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Organizational Quality on the Rey-Osterrieth and Taylor Complex Figure

Tests: A New Scoring System

Article  in  Archives of Clinical Neuropsychology · January 1992

DOI: 10.1093/arclin/7.4.332

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 Psychological Assessment Copvrieht 1993 by the American Psychological Association, Inc.
1993, Vol.5. No. 1,27-33 1040-3590/93/$3.00

Organizational Quality on the Rey-Osterrieth and Taylor

Complex Figure Tests: A New Scoring System
Sherry L. Hamby, Jean W Wilkins, and Neil S. Barry

A new system for measuring organizational quality on the Complex Figure Test (Rey, 1942; Taylor,
1969) is described. This system extends the traditional use of the test as a measure of constructional
ability and figural memory. The new system is easy to learn, quick to score, and shows very good
interrater reliability. Organizational quality was found to correlate moderately with copy accuracy,
half-hour recall, and percentage retained. In an initial application of the system (N= 63), organiza-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

tional quality of the Rey-Osterrieth Complex Figure successfully discriminated between symptom-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

atic (those with acquired immunodeficiency syndrome [AIDS] or AIDS-related complex [ARC])
and asymptomatic subjects positive for human immunodeficiency virus (HIV), but organizational
quality ratings of the Taylor figure did not. The results suggest that the Taylor figure is easier to
organize than the Rey-Osterrieth. Thus, the Taylor figure may not be an appropriate alternative to
the Rey-Osterrieth for the assessment of organizational quality.

