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THE TEST OF BENDER-Koppitz

1. INTRODUCTION
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The Bender Gestalt Test (L. Bender, 1938) is to copy 9 cards (size 10 x 15) with
abstract designs. It was initially a clinical test for adults, based on figures
Wertheimer used to demonstrate the principles of Gestalt psychology of percepti
on. Subsequently, systems were created and score goals was used by different pro
fessionals working with children, as Münsterberg Elizabeth Koppitz. Koppitz's fi
rst book on the Test of Bender (The Viso-motor Gestalt test for children, Guadal
upe, Buenos Aires, 1974) was written in the early '60s, when there was great int
erest in perceptual processes and their relationship with learning problems, and
established special classes for children in difficulty, depending on the diagno
sis. Thus, his objective was to establish "different ways of analyzing Bender pr
otocols produced by children to evaluate the perceptual maturity, possible neuro
logical impairment, and emotional adjustment based on a single protocol." He rec
eived wide circulation and used in many subsequent investigations, which led to
revise some of the assumptions made. The second book (Koppitz EM, The Bender Tes
t, oikos-tau, Barcelona, 1981) presents the updates from 1963 to 1973. This is a
synthesis resumen1 adapted mainly from the second book. We selected the points
necessary for the application, correction and interpretation Fig. 1, the nine fi
gures of the Bender Gestalt Test of Lauretta Bender, adapted from Wertheimer. up
dated by removing statistical and technical changes little use (application to g
roups, evocation, etc..) We include a sheet that makes the correction. For a mor
e complete and, above all, see the studies performed by children, examples of pu
nctuation and consult the Revised Manual Assessment, refers to reading the book.
2. GENERAL DESCRIPTION
2.1. Scope. The Bender-Koppitz test reflects the level of maturity of the child
in the visual-motor perception and may reveal possible shortcomings in it. It ca
n be used as a test of personality (emotional factors and attitudes) as well as
test surveys to identify children with learning problems. But it was not specifi
cally designed to predict
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INTERNAL WORKING DOCUMENT. E.O.E.P. Coslada. J.M ª. RUIZ WELL. January 2004.
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results in reading or to diagnose neurological impairment, in these respects its
validity is relative. The Bender-Koppitz test is relatively simple, fast, relia
ble and easy to apply even with different cultural groups, regardless of previou
s level of schooling or language. It is suitable for students of Primary Educati
on. It has been standardized for ages 5 years 0 months to 10 years 11 months. It
is valid for children 5 years with normal or above capacity, but does not discr
iminate on children this age are very immature or dysfunctional. After 10 years,
once the visual-motor function of a child has matured, it can not discriminate.
Only children with a marked immaturity or dysfunction in visual-motor perceptio
n scores then presented significant. (It can be applied in patients up to 16 yea
rs whose mental age is about 10 years.) 2.2. Theory. It is a test of visual-moto
r integration, more complex process of visual perception or motor coordination s
eparately (Determined as L. Bender, by biological principles vary depending on t
he level of development, maturation and pathological state. Organic or functiona
l for each individual). Visual perception (interpretation of what you see) depen
ds on the maturation as the experiences of the child. We can not say that a chil
d is able to correctly perceive the figure "A", until you can determine, conscio
usly or unconsciously, that consists of a circle and a square tipped, not a diam
ond, and both are about the same size, arranged horizontally and touching. But t
he child can perceive does not necessarily mean that you can copy it. You have t
o translate what he sees in a motor activity, transfer it to paper. Consequently
, difficulties in copying the figures may be due to immaturity or malfunction of
visual perception, motor coordination or integration of both. Most children wit
h poor results in the Test of Bender have no difficulty either in visual percept
ion or motor coordination, but in the perceptual-motor integration, ie, still ha
ve difficulties in a function that requires a higher level integration. Maturity
usually get a child from 8 or 9 years.€Before that age, even children
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Schematic representation of the process of visual-motor perception involved in t
he copy of Bender.
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normal tend to have difficulty copying the Bender Test without any imperfection.
3. RULES OF APPLICATION
They give the child two sheets of letter size paper (similar to A-4 size), numbe
r two and a pencil eraser. After establishing a good "rapport" Bender cards show
saying, "Here I have nine cards with drawings for copies. Here is the first. Ma
ke one just like it." After the child has settled the position of the paper, pla
ce the first card, the picture A, facing the child. When the child has finished
drawing a picture, remove the card and put the next one. We proceed in the same
way until the end. Do not make comments, are noted observations on the child's b
ehavior during the test. Although the test has no time limit, you must register
the time spent, because if it is short or long has diagnostic value. One should
not encourage or discourage the use of the eraser or make several attempts. You
may use any paper you want (to the additional role without comment). If a child
asks about the number of points or the size of the drawings, etc., you should gi
ve a neutral response type: "Make it more like the picture of the card you can."
If you start to count the points of the figures, the examiner can say, "No need
to count points, just try to make it as similar. If the child still persists in
counting, then acquires diagnostic significance (or obsessive perfectionist tra
it). If the child has filled most of the paper and the tour to locate the fig. e
ight in the remaining space is not considered rotation of the drawing. Assuming
that the child has been very fast or not at all possible good, you may be asked
to repeat a figure of Bender on another sheet, scoring in the protocol. The diff
erent orientation between the set of test cards and drawing paper, increases the
rotations. The Standard method (Koppitz, 1974) for the implementation of the Be
nder Test, appears to reduce the number rotations: • Place the paper in front of
the child upright. Allow the child to adjust the tilt of the paper at their con
venience, provided that the axis of the paper is closer to vertical than horizon
tal. • Then align the card horizontally with the upper edge of the paper. Let th
e child manipulate the card if you wish, but insist to be put back in the starti
ng position. Do not allow children to copy a figure from a rotated card. If chil
dren insist on turning the paper while copying a figure, let them do it. But onc
e the figure has been drawn , put the paper back to its initial position. Note i
f a figure was drawn rotated, or if the paper was turned on and the figure was d
rawn correctly. Some children have difficulty copying the abstract figures of th
e Bender until he put a label verbal (say that 3 is "a Christmas tree lying.") r
espond to the content received and, obviously, there is nothing wrong with the c
hild's visual perception.
