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Test Sematary: Koppitz-2 Bender Visual-Motor Gestalt

Test
a
David E. Hartman PhD, ABPP, ABPN
a
Medical and Forensic Neuropsychology, Chicago, Illinois
Version of record first published: 27 Mar 2008.

To cite this article: David E. Hartman PhD, ABPP, ABPN (2008): Test Sematary: Koppitz-2 Bender Visual-Motor Gestalt Test,
Applied Neuropsychology: Adult, 15:1, 94-95

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 APPLIED NEUROPSYCHOLOGY, 15: 94–95, 2008
Copyright # Taylor & Francis Group, LLC
ISSN: 0908-4282 print=1532-4826 online
DOI: 10.1080/09084280801922079
Test Review:
Test Sematary: Koppitz-2 Bender Visual-Motor Gestalt Test
David E. Hartman, PhD, ABPP, ABPN
Medical and Forensic Neuropsychology, Chicago, Illinois
It was a dark and stormy night. The town neuropsychol-
ogists thought they had buried the 10 cards from
Loretta Bender’s Visual-Motor Gestalt Test deep in the
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back of their testing closets. The Bender cards and their
association with the disreputable and outdated concept
of ‘‘organicity’’ had ensured the death of the test surely
as a stake through the heart of Dracula.
Flash forward to 2007. Unbeknownst to all but his
most trusted test publisher, Dr. Cecil Reynolds has
discovered an old formula to bring back a test from
the dead. Laboring in his Texas laboratory, and having
distilled the normative essence of over 3,500 children
and adults, Dr. Reynolds fires up the ancient machinery,
and rising from the dead, the Koppitz-2 Developmental
Scoring System for the Bender Gestalt Test (K2-BG) is
reborn.
At the juncture where old horror movies and neurop-
sychology meet, it is probably reasonable to ask whether
the reanimation of a dead test is a service to neuropsy-
chology or a slippery slope back to the dark ages where
psychologists were called upon by psychiatrists to deter-
mine whether a patient’s diagnosis was ‘‘psychiatric’’
(synonymous with ‘‘of interest to the psychiatrist’’)
versus ‘‘organic’’ (having some form of brain dysfunc-
tion of no interest to the psychiatrist, e.g., syphilis, seiz-
ure disorder, dementia). The fact that the Bender was
one of the most widely used psychological tests as
recently as 1995 (Piotrowski, 1995) does not automati-
cally suggest that it is worth saving in the service of
neuropsychological assessment.
Dr. Reynolds, who had been a friend of the late
Elizabeth Koppitz, felt strongly that the Bender was worth
All opinions and conclusions in this review are the sole responsi-
bility of the author.
Address correspondence to David E. Hartman, Ph.D., ABPP,
ABPN, Medical and Forensic Neuropsychology, 401 East Illinois,
Suite 320, Chicago, IL 60611, USA. E-mail: drdavidhartman@
forensicneuropsychology.net
reviving. With the help of a colleague at Allyn and
Bacon and PRO-ED (the test’s publisher), Dr. Reynolds
located and negotiated the rights to Dr. Koppitz’s scoring
system. With the rights secured, Dr. Reynolds did
much more than reissue the test in a new box. The
original Koppitz scoring system was derived from only
77 children and cross-validated on only 51 more.
In contrast, the error scoring on the new K2-BG was
derived from data on more than 3,500 children and
adults. The basic concept of the K2-BG remains the
same, which is that constructional errors reflect visual-
motor integration processing and that these errors
gradually disappear as a function of normal cognitive
development.
The test now covers almost the entire life span, from
5 to 85þ (scores from children younger than 5 were
found to be unreliable). The test itself was extended with
six additional designs from the Bender-Gestalt II created
by Brannigan and Decker (2003); cards 1–13 form the
subtest given to 5- to 7-year-olds, whereas cards 5–16
are administered to all examinees 8 and older.
Test administration remains the same. Examinees are
given a set of cards, one card at a time, containing
abstract or geometric line drawings and asked to copy
them without time limit. There is no formal discontinue
rule and all subjects attempt to draw all designs in their
age group. There is no ‘‘Canter’’-type background inter-
ference administration, such as drawing the designs on
squiggly-line paper to increase difficulty (Canter, 1976).
Designs are drawn on plain paper. Scoring criteria for
each design are unambiguous but will require a ruler
and protractor to measure distances and angles.
There has always been a need for assessment of
visual-motor=visual-constructional function in a neuro-
psychological battery. The test manual does its best to
rebadge the K2-BG as a test of visual-motor integration
and visual-perceptual skill, rather than for organicity
screening. However, the concept is not banished
entirely; page 8 of the manual (Reynolds, 2007) states

