WWW. THE TEST OF BENDER-Koppitz 1. INTRODUCTION Dls @ The Bender Gestalt Test (L.

Bender, 1938) is to copy 9 cards (size 10 x 15) with abstract designs. It was initially a clinical test for adults, based on figures Wertheimer used to demonstrate the principles of Gestalt psychology of percepti on. Subsequently, systems were created and score goals was used by different pro fessionals working with children, as Münsterberg Elizabeth Koppitz. Koppitz's fi rst book on the Test of Bender (The Viso-motor Gestalt test for children, Guadal upe, Buenos Aires, 1974) was written in the early '60s, when there was great int erest in perceptual processes and their relationship with learning problems, and established special classes for children in difficulty, depending on the diagno sis. Thus, his objective was to establish "different ways of analyzing Bender pr otocols produced by children to evaluate the perceptual maturity, possible neuro logical impairment, and emotional adjustment based on a single protocol." He rec eived wide circulation and used in many subsequent investigations, which led to revise some of the assumptions made. The second book (Koppitz EM, The Bender Tes t, oikos-tau, Barcelona, 1981) presents the updates from 1963 to 1973. This is a synthesis resumen1 adapted mainly from the second book. We selected the points necessary for the application, correction and interpretation Fig. 1, the nine fi gures of the Bender Gestalt Test of Lauretta Bender, adapted from Wertheimer. up dated by removing statistical and technical changes little use (application to g roups, evocation, etc..) We include a sheet that makes the correction. For a mor e complete and, above all, see the studies performed by children, examples of pu nctuation and consult the Revised Manual Assessment, refers to reading the book. 2. GENERAL DESCRIPTION 2.1. Scope. The Bender-Koppitz test reflects the level of maturity of the child in the visual-motor perception and may reveal possible shortcomings in it. It ca n be used as a test of personality (emotional factors and attitudes) as well as test surveys to identify children with learning problems. But it was not specifi cally designed to predict 1 INTERNAL WORKING DOCUMENT. E.O.E.P. Coslada. J.M ª. RUIZ WELL. January 2004. 1 WWW. Dls @ results in reading or to diagnose neurological impairment, in these respects its validity is relative. The Bender-Koppitz test is relatively simple, fast, relia ble and easy to apply even with different cultural groups, regardless of previou s level of schooling or language. It is suitable for students of Primary Educati on. It has been standardized for ages 5 years 0 months to 10 years 11 months. It is valid for children 5 years with normal or above capacity, but does not discr iminate on children this age are very immature or dysfunctional. After 10 years, once the visual-motor function of a child has matured, it can not discriminate. Only children with a marked immaturity or dysfunction in visual-motor perceptio n scores then presented significant. (It can be applied in patients up to 16 yea rs whose mental age is about 10 years.) 2.2. Theory. It is a test of visual-moto r integration, more complex process of visual perception or motor coordination s eparately (Determined as L. Bender, by biological principles vary depending on t he level of development, maturation and pathological state. Organic or functiona l for each individual). Visual perception (interpretation of what you see) depen

ds on the maturation as the experiences of the child. We can not say that a chil d is able to correctly perceive the figure "A", until you can determine, conscio usly or unconsciously, that consists of a circle and a square tipped, not a diam ond, and both are about the same size, arranged horizontally and touching. But t he child can perceive does not necessarily mean that you can copy it. You have t o translate what he sees in a motor activity, transfer it to paper. Consequently , difficulties in copying the figures may be due to immaturity or malfunction of visual perception, motor coordination or integration of both. Most children wit h poor results in the Test of Bender have no difficulty either in visual percept ion or motor coordination, but in the perceptual-motor integration, ie, still ha ve difficulties in a function that requires a higher level integration. Maturity usually get a child from 8 or 9 years.€Before that age, even children 2 WWW. Schematic representation of the process of visual-motor perception involved in t he copy of Bender. Dls @ normal tend to have difficulty copying the Bender Test without any imperfection. 3. RULES OF APPLICATION They give the child two sheets of letter size paper (similar to A-4 size), numbe r two and a pencil eraser. After establishing a good "rapport" Bender cards show saying, "Here I have nine cards with drawings for copies. Here is the first. Ma ke one just like it." After the child has settled the position of the paper, pla ce the first card, the picture A, facing the child. When the child has finished drawing a picture, remove the card and put the next one. We proceed in the same way until the end. Do not make comments, are noted observations on the child's b ehavior during the test. Although the test has no time limit, you must register the time spent, because if it is short or long has diagnostic value. One should not encourage or discourage the use of the eraser or make several attempts. You may use any paper you want (to the additional role without comment). If a child asks about the number of points or the size of the drawings, etc., you should gi ve a neutral response type: "Make it more like the picture of the card you can." If you start to count the points of the figures, the examiner can say, "No need to count points, just try to make it as similar. If the child still persists in counting, then acquires diagnostic significance (or obsessive perfectionist tra it). If the child has filled most of the paper and the tour to locate the fig. e ight in the remaining space is not considered rotation of the drawing. Assuming that the child has been very fast or not at all possible good, you may be asked to repeat a figure of Bender on another sheet, scoring in the protocol. The diff erent orientation between the set of test cards and drawing paper, increases the rotations. The Standard method (Koppitz, 1974) for the implementation of the Be nder Test, appears to reduce the number rotations: • Place the paper in front of the child upright. Allow the child to adjust the tilt of the paper at their con venience, provided that the axis of the paper is closer to vertical than horizon tal. • Then align the card horizontally with the upper edge of the paper. Let th e child manipulate the card if you wish, but insist to be put back in the starti ng position. Do not allow children to copy a figure from a rotated card. If chil dren insist on turning the paper while copying a figure, let them do it. But onc e the figure has been drawn , put the paper back to its initial position. Note i f a figure was drawn rotated, or if the paper was turned on and the figure was d rawn correctly. Some children have difficulty copying the abstract figures of th e Bender until he put a label verbal (say that 3 is "a Christmas tree lying.") r espond to the content received and, obviously, there is nothing wrong with the c hild's visual perception.