The Complex Figure Test, originally developed by Rey
(1942), is widely used by clinical neuropsychologists. Copy and
memory trials are often used to assess constructional skills and
figural memory, respectively. Two versions of the Complex Fig-
ure are available. The original figure is the Rey-Osterrieth. Os-
terrieth (1944) developed a 36-point system for scoring repro-
duction accuracy on this figure that has been in wide use (for a
review, see Lezak, 1983) since its translation into English by
E. M. Taylor (1959). The second, the Taylor figure, was devel-
oped more recently by L. B. Taylor and his associates (Taylor,
1969,1979). Lezak (1983) has recommended its use as an alter-
native to the Rey-Osterrieth when the Complex Figure Test will
be administered more than once.
More recent articles have explored the Complex Figure's use-
fulness as a measure of planning and organizational ability by
examining the subject's copy strategy (Bennett-Levy, 1984;
Binder, 1982; Klicpera, 1983; Waber& Holmes, 1985). Bennett-
Levy (1984) and Klicpera (1983) have also examined the rela-
tionship between copy strategy and recall score, noting that a
poor recall score may be the result of either a poorly planned,
piecemeal copy or "pure" forgetting of an organized copy. In
clinical use, copy strategy is often recorded informally by
switching pen colors as the patient completes the drawing (Le-
zak, 1983).
Four formal scoring systems have been developed to quantify
the subject's degree of planfulness and organization. Each study
Sherry L. Hamby, Jean W Wilkins, and Neil S. Barry, AIDS Neuro-
logic Center and Departments of Neurology, Psychology, and Psychia-
try, University of North Carolina at Chapel Hill.
This research was supported by National Institutes of Health/
NINDS Grant 2 PO1 NS 26680-04A1 to the University of North Caro-
lina AIDS Neurologic Center.
Correspondence concerning this article should be addressed to
Sherry L. Hamby, Department of Neurology, University of North Car-
olina at Chapel Hill, CB # 7025, Clinical Sciences Building, Chapel,
Hill, North Carolina 27599-7025.
27
has demonstrated the clinical utility of such a scoring system.
Copy planfulness has been shown to differentiate brain-dam-
aged subjects from normals (Binder, 1982) and dyslexic from
nondyslexic children (Klicpera, 1983). Copy planfulness also
predicts delayed recall scores (Bennett-Levy, 1984) and im-
proves with age in children (Waber & Holmes, 1985).
All of the methods developed to date have demonstrated util-
ity; nonetheless, each has difficulties for use as either a clinical
or research tool. One problem shared by all four methods is the
difficulty of administration: Each approach requires the exam-
iner to record the order of every line segment as it is drawn by
the subject. This is typically done by copying the figure that the
subject draws and numbering each line segment as the subject
proceeds.
The systems of Bennett-Levy, Waber and Holmes, and Klic-
pera share an additional difficulty. These systems are quite
complex and require close inspection of every line segment in
the reproduction. Consequently, it appears difficult to obtain
reliable and replicable scores for any of these systems. Waber
and Holmes (1985) reported good interrater reliability on many
of their measures but achieved only 52% agreement for their
organization score (between a coder and a computer scoring
system). Bennett-Levy (1984) also reported good interrater reli-
ability data for accuracy scoring but did not report interrater
reliabilities for his two new strategy measures, symmetry and
good continuation. Klicpera (1983) did not report interrater
reliabilities. The possibility of obtaining accurate and mean-
ingful data with these methods, especially by other researchers
and clinicians, is unclear.
Binder's method (1982) does not show problems with in-
terrater reliability. However, his system does not make use of
much of the information available in the figure, and most ele-
ments are not evaluated in his rating system. For research pur-
poses, Binder's system presents additional problems because
his scaling method is not adequate for use with traditional infer-
ential statistics (Binder, 1982); for example, his scale exhibited
floor effects and heterogeneity of variance across groups.
 28 S. HAMBY, J. WILKINS, AND N. BARRY
A final limitation of the previously published scoring sys-
tems is that all have been limited to the Rey-Osterrieth Com-
plex Figure. Because the Taylor figure is widely used as an alter-
nate form in clinical and research contexts where practice ef-
fects are a concern, a scoring system for both Complex Figures
is needed.
Despite the problems with the systems developed to date,
several promising findings have emerged: (a) Drawing lines in
more segments than necessary is characteristic of poor organi-
zation, and more common among various impaired popula-
tions (Bennett-Levy, 1984; Binder, 1982; Klicpera, 1983), (b)
drawing details before configural elements is more characteris-
tic of impaired populations (Klicpera, 1983), and (c) organiza-
tional scores positively correlate with accuracy of reproduction
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
