Home Browse Evaluation of the Bender Visual-Motor Gestalt Test in young subjects:...
ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
▬
✚
Systematic Review

Evaluation of the Bender Visual-Motor Gestalt Test in young subjects: a systematic review

[version 1; peer review: awaiting peer review]
Hicham Lafhal
https://orcid.org/0009-0006-4245-7043
1-3, Ahmed Omar Touhami Ahami1, Siham Goutou4, Atmane Rochdi2
Hicham Lafhal
https://orcid.org/0009-0006-4245-7043
1-3, Ahmed Omar Touhami Ahami1, Siham Goutou4, Atmane Rochdi2
PUBLISHED 02 Sep 2025
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS AWAITING PEER REVIEW

Abstract

Introduction

The Bender Visual-Motor Gestalt Test (BGT) is a widely used tool for assessing visual-motor skills in children. However, its use remains controversial due to persistent questions about its validity and specificity, particularly in screening for neurodevelopmental disorders. This systematic review aims to analyze studies published between 2014 and 2024 that have used the BGT in young subjects, in order to assess its clinical and psychometric relevance in this population.

Methods

A systematic search was conducted according to PRISMA 2020 guidelines in the PubMed, Embase and Scielo databases, targeting publications between 2014 and 2024. Seventeen studies meeting the inclusion criteria were selected. Their methodological quality was assessed using the Jadad, Newcastle-Ottawa and AMSTAR 2 scales.

Results

The BGT is used in a variety of contexts (neurodevelopmental disorders, learning disabilities, environmental exposure, etc.). It is useful for initial screening, although its diagnostic sensitivity varies between populations. Some studies integrate the BGT into combined batteries or exploit innovative technological approaches. Results suggest a correlation between age, pubertal development and visuo-motor performance, but gender-related differences remain poorly documented.

Discussion

The BGT remains a relevant tool for assessing visuomotor function in children, especially when used in a multidimensional framework. Its lack of diagnostic specificity and the heterogeneity of the studies nevertheless highlight the need for further research, particularly longitudinal and normative.

Keywords

Bender-Gestalt test, Visuomotor assessment, Child, Neuropsychology, Developmental disorders,

Corresponding authors: Hicham Lafhal, Ahmed Omar Touhami Ahami, Siham Goutou, Atmane Rochdi
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2025 Lafhal H et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Lafhal H, Ahami AOT, Goutou S and Rochdi A. Evaluation of the Bender Visual-Motor Gestalt Test in young subjects: a systematic review [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:848 (https://doi.org/10.12688/f1000research.168814.1) First published: 02 Sep 2025, 14:848 (https://doi.org/10.12688/f1000research.168814.1) Latest published: 02 Sep 2025, 14:848 (https://doi.org/10.12688/f1000research.168814.1)

Introduction

Visual-motor, or perceptual-motor, development is an essential component of early neuropsychological function. It refers to the coordinated integration between perceived visual information and executed motor responses, notably in graphic reproduction or hand-eye coordination tasks. These skills are at the heart of fundamental learning, such as reading, writing and mathematical reasoning.1 Their assessment is therefore of particular importance in screening for neurodevelopmental disorders and difficulties at school.

The Bender Visual-Motor Gestalt Test (BGT), designed by Lauretta Bender in 1938, is one of the most widely used tools for this purpose, and is frequently used by school and clinical psychologists.2 This test asks children to reproduce a series of standardized geometric figures, enabling observation of perceptual-motor abilities, spatial organization, motor planning and sustained attention. Even in the early decades of its use, authors such as Kitay (1972) emphasized its unique clinical benefits in identifying neurological deficits or atypical cognitive styles.3 However, Keogh (1969) showed that, while the BGT could globally distinguish atypical from normal children, overlaps between groups limited its individual predictive validity.4

The BGT was originally conceived as a measure of perceptual-motor maturity, which was assumed to be reached around the age of 11. Since then, numerous studies have confirmed that test performance evolves with age and is generally less influenced by cultural factors than other cognitive tests.5,6 This explains its widespread use in children, but also its occasional use in adolescents and adults, particularly in cases of neurological, psychiatric or learning disorders.7,8

The use of BGT in contemporary clinical contexts has also been enriched by new perspectives. It is now combined with other psychometric tools or mobilized in innovative technological approaches, including artificial intelligence for automated analysis of graphic productions. Yet, despite this expansion, uncertainties persist as to its sensitivity and specificity for different child profiles, and its discriminative value remains open to debate.

In this context, the present systematic review aims to synthesize the scientific knowledge produced between 2014 and 2024 concerning the use of BGT in young subjects aged 3 to 15. The objectives are to identify the contexts in which the test has been used in clinical, educational or experimental settings, to assess the methodological quality and specific contributions of the studies reviewed, and to identify the current limitations of the tool and prospects for future research in neuropsychological assessment.