3 WWW. Dls @ It should say: "Yes, it seemed, but really is just a drawing. I would like you t o do the figure as it appears on the card. " When the child then turns to draw t he figure, it usually does without any rotation. For such children, the rotation s in Figures 3, 4 and 5 are due more to problems in the conceptualization of vis ual impressions that difficulties in visual perception as such. They need to int erpret them in a concrete form that matches your own experience. The perception of form, in general, seems to rely on cognitive processes in a proportion higher than maintaining the usual theories. 4. CORRECTION AND INTERPRETATION OF RULES It is interpreted objectively and intuitively. In addition to the score on the t est, much information can be obtained by observing the child during the copying of figures. Along with the Koppitz system, the method of scoring is the most cit ed Bender Keogh and Smith (1961), developed for children Kindergarten and First Grade. Correlates with the maturation of Koppitz Scale and both methods are equa lly effective. The scoring system rather complex and Suttell Pascal (1951) is mo st often used for adults. Other researchers developed their own scoring systems. 4.1. Observations on the behavior for its little resemblance to school work, th e test produces much less anxiety than school-related tasks,€and provides inform ation on the child's spontaneous behavior when faced with a new task. Difference s in attitudes among the well-adjusted children and have problems with behavior and learning are often significant: Child well-adjusted. He sits down with ease and confidence in yourself, pay attention, analyze the problem in front of him a nd proceeds to copy the drawings. Show good pencil control and work carefully. E ven young children are to be aware of the imperfections of his drawings and try to fix their own. Rarely ask that reassures them and are satisfied with themselv es and their executions. Those who have behavioral difficulties and / or learnin g. Some hesitate, trying to delay the task to avoid failures, sharpen your penci l, draw something else, tell the examiner a story ... Finally, do quickly withou t looking at the pictures and analyze the figures before you start copying. Othe rs work very slowly, constantly counted and recounted the number of dots and cir cles, expressed strong dissatisfaction with their work. The insecure need to con stantly encourage them and give confidence. They ask: "Am I doing well?". Simila r types of behavior can occur in the classroom and greatly influence the progres s of students and their success, so it is important to note them. • • Children with poor internal control and / or immature visual-motor coordination: Although the test is short, can be most frustrating for them. As the test conti nues, half weary, designs are increasingly neglected and large. Children perfect ionists can not fill their own level of demand, when in reality they are doing q uite well. 4 WWW. • Dls @ • •

• • • Children with short attention span who literally can not concentrate for more th an a few minutes each time, running careless mistakes, omitted details, with abb reviations, as happens in the work. Too often concludes with "problems of percep tion" and is prescribed rehabilitation of that area, when you really need help t o slow down, to develop better internal control and to improve their work habits . The time a child takes to complete the test is highly significant. Most need a bout 6 minutes 20 seconds, while children with learning and behavior tend to wor k faster. (5 min. 19 sec. On average), Hyperactive children, only 4 minutes 41 s econds. Children with skill and good understanding which strive to make real pro blems of visual-motor perception: Some prefer to work from memory (give out the card and leave it aside, to avoid confusion with visual stimuli). Sometimes they give their own verbal instructions as if they had heard themselves, sub-verbal or verbally. Other children use kinesthetic sensations to help integrate their v isual perceptions and expressions graph-motor (eg, draw the figure with your fin ger or in the air before copying). The "anchor" is to place a finger on the part of the figure that is being copied, while drawing the same part with the other hand, gets lost and not (A child less intelligent or telling and retelling small dots or circles after each point or circle drawing isolated forget the number, account and repeat the process again and again. They are predisposed to be lost in reading or forget a step when calculating an arithmetic problem). Some, but i ntelligent impulsive children learn to control their impulsivity through compuls ion (obsessive), which differs from the above perfectionism. So, can align the f igures, including many at times. They work extremely slowly and carefully, using a considerable amount of effort. Turn the paper and the card is another form of help, very intelligent children with problems in visual-motor perception of chi ldren's observation during the work to determine the directionality of plotting. 4.2. Direct ratings Maturation Scale Test of Bender-Koppitz Test Each drawing is scored in distortion, rotation, integration, and perseveration. In total there are 30 scoring items. Deviations are computed only good net. If in doubt, do not compute. The total score recorded errors in the copy of the cards. A high score indicates a poor achievement test, while a low score reflects a good performanc e.€Rarely get a score above 18 or 20 and all I can say in this case is that the visual-motor perception of children is still at a level less than 4 years. 4.3. Changes in the Bender test score. The total score is interpreted in terms of men tal age and chronological age, standard deviation and percentiles. Direct score score does not become typical, as only for children 5 to 7 or 8 years will see a normal distribution. By age 9 most children with mental ability tend to have ha lf an appropriate visual-motor integration and then only discriminates between c hildren with visual-motor perception average or below average, but no difference between middle and upper . The ceiling effect prevents discrimination between b oys and mature. 5 WWW. 4.4. Analysis of punctuation problems Dls @ To improve the scoring criteria, there has been a review of the valuation manual . The Revised Assessment Manual for the Scoring System Scale Test of Bender matu ration is presented in Appendix A. The main sources of errors in punctuation is the examiner and the manual scoring (questions about the rotations):

