379

'V7

THE BENDER-GESTALT TEST AND ITS RELATIONSHIPS

WITH INTELLIGENCE AND ORGANICITY IN

NEUROLOGICALLY IMPAIRED AND

EMOTIONALLY DISTURBED

CHILDREN

THESIS

Presented to the Graduate Council of the

North Texas State University in Partial

Fulfillment of the Requirements

For the Degree of

MASTER OF SCIENCE

By

Carl H. Brown, B. A.

Denton, Texas

December, 1973

TABLE OF CONTENTS

Page

LIST OF TABLES......................................iv

Chapter

I. INTRODUCTION...............................

The Problem

II. LITERATURE SURVEY...........................

III. METHOD......................................

Research DesignSubjectsProcedure

BIBLIOGRAPHY.........................................

I

11

23

46

iii

LIST OF TABLES

Table Page

I. Means and Standard Deviations ofNeurologically Impaired Children.........27

II. Means and Standard Deviations ofEmotionally Disturbed Children.......... 28

III. Correlation Between Bender Scores and WISCScores for Organic and Non-OrganicCategories Combined......................29

IV. Correlation Between Bender Scores and WISCScores of Neurologically ImpairedChildren.................................30

V. Correlations Between Bender Scores and WISCScores of Emotionally DisturbedChildren.................................31

VI. Chi Square Test of Independence Applied tothe BGT in Differentiating OrganicFrom Functional Disorders by Compari-son of the Occurrence of MarkedDeviations In Both Groups................32

VII. t Test for Differences of Mean BGT and WISCScores of Both Groups....................33

iv

CHAPTER I

INTRODUCTION

The Problem

There have been several studies investigating the re-

lationship between the Bender Gestalt Test and intelligence.

There has also been much research on the difference between

the BGT performance of children who are neurologically im-

paired and those who are not, as well as those of emotionally

disturbed and normal children. It has been demonstrated

that the BGT can be used as a rough indicator of intelligence

when used with young children. It has also been used as an

instrument to indicate emotional and organic disorders as

well as to differentiate between functional and organic dis-

orders. The BGT is then an instrument upon which such factors

as intelligence, emotional problems, and neurological sound-

ness are all interacting to produce the final test results.

Because of the interactions of these and other variables

the BGT can very easily be misinterpreted. However, if used

in conjunction with another instrument, a possibly more

valid judgment concerning a specific diagnosis might be made.

If differential profiles could be established in a clinic

1

2

population of emotionally disturbed and neurologically im-

paired children, then better indicators on present instruments

or better instruments could be obtained that would help to

distinguish these two diagnostic categories.

The purpose of the present study is to investigate the

differences in performance of a sample of children with

organically based test behavior and learning disabilities

and those children whose disorders are functional in origin.

It is the purpose of this paper to determine if there exists

a particular profile on the Bender Gestalt and the WISC that

would help to differentiate these two diagnostic categories

which at some levels of behavior are quite similar. The

present study is an attempt to compare the WISC and the BGT

of emotionally disturbed children with the WISC and the BGT

of those children who have been diagnosed as neurologically

impaired.

It is more important today than ever before to ascertain

a correct estimate of ability, the reasons for difficulties

in learning and behavioral problems of young school age

children, while at the same time taking into consideration

the global intelligence and potentials of the individual.

This eminates from the growing interest in, and work with,

the different diagnostic categories of children by clinics

3

and schools. This increased interest is evident in the

larger number of diagnostic personnel associated with the

school systems and more individualized types of instruction

for the child with unusual difficulties or abilities.

According to Koppitz (4), the Bender-Gestalt is one of

the most widely administered tests in today's mental health

agency. It is routinely administered by many practicing

clinicians, especially those working with children. The

vastness of its administration, however, is almost matched

by its wide range of interpretations and rationales. It has

been used for such varied purposes as determining ego

strength, differentiating neurotics from psychotics and

normal individuals, as well as many other psychodiagnostic

indicators for numerous other psychiatric and neurological

problems.

The BGT consists of a series of nine geometric figures

which Bender adapted from Wertheimer's (6) designs. These

figures included designs consisting of straight lines,

circles, dots, angles, and curves. In the usual admini-

stration of the test, the subject is instructed to copy

each of the designs one at a time in a given sequence. The

test itself is neither a test measuring abilities using a

timed speed method, nor one of visual memory. It is simply

4

a test that purports to measure the individual's perceptual

and visual motor ability.

The original Wertheimer figures were devised while he

was investigating the perceptual area of the Gestalt school

of psychology. The rationale behind the test, as espoused

by the Gestaltist, is that individuals primarily perceive

the figures as an organized whole. Then, in the process of

reproducing the figures, a series of internal events occur.

This perceptual motor process consists of three

processes: the sensory input of the designs, the interpre-

tation of the sensory input at the central levels of the

nervous system, and finally the output or motor performance.

If this sequence of events is distorted or disrupted during

any stage of this process, the BGT reproductions will be

affected. According to Freeman (2), these disruptions might

be in the form of a personality maladjustment, neurological

impairment, the general level of intelligence, or even

possibly an interaction of these disturbances. Hutt (3)

states that what seems to be an apparently simple task is in

reality far more complex than one might expect. Not only

visual and motor behavior is elicited in the process of re-

producing the figures but also the extremely complex process

of perception and interpretation occurs. The final outcome,

5

the quality of the integrated whole of the reproduced

figures, is thus determined by many factors.

Bender(l) points out that biological principles also

affect the perception, sensory motor activities, and repro-

duction of these forms. The reproductions are interacted

on by the pattern of growth and maturity level of the indi-

vidual as well as the pathological state of the individual,

whether organic or functional in origin.

While individuals perceive, interpret, and reproduce

these figures differently, it is assumed that there is a

normal range into which the reproduction of the average

person will fall. If the individual's reproductions fall

outside of this range, some aspect of the individual's

functioning is suspect.

The historical course of the scoring methods has been

mostly unstructured, and has included a lot of overt behavioral

observations. M. L. Hutt (3), while using the test in the

armed services, gave rather broad guidelines that could be

followed. A system of scoring adult protocols that proved

to be more standardized and objective was then developed by

Pascal and Suttell (19). Koppitz (4) has since designed a

scoring system for children that has been widely accepted.

