THE LANGUAGE OF BVRT ERRORS: A PRINCIPAL COMPONENT ANALYSIS OF

BVRT MEMORY ERROR CATEGORIES, MAE SUBTESTS,

WAIS-III, AND BOSTON NAMING TEST

A Dissertation

Presented to the Faculty of

Palo Alto University

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Palo Alto, California
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In Partial Fulfillment of the

Requirements for the Degree of

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Doctor of Philosophy in Clinical Psychology
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by

Sarah Caffrey

June, 2021

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 THE LANGUAGE OF BVRT ERRORS: A PRINCIPAL COMPONENT ANALYSIS OF

BVRT MEMORY ERROR CATEGORIES, MAE SUBTESTS,

WAIS-III, AND BOSTON NAMING TEST

Sarah Caffrey
Palo Alto University, 2021

This study examined the role of verbal mediation in the commission of memory errors on

the Benton Visual Retention Test (BVRT). This investigation exposed the influence of language

by analyzing the relationships between the BVRT’s memory error categories and performance on

the Weschler Adult Intelligence Scale-III (WAIS-III), Boston Naming Test (BNT), and spoken

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language subtests of the Multilingual Aphasia Examination (MAE). The study used archival data

obtained from the Psychological Assessment Unit at the Veterans Administration Palo Alto
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Health Care System. Principal component analyses were conducted using the data from one

hundred veterans who were administered the BVRT, WAIS-III, BNT, and MAE as part of a
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comprehensive neuropsychological battery.

The first principal component analysis, which included the WAIS-III modular
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components, the BVRT memory error categories, and the four subtests of spoken language on

the MAE, resulted in a five-component model which explained 73.490% of the variance. The

second principal component analysis, which added the three factors of the BNT, resulted in a

four-component model which explained 68.563% of the variance. The resulting component

loadings demonstrate that distinct language processes are involved with individual types of

BVRT memory errors, and that some BVRT memory errors are more heavily influenced by

language than others. The study findings validate previous research which established verbal

mediation within BVRT performance, while also providing a new understanding about the

commission of BVRT memory errors that clinicians and researchers can use to enhance the

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utility of BVRT error scoring and investigate the role of language in other nonverbal assessment

measures.

Keywords: BVRT errors, verbal mediation, principal component analysis

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 © Copyright 2021

by

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Sarah Caffrey
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All Rights Reserved
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 TABLE OF CONTENTS

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LIST OF TABLES .......................................................................................................................13
LIST OF FIGURES .....................................................................................................................14
CHAPTER
I. INTRODUCTION ....................................................................................................................15
II. LITERATURE REVIEW ........................................................................................................17
The Benton Visual Retention Test ...............................................................................................17
History of the BVRT ...............................................................................................................17
Administration ........................................................................................................................18

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Psychometrics .........................................................................................................................21
Clinical Utility and Research ..................................................................................................22
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Neurological Research .....................................................................................................22
Medical Research .............................................................................................................25
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Psychiatric Research ........................................................................................................27
Demographic Research ....................................................................................................29
Memory ........................................................................................................................................31
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Historical Perspective of Memory ..........................................................................................31

Types of Memory ....................................................................................................................32
Sensory Memory ..............................................................................................................32
Short-Term Memory ........................................................................................................32
Long-Term Memory ........................................................................................................33
Popular Theoretical Models of Memory .................................................................................34
Atkinson and Shiffrin’s Multistore Model .......................................................................34
Sensory Register .........................................................................................................34
Shot-Term Store ..........................................................................................................35
Long-Term Store .........................................................................................................36

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 Baddeley & Hitch’s Multiple Component Model of Working Memory .........................36
Phonological Loop .....................................................................................................38
Visuo-Spatial Sketchpad ............................................................................................40
Central Executive ......................................................................................................42
Episodic Buffer .........................................................................................................43
Cowan’s Embedded-Processes Model of Working Memory...........................................44
Activated Long-Term Memory ..................................................................................45
Focus of Attention......................................................................................................46
Verbalization of Visual Memory .................................................................................................48

