VISUAL RETENTION TEST
Arthur
l.
Benton
RECORD FORM
NO. _ _ _ _
NAME __________________________________________________________ _ AGE _ _ _ _ __ SEX _ _ _ _
PLACE OF TESTING ______________________________ __ EXAMINER __________________________________ _
FIRST TESTING DATE SECOND TESTING DATE
FORM ADMINISTRATION FORM ADMINISTRATION
Score Number Score Number
Design (0 or 1) Errors' of Errors Design (0 or 1) Errors· of Errors
I I II II III III IV IV V V VI VI VII VII VIII VIII IX IX X X Number Number
Correct Error Correct Error
Score Score Score Score
'Use symbols; see Chapter 2 of manual. 'Use symbols; see Chapter 2 of manual.
ERROR CATEGORIES: ERROR CATEGORIES:
Omissions Omissions
Distortions Distortions
Perseverations Perseverations
Rotations Rotations
Misplacements Misplacements
Size Errors Size Errors
Left Errors Left Errors
Right Errors Right Errors
REMARKS __________________________________________________________________________________ __ INTERPRETATION __________________________________________________________________________ __ o o N M o o () "- I--w o u o:J « o " Q) to 00 to " to to to '" to <:t to M to -I
REVISED
VISUAL RETENTION
TEST
Clinical and Experimental Applications
Arthur L. Benton
Professor of Neurology and PsychologY1
University of Iowa
FOURTH EDITION
@
THE PSYCHOLOGICAL CORPORATION
HARCOURT BRACE JOVANOVICH, INC.
The Psychological Corporation
All rights reserved, including translation. No part of this manual, or of the test, recording forms, and norms associated with it may be repro-duced in any form of printing or by any other means, electronic or mechanical, including, but not limited to, photocopying, audiovisual recording and transmission, and portrayal or duplication in any in-formation storage and retrieval system, without permission in writing from the publisher. See Catalog for further information.
PREFACE
The fourth edition of the manual for the Revised Visual Reten-tion Test takes account of developments since 1963, the most important of which is perhaps the establishment of normative standards for Administration C (copying of the designs) for children. Chapter 5 reviews recent literature bearing on various clinical and experimental applications of the test not covered in other sections of the manual.
ARTHUR L. BENTON
TABLE OF CONTENTS
Page
Preface I . . . I . . . , . . . . 111
List of Tables ... Vll List of Figures ... vii
Chapter 1. Administration ... 1
Introduction ... 1
Administration of the Test . . . .. . . . 1
Administration A ... 1
Administration B ... 2
Administration C ... 2
Administration D ... 2
Chapter 2. Scoring ... . . . 4
The Two Scoring Systems ... 4
Number ·of Correct Reproductions. . . 4
Error Score . . . 4
Scoring Principles and Samples ... 10
Chapter 3. Norms ... , 42 Administration A ... , 42 Adult Norms. . . .. 43 Children's Norms ... 44 Administration B . . . .. 45 Administration C . . . .. 46 Adult Norms ... , 46 Children's Norms ... 47 Administration D ... 50
Chapter 4. Diagnostic Interpretation ... 51
Performance of Patients with Cerebral Lesions ... , 52
Qualitative Analysis of Performance ... , 55
Omission of a Peripheral Figure . . . .. 56
Rotations . . . .. 57
Size Errors ... 58
Localization of Lesion ... 58
Performance of Brain-Damaged Patients on Administration C ... 61
Performance of Children ... 64
Performance of Mental Defectives .. . . .. 67
Performance of Schizophrenic Patients ... , 69
Performance of Depressed Patients ... 71
Performance of Simulators ... , 71
Performance in Old Age ... 72 Performance under Administration D (Delayed Memory) 72
Chapter 5. Review of Recent Literature ... 74
Normative Studies ... " 74 Reliability and Comparability of Forms . . . .. 77
Correlations with Other Tests. . . .. 78
Validity and Clinical Application . . . .. 79
Experimental-Clinical Application ... 82
Concluding Comments ... 85
LIST OF TABLES
Th~ ~p
1 Norms for Administration A:
Adults - Number Correct Scores. . . .. 44 2 Norms for Administration A:
Adults - Error Scores . . . .. 44 3 Norms for Administration A:
Children - Number Correct Scores ... 45 4 Norms for Administration A:
Children - Error Scores ... . . . . .. 45 5 Norms for Administration C:
Adults - Error Scores ... 47 6 Norms for Administration C:
Children - Number Correct Scores. . . . .. 48 7 Norms for Administration C:
Children - Error Scores ... 48 8 Administration C:
Superior Children - Number Correct Scores .... . . . .. 49 9 Administration C:
Superior Children - Error Scores . . . .. 49 10 Distributions of Deviation Scores, Derived from
Number Correct Scores, for Patients with Brain Disease
and for Control Patients ... " 53 11 Distributions of Error Scores for Brain-Damaged Patients
and for Control Patients ... " 62 12 Distributions of Deviation Scores, Derived from
Number Correct Scores, for Brain-Damaged Children
and for Emotionally Disturbed Children ... 66 13 Mean Number Correct Scores for 504 Normal Subjects,
by Age and Intelligence Level. . . . .. 75 14 Mean Error Scores for 545 Kindergarten Children. . . . . .. 76
LIST OF FIGURES
Figure Page
1 Types of errors made by R. C. in copying designs
(Administration C) of Form C ... " 63 2 Examples of reproductions of Form C designs made
Chapter 1
ADMINISTRATION
Introduction
The Revised Visual Retention Test is a clinical and research
in-strument designed to assess visual perception, visual memory, and visuoconstructive abilities. There are three alternate forms of the test (Forms C, D, and E). Each form consists of ten designs, with each design containing one or more figures. The time required for the administration of one form is about five minutes.
The various modes of administration of the test are as follows:
Administration A. - Each design is exposed for 10 seconds,
fol-lowed by immediate reproduction from mem-ory by the subject.
