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Kelly R. MeYers

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- : - : : :nt tlf this l.nanual ancl all the research sparkecl Iry interest i¡r clinical netrropsychology and
g¿rve rne an opporttlltity to wollt in his t'tcttrollsychol-

: - " ..- :s-t to say, tlany hottrs of work wetrt ogy lltborltory.
L-. -:,: rlment. The purpose was to provicle a A speciiil worcl of tl'rani<s goes to Tr¿rvis White,
l--^ : : -.- .:iiJ scorin-e and ¿rdrr.rinistratioll Proce- PhD, ¡incl the stalf ol PAlL. I'heir patience ¿rnd knowl-
l--^ : -
= R.CFT L'rasecl on a well-researchecl eclgeable assistance were most helplirl in cleveloping

Lr . ' . .-: ''r'ork, some clirectly anci some incli-

this worl<.
Finally, [o rry coatrthr¡r' I(ellv R. Meyers, who
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. -ll :rlses their contribntions are greatly

' -.-i -..1 go to Doll Lnnge, PhD' fl-om whose

has been involvecl with the development ol'this rllan-
rual ancl approaclr ñ-or¡ its beginnings, tmy clee¡lest
thanl<s ancl appreciation.

u; . - : - -,:'-ly arlcl Statistics course I developed

: -,..r-. this tvolh. Adclitional tl-ranks go to
L-^
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-,ich Kernper, PlrD, my internship strper-

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. - . :-:.-)ur¿lged me to purstle rny clinical ir-rter- Jol-rn E. Meyers, PsYD
October, 1995

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5
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"t : -- l .j:i,rrulus Figure
4 : -- . Test Booklet
- " _- ._le Populations.
1 : ' ': :.. -."1 Requirelrents
.................5

I - - ,:-:tiOn
,6

I - : -: -., Guidelines.
6
6
c : . .'C,¡ltl'ed Markers
l
I --- .s¡r.aiion Directi<¡ns.
l
c Cffir 3: Scoring and Frofi limg Fnocedures...................,
"4 .hr¡I Scoring Criteria for RCFT Drawings..... .......................................... .......................... il
4
-at
§coring Unit [: Vertical Cross ..........
) .........................14
§coring Unit 2: Large Rectang1e.............. ..................15
Scoring Unit 3: Diagonal Cross of the Large Rectangle (2). .. .......... ...............16
§coring Unit 4: Horizonral Midline of the Large Reoangle (Z) .... ......... .-.......11
ScoringUnir 5: Vertical Midline of the Large Recrangle (Z)....... ....... ..............1g
§coring Unit 6: Small Rectangle Wirhin rhe Large Reoangle (2)............... ........,.................19
§coring unit 7: small Horizontal Line Above the small Rectangle (6)..........,....

E
.................20
§cuing Unit 8: Four Parallel Lines Within rhe Large Recrangle (2) ... ...,, ..... .....................21
Scoring Unit 9: Srnall Triangle Above the Large Recrangle (21 ........... ... ..-......22
§coring Unit i0: Small Vertical Line Within the Large Recangle (2), Below the Small Triangle (9)......23
§uing Unit I l: Circle With Three Dors.............
H
E-,
Scoring Unit 1?: Five Parallel Lines Inrersecring the Diagonal Cr-oss (3)

Scming Unit 14: Diamond Attachecl ro tlre Large Triangle ( 13.¡..............

..........................24
..,......25
Scoring Uüit 13: Sides of the Large Triangle Attachecl to tlre Large Rectangle (2) ..... ............................26
..........21
h--, Scoring Unit 15: \/ertical LineWithin the Sides of the LargeTriangle (13)............. ............2g

w Scrring Unit 16: Horizontal Line Within the Sides of the Large Triangle (13¡.....-........
Scorin-e Unit l7: Horizontal Cross..-........
..."...2g
...............,..30

