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Reliability and Validity of a Scoring System for Measuring Organizational

Approach in the Complex Figure Test

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Journal of Clinical and Experimental Neuropsychology 1380-3395/00/2205-640$15.00
2000, Vol. 22, No. 5, pp. 640-648 © Swets & Zeitlinger

Reliability and Validity of a Scoring System for Measuring

Organizational Approach in the Complex Figure Test*
Thilo Deckersbach1, Cary R. Savage1, Aude Henin1, David Mataix-Cols2, Michael W. Otto1,
Sabine Wilhelm 1, Scott L. Rauch1, Lee Baer1, and Michael A. Jenike1
1Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School,
2
Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Catalunya, Spain

ABSTRACT

The Rey-Osterrieth Complex Figure Test (RCFT) is a widely-used measure of visuospatial construction
and nonverbal memory. One of the critical aspects of this test is that organizing the figure into meaningful
perceptual units during copy enhances its subsequent free recall from memory. This study examined the
psychometric properties of a new system for quantifying the organizational approach to the RCFT figure
and compared it to another compatible scoring system. We investigated interrater reliability of both sys-
tems and explored the influences of copy organization and copy accuracy on immediate recall. Seventy-one
participants meeting DSM-IV criteria for obsessive-compulsive disorder and 55 healthy control partici-
pants completed the copy and immediate free recall condition of the RCFT. Interrater reliability was evalu-
ated by Kappa coefficients and Pearson correlations. The effects of copy organization and copy accuracy
on immediate recall were evaluated using multiple regression analyses. Results indicated that the organiza-
tional approach could be assessed with high reliability using both scoring systems. Organization during
copy was a strong predictor for subsequent free recall from memory using both approaches. Multiple
regression analysis indicated that all organizational elements were not equally predictive of memory per-
formance. This new system represents a very simple and reliable approach to scoring organization on the
RCFT, since it requires the identification of only 5 figure components. These characteristics should con-
tribute to its clinical utility.

The Rey-Osterrieth Complex Figure Test (Os-
terrieth, 1944) is a popular measure of visuo-
spatial construction and nonverbal memory. De-
veloped by Rey (1941), it consists of a complex
geometric figure that is copied and then redrawn
from memory. As a measure of memory, the
RCFT taps the domain of episodic memory,
which refers to the explicit recollection of infor-
mation encountered in a specific study episode
(Graf & Schacter, 1985; Schacter, 1987). Orga-
nization of information during encoding is
known to enhance recollection accuracy. For
example, verbal free recall benefits from group-
ing items into semantic categories, or imposing
a subjective structure on a set of words (Tul-
ving, 1962). Likewise, organizing the RCFT
figure into meaningful perceptual units during
encoding has been shown to enhance subsequent
free recall from memory (Savage et al., 1999,
2000; Shorr, Delis, & Massman, 1992; Waber &
Holmes, 1986).
The prefrontal cortex has been implicated in
the ability to utilize organizational strategies to
enhance encoding and retrieval of episodic