Administration B. - Each design is exposed for 5 seconds,
fol-lowed by immediate reproduction from mem-ory by the subject.
Administration C. - Each design is copied by the subject, with the
design remaining in the subject's view.
Administration D. - Each design is exposed for 10 seconds,
fol-lowed by reproduction from memory by the subject after a delay of 15 seconds.
Any of the three forms may be used in any mode of administration.
Administration of the Test Administration A
The subject is given blank sheets of paper of the same size as the cards on which the designs are printed (5 ~ x 8 ~ inches), and a pencil with an eraser. He is told that he will be shown a card on which there are one or more figures, that he will study the card for
10 seconds, and that when the card is removed, he will draw what
he has seen. Either a stopwatch or a watch with a second hand may be used for timing. The design book should be positioned at an angle
of about 60 degrees from the surface of the table to permit optimal viewing by the subject. (It should not be placed fiat on the table.)
Occasionally, a subject will start to draw the first design before the 10 seconds have elapsed. He should be stopped and told to study the card for the full time of exposure. The examiner may make a comment such as, "I know this design is an easy one, but the others are harder, and I want you to get into the habit of looking at the card for the full 10 seconds." Each card is presented without com-ment, except that before introducing Design III (the first to include two major figures and a peripheral minor figure), the examiner should say, "Do not forget to draw everything you see." If the subject omits the peripheral minor figure in his reproduction of Design III, the examiner should make the same statement before introducing Design IV. The subject is permitted to make erasures or corrections. No spontaneous praise is offered, but reassurance may be given if the subject asks about the quality of his performance.
Administration B
The procedure is essentially the same as for Administration A, except that the subject is told that he will have 5 seconds to study
the card.
Administration C
The subject is given blank sheets of paper of the same size as the cards on which the designs are printed (5 ~ x 8112 inches), and a
pencil with an eraser. He
is
told that he will be shown a card on which there are one or more-- figures, and that he is to copy the design, making a drawing whichis
as much like the original as pos-sible. The card is left in the subject's view while he performs the task.If the subject asks specific questions (e.g., whether size is impor-tant, whether lines must be perfectly straight), only the same gen-eral instruction about making the drawing as much like the original as possible is repeated and no more specific instructions are given. The general instruction should be repeated if it seems that the subject is not exerting optimal effort. If he takes an excessively long time in making a drawing, he should be encouraged to work a little faster. Erasures or corrections are permitted. No spontaneous praise is offered, but reassurance may be given if the subject asks about the quality of his performance.
Administration D
The subject is told that he will be shown a card on which there are one or more figures, that he will study the card for 10 seconds,
that the card will then be removed, and that after an interval of 15
seconds he will draw what he has seen. Unlike the other modes of
administration, the subject is not given blank sheets of paper and a pencil. Instead, the examiner gives him a single sheet of paper (SY2 x
81h inches) and a pencil with an eraser as the IS-second
post-exposure interval ends. Erasures or corrections are permitted. After the subject has finished drawing the design, both his drawing and the pencil are taken from him.
Each card is presented without comment, except that before in-troducing Design III (the first to include two major figures and a peripheral minor figure), the examiner should say, "Do not forget t6 draw everything you see." If the subject omits the peripheral minor figure in his reproduction of Design III, the examiner should make the same statement before introducing Design IV~ No spon-taneous praise is offered, but reassurance may be given if the subject asks about the quality of his performance.
Sometimes a subject attempts to fill the IS-second waiting interval by starting a conversation with the examiner. When this happens, the examiner should tactfully terminate this by encouraging the subject to concentrate and to keep the design in mind. Soine subjects attempt to retain the memory of a design by sketching it with their fingers on the table top. This is permissible as long as no visual record is made by the finger-sketching.
Chapter 2
SCORING
The Two Scoring Sy~tems
Scoring of the Visual Retention Test is objective and is accom-plished on the basis of explicit principles. Interscorer agreement has been found to be extremely high (r
=
.95) with respect to total scores, and satisfactory (r=
.75-.98) with respect to major categor-ies of errors (Wahler, 1956). Two scoring systems are available for the evaluation of subjects' performances. One, Number of CorrectReproductions, provides a measure of general efficiency of
perform-ance; the other, Error Score, takes account of the specific types of errors made by the subject.
Number of Correct Reproductions
Each design is judged on an all-or-none basis and given a score of 1 or O. Therefore, the range of possible scores for any single form of the test is from 0 to 10.
The principles underlying the scoring of each design of Forms C, D, and E, together with samples of correct and incorrect reproduc-tions, are presented on pages 12-41. The scoring standards are rather lenient because one is interested in the subject's capacity to retain a visual impression and not in his drawing ability. Thus, the size of the reproduction as a whole, as compared with the original design, is not considered in the scoring. However, within a specific design, the relative size of the figures (as compared with each other) is taken into account.
Error Score
In any less-than-perfect performance on a design, one or more specific types of errors are necessarily made by the subject. The Error Score system of evaluation classifies errors by type, and pro-vides for a total Error Score. This system, in addition to providing a measure of general efficiency of performance, facilitates analysis of the qualitative characteristics of a subject's performance.
The specific types of errors which may be made have been grouped into six major categories: omissions, distortions, perseverations, rota-tions, misplacements, and size errors. The complete scoring system is as follows: SYMBOL M MR MR! ML ML! PR PL Add SYMBOL SM SMR
OMISSIONS (AND ADDITIONS) DEFINITION
Omission of the single major figure of Design I or II; scored when the figure is completely omitted or when the subject draws only one or two lines which are not a recognizable attempt to repro-duce it.
Omission of a right major figure (i.e., in the sub-ject's right visual field); scored when the figure is completely omitted, space being provided for it
in the reproduction, or when the subject draws only one or two lines which are not a recognizable attempt to reproduce it.
Omission of a right major figure; scored when the figure is completely omitted, no space being pro-vided for it in the reproduction.
Omission of a left major figure; scored In the same manner as MR.
Omission of a left major figure; scored m the same manner as MR!