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Verbal Coding .........................................................................................................................48
Verbal Distractors ...................................................................................................................51
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Language Differences .............................................................................................................52
Verbal Mediation in the BVRT...............................................................................................54
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Neuropsychological Assessments for Proposed Analyses ...........................................................57
Boston Naming Test ...............................................................................................................57
Development ....................................................................................................................57
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Administration .................................................................................................................58
Psychometrics ..................................................................................................................58
Clinical Utility .................................................................................................................59
Instrument Limitations .....................................................................................................60
Factor Analysis ................................................................................................................62
Use in Current Study ........................................................................................................64
Multilingual Aphasia Examination .........................................................................................64
Development ....................................................................................................................64
Administration .................................................................................................................65
Oral Expression ...........................................................................................................65
Visual Naming ......................................................................................................65

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 Sentence Repetition ..............................................................................................65
Controlled Oral Word Association .......................................................................66
Spelling .......................................................................................................................66
Oral Spelling .........................................................................................................66
Written Spelling ....................................................................................................66
Block Spelling .............................................................................................................67
Oral Verbal Understanding ........................................................................................67
MAE Token Test .................................................................................................67
Aural Comprehension of Words and Phrases ......................................................67
Reading .......................................................................................................................68

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Reading Comprehension of Words and Phrases ..................................................68
Rating Scales ...............................................................................................................68
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Rating of Articulation .........................................................................................68
Rating of Praxis Features of Writing ..................................................................69
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Psychometrics ..................................................................................................................69
Clinical Utility .................................................................................................................71
Use in Current Study ........................................................................................................72
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Wechsler Adult Intelligence Scale-III ....................................................................................72

Development ....................................................................................................................72
Administration .................................................................................................................73
Information .................................................................................................................74
Comprehension ..........................................................................................................74
Arithmetic ..................................................................................................................74
Similarities .................................................................................................................74
Digit Span ..................................................................................................................74
Vocabulary .................................................................................................................74
Coding-Digit Symbol .................................................................................................75
Picture Completion ....................................................................................................75

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 Block Design ..............................................................................................................75
Picture Arrangement .................................................................................................75
Matrix Reasoning .......................................................................................................76
Symbol Search ..........................................................................................................76
Letter-Number Sequence ..........................................................................................76
Object Assembly .......................................................................................................76
Psychometrics ..................................................................................................................77
Four-Factor Model ...........................................................................................................78
Theoretical Foundations.............................................................................................79
Utility .........................................................................................................................80

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Instrument Limitations .....................................................................................................81
Use in Current Study ........................................................................................................82
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Present Study ...............................................................................................................................82
III. METHOD ..............................................................................................................................84
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Participants ...................................................................................................................................84
Measures ......................................................................................................................................84
Benton Visual Retention Test .................................................................................................84
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Multilingual Aphasia Examination .........................................................................................85

Visual Naming .................................................................................................................86
Sentence Repetition .........................................................................................................86
Controlled Oral Word Association ..................................................................................86
Token Test .......................................................................................................................87
Boston Naming Test ...............................................................................................................87
Wechsler Adult Intelligence Scale-III ....................................................................................88
Information ......................................................................................................................88
Comprehension ................................................................................................................89
Arithmetic ........................................................................................................................89
Similarities .......................................................................................................................89

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 Digit Span ........................................................................................................................89
Vocabulary .......................................................................................................................90
Coding-Digit Symbol .......................................................................................................90
Picture Completion ..........................................................................................................90
Block Design ....................................................................................................................90
Picture Arrangement .......................................................................................................91
Matrix Reasoning .............................................................................................................91
Symbol Search ................................................................................................................91
Letter-Number Sequence ................................................................................................91
Object Assembly .............................................................................................................92

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Procedure .....................................................................................................................................93
Data Analysis ...............................................................................................................................93
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Principal Component Analysis ...............................................................................................93
Creation of Factor Scale Variables .........................................................................................94
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WAIS-III and BVRT Errors.............................................................................................95
MAE.................................................................................................................................95
BNT..................................................................................................................................95
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Exploratory Aims ....................................................................................................................96

Exploratory Aim 1 ...........................................................................................................96
Principal Component Analysis 1 ................................................................................96
Exploratory Aim 2 ...........................................................................................................96
Principal Component Analysis 2 ................................................................................96
IV. RESULTS ..............................................................................................................................98
Principal Component Analysis 1 .................................................................................................98
Principal Component Analysis 2 .................................................................................................99
V. DISCUSSION .........................................................................................................................102
Exploratory Aim 1 .......................................................................................................................102
Principal Component Analysis 1 ............................................................................................102