*
This research was supported by the David Judah Research Fund, by a Deutscher Akademischer Austauschdienst
(DAAD) Graduate Research Fellowship to Thilo Deckersbach and by the Spanish Ministerio de Education y
Cultura (David Mataix-Cols).
Address correspondence to: Cary Savage, Cognitive Neuroscience Group, Department of Psychiatry, 149-9102,
Massachusetts General Hospital, Bldg. 149, 13th St., Charlestown, MA 02129. Tel.: ++1 617 726-4076. Fax: ++1
617 726-4078. Email: savage@psych.mgh.harvard.edu
Accepted For Publication: March 28, 2000.
 ORGANIZATION SCORING FOR COMPLEX FIGURE TEST
memories. Individuals with lesions of the frontal
lobes or with disorders affecting frontal-striatal
system function (e.g., Parkinson’s disease, Hun-
tington’s disease) have difficulties with organi-
zational processes crucial for efficient encoding
and retrieval of information (e.g., Bondi et al.,
1993; Buytenhuijs et al., 1994; Gershberg &
Shimamura, 1995; Grossman et al., 1993; Pillon
et al., 1993; Savage, 1997; Shimamura et al.,
1991). This pattern of memory impairment can
be differentiated from problems associated with
medial temporal system dysfunction, in which
individuals have difficulty storing and consoli-
dating new memories (Squire, 1992). Thus, it is
clinically important to differentiate strategic
memory impairment from other types of mem-
ory dysfunction. The RCFT is ideally suited to
address this distinction because of the opportu-
nity to observe planning and organizational
strategies used by patients as they copy the fig-
ure.
Several systems have been designed to char-
acterize the organizational approach to the
RCFT figure. These systems quantify the extent
to which the figure is grouped into meaningful
perceptual units as it is copied. For example,
Binder (1982) identified four elementary units in
the complex design (the two diagonals, the hori-
zontal midline, the vertical midline, and the ver-
tex of the triangle) which tended to be drawn as
single unfragmented units by healthy controls.
Waber and Holmes (1985, 1986) defined five
different levels of organization in the geometric
design and found that higher organization was
associated with better recall from memory in a
large sample of children. Similarly, Akshoomoff
and Stiles (1995), using the Boston Qualitative
Scoring System (Stern et al., 1994), found that
organization in children became more integrated
with age. As shown by Shorr et al. (1992), the
relationship between organization and memory
is also found in adults. They identified critical
junctures in the RCFT figure where breaks in
continuous drawing may occur, and constructed
a scale that assessed how well individuals orga-
nized the RCFT figure. Using this approach in a
mixed sample of neurologic and psychiatric pa-
tients, Shorr et al. (1992) documented that orga-
nizational scores obtained during copy were
641
highly predictive of subsequent free recall from
memory in the neurologic patients.
Recently, Savage and colleagues (1999) de-
vised a simple system for quantifying the orga-
nizational approach to the RCFT figure. Based
on the work of Binder (1982), it consists of five
organizational units (the units of Binder plus the
large base rectangle), each of which must be
drawn as an unfragmented piece to receive
credit for organization. Thus, unlike other avail-
able scoring systems (e.g., Shorr et al., 1992) it
scores organizational elements in a simple all-or
none-fashion rather than considering multiple
junctures for each element. In a series of three
studies, our group (Deckersbach, Otto, Savage,
Baer, & Jenike, 2000; Savage et al., 1999, 2000)
evaluated the organizational approach in indi-
viduals with obsessive-compulsive disorder
(OCD), a disorder for which neuroimaging re-
search implicates fronto-striatal dysfunction
(e.g., Baxter et al., 1987, 1988; Nordahl et al.,
1989, Rauch et al., 1994; Swedo et al., 1989).
Despite drawing accurate copies of the geomet-
ric figure, individuals with OCD failed to con-
struct the geometric figure in an organized fash-
ion. Subsequently, patients with OCD showed
impairments in immediate free recall. Multiple
regression modeling indicated that impairments
in immediate free recall were statistically ex-
plained by deficits in organization during copy.
This approach has also been used to characterize
memory functioning in body dysmorphic disor-
der (Deckersbach, Savage, et al., 2000).
The present study was designed to investigate
the psychometric properties of the Savage et al.
(1999) organizational scoring system and com-
pare it to a previously described scoring system
for organization (Shorr et al., 1992). The Shorr
et al. (1992) approach was chosen because it
adopts a compatible approach for quantifying
organization. It has been shown to predict im-
mediate recall performance, and both systems
overlap substantially in their organizational ele-
ments. The Shorr et al. system characterizes ad-