Materials and methods

Study design

This study is based on a systematic review conducted according to the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations,9 with the aim of identifying and analyzing studies using the Bender Visual-Motor Gestalt Test (BGT) to assess visual-motor skills in children aged 3 to 15.

Search strategy

A systematic search was conducted in three electronic databases: PubMed (Medline), Embase and Scielo. The search period covered publications between January 2014 and April 2024. Keywords were selected from the MeSH thesaurus and included: “Bender Visual-Motor Gestalt Test”, “Bender Test”, “Bender Gestalt Visuomotor Test”, and “Visual-Motor Performance Test”. These descriptors were combined with the Boolean operators AND, OR, and NOT to optimize the relevance of the results.

Inclusion and exclusion criteria

Studies were included if they met the following criteria:

  • • Published between 2014 and 2024, with no language restrictions;

  • • Target population: children aged 3 to 15;

  • • Use of the BGT as a primary or complementary tool for assessing motor skills;

  • • Quantitative, qualitative, observational, experimental studies or systematic reviews.

Excluded:

  • • Publications without full text available;

  • • Studies in which the role of the BGT in the assessment was not clearly defined;

  • • Conference abstracts without an associated full-text article.

Study selection

After eliminating duplicates, titles and abstracts were reviewed independently by two reviewers. Potentially eligible articles were then read in full text to confirm their inclusion. Discrepancies were resolved by consensus.

Assessment of methodological quality

The quality of the selected studies was assessed using validated tools adapted to the type of study:

  • • Jadad scale for randomized clinical trials.10

  • • Newcastle-Ottawa scale for observational studies.11

  • • AMSTAR 2 for systematic reviews and meta-analyses.12

Data extraction and analysis

A standardized extraction table was used to collect the following information: author’s name, year of publication, study type, objectives, study population, psychometric tools used, main results and conclusions. A second table was drawn up to summarize the methodological characteristics of the studies and assess their relevance, the rigor of the methodology, and the robustness of the conclusions.

Results

Our study highlighted a scarcity of publications, between 2014 and 2024, on the role of the Bender Visual-Motor Gestalt Test in assessing visuomotor and psychometric skills in young people aged 3 to 15, in a variety of contexts.

In fact, only 40 articles were retrieved by the electronic search. After reviewing the various abstracts and reading the full texts, 17 articles were deemed eligible, meeting our inclusion criteria ( Figure 1).

b6c79521-4778-491c-9700-dcb0c50d3577_figure1.gif

Figure 1. Flow chart of study selection process and results.

Table 1. Evaluation of studies included in the review. Compilation personnelle des auteurs (Lafhal et al., 2024).

Author/Year Type of studyRelevance to this studyClearly stated objectives Appropriate study methodSample Consideration of confounding factors and biases Validation of questionsUnderstandable tables/figures Conclusions supported by results
Orak, Sibğatullah Ali (2024)13Prospective observational comparative studyYesYesYesYesNoYesYesYes
AKIL, Mustafa (2024)14Comparative experimental studyYesYesYesYesNoYesYesYes
Ahmadsaraei (2024)15Comparative experimental studyYesYesYesYesYesYesYesYes
Shivangi Sharma, 202216Observational studyYesYesYesYesYesYesNoYes
Sarah mufti 202117Comparative cross-sectional studyYesYesYesYesYesYesYesYes
Tafti, Mahnaz Akhavan, 202118Cross-sectional comparative studyYesYesYesYesYesYesYesYes
Barbora Blazkova, 202019Cross-sectional studyYesYesYesYesYesYesYesYes
KILIÇ, Ayben 202020Comparative pilot studyYesYesYesYesYesYesYesYes
Saniee, S, 201921Quasi- experimental studyYesYesYesYesNoYesYesYes
Kyung Hyun Kim, 201922Retrospective observational studyYesYesYesYesYesYesYesYes
Strait, Julia, 201923Psychometric studyYesYesYesYesYesYesYesYes
Patrícia Cunha, 201924Analytical observational studyYesYesYesYesYesYesYesYes
Lívia de Freitas Keppeke, 201825Correlational studyYesYesYesYesNoYesYesYes
Mukherjee, Soumava, 201826Observational, correlational, exploratory studyYesYesYesYesYesYesYesYes
Bildiren, Ahmet, 201727Psychometric studyYesYesYesYesNoYesYesYes
Lamônica, Dionísi, 201628Case studyYesYesYesYesYesYesYesYes
Vasanthi Done 201629Comparative observational cohortYesYesYesYesYesYesYesYes

Table 2. Comparison of characteristics and results of the studies included in the review. Compilation personnelle des auteurs (Lafhal et al., 2024).