6

Even in the early work with the BGT, it was thought

that in children there was a very close relationship with

the BGT performance and general intelligence. Bender (1)

felt that visual motor perception was related quite closely

to the maturational level of the child. Since the matura-

tional level of the child is again quite closely akin to

language abilities, as well as other abilities that are

measured by, the instruments used to determine the general

level of intelligence, it follows that visual motor per-

formance has a positive relationship with general intelligence.

It could also be said that the maturational level of the

child is somewhat akin to the construct of mental age in

the concept of intelligence. While the relationship between

general intelligence and BGT quality holds at early ages,

this covarying relationship progressively declines with the

increase of the child's age.

It could be assumed that the neurologically impaired

children will function at a neurological level that is lower

than their chronological age. In a sense, they are neuro-

logically immature. This immaturity will be evident in

certain areas, possibly in the visual-perceptual-motor area,

which is tapped by the BGT. In many cases, the maturity

differential level between their neurological level of

7

functioning and their chronological age will close, or

appear to close on the BGT, around the age of eleven. This

maturational differential should be taken into consideration

while evaluating the performance on the BGT and WISC. How-

ever, a factor that must also be considered is that of the

changing task on the subtests of the WISC. Wechsler

cautions against "assuming that similar materials have the

same clinical meaningfullness at all ages or that similar

tests tap identical abilities at all ages " (6, p.2). It is

also true that the nature of the tasks of the subtests them-

selves change. This is especially true of testing levels

on the WISC at eight years. At times these changes may be

subtle, at times rather blatant. Picture Arrangement, for

example, is initially a visual perceptual motor task not

unlike that measured by the BGT, i.e. putting parts together

to make a whole. In the portions of the same subtest for

older children, however, it is more a task involving reason-

ing and social awareness, which is probably less related to

the BGT. In a sense, there are two variables working upon

the data. One is a natural factor of the closing of the

maturational differential. While the other is an artifact

of the WISC, the changing of the subtest's nature from a

purer form of visual-perceptual requirements to one that

8

would be less related. Bender (1) points out that perceptual

motor ability is in some manner related to language ability

in young children. Then, this too is another variable that

might affect the profile of the WISC. Therefore, if some

aspect of perceptual motor ability has a relationship with

language ability, then, perceptual motor ability as seen on

the BGT could have an effect not only on the performance

section of the WISC but also on the verbal section. This

perceptual motor ability is so closely related to age that

this variable, age, must be taken into consideration. Be-

cause of the above factors, comparisons of organic and

functional disorders should be done at different age levels.

They should not be lumped together as a group of children,

categorized in a certain grouping, but should be studied on

the basis of age maturity level as well as their neurological

capacities.

9

Hypotheses

1. It is hypothesized that there exists a statisti-

cally significant negative correlation between the number

of errors on the BGT and the WISC Full Scale, Verbal, and

Performance IQ's of both the neurologically impaired and

the emotionally disturbed groups and that the relationship

will hold when both the organic and functional categories

are combined to form a single group based solely on age.

2. It is hypothesized that the performance of the

neurologically impaired children in reproducing the BGT is

poorer, particularly at the younger age levels.

3. It is hypothesized that the performance of the

neurologically impaired group is inferior to that of the

emotionally disturbed in the verbal areas of the WISC.

4. It is hypothesized that in the six through nine

age levels of the, neurologically impaired children, the

performance of the BGT covaries significantly with the WISC

subtests of Arithmetic, Picture Arrangement, Object Assembly,

and Block Design.

CHAPTER BIBLIOGRAPHY

1. Bender, L. A visual-motor test and its clinical use.American Journal of Orthopsychiatry Monograph,1938, No. 3.

2. Freeman, F. S. Theory and practice of psychologicaltesting. New York: Henry Holt, 1955.

3. Hutt, M. L. The use of projective methods of personalitymeasurements in army medical installations. Journalof Clinical Psychology, 1954, 1, 134-140.

4. Koppitz, E. M. The Bender-Gestalt test for young chil-dren. New York: Grune and Stratton, 1966.

5. Pascal, G. R. and Suttell, B. J. The Bender-Gestalttest: its qualifications and validity for adults.New York: Grune and Stratton, 1951

6. Wechsler, P. Wechsler Intelligence Scale for Children.New York: The Psychological Corporation, 1949.

7. Wertheimer, W. Studies in the theory of gestalt psycho-logy. Psychol. Forsch. 1923, 4.

10

CHAPTER II

LITERATURE SURVEY

While the main premise which associates the BGT per-

formance with intelligence is based primarily on some

maturational development basis, there have been studies which

have attempted to link general intelligence with BGT per-

formance even though this maturational process should have

been completed, i.e., with adults. In general, studies with

adults have had results that showed-either no relationship

between the BGT and intelligence, or if the results did show

a significant relationship, it was within an abnormal popu-

lation, e.g. patients in mental hospitals, mental retardates,

or patients with organic problems.

In review of related research on children, initially

the same results prevail as those that were found in the

research on adults. Generally, in the normal population of

children, most of the studies have found no relationship

between the performance on the BGT and intelligence tests.

In a study by Pascal and Suttell (19), it was found that

there was no significant correlation between intelligence

scores and BGT performance. In this study, the children

11

12

were comprised of a normal range of adjustment and intelli-

gence and the protocols were scored using the Pascal and

Suttell system. Normal children were also used in a study

by Sullivan and Welsh (21). Again, the results showed no

relationship between the BGT protocol scores, which were

scored by the Sullivan and Welsh system, and intelligence.

These studies used scoring systems that were developed for

scoring the protocols of adults and possibly not applicable

to children's protocols. The Koppitz system of scoring BGT

protocols is one that was studied and standardized on a

sample of normal children. Koppitz (13) found that there

was a close relationship between the BGT test scores and

intelligence when the population studied was that of refer-

rals to a child guidance clinic or to a school psychologist.

These children were referred for evaluation of emotional

problems or learning disabilities. The BGT protocols were

scored by the Developmental Bender Scoring System which was

originated by Koppitz (13). The results indicated that there

was a significant correlation at the .01 level between BGT

scores and the intelligence of children who ranged in age

from five through ten. This relationship also held for

mental retardates. The highest correlation was at the five

year old level, which suggests that visual-perceptual

13

abilities are indicative of a highly important function

that is also measured by intelligence tests at this age

level. Koppitz also states that the BGT would make a good

screening instrument for determining school preparedness.