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It should say: "Yes, it seemed, but really is just a drawing. I would like you t
o do the figure as it appears on the card. " When the child then turns to draw t
he figure, it usually does without any rotation. For such children, the rotation
s in Figures 3, 4 and 5 are due more to problems in the conceptualization of vis
ual impressions that difficulties in visual perception as such. They need to int
erpret them in a concrete form that matches your own experience. The perception
of form, in general, seems to rely on cognitive processes in a proportion higher
than maintaining the usual theories.
4. CORRECTION AND INTERPRETATION OF RULES
It is interpreted objectively and intuitively. In addition to the score on the t
est, much information can be obtained by observing the child during the copying
of figures. Along with the Koppitz system, the method of scoring is the most cit
ed Bender Keogh and Smith (1961), developed for children Kindergarten and First
Grade. Correlates with the maturation of Koppitz Scale and both methods are equa
lly effective. The scoring system rather complex and Suttell Pascal (1951) is mo
st often used for adults. Other researchers developed their own scoring systems.
4.1. Observations on the behavior for its little resemblance to school work, th
e test produces much less anxiety than school-related tasks,€and provides inform
ation on the child's spontaneous behavior when faced with a new task. Difference
s in attitudes among the well-adjusted children and have problems with behavior
and learning are often significant: Child well-adjusted. He sits down with ease
and confidence in yourself, pay attention, analyze the problem in front of him a
nd proceeds to copy the drawings. Show good pencil control and work carefully. E
ven young children are to be aware of the imperfections of his drawings and try
to fix their own. Rarely ask that reassures them and are satisfied with themselv
es and their executions. Those who have behavioral difficulties and / or learnin
g. Some hesitate, trying to delay the task to avoid failures, sharpen your penci
l, draw something else, tell the examiner a story ... Finally, do quickly withou
t looking at the pictures and analyze the figures before you start copying. Othe
rs work very slowly, constantly counted and recounted the number of dots and cir
cles, expressed strong dissatisfaction with their work. The insecure need to con
stantly encourage them and give confidence. They ask: "Am I doing well?". Simila
r types of behavior can occur in the classroom and greatly influence the progres
s of students and their success, so it is important to note them.
• •
Children with poor internal control and / or immature visual-motor coordination:
Although the test is short, can be most frustrating for them. As the test conti
nues, half weary, designs are increasingly neglected and large. Children perfect
ionists can not fill their own level of demand, when in reality they are doing q
uite well.
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•
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Children with short attention span who literally can not concentrate for more th
an a few minutes each time, running careless mistakes, omitted details, with abb
reviations, as happens in the work. Too often concludes with "problems of percep
tion" and is prescribed rehabilitation of that area, when you really need help t
o slow down, to develop better internal control and to improve their work habits
. The time a child takes to complete the test is highly significant. Most need a
bout 6 minutes 20 seconds, while children with learning and behavior tend to wor
k faster. (5 min. 19 sec. On average), Hyperactive children, only 4 minutes 41 s
econds. Children with skill and good understanding which strive to make real pro
blems of visual-motor perception: Some prefer to work from memory (give out the
card and leave it aside, to avoid confusion with visual stimuli). Sometimes they
give their own verbal instructions as if they had heard themselves, sub-verbal
or verbally. Other children use kinesthetic sensations to help integrate their v
isual perceptions and expressions graph-motor (eg, draw the figure with your fin
ger or in the air before copying). The "anchor" is to place a finger on the part
of the figure that is being copied, while drawing the same part with the other
hand, gets lost and not (A child less intelligent or telling and retelling small
dots or circles after each point or circle drawing isolated forget the number,
account and repeat the process again and again. They are predisposed to be lost
in reading or forget a step when calculating an arithmetic problem). Some, but i
ntelligent impulsive children learn to control their impulsivity through compuls
ion (obsessive), which differs from the above perfectionism. So, can align the f
igures, including many at times. They work extremely slowly and carefully, using
a considerable amount of effort. Turn the paper and the card is another form of
help, very intelligent children with problems in visual-motor perception of chi
ldren's observation during the work to determine the directionality of plotting.
4.2. Direct ratings Maturation Scale Test of Bender-Koppitz Test Each drawing is
scored in distortion, rotation, integration, and perseveration. In total there
are 30 scoring items. Deviations are computed only good net. If in doubt, do not
compute. The total score recorded errors in the copy of the cards. A high score
indicates a poor achievement test, while a low score reflects a good performanc
e.€Rarely get a score above 18 or 20 and all I can say in this case is that the
visual-motor perception of children is still at a level less than 4 years. 4.3.
Changes in the Bender test score. The total score is interpreted in terms of men
tal age and chronological age, standard deviation and percentiles. Direct score
score does not become typical, as only for children 5 to 7 or 8 years will see a
normal distribution. By age 9 most children with mental ability tend to have ha
lf an appropriate visual-motor integration and then only discriminates between c
hildren with visual-motor perception average or below average, but no difference
between middle and upper . The ceiling effect prevents discrimination between b
oys and mature.