• Examiners perfectionist who expect too much of the Bender Test, tend to penalize the children for minor irregularities. They think they can diagnose brain injur y, to predict reading performance and identify emotional problems ... Bender tre at it like a precision instrument, when it's really only one answer of a child a t a given time. A child rarely produce two identical test protocols Bender. It i s only a guideline on which the examiner can build their hypotheses. The executi on of a child in the Bender test primarily reflects the level of maturation in v isual-motor perception, disposition and attitude, ability to concentrate at the moment, and extraneous factors. The opposite of a perfectionist is the inexperie nced examiner fails to observe the child while working and do not bother to take notes when a small tour of the paper or superimposed figures. Rotation of the f igures. Koppitz recommended vertical orientation of the drawing paper, more like a sheet of notebook paper. Others prefer the horizontal orientation, which more closely resembles the shape of the stimulus card. The tendency to rotation decr eases as children get older. But the figures A, 3 and 4 retain a "tendency to tu rn" more. Young children or with a poor visual perception, perceive the figures of how distorted or rotated and tend to draw with rotations. When asked, they ar e usually quite unaware of their mistakes. If you are asked to redraw the figure s, tend to repeat the same distortions and rotations. • 5. STATISTICAL JUSTIFICATION: VALIDITY AND RELIABILITY Prior to establishing the reliability must be demonstrated that it is actually a test of the development of visual-motor perception (experimental research desig n and statistical analysis). 5.1. Validity. Most children get better at it again . Those who make an initial poor workmanship can do a little less evil in the re petition, but even then their performances on the test remained below average. I ncreased motivation, copy or describe the figures in the Test, and perceptual-mo tor training, have little effect on improvement in test performance in general, but some individual children may get a small profit. Conclusion: The implementat ion in the test mainly reflects Bender maduraclón level in perceptual-motor inte gration and to a lesser extent, the experience learned perceptivomotrices tasks. They will expect little change from one application to the next test if there i s a short time and rarely alter the original findings. 5.2. Reliability between examiners in scores on the scale of maturity 6 WWW. Dls @ There is a high probability that two examiners to evaluate the protocol of the B ender Test of a child, get about the same test score. 5.3. Test-retest reliabili ty as Bender said, the test results are never the same, regardless of the number of times a child will perform. Nine studies indicated that the total Scale Matu ration of normal children was reasonably stable. It provides valid and reliable information at the time of application, and is also very useful for monitoring c ases: - a performance given in Bender Test reflects the current state of maturit y in visual-motor perception of a child and their attitudes and emotional state. €As the child evolves, its implementation in the Test will change and evolve as well. - Children with educational delays or dysfunction tend to mature at a slow er pace and often irregular. Consequently, the pace of improvement in test score s Bender of a child is highly significant from a diagnostic point of view. Incon sistent progress reflects an unstable operation. 6. NORMATIVE DATA FOR THE SCALE OF MATURATION

View Sample 1974 legislation (Appendix B and Appendix C). The percentiles (Appen dix E). Influence of age. At age 9 scores reach a plateau (ceiling) and Bender T est scores do not discriminate between normal and above. At 10 years longer test normal child development and has significance only if the integration of childr en perceptivomotriz works below the level of 9. The width (standard deviation) o f the mean scores decreased with increasing age of the children. For ages 5 year s for children ranging from 10.6 to 15.6 average for children being deprived env ironment. At 8 and 9 years, the differences include only a 2.5 points. At age 10 appears to be no difference between average and gifted students, and there are 1.5-point difference between the highest score and lowest average scores. Sex di fferences in the Bender test. No statistically significant differences between t he scores of boys and girls. It seems that girls mature a little earlier than ch ildren in the visual-motor perception, but this difference was not significant. Children of high ability. It is expected to make a realization above the level o f the normative data. Level of schooling. As with age, school level reveals an a mplitude (standard deviation) of mean scores significantly in the Bender test, a s the ages of the children and their cultural and socioeconomic environment. - S cores for students who begin first, in a high socioeconomic level, are between 5 and 9, the middle-class children between 8 and 10, the deficiency areas, betwee n 10 and 13. In addition, there is a difference between the Bender test is admin istered at the beginning or end of the year. At the end of First, gifted childre n obtained average scores of 4'4, the middle class had average 5-7; the atmosphe re deficiency, 8'4. - Secondly, the amplitude decreases to stabilize at a point or two for most groups of children. 7 WWW. 7. SOCIO-CULTURAL FACTORS IN THE TEST OF BENDER Dls @ 7.1. Children deficiency ambient atmosphere in front of children not being depri ved many children of disadvantaged areas or with limited capacity or specific le arning problems, hopefully with a performance by below average. For those who wo rk in a particular ethnic or socio-economic area, it is useful to establish spec ific scales for this particular population. A child with an average score for th eir age and social group can not be considered as having serious problems in vis ual-motor area, although implementation of the Bender test is more immature than the general rule for their age level. 7.2. Ethnicity and maturation Development of visual-motor perception varies among children of different ethnic groups (Hi spanics, whites, Indians and blacks ...) both gifted and retarded. But by 10 or 11 years the differences had disappeared in all cases. The speed of development of visual-motor perception may be at least partly determined by the child-rearin g habits of a people and the importance given to certain skills. Tiedeman (1971) collected Bender protocols in the United States and 13 countries in Africa, Asi a and Europe. The process of maturation of visual-motor perception seems to be m ore rapid among Oriental children. By the nine years the differences are no long er significant. Tiedeman's study raises interesting questions: - We know that sp ecific training of visual-motor perception of children of school age have a limi ted impact. - It might be supposed that the Japanese and Chinese are innately en dowed with visual-motor in the area (both in China and Japan the visual arts hav e been developed and have flourished since prehistoric times.) Not so, significa nt differences between Japanese children in Japan and Japanese-American children (same genes) and found no difference between children raised in environments Ja panese Americans or Europeans. In addition, children japonesesnorteamericanos ad apted to American life were like the Americans more than Japanese children. By c ontrast, Chinese-American children educated according to Chinese tradition,€San Francisco, differed from other American children, and showed the same rapid pace of development in the Bender test than other groups of Chinese children in Taip

