292 Assessment Psychology
attend to what people are thinking and feeling as well what
they are doing. As for the Goldfried and Kent distinction, be-
havioral assessors recognized that they could extend the
practical applications of their approach by supplementing be-
havioral observations with judicious utilization of clinical
judgment. As reflected in the behavioral assessment literature
that ushered in the 1990s, strictly behavioral methods became
appreciated as having some limitations, and traditional meth-
ods as having some strengths; correspondingly, behavioral
assessment evolved into a multifaceted process comprising a
broader range of techniques and levels of evaluation than had
been its legacy (see Bellack & Hersen, 1988; Ciminero,
Calhoun, & Adams, 1986; Haynes & O’Brien, 2000).
MONITORING NEUROPSYCHOLOGICAL
FUNCTIONING
As summarized by Boll (1983), neuropsychology emerged
both as a discipline and as an area of professional practice.
As a discipline, neuropsychology is the field of science con-
cerned with the study of relationships between brain func-
tions and behavior. As applied practice, neuropsychology
consists primarily of using various assessment procedures to
measure the development and decline of brain functions and
their impairment as a consequence of head injury, cere-
brovascular accidents (stroke), neoplastic disease (tumors),
and other illnesses affecting the central nervous system, of
which Alzheimer’s disease is the most prevalent. The histori-
cal highlights of formal neuropsychological assessment clus-
ter around the development of the Bender Visual Motor
Gestalt Test and the subsequent emergence of neuropsycho-
logical test batteries.
Bender Gestalt
Best known among the earliest formal psychological assess-
ment methods constructed to measure brain functions was the
Bender Visual Motor Gestalt Test, first described by Lauretta
Bender (1897–1987) in 1938 (Bender, 1938). Historical lore
has it that Bender, then a psychiatrist at Bellevue Hospital in
New York, became intrigued by psychomotor differences she
observed among children as they made chalk drawings on
the city sidewalks in preparation for playing hopscotch. She
noted that some of the children were more skillful than others
in executing these drawings. By and large, older children
were better at it than younger ones, but some older chil-
dren appeared to have persistent difficulty in drawing the
hopscotch designs accurately. These observations led Bender
to conclude that Gestalt principles of visual organization
and perception, as reflected in the drawing of designs, could
be applied to identifying individual differences in matura-
tion and detecting forms of organic brain disease and psy-
chopathology. Selecting for her test nine designs that had
been developed by Wertheimer, she presented in her 1938 text
illustrations of how these designs were likely to be copied by
normally developing children age 4 to 11 and by normal,
brain-damaged, and emotionally disturbed adults.
The Bender Gestalt test has fared both well and poorly
since 1946, when the stimulus cards were first published sep-
arately from Bender’s book and made generally available for
professional use. Among important refinements of the test,
Pascal and Suttell (1951) developed an extensive scoring sys-
tem for identifying brain dysfunction in adults, and Koppitz
(1975) undertook a large standardization study in the 1960s
to construct a scoring scheme that would measure both cog-
nitive maturation and neuropsychological impairment in
children. Lacks (1998) later proposed a simplified 12-item
criterion list that has proved fairly accurate in differentiating
brain-damaged from neuropsychologically intact adults. The
Bender Gestalt also became and has remained very popular
among assessment psychologists as a screening device for
brain dysfunction in adults and for developmental delay in
young people. In the recent test use surveys mentioned previ-
ously, this instrument was ranked fifth in frequency of use
among samples of clinical psychologists (Camara et al.,
2000) and experienced professionals conducting child cus-
tody evaluations (Ackerman & Ackerman, 1997), and seventh
among forensic examiners experienced in neuropsychology
(Lees-Haley et al., 1995).
On the other hand, with respect to its faring poorly, the
Bender was reported as being used by only 27% of sampled
members of the International Neuropsychological Society
(Butler et al., 1991), and a sample of the National Academy of
Neuropsychologists membership ranked the Bender 25th in
frequency among the measures they use (Camara et al.,
2000). The apparent disrepute of the Bender among main-
stream neuropsychologists, despite its extensive research
base, may have several origins. These include (a) its having
been developed prior to the emergence of neuropsychological
assessment as a well-defined practice specialty, which began
in the 1950s; (b) its having typically been interpreted by prac-
titioners on the basis of their subjective impressions rather
than one of the available scoring systems for it; and (c) its fre-
quently having been given more credence than was warranted
as a definitive and stand-alone indicator of cognitive insuffi-
ciency or brain dysfunction. Particularly relevant in this last
regard is the fact that, although the Bender provides useful
information concerning aspects of visual organization and
perceptual-motor coordination, it does not encompass the