ditional features of the figure; thus, one goal of
this study was to evaluate whether these features
added to the predictive power of the organiza-
tion score.
642 T. DECKERSBACH ET AL.
METHOD
Participants
Study participants were 71 individuals meeting
DSM-IV criteria (American Psychiatric Associa-
tion, 1994) for OCD (54% female), and 55 healthy
control participants (62% female). These individu-
als came from the combined participant pool of the
Deckersbach et al. (2000) and Savage et al. (1999,
2000) studies, and included eight additional partic-
ipants who had subsequently entered our research
program. Participants with OCD were recruited via
the Massachusetts General Hospital Outpatient
Psychiatry Service. Control participants were re-
cruited through bulletin board notices at the Mas-
sachusetts General Hospital. Diagnoses of partici-
pants with OCD and the status of healthy controls
were determined by a Structured Clinical Interview
(SCID; First, Spitzer, Gibbon, & Williams, 1995).
Normal controls had no history of any Axis I psy-
chiatric disorder. Participants with OCD had no
history of psychosis, bipolar disorder, or substance
dependence and did not meet criteria for current
major depression. All participants had no history
of significant head injury, seizure, neurologic con-
dition or current medical condition. All partici-
pants were Caucasian. Members of the sample pro-
vided written consent prior to enrolling and were
paid for their participation.
Participants with OCD and healthy controls had
mean ages of 36.1 (SD = 10.8, range = 19-65) and
35.13 (SD = 12.6, range = 19-64; t(124) = .47, p =
.64), respectively. Mean years of education were
15.6 (SD = 2.3, range = 11-20) for the group with
OCD and 16.7 for the control group (SD = 2.3,
range = 12-20; t(124) = 2.58, p = .01). Scores on
the Yale-Brown Obsessive-Compulsive Scale
(YBOCS; Goodman et al., 1989) indicated moder-
ate to severe OCD symptoms (M = 21.2, SD = 5.5,
range = 10-31). The degree of depression as as-
sessed by the Beck Depression Inventory (BDI;
Beck & Steer, 1987) was subclinical in the group
with OCD (M = 14.1, SD = 8.4, range = 0-41), and
well-within the nondepressed range for the healthy
control sample (M = 2.3, SD = 3.2, range = 0-15;
t(121) = 9.97, p < .001). Scores on the Edinburgh
Handedness Inventory (Oldfield, 1971) indicated
that 68 of the 71 individuals in the group with
OCD, and all healthy control participants were
right-handed. Verbal intelligence was estimated
with the Vocabulary subtest of the Wechsler Adult
Intelligence Scale – Revised (WAIS-R; Wechsler,
1981) or the Vocabulary subtest of the Shipley In-
stitute of Living Scale (Zachary, 1991), which re-
quires indviduals to find the synonyms of given
words. Twenty control (36%) and 36 (51%) partic-
ipants with OCD completed the WAIS-R subtest.
Thirty five control (63%) and 34 (49%) partici-
pants with OCD completed the Shipley vocabulary
subtest. Raw scores on both scales were converted
into age-corrected standard values (WAIS-R:
scaled scores; Shipley: T scores) and then trans-
formed into standard scores (z-scores). Standard
scores indicated that both participants with OCD
and controls had above average estimated verbal
intelligence (OCD: M(z) = .87, SD = 1.0; controls:
M(z) = .99, SD = .80). A t-test for independent sam-
ples confirmed that the groups did not differ sig-
nificantly from each other (t(124) = .69, p = .49).
All participants completed the Rey-Osterrieth
Complex Figure Test (RCFT; Osterrieth, 1944;
Rey, 1941).
Rey-Osterrieth Complex Figure Test (RCFT)
The RCFT figure was presented on a sheet of pa-
per in landscape (horizontal) orientation. Partici-
pants copied the figure (see Fig. 1), and immedi-
ately afterwards, they were instructed to redraw
the design from memory. For copy and recall, par-
ticipants were provided colored pencils that were
changed approximately every 15 seconds in order
to allow subsequent scoring of organization based
on the order in which the component parts were
constructed. If participants were completing a ma-
jor feature at the end of 15 seconds, they were al-
lowed to complete that feature before the pencil
was switched.
Copy accuracy
Copy and recall drawings were scored for the ac-
curacy of construction (correctly copied or recalled
elements) using the system described by Meyers
and Meyers (1995). In this system, the figure is
subdivided into 18 components. Each piece is eval-
uated with respect to its drawing accuracy (1 point)
and its correct placement (1 point) resulting in a
range of scores per element from 0 to 2 and a total
range of scores from 0 to 36. As demonstrated by
Meyers and Meyers (1995), interrater reliability is
high (r > .90). To ensure sufficient reliability of
copy and recall accuracy scores, a subsample of 30
copy and recall drawings (15 randomly selected
from each group) were scored by two independent
raters blind to group membership.