for both copy and delay trials (Bennett-Levy, 1984; Klicpera,
This document is copyrighted by the American Psychological Association or one of its allied publishers.
1983). Presumably, subjects who are able to organize the figure
in a coherent way will be able to recall it more accurately later.
The present scoring system was designed to meet five goals:
(a) to obtain good interrater reliability; (b) to be easy to learn
and quick to use, so that it will be useful in a wide variety of
both clinical and research settings; (c) to be useful when only
colored pens are used to record the subject's strategy rather
than a full record of every line segment; (d) to establish con-
struct validity by demonstrating correlations between organiza-
tional quality and other scores typically obtained for the Com-
plex Figure. Specifically, organizational quality should posi-
tively correlate with reproduction accuracy on both copy and
delay trials, and with the percentage of the figure that is re-
tained from copy to delay trial (percentage retained = delay/
copy); and (e) to be applicable to both the Rey-Osterrieth and
Taylor figures. In addition to the above goals relating to the
development of the organizational quality scoring system, an
initial application of the system is presented here. It is hoped
that organizational quality will be useful in evaluating different
patient populations. We examine whether or not organizational
quality can discriminate between asymptomatic and symptom-
atic HIV-positive patients and hypothesize that symptomatic
subjects will receive lower organizational quality scores than
asymptomatic subjects.
The organizational quality system described here is based on
the common division of both figures into 18 scoring elements
(Lezak, 1983). See Appendixes A and B for a full listing of the
standard scoring elements for the Rey-Osterrieth and Taylor
figures, respectively. The new system focuses on three attributes
that seem central to an evaluation of the patient's approach to
the drawing task: the order in which configural elements are
placed in the figure, the appropriate continuation of lines, and
the order of detail elements. In this scoring system, primary
emphasis is given to "configural elements": the base rectangle
or square and the horizontal and vertical midlines. These items
were chosen because the placement of virtually all other items
is contingent on the position of these elements. Illustrations of
the complex figures with configural elements highlighted can
be found in Figures 1 and 2. Ratings are made on a 5-point
Likert scale that is appropriate for inferential statistical analy-
sis; higher scores indicate better organization. The organiza-
tional quality scoring system for the two figures can be found in
Appendix C.
Method
Subjects
The subjects were 63 HIV-infected patients who were evaluated at
entry into a longitudinal neurological study. Subjects who reported any
of the following were excluded: active substance abuse; neurologic dis-
ease predating HIV infection; severe psychiatric disorder predating
HIV infection (i.e., schizophrenia, bipolar disorder, or psychotic de-
pression); a history of mental retardation or learning disability requir-
ing special classes; and less than 9 years of education. On the basis of
these exclusion criteria, 39% of the subjects participating in the longi-
tudinal study were dropped from analyses.
Of the 63 subjects, 36 were asymptomatic at the time of evaluation,
and 27 were symptomatic (22 were diagnosed with AIDS-related com-
plex, and 5 with AIDS on the basis of Centers for Disease Control,
1986, definitions). There were 59 men in the sample and 4 women.
Their average age was 33.7 years (SD = 8.1), and they averaged 14.6
years of education (SD = 2.6). Neither age nor education differed
across groups (p > .35 for both tests).
Procedure
As part of a comprehensive neuropsychological evaluation, subjects
were administered copy and 30-minute delayed recall trials of either
the Rey-Osterrieth or Taylor Complex Figures (randomly assigned).
The copy trials were completed using three pens of different colors to
record subjects' approaches to the task. There was no time limit for
either trial. The copy and delay protocols were subsequently scored for
accuracy using Taylor's adaptation of Osterrieth's 18-element system
(Duley et al., in press; Taylor, 1959), and the copy trials were further
scored for organizational quality.
Demographic information and neurologic and school histories were
obtained through a structured interview developed at the AIDS Neuro-
logic Center. Psychiatric and substance abuse histories were obtained
using the Diagnostic Interview Schedule (Robins, Helzer, & Croughan,
1985). In addition, each subject completed the Profile of Mood States
(McNair, Lorr, & Droppleman, 1981) on the day of neuropsychological
Figure 1. The Rey-Osterrieth figure with configural elements high-
lighted. (From "UExamen Psychologique Dans Les Cas D'Encephalo-
pathie Traumatique" by A. Rey, 1942, Archives de Psychologic, 28, p.
329. Copyright 1942 by the Archives de Psychologic. Reprinted by
permission [highlights added]).
 ORGANIZATIONAL QUALITY ON COMPLEX FIGURE 29

