What is the Bender Gestalt test, how is it given to children, which errors are looked at and what do the results show? A guide to visual-motor assessment.
As you leave the child psychiatry outpatient clinic, you are holding a sheet of paper: "Psychometric assessment: WISC, Bender." You will probably have heard of intelligence tests somewhere; but what is the Bender? When you search online that evening, you come across a muddle of information about a nine-card shape-copying test, brain damage and emotional indicators, and instead of feeling reassured you become even more anxious. The Bender Gestalt test is in fact a fairly simple procedure: the child copies the geometric shapes on cards onto a blank sheet of paper. But this simple procedure provides valuable information about the child's ability to transfer what they see through their hand. In this article I explain what the Bender Gestalt test is, how it is administered, what is looked at in the assessment, and what the results can and cannot tell you.
What Is the Bender Gestalt Test?
The Bender Visual Motor Gestalt Test was developed in the late 1930s by the American child psychiatrist Lauretta Bender. Bender selected some of the geometric designs used in Gestalt psychology's studies of perception and used them to assess a person's visual perception and their ability to turn that perception into a motor action, namely drawing.
The core idea of Gestalt psychology is that the mind perceives parts not one by one but as a whole. It is thanks to this perceptual organisation that we see a series of dots as a "line" and two overlapping shapes as "two separate shapes". Bender thought that by looking at how children copied these designs, it would be possible to track their perceptual maturity.
The classic form of the test consists of nine cards. The cards show designs made up of dots, lines, circles, angles and shapes that touch or overlap. Over the years, the number of cards has been increased and a new version covering a wider age range has also been developed. In Turkey, particularly in assessments with children, the classic nine-card form and the scoring systems based on it are widely used.
What Does the Bender Gestalt Test Measure?
The core skill the test measures is called visual-motor integration: the eye perceiving what it sees, the brain making sense of it, and the hand transferring it onto paper. Difficulty at any of these three steps shows up in the copying.
To copy a shape correctly, a child needs to:
- Perceive the shape accurately, noticing its angles, its orientation and the position of its parts relative to each other
- Use the pencil with sufficient control
- Maintain coordination between eye and hand
- Use the paper in a planned way, placing the shapes at a reasonable size without them running into each other
- Sustain attention throughout the task and not draw in a rush
That is why an error in the Bender Gestalt test cannot be explained by a single cause. Was it the perception, the fine motor skill or the impatience of the child who drew the shape crookedly that led to this result? Answering this question means looking not only at the drawing but also at how the drawing was done.
How Is the Test Administered?
The procedure is extremely simple and generally not demanding for the child. A blank A4 sheet, a pencil and a rubber are placed in front of the child. The practitioner shows the cards one at a time and asks the child to copy each shape onto the paper as closely as possible. There is no time limit; most children finish the test in ten to twenty minutes.
During this process, the practitioner notes not only the resulting drawings but also the child's behaviour:
- Do they turn the card or the paper?
- Do they count the dots one by one, or draw them by eye?
- Do they rub out a lot, starting again and again because they are not happy with what they have drawn?
- Do they work very quickly and carelessly, or very slowly and nervously?
- How do they use the paper: do they arrange the shapes in order, place them at random, or ask for a second sheet?
- Are there signs that they are tired, bored or anxious?
Let's say two children have made the same number of errors. The first finished the test in three minutes, barely looking at the cards and drawing shapes scattered all over the paper. The second counted every dot one by one, rubbed out every line three times and took twenty-five minutes. Although their scores are similar, these two children's needs are very different: in the first, impulsivity and attention may come to the fore, and in the second, anxiety and perfectionism.
There is no need to give the child long explanations before the assessment day. Saying "You're going to look at some pictures with a nice lady/young man and draw them on paper" is enough. A hospital setting can make some children uneasy; for a child expecting white coats, injections or an examination, it is reassuring to be told in advance that nothing in this appointment will hurt. If the child wears glasses, wearing them, and not being tired or hungry, makes it more likely that the result reflects their real ability. Because the assessment is often part of a session made up of several tests, the family is also entitled to ask for short breaks in between.
Which Errors Are Looked At in the Bender Gestalt Test?
The most commonly used scoring method with children is the developmental scoring system devised by Elizabeth Koppitz. This system counts specific types of error and compares the child's total error score with the norms for their peers. The main error types assessed are:
- Distortion: The form of the shape is distorted; for example, lines or dots are drawn instead of circles, or the proportions of the shape change markedly.
- Rotation: The shape, or part of it, is drawn turned at a marked angle.
- Integration error: Parts that should touch or join remain separate, or shapes that should overlap are not related to each other correctly.
- Perseveration: Part of a shape is repeated more than necessary; for example, a row continues to the edge of the paper instead of having a set number of dots.
Scoring makes it possible to estimate where the child's visual-motor development stands compared with their peers. Many errors are normal at a young age; the number of errors falls as children get older. So the same number of errors may be age-appropriate for a five-year-old but a finding that needs attention for a nine-year-old.
The shape a child draws does not tell you how intelligent they are, but how well they could transfer what they saw to their hand on that day.
What Can't the Bender Test Tell You?
The Bender Gestalt test has a long history, and over that history it has been used for different purposes. For a time it was used to screen for brain damage in adults and children. Koppitz also suggested interpreting certain features of the drawings as signs of emotional problems. Today, both of these uses are approached with much more caution.
