Perceptual and Motor Skills, 2010, 111, 1, 45-59.

© Perceptual and Motor Skills 2010

THE RELIABILITY OF THREE VISUAL PERCEPTION

TESTS USED TO ASSESS ADULTS1, 2

TED BROWN RALDA BOURNE

Department of Occupational Therapy Occupational Therapy Services

School of Primary Health Care St Vincent’s Health
Faculty of Medicine, Nursing & Health Sciences
Monash University–Peninsula Campus
EMMA SUTTON STEFAN WIGG

Occupational Therapy Occupational Therapy

Rehabilitation Care Centre Acute Health Services
St Vincent’s Hospital St Vincent’s Hospital

DEIDRE BURGESS SHARON GLASS

Occupational Therapy Service Occupational Therapy Service

Peninsula Health Peninsula Health

STEPHEN ELLIOTT AISLINN LALOR

Department of Occupational Therapy Department of Occupational Therapy

School of Primary Health Care School of Primary Health Care
Faculty of Medicine, Nursing & Health Sciences Faculty of Medicine, Nursing & Health Sciences
Monash University–Peninsula Campus Monash University–Peninsula Campus

Summary.—The reliability of three adult visual perceptual tests was investi-

gated. Participants aged 20 years and older (N = 221; 49 adults with neurological
impairment, 172 adults without) completed the Developmental Test of Visual Per-
ception–Adolescent and Adult (DTVP–A), the Motor-Free Visual Perception Test–3
(MVPT–3), and the Test of Visual Perceptual Skills (non-motor) Third Edition
(TVPS–3). Participants (n = 46) without neurological impairment completed these
tests twice. Cronbach’s alpha for the DTVP–A, MVPT–3, and TVPS–3 total scales
were .86, .74, and .80 and test-retest correlations .51, .71, and .72, respectively.

Visual perception is the capacity to interpret what is seen (Zoltan,

1996), i.e., recognition, insight, and interpretation. Types of visual per-
ceptual abilities have been identified in the theoretical and clinical liter-

1
Address correspondence to Dr. Ted Brown, Associate Professor and Postgraduate Coor-
dinator, Department of Occupational Therapy, School of Primary Health Care, Faculty of
Medicine, Nursing & Health Sciences, Monash University–Peninsula Campus, Building G,
4th Floor, McMahons Road, Frankston, Victoria 3199, Australia or e-mail (ted.brown@med.
monash.edu.au).
2
Participants who volunteered their time to take part in the study are thanked for their valu-
able contribution toward this study. The Walter Cottman Endowment Fund/Equity Trustees,
Limited, and the Peninsula Health Research Development Fund are acknowledged for their
financial contribution in the form of research grants that made the completion of this study
possible.

DOI 10.2466/03.24.27.PMS.111.4.45-59 ISSN 0031-5125

46 T. BROWN, ET AL.

ature: visual discrimination, visual memory, visual spatial relationships,

visual form constancy, visual sequential memory, visual figure-ground,
and visual closure (Colarusso & Hammill, 2003; Schneck, 2005; Martin,
2006). These abilities allow orientation of the body in space, perception
of the relative position of objects, discrimination between the features of
objects (e.g., position, shape, color, etc.), distinguishing an object from its
surroundings, identification of a whole figure when only fragments of the
figure are visible, and recognition of a stimulus item following a brief in-
terval (Reynolds, Pearson, & Voress, 2002; Colarusso & Hammill, 2003;
Schneck, 2005; Martin, 2006). Definitions of these subtypes of visual per-
ception are included in Table 1.
Disorders of visual perception are primarily caused by dysfunction in
the association areas of the brain or their related nerve tracts (Reed, 2001;
Titcomb & Okoye, 2005). It is common for persons with visual percep-
tual dysfunction to possess a poor concept of distance and position, and
be unable to interpret the meaning of objects within their immediate sur-
roundings (Phipps, 2006). Activities of daily living such as dressing, eat-
ing, reading, writing, housekeeping, driving, and participating in leisure
pursuits are limited (Edmans, Towle, & Lincoln, 1991; Mercier, Audet, He-
bert, Rochette, & Dubois, 2001; Reed, 2001; Ishihara, Ishihara, Nagamachi,
Osaki, & Hiramatsu, 2004; Faye, 2005; Gianutsos, 2005; Schneck, 2005),
and the risk of serious injury increased (Zoltan, 1996; Warren, 2006).
Visual perceptual dysfunction is associated often with the presenta-
tion of a clinical condition involving either a neurological disorder or an
acquired injury (Brown, Mullins, & Stagnitti, 2008). Diagnoses associated
with visual perceptual dysfunction include multiple sclerosis, dementia,
cerebral palsy, spina bifida, Parkinson’s disease, cerebrovascular accident,
and acquired brain injury (Bouska, Kauffman, & Marcus, 1990; Edmans,
et al., 1991; Hill, Backman, & Fratiglioni, 1995; Lezak, 1995; Zoltan, 1996;
Unsworth, 1999; Mercier, et al., 2001; Glosser, Gallo, Duda, de Vries, Clark,
& Grossman, 2002). Hence, visual perception is a performance component
frequently evaluated by practitioners (Zoltan, 1996; Unsworth, 1999).
To ensure accuracy and consistency in the assessment of visual per-
ceptual skills and appropriate intervention delivery, the instruments em-
ployed to assess such skills should have documented psychometric prop-
erties including reliability (American Educational Research Association,
American Psychological Association, and the National Council on Mea-
surement in Education, 1999). Three visual perceptual tests suitable for
use with adults were created from tests originally developed for children;
these are the Developmental Test of Visual Perception–Adolescent and
Adult (DTVP–A; Reynolds, et al., 2002), the Motor-Free Visual Perception-
Test–Third Edition (MVPT–3; Colarusso & Hammill, 2003), and the Test
 RELIABILITY OF THE DTVP–A, MVPT–3, AND TVPS–3 47

