The use of computed tomography scans and the Bender Gestalt Test in the assessment of competency to stand trial and criminal responsibility in the field of mental health and law

computed tomography and the Bender Gestalt Test are some of the tests used routinely for the assessment of alleged offenders referred under Sections 77 and 78 of the Criminal Procedure Act 51 of 1977. An exploratory retrospective study was conducted at the Free State Psychiatric Complex. The aim of this study was to identify the extent to which the Bender Gestalt Test results and the computed tomography scans are associated with outcomes in the assessment of competency to stand trial and criminal responsibility in individuals referred to the Free State Psychiatric Complex (FSPC) observation unit. This was a cross-sectional study and the entire population of patients admitted in 2013 was included in the study. The clinical and demographic data were obtained from patient files. The majority of participants were black, males, single and unemployed. The most common diagnosis was schizophrenia. The current study showed no statistically significant association between the Bender Gestalt Test Hain's scores and the outcome of criminal responsibility and competency to stand trial. Similarly, the study also showed no statistically significant association between the presence of a brain lesion and the outcome of criminal responsibility and competency to stand trial. It was also concluded that as CT scans are expensive, patients should be referred for that service only when there is a clear clinical indication to do so.

Relationships between Visual-Motor and Cognitive Abilities in Intellectual Disabilities

The neurobiological hypothesis supports the relevance of studying visual-perceptual and visual-motor skills in relation to cognitive abilities in intellectual disabilities because the defective intellectual functioning in intellectual disabilities is not restricted to higher cognitive functions but also to more basic functions. The sample was 102 children 6 to 16 years old and with different severities of intellectual disabilities. Children were administered the Wechsler Intelligence Scale for Children, the Bender Visual Motor Gestalt Test, and the Developmental Test of Visual Perception, and data were also analysed according to the presence or absence of organic anomalies, which are etiologically relevant for mental disabilities. Children with intellectual disabilities had deficits in perceptual organisation which correlated with the severity of intellectual disabilities. Higher correlations between the spatial subtests of the Developmental Test of Visual Perception and the Performance subtests of the Wechsler Intelligence Scale for Children suggested that the spatial skills and cognitive performance may have a similar basis in information processing. Need to differentiate protocols for rehabilitation and intervention for recovery of perceptual abilities from general programs of cognitive stimulations is suggested.

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.

Constructing local age norms based on ability for the Bender-Gestalt test

The purpose of this study was to examine developmental patterns in visuomotor functioning across age and ability groups. A second purpose was to develop local norms to allow practicing psychologists to examine relative differences within age and IQ groups in visuomotor performance. Thus, an age-by-mental ability normative data set (N=4,014) was constructed from archival records from 10 public school systems and analyzed to identify both qualitative and quantitative differences in visuomotor functioning for children between 6 and 18.11 yr. of age across 9 IQ levels ranging from 40 to 129.

Performance of children with and without learning disabilities on Canter's Background Interference Procedure and Koppitz's scoring system for the Bender test

Performance of 66 children, 30 with and 36 without learning disabilities, in four ways using the Bender Visual-motor Gestalt Test was compared. First, the test with the standard Koppitz scoring procedure, second with the Canter Background Interference Procedure sheet using the standard Koppitz scoring procedure; third, the Bender test on a standard sheet of paper using Canter scoring procedure; and fourth, the Canter Background Interference Procedure (BIP) sheet using the Canter scoring procedure. The effectiveness of the Canter procedure was examined when scored with an age-appropriate normative scoring system. This was accomplished by combining the Canter BIP interference sheet with the Koppitz scoring system. The children ranged in age from 6 to 10 years. Using discriminant analysis, all four methods correctly categorized statistically significant percentages of both types of students but there was a significant difference on the Canter BIP sheet using the Canter scoring procedure. This procedure classified students with the least absolute number and percentage of either false negatives or false positives when compared with the other three methods, suggesting that using this scoring method with the Bender Gestalt may be better for identifying younger children with learning disabilities.