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 Component 1 ....................................................................................................................102
Component 2 ...................................................................................................................103
Component 3 ...................................................................................................................104
Component 4 ...................................................................................................................104
Component 5 ...................................................................................................................105
Dimensionality .................................................................................................................106
Exploratory Aims 2 ......................................................................................................................106
Principal Component Analysis 2 ............................................................................................106
BNT 1...............................................................................................................................107
BNT 2 ..............................................................................................................................107

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BNT 3 ..............................................................................................................................108
BNT No Factor Load ......................................................................................................108
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Magnitude of Verbal Mediation.......................................................................................108
Verbal Strategy ................................................................................................................109
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Implications..................................................................................................................................110
Clinical ....................................................................................................................................110
Research ..................................................................................................................................111
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Theoretical ..............................................................................................................................113
Strengths and Limitations ............................................................................................................114
Strengths .................................................................................................................................114
Limitations .............................................................................................................................115
Future Directions .........................................................................................................................115
Repeat Analysis & Replication Studies ..................................................................................115
Generalizability ................................................................................................................115
Alternate Measures ..........................................................................................................116
Analogous Studies .................................................................................................................117
REFERENCES ............................................................................................................................119
APPENDICES .............................................................................................................................155

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A. Palo Alto University’s Institutional Review Board Approval Letter ......................................155
B. Preliminary Statistical Analysis ..............................................................................................156

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 LIST OF TABLES

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1. Principal Component Analysis of the Derived WAIS-III Modular Component & BVRT

Memory Error Category Factors with the Four Subtests of Spoken Language on the MAE

(Visual Naming, Controlled Oral Word Association, Sentence Repetition, and Token Test) ..... 99

2. Principal Component Analysis of the Derived MAE Spoken Language Component,

WAIS-III Modular Component, and BVRT Memory Error Category Factors with the Three

Factors of the BNT...................................................................................................................... 100

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B1. Principal Component Analysis of the WAIS-III Modular Components with the BVRT
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Memory Error Categories ........................................................................................................... 156
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 LIST OF FIGURES

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1. Examples of Early and Late Stimuli in the Benton Visual Retention Test ............................... 20

2. Multistore Model ...................................................................................................................... 35

3. The Original Baddeley and Hitch (1974) Working Memory Model ........................................ 38

4. A Modification of the Original Model to Take Account of the Evidence of Links Between

Working Memory and Long-Term Memory................................................................................. 42

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5. The Model Following the Introduction of a Fourth Component, The Episodic Buffer, a
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System for Integrating Information from a Range of Sources into a Multidimensional Code

(Baddeley, 2012) ........................................................................................................................... 44

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6. Embedded-Processes Model of Working Memory ................................................................... 46

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7. Effects of Verbal Labels on Memory for Ambiguous Figures ................................................. 49

8. Differences in Spatial-Semantic Concepts Based on Primary Language, English, Finnish,

Dutch, and Spanish ....................................................................................................................... 53

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 CHAPTER I

INTRODUCTION

It is difficult to construct a pure measure of visual memory due to the verbal mediation

involved in visual memory tasks. The Benton Visual Retention Test (BVRT) is an instrument

that was designed to assess immediate visual memory and to capture nonverbal abilities, but

instead the test has been found to measure a multitude of factors, including language (Feinberg,

2016; Lai, 2018; Lockwood et al., 2011; Moses, 1986; Thompson, 2018). Understanding the

cognitive processes that are activated when completing the BVRT is valuable given its extensive

utilization in clinical practice and research. Previous researchers have established that

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performance on the BVRT involves aspects of language (Lockwood et al., 2011; Thompson,
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2018) as well as verbal mediation, which plays a role in the commission of BVRT memory

errors (Feinberg, 2016; Lai, 2018). To this researcher’s knowledge, however, no scholars have
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yet investigated the relationship between individual BVRT memory error categories and

language.

The purpose of the current study was to enhance the understanding of the effect of verbal
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mediation on the BVRT by further exploring the role of language in the commission of

individual BVRT memory errors. In this investigation, the researcher examined the relationships

between specific language dimensions and individual BVRT memory error categories by using

well-established components of spoken language that are measured by subtests of the

Multilingual Aphasia Examination (MAE) and the Boston Naming Test (BNT). The addition of a

three-factor solution for the BNT into the analysis also allowed for interpretation of the

magnitude and type of verbal strategy associated with individual BVRT memory error

categories. The Wechsler Adult Intelligence Scale-III (WAIS-III) four-factor solution was

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employed as a conceptual framework for discriminating areas of verbal and nonverbal ability.