Omission of a right peripheral figure. Omission of a left peripheral figure.
Drawing of an additional figure not present in the original design and not scorable as a distortion (multiple reproduction) or a perseveration.
DEFINITION
Inaccurate reproduction of the single major figure of Design I or II by simple substitution (e.g., square for oblique parallelogram; pentagon for hexagon).
Inaccurate reproduction of a right major figure by simple substitution (e.g., circle for square; pentagon for triangle).
SML SPR SPL 1M IMR IML IMC IPR IPL
Inaccurate reproduction of a left major figure by simple substitution; scored in the same manner as SMR.
Inaccurate reproduction of a right peripheral fig-ure by simple substitution.
Inaccurate reproduction of a left peripheral fig-ure by simple substitution.
Inaccurate reproduction of the single major fig-ure of Design I or II in some manner other than simple substitution or rotation (e.g., omission, ad-dition, or misplacement of an" internal detail of the figure, fragmentation of the figure, multiple repro-duction of the figure).
Inaccurate reproduction of a right major figure in some manner other than simple substitution or rotation; scored in the same manner as 1M. Inaccurate reproduction of a left major figure in some manner other than simple substitution or rotation; scored in the same manner as 1M. Inaccurate reproduction limited to the central overlapping area of the major figures in Design III of Fonn C or D.
Inaccurate reproduction of a right peripheral fig-ure in some manner other than simple substitution or rotation (e.g., fragmentation or multiple repro-duction of the figure).
Inaccurate reproduction of a left peripheral fig-ure in some manner other than simple substitution or rotation.
PERSEVERA TIONS
A perseveration is a simple substitutive or additive response consisting of the reproduction of a figure present in the immedi-ately preceding design. If the perseverated figure is drawn on consecutive succeeding reproductions, it is scored as a per-severation each time it is drawn. (For example, if a subject draws a circle for the left major figure of Design V of Fonn .C, this is scored as a perseveration since the circle appears as the left major figure of Design IV. If the subject also draws circles for the right major figures of Designs VI and VII, they are
also scored as perseverations since they appear to relate back to the presentation of Design IV.) Perseveration is also scored when a peripheral or major figure is drawn so that it is identi-cal with a major figure in the same design. When perseveration is scored, no other type of substitutive or' additive'errot""''is'
'y/ score(rfor~~ifie~'saffie'~ngute:' Noris'a -rotatiohal' eirof'sco'redIf
,-/I~
Hie-perseverate<f'ffgureis-"tdtatecL- However, a misplacemerif-or?-~s~anJ~_e scOf~(:LfOtJhe~[~re- -.
SYMBOL DEFINITION
PerM Perseveration on Design II of the figure presented in Design I. PerMR PerML PerPR PerPL SYMBOL 180M 90M 45M StM 180MR - - - ' l80ML 90MR 90ML 45MR 45ML
Perseveration in the drawing of a right major figure.
Perseveration in the drawing of a left major figure. Perseveration in the drawing of a right peripheral figure.
Perseveration in the drawing of a left peripheral figure.
ROTATIONS s....'~ .)"'/~
...
.s.
0'\, ~~a /~;-l,""'.DEFINITION
A plane rotation of approximately 180 degrees of the single major figure of Design I or II.
A plane rotation of approximately 90 degrees of the single major figure of Design I or II.
A plane rotation of 25 to 65 degrees of the single major figure of Design I or II (but see StM, below).
A plane rotation of approximately 45 degrees of the single major figure of Design II, when a figure resting on an angle is drawn as resting on a side. l80-degree plane rotation of a right major figure. 180-degree plane rotation of a left major figure. 90-degree plane rotation of a right major figure. , 90-degree plane rotation of a left major figure. 45-degree plane rotation of a right major figure (but see StMR, below).
45-degree plane rotation of a left major figure (but see StML, below).
StMR StML ISOPR ISOPL 90PR 90PL 45PR 45PL
45 -degree plane rotation of a right major figure, when a figure resting on an angle is drawn as rest-ing on a side.
45-degree plane rotation of a left major figure, when a figure resting on an angle is drawn as resting on a side.
ISO-degree plane rotation of a right peripheral figure.
180-degree plane rotation of a left peripheral figure.
90-degree plane rotation of a right peripheral figure.
90-degree plane rotation of a left peripheral figure.
45-degree plane rotation of a right peripheral figure.
45-degree plane rotation of a left peripheral figure.
Mir 180-degree rotation in space (mirror-imaging) of an entire design.
MirMR ISO-degree rotation in space (mirror-imaging) of a right major figure.
MirML ISO-degree rotation in space (mirror-imaging) of a left major figure.
ISOMR(Mir) Rotation of a right major figure scorable as either a 180-degree plane rotation or a 180-degree rota-tion in space (mirror-imaging).
ISOML(Mir) Rotation of a left major figure scorable as either a 180-degree plane rotation or a ISO-degree rota-tion in space (mirror-imaging).
90MR(Mir) Rotation of a right major figure scorable as either a 90-degree plane rotation or a 180-degree rota-tion in space (mirror-imaging).
90ML(Mir) Rotation of a left major figure scorable as either a 90-degree plane rotation or al80-degree rota-tion in space (mirror-imaging).
VerM Rotation of the horizontal axis through major fig-ures; scored when one major figure does not ex-tend across the midline of the other.
MISPLACEMENTS
Misplacements are various types of distortions of the spatial relationship between the figures of a design. Only one
misplace-~~ ment error is scored for any single design. SYMBOL Rev NOv Ov WOv MisPR MisPL UPR UPL DPR DPL SYMBOL SzMR SzML SzPR DEFINITION
Left-right reversal of the relative positions of the two major figures.
Reproduction of overlapping major figures as non-overlapping.
Reproduction of noncontiguou$ figures as con-tiguous or overlapping.
Reproduction of overlapping major figures as over-lapping at the wrong juncture.
Misplacement of a right peripheral figure so that it is to the left of, between, within, above, or below the major figures.