ei and other areas ... - Tiedeman concluded that the education children receive in Japan from small, in the areas of visual awareness, appreciation of beauty an d motor control, contributes to the development of perceptual-motor integration at an earlier age. Would it be possible, for example, increase the pace of devel opment of visual-motor perception in children being deprived environment by chan ging patterns in early childhood education? The study by Kagan and Klein (1973) with Guatemalan children seems to support this hypothesis. (Note: These findings are consistent with Vygotsky's theories on social influence in the development of higher mental functions). 8. BENDER TEST AND OTHER TESTS 8.1. There is correlation between Bender scores and IQ scores the WISC. - Childr en with good performances on the Bender test tend to have an IQ score in the ave rage or above average and vice versa (though not always). Bender does not discri minate between mental capacity medium, high or higher. 8 WWW. Dls @ - Children with IQ scores below the average scores also tend to have poor or imm ature in the Bender test. - Children with scores on the Bender immature IQ score s may have high or low, depending on other factors involved. - The correlation w ith the WISC IQ is significantly higher than Verbal IQ. - Students with learning difficulties but a good score on the Bender test, had low scores on the Verbal IQ. 8.2. Quality of designs C.I. The way the figures are copied from the Test of Bender also has a significant relationship with the mental capacity of children . Bravo (1972) examined 200 students in fifth grade, superior intelligence, from different social and cultural rights: • • • • Figures were well organized and c arefully distributed on the page. Used less than one full page for their drawing s. They were aware of the imperfections and trying to correct them. 84% fully or partially erased one or more of the figures. Furthermore, 25% sought to correct by reviewing some of the figures. They showed no traces of pencil lines too thi ck or thin irregularly. Therefore, good organization and site designs, spontaneous deletions and careful correction of the imperfections, and the figures carefully small, are associate d with an elevated IQ score. 8.3. Bender Test and mental retardation - The corre lation is higher with the mental age of retarded children than chronological age . Scores improve gradually as children get older, but with a much slower pace. M ost are not yet able, at age 14, of copying the nine figures of the Bender Test, without imperfections. - Scores on the Bender Test reflect their slow mental de velopment, while the quality of the drawings reflects his personality labile and unstable. Emotional Indicator Only "Expansion" is more common in retarded child ren with emotional problems than other children with emotional problems (8 of 9 children who were held behind, also very impulsive and acting-out behavior). 8.4 . Relationship between Visual Perception test and visual-motor integration is wi dely recognized that some measure of visual perception or visual-motor integrati on is needed to assess the mental development and learning ability of children. Most tests C.I. include items or subscales of this type, as well as aptitude tes ts most common reader. There are several specific tests to evaluate these aspect s: Frostig (1961), Progressive Matrices (Raven, 1956), etc. Research shows signi ficant correlations between the Bender test and those tests, the differences bet ween them are smaller than generally assumed. • The Progressive Matrices Test (R aven) is a test of visual perception and nonverbal reasoning. Bender differs fro m that requires no motor activity. The correlations between the two, for childre n 5-9 years ranged from 0.58 to 0.69. • Correlation with the Frostig test is 0.4 , but with significant inconsistencies in the subtest of the Frostig (seems to c