Table 2: presents the main characteristics of the included studies, detailing the types of research, assessment tools mobilized, objectives pursued, and populations studied. It reflects the diversity of contexts in which the Bender test is used, from neurodevelopmental disorders to targeted cognitive assessments. This summary highlights the wealth of clinical and experimental applications of the BGT.

Author/Year Type of study Assessment scale Scale Score Study objective Study population Parameters analyzed Means of assessment
ORAK, Sibğatullah Ali 202413Prospective comparative observational study

  • - WISC-R

  • - SCWT

  • - BGT

  • - EEG

  • - Significantly lower verbal and total IQ in SeLECTS group vs. ADHD group

  • - SCWT: completion time significantly longer in SeLECTS + ADHD group vs. SeLECTS alone or ADHD alone

  • - No significant difference in Bender test between groups

  • - Verbal IQ below norm in both SeLECTS and SeLECTS + ADHD groups

Examine the prevalence of ADHD in children with SeLECTS and vice versa, as well as correlations between electroclinical, neurocognitive and comorbidity parameters, via psychometric and electrophysiological tests

  • - Children aged 7 to 13

  • - Groups: SeLECTS, SeLECTS + ADHD, and ADHD (exact numbers not specified, but n=11 for SeLECTS + ADHD)

  • - Verbal IQ, performance IQ, total IQ

  • - Sustained attention (SCWT)

  • - Visual-motor distortions (Bender test)

  • - Epileptiform activity (EEG)

  • - ADHD/epilepsy comorbidity rate

  • - Standardized psychometric tests: WISC-R, SCWT, Bender Gestalt (SeLECTS only)

  • - EEG for identification of epileptiform activity

  • - Intergroup statistical comparisons (p < 0.05 for significance thresholds)

AKIL, Mustafa 202414Comparative experimental study

  • - Bender- Gestalt test

  • - Attention test

Improved scores in visuo-motor integration and selective attention in both groups, but with a higher gain in the cooperative learning groupTo evaluate the effect of a physical education program incorporating fundamental motor skills using a cooperative learning method on children's cognitive health (visuo-motor integration and attention)60 boys aged 10 to 11 divided into two groups:

  • - classic method group (mean age: 10.95 ± 0.58 years)

  • - Cooperative learning group (mean age: 10.91 ± 0.42 years)

  • - Visual-motor integration

  • - Selective attention Intra- and inter-group comparison

  • - 8-week physical education program (40 min/3 days/week)

  • - Tests administered before and after:Bender-Gestalt, d2 test - Intra- and inter- group statistical analysis

Ahmad saraei. 202415Comparative experimental studyBender Gestalt testAccuracy rate obtained by the models:

  • - MYOLO v5: highest accuracy

  • - MResNet 50: slightly lower accuracy

Compare the performance of two deep learning models (MYOLO v5 vs. MResNet 50) in automatically detecting patterns in children's psychological drawings from the Bender-Gestalt test386 Bender-Gestalt drawings of children aged 4 to 11; available metadata: age, gender, family composition, psychological evaluation, etc.

  • - Pattern classification accuracy

  • - Comparative performance of the two deep learning architectures

  • - Analysis on pre-processed and semi-automatically annotated images

  • - Deep learning algorithms: MYOLO v5 and MResNet 50

  • - OBGET dataset for children (C-OBGET )

  • - Preprocessing, semi-automatic labeling and deployment of models for comparison

Shivangi Sharma 202216Observational study

  • - Pulse oximeter

  • - Bender Visual Motor Gestalt Test

  • - Electric pulp tester

Physiological, psychomotor and analgesic changesEvaluate changes in physiological, psychomotor and analgesic parameters during nitrous oxide (N2O) titration in children aged 3-12 years100 children aged 3 to 12Oxygen saturation, heart rate, pain and psychomotor performanceOximeter, Bender Visual-Motor Gestalt Test, electric pulpometer test
Sarah mufti 202117Comparative cross-sectional study

  • - Bender Gestalt Test II

Subtest scores (copy, recall, perceptual, motor) with significant difference in recall testTo study neuropsychological functioning in children with and without specific learning disabilities116 children aged 8Memory function, with comparison of recall scores between the two groupsBender Gestalt Test II (copy, recall, perceptual and motor test subscales), SPSS 21 analysis
TAFTI, Mahnaz Akhavan. 202118Cross-sectional comparative study

