USING THE BICYCLE DRAWING TEST WITH ADULTS Anita M.

Hubley & Lydia Hamilton University of British Columbia Vancouver, BC, Canada Poster presented at the 22nd Annual Meeting of the National Academy of Neuropsychology, Miami, Florida, USA, October 9-12, 2002 Correspondence: Dr. Anita M. Hubley, Dept. of ECPS, 2125 Main Mall, University of British Columbia, Vancouver, BC, Canada, V6T 1Z4; E-mail: anita.hubley@ubc.ca ABSTRACT The Bicycle Drawing Test (BDT) was first developed as a measure of childrens higher conceptual reasoning (Piaget, 1930; Taylor, 1959), but has since been described as a measure of visuographic functioning and mechanical reasoning (Lezak, 1995). The BDT is currently used in clinical settings with both children and adults. Greenberg, Rodriguez, and Sesta (1994) presented a standardized administration and scoring system for the BDT and provided reliability and validity evidence to support its use with children. Using the administration and scoring system developed by Greenberg et al., the present study provides preliminary reliability and construct validity evidence with respect to the use of the BDT with adults and introduces a copy trial to supplement the free drawing portion of the test. In a sample of 50 community-dwelling men and women ages 20-80 years, mean performance on the BDT is described, one-week testretest reliability coefficients are computed, gender differences and correlations with age are reported, and correlations of the BDT with other visuospatial measures (i.e., ReyOsterrieth Complex Figure, WAIS-III Block Design, Hooper Visual Organization Test) and a verbal measure (i.e., Rey Auditory-Verbal Learning Test) are examined. INTRODUCTION The Bicycle Drawing Test (BDT) currently is used as a measure of mechanical reasoning and visuographic functioning in both children and adults (Lezak, 1995). An advantage of the BDT over other drawing tests is the opportunity to measure visuospatial and visuographic functioning using a commonly encountered, yet complex, object with which most adults and children are familiar. The BDT has been shown to be useful in evaluating the effects of damage or lesions to different areas of the brain (e.g., Lebrun & Hoops, 1974; McFie & Zangwill, 1960; Messerli, Seron, & Tissot, 1979) and assessing the effects of treatment for individuals with multiple sclerosis (e.g., Sandyk, 1997) and Parkinsons disease (e.g., Sandyk, 1996). Greenberg, Rodriguez, and Sesta (1994) developed a standardized administration for the BDT and a scoring system that yields subscores for categories of errors rather than a simple composite score. They also provided reliability and validity evidence to support the use of the BDT and their scoring system with children. Using the Greenberg et al. system, the present study provides preliminary reliability and construct validity evidence for the use of the BDT with adults and introduces a copy trial to supplement the free drawing portion of the

test. METHOD Participants Participants consisted of 50 community-dwelling adults (22 men, 28 women) aged 21-80 years (M = 49.4, s = 17.9) whose education ranged from 10-21 years (M = 15.0, s = 2.7). All participants scored > 24 on the Mini-Mental State Examination (M = 28.2, s = 1.4) and < 13 on the Geriatric Depression Scale (M = 4.9, s = 3.6). Procedure Participants were administered a battery of tests over two sessions scheduled one week apart. The tests administered included the Bicycle Drawing Test (BDT), ReyOsterrieth Complex Figure (ROCF), WAIS-III Block Design, Hooper Visual Organization Test (HVOT), and the Rey Auditory-Verbal Learning Test (RAVLT) List A. Participants were asked to draw a regular bicycle without a rider in both sessions. Participants were not told in advance that they would be asked to draw the bicycle a second time. In the retest session, participants were also asked to copy a drawing of a bicycle (see Figure 1). RESULTS Bicycles were scored using Greenberg et al.s (1994) scoring system (see Figure 2). Mean Performance: Mean performance on the test, retest, and copy trials of the BDT is presented in Table 1. Only Mechanical Reasoning showed a significant increase at retest, t(49) = -3.84, p < .001, which also resulted in a significant increase in Total Score at retest, t(49) = -2.70, p < .01. As expected, mean copy trial performance shows few errors. Test-Retest Reliability: One-week test-retest reliability estimates were as follows: Parts/Complexity: r = .70; Motor Control: r = .62; Spatial Relationships: r = .52; Mechanical Reasoning: r = .79; Total Score: r = .77 (all: p < .001). Gender Differences: Mean performance on the BDT (at test) by gender is shown in Table 2. Gender differences were found only on Mechanical Reasoning, t(48) = 3.30, p < .01, and Total Score, t(48) = 2.31, p < .05, with men outperforming women. Age Effects: Younger adults tended to obtain higher scores on the BDT (at test) than older adults, but this was only statistically significant for Total Score (p < .05). Correlations of the BDT with age were as follows: Parts/Complexity: r = -.14; Motor Control: r = -.24; Spatial Relationships: r = -.26; Mechanical Reasoning: r = -.23; Total Score: r = -.28. Convergent and Discriminant Validity: Correlations of the BDT (at test) with visuospatial measures (i.e., ROCF, Block Design, and HVOT) and a verbal measure (i.e., RAVLT) are shown in Table 3.