E
 Scoring Unit ltl: Sc¡uare Attaclrecl to the Large Rectartgie
(2)"" " "" _11

32
Scoring tlte Recognitiorl Tlial
Obtaining Norllrative Scclres and Prof iling
-f_

33
C[aaXaten 4: Nonmative amd Descrinrtive Statistics.-...
--) -1
Nornlati ve Santple....
33
I n1'l uencc of Derntlgraphi c V¿u'i ables
-j tl
Dcnrographically Con"octed Norm¿ttivc Dat¿r " ". " "
36
CorrtiutloLts Norrns .......
-1 c)
Categorical Norlrls
-l c\
tJ.S. Census A-qe-Meltched Nol.nl¿rtive Data """"""
39
Chapten 5: {mtenPnetatiom....
39
Non.natir¡e Contl-rar-i sons. -..
40
Interpletati orl ol' llCI'-T Pcrfbrllauce
40
Perlbnnance on Single RCFT Measures....
40
Memory Profile Patterus
4t)
Qualitative Aspects ol' Perlbrtn¿ruce. ......""""' ,11
Case Illustratiorls .-.........- la
Case Illustl'¿rtioll I: Brain Injury
49
Case Illustr¿Ltion ?: Delllessioll
56
Case IIlustratiorl 3: Qtrestionable Motivation

Chapten 6: I)eve[oprmemt, Eteliahility, and Validity ' "' ' 63

63
63
Oilentation o[ tltc Stimulus Figure and Drawings """""""" "'
64
Developruent ol' the Scori rrg Criteria
65
Develo¡rueltt of thc l{ecognition'fi ial ". """"
65
Reliability
(f-)
Lrterr¿Lter Reliabili tY...
65
Tenrpolal Stabil ity.......
66
Vzüidity
66
Convetgertt and Discl'itri narrt Validity
1l
Factorial Validity........ I

72
Gloup Diflbrentiatior1.................. i

Prol'i le Analysis tl1' Mctllory Patterlls i

77
llasc Rate Inlbrmation
79 I

Special Valiclity Topics...-.-....

81 I

Sunrmary o1' Vali dity Studies

I
83
Ref'enemces.................. ¡

Ap¡lenclix A: Scorimg.Examaptres """ ""87 I

Scoring Example l: hrmecliate Recall trial """ """ """90

I
Scoring Exarnple l: Delayecl Recall trial " """ "' """ "91
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 §üiry Example 2: Delayed Recall tria1............. ..........96
hngE:rample 2: Recognition trial ........91

. E,.¡nrple 3: Delayed Recall tria[............. ........101

: =t.:rmple 3: Recognition trial .......... ..............."1,J2

E: -a.orrmative Data f'on U.S" Cemsurs.Age-Matclaed Saraaple....................................... t03

C: DemographicaBfly Corrected l{or¡mative Daúa.......... ........105

':
=.:s ir \lonths 0 Days Through 19 Years 1l Months 3l Days .............106
":-: .:s rl, \lonths 0 Days Through 24 Years 1l Months 31 Days
...........101
.:'=.is \lonths
I 0 Days Through 29 Years Il Montlis 3l Days .............108
':':::-. -l \f onths 0 Days ThroLrgh 34 Years 1 I Months 31 Days .......-.... I09
:-::rs r-i -\'lonths 0 Days Through 39 Yeals I 1 Months 3l Days .............I l0
':'=: . i \fonths 0 Days Through 44 Years 1l Months 31 Days ............. I I I
':'..:. I \lcnths 0 Days Through 49 Years ll Months 3l Days ............112
- if onths 0 Days Through -521. Years I I Months 3l Days .............1 13
-' \lo:rths 0 Days Through 59 Years 11 Months 3l Days .............114
,, \Ionths 0 Days Through 64 Years 1l Months 3l Days ......-...... l 15
I'l¡nths 0 Days Throu-qh 69 Years I I Months 31 l)ays ............1 16
, )'fcnths 0 Days Through 74 Years ll Months 31 Days .............117
- )f¡r,hs 0 Days Through T9Years 11 Months 3l Days .............118
1.1:,n:l:s 0 Days Through 89 Years l l Months 3l Days .......,....1 19

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: ET 3?;leAt EACKGROUIVD copy trial [o ¿rssess visLrospatial constructional ability,
fbllowecl by irrrmeclilte rec¿rll anc[ elclayed rec¿rll tlitls
1ruD OVERVflE\i\/ to ¿lssess visLros¡.latial rrer.nory, whereas otlrcrs
V,, - ' .:r- ligLrre" was or iginally derivecl by
enr¡rloyecl co¡ry ancl clelayecl recall trials but lro ilnrue-
,C, cliate recall tri¡rl. Srill othet's reportecl tising copy ancl
- f ,¡rri,irr & Bylsnra, I99-3) to invr's{igute irrrnreclitte recall trills, but no clelaye¡l reclll trial.
-
-n<tructic.rnal
ability and visual nremory The ¡rresence or absencc of an imlrrecliate recall trial
.-..:cl person,s (Lezak, I 995 ). In r.nore
see¡r'ls to ir.npact l)erl'onnilnce on l clelayecl recall tri¿l
r :'. ,5e Conrplex Fi-qure Test (CFT¡ has (Lezak, I99-5; Meyers & Nleyers, I99,5¡.
'--:', :nrployerl as ¿ neuropsychological
: . i:-rrill constructional ability ¿rud visL¡o- The intelvals ol'tirrre beti,veeu the c«rpy uncl
V., . :-- -.i (Butler. Retzl¿rfl', & Vanclerploe-s.
imrlc'cliate rccalI tlials v¿rriccl lrom irrnrecliately al'ter
(the copy) to 3 minutes, ancl the intervals betrveen the
:- . .-1.,,5).
copy ancl the clela¡zerl lecall triirls rangecl l'r'om l-5
L,, : :-., using a cropy trial. l'ol-
itclvoc¿rtecl rr.rir.lulc's to I hour'. These intervals are consisterlt with

