This article was downloaded by: [Carnegie Mellon University]

On: 02 February 2015, At: 02:10

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954
Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Clinical and

Experimental Neuropsychology
Publication details, including instructions for authors
and subscription information:
http://www.tandfonline.com/loi/ncen19

Assessing children's copy

productions of the Rey-Osterrieth
complex figure
a a
Deborah P. Waber & Jane M. Holmes
a
Department of Psychiatry , Mental Retardation Center,
Children's Hospital , Boston, MA
Published online: 04 Jan 2008.

To cite this article: Deborah P. Waber & Jane M. Holmes (1985) Assessing children's copy
productions of the Rey-Osterrieth complex figure, Journal of Clinical and Experimental
Neuropsychology, 7:3, 264-280, DOI: 10.1080/01688638508401259

To link to this article: http://dx.doi.org/10.1080/01688638508401259

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information
(the “Content”) contained in the publications on our platform. However, Taylor
& Francis, our agents, and our licensors make no representations or warranties
whatsoever as to the accuracy, completeness, or suitability for any purpose
of the Content. Any opinions and views expressed in this publication are the
opinions and views of the authors, and are not the views of or endorsed by
Taylor & Francis. The accuracy of the Content should not be relied upon and
should be independently verified with primary sources of information. Taylor and
Francis shall not be liable for any losses, actions, claims, proceedings, demands,
costs, expenses, damages, and other liabilities whatsoever or howsoever caused
arising directly or indirectly in connection with, in relation to or arising out of
the use of the Content.

This article may be used for research, teaching, and private study purposes.
Any substantial or systematic reproduction, redistribution, reselling, loan, sub-
licensing, systematic supply, or distribution in any form to anyone is expressly
 forbidden. Terms & Conditions of access and use can be found at http://
www.tandfonline.com/page/terms-and-conditions
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015
 Journal of Clinical and Experimental Neuropsychology 0168/8634/0703-0264 5 3.00
1985, Vol. 7, No.3, pp. 264-280 @ Swets & Zeitlinger

Assessing Children’s Copy Productions of the

Rey-Osterrieth Complex Figure*

Deborah P. Waber and Jane M.Holmes

Department of Psychiatry and Mental Retardation Center Children’s Hospital
Boston, MA
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

ABSTRACT

This report describes developmental changes in children’s copy productions of the

Rey-Osterrieth Complex Figure as well as a new method for evaluating these
productions that is sensitive to parameters relevant for neuropsychologicaldiagno-
sis. Based on protocols from a standardization sample of 454 children between the
ages of 5 and 14,a system was devised for evaluating objectively: (1) organization; (2)
production style; and, (3) accuracy. Normative findings are described and implica-
tions for the use of this instrument in the neuropsychologicalassessmentof children
discussed.

In the nearly 10 years that we have been routinely applying the Rey-Osterrieth
Complex Figure in the neuropsychologicalevaluation of children, we have found
it to be an exceptionally valuable tool for both clinical diagnosis and research
(Holmes & Waber, 1977; Waber, 1979a;Waber, 1979b;Waber, Mann, Merola, &
Moylan, in press). The figure itself has a long history in the practice of neuropsych-
ology. It was devised nearly half a century ago by the Swiss neuropsychologist
Andrk Rey (Rey, 1941) for use in the evaluation of brain-damaged adults. The
figure is structured around a base rectangle, which is divided into eight equal
segments by a horizontal and vertical line intersected by two diagonal lines,and
includes a variety of internal features. Because of its complexity, the figure has
proved especially useful for evaluating the ability to plan, organize, and assemble
complex information (Binder, 1982; Goodglass & Kaplan, 1979; Lhermitte,
Derouesne, & Signoret, 1972; Messerli, Seron, & Tissot, 1979).
An extensive developmental study of children’s performance on this task was

* This research was supported by the Rowland Foundation, by Research Scientist Deve-
lopment Award MH00287 to D. P. W. and in part by NICHHD Core Grant HDO6276 to
the Mental Retardation Center. The authors wish to thank James Merola for his assistance
in carrying out the statistical procedures and Ann McElroy for her assistance in assembling
the manuscript. Requests for reprints should be sent to Deborah P. Waber, Department of
Psychiatry, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

Accepted for publication: July 12, 1984.