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4.4. Analysis of punctuation problems
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To improve the scoring criteria, there has been a review of the valuation manual
. The Revised Assessment Manual for the Scoring System Scale Test of Bender matu
ration is presented in Appendix A. The main sources of errors in punctuation is
the examiner and the manual scoring (questions about the rotations):
•
Examiners perfectionist who expect too much of the Bender Test, tend to penalize
the children for minor irregularities. They think they can diagnose brain injur
y, to predict reading performance and identify emotional problems ... Bender tre
at it like a precision instrument, when it's really only one answer of a child a
t a given time. A child rarely produce two identical test protocols Bender. It i
s only a guideline on which the examiner can build their hypotheses. The executi
on of a child in the Bender test primarily reflects the level of maturation in v
isual-motor perception, disposition and attitude, ability to concentrate at the
moment, and extraneous factors. The opposite of a perfectionist is the inexperie
nced examiner fails to observe the child while working and do not bother to take
notes when a small tour of the paper or superimposed figures. Rotation of the f
igures. Koppitz recommended vertical orientation of the drawing paper, more like
a sheet of notebook paper. Others prefer the horizontal orientation, which more
closely resembles the shape of the stimulus card. The tendency to rotation decr
eases as children get older. But the figures A, 3 and 4 retain a "tendency to tu
rn" more. Young children or with a poor visual perception, perceive the figures
of how distorted or rotated and tend to draw with rotations. When asked, they ar
e usually quite unaware of their mistakes. If you are asked to redraw the figure
s, tend to repeat the same distortions and rotations.
•
5. STATISTICAL JUSTIFICATION: VALIDITY AND RELIABILITY
Prior to establishing the reliability must be demonstrated that it is actually a
test of the development of visual-motor perception (experimental research desig
n and statistical analysis). 5.1. Validity. Most children get better at it again
. Those who make an initial poor workmanship can do a little less evil in the re
petition, but even then their performances on the test remained below average. I
ncreased motivation, copy or describe the figures in the Test, and perceptual-mo
tor training, have little effect on improvement in test performance in general,
but some individual children may get a small profit. Conclusion: The implementat
ion in the test mainly reflects Bender maduraclón level in perceptual-motor inte
gration and to a lesser extent, the experience learned perceptivomotrices tasks.
They will expect little change from one application to the next test if there i
s a short time and rarely alter the original findings. 5.2. Reliability between
examiners in scores on the scale of maturity
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There is a high probability that two examiners to evaluate the protocol of the B
ender Test of a child, get about the same test score. 5.3. Test-retest reliabili
ty as Bender said, the test results are never the same, regardless of the number
of times a child will perform. Nine studies indicated that the total Scale Matu
ration of normal children was reasonably stable. It provides valid and reliable
information at the time of application, and is also very useful for monitoring c
ases: - a performance given in Bender Test reflects the current state of maturit
y in visual-motor perception of a child and their attitudes and emotional state.
€As the child evolves, its implementation in the Test will change and evolve as
well. - Children with educational delays or dysfunction tend to mature at a slow
er pace and often irregular. Consequently, the pace of improvement in test score
s Bender of a child is highly significant from a diagnostic point of view. Incon
sistent progress reflects an unstable operation.
6. NORMATIVE DATA FOR THE SCALE OF MATURATION
View Sample 1974 legislation (Appendix B and Appendix C). The percentiles (Appen
dix E). Influence of age. At age 9 scores reach a plateau (ceiling) and Bender T
est scores do not discriminate between normal and above. At 10 years longer test
normal child development and has significance only if the integration of childr
en perceptivomotriz works below the level of 9. The width (standard deviation) o
f the mean scores decreased with increasing age of the children. For ages 5 year
s for children ranging from 10.6 to 15.6 average for children being deprived env
ironment. At 8 and 9 years, the differences include only a 2.5 points. At age 10
appears to be no difference between average and gifted students, and there are
1.5-point difference between the highest score and lowest average scores. Sex di
fferences in the Bender test. No statistically significant differences between t
he scores of boys and girls. It seems that girls mature a little earlier than ch
ildren in the visual-motor perception, but this difference was not significant.
Children of high ability. It is expected to make a realization above the level o
f the normative data. Level of schooling. As with age, school level reveals an a
mplitude (standard deviation) of mean scores significantly in the Bender test, a
s the ages of the children and their cultural and socioeconomic environment. - S
cores for students who begin first, in a high socioeconomic level, are between 5
and 9, the middle-class children between 8 and 10, the deficiency areas, betwee
n 10 and 13. In addition, there is a difference between the Bender test is admin
istered at the beginning or end of the year. At the end of First, gifted childre
n obtained average scores of 4'4, the middle class had average 5-7; the atmosphe
re deficiency, 8'4. - Secondly, the amplitude decreases to stabilize at a point
or two for most groups of children.