?
Y-=J I
:::Li1 t|ial that was acht.riniste¡ecl -l min-
-. -'-rpy trial. Osterrieth (1944; Coru,in &
:-: , st¿ruclrtrclized Rey's aclntinistrltiori
those e rrrployecl in c'ntpirical stuclics ol' the CFT
(Broolis. 1972; Cr¡rwin & Bylsnra, 1993: Delauey,
Prevey, Crar.l'lc:r'. ct Mattson, 1988; I-ezali." I9t)5;
v, : -'-
-: -- - :roViclecl initi¿rl nornlirtive drlta ou 130
.-< reaLs ofage) ancl60aclults (16 toÓ0
Oclgen, Glowclon, .t Coll<ir¡, 1990. Spleen & Strauss,

ff-t
Et¿ :- ?,.'\''s origiual contplex li-qure stinrultts
l99l; T¿ylor, 1979). Ot,er¿tll, I(night ¿rnd colleagues
(Krright et a1.. 1994) liruncl the nrost lrecluently used

U:-t -- ,-.-:\'., at [irnes, been relcrr-ecl to as tlre CFI' iiclministraticln 1;ai'acligrrr ir.lv<¡lves a copy trial,
j: ':- !'.rt Cort.rplex Fi-e.ure," lvlrich ¿rcl<trovvl- Iollowecl by an irnnrecliate reclLll trial that is atlr-¡linis-
?" r , -, - r.:.. s ancl Osterrieth's contribtrtions. terecl 20 to 30 seconcls al'tel' the copy trial, fbltowL'd

7" - . ' - - -: rtd¡linistration proceclLlres ¿rtttl scor- by a clelayccl lecall tri¿rl tlrat is achi.riuisterecl 30 to 4-5

?. .
-
r '- - .'..\ e beeu cleveiopecl lor the CF"f. In
r:.' s trriginirl stimullts tigure, other cont-
r.uinute's after the ir.nntecli¿rte lecall tl'ial. In aclclition to
thesr: aclministlation p¿IrantctLrrs, so¡ne rescarchel's
suggest using l'elt-tip ¡.rens (Bincler', 199 I, citecl i¡l
Z;:¿ : .' i:-slri'es havc' been clesignc:cl [o acco!l]-
, i : -..':ri for equivalerrt lornls lbr repeated Lezah. 199-5) ancl having the c-xatrinet'l<ecp a clctailecl
á:-) recolcl of cacl'r lespottdcrtt's clr:iwillg seqLlence
á'-)
-
. ' i - rJ Conrplex Fisttres; Lee, Loling, & (Mi1bers. Flebben. & l(aplan, 1986).
V-' - - "".
. ... Kaplan. ancl lrelancl
- (lL)94) sttrveyc'cl Various scoritlg systents that yield both clttitrttitrt-
ff:'t tive nncl qLralitative i¡lclices ol'CFT petfbrtnetttce hitve

ft--; .-: ,l:- .