Misplacement of a left peripheral figure so that it is to the right of, between, within, above, or below the major figures.
Displacement of a right peripheral figure upward. Displacement of a left peripheral figure upward. Displacement of a right peripheral figure down-ward.
Displacement of a left peripheral figure down-ward.
SIZE ERRORS
DEFINITION
Distortion in the relative size of the right major figure; scored when the height of the right major figure is less than % the height of the left major figure, both figures being measured at the point of maximal height.
Distortion in the relative size of the left major figure; scored in the same manner as SzMR. Distortion in the relative size of the right pheral figure; scored when the height of the peri-pheral figure is greater than % the height of the
larger of the two major figures, all figures being measured at the point of maximal height.
SzPL Distortion in the relative size of the left peripheral figure; scored in the same manner as SzPR.
Thus, the six major scoring categories contain a total of 64 specific errors. It will be noted that the division of errors as they apply to right, left, and central figures more than doubles the number of specific errors. Actually, there are 27 fundamental error-types.
The principles of scoring and the sample reproductions on pages 12-41 may be used as a guide when scoring by the Error Score system. For each sample of an incorrect reproduction, the specific errors are indicated directly under the faulty drawing. An incorrect reproduction may include as many as 4 or 5 specific errors. Theoreti~ cally, the possible range of total Error Scores for a single form of the test is very wide. In practice, however, one finds the upper limit to be about 24 errors.
At first glance, it may seem that the Error Score system is in~ ordinately detailed and time-consuming, but this has not proved to be the case. Examiners with relatively little scoring experience can accurately score a record containing a fair number of errors in about five minutes.
Scoring, recording, and interpretation are facilitated by the use of the Visual Retention Test Record Form. On this sheet, the subject's performance is summarized not only in terms of the total number of errors and the number of errors in each of the six major categories, but also in terms of the total number of "right" (e.g., MR, DPR) and "Jeft" (e.g., PL, SPL) errors which have been made.
Scoring Principles and Samples .
The underlying scoring principles for each design, followed by samples of correct and incorrect reproductions (with the specific errors listed under each faulty design), are presented on pages 12-41.
Since the scoring is based on explicitly stated criteria, there is usually no question as to whether a reproduction is correct or not. Occasional difficulties that arise in evaluating such aspects as size distortion, or the location of a peripheral figure, can often be resolved by making accurate measurements.
incorrect response which can be scored in more than one way. The following examples illustrate this situation:
a. When an incorrect placement of an internal detail can be scored either as a rotation or as a distortion, in the interest of consist-ency, the convention of scoring these errors as rotations has been adopted. Of course, the response must clearly satisfy the criterion of a rotational error that further rotation of the figure would result in a correct reproduction.
b. When a response can be scored either as a plane rotation or as a rotation in space (mirror-imaging), the scoring system provides specific symbols for this type of reproduction (e.g., 180MR[Mir], 90ML[MirJ). The specificity of this designation will permit the examiner who is particularly Interested in mirror-image reproduction to take account of these responses.
Other aspects of the Error Score system which warrant emphasis are the following:
c. Only one misplacement error is scored for any single figure (e.g., if a lower right peripheral figure is reproduced in the upper left corner, it is scored as MisPR, without account being taken of its upward displacement).
d. When the reproduction of a figure is scored as a perseveration, a misplacement or size error can also be scored, if warranted, but a substitutive, additive, or rotational error should not be scored for the figure.
e. Difficulty in deciding whether a peripheral figure is too high or too low in relation to the major figures may be encountered when the major figures themselves are drawn in different sizes, on different levels, or on an axis which is not parallel to the edges of the paper. Judgment of the pexiP-h_eraL.fig!l--DL-~!t9"yld be based __ Qn..lines~para1lel to the edges .Qf th£ ]!aper (i.e., any rotation in the orientation of the major figures is ignored). In
establishing the limits for the major figures, that figure which makes scoring more liberal is taken as the criterion. Thus, if a subject draws the two major figures in different sizes, or on
dif-ferent levels, the peripheral figure might be displaced with respect to one but not the other. In such a case, a displacement error would not be scored.
FORM C
DESIGN I
Any parallelogram which is not a square, or which the subject indicates is not a square, is considered correct. The figure should rest on a side and not on a corner. The oblique lines should be inclined in the same direction as in the model.
CORRECT INCORRECT
Subject called this "a square" (SM).
o
Figure should rest on side (45M).
o
FORM C
DESIGN II
o
The figure must be a hexagon with one side serving as the base. The sides need not be equal.
CORRECT INCORRECT
Figure should rest on side (90M).
Figure not a hexagon (SM).
DESIGN III
D
The circles must overlap. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the upper and lower limits of the major figures.
CORRECT INCORRECT
o
CD
IlCircles do not overlap (NOv).
a
Q)
Peripheral figure omitted (PR).
a
CD
a
FORM C
DESIGN IV
o
The' triangle must rest on a side and must not be a right triangle. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the upper and lower limits of the major figures. CORRECT
CI
O~
Cl
()6
tI
O~
INCORRECTC1
OLJ
Right major figure is right triangle(SMR).
Q6
Peripheral figure omitted (PL).
FORM C
DESIGN V
o
The triangle must rest on a side and must not be a right triangle. The small circle must be drawn so that at least a part of it lies in the area defined by the midline and upper limit of the major figures.
CORRECT
o
INCORRECT
Right major figure incorrect (SMR).
Peripheral figure too low and too large (DPL; SzPL).
o
FORM C
DESIGN VI
o
There must be a space between the major figures. The lines within each figure need not extend to the center of the figure. The small circle must be drawn so that at least a part of it lies in the area defined by the midline and upper limit of the major figures.
CORRECT
[55]
0
[3bJ
0,
~o
0
.J -INCORRECTQbJ
o
Left major figure rotated (90ML).
C9bJ
o
Peripheral figure too low (DPR).
o
Left major figure distorted (internal detail drawn incorrectly); right major figure rotated (lML; 180MR).