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7. SOCIO-CULTURAL FACTORS IN THE TEST OF BENDER
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7.1. Children deficiency ambient atmosphere in front of children not being depri
ved many children of disadvantaged areas or with limited capacity or specific le
arning problems, hopefully with a performance by below average. For those who wo
rk in a particular ethnic or socio-economic area, it is useful to establish spec
ific scales for this particular population. A child with an average score for th
eir age and social group can not be considered as having serious problems in vis
ual-motor area, although implementation of the Bender test is more immature than
the general rule for their age level. 7.2. Ethnicity and maturation Development
of visual-motor perception varies among children of different ethnic groups (Hi
spanics, whites, Indians and blacks ...) both gifted and retarded. But by 10 or
11 years the differences had disappeared in all cases. The speed of development
of visual-motor perception may be at least partly determined by the child-rearin
g habits of a people and the importance given to certain skills. Tiedeman (1971)
collected Bender protocols in the United States and 13 countries in Africa, Asi
a and Europe. The process of maturation of visual-motor perception seems to be m
ore rapid among Oriental children. By the nine years the differences are no long
er significant. Tiedeman's study raises interesting questions: - We know that sp
ecific training of visual-motor perception of children of school age have a limi
ted impact. - It might be supposed that the Japanese and Chinese are innately en
dowed with visual-motor in the area (both in China and Japan the visual arts hav
e been developed and have flourished since prehistoric times.) Not so, significa
nt differences between Japanese children in Japan and Japanese-American children
(same genes) and found no difference between children raised in environments Ja
panese Americans or Europeans. In addition, children japonesesnorteamericanos ad
apted to American life were like the Americans more than Japanese children. By c
ontrast, Chinese-American children educated according to Chinese tradition,€San
Francisco, differed from other American children, and showed the same rapid pace
of development in the Bender test than other groups of Chinese children in Taip
ei and other areas ... - Tiedeman concluded that the education children receive
in Japan from small, in the areas of visual awareness, appreciation of beauty an
d motor control, contributes to the development of perceptual-motor integration
at an earlier age. Would it be possible, for example, increase the pace of devel
opment of visual-motor perception in children being deprived environment by chan
ging patterns in early childhood education? The study by Kagan and Klein (1973)
with Guatemalan children seems to support this hypothesis. (Note: These findings
are consistent with Vygotsky's theories on social influence in the development
of higher mental functions).
8. BENDER TEST AND OTHER TESTS
8.1. There is correlation between Bender scores and IQ scores the WISC. - Childr
en with good performances on the Bender test tend to have an IQ score in the ave
rage or above average and vice versa (though not always). Bender does not discri
minate between mental capacity medium, high or higher.
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- Children with IQ scores below the average scores also tend to have poor or imm
ature in the Bender test. - Children with scores on the Bender immature IQ score
s may have high or low, depending on other factors involved. - The correlation w
ith the WISC IQ is significantly higher than Verbal IQ. - Students with learning
difficulties but a good score on the Bender test, had low scores on the Verbal
IQ. 8.2. Quality of designs C.I. The way the figures are copied from the Test of
Bender also has a significant relationship with the mental capacity of children
. Bravo (1972) examined 200 students in fifth grade, superior intelligence, from
different social and cultural rights: • • • • Figures were well organized and c
arefully distributed on the page. Used less than one full page for their drawing
s. They were aware of the imperfections and trying to correct them. 84% fully or
partially erased one or more of the figures. Furthermore, 25% sought to correct
by reviewing some of the figures. They showed no traces of pencil lines too thi
ck or thin irregularly.
Therefore, good organization and site designs, spontaneous deletions and careful
correction of the imperfections, and the figures carefully small, are associate
d with an elevated IQ score. 8.3. Bender Test and mental retardation - The corre
lation is higher with the mental age of retarded children than chronological age
. Scores improve gradually as children get older, but with a much slower pace. M
ost are not yet able, at age 14, of copying the nine figures of the Bender Test,
without imperfections. - Scores on the Bender Test reflect their slow mental de
velopment, while the quality of the drawings reflects his personality labile and
unstable. Emotional Indicator Only "Expansion" is more common in retarded child
ren with emotional problems than other children with emotional problems (8 of 9
children who were held behind, also very impulsive and acting-out behavior). 8.4
. Relationship between Visual Perception test and visual-motor integration is wi
dely recognized that some measure of visual perception or visual-motor integrati
on is needed to assess the mental development and learning ability of children.
Most tests C.I. include items or subscales of this type, as well as aptitude tes
ts most common reader. There are several specific tests to evaluate these aspect
s: Frostig (1961), Progressive Matrices (Raven, 1956), etc. Research shows signi
ficant correlations between the Bender test and those tests, the differences bet
ween them are smaller than generally assumed. • The Progressive Matrices Test (R
aven) is a test of visual perception and nonverbal reasoning. Bender differs fro
m that requires no motor activity. The correlations between the two, for childre
n 5-9 years ranged from 0.58 to 0.69. • Correlation with the Frostig test is 0.4
, but with significant inconsistencies in the subtest of the Frostig (seems to c
orrelate more with the subtest
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9. THE TEST OF SCHOOL PERFORMANCE AND BENDER
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Spatial Relations). Bender was able to discriminate between children with and wi
thout reading problems, while the Frostig no.