-. .. t:iv o[' aclminisirlitiorl proceclllres were appearL'd in the literature. Perhaps the nlost fi'ec¡trently

-:- ::-::. :ilfe.ssionals. Stlllle scorins systenr in clirlical t¡se is the 36-point
?-t leportecl Ltsirtg a tusecl

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systelll that w¿ts originally developed by Ostelrieth
(1944), ztclapted by Taylor ( 1959), and widely dissern-
In faci, it is the inherent corltplexity of the stinrulus
t¡nits f igure that suppor-ts the wicle
variety of scolin I
inatccl in Lezak (1983, 1995) Eiglrtcen scoritr-g
ol the s{imulus aplrroaches.
that rel'er to specitic ¿rre¿is 01'det¿rils
of visuospatial cotrstructional aL¡i1-
figurc are nutlbered fbr scoring colrvenie¡rce' Scores As ¿r trreasure
ity. research has shown that the CFT is sensitive
to
rarrge fi'orr 2 \f'ult r:reclit) to 0 (rto cretlit) for
each

unit. The tluit scorcs are stturt¡ed to obtaitl a r¿rw
score lbr each acllninistraticln trial ' Flowever' the
inrplenrentation of' this 36-point systelll is character-
izecl by vzrriability arllollg clif terent laboratories
and
(199-5) recotrttnetlds
clinici¿rlls. For exanrple, Lezak
strict aclherence to thc scoring criteria for the copl'
trial, but sonrewhat trlore lelrietrt application of
the
scoritig rules l'or the recall trials' Otller variants of tlie
36-point systclll are presented by Bennett-Levy
(lq8+1, Guyot and lligaLrlt (1965), Loritig' Marl"in'
Meaclor, anrl Lee (1990), and Duley et al'
(1993)'
cotnplex
Denl.llalt (1984, 1987.¡ provides a rllore
quantitative scoring system witl't72 points'
Loring. Lee, ancl Meaclor ( 1988 ) develo¡red an 1l
-
coln-
point systern fbr scoring qualitative errors filost
darn-
monly ntade by patierrts with right-helnisphere
agc, whereas Waber and Holrnes (1985' l9B6)
three indices to capture l-he qualitative fea-
"mptcry
tr.", of chilclren's CFT reprocltrctiotrs' By dividin-t
the scoring uuits into conl'igural, fragrnented'
ancl
that slroke
missing units, Birrcler (1982) dctrlonstrated
patienis differellt types o1' errors thatr tlortnal
lr-racle
sut.,jects. Harrby' Wilkins, ancl Barry
(1993)' Schon'
Delis, and Masstnau (1gg}), ancl Beutrett-Levy
(1984)
a[e other exatlrples of qualitative applo¿tches
to scor-
ing CFT dlarwir.r-es.
Several other instl'tlulellts lllay be employed to
including
assess visuospatial constructiollal ability'
thc Bentler-Gest¿rlt test (Bencler, 1938) and the
C¿ruter
(Canter' I966'
Backgrouncl Interl'erence Plocedure
visual
1976). In adclition, other iustrulnellts colltain
nretllory colnpollellts sirlil¿rr to the CFT' including
the Visual Reprocluction subtests ol the Wechslei
Mernory Scale-Revised (WMS-I{; Weclisler'
1987)
artcl tl'tc Bentotl Visual Retention Test
(BVRT; Sivan'
tl.rat these
1992). Although reseatch has demorlstrated
measures are sensitive to a variety of neurobehavioral
Sivan'
syuclroures (Heaton, Baacle, & Johnson' 1978;
virtue ol the inherent
lgg}),ir is Ítlt that thc CFT, by
cornplexity ol'tlle stimulus figure arrd task dellrands'
yielJs rrore clinical ilrforlna(ioll arld is tnol'c serlsitlve
to ."rtuirl fbrnls o1'brain clysl'trnction (e'g'' ternporal
trallrratic brain injur¡' (Osterrieth, I 944)' cerebrovas-
cular clisease (Binder. 1982)' HIV serpositivity
(Hamby et al., 1993), Alzheirrer's dise¿rse (Bronwers'
Cox, Martin, Chase, & Feclio, 1984)' Huntington's
clisease (Brouwers et ai', 19[j4; Fedio'
Cox'
Necrphyticles, Canal-Frederic-k' & Ch¿rse'
1919)'
Parkinson's disease (Ogden et a1', 1990)' tenr¡rorarl
lobe epilepsy (O'Callaghan. I985), and undift-erenti-
ated braitr datlrage (Schorr et a1'' 1992)'
As a llleasure
to
of visr-rospaltial uremory, the CFT has been shown
(Osterrieth'
be sensitive to latcrality of cerebral lesiorl
lg44\, especially right hemispliere ittvolvenlellt
(Lor:ing, Lee, & Meaclor, 1988), frontal lobe darnagc-
(Brooks'
(I-e Gall et al'' 1990)' trauuratic brain injury
1972; Leininger, Gramling, Farrell' Kreutzer'
& Pecli'
I990). Huntington's disease (Fedio et al'' 1979)' ¿rrtd
Perfonr-
Parkinson's disease (Ogden et al', 1990;'
rnay also bc useful in differentiat-
ance on thc CFT
ing among cliflerent forurs of metlrory disolder
(Bigler, 1988).
THE REV COIVIPtEX F$GURE TEST
AN§D RECOGNüITIOB\ü TRIAI
itr
The testing ¡rrocedut'es and mate¡:ials preserrtecl
this ntattuai involve Rey's originirl con-rplex f igure'
is'
but not Osterrieth's uormative data' The procedtrre
Test
therelbre. referrecl to as tire Rey Complex Figurc
(RCFT) to avoid confLrsion witl-r otlrer paradigms thtt
involve dil'terent adr-ninistratiot.r proccdures' scoritlg
will
criteria. or cotnplex tigr:re stiruuli' The RCFT
the
serve the itnportar-rt function of standardizing
aud procedures'
courplex figure testing materials
Aclninistlation of the RCFT involves a Copy triaf
ir
.3-minute Irllnecliale Recall tri¿rl, a 30-rninute
De layecl Recal I trial, ancl a newly
developed
which is
l{ecognition lnal (Meyers & Lange, l9t)4)'
aclministered immecliately aiLer thc Delayed Recall
trial. 'lhe Recognitiotl tr-ial presents 12 of'the l8 scor-
ing eleluertts of the complex figure stiruulus' along
*i,¡ l2 clesigns that serve as foils' TI.re responder.rt