Construct Validity
Organizational quality was significantly correlated with
three other measures of performance: accuracy of the copy re-
production, accuracy of the delay reproduction, and percentage
retained (delay/copy). For copy scores, r(61) = .32, p < .05, and
for delayed recall, r(61) = .42, p < .001. Finally, for percentage
retained, r(61) = .30, p < .05 (to control for the nonnormality of
percentile data, an arcsine transformation was performed prior
to analysis, Winer, 1971). Tests of the differences between the
Rey-Osterrieth and Taylor figures indicated that the magnitude
of the correlations is the same for both figures (p > .05 for all
three tests).
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Differences by Symptom Status

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A 2 X 2 (Symptom Status X Figure Type) analysis of covari-

ance (ANCOVA) was performed on organizational quality
Figure 2. The Taylor figure with configural elements highlighted. scores, using WAIS-R Vocabulary age-adjusted scaled score,
(From "Alteration of Perception and Memory in Man: Reflections on education, age, history of substance abuse, and depressed
Methods" by B. Milner & H. Teuber, 1968, in L. Weiskrantz [Ed.], mood (as measured by the Profile of Mood States) as covariates.
Analysis of Behavioral Change [p. 338], New York: Harper & Row. Preliminary analyses indicated that there were no significant
Copyright 1968 by Laughlin Taylor. Reprinted by permission [high- differences among the four subgroups on any covariates (all p >
lights added]). .10). The means and standard deviations of the covariates
across the subgroups can be found in Table 1.
The interaction of Symptom Status X Figure Type was signifi-
testing. The subject was asked to describe his or her mood during the cant, F(\, 54) = 7.14, p < .01. Simple main effects indicated that
previous week, including the day of testing. organizational quality scores for the Rey-Osterrieth figure dis-
criminated between symptomatic and asymptomatic subjects,
F(\, 54) = 4.37, p < .05, but that the Taylor figure did not
Results discriminate between symptom groups, F(l, 54) = 2.17, p >
.10. The means for this analysis can be found in Table 2.
Interrater Reliability and Consensus Scores
All protocols were independently rated by Sherry L. Hamby
and Neil S. Barry, who were unaware of symptom status at the Table I
time of the ratings. Before scoring the experimental protocols, Means and Standard Deviations for Covariates as a Function of
the raters were trained on a separate blind sample of clinical Symptom Status and Figure Type
protocols.
Interrater reliability was calculated using the kappa statistic, Symptom status
which yielded an overall reliability of 87.6% (+/- .2%). All but Asymptomatic Symptomatic
one discrepancy diifered by 1 point. For each discrepancy, a
final score was reached by consensus and used in subsequent Variable M SD M SD
analyses. The rating of each protocol typically took less than 1
Rey-Osterrieth
minute. The consensus scores yielded a mean of 2.81 (SD =
1.45) for the Rey-Osterrieth and 3.41 (SD = 1.50) for the Taylor. Age 34.95 10.10 32.44 5.33
For both figures, the mean score was 3.06 (SD = 1.49). Education (years) 15.25 2.24 14.75 2.79
WAIS-R Vocabulary3 12.35 2.87 10.44 2.73
POMS 9.20 10.41 11.94 15.73
Past substance abuseb 45% 37 .5%
Ease of Learning Coding System
Taylor
A third rater, a graduate student with prior experience scor-
ing Complex Figures for accuracy, also rated all of the proto- Age 32.31 6.83 35.10 9.49
Education (years) 14.31 3.40 13.55 1.44
cols. After less than 1 hour of training on the new system, he WAIS-R Vocabulary2 10.81 3.10 10.73 2.83
achieved good agreement with the consensus scores; K = 79.3% POMS 12.19 13.42 11.18 10.75
(+/— .3). An undergraduate psychology major, with no prior Past substance abuseb 56.25% 54. 55%
exposure to neuropsychological assessment (or to either figure),
learned the systems for scoring both figures in less than 1 hour. Note. WAIS-R = Wechsler Adult Intelligence Scale—Revised;
POMS = Profile of Mood States.
She obtained 75% agreement with the consensus scores for a a
Means are for age-adjusted scaled score. b Percentages ind icate sub-
subset of the figures (15 of 20 protocols). jects who were positive for past substance abuse.
 30 S. HAMBY, J. WILKINS, AND N. BARRY
Table 2
Means and Standard Deviations for Organization Scores as a
Function of Symptom Status and Figure Type
Symptom status
Figure type Asymptomatic Symptomatic
Rey-Osterrieth
M 3.40* 2.06
SD 1.27 1.34
Taylor
M 3.13 3.82
SD 1.53 1.33
* p < .05.
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
The main effect for Figure Type was also significant: F(l,
54) = 4.48, p < .05. Organizational quality scores on the Taylor
were significantly higher than scores on the Rey-Osterrieth.
The main effect for Symptom Status was not significant. Of the