orrelate more with the subtest 9 WWW. 9. THE TEST OF SCHOOL PERFORMANCE AND BENDER Dls @ Spatial Relations). Bender was able to discriminate between children with and wi thout reading problems, while the Frostig no. The success or failure in school is influenced by many factors.€In previous stud ies appear to have overestimated the significance of visual-motor perception. Es pecially influence the development of language, oral-visual integration, the abi lity of serialization, the evocation of symbols and information and training con cepts. Age, attitude, sex and social and family environment of children also aff ect their performance in various proportions. The progress of a child in school depends on the combination and interaction of all these factors. 9.1. Rating mat urity and school performance total score is more related to general school achie vement than any single item. Emotional Indicators are not good predictors of sch ool achievement. The erasures and careful review are most often good students. A good record of Bender at the time of entering primary is usually a good predict or of later school success, a good cross-modal integration and good mental abili ty, but a poor record at the beginning of first does not necessarily mean that a child will fail . Some normal children simply need more time to mature. To pred ict school performance, it is best to apply early in the First Degree, as it see ms to be especially effective for children between 5 ½ and 6 ½ years. Children w ith difficulties in school often have poor test scores on the Bender. This inclu des children with limited mental capacity and children with normal intelligence but with specific learning problems. Some children are affected by a malfunction real visual-motor perception. However, if you are smart, if you have good langu age skills and evocative, if they have a good motivation, if they have behavior problems and if they have some parents and teachers who help them, they can over come or compensate for perceptual-motor problems and over time become good stude nts. 9.2. Sex differences and academic achievement Bender Test Predicts The most successful educational outcomes for children than girls. This is not due to dif ferences in visual-motor function, but to other factors affecting school progres s. Immature Children with scores in the Test of Bender are usually poor readers, whereas girls may have reading scores high or low. Girls tend to be more contro lled, more advanced in language development, are also more able to compensate fo r their problems in visual-motor area. Therefore, many girls develop a successfu l work despite their protocols immature at the time of entering school. Children are more impulsive and restless. Many activities help girls yet. The inappropri ate behavior of children influences the teacher's attitude towards them. Therefo re, a child with an immature implementation of the Test of Bender poor school re sults will more likely than a girl with a bad score on the Bender Test, even tho ugh their scores on the Bender Test and CI are the same. 9.3. Reading and arithm etic 10 WWW. Dls @ There is no relationship between the Bender and reading. Reading problems are mo re related to the socio-economic, mental ability and language ability than with visual-motor perception. Although both the Bender Test as reading require childr en to have a minimum level of maturity of visual-motor perception. A child whose

level of visual-motor integration is still well below that of a 5 ½ years have difficulties both in the Test of Bender and reading, regardless of whether it sh ows a developmental delay, or minimal brain dysfunction. The Bender test correla tes better with the achievement in arithmetic, since both involve visual-motor p erception and the relations of part-to-all and space. 9.4. Test of Bender and le arning disability data show convincingly that visual-motor integration of childr en with LD is evolving at a slower pace than normal. The rate of evolution depen ds on the age and mental capacity of children: - The majority of children were a t 5 ½ years a score of 10 in the Bender Test, this is the level at which they ar e prepared to begin the schoolwork. - Students with LD with IQ scores of 100 or more did not reach the level to 6 years. - Those who had an IQ of 85-99 were not getting an average of 10 until they reached age 7. - Small with learning diffic ulties uncertain mental capacity (IQ 70-84) already had eight years when his ave rage score was 10. - Finally, the moderately retarded children (IQ 50-69) did no t reach the score of 10 on the Test of Bender to 9 ½ to 10 years.€The normal stu dents usually show a sharp rise in learning for third, when they are 8 years and their scores on the Test of Bender are 3 or 4. Students with LD, show no real p rogress until they are about 9 years. Children with difficulties and with an IQ score below average, show no significant improvement in performance Bender and u ntil they are 10 ½ years or even 11 years, while children uncertain at 12, 13 or even 14. Most students fail behind scores of 3 or 4 on the Bender test even at age 14. It recommends individualized instruction in the classroom, but many teac hers and administrators still expect all children to reach the same performance. The repeated application of the Bender Test will provide a record of the rate o f maturation of a given child and may be helpful to establish realistic performa nce expectations of this child. It is absurd to expect a child to give up a four th level when the evolution of perceptual-motor integration is still at the firs t level. Repeated applications are good indicators of the pace of progress being made by a child, and are useful for planning an individualized education progra m. A child with a marked discrepancy between IQ and scores on the Bender test us ually has specific learning difficulties. 10. THE TEST OF BENDER and minimal brain dysfunction 11 WWW. Dls @ "This chapter reflects my current view. Instead of treating Bender as a test for the diagnosis of brain injury as I did in my first book, this time we will anal yze the relationship between the Bender Test and Minimal Brain Dysfunction. " (K oppitz, 1974) The term DCM, in the broadest sense, implies that the behavior and learning diff iculties of a child are, at least in part, an organic base. I base a diagnosis o f DCM in a combination of several factors: the child's development, and social h istory, school performance, behavioral observations, and of course the results o f psychological tests including the Bender. A diagnosis of brain injury implies the presence of brain damage is not the case of DCM. The DCM can be caused by a prenatal or birth trauma, accidents or diseases, genetic factors, early and seve re deficiency or lack of emotional or physical care, or other known and unknown causes. Brain injury is a medical diagnosis. The DCM can be diagnosed by a docto r or a qualified psychologist.

