B

Benton Visual Retention Test The following description of the BVRT was
adapted from Strauss et al. (2006). The test
Carlye B. G. Manna1, Carole M. Filangieri2, includes four alternative methods of administra-
Joan C. Borod3,4, Karin Alterescu1 and H. Allison tion (A, B, C, and D) that assess different aspects
Bender4 of functioning. The most common administration
1
Department of Psychology, Queens College of (A) assesses immediate recall of a visual display.
the City University of New York (CUNY), After presenting a stimulus card for 10 s, the card
Flushing, NY, USA is removed, and the examinee is asked to draw the
2
Department of Behavioral Health, NYU design from memory. Administration B follows
Winthrop Hospital, Mineola, NY, USA the same procedure as A, but with a 5-s exposure
3
Department of Psychology, Queens College & interval. Administration C allows the examiner to
The Graduate Center of the City University of dissociate memory functioning from perceptual
New York (CUNY), Flushing, NY, USA and motor aspects of the task by asking the exam-
4
Department of Neurology, Icahn School of inee to reproduce the designs while each item is in
Medicine at Mount Sinai, New York, NY, USA plain view. There is no time limit, but individuals
who work very slowly should be encouraged to
increase their speed. In Administration D, a 15-s
Synonyms interval is inserted between the 10-s encoding
phase and the figure reproduction, allowing the
Benton test; BVRT examiner to assess short-term retention of visual
information. Scoring consists of both the number
of correct designs and the number of six different
Description types of errors: omissions, distortions, persevera-
tions, rotations, misplacements, and size errors.
The Benton Visual Retention Test (BVRT) is a Administration time for each form is approxi-
widely used test of visual memory, visual percep- mately 5 min. Several sets of norms are available
tion, and/or visual construction. Now in its fifth and reflect different demographic characteristics,
edition (Sivan 1992), the test consists of three including age ranges and education levels
equivalent forms (Forms C, D, and E), each com- (Mitrushina et al. 2005; Strauss et al. 2006).
posed of ten items of visual stimuli. Most items A multiple-choice recognition administration
include three geometric forms presented along a (Administration M, with alternate forms F and
horizontal plane, making the test particularly sen- G) is also sometimes used to assess visual mem-
sitive to visual neglect (Sivan 1992). ory without visuoconstructional or motor
# Springer International Publishing AG 2017
J. Kreutzer et al. (eds.), Encyclopedia of Clinical Neuropsychology,
DOI 10.1007/978-3-319-56782-2_1110-2
2 Benton Visual Retention Test

coordination demands (Amieva et al. 2006). For D) recall are positive and range from 0.40 to 0.83,
Administration M, the examinee views a target depending on the combination of forms used.
stimulus for 10 s and, after it has been removed, Construct validity has been demonstrated through
is required to identify it from among four choices. moderate correlations (0.46–0.62) of the BVRT
Although not part of the English-language ver- with nonverbal subtests from the Wechsler Adult
sion, materials for this special administration are Intelligence Scales.
available in the German (Sivan and Spreen 1996) Child and adolescent normative data are
and French (Benton 1965) editions. included for Administrations A and C. The nor-
mative data for each method of administration are
based on different standardization samples, and
Historical Background sample characteristics are provided for
Administrations A, B, and C. (Normative data
Dr. Arthur L. Benton developed the Visual Reten- for Administration D are not included in the man-
tion Test as a brief measure of immediate nonver- ual.) The standardization sample for Administra-
bal memory to supplement the popular auditory tion A is based on a compilation of three separate
digit span test in neuropsychological evaluations studies totaling over 1,300 participants, ranging in
(Benton 1945). It was first published in 1946. age from 8 to 69. (See manual for discussion of
Memory-for-designs tasks had appeared earlier participant inclusion criteria for each of these
in the century as part of larger intelligence tests studies.) The standardization sample for Admin-
but included only a few designs and did not have istration B is based on 103 medical inpatients and
separate normative data. As an addition to the outpatients, aged 16–60 years, with no evidence
digit span test, the BVRT was intended to provide or history of brain disease. The standardization
a broader assessment of short-term memory, and samples for Administration C are 200 medical
its format was selected for its resistance to emo- patients with no history of brain disease for the
tional influence, employment of different sensori- adult norms and 236 children, aged 6–13 years,
motor components (graphomotor versus auditory- enrolled in public schools in Iowa and Wisconsin
vocal), and minimal examiner-subject interaction for the child and adolescent norms.