covariates, only past substance abuse and depressed mood were
significant. For past substance abuse, F(l, 54) = 4.43, p < .05,
and for depression, F(l, 54) = 4.09, p < .05.
The same 2 x 2 (Symptom Status X Figure Type) ANCOVA
was performed on copy and delay scores as well. For copy
scores, no effects were significant (all p > . 10). For delay scores,
only the main effect for Figure Type was significant, F(l, 54) =
6.21, p < .05 (for all other effects, p > .20). Inspection of the
means indicates that subjects scored higher on the Taylor (M=
20.5, SD = 4.7) than on the Rey-Osterrieth figure (M = 17.9,
SD = 4.2).
Discussion
Three main conclusions emerge from these data. First, the
organizational quality scoring system presented here provides a
simple, reliable, and meaningful measure of subjects' copy strat-
egy. The system can be learned readily, even by someone unfa-
miliar with the Complex Figure Test. The system can also be
applied quickly: Scoring a protocol typically takes less than 1
minute. In addition, good interrater reliability was obtained:
The system presented here led to identical scores by indepen-
dent raters in the majority of cases.
Organizational quality also showed the hypothesized positive
correlation with copy, delay, and percentage-retained scores.
The significant moderate correlations suggest that organiza-
tional quality is related to but distinct from these other mea-
sures of performance on the Complex Figure. As hoped, these
goals were met when the simple method of changing pen color
to record the subjects' approach was used. We anticipate that
this will make the system practical and useful in both clinical
and research settings.
Second, this organizational quality scoring system has dem-
onstrated clinical utility, like its predecessors. Organizational
quality on the Rey-Osterrieth figure distinguished asymptom-
atic from symptomatic HIV+ subjects. This result is especially
interesting because copy and delay scores alone were unable to
discriminate between symptomatic and asymptomatic sub-
jects. Thus, organizational quality may be a more sensitive
measure for identifying some forms of neuropsychological im-
pairment. The significant results for past substance abuse and
depressed mood (as covariates) suggest that this system may be
useful for evaluating these patient groups as well.
Third, it appears from these data that the Taylor figure is not
completely interchangeable with the Rey-Osterrieth. Although
the Taylor and Rey-Osterrieth appear to be comparable mea-
sures of constructional ability, the Taylor figure is easier to orga-
nize and recall than the Rey-Osterrieth. Further, the Taylor
does not discriminate between symptomatic and asymptom-
atic subjects. Other recent studies provide growing evidence
that the two complex figures are not interchangeable. Tom-
baugh and Hubley (1991) have agreed that the Taylor figure is
easier to recall. Casey et al. (1991) have reported that the Taylor
figure is more amenable to verbal mediation, whereas the Rey-
Osterrieth is the purer test of visual memory.
The reason for the difference appears to lie in the basic orga-
nization of the two figures. On the Taylor, it is easy to adopt a
quadrant-by-quadrant approach, because most details fall into
one of the four main quadrants that are created by the configu-
ral elements. In contrast, the Rey-Osterrieth figure has two diag-
onals that create eight triangles in the internal structure of the
rectangle. This difference between the two figures presents a
problem in constructing equivalent scoring systems. The solu-
tion presented here, of equating the upper horizontal line of the
Taylor with the two diagonals of the Rey-Osterrieth, is not com-
pletely satisfactory and may have contributed to the difference
in the scores for the two figures.
The simpler structure of the Taylor figure appears to lead not
only to higher organizational quality scores but to higher delay
scores as well. Although no differences were found between
figures on the copy trials, subjects scored significantly higher
on delay when the Taylor figure was used (see also, Tombaugh &
Hubley, 1991). Taylor's data (1969) follows a similar pattern.
In Taylor's original paper (1969), the results are confounded
because his subjects completed the Rey-Osterrieth figure prior
to surgery and the Taylor figure 2 weeks afterward. Taylor pre-
dicted from past research that patients with right temporal lo-
bectomies would perform more poorly after surgery. However,
he found no decrease in scores on these patients. Patients who
received left temporal lobectomies obtained scores on the copy
trials that were nearly identical before and after surgery, yet
their scores on delay trials increased by more than 4 points. It
seems plausible that the improvement seen in the performance
of these patients is due to the simpler structure of the Taylor
figure.1