The success or failure in school is influenced by many factors.€In previous stud
ies appear to have overestimated the significance of visual-motor perception. Es
pecially influence the development of language, oral-visual integration, the abi
lity of serialization, the evocation of symbols and information and training con
cepts. Age, attitude, sex and social and family environment of children also aff
ect their performance in various proportions. The progress of a child in school
depends on the combination and interaction of all these factors. 9.1. Rating mat
urity and school performance total score is more related to general school achie
vement than any single item. Emotional Indicators are not good predictors of sch
ool achievement. The erasures and careful review are most often good students. A
good record of Bender at the time of entering primary is usually a good predict
or of later school success, a good cross-modal integration and good mental abili
ty, but a poor record at the beginning of first does not necessarily mean that a
child will fail . Some normal children simply need more time to mature. To pred
ict school performance, it is best to apply early in the First Degree, as it see
ms to be especially effective for children between 5 ½ and 6 ½ years. Children w
ith difficulties in school often have poor test scores on the Bender. This inclu
des children with limited mental capacity and children with normal intelligence
but with specific learning problems. Some children are affected by a malfunction
real visual-motor perception. However, if you are smart, if you have good langu
age skills and evocative, if they have a good motivation, if they have behavior
problems and if they have some parents and teachers who help them, they can over
come or compensate for perceptual-motor problems and over time become good stude
nts. 9.2. Sex differences and academic achievement Bender Test Predicts The most
successful educational outcomes for children than girls. This is not due to dif
ferences in visual-motor function, but to other factors affecting school progres
s. Immature Children with scores in the Test of Bender are usually poor readers,
whereas girls may have reading scores high or low. Girls tend to be more contro
lled, more advanced in language development, are also more able to compensate fo
r their problems in visual-motor area. Therefore, many girls develop a successfu
l work despite their protocols immature at the time of entering school. Children
are more impulsive and restless. Many activities help girls yet. The inappropri
ate behavior of children influences the teacher's attitude towards them. Therefo
re, a child with an immature implementation of the Test of Bender poor school re
sults will more likely than a girl with a bad score on the Bender Test, even tho
ugh their scores on the Bender Test and CI are the same. 9.3. Reading and arithm
etic
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There is no relationship between the Bender and reading. Reading problems are mo
re related to the socio-economic, mental ability and language ability than with
visual-motor perception. Although both the Bender Test as reading require childr
en to have a minimum level of maturity of visual-motor perception. A child whose
 level of visual-motor integration is still well below that of a 5 ½ years have
difficulties both in the Test of Bender and reading, regardless of whether it sh
ows a developmental delay, or minimal brain dysfunction. The Bender test correla
tes better with the achievement in arithmetic, since both involve visual-motor p
erception and the relations of part-to-all and space. 9.4. Test of Bender and le
arning disability data show convincingly that visual-motor integration of childr
en with LD is evolving at a slower pace than normal. The rate of evolution depen
ds on the age and mental capacity of children: - The majority of children were a
t 5 ½ years a score of 10 in the Bender Test, this is the level at which they ar
e prepared to begin the schoolwork. - Students with LD with IQ scores of 100 or
more did not reach the level to 6 years. - Those who had an IQ of 85-99 were not
getting an average of 10 until they reached age 7. - Small with learning diffic
ulties uncertain mental capacity (IQ 70-84) already had eight years when his ave
rage score was 10. - Finally, the moderately retarded children (IQ 50-69) did no
t reach the score of 10 on the Test of Bender to 9 ½ to 10 years.€The normal stu
dents usually show a sharp rise in learning for third, when they are 8 years and
their scores on the Test of Bender are 3 or 4. Students with LD, show no real p
rogress until they are about 9 years. Children with difficulties and with an IQ
score below average, show no significant improvement in performance Bender and u
ntil they are 10 ½ years or even 11 years, while children uncertain at 12, 13 or
even 14. Most students fail behind scores of 3 or 4 on the Bender test even at
age 14. It recommends individualized instruction in the classroom, but many teac
hers and administrators still expect all children to reach the same performance.
The repeated application of the Bender Test will provide a record of the rate o
f maturation of a given child and may be helpful to establish realistic performa
nce expectations of this child. It is absurd to expect a child to give up a four
th level when the evolution of perceptual-motor integration is still at the firs
t level. Repeated applications are good indicators of the pace of progress being
made by a child, and are useful for planning an individualized education progra
m. A child with a marked discrepancy between IQ and scores on the Bender test us
ually has specific learning difficulties.
10. THE TEST OF BENDER and minimal brain dysfunction
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"This chapter reflects my current view. Instead of treating Bender as a test for
the diagnosis of brain injury as I did in my first book, this time we will anal
yze the relationship between the Bender Test and Minimal Brain Dysfunction. " (K
oppitz, 1974)
-
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The term DCM, in the broadest sense, implies that the behavior and learning diff
iculties of a child are, at least in part, an organic base. I base a diagnosis o
f DCM in a combination of several factors: the child's development, and social h
istory, school performance, behavioral observations, and of course the results o
f psychological tests including the Bender. A diagnosis of brain injury implies
the presence of brain damage is not the case of DCM. The DCM can be caused by a
prenatal or birth trauma, accidents or diseases, genetic factors, early and seve
re deficiency or lack of emotional or physical care, or other known and unknown
causes. Brain injury is a medical diagnosis. The DCM can be diagnosed by a docto
r or a qualified psychologist.
Total score against indicators of brain injury.
-
-
A poor Bender indicates the possibility of DCM, particularly if more than one st
andard deviation of age. There should be a diagnosis of DCM based solely on a ps
ychological test. You can not rule out the existence of DCM for good performance
. The total score is able to differentiate between groups of children with and w
ithout DCM, and little is gained by using both the indicators and Neurological S
cale score in the maturation of the Bender Test.
DCM rotations and rotations are an evolutionary phenomenon and not necessarily c
onnected with DCM. Diagnosis of the degree of organic impairment of children's a
chievements with a medical diagnosis of neurological damage are much lower and c
an be recognized regardless of how they are analyzed or interpreted the records
of the Bender Test. IC and DCM A marked discrepancy between mental age of a chil
d resulting from their IQ score, and perceptual-motor age derived from the score
on the Bender Test, is usually one of several indicators that the child may hav
e one DCM. Medical problems and DCM
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Studies of children with low birth weight (<2,500 g) from birth to 10 years. Sho
wed marked differences in: Bender test performance, understanding and abstract r
easoning, attention, motor development, language and IQ scores. Small with low b
irth weights had a higher degree of disability in the 6 and 7. Low birth weight
is also associated with neurological damage. Abnormal EEG. The subjects for this
study were normal intelligence children 5-10 years who had performed below aver
age protocols in the Bender test. It
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found that 75% had abnormal EEG, therefore, the Bender correlated significantly
with abnormal EEG, but not for all children. Encephalitis. In the aftermath of e
ncephalitis were found serious problems in visual-motor perception.