The researcher collected archival clinical assessment data from a mixed neuropsychiatric

population. Through exploratory factor analyses, the researcher determined how individual

BVRT memory errors are associated with specific verbal skills. The findings have implications

for clinicians and researchers who use the BVRT as a clinical and experimental measure. The

results also provide opportunities for future avenues of study of the psychometric properties of

the test.

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 CHAPTER II

LITERATURE REVIEW

In this chapter, the researcher first introduces the BVRT, which is a measure of

immediate visual memory that is the criterion measure in this study. A review of memory

constructs and theoretical memorial models is then presented to deconstruct the underlying

cognitive processes that are activated during performance of a visual memory task. This

presentation will be followed by an analysis of evidence that visual memory is a nonverbal

process, and transitively, that performance on the BVRT is verbally mediated. Lastly, the

neuropsychological assessments that are included as criterion comparison measures for

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comparative analysis with the BVRT will be introduced. Discussions of established factor
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structures of these comparative measures are included due to their relevance to the current

investigation.
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The Benton Visual Retention Test

History of the BVRT

The BVRT (Benton, 1945) was developed by Arthur Benton, PhD, a professor of
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psychology and neurology. He also was responsible for the development of a variety of

neuropsychological assessments that are in common use today (Sivan et al., 2007). In the

construction of the BVRT, Benton sought to create an immediate visual memory assessment that

was almost purely nonverbal. At the time, a popular tool for the assessment of immediate

memory was Jacobs’s (1887) Digit Span Test. The Digit Span Test had many characteristics that

influenced performance beyond the cognitive areas of retention and immediate recall.

Administration of the Digit Span Test involved comprehension of auditory instructions and

vocalized responses that resulted in the use of verbal skills. This call-and-response style involved

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interpersonal interactions that make it susceptible to emotional influences (Benton, 1945). The

Digit Span Test’s use of numbers also involves a stimulus that is symbolic to which the

examinee can apply meaning. Benton identified that these characteristics could negatively impact

performance even in the absence of memory deficits (Benton, 1945). In the first form of the

BVRT, Benton attempted to eliminate these influences by creating a brief visual recall test

involving abstract figures and minimal interpersonal interaction during test administration. In

doing this, Benton created what he believed to be a purely nonverbal assessment measure of

immediate memory (Benton, 1945).

Administration

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The BVRT test manual has gone through four revisions, the first being in 1955 where
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Benton increased the number of designs from 7–10, developed equivalent forms of the test,

developed additional administration methods and scoring systems, and normed the test for
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different demographic groups (Benton, 1955). The additional BVRT manual revisions in 1963,

1974, and 1992 have provided updates on the normative data and clinical uses of the test

(Benton, 1963, 1974; Sivan, 1992). The current BVRT has four administration methods and
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three types of scoring (Sivan, 1992).

The four types of BVRT administrations are alphabetically denoted A, B, C, and D

(Sivan, 1992). All four administration methods make use of the same 10 geometric designs, but

they vary in type of design exposure. Administration A is the original administration method that

was developed by Benton in 1945. The examinees view each design for 10 s before being asked

to reproduce the stimuli from memory (Sivan, 1992). Performance on this task is intended to

measure immediate visual memory; however, scholars have identified that performance may

relate to the following additional constructs: psychomotor speed, visual-perceptual-motor skills,

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vigilance, and impulsivity (Crook & Larrabee, 1988; Dougherty et al., 2003; Larrabee et al.,

1985; Snow, 1998). Administration B involves the same procedure with a decreased exposure

time of 5 s (Sivan, 1992). Again, performance on this test was intended to measure visual recall,

but was theorized by Benton to be more sensitive due to the shorter stimulus exposure time for

the task. Benton theorized that this sensitivity was important for specific populations, such as

young adults, who had optimal processing speed (Sivan, 1992). Administration C eliminated the

use of brief exposure time and allows examinees to copy the visual designs directly from the

image. Performance on this task was intended to measure visual perception and motor

capabilities, as the memory component had been removed (Sivan, 1992). Here again, Benton

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hoped to capture strategic information about different populations, including patients with
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schizophrenia or patients who might be malingering. Administration D involved the same

procedures as Administration A, but there is inclusion of an additional 15 s delay after the

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stimulus is removed and before the stimuli can be replicated (Sivan, 1992). Performance on this

task again was meant to measure visual memory. It was intended to be used with those

populations that Benton believed had not displayed deficits previously because of the brevity of
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stimulus exposure. Benton indicated that this administration would be sensitive to patients with

frontal lobe damage, or amnestic syndrome (Sivan, 1992).