of Visual Perceptual Skills (non-motor)–Third Edition (TVPS–3; Martin,

2006). As these tests are commonly used by clinicians, it is important that
their respective psychometric properties be replicated in various groups.
The purpose of this study was to investigate internal consistency and test-
retest reliability of these three visual perceptual tests in adults.
Method
Participants
A total of 221 participants from Melbourne, Victoria, Australia, were
involved in this study. Of the 221 participants, 172 were healthy partici-
pants, and 49 presented with a neurological impairment (e.g., stroke, trau-
matic brain injury). The sample size for the study was based on a number
sufficient to complete the required reliability analyses. Inclusion criteria
for both groups were giving consent to take part in the study, having a
working knowledge of the English language, and having the stamina to
complete the three visual perceptual tests. The group of participants with
impairment also had to have a formal medical diagnosis of a neurologi-
cal impairment.
Convenience sampling was used for both groups, with 20 of the 49
participants with neurological impairment being recruited from an inpa-
tient rehabilitation centre and the remaining 29 being recruited from an
acute care hospital inpatient setting. All participants were over the age
of 20 yr., and were required to provide informed consent prior to being
enrolled in the study. Ethics committee approvas was obtained from the
Monash University Standing Committee on Ethics in Research Involving
Humans, Peninsula Health Human Research and Ethics Committee, and
St Vincent’s Health Human Research Ethics Committee prior to data col-
lection with participants commencing.
Instruments
Developmental Test of Visual Perception–Adolescent and Adult (DTVP–A;
Reynolds, et al., 2002).—The DTVP–A is an assessment battery designed
to measure the visual perception and visual-motor integration abilities of
persons ages 11 to 74 years and comprises three “motor-enhanced” sub-
scales (copying, visual-motor search, and visual-motor speed) and three
“motor-reduced” subscales (figure-ground, visual closure and form con-
stancy). The “motor-enhanced” subscales require the respondent to use
eye-hand coordination, while the “motor-reduced” test items require little
or no motor ability (Reynolds, et al., 2002). Three composite index perfor-
mance scores are calculated: Visual-Motor Integration Index score, Motor-
Reduced Visual Perception Index score, and a General Visual Perception
Index score (the sum of the two specific indexes); each index can be used
independently. Only the three “motor-reduced” subscales of the DTVP–
48 T. BROWN, ET AL.

A were included in this study: figure-ground, visual closure, and form

constancy subscales (see Table 1). Collectively, the three DTVP–A motor-
reduced subscales take approximately 20 min. to administer. The DTVP–

TABLE 1
Definitions of Motor-Free Visual Perceptual Skills From the
Developmental Test of Visual Perception–Adolescent and Adult,
the Motor-Free Visual Perception Test–Third Edition, and the Test
of Visual Perceptual Skills (non-motor)–Third Edition Instruments

Developmental Test of Visual Perception–Adolescent and Adult

1. Figure-Ground: involves the recognition of figures embedded within a general sensory
background. Respondents are shown stimulus figures and asked to find as many of the
figures as they can on a page where the figures are hidden in a complex, confusing back-
ground.
2. Visual Closure: respondents are shown a stimulus figure and asked to select the exact fig-
ure from a series of figures that have been incompletely drawn. In order to complete the
match, respondents have to mentally supply the missing parts of the figures in the series.
3. Form Constancy: involves the recognition of the dominant features of certain figures or
shapes when they appear in different sizes, shadings, textures, and positions. Respon-
dents are shown a stimulus figure and asked to find it twice in a series of figures. In the
series, the targeted figure will have a different size, position, and/or shade, and it may be
hidden in a distracting background.
Motor-Free Visual Perception Test–Third Edition
1. Spatial Relationships: the ability to orient one’s body in space and to perceive the positions
of objects in relation to oneself and to other objects.
2. Visual Discrimination: the ability to discriminate the dominant features in different ob-
jects; for example, the ability to discriminate position, shapes, forms, colours, and letter-
like drawings.
3. Figure Ground: the ability to distinguish an object from its background.
4. Visual Closure: the ability to identify incomplete figures when only fragments of it are
presented.
5. Visual Memory: the ability to recall dominant features of one stimulus item or to remem-
ber the sequence of several items.
Test of Visual Perceptual Skills (non-motor)–Third Edition
1. Visual Discrimination: the ability to match or determine exactly the characteristics of two
forms when one of the forms is among similarly shaped forms.
2. Visual Memory: the ability to remember for immediate recall (after four or five seconds)
all of the characteristics of a given form, and be able to find this form in an array of simi-
lar forms.
3. Visual-Spatial Relationships: the ability to determine, from among five forms of identical
configuration, the one single form or part of a single form that is going in a different direc-
tion from the other forms.
4. Visual Form Constancy: the ability to see a form and find that form, even though the form
may be smaller, larger, rotated, reversed, and/or hidden.
5. Visual Sequential Memory: the ability to remember for immediate recall (after four or five
seconds) a series of forms from among four separate series of forms.
6. Visual Figure-Ground: the ability to perceive a form visually, and then to find this form
hidden in a conglomerated ground of matter.
7. Visual Closure: the ability to determine, from among four incomplete forms, the one form
that is the same as the stimulus form (e.g., the completed form).
 RELIABILITY OF THE DTVP–A, MVPT–3, AND TVPS–3 49