The availability of an alternate figure to the Rey-Osterrieth
helps alleviate the problems of practice effects in longitudinal
studies such as ours or in pre- and postoperative assessments
such as Taylor has done. Taylor's figure appears to replicate the
visuoconstructional properties of the Rey-Osterrieth figure but
1
Bachtler, Roth, Smith, and Weber (1990) found a smaller improve-
ment after surgery in their patients with left temporal lobectomies
using the Rey-Osterrieth at all assessments. However, they were only
able to follow-up half of their subjects and used a considerably longer
6-month follow-up period, so their study is not directly comparable to
Taylor's.
 ORGANIZATIONAL QUALITY ON COMPLEX FIGURE
not its organizational qualities. A consideration of organiza-
tional quality could be used to develop a new figure with a
structure as complex as that of the Rey-Osterrieth.
Organizational quality holds promise as a useful measure of a
subject's ability to organize unstructured figural material. Our
scoring system fulfills our initial objectives. The simplicity of
the scoring method and the reliability of the measure over-
comes the major limitations of previous scoring systems. The
use of organizational quality as a measure of planning ability
will provide a useful complement to the traditional assessment
of constructional skill and figural memory on the Complex
Figure. Because the Complex Figure is frequently administered
during neuropsychological assessment, organizational quality
provides an especially efficient means of measuring planning
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
ability that should be useful in a wide variety of clinical and
This document is copyrighted by the American Psychological Association or one of its allied publishers.
research settings.
References
Bachtler, S. D., Roth, D. L., Smith, G. E., & Weber, A. M. (1990, Febru-
ary). Qualitative performances on the Rey-Osterrieth Complex Figure
in patients with complex partial seizures. Poster presented at the an-
nual meeting of the International Neuropsychological Society, Or-
lando, FL.
Bennett-Levy, J. (1984). Determinants of performance on the Rey-Os-
terrieth Complex Figure Test: An analysis, and a new technique for
single-case assessment. British Journal of Clinical Psychology, 23,
109-119.
Binder, L. M. (1982). Constructional strategies on Complex Figure
drawings after unilateral brain damage. Journal of Clinical Neuropsy-
chology, 4, 58.
Casey, M. B., Winner, E., Hurwitz, I., & DaSilva, D. (1991). Does pro-
cessing style affect recall of the Rey-Osterrieth or Taylor Complex
Figures? Journal of Clinical and Experimental Neuropsychology, 13,
600-606.
Centers for Disease Control. (1986). Classification system for human
T-lymphtropic virus type III/lymphadenopathy-associated virus in-
(Appendix follows on next page)
31
fections. Morbidity & Mortality Weekly Report, 35, 334-339.
Duley, J. F, Wilkins, J. W, Hamby, S. L., Hopkins, D. G., Burwell, R. D,
& Barry, N. S. (in press). Explicit scoring criteria for the Rey-Os-
terrieth and Taylor complex figures. Clinical Neuropsychologist.
Klicpera, C. (1983). Poor planning as a characteristic of problem-solv-
ing behavior in dyslexic children. Acta Paedopsychiatra, 49, 73-82.
Lezak, M. D. (1983). Neuropsychological assessment (2nd ed.). New
York: Oxford University Press.
McNair, D. M., Lorr, M., & Droppleman, L. F. (1981). Profile of Mood
States manual. San Diego, CA: Educational and Industrial Testing
Service.
Milner, B., & Teuber, H. L. (1968). Alteration of perception and mem-
ory in man: Reflections on methods. In L. Weiskrantz (Ed.), Analy-
sis of behavioral change (pp. 268-375). New York: Harper & Row.
Robins, L. N., Helzer, J. E., & Croughan, J. (1985). NIMH Diagnostic
Interview Schedule, Version lll-A. Rockville, MD: National Institute
of Mental Health.
Osterrieth, P. A. (1944). Le test de copie d'une figure complexe. Ar-
chives de Psychologic, 30, 206-356.
Rey, A. (1942). tfexamen psychologique dans les cas d'encephalopathie
traumatique. Archives de Psychologie, 28, 286-340.
Taylor, E. M. (1959). Psychological appraisal of children with cerebral
defects. Cambridge, MA: Harvard University Press.
Taylor, L. B. (1969). Localisation of cerebral lesions by psychological
testing. Clinical Neurosurgery, 16, 269-287.
Taylor, L. B. (1979). Psychological assessment of neurosurgical pa-
tients. In T. Rasmussen & R. Marino (Eds.), Functional neurosurgery
(pp. 165-180). New York: Raven Press.
Tombaugh, T. R, & Hubley, A. M. (1991). Four studies comparing the
Rey-Osterrieth and Taylor Complex Figures. Journal of Clinical and
Experimental Neuropsychology, 13, 587-599.
Waber, D. P., & Holmes, J. M. (1985). Assessing children's copy produc-
tions of the Rey-Osterrieth Complex Figure. Journal of Clinical and
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York: McGraw-Hill.
 32 S. HAMBY, J. WILKINS, AND N. BARRY