Neurological conditions can only be understood through a medical assessment and, where necessary, comprehensive neuropsychological testing. Emotional interpretations, such as a child drawing small shapes showing that they are "withdrawn" or drawing large ones showing that they are "impulsive", are not reliable on their own; they can only be considered together with other information, at the level of a hypothesis.
In short, the Bender Gestalt test:
- Is not an intelligence test; it gives only indirect and limited information about intelligence.
- Is not a diagnostic tool for conditions such as attention deficit, specific learning difficulty or autism.
- Cannot on its own show whether there is brain damage.
- Cannot form the basis for firm judgements about the child's personality or emotional state.
These limits do not mean the test is worthless. When used with the right question, namely "Where are this child's visual-motor skills compared with their age?", it provides useful information in a short time.
What Do the Results Mean for the Family?
The test result is usually included in a report alongside other assessments. When reading this report, it is useful to look out for the following:
- Has the result been interpreted according to the child's age? The information "twelve errors" alone is not meaningful; what this number means compared with their peers should be stated.
- Are behavioural observations included in the report? How the child did the test is as important as the score.
- Is it consistent with the other tests? For example, if the visual-spatial subtests of the intelligence test are also low, the finding becomes more meaningful. A low Bender result on its own, if not supported by other findings, is interpreted more cautiously.
- What is the recommended next step? An occupational therapy assessment, adjustments related to writing at school, an attention assessment, or simply monitoring may have been recommended.
During this process, frightening questions such as "Is there some kind of damage in my child?" may come to mind. If you have such a concern, don't hesitate to ask the specialist who wrote the report or your child's doctor directly. Uncertainty often creates more anxiety than real information.
In Turkey, assessments of this kind are sometimes requested for support education at school or for the Guidance and Research Centre (RAM, the state centres for educational assessment) process. In such cases, it helps if the report includes not only the scores but also, in clear terms, what the child needs at school: more time, homework that requires less copying, the option of answering orally, and so on. When sharing the report with the teacher, highlighting these concrete recommendations helps ensure that the child is genuinely noticed in class.
For another test that examines the more detailed sub-dimensions of visual perception, you can take a look at the article on the Frostig visual perception test, and for how the psychological assessment process works in general, the article what is a psychological test.
Supporting Visual-Motor Skills at Home
It is not recommended to "train" a child who struggled on the Bender test by having them copy designs similar to the shapes on the cards. This both undermines the reliability of the next assessment and does not give the child the skill they actually need. Instead, activities that support visual-motor skills in general can be chosen:
- Working on vertical surfaces: Drawing on a sheet of paper stuck to the wall or on a whiteboard strengthens shoulder and wrist control.
- Play dough, clay and beads: These develop finger muscles and manual dexterity.
- Model-copying games: Copying a simple shape made of matchsticks or straws by making an identical one.
- Mazes, dot-to-dot, completing shapes: For short periods, as an enjoyable game.
- Helping in the kitchen: Rolling out dough, cutting shapes with a biscuit cutter, laying out forks and knives on the table.
- Outdoor play: Climbing, catching a ball, skipping; control of the body's large muscles is also the foundation of fine motor skills.
If the pencil grip is clearly a struggle, and the child tires quickly when writing and complains that their hand hurts, an occupational therapy assessment may also be considered.
Psychological Support After the Assessment
The Bender Gestalt test is often a small part of a child's psychological assessment. What really matters is bringing all the findings together and turning them into a meaningful picture of the child's daily life. Children with visual-motor difficulties often avoid written homework, are the last to finish in class and feel behind their friends. Over time this can turn into school anxiety, angry outbursts or the thought "I can't do it."
The psychologist interprets the assessment findings together with the family and, where needed, recommends working with a child psychiatrist, an occupational therapist or a special education specialist. The emotional strain the child is experiencing can be addressed through play. In child and play therapy, children can express a sense of failure, the hurt of being compared and their worries about school in a safe setting. In sessions with families, the focus is on how homework time can be structured, how to communicate with the teacher and how to bring the child's strengths to the fore.
Frequently Asked Questions
Does the Bender Gestalt test measure intelligence?
No. The test assesses how visual perception and manual skill work together. Although it has some relationship with intelligence, reaching a judgement about intelligence requires a comprehensive intelligence test. A child with a low Bender result may have age-appropriate or even high intelligence.
Are left-handed children at a disadvantage on this test?
Being left-handed is not a disadvantage in itself, and the scoring system does not change according to hand preference. However, if a left-handed child has been made to use their right hand, or their pencil grip is not suitable, this can affect the quality of their drawing. Knowing this helps the practitioner interpret the result correctly.
Can the test be repeated, and how far apart?
Yes, the test can be given again after a certain period to monitor the child's development. Repeating it at very short intervals can lead the child to remember the cards and the result to improve artificially. The specialist who carried out the first assessment decides on a suitable interval according to the child's age and the recommended support; usually a gap of some months is expected.
Can the Bender test reveal a child's emotional state?
Not on its own. Some features of the drawings may give clues about anxiety or impulsivity, but these only become meaningful when considered together with an interview, observation and other assessments. An interpretation about emotional state should not be based on a single drawing test.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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