. Each child underwent a Stroop test as an activation method 15 minutes before the SPECT procedure. Results: Sixty patients were assessed for inclusion. Twenty-one children (18 boys [85.7%], 3 girls [14.3%]; mean [SD] age, 9.7 [1.7] years; range, 8–13 years) with a diagnosis of ADHD were included in and completed the study. Mean (SD) BGT scores before MPH treatment compared with after MPH treatment were significantly decreased (9.8 [4.2] vs 6.3 [3.4]; Z = -3.27; P = 0.001). After treatment with MPH, the visual SPECT results suggested that low rCBF was normalized in the right frontotemporal areas in 10 children with ADHD. After treatment, 12 patients (57.1%) had no change in EEG activity, 5 (23.8%) had improvement, and 4 (19.0%) had worsening activity. Patients who had improvement or no worsening on EEG after MPH treatment were associated with significant improvement after MPH treatment compared with before treatment in mean (SD) CTRS scores (25.9 [14.3] vs 35.0 [14.4]; P = 0.003), teachers' T- DSM-IV-S total score (25.1 [14.2] vs 38.4 [18.7]; P = 0.005), and CPRS scores (mothers scores: 29.7 [16.6] vs 42.6 [17.2], P = 0.002; fathers' scores: 29.4 [16.8] vs 41.9 [23.7], P = 0.004). No significant difference was found in these scores in the patients whose EEG findings showed deterioration after MPH treatment. The quantitative values for SPECT observed before treatment compared with those observed after 3 months of MPH treatment were not found to be significantly different in any areas of the brain. Conclusions: MPH use over 3 months was associated with improvement from baseline in visual-motor function and behavioral disorders in these children and adolescents with ADHD. However, no significant difference in rCBF or electrical activity in the brain was observed in this small study.

Ocena zaburzeń procesów pamięciowych u chorych na obturacyjny bezdech senny

Hypoxia, reduced cerebral perfusion and sleep fragmentation as the result of recurrent apnea-related episodes in sleep apnea patients may have impact on mental performance such as memory and concentration. Increased number of traffic accidents has been observed in OSAS patients. Patients often complain of concentration and memory problems, as well as sleepiness. The diagnosis of perception processes requires neuropsychological diagnosis. 22 sleep apnea patients were involved in the study. Correlation between the number of mistakes in Benton Test and AHI has been observed (r = 0.63; p < 0.005), as well as between AHI and memory in Number Repeating Test based on Wechsler-R (r = 0.49; p < 0.05). No correlations have been found between results of Benton Test and sleepiness scale. Mean saturation and lowest saturation didn't show any correlation with neuropsychological tests. Qualitative analysis of mistakes in both Benton and Bender-Gestalt Tests did not suggest any organic changes in the brain. AHI seems to be more important predictor of memory dysfunction than sleepiness scale score. Specific tests, specially used in neuropsychological diagnosis, could be useful in the diagnosis of memory perception disorders and treatment effectiveness assessment in OSAS patients.