Organization Scoring
The organizational approach used during the copy
condition was assessed using the Shorr et al.
(1992) and Savage et al. (1999) scoring ap-
proaches.
A detailed description of the Shorr et al. organi-
zational scoring system can be found in Shorr et al.
 ORGANIZATION SCORING FOR COMPLEX FIGURE TEST
(1992). Briefly, in this system, 20 junctures in 8
organizational units are identified (the large rect-
angle, the diagonals, the vertical and horizontal
midline, the vertex of the triangle, the small rect-
angle within the large rectangle, the diagonals
within the small rectangle and the small square
beneath the large rectangle). Individuals receive a
point for organization if a line on each side of a
juncture is drawn continuously or contiguously.
Scores for organization are summed together re-
sulting in a scale with a range of scores from 0 to
20.
In the Savage et al. (1999) scoring system, the
geometric figure is subdivided into five configural
elements: the large rectangle, the diagonal cross,
the vertical midline, the horizontal midline and the
vertex of the triangle on the right (see Fig. 1).
Participants receive points for constructing each
element as an unfragmented unit. The large rectan-
gle is assigned two points to reflect its importance
to the fundamental organization of the figure. All
other elements are assigned one point, resulting in
a range of scores from 0 to 6. The accuracy of
drawing is not considered in this score. An organi-
zational element is considered to be drawn as an
unfragmented unit whenever (1) each side com-
prising a unit (e.g., each of the four sides of the
rectangle) is drawn as a continuous line without
interruption; and (2) all sides are drawn one after
another. The order in which the sides of a unit are
drawn is not taken into account as long as they are
drawn one after another. Participants did not re-
ceive credit for organization whenever a part of an
organizational unit was missing.
Two raters whom were blind to group member-
ship independently evaluated copy organization.
The raters had no experience with either scoring
system prior to training. Final scores for the pur-
pose of multiple regression analyses were deter-
mined by consensus discussion; agreement was
reached for all drawings.
Statistical Analysis
Interrater reliability for the organizational scoring
of each element in the Savage et al. (1999) scoring
system was evaluated by Cohen’s kappa coeffi-
cient. Interrater reliability for both the Shorr et al.
(1992) and Savage et al. (1999) organization
scales, as well as interrater reliability of copy ac-
curacy, was evaluated by Pearson correlations.
Group differences (OCD vs. Control) in copy orga-
nization (both Savage et al., 1999 and Shorr et al.,
1992), and copy and recall accuracy, were evalu-
ated with independent samples t-tests. The impact
of copy organization and copy accuracy on imme-
diate free recall was evaluated by multiple regres-
643
sion analysis. The predictive value of individual
organizational units for immediate recall was also
evaluated using simple and multiple regression
analyses.
RESULTS
Interrater Reliability
Cohen’s Kappa coefficients indicated moderate
to high interrater agreement for the organiza-
tional elements included in Savage et al.’s
(1999) scoring system. The highest agreement
was achieved for the vertical midline (Cohen’s
Kappa = .92, p < .001), followed by the large
rectangle (Cohen’s Kappa = .90, p < .001), the
diagonals (Cohen’s Kappa = .89, p < .001), the
horizontal midline (Cohen’s Kappa = .84, p <
.001) and the vertex of the triangle (Cohen’s
Kappa = .69, p < .001). The number of disagree-
ments for the elements ranged from as few as 2
for the vertical midline to as many as 16 for the
vertex of the triangle. Interrater agreements for
copy organization (whole scale) in both scoring
systems were high as indicated by Pearson cor-
relations of r = .94 (p < .001) for both ap-
proaches. Accuracy scores for copy and recall
also showed high interrater agreement, as indi-
cated by Pearson correlations of r = .93 (p <
.001) and r = .97 (p < .001), respectively. Copy
organization scores for both organization sys-
tems were highly intercorrelated as indicated by
a Pearson correlation of r = .80 (p < .001).
Group Comparisons
Table 1 shows means and standard deviations
for copy accuracy scores, organization scale
scores (both Savage et al., 1999 and Shorr et al.,
1992), and free recall scores (all agreement
scores).
Group comparisons for a subsample of partic-
ipants with OCD and controls included in this
study have been previously reported in Savage
et al. (1999, 2000). For the pooled data in this
study, independent samples t tests indicated that
participants with OCD copied the figure less
accurately than control participants (t(124) =
2.02, p = .05), and organized the RCFT figure to
a lower extent than control participants as as-
644 T. DECKERSBACH ET AL.