The Bender-Gestalt test in an Italian sample: an analysis of Koppitz's Developmental Bender Scoring System deviations

This study extended the research of the psychometric characteristics of Koppitz's 1963/1975 Developmental Scoring System of the Bender-Gestalt test. Attention was paid to relations among the 7 deviations. The test was administered by licensed psychologists to 1,065 white children, aged from 3 yr., 6 mo. to 11 yr., 5 mo., enrolled in the regular education track of kindergarten and elementary school in Italy.

Relationship of visual motor development and academic performance of young children in Hong Kong assessed on the Bender-Gestalt test

This study compared the Qualitative Scoring System for the Modified Version of the Bender-Gestalt test and the Developmental Scoring System for the Bender-Gestalt test in predicting performance on the Standardized Attainment Test of young children in Hong Kong. The study was done in two phases. First, 748 middle class children ages 4 to 8 years from 6 kindergartens and 6 primary schools were given the Bender-Gestalt test individually in kindergarten and in groups for older children, respectively. Both scoring systems were used to measure the children's visual motor development. Second, among the participants' protocols, 257 Primary 1 to Primary 3 children ages 6 to 8 years were selected to compare the Qualitative Scoring System for the 6 designs of the Modified Version of the Bender-Gestalt test and the Developmental Scoring System for the 9 designs of the Bender-Gestalt test in predicting performance on the Standardized Attainment Test. Results indicated that the Qualitative Scoring System differentiates better than the Developmental Scoring System in evaluating visual-motor development among young Chinese children from Hong Kong. Results also indicated that the Qualitative Scoring System correlated significantly with achievement in Chinese and English at all three levels. Scores on the Developmental Scoring System correlated significantly with only marks for Primary 1 and Primary 2 Chinese.

The Bender-Gestalt test: Koppitz's Developmental Scoring System administered to two samples of Italian preschool and primary school children

The purpose of this paper was to extend research on Koppitz's Developmental Scoring System to Italian samples. Specific attention has been given to the study of errors for the single designs to assess the relationship of these errors with total errors and to assess the designs' varying difficulty. A second purpose was to study possible cultural influences between different Italian regions. According to Koppitz (1975) research findings support that the rate of development in visuomotor perception differs among children of various ethnic groups. Subjects were 538 boys and 527 girls enrolled in the regular kindergarten and elementary schools in Italy. Detailed analyses were carried out on total mean errors and mean errors for each design. Mean errors decrease across age groups; that is, perceptuomotor integration is improved for older children. No significant differences were found between Northern and Southern Italy.

Visuomotor perception in children with attention deficit hyperactivity disorder--combined type

Children with Attention Deficit Hyperactivity Disorder--Combined Type (ADHD-CT) defined by behavioral characteristics of inattention, impulsivity, and hyperactivity including weaknesses in fine motor coordination and poor motor inhibition frequently exhibit poor handwriting and penmanship. Performance of children on visuomotor tasks is further complicated, as most studies have not excluded children with specific learning disabilities who are known to do poorly on these tests. This study was designed to examine the performance of children diagnosed with this disorder, without learning disabilities on visuomotor tasks. 26 preadolescent patients were administered a battery of tests that included the Bender-Gestalt, Conners' Parent Rating Scale, Continuous Performance Task, and Wide Range Achievement Test-Third Edition Scores on the Bender-Gestalt test averaged significantly lower than Koppitz normative data. This study lends support to the hypothesis that ADHD-CT children without learning disabilities exhibit deficits on tasks requiring visuomotor perception.

Effects of serial position on Bender-Gestalt errors using Koppitz's criteria

The validity of the Koppitz Developmental scoring system in identifying organic impairment among functionally impaired adolescents was challenged in the current study. It was proposed that there are two distinct subtypes of errors in this system: those that are valid indicators of organic impairment (Category A) and those which are not but occur as a function of specific emotional factors (Category B). 46 male adolescents with a primary diagnosis of Conduct Disorder, Oppositional Defiant Disorder, or Attention-Deficit Hyperactivity Disorder were administered the Bender-Gestalt once using the standard order of administration and once in reverse order. It was hypothesized that more errors would be committed on cards presented later than those presented earlier in sequence for Category B but not Category A errors. Analysis provided partial support for this hypothesis.