A requires the participant to analyze 49 black-and-white designs and re-

spond appropriately within a multiple-choice format (Reynolds, et al.,
2002). The participant is asked to point to the design that he thinks is cor-
rect and the examiner records the participant’s answer. The participant’s
answer is then scored as correct (1) or incorrect (0). Four scores can be cal-
culated: figure-ground subscale score, visual closure subscale score, form
constancy subscale score, and the composite Motor-Reduced Visual Per-
ception Index score. The highest possible raw scores on the subscales are
14, 16, and 19, respectively. Cronbach’s alpha reported in the DTVP–A test
manual for the Motor-Reduced Visual Perception Index and three sub-
scales were .77, .81, .89, and .92, respectively (Reynolds, et al., 2002). The
1-wk. test-retest reliability correlations were .81, .71, .70, and .74, respec-
tively.
Motor-Free Visual Perception Test–Third edition (MVPT–3; Colarusso &
Hammill, 2003).— The MVPT–3 “assesses an individual’s visual perceptu-
al ability without any motor involvement needed to make a response” (p.
8). It is a revision of two previous versions (Colarusso & Hammill, 1972,
1996), for use with clients 4 to 95+ years of age (Colarusso & Hammill,
2003). Clients older than 11 years should only be examined using Items 14
to 65. The five visual perceptual skill areas assessed include spatial rela-
tionships, visual discrimination, figure-ground, visual closure, and visual
memory (see Table 1; Colarusso & Hammill, 2003). The test authors em-
phasize that identification of specific subskill deficits is not possible, so the
MVPT–3 is only a measure of overall visual perceptual ability (Colarus-
so & Hammill, 2003). The test requires participants to inspect 65 black-
and-white line drawings and, for each, identify a matching stimulus from
four response options (Colarusso & Hammill, 2003). The total number of
correct (1) responses are summed to obtain the overall visual perceptual
performance score. The highest possible raw score is 65. The MVPT–3 is
administered individually, and takes approximately 20 to 30 minutes to
administer. The MVPT–3 manual reported Cronbach’s alpha values of .76
to .87 for participants ages 5 to 10 years, and .86 to .90 for five age groups
that spanned 11 to 84+ years. The test-retest correlation reported in the
manual for ages 11 to 84+ years was .92 with an average test-retest time
period of 34 days.
Test of Visual Perceptual Skills (non-motor)–Third Edition (TVPS–3; Mar-
tin, 2006).—The TVPS–3 is used for academic diagnostic purposes to as-
sess the visual perceptual strengths and weaknessess of students ages 4
to 18 years, 11 months, but is also appropriate for adults using norms for
the oldest age group (Martin, 2006). Several studies have used the earli-
er versions of the TVPS–3 with adults: Hung, Fisher, and Cermak (1987),
Su, Chien, Cheng, and Lin (1995), Block, Brusca-Vega, Pizzi, Berry-Kravis,
50 T. BROWN, ET AL.

Maino, and Treitman (2000), and Rege and Joshi (2005). The test contains
seven subscales, each with two example and sixteen scored items arranged
in order of increasing difficulty: visual discrimination, visual memory, vi-
sual spatial relationships, visual form constancy, visual sequential memo-
ry, visual figure-ground, and visual closure (see Table 1). The test takes ap-
proximately 30 minutes to administer and requires participants to analyse
112 black-and-white designs and respond appropriately within a multi-
ple-choice format. Participants are required to point to a design they think
is the correct answer. The participant obtains a score of one for each cor-
rect answer and a score of zero for each incorrect answer. Scores are calcu-
lated for each of the seven subscales as well as an overall visual perceptual
ability index. The maximum raw score for each of the seven TVPS–3 sub-
scales is 16. The TVPS–3 manual reported Cronbach’s alpha of .96 for the
overall index and subscale coefficients of .76 for visual discrimination, .76
for visual memory, .87 for visual spatial relationships, .75 for visual form
constancy, .78 for visual sequential memory, .82 for visual figure-ground,
and .82 for visual closure (Martin, 2006). The test-retest correlation coef-
ficient for the overall index was .97, and for specific subscales .63, .82, .75,
.78, .58, .73, and .80, respectively.
Procedures
Potential participants were identified and invited to participate in the
study. After volunteering, the participants were contacted and a time and
place were arranged to administer the three instruments. Tests were ad-
ministered individually by a single trained research assistant, and the or-
der was randomized (as described in Table 2). A 5-min. break was sched-
uled between each of the three perceptual tests.
Test-retest reliability data were gathered from 46 of the 172 partici-
pants without neurological impairment. These 46 participants complet-
ed the three visual perceptual tests upon two separate occasions separat-
ed by a two-week interval. Due to the demanding nature of the retesting
process, participants with neurological impairments were not included as
advised by the two hospital ethics committees. Internal consistency data
were gathered for all participants.
Data Analysis
The Statistical Package for Social Sciences (SPSS) was used. Cron-
bach’s alpha was used to examine the internal consistency of the three vi-
sual perceptual tests and their subscales (�����������������������������
Anastasi & Urbina, 1997; Nor-
����
man & Streiner, 2000). The Spearman’s ρ correlation coefficient was used
for calculating test-retest reliabilties (Streiner & Norman, 1995). The inter-
nal consistencies were interpreted according to Nunnally and Bernstein
 RELIABILITY OF THE DTVP–A, MVPT–3, AND TVPS–3 51

