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An interview with Gary Brannigan: revising the Bender-Gestalt test.

NAJP: Let's hear about the recent revision of the Bender-Gestalt Test, but before that can you give some historical background on the test?

GB: The Bender-Gestalt Test, actually titled the Visual Motor Gestalt Test, evolved from the research of Gestalt psychologist, Max Wertheimer (1923). He studied the organizing principles of perception using geometric designs. He would present these designs to his subjects and ask them to describe what they saw.

Lauretta Bender, a psychiatrist, was intrigued by Wertheimer's studies and wanted to see how psychiatric patients would experience these designs. However, because it was not always possible to get patients to verbalize their perceptions, she adapted nine of the designs, put them on cards, and asked patients to draw them with pencil on paper. Her research on the test was detailed in her 1938 monograph "A Visual Motor Gestalt Test and Its Clinical Use." The monograph also provided clinicians with an elaborate scoring system and normative data on the maturation of visual-motor-gestalt functioning in children from 3 to 11 years of age, as well as descriptions of the performance of individuals with organic and functional pathological conditions.

NAJP: Can you describe Bender's scoring system?

GB: Bender's scoring system evaluated the overall quality of the reproduction of each design on a scale of 1 to 5 on one design to 1 to 7 on others. She provided detailed descriptions of each point on the scale for each design. For example, on Design 6 a score of 1 was given for an inhibited scribble, a score of 4 was given for two wavy lines crossing at right angles, and a score of 6 was given for perfection. Her scoring system was cumbersome and it did not generate much research interest. However, it did stimulate others to research new methods of administering and scoring the test.

NAJP: Can you describe some of the scoring systems that evolved from Bender's work?

GB: The Bender-Gestalt Test came to be used for neurological, psychopathological, and educational assessment purposes. Two types of scoring systems evolved: global systems and deviation systems. Global systems evaluate the overall intactness of the reproductions. Deviation systems inspect the reproductions for specific signs that are believed to have clinical relevance. As an example, I can describe a deviation system, Elizabeth Koppitz's (1963) Developmental Bender Scoring System; and a global system, my (with Nancy Brunner; 2002) Qualitative Scoring System. Our System consists of 30 discrete errors (distortion, rotation, integration, perseveration) across the nine designs. The Qualitative Scoring System evaluates the overall accuracy of each drawing on a 6-point scale. For Design 6, for example, a score of 0 would be given for scribbling, random lines, absence of design; a score of 3 for two lines crossing at or near center with some attempt at waves; and a score of 5 for accurate representation. So far most of the scoring systems that are available are deviation systems. Both types provide useful information for clinicians.

NAJP: What got you interested in the Bender-Gestalt in the first place?

GB: I was introduced to the test during my undergraduate years in the 1960s at Fairfield University. Actually, I first saw the designs in an Introductory Psychology course. Later, during my senior year, I had the good fortune to be selected as a research assistant by Alex Tolor, a clinical psychologist and noted authority on the Bender-Gestalt. His comprehensive book "An Evaluation of the Bender-Gestalt Test," published with Herbert Schulberg in 1963, examined the research on the test from its beginning through the early 1960s. It was called by some "the bible for the Bender-Gestalt Test."

I was surprised at the simplicity of the test and impressed by the prominent role it assumed in the psychological assessment battery. However, it was not until I was in graduate school at the University of Delaware that I began to learn the intricacies of the test. In a personality assessment course taught by Marv Zuckerman, I was introduced to the administration, scoring, and interpretation of the test. Shortly after that course, under the guidance of my advisor, Al Duchnowski, a clinical-child psychologist, I gained experience with the test in a variety of psychiatric and educational settings. The more I used it, the more fascinated I became with it. It served a number of purposes (neurological, personality, educational) and quickly became a regular part of my psychoeducational assessment battery.

Shortly thereafter, while at the Devereux Foundation, I conducted my first research on the test with Marty Benowitz (1975), a staff psychologist. We routinely discussed the Bender-Gestalt protocols of children and adolescents being evaluated for possible admission to the treatment facility. In the process, we consistently noted patterns in the test performance of pre-delinquent boys, and decided to see if the qualitative aspects of the drawings were related to behaviors they exhibited. Without going into the details of the study, we found specific relationships between features of boys' drawings (e.g., exaggerated curvature, progressive increase in figure size) and acting-out behaviors (e.g., poor emotional control, inability to delay gratification).