DESIGN VII
v<1>
The hypotenuse of the large right triangle must be drawn in the same general direction as in the model. The large square must rest on a corner. The small triangle must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT
A
INCORRECT
o
Perseverative reproduction of periph-eral figure from Design VI (PerPR).
Right major figure should rest on angle (StMR).
o
Left major figure rotated: peripheral figure incorrect and too high (45ML; SPR; UPR).
FORM C
DESIGN VIII
GO
The curved line in the left square must end at, or very near to, the upper corners of the square. The small triangle must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and upper limit of the major figures.
CORRECT
EJD
INCORRECT
BO
Peripheral figure too low (DPR).
B
Right major figure omitted; peripheral figure inverted (MR; 180PR).
so
o
DESIGN IX
D
DJLJ
The curved line in the large square must end at, or very near to, the left corners of the square. The left side of the right major figure must be in-clined in the same direction as in the model, and the right side must approximate the vertical position. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and upper limit of the major figures.
CORRECT
[JD
o
o
(J]LJ
INCORRECT
Perseverative reproduction of right major figure (same figure was drawn in subject's reproduction of Design VIII and relates back to left major figure of Design VII) (PerMR).
o
[ff
0
Left major figure rotated; persevera-tive reproduction of right major figure from Design VIII (180ML [Mir]; PerMR).
a
illL7
Left major figure distorted (internal detail drawn incorrectly); right major figure incorrect (I M L; SMR).
FORM C
DESIGN X
o
The large square must rest on a corner, and the line drawn through it must follow the direction in the model. The diagonal line in the right major figure must originate at the left corner of the figure and follow the direction in the model. The small circle must be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT
<S>v
0
~u
'0\$>0
0
INCORRECT
Left major figure rotated (90ML-[Mir] ),
n
Perseverative reproduction' of right major figure and peripheral figure from Design IX (PerMR; PerPR).
Both major figures distorted (internal details drawn incorrectly) (IML; IMR).
FORM D
DESIGN I
Any rectangle, the entire upper side of which serves as the base of a triangle, is considered correct. Neither side of the triangle may form a right angle where it meets the upper side of the rectangle.
CORRECT INCORRECT
Lower part of figure not a rectangle (SM).
Entire upper side of rectangle does not serve as base of triangle (SM).
FORM D
DESIGN II
o
The figure must be a hexagon which rests on a corner. The sides need not be equal.
CORRECT INCORRECT
Figure not a hexagon (SM).
Figure not a hexagon (SM).
DESIGN III
o
The two squares must rest on corners, and overlap at the same junction as in the model. The small circle must be drawn so that at least a part of it lies in the area defined by the upper and lower limits of the major figures. CORRECT
o
o
INCORRECTo
Rotation of horizontal axis through major figures (VerM).
o
Right major figure incorrect (SMR).
o
FORMD
DESIGN IV
D
The triangle must rest on a corner. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT
CDv
D
(]Jv
JJ
CD
\7
D
INCORRECT
Right major figure inverted (180MR).
o
Perseverative reproduction of periph· eral figure from Design III (PerPR).
D
Left major figure rotated; peripheral figure too high (90ML; UPR).
DESIGN V
vB
The small triangle must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures. CORRECT
A
UB
6-
08
~
UB
INCORRECTVB
Peripheral figure inverted (180PL),
Reversal of relative positions of two major figures (Rev),
Incorrect reproduction of internal de· tail of right major figure (lMR) ,
FORM D
DESIGN VI
Me
o
The diagonal lines in the large square must originate near the center of the base and end at, or very near to, the upper corners. The small circle must be drawn so that at least a part of it lies in the area defined by the upper and lower limits of the major figures.
CORRECT
Me
o
o
!J
INCORRECTMe
Incorrect reproduction of internal de-tail of left major figure; perseverative reproduction of peripheral figure from Design V (lML; PerPR).
c.
Incorrect reproduction of internal de-tail of left major figure; perseverative reproduction of peripheral figure from right major figure (lML; PerPR).
DESIGN VII
o
The diagonal line in the square must not extend more than two-thirds of the distance to the opposite corner. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT
au
lJ
[JV
0
~~
rI
INCORRECTo
Perseverative reproduction of periph-eral figure from Design VI (PerPR).
D
Right major figure incorrect; periph-eral figure too low (SMR; DPR).
o
Rotation of horizontal axis. through major figures; peripheral figure too high (VerM; UPR).
FORM D
DESIGN VIII
D
The diagonal line in the left square must be curved, and that in the right square must be straight. Both lines must follow the direction indicated in the model and end at, or very near to, the corners of the squares. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the upper and lower limits of the major figures.
CORRECT INCORRECT
GtsJ
\)
~
8
0
Incorrect reproduction of internal de-tails of both major figures (IML; IMR).
CS1~
.c
Cl
{SJ
0Peripheral figure incorrect and too low (SPR; DPR).
[jE;J
0
~
\2j
IJ
Right major figure rotated (90MR-[MirJ).
DESIGN IX
o
IUIJ
The small circle must be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT
0
ru]
0
rv]
1)
ruB
INCORRECT
Right major figure rotated (180MR-[MirJ).
Fragmentation - of left major figure (IML).
o
Ln]
Mirror-image rotation of left major figure (MirML).
FORMD
DESIGN X
80
o
A horizontal line must be drawn through the semicircle. The square must rest on a corner. The small circle must be drawn so that at least a part of it lies in the area defined by the upper and lower limits of the major figures. CORRECT
eo
o
o
INCORRECT8<)
o
Fragmentation of left major figure (IML).
0<)
Omission of internal detail in left ma-jor figure (IML).
Omission of internal detail in left major figure; addition of internal de-tail in right major figure; omission of peripheral figure (lML; IMR; PR).
DESIGN I
The figure must be a truncated triangle as in the model. The angles formed by the top side and the lateral sides must be greater than right angles. CORRECT INCORRECT
...
I
0
(SM)....