Total score against indicators of brain injury. A poor Bender indicates the possibility of DCM, particularly if more than one st andard deviation of age. There should be a diagnosis of DCM based solely on a ps ychological test. You can not rule out the existence of DCM for good performance . The total score is able to differentiate between groups of children with and w ithout DCM, and little is gained by using both the indicators and Neurological S cale score in the maturation of the Bender Test. DCM rotations and rotations are an evolutionary phenomenon and not necessarily c onnected with DCM. Diagnosis of the degree of organic impairment of children's a chievements with a medical diagnosis of neurological damage are much lower and c an be recognized regardless of how they are analyzed or interpreted the records of the Bender Test. IC and DCM A marked discrepancy between mental age of a chil d resulting from their IQ score, and perceptual-motor age derived from the score on the Bender Test, is usually one of several indicators that the child may hav e one DCM. Medical problems and DCM Studies of children with low birth weight (<2,500 g) from birth to 10 years. Sho wed marked differences in: Bender test performance, understanding and abstract r easoning, attention, motor development, language and IQ scores. Small with low b irth weights had a higher degree of disability in the 6 and 7. Low birth weight is also associated with neurological damage. Abnormal EEG. The subjects for this study were normal intelligence children 5-10 years who had performed below aver age protocols in the Bender test. It 12 WWW. Dls @ found that 75% had abnormal EEG, therefore, the Bender correlated significantly with abnormal EEG, but not for all children. Encephalitis. In the aftermath of e ncephalitis were found serious problems in visual-motor perception. DCM behavior and observation of children while conducting the test is absolutely necessary and has diagnostic value,€but there is no relationship between any co nduct on the Bender and DCM. There is a child type of DCM. As a group, are most vulnerable. They tend to mature more slowly not only in visual-motor perception, but also in their behavior and attitudes. But the specific reaction of children with DCM compared with stress depends on many factors: degree of DCM, mental ca pacity and, above all, interpersonal relationships, the child has experienced. T he underlying emotional attitudes are reflected in the emotional indicators Bend er protocol. 11. THE TEST OF BENDER AND EMOTIONAL PROBLEMS Koppitz, 1963, held ten signs that can differentiate between children with and w ithout emotional problems. Then added two more, which appear rarely, but often h ave considerable clinical implications. Emotional Indicators (EI) are mainly rel ated to age and maturity. Children with poor perceptual-motor integration are of

ten vulnerable to develop secondary emotional difficulties. But not all necessar ily have emotional problems, and not all children with Emotional Indicators show ed Bender in unavoidably dysfunction or immaturity in visual-motor area. I. Conf used Order. The figures of the Bender Test, without any logical sequence or orde r, are common in children aged 5-7 years, associated with a failure in planning capacity. In children older smarter and Confused Order may also reflect confusio n. Confusing order occurs more often in children with learning difficulties and test protocols of the children acting out. II. Wavy line on Figures 1 and 2. Two or more abrupt changes in the direction of the dotted line or circles. Appears to be associated with poor motor coordination and / or emotional instability. It was found that psychiatric patients and significantly discriminated between stu dents with and without emotional problems. III. Circles stripes replaced by Figu re 2. It was associated with impulsivity and lack of interest and emotional prob lems. IV. Progressive increase in size in ali Fig. 1, 2 or 3. The dots or circle s progressively increase in size until the last at least three times larger than the former. It is also associated with low tolerance to frustration and explosi on and acting-out and emotional problems. V. Great size. The area covered by a f igure is twice the area of the figure of the stimulus card. It is associated wit h acting-out behavior. Difference between psychiatric patients and children with out emotional problems 13 WWW. Dls @ VI. Small size. It is half or less than the card. It tends to be related to anxi ety, withdrawn behavior, constraint and shyness in children. VII. Thin line. It is associated with shyness, embarrassment and withdrawal. Psychiatric patients w ith emotional problems. VIII. Rest neglected or heavily reinforced lines. A full figure or part of it is reviewed by thick lines compulsive. When a figure is er ased and redrawn carefully or if a figure is corrected with deliberate lines tha t actually enhance the picture, then this category is not counted. It is associa ted with impulsivity, aggression and hostility, acting-out behavior in children. IX. Second attempt. The drawing is spontaneously dropped out before or after be ing completed and made a new drawing of the figure. It is scored only when they have made two drawings of a figure in two different places of the paper. This IE has been associated with impulsiveness and anxiety. Impulsive and aggressive ch ildren with emotional problems. X. Expansion. Use two or more sheets of paper. I t is associated with impulsivity and acting-out behavior. Among school-age child ren occurs almost exclusively in the protocols of children with mental retardati on and emotionally disturbed. XI. Frames around the figures. Draw a frame around one or more of the figures after being copied. Is associated with an attempt to control their impulsivity. Own children who often have a poor self-control, nee d and want boundaries and external controls to be able to function at school and at home. XII. Preparation spontaneous or added to the figure. In one or more fi gures of the Bender Test of spontaneous changes are made. This kind of pictures are rare and occur almost exclusively in children overwhelmed by fear or anxiety or totally preoccupied with their own thoughts. These children often have a wea k contact with reality. Number of IE in the protocols of the Bender Test Emotion al Indicators should be evaluated individually. They may appear singly or in com bination.€Allow to formulate hypotheses that need to be checked with other obser vations and psychological data. There was no significant relationship between sc hool performance and IE. A single IE on a protocol of a child reflects an attitu de or tendency given, but by itself does not indicate any serious emotional prob lem. It takes three or more IE before we can say with some confidence that a chi ld has serious emotional problems. This does not mean that a child with six IE i s twice more upset that a child who has only three IE. The clinic patients had s ignificantly more IE in Test Protocols. There are significant differences in the