She also reported that there was even a more significant

relationship with the MA of the retarded child than with his

IQ.

In a later study by Koppitz (14), the relationship be-

tween the BGT and the WISC was investigated. Again, the

children were from a group of referrals to a child guidance

clinic. The statistical analysis of the data indicated a

highly significant relationship between the BGT and the WISC

Performance IQ, Full Scale IQ, and Verbal IQ. There was

also a highly statistically significant relationship between

the Performance IQ subtests with the exception of Coding and

Arithmetic. The most highly statistically significant re-

lationship was between Object Arrangement and the Performance

IQ.

In a study by Cerbius and Oziel (5) using Negro chil-

dren between the ages of six and twelve, a statistically

significant relationship was established between the intel-

ligence of a population of children with emotional problems

and children with learning difficulties as well as a sample

of normal children. The WISC Full Scale IQ was significantly

14

correlated at the .01 level, but this was attributed mainly

to the high correlation between the BGT and the Performance

IQ because the Verbal scores and the BGT scores were found

not to be significantly correlated. These results, however,

were contradictory to the results of Baer and Gale (3) who

found that the BGT was correlated with intelligence in an

institutionalized group but not with a group of non-

institutionalized children.

Studies concerned with relating the BGT to intelli-

gence in mental retardates have in general been successful.

Keller (11) found a statistically significant relationship

between the BGT and the Grace-Arther Scale as well as the

BGT and the Stanford Binet. Koppitz (13) also found this

relationship to be present.

In general, the studies using so called "normal" popu-

lations of children have been unsuccessful in relating BGT

performance with intelligence; but, when "abnormal" popula-

tions are used along with the Koppitz system of scoring, the

results usually support this relationship.

While it has been established that in young children,

at least in an abnormal population, the BGT measures some

of the same abilities that intelligence tests do; the BGT

is also used for diagnosing organic disturbances. The BGT

15

has been used successfully in distinguishing those children

with neurological impairment from those who are "normal".

Koppitz (13) was successful in discriminating between

"normals" and those who were having reading difficulties

because of visual motor dysfunction. She hypothesized that

this difficulty could be due to neurological immaturity in

the younger children while they suggested retardation and

possible brain damage in older children. McConnell (17)

attempted to distinguish between the emotional and organic

populations but was unable to adequately do so. He found,

through the use of specified organic and emotional indi-

cators, that the developmental scores related significantly

to organic but not emotional problems. This, he felt, indi-

cated that there was a possibility of evaluating organic

problems in emotionally disturbed children but that the BGT,

when used alone, was not truely capable of definite diagnosis.

Studies based on organic indicators of the BGT have

frequently used rotation of designs as a primary indicator

of organic brain damage. Hanvik (10) found that child

psychiatric patients who produced rotations on the BGT were

more likely to have abnormal EEGs that were associated with

brain damage. Chorost, Spivack, and Levine (6) report similar

findings. Halpin (9) reported that rotations were not any

16

more common among organic child retardates than those chil-

dren who were retarded for other reasons. However, the

reproductions of the BGT in the brain damaged group were

inferior. These results might be attributed to the low IQs

of the groups studied. Quast (20), when using signs that

had been previously suggested as organic indicators, was

able to differentiate organic disorders from emotional dis-

orders in children whose ages range from ten to twelve.

Working on the supposition that the BGT, by itself, is

not an adequate instrument for diagnosing and assessing

neurological impairment in the child, Doubros and Mascarenhas

(7) did a study attempting to determine the organically

sensitive scores on the WISC. They concluded that although

there is a strong relationship between the general intelligence

of the child, and perceptual motor functions, the BGT protocol

should not be examined alone. They concluded that "the

clinician must take into account the child's global intel-

lectual abilities before a diagnosis of perceptual-motor

dysfunction is made. He must also pay attention to specific

subtest scores, especially those related to verbal abstrac-

tions, short-term memory, and color-form organization. (7,p.722)

A significant relationship was established between the BGT

and Full Scale IQ, Similarities, Digit Span, and Block Design.

17

The results were fairly consistant with those of Koppitz (14).

Beck and Lam (4) found that when children, whose ages ranged

from ten to eleven years and whose IQs were below eighty

were studied, those children who had no organic damage had

higher WISC Performance IQ scores than Verbal IQ scores when

compared to those children with organic damage.

In a study by Acherman, et al. (2), children with

learning diaabilities were compared with a control of "nor-

mal" children on their WISC performance. Through the use

of neurological examinations, it was determined that the

learning disabled group was comprised mainly of neurologi-

cally impaired children. It was found that the controls

had significantly higher Verbal and Full Scale IQs than did

the neurologically impaired. However, when the controls were

matched with the neurologically impaired group on mental

age, as estimated by the Full Scale IQ and chronological

age, the neurologically impaired group had higher performance

IQs than the control group; but, the control group was

superior on the Verbal IQ.

In a later study by Acherman, etal. (1), the neurolo-

gically impaired group and the control group were combined

in a different grouping on the basis of their BGT performance.

It was found that those children with adequate BGT performances

18

were superior on the Verbal, Performance, and Full Scale IQs.

and on the WISC subtests of Information, Arithmetic, Simi-

larities, Picture Completion, Block Design, Object Assembly

and Mazes. These results are somewhat divergent from those

of Koppitz (13) and those of Doubros and Mascarenhas (7).

In general, the results of most of the various studies

indicate that there is definitely a relationship between

the BGT and intelligence in both the neurologically impaired,

emotionally disturbed samples, and possibly normal popula-

tions. There is, however, a difference of opinion on which

of the WISC subtests and IQs are related to the BGT. This

possibly could be attributed to subtle differences in the

groups in classification or even severity of the problems.

The variable of the sex of the individual has been

examined in previous studies and it has been determined

that the sex of the child does not significantly enter into

their performances on the BGT. Koegh and Smith (12) found

that there was no significant difference between the per-

formance on the BGT of the boys and that of girls from

kindergarten through the third grade. Koppitz (16) states

that at no age level is the mean score for boys and girls

significantly different. Fiedler and Schmidt (8) found

similar results when investigating the BGT protocols of

19

300 seven year old girls and 300 seven year old boys.