Appendix A Appendix B

Scoring Elements for the Rey-Osterrieth

Complex Figure Scoring Elements for the Taylor Complex Figure
1. Cross upper left corner, outside of rectangle 1. Arrow at left of figure
2. Large rectangle 2. Triangle to left of large square
3. Diagonal cross 3. Square, which is the base of figure
4. Horizontal midline of 2 4. Horizontal midline of large square, which extends to 1
5. Vertical midline 5. Vertical midline of large square
6. Small rectangle, within 2 to the left 6. Horizontal line in top half of large square
7. Small segment above 6 7. Diagonals in top left quadrant of large square
8. Four parallel lines within 2, upper left 8. Small square in top left quadrant
9. Triangle above 2 upper right 9. Circle in top left quadrant
10. Small vertical line within 2, below 9 10. Rectangle above top left quadrant
11. Circle with three dots within 2 11. Arrow through and extending out of top right quadrant
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

12. Five parallel lines with 2 crossing 3, lower right 12. Semicircle to right of large square
This document is copyrighted by the American Psychological Association or one of its allied publishers.

13. Sides of triangle attached to 2 on right 13. Triangle with enclosed line in right half of large square
14. Diamond attached to 13 14. Row of 7 dots in lower right quadrant
15. Vertical line within triangle 13 parallel to right vertical of 2 15. Horizontal line between 6th and 7th dot
16. Horizontal line within 13, continuing 4 to right 16. Triangle at bottom right corner of lower right quadrant
17. Cross attached to low center 17. Curved line with 3 cross-bars in lower left quadrant
18. Square attached to 2, lower left 18. Star in lower left quadrant

Note. From Psychological Appraisal ofChildrenwithCerebral Defects (p. Note- From Neuropsychological Assessment (2nd ed., p. 397) by M.
399) by E. Taylor, 1959, Cambridge, MA: Harvard University Press. Lezak, 1983, New York: Oxford University Press. Copyright 1983 by
Copyright 1959 by Harvard University Press. Reprinted by permission. Laughlin Taylor. Reprinted by permission.

Appendix C

Complex Figure Organizational Quality Scoring for the Rey-Osterrieth and Taylor Complex Figures