(freedom from interpersonal demands). The initial
version included seven cards and two parallel
forms. A 1955 revision increased the number of Clinical Uses
designs and alternate forms and added norms for
children aged 8–16. Later editions included a As it recruits a number of different cognitive
design copy administration and updated norms. functions, the BVRT is sensitive to many forms
The most recent revision was authored by Abigail of brain damage and disease; however, its ability
Benton Sivan (Sivan 1992) and is available from to discriminate among diagnoses is low (for a
its publisher, Pearson Assessments (http:// review, see Mitrushina et al. 2005). An individ-
pearsonassess.com). ual’s global performance, quantified as either the
number correct score or error score, provides the
best indicator of impairment. According to the
Psychometric Data manual, measures of specific error types, such as
omissions, perseverations, and distortions, are not
Information on reliability and validity may be by themselves diagnostic but may raise hypothe-
found in the manual. Test-retest reliability is ses for further testing. For example, a high number
0.85. Alternate form reliability ranges from 0.79 of perseverative errors suggests possible frontal
to 0.84. There is evidence that Form C is slightly lobe damage, particularly if supported by other
less difficult than Forms D and E under Adminis- test and behavioral data. Omission of peripheral
tration A. Correlations between immediate figures may raise suspicion of brain damage and is
(Administration A) and delayed (Administration most frequently associated with left hemispatial
Benton Visual Retention Test 3

neglect as a result of damage to right parietal lobe abnormal patterns of visual scanning and fixation
regions. In contrast, global performance has not related to deficient attention (Obayashi et al. 2003)
been found to consistently distinguish between or be related to poor executive functions (Egan et al.
patients with unilateral right and left brain dam- 2011). Another clinical application is the inclusion
age. Though the BVRT is sensitive to visuospatial of the BVRT in a neuropsychological battery for the
disturbance often observed in patients with right prediction of driving safety in patients with early
hemisphere damage, studies have shown that indi- dementia (Dawson et al. 2009). The BVRT may
viduals with unilateral left hemisphere damage also be useful in detecting malingering, which has
can exhibit similarly poor results on Administra- been characterized by a greater number of errors,
tion A (Vakil et al. 1989), as well as on copy and particularly distortion errors, than seen in neuropsy-
multiple-choice administrations (Arena and chologically impaired patients (Suhr et al. 1997).
Gainotti 1978). This indicates that memory for In evaluating results, it is important to consider
the BVRT designs, many of which can be verbal- that the BVRT may also be sensitive to individual
ized, is mediated by both hemispheres. However, differences that do not reflect neuropathology.
the presence of a delay interval may differentially Stratified normative data confirm that age is neg-
affect verbally and visually encoded material. Par- atively correlated and that baseline intellectual
ticipants with right hemisphere damage achieved functioning is positively correlated with the
a lower total correct score on Administration BVRT number correct score. The association
D than Administration A, whereas individuals with baseline intellect is strongest in the lower
with left hemisphere damage had the opposite than average IQ ranges. Education-stratified
pattern of performance, benefitting from the norms are also available and indicate a positive
delay. In contrast, scores from healthy participants relationship between years of education and the
did not differ between the two administrations number correct score (Strauss et al. 2006).
(Vakil et al. 1989). Declines in executive function and attention with
Both copy and memory administrations are normal aging have been associated with lower
highly sensitive to early dementia and may also BVRT scores and may be related to educational
help to identify individuals who are at risk for level or “cognitive reserve.” In a large sample of
developing dementia in the future. In one such healthy elderly adults, those with higher education
study, participants with six or more errors on performed better by using a more exhaustive
Administration A were nearly twice as likely to search strategy in the multiple choice administra-
develop Alzheimer’s disease 10–15 years later, tion (Le Carret et al. 2003). The BVRT is used
when compared to participants who had fewer worldwide, and normative data have been
errors (Kawas et al. 2003). The BVRT also aids published from more than a dozen countries
in identifying children with a learning disability (Mitrushina et al. 2005). Most studies have
and discriminating among types of learning dis- shown no gender differences. While relatively
abilities, with reading deficits associated with the few in number, studies involving direct cross-
lowest levels of performance (Snow 1998). Poorer cultural comparisons demonstrate generally good
performance on the BVRT in learning disabilities consistency; however, caution is recommended
has been linked with deficits in the identification of when testing individuals with very low levels of
facial emotional expression (Dimitrovsky et al. education (Mitrushina et al. 2005). Results from a
1998). Children with attention-deficit/hyperactivity large Columbian sample of school-aged children
disorder receiving stimulant medication have also did not differ from North American norms
been shown to perform more poorly on the BVRT (Rosselli et al. 2001), suggesting that when edu-
than healthy participants (Risser and Bowers 1993). cational quality is similar, as is increasingly more
Poorer performance is also evident in a subset of common in developed countries, cross-cultural
patients with schizophrenia and may result from differences, if present, are relatively small.