Savage et al.,
Organizational 1999
Elements
Points

(0-2)

(0-1)

(0-1)

(0-1)

(0-1)

Total Score (0-6)

Fig. 1. The original Savage et al. (1999) system for scoring the organizational approach on the Rey-Osterrieth
Complex Figure. Five core configurational elements are identified: The large rectangle (2 points), the
two diagonals (1 point), the vertical midline (1 point), the horizontal midline (1 point), and the vertex
of the triangle to the right (1 point). The scores for each element are summed, resulting in a scale with
a range of scores from 0 to 6.
 ORGANIZATION SCORING FOR COMPLEX FIGURE TEST 645

Table 1. Scores for the Two Organizational Scoring Approaches, Copy Accuracy and Immediate Free Recall.

Controls OCD Combined

n = 55 n = 71 Controls/
OCD p
(Controls
Organizational Elements M (SD) M (SD) M (SD) vs. OCD)
Copy Organization – Savage et al. (1999) 4.18 1.65 2.97 1.67 3.50 1.76 < .001
Copy Organization – Shorr et al. (1992) 17.25 2.37 14.93 3.78 15.94 3.43 < .001
Copy Accuracy* 33.81 2.71 32.69 3.33 33.18 3.12 .05
Immediate Recall* 20.84 7.47 14.70 7.86 17.38 8.25 < .001

Note. OCD = Obsessive-Compulsive Disorder.

* scored based on Meyers & Meyers (1995).

sessed by both the Savage et al. (1999) scoring
system (t(124) = 4.06, p < .001) and the Shorr et
al. (1992) scoring system (t(124) = 3.99, p <
.001). Participants with OCD also recalled fewer
elements of the RCFT figure than control partic-
ipants (t(124) = 4.44, p < .001).
Prediction of Free Recall Scores
Both accuracy and organization of the copy con-
dition might affect the quality of encoding in the
RCFT. The impact of copy organization and
copy accuracy on immediate free recall was,
therefore, evaluated separately for both scoring
systems. The correlations between copy organi-
zation (agreement scores) as assessed by both
Savage et al. (1999) and Shorr et al. (1992), and
copy accuracy (agreement scores) and immedi-
ate free recall (agreement scores) were almost
identical in the OCD and control groups. A se-
ries of independent t tests confirmed that these
correlations did not differ significantly from
each other across the two groups (all p > .16).
Therefore, the data were collapsed over the two
groups in order to increase statistical power.
Table 2 shows the correlations between copy
organization, copy accuracy, and recall accuracy
for the whole sample.
As shown in Table 2, both copy organization
and copy accuracy scores were significantly cor-
related with each other and correlated with im-
mediate free recall (p < .01).
Copy organization and copy accuracy scores
were entered stepwise in a multiple regression
equation as predictors for immediate free recall.
Copy organization as assessed by Savage et al.
(1999) explained 36% of the free recall variance
(R2 = .36, F(1,124) = 70.65, p < .001). Inclusion
of copy accuracy did not significantly increase
explanatory power (R2 = .42, F(2,123) = 45.26,
)R2 = .06, p > .05). Likewise, copy organization
as assessed by Shorr et al. (1992) explained 28%
of the variance (R2 = .28, F(1,124) = 48.65, p <
.001). Inclusion of copy accuracy did not in-
crease the amount of free recall variance ex-
plained (R2 = .35, F(2,123) = 33.66, )R2 = .07,
p > .05). The simple correlation of organization

Table 2. Correlations Between Variables in the Rey-Osterrieth Complex Figure Test.

Copy Organization Copy Immediate

Savage Accuracy Recall
Copy Organization (Shorr) .81** .42** .53**
Copy Organization (Savage) ––– .40** .60**
Copy Accuracy ––– .47**