As previously stated, all administrations make use of a set of 10 geometrics design arrays.

These designs consist of black and white figures presented on stimulus cards one at a time

(Sivan, 1992). Each image increases in difficulty from a single, easily named and perceptually

recognizable shape, up to three, less-readily identifiable shapes. The designs also make use of

size differences, with the more difficult cards including two large major figures and one small

peripheral figure (Sivan, 1992). Examples of early and late BVRT stimuli are presented in

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Figure 1. Benton developed three sets of cards to provide comparable alternate forms for retest

evaluation. The original and default card set, Form C, is the design set that was used in the

current study (Sivan, 1992).

Benton devised three ways to score and interpret performance on the BVRT. The first is

to sum scores for all designs that were recalled correctly and compare this total score to group

norms (Benton, 1945, 1955, 1963, 1974; Sivan, 1992). The second method is to sum the number

of errors that were made and compare that total to group norms. Both scoring systems were part

of Benton’s original conception in 1945 and continued to be used with the updated norms of each

BVRT revision (Benton, 1945, 1955, 1963, 1974; Sivan, 1992). The third scoring system

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involves the interpretation of specific error types, which was not introduced until the first BVRT
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revision in 1955. Benton believed that introducing a qualitative analysis of responses would

assist in understanding the specific performances that are related to focal brain lesions (Sivan,
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1992).

Figure 1

Examples of Early and Late Stimuli in the Benton Visual Retention Test
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Note. The above figures are digital recreations made by this author of BVRT stimulus cards 2

and 8, respectively, as they appear in Form C of the BVRT.

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 Benton (1955) identified the following six BVRT categorical error types: omissions,

distortions, perseverations, rotations, misplacements, and size errors. Omission errors are made

when an examinee fails to draw a major or peripheral figure, or if the examinee draws a figure

that is not otherwise scored. Distortion errors are made when an examinee fails to draw a major

or peripheral figure accurately. Perseveration errors are made when an examinee substitutes a

different geometric figure for a major or peripheral figure. Rotation errors are made when an

examinee draws a major or peripheral figure at an angle that is different from that of the original

stimulus. The most common rotation error is a stabilization rotation, where the examinee alters

the angle of their figure such that the geometric shape is resting on its side. Misplacement errors

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are made when an examinee fails to draw a major or peripheral figure with the same spatial
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orientation as the original figure. Finally, size errors are made when an examinee fails to draw a

major or peripheral figure with the same size relationships as shown in the stimulus array (Sivan,
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1992).

Psychometrics

Since its introduction, the BVRT has been found to have strong psychometric properties.
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Researchers have confirmed adequate interrater reliability for the BVRT. Coefficient findings for

BVRT interrater reliability have been .90–.94 (Egeland et al., 1967), .85–.93 (Randall et al.,

1988), .96–.97 (Swan et al., 1990), and .95 (Prakash & Bhogle, 1992). Swan et al. (1990) was

also able to establish interrater reliability for the scoring of error types. The highest kappa value

was associated with to the scoring of omission errors (.96), while the lowest kappa value was

associated with the scoring of size errors (.73). Furthermore, Messinis et al. (2009) found a

moderate BVRT test-retest reliability coefficient of .78 that was specific to total correct scoring.

Silverstein (1963) reported that the reliability across all BVRT forms fell between .81–.90.

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 The literature also reports strong validity for the BVRT. Early analyses placed the

BVRT’s internal item consistency at a Cronbach’s alpha of 0.66 (Hahlweg & Kühnlein, 1981).

Since this early report exclusively used BVRT Form C, Steck et al. (1990) examined the internal

validity across all three BVRT forms. Analyses using both Cronbach’s alpha and Guttman’s split

half reliability found the validity to range from .67–.83. The BVRT also has been shown to have

good criterion-related validity (Lockwood et al., 2011), which is consistent with its international

use in research as a measure of visual recall (Alexander et al., 1966; Hay et al., 1992; Jones et

al., 2011). Moreover, the BVRT has been shown to have good discriminant validity, specifically

within the patient populations of acute stroke (Messinis et al., 2009), dementia (Eslinger et al.,

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1985), Alzheimer’s disease (Kawas et al., 2003), and posttraumatic stress disorder (Emdad &

Söndergaard, 2006).
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Clinical Utility and Research
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The psychometric properties of the BVRT make it a prime instrument for use in clinical

research where it has been utilized to examine visual memory impairment across a range of

clinical syndromes, including neurological, medical, and psychiatric conditions. The following
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topical summaries provide a sampling of the related literature. Emphasis is placed on the

inclusion of research studies in which the BVRT memory administration was used and error

scoring was included in the reported analyses.