A few years later, after I joined the psychology faculty at SUNY Plattsburgh, Toni McCormick and I (1984) replicated and extended this research with adolescent girls. After that, I was sold on the test!

NAJP: Whose idea was it to revise the Bender-Gestalt Test?

GB: I don't know exactly when, but the American Orthopsychiatric Association, which owned the copyright for the test, was interested in revising it for some time before the project was announced. Representatives of the association and Riverside Publishing finalized an agreement and developed a preliminary plan for the revision. A large advisory panel, including Bender's son, Peter Schilder, was instrumental in finalizing the plan for the revision and monitoring its progress. The basic guidelines that were agreed upon were:
   Keep the original nine designs in the revision, increase the number
   of designs in the revision, add a memory procedure, compare both
   deviation and quality based scoring systems, and decide on which
   approach to use. Finally, obtain a large, nationally representative
   sample to norm the revision.


NAJP: What did the panel decide?

GB: The panel generated a large number of possible new designs to add to the original nine. After considerable discussion and a pilot study, seven designs were selected for the revision: three easier designs and four harder ones. The Bender-Gestalt II is actually two separate tests. There are 13 designs for children below eight years of age, and 12 designs for individuals eight years of age and older. A memory procedure was included in the revision. Based on previous research studies and input from clinicians who routinely included a Memory phase in their testing, a recall procedure was selected. For scoring, the panel compared scoring systems on several criteria, including reliability, validity, ease of use, and sensitivity to clinical conditions involving visual-motor functioning. After a trial-and-error process and pilot studies, a qualitative scoring system called the Global Scoring System was selected. Finally, a large representative normative sample, the largest in the history of the test, was acquired. It was stratified to closely match the 2000 U.S. Census for individuals from 4 to 85+ years of age.

NAJP: Why were you asked to join the project?

GB: Initially, I was asked to serve as a consultant on the project when the panel decided to go with the Global Scoring System. Scott Decker, a psychologist at Riverside Publishing who was extensively involved in many of the technical aspects of the revision, patterned the Global Scoring System after my previous work on the Qualitative Scoring System.

I didn't mention this earlier, but in the late 70s, Alex Tolor asked me to coauthor an extension of his book on the research on the Bender-Gestalt Test. The new book covered the research since the publication of the first (Tolor & Brannigan, 1980).

It was during this time that I happened upon two studies that guided my work for the next 25 years. Barbara Keogh and Carol Smith (1961) developed a global scoring system for their research on children's academic achievement, and Katrina deHirsch, Jannette Jansky, and William Langford (1966) modified the Bender for their work on children's achievement by eliminating three of the more difficult designs. The new slant on scoring and modifying the test led to the development of a test for children who fell at what I believed was the optimal age range to assess the role of visual-motor integration in children's academic achievement: 4 1/2 to 8 1/2 years (grades K-2). As a result, I (along with my student, Nancy Brunner) authored the Modified Version of The Bender-Gestalt Test for Preschool and Primary School Children in 1989. The norms were expanded and a revised edition was published in 1996. Because there was increased interest in the test beyond North America, we published a book (also in ebook form) on the most recent version of the test, including normative data on children from Hong Kong (Brannigan & Brunner, 2002).

I believe that I was the only one who had ever developed and normed a qualitative scoring system for a modified form of the Bender-Gestalt Test. That's what AOA and Riverside were interested in doing. As we discussed my work on test development in general and the Bender-Gestalt Test in particular, Dave Madsen, who was handling the administrative details of the project, asked me to be senior author on the project. Scott Decker and I published the Bender-Gestalt II in 2003.

NAJP: I have always felt that the original Bender-Gestalt Test had developmental, clinical, and personality aspects. Do you agree?

GB: Yes, I agree. I would include organic and functional mental disorders in the clinical aspect. With respect to the developmental aspect, both qualitative and deviation scoring systems have been found to be related to academic performance. The Global Scoring System for the Bender-Gestalt II continued this trend.

As for the clinical and personality aspects of the test, I would be remiss if I did not highlight the major impact of Max Hutt's work (Hutt, 1985) on me and other researchers and clinicians. He combined objective scoring systems for functional and organic disorders with clinical insight based on astute observation of individuals' test-taking behavior. He also extended the test beyond the Copy phase to include Recall, Elaboration, and Association phases to increase the projective value of the test and the testing situation. I expect his work will extend to the Bender-Gestalt II.