number of IE institutionalized children acting out and a group of normal subjec ts matched for age, sex and IQ score. PRACTICAL CONCLUSIONS The Bender-Koppitz Test is an effective diagnostic if included as part of a batt ery of tests and in combination with other information. 14 WWW. • • Dls @ It provides information on the level of maturity of the child in the visual-moto r perception and can be used as a test of personality and for children with lear ning problems. The difficulties in copying the figures may be due to immaturity or malfunction of visual perception, motor coordination and, most of the time, t he integration of both (this is the function that requires higher level of integ ration). Strategies to differentiate whether the failures are due more to percep tion or execution: - Young children or with a poor visual perception, perceive d istorted figures and tend to draw with errors. When asked, they are unaware of t heir mistakes. If you are asked to redraw the figures, tend to repeat the same d istortions and rotations. - Indicators of visual perceptual performance: contras t with results of tests that do not involve motor skills (Raven's Progressive Ma trices) and, by contrast, tests that measure abstraction but does not depend on perceptual factors (verbal reasoning, Similarities) • There is consistent evidence on that the pace of socio-cultural factors influenc ing maturation: Average scores differ according to ethnicity and social class, i n addition to age and intelligence of children and their functional and emotiona l status. But the nine years the differences are minimal in normal children. Bender test, school performance and learning difficulties. • Children with diffi culties in school often display poor scores on the Bender (this includes childre n with limited IQ, and children with normal IQ but specific disorders) A good re cord of Bender on First usually predict later academic success (to be related to arithmetic and writing). A bad record can be just immaturity. It is not related to reading, since it includes linguistic factors of mental ability and social b ackground. Although both the Bender Test as reading require children to have a m inimum level of maturity of visual-motor perception. A child whose level is stil l below the 5 ½ years, will have difficulty in reading. Students with mental ret ardation (Mental Age correlates Bender): mature very slowly and most are not abl e to copy the cards without errors even at age 14. Indicator of possible specifi c learning disorders: students who show a marked difference between a good score on the Bender and low IQ scores (especially verbal IQ). Learning disabilities: visual-motor integration of children with LD is evolving at a slower pace than n ormal. The rate of evolution depends on the age and mental capacity of children: 10 score on the Bender test is the level that indicates that a child is ready t o start school work (usually after 5 ½ years) . Students with LD: - with IQ of 1 00 or more: not reached the level to 6 years. (~ 1 EP) • • • •

• 15 WWW. Dls @ - With IQ of 85-99 were not getting an average of 10 to 7 years. (~ 2 º EP) - wi th IC were 70-84 and 8 years old when his average score was 10. (~ 3 º EP) - wit h IC 50-69, did not reach the score of 10 to 9 ½ to 10 years. (~ 4 th or 5 th) • normal students usually show a sharp rise in learning for third, when they are 8 years and their scores on the Test of Bender are 3 or 4. - Students with LD, s how no real progress until they are about 9 years. - Children with LD and IQ bel ow average, show no significant improvement in performance Bender and until they are 10 ½ years or even 11 years - Children limit, at 12, 13 or even 14 years.€Most retarded pupils fail scores of 3 or 4 on the Bender test even at age 14. The pace of improvement in the Bender is related to the rate of progress in perf ormance escolar.La repeated application of the Bender Test will provide a record of the rate of maturation of a given child and may be helpful to establish real istic performance expectations of this child. The Bender Test and Brain Dysfunct ion can reveal brain dysfunction in children, but does not determine whether a c hild has immaturity or dysfunction in visual-motor perception as a result of dev elopmental delay or neurological impairment. A poor Bender indicates the possibi lity of DCM, particularly if more than one standard deviation of age. The achiev ements of children with medical diagnosis of neurological damage are much lower and can be recognized regardless of how they are analyzed or interpreted the rec ords of the Bender Test. A marked discrepancy between mental age of a child resu lting from their IQ score, and perceptual-motor age derived from the score on th e Bender Test, is usually one of several indicators that the child may have a DC M. The Test of Bender and Emotional Problems Emotional Indicators (EI) different iate between children with psychological problems and well-adjusted children. Bu t does not discriminate between neurotic, psychotic and brain damaged. No signif icant relationship with school performance. It takes three or more IE before we can say with some confidence that a child has serious emotional problems. 16 WWW. Dls @ Visual-motor perception test Bender-Koppitz. Name and apellidos__________________________________ F. Nacimiento_____________E dad: ____ years. ____meses School: ____________________________ Grade Level :___ ________________ Date of application: _____________ _ Critical Limit time spent to complete the test. (It is significant only when terminating beyond critical l imits.) Age Range Start: Largo: Slow, perfectionist, five years effort to compen sate for 3-10 min. End: motor perception difficulties. 5 ½ 4-10 min. Short: impu lsivity, poor concentration, poor performance 6A8 4-9 ½ min. TOTAL school minute s. (Or High Capacity) 9-10 years 4 to 8 min. DYSFUNCTION INDICATORS (*) Common f unctional immaturity (**) Almost exclusive or omission DCM * Addiction * angles (from 6 years) * * ** ** (> 7 years) * (> 8 years) ** (> 6 years) ** (> 7 years) * (> 6 years) ** (> 7 years) * (> 5 years) ** ** * * (> 8 years) * ** * For all ages Replacement curves for angles curves Subst. ** X * ** straight lines (> 7 years) * Addition / omission angles (> 8 years) * (> 7 years) ** (> 6 years) * ( > 6 years) * Addition / omission angles (> 6 years) ** FIGURE A