Neurological Research

The most common use of the BVRT is in clinical diagnostic assessment and clinical

research related to dementia. Eslinger et al. (1985) found that the BVRT was 66% accurate for

differentiation of normally aging patients from patients with dementia. Even when considering a

specific type of dementia, Alzheimer’s disease research has established that the BVRT can

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discriminate between patients with Alzheimer’s disease and those who show normal aging

effects (Robinson-Whelen, 1992; Zanini et al., 2014). In a study by Robinson-Whelen (1992),

performance on the BVRT was compared between four groups: patients with very mild

Alzheimer’s disease, patients with mild Alzheimer’s disease, patients with moderate Alzheimer’s

disease, and healthy controls. This author found that performance accuracy scores on the BVRT

not only were lower in the samples of patients with Alzheimer’s disease, but that BVRT scores

declined relative to disease severity. Furthermore, the rates of both distortion and omission errors

increased as disease severity increased, with omission rates rising to a greater extent. Based on

this finding Robinson-Whelen (1992) suggested that monitoring omission errors on the BVRT

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may be a meaningful way to track dementia progression. Zanini et al. (2014) reinforced these
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findings through their experiment that paralleled Robinson-Whelen’s (1992) results using a

Brazilian sample. Again, when comparing older adults with Alzheimer’s disease to healthy
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controls, the researchers found that the clinical group committed more omission, distortion, and

size errors than the controls.

Scholars have investigated the utility of the BVRT for detection of early signs of
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Alzheimer’s disease. Zonderman et al. (1995) examined BVRT performance longitudinally in a

sample of 371 adults. These individuals completed the BVRT every 2 years as part of the

Baltimore Longitudinal Study of Aging. The authors found that individuals who eventually

received a diagnosis of Alzheimer’s disease had larger changes in BVRT performance over the

6-year interval prior to disease onset. A subgroup of these same researchers analyzed more data

from the Baltimore Longitudinal Study of Aging a few years later, this time including

longitudinal data from 1,425 adults in their study (Kawas et al., 2003). Kawas et al. (2003) found

that individuals who eventually received a diagnosis of Alzheimer’s disease had greater error

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 rates in BVRT performance over the 15-year interval prior to disease onset. These researchers

also were able to determine that the commission of six or more BVRT errors was associated with

risk factors of magnitude 5.69, 2.11, 1.76, and 1.83 times increased risk for Alzheimer’s disease,

at corresponding time intervals of 1–3, 3–5, 5–10, and 10–15 years before diagnosis.

There also is a growing body of evidence to support the use of the BVRT in research

relating to brain injury and brain disease. During the early years of establishment of normative

data for the BVRT, Benton and Collins (1949) observed differences in children with brain injury.

The researchers tested 14 children who scored within the average range of intelligence after brain

injury and found impaired BVRT performance in half of their sample. Wahler (1956) explored

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differences in the BVRT performance of patients with brain disease in comparison to healthy
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controls. Wahler (1956) found that patients in their clinical sample that was comprised of

patients with cerebral trauma, encephalitis, focal epilepsy, and multiple sclerosis committed 1.76
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times more BVRT errors than healthy controls. While no clear error profile was found, the

author indicated that the clinical sample was more prone to commission of size and rotation

errors. Additionally, significant correlations between BVRT error rates and the size of brain
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lesions have been found (Kasahara et al., 1993, 1995) as well as associations between specific

BVRT error profiles and lesion locations. Specifically, misplacement errors were found to be

more prevalent in patients with right-hemispheric lesions, distortion errors were found to be

more prevalent in patients with left-hemispheric lesions (Pettifor, 1967) and basal ganglia lesions

(Kasahara et al., 1995), and perseveration errors were found to be more prevalent in patients with

anterior lesions (Vilkki, 1989) and thalamic lesions (Kasahara et al., 1995).

The BVRT also has been used to assess cognitive features of learning disabilities.

Originally, while establishing normative data for children, Benton and Collins (1949) were

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