NAJP: Reproducing the designs from memory requires good visual memory, but people are not told that they are going to be asked to do this until after the Copy phase. Do you see that as a factor? Would the results differ if they were prompted beforehand?

GB: Yes, it is a factor. You are comparing two different memory tasks. You are describing an intentional memory task, and the Bender-Gestalt II uses an incidental memory task. When people are primed beforehand, they can initiate strategies to process the information. This is less likely to occur in an incidental task. So the intentional task would very likely yield better recall. On the other hand, the inclusion of an incidental task can provide information that is more typical of everyday experiences people have where they try to recall something that happened.

The panel decided to add the memory phase following the Copy phase to preserve the typical administration of the test. Priming people before the Copy phase changes the standard procedure for administration and could change the nature of that task. Unlike the Copy phase, there has been little research on the Recall phase. Now clinicians and researchers will have clear guidelines to go by: a standardized procedure for administration and scoring, and normative data for comparison. This information should aid the assessment and differential diagnostic process. Remember, the Bender-Gestalt II is not a stand-alone test. It is meant to be a part of psychological, neurological, and psycho-educational test batteries. Also, it may serve as a guide to further, more comprehensive testing based on observation of the individual taking the test and the results of his/her efforts.

NAJP: You mentioned two supplementary tests: motor and perceptual. Tell us about them.

GB: The Bender-Gestalt II, like the original test, is a visual-motor-integration test. The Motor and Perception Supplementary tests, which can be easily administered in a few minutes, were designed to provide specific information on each of these elements separately. This can provide clinicians with additional information to aid in diagnosis.

NAJP: Are there any indicators or signs during testing that perhaps the child/adolescent might need glasses (e.g., squinting)?

GB: That, for me, is the big question! In addition to the Motor and Perception Supplementary tests, the Bender-Gestalt II includes an elaborate Observation Form. The questions on the form cover motor, sensory, physical, cognitive, and emotional factors that provide information about the individual and insights into his/her performance. Observation is critical to evaluation. With tests like the Bender-Gestalt II, there is added pressure on the clinician to be observant because the individual is so active during the process of copying and recalling the designs. Sometimes subtle actions can lead to insight about why an individual performed the way he/she did. A test is only as good as the clinician administering, scoring, and interpreting it.

To get to your specific question, an experienced clinician should be able to note what individuals are saying and doing during all phases of the assessment, and even include additional tasks that go beyond the formal ones in the test battery. If, during an evaluation, I notice a child squinting on the Bender-Gestalt Test, even though it might not affect his/her performance on the test, I want to watch and hear him/her read from classroom materials. I would very likely refer the child for an eye examination. I want to determine if the most parsimonious reason (not seeing clearly) is causing the problem or contributing to it.

NAJP: Does the Bender-Gestalt II have suggestions for remediation?

GB: The test has no specific suggestions for remediation. It is usually administered as part of a test battery that includes other educational, psychological, and/or neurological tests. Most often, any suggestions would be determined on an individual basis from the integration of the results of the Bender-Gestalt II and other tests in the battery.

NAJP: What feedback have you received thus far about the revision?

GB: It has been very good. Actually, extensive research was done on the Bender-Gestalt II prior to its publication. It was found to be highly reliable and valid. The average interrater reliability coefficient was .90 for the Copy phase and .96 for the Recall phase. The internal consistency coefficient based on the split-half method for the Copy phase was .91. Test-retest coefficients for two to three week intervals averaged .85 for the Copy phase and .83 for the Recall phase. Research findings on validity of the Copy and Recall phases were also high, based on correlations with such factors as intelligence, visual-motor ability, and academic achievement. And, the test demonstrated sensitivity to a variety of functional and organic clinical disorders, including learning disabilities, attention-deficit-hyperactivity-disorder, and Alzheimers.

The test is being used worldwide. At first, though, a few clinicians had questions about the new enhancements and scoring system, especially if they had been using a deviation scoring system in the past. This prompted Decker, Madsen, and me to co-author a bulletin explaining the new features (2004). It is primarily a teaching tool for anyone who has questions about the test. Even though high inter-rater reliability has been shown for examiners with minimal training, I recommend extensive training in all aspects of the test: administration, scoring, and interpretation. There is much more that can be gained from this test than the scores it yields!