Concurrent validity of the Koppitz Bender-Gestalt emotional indicators among women with mental retardation

This study evaluated the concurrent validity of Koppitz' revised Bender-Gestalt Emotional Indicators among 44 women with mental retardation. The concurrent validity of the Emotional Indicator total score was not supported when compared with responses on two widely used and accepted screening inventories, the Reiss Screen and the Inventory for Client and Agency Planning.

Comparison of preschool children's scores on the Modified Version of the Bender-Gestalt Test and the Developmental Test of Visual-Motor Integration

A Pearson product-moment correlation of .54 was obtained for 50 preschool children's scores on the Modified Version of the Bender-Gestalt Test and the Developmental Test of Visual-Motor Integration.

The Bender Gestalt test for 5- to 15-year old Brazilian children: norms and validity

Norms for two modalities (normal and stress) of the Bender Gestalt test were developed for the neuropsychological assessment of children in the greater Rio de Janeiro area. For each modality, a measure of performance, a measure of speed and a measure of emotional disturbance were obtained. A total of 398 children (199 males and 199 females), 5 to 15 years old, who were attending a public school in Niterói were the subjects of this study. Analysis of the data revealed that age, but not sex, had a significant effect on performance, but not on speed, in both modalities such that older children made fewer errors than younger children. Also, the number of emotional indicators significantly decreased with age. Additionally, boys needed more time to complete the normal modality than girls, and showed a higher number of emotional indicators in both modalities. The Bender test was found to be valid in the sense that children who had failed at least one grade in school performed worse than those who had not. The number of emotional indicators was shown to be valid since it was significantly correlated with factors such as hyperactivity-conduct problem, and independent functioning, and inattention of the Composite Teacher Rating Scale (Brito GNO and Pinto RCA (1991). Journal of Clinical and Experimental Neuropsychology, 13: 417-418). We conclude that the Bender test is valid for use in schoolchildren, and the number of emotional indicators is valid as an index of psychopathology, but sex and age should be considered when using the norms in Brazil.

Comparison of individual versus group administration of the Modified Version of the Bender-Gestalt Test

No significant difference was found for a comparison of Qualitative scores for individual versus group (slide projection) ( ns = 45 children, Grades K—2) administration of the Modified Version of the Bender-Gestalt Test.

Agreement between two methods of computing the fractal dimensions of complex figures

Agreement between two methods of computing the fractal dimensions of complex figures was examined. 16 complex figures were scanned and the fractal dimensions were computed under two conditions. There was no significant difference between the two methods.

Koppitz scoring system as a measure of Bender-Gestalt performance in behaviorally and emotionally disturbed adolescents

Data are presented to assess the use of the Koppitz scoring system for the Bender-Gestalt Test in a sample (N = 87) of behaviorally and emotionally disturbed adolescents. Results suggested that age was modestly related to Koppitz Developmental scores, an indication that visual-motor skills continue to develop beyond age 11. Scores were related to spatial perception skills as measured on the WISC-R. Gender, primary psychiatric diagnosis, educational tests, and MMPI scores were not related to Bender performance. Findings are discussed in terms of a need for additional research into the utility of the Bender as a measure of visual-motor skills in adolescents.

The sugar scoring system for the Bender-Gestalt test: an objective approach that reflects clinical judgment

Although several objective scoring systems have been developed for use with the abbreviated form of the Bender-Gestalt test of visuomotor development (Figures A, 1, 2, 4, 6, and 8), each has been criticized as being inadequate in some way or other. This paper reviews the inadequacies of these systems as described in the literature and presents the results of a small study designed to investigate the psychometric properties of a new objective scoring system, recently proposed by Sugar, which incorporates both quantitative and qualitative perspectives. The new system is shown to be psychometrically sound in validity and reliability. Additional advantages are described. The new system is recommended as a good, if not better, alternative to other, existing methods for scoring the Bender-Gestalt test.