  • - FEATS

  • - BGT

  • - WISC-IV

  • - PPAT

  • - 4 FEATS subscales: integration, realism, perseverance, rotation

  • - -Bender-Gestalt: distortion, disintegration, perseverance, rotation

To compare the diagnostic power of the FEATS test and the Bender-Gestalt test in identifying specific learning disabilities (SLD) in students80 primary school pupils aged 7 to 11 (40 with SLI, 40 without SLI), matched for age, gender and grade. Sample recruited in Iran (Babol SAD center and public schools)

  • - FEATS and Bender-Gestalt subscale scores

  • - Intergroup differences (TAS vs. non-TAS)

  • - Construct validity between components

  • - PPAT test

  • - FEATS scales (4 subscales)

  • - Bender-Gestalt test

  • - WISC-IV

  • - Statistical analysis: t-test, Pearson correlation, MANOVA

Barbora Blazkova 202019Cross-sectional study

  • - BGT

  • - RCPM

Links between prenatal oxidation and cognitive performanceInvestigating the impact of PM2.5 particle-related oxidative damage during the prenatal period on children's cognitive development at five years of age5-year-old children, n = 169, born in 2013 and 2014, living in Karvina (polluted area) and Ceske Budejovice (control area)Prenatal PM2.5 levels, oxidation biomarkers in urine and plasma (8-oxodG, 15- F2t-IsoP), cognitive testsMeasurement of PM2.5 levels during the 3rd trimester of pregnancy, cognitive tests (BGT and RCPM)
KILIÇ, Ayben 202020Comparative pilot study

  • - WISC-R

  • - BGTender

  • - Significantly weaker performance subtests: → image completion (p = 0.024), → image arrangement (p = 0.001), → object assembly (p = 0.000)

  • - Significantly weaker verbal subtests:→ similarity (p = 0.021), → judgment (p = 0.048)

Assessing the neuropsychological development of children with primary monosymptomatic nocturnal enuresis using standardized cognitive tests

  • - 30 children with primary monosymptomatic nocturnal enuresis

  • - 30 matched control children (mean age ≈ 8 years; equal distribution F/H

  • - Verbal and non-verbal reasoning

  • - Perception visuo-motor and integration

  • - Short-term memory, abstract thinking, problem solving

Psychometric assessment with WISC-R (6 verbal subtests and 6 of performance) - Bender Gestalt test
Saniee, S 201921Quasi- experimental study

  • - WCST

  • - BGT

  • - Behavioural Flexibility Rating Scale

Significant improvement:

  • - Cognitive flexibility: Bender (ηp2 = 0.84), WCST (ηp2 = 0.87)

  • - Behavioural flexibility (ηp2 = 0.79)

  • - Repetitive behaviors (ηp2 = 0.45)

Develop and evaluate a training program (SSIT) aimed at improving cognitive and behavioral flexibility (set- shifting) in children with high-functioning autism13 children aged 5 to 7 with high- functioning autism spectrum disorder (HFA)

  • - Cognitive flexibility

  • - Behavioral flexibility

  • - Repetitive behaviors

  • - Effects maintained at 6 weeks

  • - SSIT program including:

    → A puzzle-type computer game (Tatka)

    → Home tasks for generalization

  • - Assessments before, after and at 6 weeks post-intervention

Kyung Hyun Kim
201922		Observational study

  • - WISC-R

(Korean version):
Total IQ (FSIQ),
Verbal IQ (VIQ),
Performance IQ (PIQ)

  • - BGT

  • - Total IQ: 110.21 → 113.95 (p = 0.307)

  • - VIQ: 108.92 → 111.54 (p = 0.368)

  • - PIQ: 107.88 → 111.04 (p = 0.152)

  • - Block Design: significant improvement (p = 0.021)

Assessing the impact of arachnoid cyst surgery on neurocognitive functioning in children24 children (19 boys, 5 girls; mean age: 9.4 years) who underwent arachnoid cyst surgery between June 2009 and August 2012 at Seoul National University Children's Hospital

  • - Total, verbal and performance IQ (WISC-R)

  • - Visual-spatial abilities (Bloc Design)

  • - Comparison by laterality of cyst (left/right) Cyst volume (pre- and post- op)

  • - Location (20 temporal, 4 frontal)

  • - Cerebral imaging to measure cystic volume (calculation by area × slice thickness)

  • - Neuropsychological tests (WISC-R, BGT) performed twice by psychologists within one year of surgery

STRAIT, Julia 201923Psychometric studyBGT-II Results not quantified in abstract, but show score invariance between ethnic groupsTo assess the presence of differential item functioning (DIF) according to ethnicity (African-American vs. Caucasian) for children aged 4 to 7 using BG-II visuomotor scoresChildren aged 4 to 7; two groups: African-American and Caucasian Differential item functioning (DIF) in figure copying tasks (BG-II)DIF analysis (probably by IRT or Mantel-Haenszel, but not specified here) to determine whether test items discriminate equivalently according to ethnicity
Patrícia Cunha 201924Observational study