(1994); that is, .80 and above was considered high, .50 to .79 was consid-
ered moderate, and .49 and below was considered low.
Results and Discussion
A total of 172 participants without neurological impairment (77 men,
95 women) and 49 participants with neurological impairment (27 men,
22 women) took part in the study. Other demographic data are presented
in Table 2. There was a relatively even distribution of the order the three
tests were completed. The majority of tests were completed in the morn-
ing (59%). On average, it took the participants without neurological im-
pairment 1.5 hr. to complete the three visual perceptual tests, and those
with a neurological impairment 2 hr.
The participant group without neurological impairment achieved
higher subscale and overall scores on all tests than did the group of par-

TABLE 2
Descriptive Information For Participants Without Neurological
Impairment (n = 172) and With Neurological Impairment (n = 49)
Variable Descriptor No Impairment Neurological
Group (n = 172) Impairment Group
(n = 49)
n % n %
Age, yr. 18–25 68 39.53 0 0
26–35 32 18.60 5 10.20
36–45 19 11.05 4 8.16
46–55 32 18.60 7 14.29
56–65 9 5.23 12 24.50
66–75 8 4.65 11 22.45
76–99 4 2.33 10 20.41
Education level Primary school 0 0 10 20.41
High school 40 23.26 25 51.02
TAFE/college 24 13.95 3 6.12
Tertiary–undergraduate 73 42.44 4 8.16
Tertiary–postgraduate 35 20.35 5 10.20
Other 0 0 2 4.08
Geographical Inner city 69 40.12 11 22.45
location Suburban 72 41.86 20 40.82
Rural 31 18.02 18 36.73
Employment status Full-time 82 47.67 12 24.50
Part-time 57 33.14 2 4.08
Not working 9 5.23 3 6.12
Retired 14 8.14 29 59.18
Other 10 5.81 3 6.12
Time of day when Morning (9:00 a.m.–11:59 a.m.) 31 18.02 29 59.18
visual perceptual Early p.m. (12:00 p.m.–2:59 p.m.) 57 33.14 16 32.65
tests were Late p.m. (3:00 p.m.–5:59 p.m.) 41 23.84 4 8.16
completed Evening (6:00 p.m.–8:59 p.m.) 32 18.60 0 0
Other (9:00 p.m.–9:00 a.m.) 11 6.40 0 0
52 T. BROWN, ET AL.

ticipants with neurological impairment. Descriptive statistics are present-

ed in Table 3.
TABLE 3
Visual Perceptual Test Scores of Participants Without Neurological
Impairment (n = 172) And With Neurological Impairment (n = 49)
Visual Perceptual Test No Impairment Group Neurological Impairment Group
M SD Range M SD Range
DTVP–A Total (motor-
reduced) Scale 44.56 3.59 21 30.38 9.94 49
Figure-ground 10.86 2.25 10 6.91 3.14 14
Visual closure 15.47 0.96 6 11.73 3.70 16
Form constancy 18.24 1.31 7 11.73 4.52 19
MVPT–3 Total Scale 59.91 3.45 22 43.96 11.20 53
TVPS–3 Total Scale 102.16 7.20 60 66.14 23.91 109
Visual discrimination 14.81 1.68 8 9.23 4.80 16
Visual memory 13.84 1.96 19 10.02 3.17 15
Spatial relationships 15.72 .58 3 12.11 4.16 16
Form constancy 14.94 1.46 9 7.98 4.47 16
Sequential memory 12.90 1.66 8 9.82 3.45 16
Figure-Ground 15.47 0.96 6 7.77 4.67 16
Visual closure 14.87 1.30 8 9.20 4.20 16
Note.—The highest possible motor-free total scale raw scores that can be achieved on the
DTVP–A, the MVPT–3, and the TVPS–3 are 49, 65, and 112, respectively. DTVP–A = Devel-
opmental Test of Visual Perception–Adolescent and Adult; TVPS–3 = Test of Visual Percep-
tual Skills (non-motor)–Third Edition; MVPT–3 = Motor-Free Visual Perception Test–Third
Edition.