Research on the test has been progressing. There are a lot of possibilities for future research on all aspects of test usage. Now that I have completed most of my work on a 10-year project preparing parents of children with disabilities to advocate for their educational needs and rights, I will have time to get back to my first love...the Modified Version of the Bender-Gestalt Test and the Bender-Gestalt II. Don't tell my wife!

REFERENCES

Bender, L. (1938). A visual motor gestalt test and its clinical use. American Orthopsychiatric Association, Research Monographs (No.3). New York: American Orthopsychiatric Association.

Brannigan, G. G., & Benowitz, M. L. (1975). Bender-Gestalt signs and antisocial acting out in adolescents. Psychology in the Schools, 12, 15-17.

Brannigan, G. G., & Brunner, N. A. (1989). The Modified Version of the Bender-Gestalt Test for Preschool and Primary School Children. Brandon, VT: Clinical Psychology Publishing.

Brannigan, G. G., & Brunner, N. A. (1996). The Modified Version of the Bender-Gestalt Test for Preschool and Primary School Children-Revised. Brandon, VT: Clinical Psychology Publishing.

Brannigan, G. G., & Brunner, N. A. (2002). Guide to the Qualitative Scoring System for the Modified Version of the Bender-Gestalt Test. Springfield, IL: Thomas.

Brannigan, G. G., & Decker, S. L. (2003). Bender Visual-Motor Gestalt Test, Second Edition. Itasca, IL: Riverside Publishing.

Brannigan, G. G., Decker, S. L., & Madsen, D.H. (2004). Innovative features of the Bender-Gestalt II and expanded guidelines for the use of the Global Scoring System. Itasca, IL: Riverside Publishing.

deHirsch, K., Jansky, J. J., & Langford, W. S. (1966). Predicting reading failure. New York: Harper and Row.

Hutt, M. L. (1985). The Hutt adaptation of the Bender-Gestalt Test (4th Ed). New York: Grune & Stratton.

Keogh, B. K., & Smith, C. E. (1961). Group techniques and proposed scoring system for the Bender-Gestalt Test with children. Journal of Clinical Psychology, 17, 122-125.

Koppitz, E. M. (1963). The Bender-Gestalt Test for young children. New York: Grune & Stratton.

McCormick, T. T., & Brannigan, G. G. (1984). Bender Gestalt signs as indicants of anxiety, withdrawal, and acting-out behaviors in adolescents. Journal of Psychology, 118, 71-74.

Tolor, A., & Brannigan, G. G. (1980). Research and clinical applications of the Bender-Gestalt Test. Springfield, IL: Thomas.

Tolor, A., & Schuberg, H. C. (1963). An evaluation of the Bender-Gestalt Test. Springfield, IL: Thomas.

Wertheimer, M. (1923). Studies in the theory of Gestalt psychology. Psychologische Forschung, 4, 301-350.

Gary G. Brannigan

State University of New York at Plattsburgh

(Interviewed on behalf of NAJP by)

Michael F. Shaughnessy

Eastern New Mexico University

Gary Brannigan, is Professor of Psychology at SUNY at Plattsburgh. He is a licensed clinical psychologist and certified school psychologist who has worked with many children, adolescents, and families. Additionally, he was Director of the Psychological Services Clinic and supervised many clinical and school psychology students. Gary also served on the editorial boards of four journals and has authored or co-authored numerous articles and 17 books and test manuals, including his most recent: Guide to the Qualitative Scoring System for the Modified Version of the Bender-Gestalt Test (2002), Bender Visual-Motor Gestalt Test Second Edition (2003), Reading Disabilities: Beating the Odds (2009), and Reading and Learning Disabilities: Five Ways to Help Your Child (2012). He is a Fellow in the Society for Personality Assessment and received the SUNY Chancellor's Award for Excellence in Scholarship.

Author info: Correspondence should be sent to: Dr. Michael Shaughnessy, Psychology Department, Eastern New Mexico University, Portales, NM 88130.
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Author:Brannigan, Gary G.; Shaughnessy, Michael F.
Publication:North American Journal of Psychology
Article Type:Interview
Geographic Code:1USA
Date:Jun 1, 2013
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