The amount of practice and the motor techniques on the

BGT has also been studied. Rosenthal and Imbar (20) con-

cluded that practice alone has no effect on the BGT; there-

fore, prior exposure to the test should not improve performance.

In a study by McPherson and Pepen (17), motor .technique was.

studied. The results indicated that covert perceptual

responses are more important in the reproduction of the BGT

than motor technique. Therefore, it is assumed that these

variables of practice and technique have no interaction with

the final reproductions of the BGT.

CHAPTER BIBLIOGRAPHY

1. Ackerman, P. T., Peters, J. E., & Dykman, R. A. Chil-dren with specific learning disabilities: Bender Gestalttest findings and other signs. Journal of LearningDisabilities, 1971, 4, 437-446.

2. Chil-dren with specific learning disabilities: WISC profiles.Journal of Learning Disabilities, 1971, 4, 150-166.

3. Baer, D. J. and Gale, R. A. Intelligence and Bender-Gestalt test performance of institutional and non-institutional school children: Journal of GeneticPsychology, 1969, 111, 119-124.

4. Beck, H. S. and Lam, A. L. Use of the WISC in predictingorganicity. Journal of Clinical Psychology, 1955, 11,154-158.

5. Cerbus, G. and Oziel, L. J. Correlation of the Bender-Gestalt and WISC for negro children. Perceptual andMotor Skills, 1971, 32, 276.

6. Chorost, S. B., Spivack, G., and Levine, M. Bender-Gestalt rotations and EEG abnormalities in children.Journal of Consulting Psychology, 1959, 23, 559.

7. Doubros, S. G. and Mascarenhas, J. Relations amongWechsler full scale scores, organicity sensitive sub-tests scores and Bender-Gestalt errors scores.Perceptual and Motor Skills, 1969, 29, 719-722.

8. Fielder, M. A. and Schmidt, E. P. Sex differences inBender-Gestalt drawings of seven year old children.Perceptual and Motor Skills, 1969, 29, 753-754.

9. Halpin, V. Rotation errors made by brain injured andfamilial children on two visual motor tests. AmericanJournal of Mental Deficiency, 1955, 59, 485-489.

20

21

10. Hanvik, L. J. A note on rotations in the Bender-Gestalt test as predictors of EEG abnormalities in

children. Journal of Clinical Psychology, 1953, 9,399.

11. Keller, J. E. The use of the Bender-Gestalt matu-rational level scoring system with mentally handicappedchildren. American Journal of Orthopsychiatry, 1955,25, 563-573.

12. Koegh, B. K. and Smith, C. E. Developmental changeson the Bender-Gestalt test. Journal of ClinicalPsychology, 1958, 14, 292-295.

13. Koppitz, E. M. The Bender-Gestalt test and learningdisturbances in young children. Journal of ClinicalPsychology, 1958, 14, 292-295.

14. Relationship between the Bender-Gestalt

test and the Wechsler Intelligence Scale for Children.Journal of Clinical Psychology, 1958, 14, 413-416.

15. The Bender-Gestalt test for children:

a normative study. Journal of Clinical Psychology,1960, 16, 432-435.

16. The Bender-Gestalt test for young

children. New York: Grune and Stratton, 1966.

17. McConnell, 0. L. Koppitz's Bender-Gestalt scores inrelation to organic and emotional problems in chil-dren. Journal of Clinical Psychology, 1967, 23,370-374.

18. McPherson, M. W. and Pepin, L. Consistancy of re-

productions of the Bender-Gestalt designs. Journalof Clinical Psychology, 1955, 11, 163-166.

19. Pascal, G. R. and Suttell, B. J. The Bender-Gestalttest: its qualifications and validity for adults.New York: Grune and Stratton, 1951.

20. Quast, W. The Bender-Gestalt: a clinical study ofchildren's records. Journal of Consulting Psychology,1961, 25, 405-408.

22

21. Rosenthal, D. and Imver, S. D. The effects of me-phenesin and practice on the Bender-Gestalt performanceon psychiatric outpatients. Journal of ClinicalPsychology, 1955, 11, 90-92.

22. Sullivan, J. J. and Welsh, G. S. Results with theBender Visual Motor Gestalt Test. In E. L. Phillips,et. al. (Eds.) Intelligence and personality factorsassociated with poliomyelitis among school age chil-dren. Child Development Monograph, 1947, 12, No. 2.

CHAPTER III

METHOD

Research Design

The research design was one in which two categories of

neurological soundness and three age levels were compared,

The neurological categories consisted of neurologically

impaired children and neurologically sound children who

were experiencing emotional problems. The age levels con-

sisted of ages six through seven, eight through nine, and

ten through eleven years.

Subjects

The subjects were 177 children, 98 males and 79 females,

who had been examined at the Fort Worth Child Guidance Clinic

between January 1968 and June 1973. Selection criterion in-

cluded a WISC Full Scale IQ of at least 80, the presence of

a complete BGT and WISC, a reasonably clear diagnosis,and a

chronological age between seven years, zero months and

eleven years, eleven months.

One hundred four children with a previously diagnosed

organic impairment were contrasted with seventy-three chil-

dren who had been diagnosed as having emotional disorders.

23

24

A majority of the children came from middle-class homes;

but all socio-economic and racial areas were represented.

The neurologically impaired group consisted of children that

had been examined by either a neurologist, psychiatrist or

pediatrician, and were found to be functioning at a neuro-

logical level that was considered to be abnormal in some

way. Soft neurological signs indicating neurological im-

maturity and learning disabilities were predominant,while

cases with hard signs such as abnormal EEGs or convulsive

disorders comprised a smaller representation. The emo-

tionally disturbed group was composed of children who

exhibited no signs of neurological impairment. This group

consisted mostly of adjustment reactions of childhood and

adolescence; but, other diagnostic groups were represented,

with the exception of psychoses. No attempt was made to

either distinguish or deliniate sub-categories or inten-

sities within these functional and organic disorders.