  • - WISC-R Wechsler - BGT)

  • - APE

APE tests and lower parental educationTo study the cognitive profiles of children with specific learning disabilities (SLD), with an assessment of auditory processing34 children with SLD and 15 control children (aged 7-14)Auditory processing, verbal and spatial reasoning, cognitive performanceAuditory tests (tone audiometry, acoustic immittance, brainstem evoked response), Wechsler Scale tests, BGT
Livia de Freitas Keppeke 201825Correlational studyBGT
Raven's Progressive Matrices Test		Visuomotor score measured by the Bender Test and analyzed according to Tanner's pubertal stagesTo study the relationship between visuomotor development and pubertal changes according to Tanner's scale134 adolescents aged 10 to 15Visual-motor development and pubertal changes (Tanner stages), Raven's scores, influence of schooling, grade repetition and developmental problemsBender Visual-Motor Gestalt Test, Raven's Progressive Matrices Test, medical data on pubertal maturity
MUKHERJEE, Soumava 201826Observational study

  • - BKT

  • - BGT

  • - Mean IQ: 85.5 (BKT)

  • - Mean BGT score: 8.6

  • - Significant difference in BGT scores according to mutation location (p = 0.005)

  • - IQ significantly lower in case of cumulative loss of Dp427/Dp260/Dp140utr isoforms (p = 0.011)

Determining the impact of DMD gene mutation localization on cognitive and visuomotor performance in children with Duchenne muscular dystrophy

  • - 10 Indian boys with DMD

  • - 4 to 9 years old

  • - All carriers of genetic deletions identified by MLPA

  • - Correlation between genetic mutation types (and affected dystrophin isoforms) and cognitive scores (IQ, BGT)

  • - MLPA (Multiplex Ligation-dependent Probe Amplification) for mutation localization

  • - Psychometric tests: BKT for general intelligence, BGT for visuomotor functions

BILDIREN, Ahmet. 201727Psychometric study

  • - CPM

  • - BGT

  • - TONI-3

KR-20 for internal consistency: high (exact values not specified)

  • - Spearman-Brown test- retest: high

  • - Significant positive correlations with Bender- Gestalt and TONI-3 (convergent validity)

  • - Standards established in percentiles by age group (3 to 9 years)

To assess the reliability and validity of the colored progressive matrix test as a diagnostic tool for identifying gifted children in the preschool period (ages 3 to 9)925 children aged 3 to 9 (433 girls, 492 boys)Internal reliability (KR- 20), test-retest reliability (Spearman- Brown), correlations between scores on colored progressive matrices, Bender- Gestalt test and TONI-3 tests, age norms in percentilesStatistical methods of reliability (Kuder Richardson-20, Spearman-Brown), correlation analysis (Pearson product- moment) between different psychometric tests
LAMÔNICA, Dionísi 201628Single descriptive case study

  • - Peabody test

  • - School performance test

  • - Phonological awareness profile

  • - Raven

  • - Wechsler

  • - BGT

  • - Wisconsin Card Sorting Test

  • - Significant psycholinguistic delay

  • - Poor arithmetic and writing skills

  • - Impaired verbal and executive cognitive performance

  • - Limitations in graphic, perceptual-motor and sequential logical organization skills

Describing oral and written language and cognitive skills in a girl with Moyamoya disease after stroke and surgery

  • - A girl aged 7 years and 7 months

  • - Two strokes in left/right temporo- parietal and left frontal regions

  • - Treated surgically by revascularization and medically

  • - Language skills (oral and written)

  • - General cognitive skills (intellectual, visuo-motor, executive, phonological processing)

  • - Various neuropsychological tests (Peabody, Raven, WISC, Bender, Wisconsin)

  • - Clinical observation and family interviews

Vasanthi Done (2016)29Comparative observational cohortBender Visual Motor Gestalt Test IIPsychomotor performance assessed with modified version of the Bender Test; results slightly better with midazolam-N2O than with ketamine-N2OComparing the efficacy of oral sedation with Midazolam-N 2O and Ketamine-N 2O in children during dental treatment30 healthy children (3-9 years) (ASA I & II) requiring multiple dental extractionsPhysiological measurements (respiratory rate, pulse rate, oxygen saturation), psychomotor performancePhysiological measurements (respiratory rate, pulse rate, oxygen saturation) and psychomotor test (Modified Bender Visual Motor Gestalt Test)

The quality assessment of the selected studies is presented in Table.