4 Benton Visual Retention Test

See Also Le Carret, N., Rainville, C., Lechevailler, N., Lafont, S.,
Letenneur, L., & Fabrigoule, C. (2003). Influence of
education on the Benton visual retention test perfor-
▶ Short-Term Memory mance as mediated by a strategic search component.
▶ Visual-Motor Functioning Brain and Cognition, 53, 408–411.
▶ Visuoperceptual Mitrushina, M. N., Boone, K. B., Razani, J., & D’Elia, L. F.
▶ Wechsler Memory Scales (2005). Handbook of normative data for neuropsycho-
logical assessment (2nd ed.). New York: Oxford Uni-
versity Press.
Obayashi, S., Matsushima, E., Ando, H., Ando, K., &
Further Reading Kojima, T. (2003). Exploratory eye movements during
the Benton visual retention test: Characteristics of
Amieva, H., Gaestel, Y., & Dartigues, J. (2006). The visual behavior in schizophrenia. Psychiatry and Clin-
multiple-choice formats (forms F and G) of the Benton ical Neurosciences, 57, 409–415.
visual retention test as a tool to detect age-related mem- Risser, M. G., & Bowers, T. G. (1993). Cognitive and
ory changes in population-based studies and clinical neuropsychological characteristics of attention deficit
settings. Nature Protocols, 1, 1936–1938. hyperactivity disorder children receiving stimulant
Arena, R., & Gainotti, G. (1978). Constructional apraxia medications. Perceptual and Motor Skills, 77,
and visuoperceptive disabilities in relation to laterality 1023–1031.
of lesions. Cortex, 14, 463–473. Rosselli, M., Ardila, A., Bateman, J. R., & Guzman,
Benton, A. L. (1945). A visual retention test for clinical M. (2001). Neuropsychological test scores, academic
use. Archives of Neurology and Psychiatry, 54, performance, and developmental disorders in Spanish-
212–216. speaking children. Developmental Neuropsychology,
Benton, A. L. (1965). Manuel pour l’application du test de 20, 355–373.
rétention visuelle (1965). Paris: Les Editions du Centre Sivan, A. B. (1992). Benton visual retention test (5th ed.).
de Psychologie Applique. San Antonio: Psychological Corporation.
Benton, A. L. (1974). Revised visual retention test: Clini- Sivan, A. B., & Spreen, O. (1996). Der Benton-Test
cal and experimental applications (4th ed.). New York: (7th ed.). Bern: Verlag Hans Huber.
Psychological Corporation. Snow, J. H. (1998). Clinical use of the Benton visual
Dawson, J. D., Anderson, S. W., Uc, E. Y., Dastrup, E., & retention test for children and adolescents with learning
Rizzo, M. (2009). Predictors of driving safety in early disabilities. Archives of Clinical Neuropsychology, 13,
Alzheimer disease. Neurology, 72, 521–527. 629–636.
Dimitrovsky, L., Spector, H., Levy-Shiff, R., & Vakil, Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A
E. (1998). Interpretation of facial expressions of affect compendium of neuropsychological tests: Administra-
in children with learning disabilities with verbal or tion, norms, and commentary (2nd ed.). New York:
nonverbal deficits. Journal of Learning Disabilities, Oxford University Press.
31, 286–292. Suhr, J., Tranel, D., Wefel, J., & Barrash, J. (1997). Mem-
Egan, G. J., Hasenkamp, W., Wilcox, L., Green, A., Hsu, ory performance after head injury: Contributions of
N., Boshoven, W., Lewison, B., Keyes, M. D., & Dun- malingering, litigation status, psychological factors,
can, E. (2011). Declarative memory and WCST-64 and medication use. Journal of Clinical and Experi-
performance in subjects with schizophrenia and healthy mental Neuropsychology, 19, 500–514.
controls. Psychiatry Research, 188, 191–196. Vakil, E., Blachstein, H., Sheleff, P., & Grossman,
Kawas, C. H., Corrada, M. M., Brookmeyer, R., Morrison, S. (1989). BVRT-scoring system and time delay in the
A., Resnick, S. M., Zonderman, A. B., & Arenberg, differentiation of lateralized hemispheric damage.
D. (2003). Visual memory predicts Alzheimer’s disease International Journal of Clinical Neuropsychology,
more than a decade before diagnosis. Neurology, 60, 11, 125–128.
1089–1093.