1 2 3 May 4 6 7 8 ITEM (scored as present / absent: 1 or 0). P.D. If in doubt, do not compute. 1. Distortion is 1a. One or two very flattened or deformed ...... 2b. Disproportion (one is twice ).................... 2. Partial rotation / total + 45 ° or card or drawing. 3. Integration (separ / solapam.> 3mm at the junction) .. 4. Distort ion form (5 or + points are circles )....... 5. Rotation (45 º or more in credit card / drawing )............... 6. Perseveration. (> 15 points per row )....... ............ 7. Rotation ................................................. ..... .......... 8. Integr.: Missing / addiction rows. 4 + circles in most columns. Me rger with Fig 1 ............. 9. Perseveration (> 14 columns ).................. ........... 10. Dist Form (5 + points or convert. In circles) .. 11. Shaft rotat ion 45 ° or + in drawing (or card). 12. Integration (non-achieved): 12a. Disinte gration design ............................ 12b. Continuous line instead of rows of dots .. 13. Rotation (or part of the figure 45 degrees, or card). 14. Integr ation (separation or superpowers.> 3 mm .)..... 15. Dist Form (5 + points or con vert. In circles) .. 16. Rotate 45 degrees or more (total or partial ).......... ........... 17. Integration. Desinteg 17th.: Straight or circle points (not bow) , extending through the arc .. 17b. Continuous line rather than points ......... ......... 18. Distortion of shape: 18 a. Three or more angles instead of curves .......... 18 b. Straight lines .............................................. 1 9. Integration (cross bad )...................................... 20. Perseverat ion (6 or + sinusoids complete in any of the two lines )........................ ......... 21. Distortion is: 21 a. Disproportionate size (Double ).............. .. 21 b. Warp hexagons (> n º <angle) ... 22. Partial rotation / total figure or card (45 º or +).... 23. Integration (not suporponen or do too much, a hexagon fully penetrates )..... 24.€Distortion shape (deformed,> <n º angles )...... 25. Rotation axis by 45 degrees or more ...................................... Age group P.D. TOTAL (max 30): Group Media Deviation Range + / - 1 SD Age Equivalent Percentile 17 WWW. Give Design: © Jose Maria Pozo Ruiz. E.O.E.P. COSLADA. 2004. Dls @ Bender-Koppitz Test. INDICATORS emotional maladjustment. (Koppitz, 1974) The twe lve indicators differentiate between children with and without emotional problem

s. The six underlined show statistical significance and diagnostic value both in dividually and in their number present in a protocol: There are statistically si gnificant if three or more indicators. (More than 50% of children with three ind icators, 80% with 4 indicators, and 100% of children with five or more, have ser ious emotional disorders.) The last two have great clinical significance but not statistical, being little frequent. I. Order confusing. Figures distributed to the lack of capacity to plan, organize the material. Mental confusion. random, w ithout any logical sequence (not Joint 5-7 years. Significant from that age. for lack of space). II. Wavy line (Fig. 1 and / or 2) Two or instability in motor c oordination and personality, or for more changes in line direction CVM deficit o r motor control difficulties due to stress points-circles ( No scores if rotatio n) emotional. May be due to organic factors and / or emotional. III. Stripes ins tead of circles (Fig.2). Impulsiveness, lack of interest or attention. Half or m ore of the striped circles are worried about their children or problems trying t o avoid doing what (of 2 mm. Or more) are asked. IV. Progressive enlargement Low tolerance to frustration and explosiveness. (Fig. 1, 2 and 3) Normal points and circles in young children. Diagnostic value as the last child is three times th an the former. grow. V. Large size (macro graphics) One "Acting out" (discharge pulse out, in behavior) or more of the drawings is a third higher mental process ing difficulties. larger than the card. VI Small size (micro graphics) anxiety, withdrawn behavior, shyness. One or more drawings are half that of model VII. Fi ne lines. Hardly see the picture. Shyness and withdrawal. VIII. Review of the design of the incisions. The drawing or part is reviewed or amended with strong lines, impulsive IX. Second attempt. Abandon or delete a pic ture before or after the finish and start again elsewhere on the sheet. (Not cou nted if you delete and do so in the same place) X. Expansion. Use of two or more sheets XI. Frame around the figures XII. Changes or additions impulsivity, aggr ession and behavioral "acting out." Children who know they do not do well, but t hey are impulsive and lack the internal controls necessary to carefully remove a nd correct the wrong part. It does not end what is difficult, abandoned. It also occurs in anxious children who associate particular meanings to the drawings. I mpulsivity and conduct "acting out." Normal in preschool, then appears almost ex clusively in poor and emotionally disturbed children. Poor self-control, need an d want boundaries and external controls. Children overwhelmed by fears and anxie ties or their own fantasies. Loose contact with reality TOTAL NUMBER OF EMOTIONA L INDICATORS: COMMENTS: Behavior, Style face a new task (check all that apply): • Child well-adjusted. Show with confidence, pay attention, analyze before copyi ng the drawings. Good control of the pen and work carefully. He realizes and tri es to correct errors. Are you satisfied with the result. • Children with behavio ral difficulties and / or learning. Try to delay the task. Work quickly without looking at the figures previously. Or slowly, recounts, expresses great dissatis faction with their work. - Unsafe need to constantly encourage them and give con fidence. Ask if he is doing well. - Poor internal control and / or coord. immatu re visual-motor: it is frustrating, is fatigued, the drawings are getting worse. - Perfectionist. Express requirement, when in reality they are doing quite well . - Lack of attention. Careless mistakes, omitted details, need help to slow. 18 WWW. Dls @ Short time or faster. (Average: 6'20''. With problems: 5'19''. Hyperactive: 4 mi nutes 41 seconds.) Strives to make difficulties: working memory, it helps with s elf verbal instructions or sub-verbal, drawn figure with your finger or in the a ir, "anchor", etc. Obsessive: line, number the figures ... extremely slowly, car e and effort.

CONCLUSIONS: In the visual-motor perceptual maturity and its relation with cutof f scores (10, 3 or 4), other tests (CI, MS), social group, school achievement, s pecific learning disorders, the rate of maturation and previous applications , e motional factors and possible indicators of dysfunction. 19