General Reliability Analysis

Internal consistency (Cronbach alpha coefficients) is reported for each
total scale and subscale in Table 4. Data for the combined sample of par-
ticipants with and without neurological impairments were used for this
reliability analysis. Overall, the three visual perceptual tests and their sub-
scales exhibited moderate to high internal consistency.
For estimation of test-retest correlation, a total of 46 healthy partici-
pants completed the DTVP–A, the MVPT–3, and the TVPS–3 on two sepa-
rate occasions separated by a two-week interval. Spearman’s ρ coefficients
were calculated and reported in Table 5. Test-retest correlations were sig-
nificant and above .70 for the DTVP–A, MVPT–3, and TVPS–3 total scales.
For subscales, all DVTP-A and TVPS–3 subscales, and five of the seven
TVPS–3 subscales had significant test-retest correlations above .70, but not
the TVPS–3 subscales Spatial relationships and Visual closure. Overall,
the MVPT–3 and TVPS–3 total scale scores exhibited the highest test-re-
test reliabilities.
Overall, in the current study, both the internal consistency and test-
retest reliability results of the DTVP–A, MVPT–3, and TVPS–3 were low-
 RELIABILITY OF THE DTVP–A, MVPT–3, AND TVPS–3 53

TABLE 4
Internal Consistency of Visual Perceptual Tests
Visual Perceptual Test Cronbach’s Alpha
DTVP–A Total (motor-reduced) Scale .86
Figure-ground .73
Visual closure .74
Form constancy .75
MVPT–3 Total Scale .74
TVPS–3 Total Scale .80
Visual discrimination .76
Visual memory .71
Spatial relationships .76
Form constancy .76
Sequential memory .70
Figure-ground .76
Visual closure .75
Note.—DTVP–A = Developmental Test of Visual Perception–Adolescent and Adult; TVPS–
3 = Test of Visual Perceptual Skills (non-motor)–Third Edition; MVPT–3 = Motor-Free Visual
Perception Test–Third Edition.

er than those reported in the three test manuals and higher than those
reported by Brown, et al. (2008). However, with respect to the internal
consistency results, those of the current study more closely approximated
those reported within the DTVP–A, MVPT–3, and TVPS–3 test manuals
than those reported by Brown, et al. (2008). Indeed, the results of the cur-
rent study, like those reported in each of the three visual perceptual test
manuals, more often than not reflected moderate to high internal consis-
TABLE 5
Test-retest Correlations of Visual Perceptual Tests With 2-wk.
Interval Between First and Second Test Administrations (n = 46)
Visual Perceptual Test Spearman’s ρ 95%CI
DTVP–A Total (motor-reduced) Scale 0.51† .27, .86
Figure-ground 0.56† .26, .84
Visual closure 0.33† .05, .64
Form constancy 1.00† −.29, .29
MVPT–3 Total Scale 0.71† .60, 1.18
TVPS–3 Total Scale 0.72† .69, 1.27
Visual discrimination 0.55† .32, .91
Visual memory 0.44† .18, .77
Spatial relationships 0.20 −.09, .50
Form constancy 0.45† .19, .78
Sequential memory 0.42† .15, .74
Figure-ground 0.53† .30, .88
Visual closure 0.28* −.01, .88
Note.—DTVP–A = Developmental Test of Visual Perception – Adolescent and Adult; TVPS–
3 = Test of Visual Perceptual Skills (non-motor)–Third Edition; MVPT–3 = Motor-Free Visual
Perception Test–Third Edition. *p < .05. †p < .01.
54 T. BROWN, ET AL.

tency for overall test and subscale scores. In contrast, the results of the
study by Brown, et al. (2008), most often reflected low to moderate inter-
nal consistency.
Internal Consistency Analyses
DTVP–A internal consistency.—Similar to the DTVP–A test manual,
Cronbach’s alpha values obtained for each of the DTVP–A subscales were
lower than that for the DTVP–A Motor-Reduced Visual Perception Index.
Comparatively, Brown, et al. (2008) reported internal consistency coeffi-
cients of .49, .34, and .38, respectively, for the subscales, and .60 for the
DTVP–A Motor-Reduced Visual Perception Index. Brown, et al.’s values
(2008) suggest that all DTVP–A motor-reduced scales, with the exception
of the figure-ground subscale, have low internal consistency. Both the cur-
rent study and Reynolds, et al. (2002) involved participants with and with-
out some form of impairment (neurological versus cognitive impairment),
so the disparity observed between these findings and those of Brown, et
al. (2008) might be attributable to the latter study having involved only
“healthy” adults. Differences in sample size, age range, and cultural con-
text may also have affected the results; the current study involved 221
people ages 18 to 99 years, Reynolds, et al. (2002) involved 1,664 people
ages 11 to 75 years, and Brown, et al. (2008) involved 50 people ages 18
to 55 years. Furthermore, whilst Reynolds, et al. (2002) included partici-
pants from varying ethnic backgrounds and geographic locations around
the United States, the current sample and that of Brown, et al. (2008) were
more homogeneous.
MVPT–3 internal consistency.—In the current study, the internal con-
sistency coefficient for the MVPT–3 was significantly lower than those re-
ported in the MVPT–3 test manual for persons older than 11 years of age,
.86 to .90. Brown, et al. (2008) reported Cronbach’s alpha at .69 in a group
of healthy adults. Either sample size, ethnicity, or socioeconomic status
could have affected the reported values. Colarusso and Hammill (2003)
studied 670 participants from a number of different ethnic backgrounds
and geographic locations within the United States; the current sample
(N = 221) and Brown, et al.’s sample (2008; N = 50) were selected from Vic-
toria, Australia. The results from the latter two studies were more similar.
TVPS–3 internal consistency.— The TVPS–3 total scale score provides
a measure of overall visual perceptual (motor-reduced) ability, while its
subscale scores provide independent measures of distinct visual percep-
tual skills. The TVPS–3 total score had a higher internal consistency co-
efficient than its subscales. Interestingly, this trend was also apparent in
both the results reported in the TVPS–3 manual, and those reported by
Brown, et al. (2008). Internal consistency coefficients reported by Martin
(2006) were higher than both those in the current study, and those report-
 RELIABILITY OF THE DTVP–A, MVPT–3, AND TVPS–3 55