DCM behavior and observation of children while conducting the test is absolutely
necessary and has diagnostic value,€but there is no relationship between any co
nduct on the Bender and DCM. There is a child type of DCM. As a group, are most
vulnerable. They tend to mature more slowly not only in visual-motor perception,
but also in their behavior and attitudes. But the specific reaction of children
with DCM compared with stress depends on many factors: degree of DCM, mental ca
pacity and, above all, interpersonal relationships, the child has experienced. T
he underlying emotional attitudes are reflected in the emotional indicators Bend
er protocol.
11. THE TEST OF BENDER AND EMOTIONAL PROBLEMS
Koppitz, 1963, held ten signs that can differentiate between children with and w
ithout emotional problems. Then added two more, which appear rarely, but often h
ave considerable clinical implications. Emotional Indicators (EI) are mainly rel
ated to age and maturity. Children with poor perceptual-motor integration are of
ten vulnerable to develop secondary emotional difficulties. But not all necessar
ily have emotional problems, and not all children with Emotional Indicators show
ed Bender in unavoidably dysfunction or immaturity in visual-motor area. I. Conf
used Order. The figures of the Bender Test, without any logical sequence or orde
r, are common in children aged 5-7 years, associated with a failure in planning
capacity. In children older smarter and Confused Order may also reflect confusio
n. Confusing order occurs more often in children with learning difficulties and
test protocols of the children acting out. II. Wavy line on Figures 1 and 2. Two
or more abrupt changes in the direction of the dotted line or circles. Appears
to be associated with poor motor coordination and / or emotional instability. It
was found that psychiatric patients and significantly discriminated between stu
dents with and without emotional problems. III. Circles stripes replaced by Figu
re 2. It was associated with impulsivity and lack of interest and emotional prob
lems. IV. Progressive increase in size in ali Fig. 1, 2 or 3. The dots or circle
s progressively increase in size until the last at least three times larger than
the former. It is also associated with low tolerance to frustration and explosi
on and acting-out and emotional problems. V. Great size. The area covered by a f
igure is twice the area of the figure of the stimulus card. It is associated wit
h acting-out behavior. Difference between psychiatric patients and children with
out emotional problems
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VI. Small size. It is half or less than the card. It tends to be related to anxi
ety, withdrawn behavior, constraint and shyness in children. VII. Thin line. It
is associated with shyness, embarrassment and withdrawal. Psychiatric patients w
ith emotional problems. VIII. Rest neglected or heavily reinforced lines. A full
figure or part of it is reviewed by thick lines compulsive. When a figure is er
ased and redrawn carefully or if a figure is corrected with deliberate lines tha
t actually enhance the picture, then this category is not counted. It is associa
ted with impulsivity, aggression and hostility, acting-out behavior in children.
IX. Second attempt. The drawing is spontaneously dropped out before or after be
ing completed and made a new drawing of the figure. It is scored only when they
have made two drawings of a figure in two different places of the paper. This IE
has been associated with impulsiveness and anxiety. Impulsive and aggressive ch
ildren with emotional problems. X. Expansion. Use two or more sheets of paper. I
t is associated with impulsivity and acting-out behavior. Among school-age child
ren occurs almost exclusively in the protocols of children with mental retardati
on and emotionally disturbed. XI. Frames around the figures. Draw a frame around
one or more of the figures after being copied. Is associated with an attempt to
control their impulsivity. Own children who often have a poor self-control, nee
d and want boundaries and external controls to be able to function at school and
at home. XII. Preparation spontaneous or added to the figure. In one or more fi
gures of the Bender Test of spontaneous changes are made. This kind of pictures
are rare and occur almost exclusively in children overwhelmed by fear or anxiety
or totally preoccupied with their own thoughts. These children often have a wea
k contact with reality. Number of IE in the protocols of the Bender Test Emotion
al Indicators should be evaluated individually. They may appear singly or in com
bination.€Allow to formulate hypotheses that need to be checked with other obser
vations and psychological data. There was no significant relationship between sc
hool performance and IE. A single IE on a protocol of a child reflects an attitu
de or tendency given, but by itself does not indicate any serious emotional prob
lem. It takes three or more IE before we can say with some confidence that a chi
ld has serious emotional problems. This does not mean that a child with six IE i
s twice more upset that a child who has only three IE. The clinic patients had s
ignificantly more IE in Test Protocols. There are significant differences in the
 number of IE institutionalized children acting out and a group of normal subjec
ts matched for age, sex and IQ score.
PRACTICAL CONCLUSIONS
The Bender-Koppitz Test is an effective diagnostic if included as part of a batt
ery of tests and in combination with other information.
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It provides information on the level of maturity of the child in the visual-moto
r perception and can be used as a test of personality and for children with lear
ning problems. The difficulties in copying the figures may be due to immaturity
or malfunction of visual perception, motor coordination and, most of the time, t
he integration of both (this is the function that requires higher level of integ
ration). Strategies to differentiate whether the failures are due more to percep
tion or execution: - Young children or with a poor visual perception, perceive d
istorted figures and tend to draw with errors. When asked, they are unaware of t
heir mistakes. If you are asked to redraw the figures, tend to repeat the same d
istortions and rotations. - Indicators of visual perceptual performance: contras
t with results of tests that do not involve motor skills (Raven's Progressive Ma
trices) and, by contrast, tests that measure abstraction but does not depend on
perceptual factors (verbal reasoning, Similarities)
•
There is consistent evidence on that the pace of socio-cultural factors influenc
ing maturation: Average scores differ according to ethnicity and social class, i
n addition to age and intelligence of children and their functional and emotiona
l status. But the nine years the differences are minimal in normal children.