/
Q
-(45M)~-t:
l
B
(1M)FORM E
DESIGN II
o
The figure must be a pentagon which rests on a corner. The sides need not be equal. The angles formed by the top side and the lateral sides must be greater than right angles.
CORRECT INCORRECT
(180M)
(SM)
DESIGN III
DD
There must be a space between the two squares. The small triangle must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and upper limit of the major figures.
CORRECT INCORRECT
v
0
a
(180 PL; UPL)600
()[J]
-(SPL; Ov) A0
0
(MisPL)FORM E
DESIGN IV
o
vD
The triangle must rest on a corner. The small circle must be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the rna jor figures.
CORRECT INCO~RECT
0
\70
0
\70
(UPL)(:)
90
0
60
-(180ML)()
tlO
'70
.0 (PerPL; MisPL)DESIGN V
The lines in each circle must form a recognizable angle, be correctly placed, and enclose one-sixth to one-third of the area of the circle. The small triangle must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT INCORRECT
(DPL)
o
(PerPL; IML; IMR)
FORME
DESIGN VI
D
The small triangle within the square must rest on a side. The large tri-angle must rest on a side. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the mid-line and upper limit of the major figures.
CORRECT INCORRECT 0
08
(SPL; SML)0
6
8
(IMR)0
~
B
(IMR)DESIGN VII
The diagonal lines in the large square must originate near the center of the left side and must end at, or very near to, the right corners.
CORRECT INCORRECT L
}S:J
rt:i'
r2~
(180MUMir] )gJ
(a '")
r2
rD""l
0 (IML; Add)~
...
o~g(
~
(IMR)FORME
DESIGN VIII
o
The square must rest on a corner. The small triangle must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT INCORRECT
cO
A
c
<><>
(PerPR)-0
I!
C
0
~ (StMR)(
<)
L:;,.
~
<>
...
(180MUMirJ)DESIGN IX
D
The reproduction of the right major figure must include the same es-sential details as in the model. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and upper limit of the major figures.
CORRECT
c
D
Otvv
Reproduction of peripheral figure not quite large enough to warrant scoring as size error. INCORRECT
v
alA)
(PerPL; UPL; SMR) (SMR) (PerPL; PerML; SzML)FORM E
DESIGN X
D
The triangle must rest on a corner, and inc1ude a vertical line drawn through the middle. The lines in the circle must form a recognizable angle, be correctly placed, and enclose one-sixth to one-third of the area of the circle. The small square must rest on a side, and be drawn so that at least a part of it lies in the area defined by the midline and lower limit of the major figures.
CORRECT INCORRECT
0
\V8
(UPL)IJ
'VV
f)
, (lML)[J
V(])
(lML; IMR) 41Chapter 3
NORMS
The normative data for the Visual Retention Test apply to all
three forms (C, D, and E) of the test. For purposes of clinical or educational interpretation, the three forms may be considered to have equivalent levels of difficulty, even though systematic study has indicated that, under Administration A (reproduction from memory after exposure for 10 seconds), Form C is slightly easier than Forms D and E (see pages 77-78 for further discussion of comparability of forms).
The performance of normal subjects on Administration A of the
Visual Retention Test correlates highly with intelligence level, the
obtained coefficients between scores on the test and scores on stand-ard intelligence scales being approximately. 70. There is also a signifi-cant relationship between Visual Retention Test perfonnance and
chronological age. Performance level on Administration A shows a progressive rise from the age of 8 years until a plateau is reached at the 14- to IS-year level. This plateau is maintained from the late adolescent years through the thirties. A decline in efficiency of per-formance occurs in the forties and this decline is progressive, con-tinuing through the successive decades of life. Normative observa-tions indicate a drop of about 1 point in the mean Number of Correct Reproductions for persons aged 45-54 years, and a drop of about 2 points for persons aged 55-64 years, as compared with younger age groups (Benton & Fogel, 1961). The standardization data show no important differences attributable to the factor of sex.
These findings of significant relationships between Visual Retention Test performance and general intelligence level, and between test
performance and chronological age, make it evident that correct clinical interpretation can be made only within this framework of the age and premorbid intellectual endowment of a patient. The norma-tive data provide the basis for such an interpretation.
Administration A
The normative data for Administration A are based on the per-formance of over 600 subjects, with the following restrictions
im-posed on their selection: (a) no evidence or history of psychosis; (b) with the exception of mentally defective subjects, no evidence of cerebral injury or disease; and (c) no serious physical depletion as a consequence of somatic disease. A majority of the adult subjects were patients in various inpatient and outpatient services of hospitals in Iowa City and Des Moines. A majority of the children were tested at schools in Iowa City, Ottumwa, and West Branch, Iowa. Most of the mentally defective subjects were patients at the Woodward (Iowa) State Hospital and School.
Adult Norms
Table 1 presents adult norms for the Number of Correct Reproduc-tions (hereafter called the "Number Correct Score") for Administra-tion A (1 O-second exposure with immediate reproducAdministra-tion). The typical performance levels of subjects of different age groups and inteIIigence are given. Interpretation of a subject's performance should be made on the basis of an expected score appropriate for his age and his assumed original or premorbid intellectual endowment, this judgment having been derived from a consideration of his educational and occupational background, his socioeconomic status, and possibly his performance on other tests.
The table is read as follows: For a 50-year:"0Id subject whose premorbid IQ is estimated as superior (i.e., 110 or more), the expected Number Correct Score is 8. His obtained score may be compared with this score. An obtained score which is 2 points below the expected score may be considered to raise the question of acquired impairment of cognitive function. An obtained score which is 3 points below the expected score suggests such impairment. An obtained score which is 4 or more points below the expected score is a strong
indication of such impairment.
Table 2 presents adult norms for the Error Score for Administra-tion A. As with the Number Correct Score, interpretaAdministra-tion of a sub-ject's performance is made on the basis of an expected score appro-priate for his age and his assumed original or premorbid intellectual endowment.