Purpose more pens may facilitate scoring without significantly increasing

The purpose is to evaluate two aspects of the patient's reproduction
of the figure. This system uses the 18 standard scoring elements that
have been developed for each figure (Lezak, 1983; Taylor, 1959).
1. Ideally, patients should begin by drawing the basic configural ele-
ments of the figure (outer rectangle/square, vertical midline, and
horizontal midline). This is the best approach because the place-
ment of all other elements is contingent upon the placement of the
configural elements. Figures 1 and 2 highlight the configural ele-
ments of the Rey-Osterrieth and Taylor figures, respectively.
2. Patients should draw their design in a parsimonious way, that is,
lines should not be broken into more segments than necessary. Pa-
tients should also approach the task in a systematic manner, so that
elements that are near each other should be completed at approxi-
mately the same time.
General Scoring Instructions
\. Remember to look at organization rather than quality or distortion.
Score for distortion only if it appears to be a sign of organizational
confusion. Crossed-out mistakes can provide information about
order.
2. Be sure to check for segmentation, even if done in same color pen.
3. Left-to-right, right-to-left, clockwise, counterclockwise, and row-
by-row (i.e., left-to-right across top, then back to left-to-right across
bottom) are all acceptable strategies for filling in the details.
Administration
1. Use at least three pensof different colors, and switch pens at approxi-
mately equal points in the construction of the figure. The use of
the difficulty of administration. Do not switch pens while the pa-
tient is in the middle of drawing one of the standard 18 elements.
Scoring Procedure
There are three types of mistakes: configural, secondary, and detail
mistakes, defined below. A person's score depends on the number and
type of mistakes in the drawing, as follows:
1. First, count the number of configural mistakes.
(a) If there are three or more configural mistakes, score 1 for very
poor organization. Stop.
2. If there are 0, 1, or 2 configural mistakes, check for a secondary
mistake. If present, add to the number of configural mistakes.
(a) If the total is 3, then score 1 for very poor organization. Stop.
(b) If the total is 2, then score 2 for poor organization. Stop.
(c) If the total is 1, then score 3 for fair organization. Stop.
3. If there are 0 configural and secondary mistakes, check for detail
mistakes.
(a) If there are 1 or more detail mistakes, score 4 for good organiza-
tion. Stop.
(b) If there are 0 detail mistakes, score 5 for excellent organization.
Stop.
Configural Mistakes
The basic configural elements of the Rey-Osterrieth are the outer
rectangle and the vertical and horizontal midlines. The configural ele-
ments of the Taylor are the outer square and the two midlines. Thus,
there are a total of six lines in the configural elements of both figures.
1. The following errors are considered configural mistakes (no line can
count for more than 1 mistake):
 ORGANIZATIONAL QUALITY ON COMPLEX FIGURE
(a) one side of rectangle/square not drawn when others are com-
pleted.
(b) either of the following drawn in two or more segments consti-
tutes 1 mistake (maximum = 6 mistakes): four sides of rectangle/
square or two midlines (i.e., it should only take six lines to com-
plete all of the elements above).
(c) any details completed before the configural elements are com-
pleted, except for the upper left cross (No. 1) of the Rey-Osterrieth.
(Because starting in the upper left-hand corner seems to be
more related to standard Western writing practice than to poor
organization, it is not penalized as heavily.) For example, draw-
ing the right triangle (No. 13) before completing the vertical
midline would constitute a configural mistake. Count one mis-
take for each conngural line drawn after the details have been
drawn. For example, if the right triangle (No. 13) of the Rey-Os-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
terrieth is begun before both midlines are drawn, score as 2
This document is copyrighted by the American Psychological Association or one of its allied publishers.
conngural mistakes.
(d) either midline drawn more than 10% away from the center (in
either direction). That is, the midlines should be in the central
40-60% of the rectangle/square.
(e) sides of the rectangle/square not joined at their endpoints, sug-
gesting that the subject does not perceive the rectangle/square.
Small draftmanship errors should not count as a configural mis-
take. For example, if the right side is placed too far to the right,
creating a 6-sided figure, that would count as one configural
mistake. Each poorly placed line counts as 1 mistake.
(f) a configural element is missing (score 1).
Secondary Mistakes
The diagonals (No. 3) of the Rey-Osterrieth and the upper horizon-
tal line (No. 6) of the Taylor are considered to be secondary elements.
1. Two errors in the reproduction of the secondary elements are consid-
ered serious enough to be counted as a secondary mistake, which
carries the same weight as configural mistakes. However, the over-
all construction of these elements can count as a maximum of one
mistake. The mistakes are the following:
(a) the segments do not meet. For the Rey-Osterrieth, all 4 slashes
of the diagonal should meet. For the Taylor, the upper horizon-
tal line should extend continuously across the figure.
(b) a segment is incomplete (i.e., does not extend all the way across
figure).
2. When the elements are drawn as connecting segments, score as a
detail mistake. For the Rey-Osterrieth, score as a detail mistake if
the patient uses more than two lines to complete the diagonals. For
the Taylor, score as a detail mistake if the patient uses more than
one line to complete the upper horizontal line.
3. Secondary elements can be completed before midlines with no pen-
alty.
Detail Mistakes
All other elements are considered to be details.
1. Detail mistakes can be made in three ways:
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33
(a) Unnecessary segmentation. The patient should not use more
lines than necessary to complete the element.
(b) Lines in a standard element, and elements that are near each
other, should be drawn consecutively.
(c) Poor planning that results in the need to redraw an element. For
instance, if they must redraw a diagonal line so that it intersects
both corners.
2. The following is a partial list of common detail mistakes found in
reproductions of the Rey-Osterrieth (identified by Taylor's num-
bers):
No. 1 Cross completed before configural elements.
No. 6 (a) 3 sides of box are not done together (with no break at midline)
(b) X is not completed immediately after box is drawn
(c) X is drawn as four slashes or two V's (rather than two inter-
secting lines).
No. 7 Not done immediately after No. 6.
No. 9 (a) Both sides of triangle not completed together
(b) Vertical side drawn as part of midline and then slanted side
completed later.
Nos. 9,13 The adjacent sides of these two triangles drawn as a single
line.
No. 13 Both sides of this triangle not completed together.
Nos. 13,15,16 Not drawn together.
No. 17 Attachment for cross not completed with rest of cross (e.g., done
as part of midline and then finished later).
No. 18 (a) Slash in box not added when box is first drawn.
(b) Box, or part of box, drawn as part of the basic configural
rectangle.
3. Common detail mistakes of the Taylor figure:
No. 2 Both sides of triangle not completed at once.
No. 4 Horizontal midline does not need to extend to left arrow (No. 1)
when originally drawn, this segment can be added later.
No. 7 Drawn as four slashes or two V's (rather than two intersecting
lines).
Nos. 7-9 These three elements not drawn in consecutive order (i.e.,
first No. 7, then No. 8, and lastly No. 9).
No. 11 Line with arrow through quadrant and extending above it
should not bend at the corner of the square; it should be a straight
line.
Nos. 12 & 13 (a) Not completed together.
(b) Do not meet upper horizontal line.
No. 15 Not completed immediately before or after No. 14.
No. 17 Line and crossbars not done together.
No. 18 Asterisk drawn as eight lines radiating from center (or from
central dot), rather than four continuous intersecting lines.
Received July 9,1991
Revision received May 28,1992
Accepted June 1,1992