(presumably without irony) that ‘‘many professionals
believe that poor visual motor skills are possible signs
of organicity’’ (p. 8). It would be unfortunate if the test
is marketed for that purpose.
Psychometrically, the test is a vast improvement on
the original Koppitz scoring system. Cronbach’s alphas
on the K2-BG are in the .80–.90 range for every age
except 5, for which it is .77. Coefficient alphas are high
across gender, ethnicity, and disability=exceptionality.
Correlations with IQ variables are moderate, with the
highest correlation with Wechsler Perceptual Organiza-
tion Indices and the lowest with Processing Speed.
K2-BG correlations with other IQ and psychoeduca-
tional tests are included in the manual. As has been typi-
cal of tests by this author, the attention to psychometric
detail is both impressive and reassuring that the reincar-
nation of the Bender-Gestalt test will be a useful clinical
neuropsychological measurement tool.
Neuropsychologists may be more bemused about
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chapter 7 of the K2-BG manual, which summarizes
Koppitz’s use of the test as a projective instrument of
emotional disturbance. Dr. Reynolds does acknowledge
that use of the test in this manner is ‘‘controversial’’ and
that the interpretation of these signs and indicators
should be used only to ‘‘develop hypotheses which then
need to be checked against other psychological data and
observations’’ (p. 87). However, it is difficult to rec-
oncile the scrupulous attention to psychometric detail
involved in the K2-BG’s neuropsychological renorming,
with the almost offhand suggestion that the test can be
used projectively. Given that no new data validate pro-
jective signs, and that projective testing per se has not
TEST REVIEW 95
been viewed favorably of late (e.g., Wood, Nezworski,
Lilienfeld, & Garb, 2003), this writer views the inclusion
of this horoscope chapter with regret. I do not look
forward to reading reports by amateur Freudians find-
ing neurosis in tiny, wavy, shaky K2-BG protocols.
In conclusion, neuropsychologists will find the phrase
‘‘it’s alive!’’ to be an appropriate description of the new
K2-BG. Dr. Reynolds has resuscitated an old test and
given it a new lease on life with a large normative base
and excellent psychometrics. As a test of developmental
visual-motor skill and a neuropsychological measure of
visuoconstructional brain function, the test is better than
it ever was and well worth using. Neuropsychologists can
only hope the parts of the monster that caused its original
burial—organicity screening and projective testing—do
not reassert themselves and weaken the reputation of a
very useful neuropsychological reincarnation.
REFERENCES
Brannigan, G. C., & Decker, S. (2003). Bender Visual-Motor Gestalt
Test (2nd ed.). Itasca, IL: Riverside.
Canter, A. (1976). The canter background interference procedure for the
Bender-Gestalt Test. Manual for administration, scoring and
interpretation. Nashville, TN: Counselor Recordings and Tests.
Piotrowski, C. (1995). A review of the clinical and research use of the
Bender-Gestalt Test. Perceptual and Motor Skills, 81, 1272–1274.
Reynolds, C. (2007). Koppitz developmental scoring system for the
Bender1 Gestalt Test (2nd ed.). (Koppitz-2). Austin, TX: PRO-ED.
Wood, J. M., Nezworski, M. T., Lilienfeld, S. O., & Garb, H. N.
(2003). What’s wrong with the Rorschach? Science confronts the
controversial inkblot test. New York: Jossey-Bass.