ed by Brown, et al. (2008). Overall, when compared against the TVPS–3

manual (Martin, 2006) and Brown, et al. (2008), the findings of the cur-
rent study most closely resembled the findings of Martin (2006). Indeed,
internal consistency reliabilities for the total TVPS–3 reported in the cur-
rent study and in the TVPS–3 test manual (.81 and .96, respectively) do not
closely resemble that reported by Brown, et al. (2008), .63. Furthermore,
the current study and the TVPS–3 test manual indicate good subscale reli-
ability (.71–.76, and .76–.88, respectively), while those reported by Brown,
et al. (.22–.49) were very low. The internal consistencies reported in the
TVPS–3 test manual were based on a sample of 2,008 presumably healthy
U.S. students, 4 to 18 years old, many more participants—and all less than
18 years of age—than the current study’s sample or that of Brown, et al.
(2008), whose participants were all adults. It is surprising that the present
internal consistency results most closely parallel those attained by Martin
(2006), indicating that the TVPS–3 should exhibit high internal consisten-
cy when used with adults, while the findings of Brown, et al. (2008) sug-
gest low internal consistency.
Test-retest Reliability
DTVP–A test-retest reliability.—The DTVP–A manual did not speci-
fy the type of correlation statistic used to calculate the correlations used
within preliminary test-retest reliability analysis (Reynolds, et al., 2002),
nor the statistical significance of the values; however, given that all values
were .70 or above, it is reasonable to assume that they were statistically
significant (Reynolds, et al., 2002). In the current study, the Spearman’s ρ
correlation coefficient for the DTVP–A total scores at a two-week interval
was .51. The DTVP–A subscales of Figure-ground and Form constancy
were significantly positively correlated. The Visual closure subscale had a
positive, but nonsignificant test-retest correlation of .33. These results dif-
fer substantially from both those reported in the DTVP–A test manual by
Reynolds, et al. (2002), and those reported by Brown, et al. (2008). Indeed,
for the overall scale, Reynolds, et al. (2002), reported test-retest at .81, and
Brown, et al. (2008) reported .46. Reynolds, et al. (2002) also reported the
subscales to have moderate test-retest reliabilities (.71, .70, and .74, respec-
tively), whereas Brown, et al. (2008) found DTVP–A subscales to have low
test-retest reliabilities (.36, .24, and −.08, respectively). The results report-
ed in the DTVP–A manual were based on a sample of 30 individuals (ages
20 to 57 years old) from Austin, Texas, and the time between tests was
one week. Sample size and time between tests were quite different from
this sample (N = 51, 14 days) and Brown, et al. (N = 25, 16 days). Partici-
pants from the studies of Reynolds, et al. (2002) and Brown, et al. (2008)
were most similar in terms of age, but the DTVP–A test-retest reliability
results of the current study were expected to most closely parallel those of
56 T. BROWN, ET AL.

Brown, et al. (2008) because the sample size, cultural context, and average
test-retest time were more similar, but this expectation was not supported.
Since Reynolds, et al. (2002) did not report the health status of the partici-
pants for test-retest measurements, it is unknown as to whether or not this
sample, like those of both the current study and the study by Brown, et al.
(2008), comprised only persons without neurological impairment.
MVPT–3 test-retest reliability.—In the current study, the test-retest re-
liability (.74) was lower than that reported by Colarusso and Hammill
(2003) in the MVPT–3 test manual for ages 11 to 84+ years (.92), yet is sub-
stantially higher than the .62 reported by Brown, et al. (2008). Indeed, the
test-retest correlation of Colarusso and Hammill (2003) reflects high test-
retest reliability, while those in both the current study and that of Brown,
et al. (2008) were moderate. This finding is interesting given that the aver-
age test-retest time period in the study by Colarusso and Hammill (2003)
was 34 days, whilst the test-retest time periods for the current study (14
days), and Brown, et al. (2008; 16 days) were half as long. Lesser time
frames may reflect practice effects (Greenwood, 2004). The observed rela-
tionship between the test-retest reliability results of the three studies may
also be attributable to the size, age, and health status of the participant
samples employed within each. Indeed, while the current study employed
a comparatively similar number of adult participants (N = 51) as Brown, et
al. (2008) (N = 46), Reynolds, et al. (2002) tested 75. Colarusso and Hammill
(2003) also employed participants who were as young as 11 years of age.
TVPS–3 test-retest reliability.—Test-retest reliability of the TVPS–3 was
statistically significant and positive (.72); test-retest for five of the sub-
scales were much lower but significant, while two others (Spatial relation-
ships and Visual closure) were not significant. Brown, et al. (2008) found
only Visual discrimination, Sequential memory, and Figure-ground had
statistically significant test-retest correlations. Brown, et al. (2008) report-
ed a much lower correlation of .59 for the total scale, as well as lower cor-
relations for each of the seven subscales (.46, .25, .08, .23, .53, .44, and .12,
respectively). In the TVPS–3 test manual, the test-retest correlation for the
total scale score was .97, with the range for subscales .43 to .81 (Martin,
2006). Interestingly, all three studies found the TVPS–3 total scale to pos-
sess higher test-retest reliability than any of its individual subscales. The
TVPS–3 may best serve as a measure of overall visual perceptual ability
as opposed to a measure of individual visual perceptual subskill deficits.
Specifically, the subscale Sequential memory has very low test-retest reli-
ability. However, it is important to note that care should be taken when
comparing the results, since in Brown, et al. (2008) and Martin (2006) the
participants were adults, but the sample reported in the test manual were
children and adolescents ages 6 to 14 years old (Martin, 2006; Brown, et
al., 2008).
 RELIABILITY OF THE DTVP–A, MVPT–3, AND TVPS–3 57