Bender test, school performance and learning difficulties. • Children with diffi
culties in school often display poor scores on the Bender (this includes childre
n with limited IQ, and children with normal IQ but specific disorders) A good re
cord of Bender on First usually predict later academic success (to be related to
arithmetic and writing). A bad record can be just immaturity. It is not related
to reading, since it includes linguistic factors of mental ability and social b
ackground. Although both the Bender Test as reading require children to have a m
inimum level of maturity of visual-motor perception. A child whose level is stil
l below the 5 ½ years, will have difficulty in reading. Students with mental ret
ardation (Mental Age correlates Bender): mature very slowly and most are not abl
e to copy the cards without errors even at age 14. Indicator of possible specifi
c learning disorders: students who show a marked difference between a good score
on the Bender and low IQ scores (especially verbal IQ). Learning disabilities:
visual-motor integration of children with LD is evolving at a slower pace than n
ormal. The rate of evolution depends on the age and mental capacity of children:
10 score on the Bender test is the level that indicates that a child is ready t
o start school work (usually after 5 ½ years) . Students with LD: - with IQ of 1
00 or more: not reached the level to 6 years. (~ 1 EP)
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- With IQ of 85-99 were not getting an average of 10 to 7 years. (~ 2 º EP) - wi
th IC were 70-84 and 8 years old when his average score was 10. (~ 3 º EP) - wit
h IC 50-69, did not reach the score of 10 to 9 ½ to 10 years. (~ 4 th or 5 th) •
normal students usually show a sharp rise in learning for third, when they are
8 years and their scores on the Test of Bender are 3 or 4. - Students with LD, s
how no real progress until they are about 9 years. - Children with LD and IQ bel
ow average, show no significant improvement in performance Bender and until they
are 10 ½ years or even 11 years - Children limit, at 12, 13 or even 14 years.€-
Most retarded pupils fail scores of 3 or 4 on the Bender test even at age 14.
The pace of improvement in the Bender is related to the rate of progress in perf
ormance escolar.La repeated application of the Bender Test will provide a record
of the rate of maturation of a given child and may be helpful to establish real
istic performance expectations of this child. The Bender Test and Brain Dysfunct
ion can reveal brain dysfunction in children, but does not determine whether a c
hild has immaturity or dysfunction in visual-motor perception as a result of dev
elopmental delay or neurological impairment. A poor Bender indicates the possibi
lity of DCM, particularly if more than one standard deviation of age. The achiev
ements of children with medical diagnosis of neurological damage are much lower
and can be recognized regardless of how they are analyzed or interpreted the rec
ords of the Bender Test. A marked discrepancy between mental age of a child resu
lting from their IQ score, and perceptual-motor age derived from the score on th
e Bender Test, is usually one of several indicators that the child may have a DC
M. The Test of Bender and Emotional Problems Emotional Indicators (EI) different
iate between children with psychological problems and well-adjusted children. Bu
t does not discriminate between neurotic, psychotic and brain damaged. No signif
icant relationship with school performance. It takes three or more IE before we
can say with some confidence that a child has serious emotional problems.
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Visual-motor perception test Bender-Koppitz.
Name and apellidos__________________________________ F. Nacimiento_____________E
dad: ____ years. ____meses School: ____________________________ Grade Level :___
________________ Date of application: _____________ _ Critical Limit time spent
to complete the test. (It is significant only when terminating beyond critical l
imits.) Age Range Start: Largo: Slow, perfectionist, five years effort to compen
sate for 3-10 min. End: motor perception difficulties. 5 ½ 4-10 min. Short: impu
lsivity, poor concentration, poor performance 6A8 4-9 ½ min. TOTAL school minute
s. (Or High Capacity) 9-10 years 4 to 8 min. DYSFUNCTION INDICATORS (*) Common f
unctional immaturity (**) Almost exclusive or omission DCM * Addiction * angles
(from 6 years) * * ** ** (> 7 years) * (> 8 years) ** (> 6 years) ** (> 7 years)
* (> 6 years) ** (> 7 years) * (> 5 years) ** ** * * (> 8 years) * ** * For all
ages Replacement curves for angles curves Subst. ** X * ** straight lines (> 7
years) * Addition / omission angles (> 8 years) * (> 7 years) ** (> 6 years) * (
> 6 years) * Addition / omission angles (> 6 years) **
FIGURE A
1
2
3
May 4
6
7
8
ITEM (scored as present / absent: 1 or 0). P.D. If in doubt, do not compute. 1.
Distortion is 1a. One or two very flattened or deformed ...... 2b. Disproportion
(one is twice ).................... 2. Partial rotation / total + 45 ° or card
or drawing. 3. Integration (separ / solapam.> 3mm at the junction) .. 4. Distort
ion form (5 or + points are circles )....... 5. Rotation (45 º or more in credit
card / drawing )............... 6. Perseveration. (> 15 points per row ).......
............ 7. Rotation ................................................. .....
.......... 8. Integr.: Missing / addiction rows. 4 + circles in most columns. Me
rger with Fig 1 ............. 9. Perseveration (> 14 columns )..................