Procedure

The protocols were picked randomly from the files of

the Fort Worth Child Guidance Center. The BGT protocols

were scored blindly and were recorded with the original WISC

scores. The BGT protocols were scored by the Koppitz scoring

system (1) and the performance of the emotionally disturbed

25

sample was compared with that of the neurologically impaired

sample at age levels six through seven, eight through nine,

ten through eleven. By the use of the Pearson product-

moment correlation coefficient, a correlation between the

WISC scores and the Koppitz error scores were calculated

for each of the three age levels for both the organic and

functional classifications and for the combination of these

classifications.

Comparisons were also made of the performance on the

WISC of the neurologically impaired group with that of the

emotionally disturbed group in order to determine if there

were areas in which one group might do poorer or excel.

It was assumed in the present study that the sex of

the child would have no effect upon the reproduction of the

BGT. It was also assumed that the BGT and the WISC were

given in similar and standardized settings and that the

final outcome was the best effort of the child. Within each

group, it was assumed that the children had at least broadly

similar categorical problems and that these children were

not representative of the normal population but of a clini-

cal population.

CHAPTER BIBLIOGRAPHY

1. Koppitz, E. M. The Bender-Gestalt test for youngchildren. New York: Grune and Stratton, 1966.

26

CHAPTER IV

RESULTS

The means and standard deviations of the BGT and WISC

scores for the neurologically impaired children are presented

in Table I.

TABLE I

MEANS AND STANDARD DEVIATIONS OFNEUROLOGICALLY IMPAIRED CHILDREN

AGE

6-7 8-9 10 -11TEST (n=39) (n=38) (n=27)

'Mean S.D. Mean S.D. Mean S.D.

BGT 10.000 3.61 6.447 2.72 2.880 2.57VIQ 94.538 10.20 94.763 9.59 92.593 12.26PIQ 105.000 11.15 104.342 10.97 102.407 12.62

FSIQ 99.538 9.44 91.104 9.91 96.963 11.83INF 8.154 1.95 8.711 2.44 8.741 2.53

COMP 10.026 3.19 9.943 2.20 8.407 2.71ART 8.923 1.83 7.605 2.22 7.962 2.13SIM 9.026 2.22 10.105 2.60 9.778 2.51VOC 9.846 1.96 9.316 2.07 9.037 2.43DS 7.769 2.15 8.237 2.23 8.407 2.20PC 10.795 2.43 11.342 2.38 11.105 2.02PA 10.523 2.61 10.474 2.19 10.519 2.81BD 11.282 2.41 10.579 2.66 9.888 2.54OA 10.846 3.09 10.526 3.08 10.185 2.06

COD 9.743 3.30 9.711 2.73 9.741 2.59

27

28

Table II presents the means and standard deviations of

the BGT and WISC scores of the emotionally disturbed chil-

dren.

TABLE II

MEANS AND STANDARD DEVIATIONS OFEMOTIONALLY DISTURBED CHILDREN

AGE

6-7 8-9 10-11TEST (n=24) (n=23) (n=26)

Mean S.D. Mean S.D. Mean S.D.

BGT 6.208 2.36 3.000 1.64 1.730 2.14VIQ 100.583 14.04 101.174 11.01 102.154 11.64PIQ 105.750 7.81 103.826 8.56 104.500 11.92FSIQ 103.167 11.28 102.391 8.69 103.500 10.55INF 8.666 2.82 9.609 2.75 9.923 2.48

COMP 10.333 2.54 10.304 2.69 9.423 2.37ARITH 11.167 2.69 9.304 1.83 9.769 2.53SIM 10.500 2.87 11.261 2.33 11.692 2.53VOC 9.750 2.60 10.261 2.03 10.230 2.38DS 10.375 212.10 9.696 1.27 9.423 2.00PC 10.208 2.43 11.087 2.52 11.038 2.98PA 10.916 :2.40 10.304 1.59 10.808 1.92BD 11.375 1.84 10.435 1.95 10.423 2.44OA 10.958 2.44 10.652 1.99 10.577 2.71

COD 10.708 2.72 9.957 2.29 10.770 2.17

Table III presents the Pearson product-moment corre-

lation coeffecient between the WISC scores and the Koppitz

error score for age groups six through seven, eight through

nine, and ten through eleven when the data for both the

29

functional and organic categories are combined at their

respective age levels.

TABLE III

CORRELATION BETWEEN BENDER SCORES AND WISC SCORESFOR ORGANIC AND NON-ORGANIC CATEGORIES COMBINED

AGE

TEST 6 -7 8 - 9 10- 11(n=63) (n=61) (n=53)

VIQ -0.1988 -0.4823** -0.1900PIQ -0.4135** -0.4018** -0.2759*

FSIQ -0.3364** -0.5195** -0.2623INF -0.3081* -0.3943** -0.1607COM -0.0144 -0.2489 -0.1319

ARIT -0.1888 -0.3942** -0.2003SIM -0.2623* -0.4191** -0.0052VOC -0.0710 -0.1884 -0.0780DS -0.3750** -0.4082** -0.3521*PC -0.0705 -0.0981 -0.1285PA -0.4368** -0.1893 -0.2274BD -0.2830* -0.3729** -0.2696OA -0.0829 -0.3458** -0.2654

COD -0.2320 -0.1007 -0.0824

* 5% significance ** 1% significance

NOTE: The negative sign of the correlations is due tothe nature of the Koppitz scoring system, whereby thehigher the score the poorer the performance.

Using the Pearson product-moment correlation, a corre-

lation between the WISC scores and the Koppitz error scores

was determined for ages six through seven, eight through

nine, and ten through eleven for both the organic and

30

emotionally disturbed groups. These results are presented

in Table IV and Table V.