Study Limitations and Recommendations

Participants were recruited from a single geographic region (Mel-
bourne metropolitan area, Victoria, Australia) using convenience sam-
pling; therefore, it was not stratified by age group, socioeconomic status,
and so forth. Participants’ visual skills (e.g., presence of acuity and field
loss, strabismus, or diplopia) were not screened. Some of the subscales
may have been more or less sensitive to unreported visual problems.
The use of the TVPS–3 could also be considered to be a limiting fac-
tor within this study, because its manual only provides normative data
for ages 4 to 18 years. The test author’s suggestion that the TVPS–3’s nor-
mative data for persons 18 years old could be extrapolated to older adults
may not be accurate. The test-retest results were based only on healthy
participants and did not include any participants with a neurological im-
pairment. For ethical reasons it was not possible to administer the three vi-
sual perceptual tests on two separate occasions with this vulnerable group.
It is recommended that future studies be completed with a sample
representative of a national population. Furthermore, by exploring the re-
liability of the three tests amongst participant groups with specific medi-
cal diagnoses (e.g., multiple sclerosis), future studies could endeavor to
define the clinical utility of each test with greater clarity. It is also rec-
ommended that alternate reliability and validity measures be used to ex-
plore test performance. This latter recommendation is reiterated by Ca-
nivez (2005) and Hodgson (2005) within their respective critiques of the
MVPT–3 and the DTVP–A.
REFERENCES
American Educational Research Association, American Psychological Associa-
tion, and the National Council on Measurement in Education. (1999) Stan-
dards for educational and psychological testing. Washington, DC: American Psycho-
logical Association.
Anastasi, A., & Urbina, S. (1997) Psychological testing. (7th ed.) Upper Saddle River,
NJ: Prentice Hall.
Block, S. S., Brusca-Vega, R., Pizzi, W. J., Berry-Kravis, E., Maino, D. M., & Treitman,
T. (2000) Cognitive and visual processing skills and their relationship to muta-
tion size in full and premutation female fragile X carriers. Optometry and Vision
Science, 77, 592-599.
Bouska, M. J., Kauffman, N. A., & Marcus, S. E. (1990) ����������������������������
Disorders of the visual per-
ceptual system. In D. A. Umphred (Ed.), Neurological rehabilitation. St. Louis, MO:
Mosby. Pp. 705-740.
Brown, T., Mullins, E., & Stagnitti, K. (2008) The reliability of performance of
healthy adults on three visual perceptual tests. British Journal of Occupational Ther-
apy, 71, 438-447.
Canivez, G. L. (2005) Review of the Motor-Free Visual Perception Test–Third Edition.
In R. A. Spies & B. S. Plake (Eds.), The sixteenth mental measurements yearbook. Lin-
coln, NE: Buros Institute of Mental Measurements. Pp. 635-638.
58 T. BROWN, ET AL.

Colarusso, R. P., & Hammill, D. D. (1972) Motor-Free Visual Perception Test. Novato,