Discussion

The main aim of this systematic review was to evaluate the use of the Bender Visual-Motor Gestalt Test (BGT) in the identification of visual-motor skills in young subjects, exploring the diversity of clinical, educational and experimental contexts. Results reveal that, while the BGT remains widely used between 2014 and 2024, its use has diversified and become integrated into increasingly complex research protocols, including cognitive, psychometric and neurodevelopmental analyses.

Variability of applications and diagnostic sensitivity

The included studies show that the BGT is frequently mobilized to detect deficits in special-needs groups: autism spectrum disorders,21 specific learning disabilities17,18; nocturnal enuresis,20 and even in the context of rare neurological disorders such as Duchenne muscular dystrophy.26 Tafti’s (2021) study highlights the complementarity between the BGT and other instruments such as the FEATS and WISC-IV, underlining its usefulness as a screening tool integrated into a multidimensional assessment battery.18

However, the sensitivity of the test to detect specific disorders remains variable. Orak’s study (2024), for example, showed no significant differences in BGT scores between children with epilepsy (SeLECTS), ADHD or comorbid conditions, despite notable differences in other tests (verbal IQ, sustained attention). This suggests that the BGT, although useful for certain developmental profiles, may lack specificity in complex clinical pictures involving several cognitive impairments.13

Influence of age and development

As Decker (2008) argues, visuomotor skills become more refined with age, and this is confirmed by several studies reviewed here.6 Keppeke’s (2018) study, for example, relates BGT scores to pubertal stages according to the Tanner scale, demonstrating an association between biological maturation and visuo-motor performance.25 Other studies support this trend, notably those showing progressive improvement through adolescence, followed by stabilization or decline in adulthood.6,30

Effects of school environment and neurodevelopmental disorders

Concerning the school context, studies by Blazkova (2020) and Cunha (2019) provide relevant evidence of an impact of the level of prenatal exposure to environmental factors (pollution, family conditions) on BGT scores.19–24 This corroborates Romi’s (2005) work on the link between school difficulties and poor visuo-motor skills.5

Finally, children with neurodevelopmental disorders such as high-functioning autism21 and ADHD6 consistently perform less well on the BGT, supporting its value in the initial screening and monitoring of atypical developmental trajectories.

Technological and innovative perspectives

One of the innovative contributions listed in this review is that of Ahmadsaraei (2024), who demonstrates the applicability of BGT in the field of artificial intelligence for the automated analysis of visuo-motor figures.15 This opens up interesting clinical prospects for low-resource countries or structures requiring mass screening.

Limitations of included studies

The majority of included studies present moderate sample sizes, often centered on a single geographic region, which limits generalizability. Furthermore, although several studies use the BGT in a combined approach with other tests (WISC-R, Raven, etc.), few rely on longitudinal measures or robust long-term experimental designs. What’s more, the heterogeneity of the test versions used (original BGT, BGT II, modified BGT) makes direct comparison of results difficult.

Clinical implications

Despite certain methodological limitations, the data collected in this review confirm the value of the BGT as an initial screening tool, particularly in pediatric neuropsychological assessments. It is particularly useful for identifying perceptual- motor deficits in children with neurodevelopmental disorders or academic difficulties. Its integration into multi-tool assessment batteries is recommended to compensate for its lack of isolated specificity.

Conclusion

This systematic review confirms that the Bender Visual-Motor Gestalt Test (BGT) remains a frequently used tool for assessing visuo-motor skills in children and adolescents, particularly in the context of neurodevelopmental disorders, learning disabilities and neurological impairment. The studies reviewed show that, although the BGT can identify certain perceptual-motor deficits, its diagnostic sensitivity remains uneven across clinical contexts, particularly in the presence of comorbidities or complex disorders.

Integrating the BGT into multidimensional assessment batteries seems to enhance its clinical value, especially when combined with tools such as the WISC, Raven or innovative psychometric approaches. Work exploring the use of the BGT in the context of artificial intelligence also highlights its potential for large-scale automated screening. Nevertheless, the diversity of test versions used, limited sample sizes and lack of robust longitudinal data hamper the comparability of results and limit generalizable conclusions.

With this in mind, future normative and longitudinal research is needed to strengthen the validity and specificity of the BGT, particularly in a variety of educational and clinical contexts, and for different developmental age ranges.

Ethical approval statement

This systematic review did not require the collection of primary data or research involving human or animal participants; therefore, formal ethical approval was not required. All sources included in the review are publicly available and have been properly cited in accordance with academic standards.

Informed consent statement

Since this research is a systematic review based on previously published studies and does not involve the direct participation of individuals, informed consent was not required.

Patient consent for publication

Patient consent for publication was not required, as no individual patient data or identifiable information was included in this systematic review.