TABLE IV

CORRELATION BETWEEN BENDER SCORES AND WISC SCORESOF NEUROLOGICALLY IMPAIRED CHILDREN

AGE

TEST 6 - 7 8-9 10-11(n=39) (n=38) (n=27)

VIQ 0.0515 -0.4919** 0.0287PIQ -0.4440* -0.5908** -0.1730FSIA -0.2309 -0.6097** -0.1155INF -0.1638 -0.4802** 0.0412COM 0.0524 -0.3080 -0.0784

ARIT 0.0583 -0.3541* -0.0342SIm 0.0256 -0.3853* -0.4572*VOC -0.0797 -0.0436 0.2083DS -0.0330 -0.3122 -0.2473PC -0.1314 -0.1904 -0.0172PA -0.5250** -0.2256 -0.2431BD -0.3270* -0.6204** -0.1832OA -0.1234 -0.6017** -0.2757

COD -0.18.93 -0.1558 -0.0987

* %signif icance* 5% significance

31

TABLE V

CORRELATIONS BETWEEN BENDER SCORES AND WISC SCORESOF EMOTIONALLY DISTURBED CHILDREN

AGE

TEST 6 - 7 8 -9 10 - 11(n=24) (n=23) (n=26)

VIQ -0.3720 -0.2430 -0.3006PIQ -0.5011** -0.2321 -0.3321

FSIQ -0.4613* -0.3016 -0.3633INF -0.5842** -0.1542 -0.3081COM -0.2061 -0.1769 -0.;-62ARIT 0.0209 0.0290 -0.2294SIm -0.3844 -0.3301 -0.0772VOC -0.5007** -0.1829 -0.3632DS -0.2342 -0.0836 -0.4028PC 0.3697 -0.0840 -0.3239PA -0.3499 -0.4172* -0.1808BD -0.2769 0.0543 -0.3094OA -0.4180* -0.3988* -0.2449

COD -0.1657 0.0808 0.0613

* 5% significance ** 1% significance

Performance on the BGT was considered adequate if the

number of errors were within one standard deviation of the

mean score according to the norms for each age as determined

by Koppitz (1). If the number of errors exceeded one stan-

dard deviation, the protocol was then considered to be

inadequate and contained marked deviations from the norms.

The frequencies of adequate and inadequate protocols were

then compared for ages six, seven, eight, nine, ten and

eleven year olds by means of chi square. The results of

this comparison are presented in Table VI.

32

TABLE VI

CHI SQUARE, TEST OF INDEPENDENCE APPLIED TO THE BGT INDIFFERENTIATING ORGANIC FROM FUNCTIONAL DISORDERS

BY COMPARISON OF THE OCCURRENCE OF MARKEDDEVIATIONS IN BOTH GROUPS

Age Chi-Square P

6 3.8040 not significant7 7.7769 .018 8.5714 .019 10.0000 .01

10 .5521 not significant11 2.4390 not significant

The mean performance on the BGT and the WISC scores of

the organic groups were compared with the performance of

the non-organic groups at ages six through seven, eight

through nine, and ten through eleven. These comparisons

were analyzed by means of a t test and are presented in

Table VII. Table VII presents the t values of the BGT and

the WISC scores means at the three age levels.

33

TABLE VII

t TEST FOR DIFFERENCES OF MEAN BGT AND WISCSCORES OF BOTH GROUPS

AGE

TEST (n=61) (n=59) (n=51)_6-7 P 8-9 P 10-11 P

BGT 4.5008 .001 5.4122 .001 9.9693 .001VIQ 1.9388 2.3536 .050 2.8566 .010PIQ 0.2843 0.1898 0.6806

FSIQ 1.3523 1.2617 3.0800 .010

INF 0.8372 1.3076 1.6848

COM 0.3945 0.5545 1.4227ARIT 3.8505 .001 3.0428 .010 2.9500 .010SIm 2.2466 .020 1.7201 2.7117 .010

VOC 0.1640 1.7164 1.7745DS 4.6384 .001 2.8248 .010 1.7235PC 0.9157 0.3911 0.2065PA 0.6052 0.3126 0.0427

BD 0.1597 0.2221 0.7658

OA 0.1489 0.1720 0.5839COD 1.1862 0.3557 1.5347

Hypothesis I

It was stated that a negative statistically significant

correlation existed between the WISC Full Scale, Verbal, and

Performance IQs and the BGT in both the neurologically im-

paired and emotionally disturbed groups. It was also

hypothesized that this relationship would be present when

both organic categories were combined. The correlations of

the combined organic groups are presented in Table III. This

data shows that when both organic and functional classifications

34

are combined to form a single group based solely on age

rather than neurological soundness there is a significant

negative relationship between the error scores at ages eight

through nine for Verbal, Performance and Full Scale IQs. At

ages six through seven, this relationship is significant for

the Performance and Full Scale IQ. In the ten through

eleven year old level, a statistically significant relation-

ship exists only between the BGT and the Performance IQ.

This portion of the hypothesis is thus only partially ac-

cepted.

When the combined category of neurological soundness is

divided into its two components of the neurologically im-

paired and the emotionally disturbed, but neurologically

sound sub-categories, a striking difference is noted. Only

in the neurologically impaired group at ages eight through

nine are the Verbal, Performance, and Full Scale IQs signi-

ficantly correlated. At ages six through seven in the

organic group, the BGT is significantly correlated with the

Performance IQ. In the same age group, the emotionally dis-

turbed had a similar relationship, but, there also existed a

significant relationship with the Full Scale IQ. There were

no significant relationships between the IQs and the BGT for

the ages eight through eleven in the emotionally disturbed

35

category or in the neurologically impaired group at ages

ten through eleven. This portion of the hypothesis is

rejected in part because it is true only for ages eight

through nine in the neurologically impaired group.

Hypothesis II

The second hypothesis stated that the general perfor-

mance on the BGT of the neurologically impaired group would

be inferior to that of the non-impaired group, particularly

at the younger ages. The protocols were classified as

adequate and inadequate depending upon whether they had

scores within one standard deviation of Koppitz's means for

the respective age norms. This data has been presented in

Table VI. Marked deviations from the mean were significantly

more prevalent in the age group of seven, eight, and nine at

the .01 level. At ages six, ten, and eleven, marked deviations

proved to be not significant and more prevalent in the or-

ganic group. However, in Table VII. A t test was applied

to the BGT of the organic and non-organic groups and the means

of the organic group proved to be significantly higher at all

three age levels. The second hypothesis is thus accepted

with some reservation. While the BGT performance is poorer

in the organic group at all levels, it is only markedly

36

inferior to the emotionally disturbed group at ages seven,

eight, and nine.

Hypothesis III

It was hypothesized that the Verbal areas on the WISC

would be most affected by organic involvement in older

children. This involvement was reflected in the comparison

of the data by the use of a t test as presented in Table VII.