CA: Academic Therapy Publications.
Colarusso, R. P., & Hammill, D. D. (1996) Motor-Free Visual Perception Test–Revised.
Novato, CA: Academic Therapy Publications.
Colarusso, R. P., & Hammill, D. D. (2003) Motor-Free Visual Perception Test–Third Edi-
tion. Novato, CA: Academic Therapy Publications.
Edmans, J. A., Towle, D., & Lincoln, N. B. (1991) The recovery of perceptual prob-
lems after stroke and the impact on daily life. Clinical Rehabilitation, 5, 301-309.
Faye, E. E. (2005) Functional aspects of the eye diagnosis in older adults. In M. Gentile
(Ed.), Functional visual behaviour in adults: an occupational therapy guide to evaluation
and treatment options. Bethesda, MD: American Occupational Therapy Associa-
tion. Pp. 65-84.
Gianutsos, R. (2005) Driving and visual information processing in cognitively at-risk
and older individuals. In M. Gentile (Ed.), Functional visual behaviour in adults: an
occupational therapy guide to evaluation and treatment options. Bethesda, MD: Ameri-
can Occupational Therapy Association. Pp. 105-125.
Glosser, G., Gallo, J., Duda, N., de Vries, J. J., Clark, C. M., & Grossman, M.
(2002) Visual perceptual functions predict instrumental activities of daily living
in patients with dementia. Neuropsychiatry, Neuropsychology, & Behavioral Neurol-
ogy, 15(3), 198-202.
Greenwood, K. M. (2004) Measurement: concepts, tools and issues. In V. Minichello,
G. Sullivan, K. Greenwood, & R. Axford (Eds.), Research methods for nursing and
health science. (2nd ed.) Frenchs Forrest, Australia: Pearson Education Australia.
Pp. 320-346.
Hill, R. D., Backman, L., & Fratiglioni, L. (1995) Determinants of functional ability
in dementia. Journal of the American Geriatrics Society, 43, 1092-1097.
Hodgson, J. M. (2005) Test review of Developmental Test of Visual Perception–Ado-
lescent and Adult. In R. A. Spies & B. S. Plake (Eds.), The sixteenth mental measure-
ments yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Available at
the Buros Institute’s Test Reviews web site: http://www.unl.edu/buros. Accessed
on 24 April, 2010.
Hung, S. S., Fisher, A. G., & Cermak, S. A. (1987) The performance of learning-dis-
abled and normal young men on the Test of Visual-Perceptual Skills. American
Journal of Occupational Therapy, 41, 790-797.
Ishihara, K., Ishihara, S., Nagamachi, M., Osaki, H., & Hiramatsu, S. (2004) Inde-
pendence of older adults in performing instrumental activities of daily living
(IADLs) and the relation of this performance to visual abilities. Theoretical Issues in
Ergonomics Science, 5, 198-213.
Lezak, M. D. (1995) Neuropsychological assessment. New York: Oxford Univer. Press.
Martin, N. A. (2006) Test of Visual Perceptual Skills–Third Edition. Novato, CA: Aca-
demic Therapy Publications.
Mercier, L. A. T., Audet, T., Hebert, R., Rochette, A., & Dubois, M. (2001) Impact of
motor, cognitive, and perceptual disorders on ability to perform activities of daily
living after stroke. Stroke, 32, 2602-2608.
Norman, G. R., & Streiner, D. L. (2000) Biostatistics—the bare essentials. Hamilton,
ON, Canada: BC Decker.
Nunnally, J., & Bernstein, I. (1994) Psychometric theory. New York: McGraw-Hill.
 RELIABILITY OF THE DTVP–A, MVPT–3, AND TVPS–3 59

Phipps, S. C. (2006) Assessment and intervention of perceptual dysfunction. In H. M.

Pendelton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills
for physical dysfunction. St. Louis, MO: Mosby Elsevier. Pp. 573-588.
Reed, K. L. (2001) Quick reference to occupational therapy. (2nd ed.) Austin, TX: PRO-ED.
Rege, S., & Joshi, A. (2005) The effects of remedial therapy on visual perception, depth
perception and balance on a community dwelling older population. Indian Journal
of Occupational Therapy, 37, 57-62.
Reynolds, C. R., Pearson, N. A., & Voress, J. K. (2002) Developmental Test of Visual
Perception: Adolescent and Adult. Austin, TX: PRO-ED.
Schneck, C. M. (2005) Visual perception. In J. Case-Smith (Ed.), Occupational therapy
for children. (5th ed.) St. Louis, MO: Mosby. Pp. 412-446.
Streiner, D., & Norman, G. (1995) Health measurement scales: a practical guide to their
development and use. Oxford, UK: Oxford Univer. Press.
Su, C. Y., Chien, T. H., Cheng, K. F., & Lin, Y. T. (1995) Performance of older adults
with and without cerebrovascular accident on the Test of Visual-Perceptual Skills.
American Journal of Occupational Therapy, 49, 491-499.
Titcomb, R. E., & Okoye, R. (2005) Functional vision: a developmental, dynamic, and
integrated process. In M. Gentile (Ed.), Functional visual behaviour in adults: an oc-
cupational therapy guide to evaluation and treatment options. Bethesda, MD: American
Occupational Therapy Association. Pp. 1-40.
Unsworth, C. (1999) Reflections on the process of therapy in cognitive and percep-
tual dysfunction. In C. Unsworth (Ed.), Cognitive and perceptual dysfunction: a clini-
cal reasoning approach to evaluation and intervention. Philadelphia, PA: F. A. Davis.
Pp. 75-124.
Warren, M. (2006) Evaluation and treatment of visual deficits following brain injury.
In H. M. Pendelton & W. Schultz-Krohn (Eds.), Pendretti’s occupational therapy prac-
tice skills for physical dysfunction. St. Louis, MO: Mosby Elsevier. Pp.532-572.
Zoltan, B. (1996) Vision, perception and cognition: a manual for the evaluation and treat-
ment of the neurologically impaired adult. Thorofare, NJ: Slack.

Accepted July 14, 2010.