Reporting guidelines

The PRISMA-related documents for this systematic review (completed PRISMA 2020 checklist and study selection flow diagram) are available in the Zenodo repository:

Title: PRISMA 2020 Checklist and Flow Diagram – Bender-Gestalt Visual-Motor Test in Young Subjects

DOI: https://doi.org/10.5281/zenodo.1673814531

License: CC0 1.0 Universal (Public Domain Dedication)

Data availability statement

The data used in this systematic review are derived exclusively from publicly available publications. All sources of information have been appropriately cited. No original data sets were generated or analyzed specifically for this study.

References

  • 1.  Carvalho LD, Noronha APP, Pinto LP, et al.: Maturidade perceptomotora e reconhecimento de palavras: Estudo correlacional entre o Bender-Sistema de Pontuação Gradual e o Teste de Reconhecimento de Palavras. Estudos de Psicologia (Campinas). 2012; 29: 371–377. Publisher Full Text
  • 2.  Bender L: A visual motor gestalt test and its clinical use. Research Monographs, American Orthopsychiatric Association; 1938.
  • 3.  Kitay PM: Review of the Bender-Gestalt Test. Seventh Mental Measurements Yearbook. Highland Park, NJ: Gryphon; 1972.
  • 4.  Keogh BK: The Bender Gestalt with children: Research implications. J. Spec. Educ. 1969; 3(1): 15–22. Publisher Full Text
  • 5.  Noronha APP, Rueda FJM, Santos AAAD: Bender Gestalt Visual-Motor Test–Sistema de Pontuação Gradual (B-SPG): A study with different samples. Paidéia (Ribeirão Preto). 2013; 23(55): 179–185. Publisher Full Text
  • 6.  Allen RA, Decker SL: Utility of the Bender Visual-Motor Gestalt Test—Second Edition in the assessment of attention-deficit/hyperactivity disorder. Percept. Mot. Skills. 2008; 107(3): 663–675. PubMed Abstract | Publisher Full Text
  • 7.  Tremblay L, Chebbi B, Bouchard S, et al.: Learning disabilities and visual-motor skills: Comparing assessment from a hapto-virtual reality tool and Bender-Gestalt test. Virtual Reality. 2014; 18: 49–60. Publisher Full Text
  • 8.  Issac TG, Chandra SR, Rajeswaran J, et al.: Demographic features and neuropsychological correlates in a cohort of 200 patients with vascular cognitive decline due to cerebral small vessel disease. Indian J. Psychol. Med. 2016; 38(2): 127–132. PubMed Abstract | Publisher Full Text | Free Full Text
  • 9.  Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. PubMed Abstract | Publisher Full Text | Free Full Text
  • 10.  Jadad AR, Moore RA, Carroll D, et al.: Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Control. Clin. Trials. 1996; 17(1): 1–12. Publisher Full Text
  • 11.  Wells GA, Shea B, O’Connell D, et al.: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute; 2000.
  • 12.  Shea BJ, Reeves BC, Wells G, et al.: AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017; 358: j4008. PubMed Abstract | Publisher Full Text | Free Full Text
  • 13.  Orak SA, Bilaç Ö, Polat M, et al.: Neurocognitive effects and electrophysiological findings in ADHD and self-limiting centrotemporal spike wave epilepsy (SeLECTS): A prospective tertiary care study. Epilepsy Behav. 2024; 157: 109900. PubMed Abstract | Publisher Full Text
  • 14.  Akil M, Tokay B, Güngör MG: Cognitive health outcomes of fundamental motor skill applications in children through cooperative learning method. BMC Psychology. 2024; 12(1): 522. PubMed Abstract | Publisher Full Text | Free Full Text
  • 15.  Ahmadsaraei MF, Bastanfard A, Amini A: Child psychological drawing pattern detection on OBGET dataset: A case study on accuracy based on MYOLO v5 and MResNet 50. Multimed. Tools Appl. 2024; 83(13): 39283–39313. Publisher Full Text
  • 16.  Sharma S, Chopra R, Mathur S, et al.: Variations in physiological, psychomotor, and analgesic parameters during titration of nitrous oxide in 3–12 years old children managed with inhalation sedation. Int. J. Clin. Pediatr. Dent. 2020; 13(6): 650–655. PubMed Abstract | Publisher Full Text | Free Full Text
  • 17.  Mufti S, Arshad M, Bibi B: Neuropsychological functioning in children with and without specific learning disorder. J. Pak. Med. Assoc. 2021; 71: 1–11. Publisher Full Text
  • 18.  Tafti MA, Azizi ZR, Mohamadzadeh S: A comparison of the diagnostic power of FEATS and Bender-Gestalt Test in identifying the problems of students with and without specific learning disorders. Arts Psychother. 2021; 73: 101760. Publisher Full Text
  • 19.  Blazkova B, Pastorkova A, Solansky I, et al.: Effect of polycyclic aromatic hydrocarbons exposure on cognitive development in 5 years old children. Brain Sci. 2020; 10(9): 619. PubMed Abstract | Publisher Full Text | Free Full Text