........... 10. Dist Form (5 + points or convert. In circles) .. 11. Shaft rotat
ion 45 ° or + in drawing (or card). 12. Integration (non-achieved): 12a. Disinte
gration design ............................ 12b. Continuous line instead of rows
of dots .. 13. Rotation (or part of the figure 45 degrees, or card). 14. Integr
ation (separation or superpowers.> 3 mm .)..... 15. Dist Form (5 + points or con
vert. In circles) .. 16. Rotate 45 degrees or more (total or partial )..........
........... 17. Integration. Desinteg 17th.: Straight or circle points (not bow)
, extending through the arc .. 17b. Continuous line rather than points .........
......... 18. Distortion of shape: 18 a. Three or more angles instead of curves
.......... 18 b. Straight lines .............................................. 1
9. Integration (cross bad )...................................... 20. Perseverat
ion (6 or + sinusoids complete in any of the two lines )........................
......... 21. Distortion is: 21 a. Disproportionate size (Double )..............
.. 21 b. Warp hexagons (> n º <angle) ... 22. Partial rotation / total figure or
card (45 º or +).... 23. Integration (not suporponen or do too much, a hexagon
fully penetrates )..... 24.€Distortion shape (deformed,> <n º angles )...... 25.
Rotation axis by 45 degrees or more ......................................
Age group
P.D. TOTAL (max 30): Group Media Deviation Range + / - 1 SD
Age Equivalent
Percentile
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Design: © Jose Maria Pozo Ruiz. E.O.E.P. COSLADA. 2004.
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Bender-Koppitz Test. INDICATORS emotional maladjustment. (Koppitz, 1974) The twe
lve indicators differentiate between children with and without emotional problem
s. The six underlined show statistical significance and diagnostic value both in
dividually and in their number present in a protocol: There are statistically si
gnificant if three or more indicators. (More than 50% of children with three ind
icators, 80% with 4 indicators, and 100% of children with five or more, have ser
ious emotional disorders.) The last two have great clinical significance but not
statistical, being little frequent. I. Order confusing. Figures distributed to
the lack of capacity to plan, organize the material. Mental confusion. random, w
ithout any logical sequence (not Joint 5-7 years. Significant from that age. for
lack of space). II. Wavy line (Fig. 1 and / or 2) Two or instability in motor c
oordination and personality, or for more changes in line direction CVM deficit o
r motor control difficulties due to stress points-circles ( No scores if rotatio
n) emotional. May be due to organic factors and / or emotional. III. Stripes ins
tead of circles (Fig.2). Impulsiveness, lack of interest or attention. Half or m
ore of the striped circles are worried about their children or problems trying t
o avoid doing what (of 2 mm. Or more) are asked. IV. Progressive enlargement Low
tolerance to frustration and explosiveness. (Fig. 1, 2 and 3) Normal points and
circles in young children. Diagnostic value as the last child is three times th
an the former. grow. V. Large size (macro graphics) One "Acting out" (discharge
pulse out, in behavior) or more of the drawings is a third higher mental process
ing difficulties. larger than the card. VI Small size (micro graphics) anxiety,
withdrawn behavior, shyness. One or more drawings are half that of model VII. Fi
ne lines. Hardly see the picture. Shyness and withdrawal.
VIII. Review of the design of the incisions. The drawing or part is reviewed or
amended with strong lines, impulsive IX. Second attempt. Abandon or delete a pic
ture before or after the finish and start again elsewhere on the sheet. (Not cou
nted if you delete and do so in the same place) X. Expansion. Use of two or more
sheets XI. Frame around the figures XII. Changes or additions impulsivity, aggr
ession and behavioral "acting out." Children who know they do not do well, but t
hey are impulsive and lack the internal controls necessary to carefully remove a
nd correct the wrong part. It does not end what is difficult, abandoned. It also
occurs in anxious children who associate particular meanings to the drawings. I
mpulsivity and conduct "acting out." Normal in preschool, then appears almost ex
clusively in poor and emotionally disturbed children. Poor self-control, need an
d want boundaries and external controls. Children overwhelmed by fears and anxie
ties or their own fantasies. Loose contact with reality TOTAL NUMBER OF EMOTIONA
L INDICATORS: COMMENTS: Behavior, Style face a new task (check all that apply):
• Child well-adjusted. Show with confidence, pay attention, analyze before copyi
ng the drawings. Good control of the pen and work carefully. He realizes and tri
es to correct errors. Are you satisfied with the result. • Children with behavio
ral difficulties and / or learning. Try to delay the task. Work quickly without
looking at the figures previously. Or slowly, recounts, expresses great dissatis
faction with their work. - Unsafe need to constantly encourage them and give con
fidence. Ask if he is doing well. - Poor internal control and / or coord. immatu
re visual-motor: it is frustrating, is fatigued, the drawings are getting worse.
- Perfectionist. Express requirement, when in reality they are doing quite well
. - Lack of attention. Careless mistakes, omitted details, need help to slow.
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Short time or faster. (Average: 6'20''. With problems: 5'19''. Hyperactive: 4 mi
nutes 41 seconds.) Strives to make difficulties: working memory, it helps with s
elf verbal instructions or sub-verbal, drawn figure with your finger or in the a
ir, "anchor", etc. Obsessive: line, number the figures ... extremely slowly, car
e and effort.
CONCLUSIONS: In the visual-motor perceptual maturity and its relation with cutof
f scores (10, 3 or 4), other tests (CI, MS), social group, school achievement, s
pecific learning disorders, the rate of maturation and previous applications , e
motional factors and possible indicators of dysfunction.
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