It was shown that in the ten through eleven year level the

performance on the Verbal IQ was indeed inferior to that of

the emotionally disturbed group. This poorer performance

was also present in the eight through eleven year level.

Without exception, when the organic group differed signifi-

cantly from the non-organic group, throughout all age levels,

it was in the Verbal portion of the WISC. The Arithmetic

subtest was consistently poorer in the organic group through-

out all age levels. At the six through seven age level,

Arithmetic, Similarities, and Digit Span were inferior. At

the eight through nine year level, the Performance IQ,

Arithmetic, and Digit Span were inferior. At the ten through

eleven year level, the Verbal IQ, Full Scale IQ, Arithmetic

and Similarities subtests were inferior to the non-organic

group. At no age level were any of the differences in the

performance areas of the WISC significant. Hypothesis III

is thus accepted.

37

Hypothesis IV

It was hypothesized that since the WISC subtests of

Arithmetic, Picture Arrangement, Object Assembly and Block

Design were related in some degree to visual-motor Gestaltist

principles, these subtests would covary with the quality of

the BGT reproductions at younger ages in the neurologically

impaired group. In Table IV, it can be seen that Arithmetic

has a correlation of -0.3541 (p<.05) at the eight through

nine year level. Picture Arrangement has a correlation of

-0.5250 (p<.Ol) at six through seven year level. Object

Assembly has a correlation of -0.6070 (p<.01) at the eight

through nine year level. Block Design has a correlation of

-0.3270 (p<.05) at the six through seven age level and -0.6204

(p<.Ol) at the eight through nine age level. All five sub-

tests were significantly correlated at the younger age levels

but only Block Design was correlated at both age levels. It

was also found that information at the eight through nine

year level had a correlation with the BGT of -0.4802 (p<.Ol)

and Similarities had a correlation of -0.3853 (p<.05).

Therefore, Hypothesis IV is accepted with reservations be-

cause there is no constant pattern.

CHAPTER BIBLIOGRAPHY

1. Koppitz, E. M. The Bender-Gestalt test for youngchildren. New York: Grune and Stratton, 1966.

2. McNemar, Q. Psychological Statistics. New York:John Wiley and Sons, Inc., 1969.

3. Spence, J. T. , et. al. Elementary Statistics. NewYork: Appleton-Century-Crofts, Inc. , 1954.

37

CHAPTER V

DISCUSSION

The results of Table III are similar to those results

reported by Koppitz (4). However, she reported significant

correlations between the BGT and intelligence from ages five

through ten; and, in the present study at the age levels of

ten through eleven, this relationship was found to be not

significant. Doubros and Mascarenhas (3), in a correlational

study of the BGT and WISC similar to that of Koppiz, reported

substantiating data but found that the WISC subtest of

Similarities had a small but significant negative relation-

ship. Cerbus and Oziel (2) reported similar findings. These

findings are consistant with the data reported in Table III

if the three age levels had been combined. On the basis of

Table III and the previously cited studies, it might be

concluded that at the years six through nine, it would be

possible to roughly predict general intelligence by the use

of the BGT. However, these studies combined those children

with reading and other difficulties with those children who

were having emotional or behavioral difficulties. This, in

all probability, would comprise a group that contained

38

39

neurologically impaired and emotionally disturbed children,

not unlike that of the present sample. This type of

grouping infers the assumption that both the neurologically

impaired and the emotionally disturbed will display similar

inherent attributes. This assumption would appear to be

faulty and thus the significant correlations are merely an

artifact. If the present groups were to be divided into

subcategories, quite divergent results would probably occur

since they are only a composite of their respective groups

and are not representative of any particular group. As can

be seen in Tables IV and V, the subtests and IQs that are

significantly correlated with the BGT at specific ages are

quite varied and inconsistent with the combined organic and

functional classifications. Thus, in order to make a valid

prediction of a child's intellectual level, his age and

neurological soundness must be known. Only at ages eight

through nine in a neurologically impaired child, or at six

through seven in the emotionally disturbed child, could an

estimate of general intelligence be tentatively made.

From this data, it would appear that the BGT is a pre-

carious screening instrument for ascertaining the general

intelligence level of a child. The BGT, in effect, might

be placed in the dubious position of serving as a two-fold

40

instrument, that of determining neurological soundness, and

then as an estimator of intelligence, which would lead to

many inaccurate evaluations.

Although the validity of the BGT to measure intelligence

is in doubt, its ability to crudely discriminate between non-

organic and organic problems is not. A markedly poor

performance on the BGT (one standard deviation above the

mean established by Koppitz) is possibly an indication of

some organic involvement at ages seven, eight, and nine as

can be seen in Table VI. This data is consistant with that

of Koppitz (4). However, at ages six, ten and eleven, no

statistically significant difference was confirmed. It

was found, however, that the mean performance of the neuro-

logically impaired was significantly poorer at all ages.

Thus, indicating that the neurologically impaired were at

least somewhat inferior in their performance on the BGT at

all ages.

Ackerman, et al. (1) found that the children with

learning disabilities performed at a reliably lower level

on the WISC subtests of Information, Arithmetic, Similarities,

and Digit Span than did controls. In the present study,

similar results were found with the exception that the mean

scores on Information were not significantly different.

41

Ackerman also found an appreciably lower Verbal IQ in the

learning disabled but not in the Performance IQ. This, too,

was confirmed in the present study.

CHAPTER BIBLIOGRAPHY

1. Ackerman, P. R., Peters, J. E. and Dykman, R. A.Children with specific learning disabilities: WISCprofiles. Journal of Learning Disabilities, 1971,4, 150-166.

2. Cerbus, G. and Oziel, L. J. Correlation of the Bender-Gestalt and WISC for negro children. Perceptual andMotor Skills, 1971, 32, 276.

3. Doubros, S. G. and Mascarenhas, J. Relations amongWechsler full scale scores, organcity sensitive subtestsscores and Bender-Gestalt errors scores. Perceptualand Motor Skills, 1969, 29, 719-722.

4. Koppitz, E. M. The Bender-Gestalt test for youngchildren. New York: Grune and Stratton, 1966.

42

CHAPTER VI

SUMMARY

It was hypothesized that the BGT could be used as a

rough indicator of intelligence at young age levels for

organic and functional disorders. It was hypothesized that

the neurologically impaired group would have a poorer per-

formance on the BGT and Verbal sections of the WISC.