  • 20.  Kılıç A, Hacıhamdioğlu DÖ, Tural E, et al.: Evaluation of neuropsychological development of children diagnosed with primary monosymptomatic nocturnal enuresis: A pilot study. Turk. J. Urol. 2020; 46(4): 320–325. PubMed Abstract | Publisher Full Text | Free Full Text
  • 21.  Saniee S, Pouretemad HR, Zardkhaneh SA: Developing set-shifting improvement tasks (SSIT) for children with high-functioning autism. J. Intellect. Disabil. Res. 2019; 63(10): 1207–1220. PubMed Abstract | Publisher Full Text
  • 22.  Kim KH, Lee JY, Phi JH, et al.: Neurocognitive profile in children with arachnoid cysts before and after surgical intervention. Childs Nerv. Syst. 2019; 35: 517–522. PubMed Abstract | Publisher Full Text
  • 23.  Strait JE, Wright EKC, Decker SL: Bender-Gestalt II differential item functioning across Caucasian and African American examinees. Psychol. Sch. 2019; 56(1): 148–158. Publisher Full Text
  • 24.  Cunha P, de Castro Silva IM , Neiva ER, et al.: Auditory processing disorder evaluations and cognitive profiles of children with specific learning disorder. Clin. Neurophysiol. Pract. 2019; 4: 119–127. PubMed Abstract | Publisher Full Text | Free Full Text
  • 25.  de Freitas Keppeke L , Schoen TH: Perceptual-motor maturity in adolescence and the Tanner stages: A study with Bender-Gradual scoring system. Span. J. Psychol. 2018; 21: E33. PubMed Abstract | Publisher Full Text
  • 26.  Mukherjee S, Roy M, Guha G, et al.: Mutation location and cognitive impairment in Duchenne muscular dystrophy. J. Neurosci. Rural Pract. 2018; 9(3): 410–413. PubMed Abstract | Publisher Full Text | Free Full Text
  • 27.  Bildiren A: Reliability and validity study for the Coloured Progressive Matrices Test between the ages of 3–9 for determining gifted children in the pre-school period. J. Educ. Train. Stud. 2017; 5(11): 13–20. Publisher Full Text
  • 28.  Lamônica DAC, Ribeiro CDC, Ferraz PMDP, et al.: Doença de Moyamoya: Impacto no desempenho da linguagem oral e escrita. CoDAS. 2016; 28(5): 661–665. PubMed Abstract | Publisher Full Text
  • 29.  Done V, Kotha R, Vasa AAK, et al.: Comparaison de l’efficacité du midazolam–N2O par voie orale et de la kétamine–N2O par voie orale chez les patients pédiatriques – une étude in vivo. J. Clin. Diagn. Res. 2016; 10(4): ZC45–ZC48. PubMed Abstract | Publisher Full Text | Free Full Text
  • 30.  Lenroot RK, Giedd JN: Brain development in children and adolescents: Insights from anatomical magnetic resonance imaging. Neurosci. Biobehav. Rev. 2006; 30(6): 718–729. Publisher Full Text
  • 31.  Lafhal H, et al.: PRISMA 2020 checklist and flow diagram – Bender-Gestalt visual-motor test in young subjects. Zenodo. 2025. Publisher Full Text

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 02 Sep 2025
Comment
Author details Author details
Competing interests
Grant information
Article Versions (1)
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
 - -
Citations
SEE MORE DETAILS
CITE
how to cite this article
Lafhal H, Ahami AOT, Goutou S and Rochdi A. Evaluation of the Bender Visual-Motor Gestalt Test in young subjects: a systematic review [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:848 (https://doi.org/10.12688/f1000research.168814.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status:
AWAITING PEER REVIEW
AWAITING PEER REVIEW
?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 02 Sep 2025
Comment

Open Peer Review

Reviewer Status

AWAITING PEER REVIEW

Comments on this article

All Comments(0)

Add a comment
Sign up for content alerts

Browse by related subjects

    Alongside their report, reviewers assign a status to the article:
    Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
    Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
    Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
    Sign In
    If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

    The email address should be the one you originally registered with F1000.
    Email address not valid, please try again

    You registered with F1000 via Google, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Google account password, please click here.

    You registered with F1000 via Facebook, so we cannot reset your password.

    To sign in, please click here.

    If you still need help with your Facebook account password, please click here.

    Code not correct, please try again
    Email us for further assistance.
    Server error, please try again.