An obtained score which is 3 points above the expected score may be considered to raise the question of acquired impairment of cogni-tive function. An obtained score which is 4 points above the expected score suggests such impairment. An obtained score which is 5 or more points above the expected score is a strong indication of such impairment. .
Norms for Administration A: Adults
Expected Number Correct Scores, by Estimated Pre morbid IQ and Age
Estimated Pre morbid IQ
110 and above (Superior)
95~109 (Average)
80-94 (Low Average) 70-79 (Borderline) 60-69 (Defective)
59 and below (Very Defective)
Expected N umber Correct Score, by Age
15·44 45·54 55·64 9 8 7 8 7 6 7 6 5 6 5 4 5 4 3 4 3 2 Table 2
Norms for Administration A: Adults
Expected Error Scores, by Estimated Premorbid IQ an_d Age
Estimated Premorbid IQ
110 and above (Superior) 105-109 (High Average) 95-104 (Average) . 90-94 (Low Average) 80-89 (Dull Average) 70-79 (Borderline.) 60-69 (Defective)
59 and below (Very Defective)
Children's Norms
Expected Error Score, by Age
15·39 40·54 55-59 60·64 1 2 3 4 5 6 7 8 2 3 4 5 6 7 8 9 3 4 5 6 7 8 9 10 4 5 6 7 8 9 10 11
Table 3 presents norms for children with resp~ct to the Number Correct Score for Administration A. The expected performance levels of children of different ages and intelligence are given. Inter-pretation is based on a comparison of observed and expected per-formance. An obtained score which is 2 points below the expected score may be considered to raise the question of a specific disability
in visual memory or visuomotor function. An obtained score which is 3 or more points below the expected score may be considered to
suggest such a disability.
Table 4 presents norms for children with respect to the Error Score for Administration A. An obtained score which is 3 points above the expected score may be considered to raise the question
Table 3
Norms for Administration A: Children
Expected Number Correct Scores, by Estimated IQ and Age
Expected Number Correct Score, by Age Estimated IQ 8 9 10 11
105 and above (High
Average and Superior) 4 5 6 7
95-104 (Average) 3 4 5 6
80-94 (Low Average) 2 3 4 5
70-79 (Borderline) 1 2 3 4
69 and below (Defective) 0 1 2 " 3
Table 4
Norms for Administration A: Children Expected Error Scores, by Estimated IQ and Age
12 8 7 6 5 4
Expected Error Score, by Age
Estimated IQ 8 9 10 11 12
105 and above (High
Average and Superior) 8-9 7-8 6 5 4
95-104 (Average) 10-11 9-10 7-8 6 5
80-94 (Low Average) 12-13 11-12 9 7-8 6 70-79 (Borderline) 14 13 10-11 9 7-8 69 and below (Defective) 15 14 12 10 9
13·14 8 7 7 6 5 13-14 3 4 5 6-7 8 of a specific disability. An obtained score which is 4 or more points above the expected score may be considered to suggest such a disability. Where the table gives two scores for a particular age and estimated 1Q, compare the child's obtained score with the higher
value.
. The diagnostic significance of children's performance is discussed
in Chapter 4 (see especially pages 64-67).
Administration B
Data for Administration B (5-second exposure with immediate reproduction) were derived from the performance of 103 medical patients between 16 and 60 years of age and with no history or evi-dence of brain disease. Their reproductions were evaluated on the basis of the usual criteria, and Number Correct Scores were obtained. Each Number Correct Score was then compared with the score that
immediate reproduction) in the light of the subject's age and esti-mated IQ, and a deviation score was computed for each subject. The mean deviation score was found to be -1.1. Both the median and modal deviation scores were -1. Thus, under the condition of reduced exposure time, it appeared that performance level, as defined by the number of designs correctly reproduced, was approximately 1 point below performance level for the 10-second exposure.
A further comparison was made of the performance of the 76 patients who were under 50 years of age and the 27 patients who were between 50 and 60 years of age. The mean deviation score was -1.2 for the younger subgroup and -.8 for the older subgroup. Median and modal deviation scores were -1 for both subgroups.
Von Kerekjarto (1961) made a direct comparison of the perform-ance of 20 normal subjects on Administrations A and B, and found mean Number Correct Scores of 8.5 for Administration A and 7.6 for Administration B. It is evident that the obtained difference of .9 is in essential agreement with the study of 103 subjects described above.
On the basis of these findings, it seems justified to conclude that a
subtraction of 1 point from each expected Number Correct Score in
Table 1 (norms for adults on Administration A) will provide satis-factory norms for Administration B.
Administration C
Adult Norms
Data for Administration C (copying the designs, with the designs remaining in the subject's view) were derived from the performance of 200 medical patients with no history or evidence of cerebral disease. These patients constituted the control group in studies of brain-damaged patients (Benton, 1962, 1972) described on pages 61-64. Their reproductions were evaluated on the basis of the usual criteria. The distribution of Error Scores in this control group is shown in Table lIon page 62. It will be noted that almost half of the group achieved perfect scores, and that 88 percent made 2 errors or less. Four patients (2 percent) made 5 errors. One of these was a 59-year-old woman with a sixth-grade education and a WAIS Verbal IQ of 77; her poor copying performance probably reflected long-standing mental subnormality. However, the other 3 patients were of average or high-average intelligence and had completed 9 to 12 years of schooling. Table 5 presents normative standards for adult performance on Administration C, based on this group of 200
pa-Error Score on Standard lO·Design Version 0-2 3 4 5 6 or more Table 5
Norms for Administration C: Adults Interpretation of Error Scores
Error Score on Abbreviated a·Design Version 0-1 2 3 4 5 or more Interpretation Average Low Average Borderline Defective Grossly Defective
tients (see the column headed "Error Score on Standard 10-Design Version") .