Note. Copy accuracy and immediate recall were scored based on Meyers & Meyers (1995).
* p < .05; ** p < .01.
646 T. DECKERSBACH ET AL.
scale scores with immediate free recall scores
did not differ significantly across the two sys-
tems (p > .05).
We also investigated whether adding the three
additional elements included in the Shorr et al.
(1992) organization scoring system (the small
rectangle in the left half of the large rectangle,
the small diagonals within the small rectangle,
and the small square below the large rectangle)
to the Savage et al. (1999) scale increased ex-
planatory power. As with the other elements,
participants received credit for these elements
whenever they were drawn as unfragmented
units. All three elements yielded high interrater
agreements (all Kappa coefficients > .90). These
elements were added to the Savage et al. (1999)
organization scale resulting in a range of scores
from 0 to 9 (sum of all elements). Entering this
score as a single predictor for free recall in a
multiple regression equation did not increase the
amount of free recall variance explained by the
original organization score (sum of five ele-
ments, range of scores 0-6) as indicated by 29%
free recall variance explained (R 2 = .29,
F(1,124) = 49.53, p < .001) The two correlation
coefficients of organization scale scores (with
and without these additional elements) with free
recall did not differ significantly from each
other (p > .05). Likewise, subtracting the scores
of these elements from the Shorr et al. (1992)
organization scale (sum of scores of the large
rectangle, diagonals, vertical and horizontal
midline and the vertex, range of scores 0-14) did
not result in a significant loss of predictive
power for the reduced organization scale (R2 =
.34, F(1,124) = 64.25, p < .001). The two corre-
lations of organization scale scores (with and
without the additional elements) with free recall
did not differ significantly from each other (p >
.05).
Next we investigated the relative contribution
of each of the five organizational elements in-
cluded in the Savage et al. (1999) organization
system to immediate free recall from memory.
The elements were entered simultaneously as
independent predictors for immediate free recall
in a multiple regression equation. This resulted
in 39% percent of the immediate free recall vari-
ance explained (R2 = .39, F(5,120) = 15.33, p <
.001). All elements but one predicted significant
portions of the free recall variance, including the
large rectangle ($ = .22, p = .006), the diagonals
($ = .31, p < .001), the horizontal line ($ = .21,
p = .009), and the triangle ($ = .16, p = .04). The
vertical line within the large rectangle did not
significantly predict free recall from memory ($
= .04, p = .58) in the multiple regression equa-
tion.
DISCUSSION
We set out to investigate the characteristics of a
new approach to scoring organizational strate-
gies for the RCFT figure (Savage et al., 1999)
and to compare its psychometric properties to
those of a compatible scoring system (Shorr et
al., 1992). Rater agreements on the five organi-
zational units used in the Savage et al. (1999)
system indicated that each element could be reli-
ably identified. Interrater agreements for the
total scores of the Savage et al. (1999) organiza-
tion scale were excellent, and compared well to
those obtained with the Shorr et al. (1992)
method. Consistent with previous findings, our
results underscore the impact of organizational
processes during encoding on the ability to sub-
sequently recall the RCFT figure (e.g., Shorr et
al., 1992; Waber & Holmes, 1986). Both the
Shorr et al. (1992) and Savage et al. (1999) or-
ganizational scoring systems explained signifi-
cant portions of the variance in free recall
scores, and inclusion of copy accuracy as an ad-
ditional predictor did not increase predictive
power for free recall.
Shorr et al. (1992) proposed that including a
wide range of organizational elements and iden-
tifying multiple junctures for each element
might provide a finer analysis of an individual’s
organizational strategy. However, our results
indicate that all organizational elements are not
equally predictive of free recall. Inclusion of the
three additional elements from Shorr et al. (the
small rectangle, the small diagonals, and the
small square) actually caused a slight nonsignif-
icant drop in the amount of explained variance
in free recall. Conversely, subtracting these ele-
ments from the Shorr et al. (1992) organization
 ORGANIZATION SCORING FOR COMPLEX FIGURE TEST
scale yielded a small nonsignificant increase in
the amount of explained variance. Thus, adding
additional elements did not add to our ability to
predict recall. Furthermore, including all five
organizational elements from the Savage et al.
(1999) system simultaneously as independent
predictors of immediate recall in multiple re-
gression analyses did not support our belief that
the large rectangle should be weighted more
heavily than other organizational elements.
Thus, a possible modification to our original
system would be to score all five elements as 0
or 1, resulting in a total score of 0-5.
Some potential limitations should be noted
regarding the generalizability of our findings.
First it is unclear whether results from our com-
bined group of healthy control participants and
patients with OCD can be generalized to other
populations. In our study, the association be-
tween copy accuracy, copy organization, and
immediate recall did not differ across the two
groups. However, this relation may vary in other
patient populations characterized by different
patterns of brain dysfunction. Furthermore, our
study can be criticized based upon its selective
focus on only one aspect of organization –
whether organizational features were drawn as
whole units. Other aspects of organization, such
as drawing sequence (Akshoomoff & Stiles,
1995), critical features associated with develop-
mental stages (Waber & Holmes, 1985, 1986),
and qualitative aspects of organization (Stern et
al., 1994) might be equally important predictors
of memory performance.
In summary, both scoring systems provided
highly reliable measures of organization on the
RCFT figure and both have predictive value for
subsequent recall from memory. Our results in-
dicate that a simple all-or-none scoring of a few
core organizational elements compares favor-
ably to a more complex scoring method. We
suggest that our approach offers a parsimonious,
and clinically practical, alternative to organiza-
tional scoring on the RCFT.
647
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