2
'"--j

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-*j

.-r,licltes rvhich items are recognizecl fl'om tl're e'arlier
Copy trial. The Recognitiou trial measures tlte
r'lspolr(leltt's recognition ¡llelllory 1br the elel¡enis of
the cornplex figtue stinrultrs alld assesses the res¡:ot.t-
clent's ability to use clles to retrieve infbrmation, thtls
evaluating the relatir¡e contlibtrtions of etlcoclit.rg,
stol'¿rge, ¿lltcl tetrieval processes to inetllory perfor-
marlce. lniti¿rl r-ese¿il'ch lras sho'"vl't tlrat scores derivecl
-; fior.u the RCFT. inclrrcling the Recognition tri¿rl, clis-
a---t criminate ntildly brairr-injured patients lrot.tr tlortnal
sLrL-rjects, cliscriminate brain-clamase:cl patierlts rvith
clocurrrentecl tttemoty impait'rnent lvl.to were able to
ambiguities in scorirtg the accttracy ancl placerllenI
ol each o1' the lB scorirlg tttlits. Nortrlative clata are
norv proviclecl lbr aclLrlts l8
throLrgh 89 years o['age'
Wlrere applopriate, nortlalizecl scores and percentile
scores ¿rre preserrtecl for the niaior RCFT nlenlory
variables to assist in inter¡ll'etation ancl in mal<ing
conr¡:arisons arrtoltg incliviclLrals ancl variotts paticnt
gror.rps. Results of reliability ancl valiclity stttclies are
also pteseuted. The chapters that lollow provide
infblr.nation on the RCfT nlatet'i¿rls, aclministurtion
of the llorllll-
ancl scorir.rg ¡rrttcedttres. char¿rcteristics
tive sample, proceclttres lbr gerreratirig the uor-
trsecl

Iive inclepenclcntly 1'rorrr braitl-dar-trergecl patierlts wlro mative tables, guiclelines I'or interpretatior.r, ¿rncl
?) were rlot, ancl clistinglrish deficient RCFT perfor- results of the reliability ancl valiclity stttclies- 'Io aicl
!-1 luiance clue to lllolor it]rpairtlleni ['t'oln that (ltle to thu: examinet' in scor.ing the RCFT, Appenclix A pre-

nremory intpairueut (Meyers & Lange, 1994). sents three colt.rplete RCFI ¡:rotocols lncl lhe scor-es
t-1
that correspor-rcl with e¿rch drawing. Appenclixes B and
ln ¿rdditiort to the llewly clevelopecl Recoqnitior-r
Vr
7' tli¿tl, this manLtal also presents enlpirically cle-rivecl
C present tlre norr¡r¿rtive clata fbr ttre U.S' censl¡s age-

r-
L.-¡
scoring ci'iteria that inrprove tlre clarity ancl objectiv-
ity ol thc 36-point scoting syster-r.r. Specilically-
matchecl sample anc[ tlte llornl¿ltive sanlple groupecl
accorclir.rg to age, rcsPcctively.

LI nrore precise r.ttles have beell clevelopecl to tesolve

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