Some normative data on the Bender Gestalt test performance of Iranian children

The Bender Gestalt test of visuomotor coordination was applied to a sample of Iranian children (N = 1,600) aged between 6.0 years and 10 years and 11 months attending grades 1 through 5 of 16 public primary schools in Shiraz city, southern Iran. The administration of the test and its scoring followed the standard procedures recommended by Koppitz. The reliability of the test in its new context was investigated through readministering it to a group of 60 children after four weeks, the r being .77. The validity of the test was established by comparing scores of children at different age levels and by correlating test results with marks obtained in two sets of examinations, results of Goodenough Harris Draw-A-Person Test and indices of parental education and occupation. The results are mostly in the expected direction and indicate that the Bender Gestalt test may be used as a simple measure of cognitive-intellectual development in Iran. Observed differences between Iranian norms and those of Koppitz (1963, 1975) for American children are briefly discussed and explained.

Bibliography of the psychometric properties of the Bender Visual-Motor Gestalt Test: 1970-1991

To provide a compilation of the literature on the psychometric characteristics of the Bender Visual-motor Gestalt Test since 1970, 192 suitable items found in Psychological Abstracts and Social Science Citation Index are presented in five categories: reliability, validity, factor analysis, scoring systems, and norms.

Bender-Gestalt developmental scores: predicting reading and mathematics achievement

This study examined the relative importance of perceptual-motor processes and intelligence in predicting reading and mathematics achievement of children of low birthweight. Subjects were two groups of 153 children, ages 6 to 12 years, of either low (3 lb. or below, n = 72) or normal birthweight (n = 81) who participated in a comparative study on sequelae of children of low birthweight. To examine the utility of the Bender-Gestalt test in predicting academic achievement, Bender developmental scores, WRAT reading and mathematics scores, and WISC-R Full Scale IQs from both groups were compared and then intercorrelated separately. The mean comparisons indicated that children of low birthweight scored significantly lower on both Bender scores and reading achievement and had lower IQs than those of normal birthweight. Bender scores also appeared to have more utility for predicting reading and mathematics achievement for children of low birthweight than for those of normal birthweight.

Assessment of short-term visual memory in child and adolescent psychiatric inpatients

This study provides normative data on 270 child and adolescent psychiatric inpatients using the Bender Recall technique as a measure of short-term visual memory. In addition, the authors present normative data on another immediate recall technique using the Coding section of the WISC-R. These findings are examined in light of age differences and IQ scores. Detailed instructions for administering the Coding Recall technique are presented.

Redundancy in the Pascal-Suttell Bender-Gestalt scoring system: discriminating organicity with only one design

The eight Bender-Gestalt (B-G) designs scored by the Pascal-Suttell (P-S) system proved to be highly intercorrelated, while the ninth component, the Configuration score, was modestly related to only design one. A factor analysis of the eight designs revealed one significant factor, which was interpreted as reflecting general reproductive accuracy rather than special gestalt properties of the drawings. While the P-S Total score could discriminate between organic (n = 52) and nonorganic (n = 52) clinical outpatient groups with a 74% hit rate, only one design (seven) yielded a 73% discrimination. It was suggested that a quick and reliable method for screening for organicity with the B-G would be to calculate the P-S score for design seven only.

Relationship between two scoring systems for the modified version of the Bender-Gestalt test

Correlations of – .80, – .78, and – .67 for 72, 94, and 92 pupils in Grades K, 1, and 2 support the validity of the Qualitative Scoring System (vs Koppitz's system) for the modified Bender-Gestalt test.

A comparison of the Lacks and Pascal-Suttell Bender-Gestalt scoring methods for diagnosing brain damage in an outpatient sample

The Pascal-Suttell method of scoring the Bender-Gestalt Test, which is molecular and seemingly homogeneous, and the Lacks method, which is molar and apparently heterogeneous, were compared for efficacy in diagnosing brain-damaged (n = 52) vs. non-brain-damaged (n = 52) outpatients. Both methods were superior to the FS WAIS IQ in making this distinction, and adding the WAIS in a discriminant analysis did not contribute much in terms of overall differentiation. The two scoring systems were correlated highly, and, although the predictive power of the Pascal-Suttell procedure was a little better than that of the Lacks, the latter has some practical advantages in terms of applicability and ease of scoring.