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.

Bender Visual-Motor Gestalt Test in adolescents: relationship between visual-motor development and the Tanner Stages.

Visual-motor skill is fundamental to human development and is an important component of psychological evaluations. The goal of the present study was to determine whether there is a correlation between visual-motor development, as measured by the Bender Visual-Motor Gestalt Test (Bender test), and sexual maturity in adolescents, based on the Tanner Stages in Adolescents. 134 adolescents from 10 to 15 years of age participated in the study. The Bender test and the Raven's Progressive Matrices Test were employed. The measures were administered individually and information on sexual maturity and the presence of developmental disorders was collected from medical charts. The results of the Bender test were not affected by gender, age, schooling, or changes stemming from puberty, but were significantly affected by having repeated a school year and by developmental disorders. An association was found with Raven's scores. The Bender test proved sensitive to developmental disorders in adolescence. No association was found between visual-motor development and sexual maturity in adolescents.

Cognitive and developmental influences in visual-motor integration skills in young children.

Measures of visual-motor integration skills continue to be widely used in psychological assessments with children. However, the construct validity of many visual-motor integration measures remains unclear. In this study, we investigated the relative contributions of maturation and cognitive skills to the development of visual-motor integration skills in young children (N = 856). We used a block regression analysis to determine the contribution of maturation, as indicated by age, followed by broad cognitive factors (Study 1) and subsequently by individual subtests in verbal and nonverbal domains subsumed under each factor (Study 2) in explaining score variance of the Bender Visual-Motor Gestalt Test (2nd ed.; BG-II; Brannigan & Decker, 2003) Copy and Recall scores in children between the ages of 4 and 7 years. Results confirm that maturation accounted for a large proportion of variance in both BG-II Copy and Recall performance, above which Stanford-Binet Intelligence Scale (5th ed.; SB-5; Roid, 2003) Quantitative Reasoning and Fluid Reasoning factors significantly contributed to visual-motor integration performance for the Copy phase, and SB-5 Quantitative Reasoning and Visual-Spatial factors accounted for a significant amount of variance for the Recall phase. Additionally, nonverbal domains were more related to visual-motor performance than verbal domains. Results from this study are interpreted to suggest nonverbal reasoning and visual-spatial attention are important contributing factors to visual-motor integration, as measured by the BG-II. Developmental implications of visual-motor integration skills, nonverbal problem solving, and mathematical competence are discussed.

Turkish children's Bender-Gestalt test performance: differences in public and private school children.

The present study was undertaken to provide data on the Bender-Gestalt test for children aged 5 to 11 in Turkey. Although it is well documented that sociocultural factors are important in cognitive evaluations, the effects of type of school and differing educational opportunities provided by these schools on the Bender-Gestalt test have not been previously investigated. The aim of the present study was to investigate the effect of age, sex, and school type on Bender-Gestalt performance. The test was individually administered to 484 children between the ages of 5 and 11 years. The children were enrolled in either public or private schools. Koppitz's Developmental Scoring System was utilized. The results indicated that older children performed with fewer errors. Girls performed with fewer errors than boys. Finally, as expected, private school children outperformed their public school peers. The results are discussed with respect to the importance of taking into account various educational factors in utilizing commonly used tests.

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.

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.

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.

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.

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.

Bender performance and socioeconomic status in Mexican children: a cross-cultural study.

Normative data are presented for Bender test performance, following the system of Koppitz, of 695 Mexican students between 5.0 and 12.1 yr. old (M = 8.7, SD = 2.01) and belonging to different socioeconomic status. The data are compared with the normative group of U.S. students used by Koppitz and with a representative sample of children from Barcelona, Spain. The results indicate that the total number of Bender errors decreased with increasing age of the children and that significant differences existed with respect to socioeconomic status. The comparison of these data with U.S. and Spanish children shows significant differences in all age groups, with the Mexican children scoring lowest. Differences in quality of schooling and in other aspects of education could explain the variability in Bender test performance.

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.

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.

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.

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.

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.

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.