DISCUSSION The present study shows community-dwelling adults performance on the BDT when the Greenberg et al. (1994) system is used. One week test-retest reliability estimates suggest stability in performance over a relatively short period of time. The increase in Mechanical Reasoning scores (and subsequently Total Scores) upon retest is likely due to participants further reflection on how a bicycle must fit together to function and examination of bicycles after the test session. The finding that men scored significantly higher on Mechanical Reasoning (and subsequently Total Scores) than women is consistent with Greenberg et al.s gender findings with children. The slight tendency for younger adults to obtain higher scores on the BDT than older adults on most of the scoring categories except Parts/Complexity is counter to the findings of Ska, Dsilets, and Nespoulous (1986). The pattern of correlations between the BDT and the ROCF, WAIS-III Block Design, and the HVOT support interpretation of the BDT as a measure of visuographic functioning and provide convergent and discriminant validity evidence for the Greenberg et al. scoring categories. The low and nonsignificant correlations between the BDT and the RAVLT provide discriminant validity evidence supporting the interpretation of the BDT as a measure of visuospatial ability that is not affected by verbal recall. Future research needs to (a) examine the utility of the BDT and the validity of the Greenberg et al. scoring system with a variety of clinical samples (e.g., individuals with brain-injuries, dementia, multiple sclerosis, HIV/AIDS) and (b) explore the kinds of errors that community-dwelling adults make on the BDT so this can be used to provide a baseline comparison for use with clinical subgroups. REFERENCES
Greenberg, G. D., Rodriguez, N. M., & Sesta, J. J. (1994). Revised scoring, reliability, and validity investigations of Piagets Bicycle Drawing Test. Assessment, 1, 89-101. Lebrun, Y., & Hoops, R. (1974). Intelligence and aphasia. Amsterdam: Swets & Zeitlinger. Lezak, M. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press. McFie, J., & Zangwill, O. L. (1960). Visual construction disabilities associated with lesions of the left cerebral hemisphere. Brain, 83, 243-260. Messerli, P., Seron, X., & Tissot, R. (1979). Quelques aspects des troubles de la programmation dans le syndrome frontal. Archives Suisse de Neurologie, Neurochirurgie et de Psychiatrie, 125, 23-35. Piaget, J. (1930). The childs conception of physical causality. New York: Harcourt Brace. Sandyk, R. (1996). Brief communication: Electromagnetic fields improve visuospatial performance and reverse agraphia in a Parkinsonian patient. International Journal of Neuroscience, 87, 209-217. Sandyk, R. (1997). Progressive cognitive improvements in multiple sclerosis from treatment with electromagnetic fields. International Journal of Neuroscience, 89, 39-51. Ska, B., Dsilets, H., & Nespoulous, J.-L. (1986) Performances visuo-constructives et vieillissement. Psychologica Belgica, 26, 125-145. Taylor, E. M. (1959). Psychological appraisal of children with cerebral deficits. Cambridge, MA: Harvard University Press.

Figure 1 Bicycle Model for Copy Trial

2002, A.M. Hubley

Figure 2 Greenberg et al. (1994) Scoring Categories for the Bicycle Drawing Test Greenberg et al. (1994) Scoring Categories Parts/Complexity (7 items): Scores for essential elements that must be present for a bicycle to take on its characteristic form (e.g., two wheels, gear assembly, complete frame). Motor Control (5 items): Evaluates pencil control and psychomotor regulation (e.g., no perseverations, lines meet target destination, no irrelevant lines). Spatial Relationships (9 items): This broad category assesses good planning, proper placement of parts, appropriate spatial orientation and relationship among parts, consistent sizing of parts, symmetry, and logical perspective. Mechanical Reasoning (5 items): Evaluates ability to convey how a bicycle is powered and how it can move through placement and orientation of parts (e.g., chain is connected to rear wheel center, steering control appears possible).

Table 1 Mean Performance on the Bicycle Drawing Test at Test, Retest, and Copy Trials Scoring Categories Parts/Complexity Motor Control Spatial Relationships Mechanical Reasoning Total Score
Note: n = 50

Max. Possible Score 7.0 5.0 9.0 5.0 26.0

Test 5.3 (1.08) 4.4 (0.71) 7.4 (1.28) 2.8 (1.83) 19.9 (3.77)

Retest 5.5 (1.03) 4.5 (0.68) 7.5 (1.25) 3.4 (1.68) 20.9 (3.69)

Copy 6.6 (0.51) 4.8 (0.52) 8.8 (0.52) 4.9 (0.35) 25.0 (1.23)

Table 2 Mean Performance on the Bicycle Drawing Test at Test by Gender Gender Scoring Categories Parts/Complexity Motor Control Spatial Relationships Mechanical Reasoning Total Score Men (n = 22) 5.6 (1.08) 4.3 (0.84) 7.7 (1.08) 3.6 (1.50) 21.3 (3.33) Women (n = 28) 5.2 (1.06) 4.5 (0.58) 7.1 (1.37) 2.1 (1.78) 18.9 (3.82)

Table 3 Convergent and Discriminant Validity: Correlations of the Bicycle Drawing Test with Measures of Visuospatial and Verbal Ability Convergent and Discriminant Measures BDT Scoring Categories Parts/Complexity Motor Control Spatial Relationships Mechanical Reasoning Total Score
a b c

ROCF .38b .32

a

Block Design .46c .28 .41c .47 .52

c c

HVOT .30a .20 .13 .35 .33

a a

RAVLT .08 .19 .17 .01 .12

.30a .48 .51

b b

Note: p < .05; p < .01; p < .001; n = 50 BDT = Bicycle Drawing Test scores at test; ROCF = Rey-Osterrieth Complex Figure immediate recall scores; Block Design = age corrected WAIS-III Block Design scores; HVOT = Hooper Visual Organization Test; RAVLT = Rey Auditory Verbal Learning Test List A total acquisition scores (summed over 5 trials).