Table 5 also presents norms for an abbreviated eight-design version of Administration C, based on the performance of 100 control patients. , The possibility that the administration could be shortened without loss of diagnostic value was first explored using a sample of 50 patients (44 brain-damaged and 6 control) who had made 4 or more errors on the full ten-design test (Benton, 1972). Error Scores on five ab-breviated versions (ranging from the first five designs to the first nine designs) were computed for each patient. Part-whole correlation coef-ficients between scores on each version and scores on the full test were then determined. It was found that the correlation between scores on the first eight designs and scores on the full test was .97, and that utilization of an eight-design test resulted in no diagnostic misclassifi-cations. Scores on even shorter versions also correlated highly with scores on the full test, but did result in some misclassifications. Thus, it did not seem possible to reduce the length of the test to any sub-stantial degree without some sacrifice in accuracy of interpretation. It appears that the eight-design version can be safely used, b,ut it saves no more than one minute of administration time. However, in some situations even this minimal reduction in time is welcome. Particu-larly where the subject is clearly performing quite well or quite badly, the examiner can feel free to terminate the test after presentation of the eighth design. (The abbreviated version of the test may be used
only with Administration C.)
Children's Norms
Children's norms for Administration C were derived from the per-formance of 236 children aged 6 years 6 months to 13 years 5 months, and enrolled in various public schools in Iowa and Wisconsin (Benton,
Spreen, Fangman, & Carr, 1967). The children were randomly selected with the single restriction that their WISe lOs be between 85 and 115. Thus, both retarded and superior children were excluded in establish-ing the normative standards. The mean lQ of the group was 102.5.
Analysis of the performance of boys and girls at each age level dis-closed no significant differences attributable to sex, and no consistency in the direction of the differences. Therefore, the data for the two sexes were combined in developing the norms. Table 6 presents the mean Number Correct Score at each age and Table 7 presents the corresponding values for the Error Score. Each table also gives a "Critical Score" for each age - the performance level which is poorer than that of 90 to 100 percent of the children at that age. A more
Agea 7 8 9 10 11 12 13 Table 6
Norms for Administration C: Children (IQ
=
85-115)Number Correct Scores
Critical Percent Exceeding
N Mean SO Score Critical Score
36 6.19 2.28 2 92 32 7.16 2.06 3 91 25 7.28 1.86 4 96 22 8.13 1.32 5 100 47 8.44 1.33 5 100 54 8.64 1.23 6 93 20 8.80 1.56 6 90
aAge to nearest birthday (e.g., 7 = 6 yrs. 6 mos. through 7 yrs. 5 mos.).
Agea 7 8 9 10 11 12 13 Table 7
Norms for Administration C: Children (IQ
=
85-115)Error Scores
Critical Percent Below N Mean SO Score Critical Score
36 4.91 3.93 10 89 32 3.41 2.77 7 91 25 3.08 2.15 6 92 22 2.13 1.65 5 91 47 1.72 1.56 5 96 54 1.42 1.34 4 89 20 1.25 1.66 4 90
precise classification of performance is not presented because of the relatively small number of children at some age levels.
It will be noted that there is a rapid rise in performance between the ages of 7 and 10, and a much slower rise between the ages of 10 and 13. The performance of 13-year-old children is very close to the adult level. Additional data for Administration C were derived from the per-formance of 79 children aged 6 years 6 months to 13 years 5 months, whose WISe lOs ranged from 116 to 147, with the mean IQ being 125. Their performance is summarized in Tables 8 and 9. Although the study is based on a small number of cases, means and standard deviations are shown by age to get an indication of general trends. In
Table 8
Administration C: Superior Children (IQ
=
116-147)Number Correct Scores
Agea N Mean 7 7 8.00 8 10 7.80 9 15 8.93 10 10 8.20 11 17 8.70 12 18 9.16 13 2 9.00
aAge to nearest birthday (e.g., 7 through 7 yrs. 5 mos.).
Table 9 SO 1.55 .91 2.15 1.70 .95 6 yrs. 6 mos.
Administration C: Superior Children (IQ
=
116-147)Error Scores Agea N Mean SO 7 7 2.28 8 10 2.40 1.87 9 15 1.13 .94 10 10 2.20 3.36 11 17 1.35 1.74 12 18 .83 .95 13 2 1.00
aAge to nearest birthday (e.g., 7 6 yrs. 6 mos. through 7 yrs. 5 mos.).
comparing these children with children of average intelligence (Tables 6 and 7), the differences appear to be greater for ages 7 through 9 than for the older groups.
Administration D
Standardization data gathered on this procedure are not yet sufficient to provide adequate norms for clinical use. Empirical observations bearing on the diagnostic application of Administration D are dis-cussed in Chapter 4 (pages 72-73).
Chapter 4
DIAGNOSTIC INTERPRETATION
Cerebral injury or disease is the most frequent determinant of de-fective performance in visual-memory and visuocbnstructive tasks. It is the sensitivity of tests such as the Visual Retention Test to the effects
of cerebral disease that is their outstanding clinical feature, and ac-counts for their frequent inclusion in psychodiagnostic batteries. Be-fore the inference of cerebral disease is made, however, a number of other possible determinants of defective performance should be con-sidered, such as:
a. Lack of adequate effort on the part of hostile, apathetic, asocial, or paranoid patients.
b. Inability of severely depressed patients to complete reproduc-tions, particularly of the more complex designs.
c. Inability of patients depleted by serious physical disease to com-plete reproductions, particularly of the more complex designs. d. Autistic preoccupation on the part of schizophrenic patients,
leading to irrelevant reproductions.
e. Defective graphomotor skill and poor task adjustment because of lack of education or relevant social experience.
f. Defective performance on the part of persons simulating mental incompetence.
It is particularly important that determinants a, b, and c, above, all having to do with the variables of effort and energy level, receive de-liberate consideration. Determinant d, expressed by irrelevant, elab-orate, and bizarre reproductions, can hardly escape attention. De-terminant e may be encountered in individuals with a background of severe cultural deprivation or in those from non-Western cultures. The characteristics of the performance of persons simulating mental in-competence (determinant f) are discussed in a later section of this chapter.
It should also be kept in mind that not every brain lesion will be re-flected in poor performance on a perceptual-mnemonic task. Factors