Correlations between the BGT and WISC scores were cal-

culated at three age levels for a neurologically impaired

group and for an emotionally disturbed group. These groups

were then combined based solely on age and correlations were

again calculated for the BGT and the WISC scores. The per-

formance on the BGT of both groups was compared by means of

chi square and t tests. WISC scores of both groups were

compared by means of a t test.

The relationship between the BGT and intelligence is

one that is sporadic and cannot be used as a screening device

for determining intelligence with any degree of confidence.

These results are contrary to those of Koppitz (3), Cerbus

and Oziel (1), and Doubros and Mascarenhas (2). It was shown

that through the combining of two dissimilar groupslit

43

44

would be possible to reach the false conclusion that the

BGT was an instrument that could be used for roughly deter-

mining intelligence.

As a screening device for organic dysfunction, the BGT

can serve a useful purpose. However, by no means, can it

be used as a singular diagnostic tool. The mean BGT error

score throughout all ages was significantly higher in the

neurologically impaired group; but, marked deviations were

significant only at ages seven through nine.

The WISC profile of the neurologically impaired groups

differed from the emotionally disturbed as was seen in a

poor performance on the Verbal section of the WISC. The

subtests of Arithmetic, Similarities, and Digit Span were

significantly lower.

It appears that the BGT is subject to many variables

interacting upon its outcome. The primary variables include

maturational level and neurological maturity. Although

mental age does appear to have an effect on the final out-

come at certain ages and degrees of neurological soundness,

its effect is minor and sporadic. As an instrument to be

used in the determination of intelligence, it lacks an all

inclusive validity at any age level. Its importance, it

appears, is in its ability to determine neurological impairment.

CHAPTER BIBLIOGRAPHY

1. Cerbus, B. and Oziel, L. J. Correlation of the Bender-Gestalt and WISC for negro children. Perceptual andMotor Skills, 1969, 29, 719-722.

2. Doubros, S. G. and Mascarenhas, J. Relations amongWechsler full scale scores, organicity sensitive sub-tests scores and Bender-Gestalt errors scores. Percep-tual and Motor Skills, 1969, 29, 719-722.

3. Koppitz, E. M. The Bender-Gestalt test for young chil-dren. New York: Grune and Stratton, 1966.

45

BIBLIOGRAPHY

Books

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Koppitz, E. M. The Bender-Gestalt test for young children.New York: Grune and Stratton, 1966.

McNemar, Q. Psychological Statistics. New York: John Wileyand Sons, Inc., 1969.

Pascal, G. R. and Suttell, B. J.. The Bender-Gestalt test:its qualifications and validity for adults. New York:Grune and Stratton, 1951.

Spence, J. T. et al. Elementary Statistics. New York:Appleton-Century-Crofts, Inc., 1954.

Wechsler, P. Wechsler Intelligence Scale for Children.New York: The Psychological Corporation, 1949.

Articles

Ackerman, P. T., Peters, J. E., and Dykman, R. A. Childrenwith specific learning disabilities: Bender-Gestalttest findings and other signs. Journal of LearningDisabilities, 1971, 4, 437-446.

Childrenwith specific learning disabilities: WISC profiles.Journal of Learning Disabilities, 1971, 4, 150-166.

Baer, D. J. and Gale, R. A. Intelligence and Bender-Gestalttest performance of institutional and noninstitutionalschool children. Journal of Genetic Psychology, 1969,111, 119-124.

Beck, H. S. and Lam, A. L. Use of the WISC in predicting

organicity. Journal of Clinical Psychology, 1955, 11,No. 3.

46

47

Bender, L. A visual-motor test and its clinical use.American Journal of Orthopsychiatry Monograph, 1938,No. 3.

Cerbus, G. and Oziel, L. J. Correlation of the Bender-Gestalt and WISC for negro children. Perceptual andMotor Skills, 1971, 32, 276.

Chorost, S. B., Spivack, G., and Levine, M. Bender-Gestaltrotations and EEG abnormalities in children. Journalof Consulting Psychology, 1959, 23, 559.

Doubros, S. G. and Mascarenhas, J. Relations among Wechslerfull scale scores, organicity sensitive subtests scoresand Bender-Gestalt errors scores. Perceptual and MotorSkills, 1969, 29, 719-722.

Fielder, M. A. and Schmidt, E. P. Sex differences in Bender-Gestalt drawings of seven year old children. Perceptualand Motor Skills, 1969, 29, 753-754.

Halpin, V. Rotation errors made by brain injured andfamilial children on two visual motor tests. AmericanJournal of Mental Deficiency, 1955, 59, 485-489.

Hanvik, L. J. A note on rotations in the Bender-Gestalttest as predictors of EEG abnormalities in children.Journal of Clinical Psychology, 1953, 9, 399.

Hutt, M. L. The use of projective methods of personalitymeasurements in army medical installations. Journal ofClinical Psychology, 1954, 1, 134-140.

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Relationship between the Bender-Gestalt test

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The Bender-Gestalt test for children: anormative study. Journal of Clinical Psychology, 1960,16, 432-435.

McConnell, 0. L. Koppitz's Bender-Gestalt scores in rela-tion to organic and emotional problems in children.Journal of Clinical Psychology, 1967, 23, 370-374.

McPherson, M. W. and Pepin, L. Consistancy of reproductionsof the Bender-Gestalt designs. Journal of ClinicalPsychology, 1955, 11, 163-166.

Quast, W. The Bender-Gestalt: a clinical study of children'srecords. Journal of Consulting Psychology, 1961, 25,405-408.

Rosenthal, D. and Imver, S. D. The effects of mephenesinand practice on the Bender-Gestalt performance onpsychiatric outpatients. Journal of Clinical Psychology,1955, 11, 90-92.

Sullivan, J. J. and Welsh, G. S. Results with the BenderVisual Motor Gestalt Test. In E. L. Phillips, et. al.(Eds.) Intelligence and personality factors associatedwith poliomyelitis among school age children. ChildDevelopment Monograph, 1947, 12, No. 2.

Wertheimer, W. Studies in the theory of gestalt psychology.Psychol. Forsch., 1923, 4.