 REY-OSTERRIETH 265

undertaken by a colleague of Rey, Paul Osterrieth (Osterrieth, 1946). He adminis-

tered the test to a normative sample of 295 individuals from 4 years of age to
adulthood. The designs were scored in three different ways: (1) seven “types” of
strategies ranging from a concatenation of parts to use of the base rectangle as a
guiding structure; (2) a quantitative indication of the completeness of the design
itself based on 18 units; and, (3) time to execute the drawing. Designs were
increasingly well-organized with age; accuracy of elements improved through 9
years of age and changed little thereafter; and, time decreased linearly until early
adolescence and changed little thereafter.
Interpretation of children’s productions of this figure in the context of contem-
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

porary neuropsychological assessment, however, is constrained by the lack of the

following: (1) a valid and reliable method for assessing parameters that are most
relevant for neuropsychological diagnosis; and, (2) detailed developmental des-
criptive data. The Ostemeth system treats all 18 units equally, be they isolated
details (e.g., the exterior cross) or organizing structures (e.g., the base rectangle).
While it does provide a basis for comparing a child’s performance to that of the
normal group, it is insensitive to aspects of the production that may be of
considerable theoretical significance.
Our clinical observation of children’s productions of the Rey-Osterrieth Com-
plex Figure has been consistent in many instances with neuropsychologicaltheory
as derived from adult populations. Some children render the design in a fragmen-
ted, part-oriented manner, while others do so in a more global or configurational
way. These stylistic variations, moreover, seem to be systematically related to
other aspects of the child’s neuropsychological functioning, such as language
impairment, hyperactivity, and motor skills. Without background knowledge of
the regular age-related changes in such characteristics as goodness of organization
and copying style, however, evaluation of an individual child’s production is
necessarily impressionistic.
In order to enhance the utility of this instrument for neuropsychological
evaluation, we undertook a large normative study whose goals were as follows: (1)
to describe regular developmental changes in various aspects of children’s produc-
tions of the figure; and, (2) to generate a reliable and valid method for quantifying
goodness of organization and style.

METHOD

Sample
The participants were 454 children from a middle to lower middle class district ranging in
age from 5 to 14 years. Childrenwere not screenedfor learning difficulties.Handedness was
ascertained by self-report.Table 1 shows the age, sex, and handedness distributionof the
sample. Overall, the group is divided evenly by sex and, consistent with other estimates
(Annett, 1970; Michel, 1981), approximately 10% of the children report themselves to be
left-handed.
 266 D P WABER and .I M HOLMES

Table I

Characteristics of Sample

Sex ( % ) Age in Months Handedness (%)

n F M M SD Right Left
5 24 62.50 37.50 67.96 2.30 83.30 12.50
6 47 48.90 51.10 78.50 2.98 89.10 10.90
7 47 53.20 46.80 89.00 3.66 91.50 8.50
8 53 47.20 52.80 102.60 3.74 94.30 5.70
9 38 47.40 52.60 I 13.20 3.40 94.70 5.30
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

10 42 45.20 54.80 124.60 3.63 97.60 2.40

11 44 63.60 36.40 137.30 3.73 95.30 4.70
12 59 4 4 10 55.90 !50.70 3.35 87.90 12.10
13 60 46.70 53.30 161.18 3.66 84.70 15.30
14 40 45.00 55.00 170.80 2.93 86.50 13.50
- _ _ _ _
454 225 229 - - 405 41
% 100 49.60 50.40 - - 90.60 9.20

Materials
The Rey-Osterrieth Complex Figure (Figure 1) was reproduced so that the base rectangle
measured 8.0 cm x 5.5 cm.’ It was mounted on a white card measuring 20 cm x 15 cm, with
an additional card of the same dimensions affixed as a cover. Each child was provided with
a piece of white paper measuring 8%”x 1 1”and five colored pencils (red, green, blue, brown,
and purple).

Figure 1. The Rey-Osterrieth Complex Figure (Osterrieth, 1946).

’ After administration of the study was completed. we realized that our version of the figure had an
extra line that does not appear on the original version of the figure (OC7 in our notation in Figure 2c).
This perseverative error, committed by two individuals holding advanced degrees from prestigious
universities, is testimony to the broad range of applicability of the task.
 REY-OSTERRIETH 267

Procedure
Kindergarten children were tested individually. ,411 other children were tested in their
classroom groups.* Each child was given a copy of the figure, a piece of paper, and the five
colored pencils. The figure was presented horizontally (with the diamond to the extreme
right); the examiner monitored the children to assure that they did not rotate the stimulus
card. (We are aware that some clinicians present the figure in a vertical orientation. As we
shall show, however, the left-right differences elicited by the horizontal administration, as
Osterrieth in fact presented it, are of considerable developmental significance, as is the
tendency by some young children to rotate their copy productions 90" to the vertical
position.) The paper was taped to the child's desk in n horizontal position so that it could
not be rotated.
To ensure that the sequence in which the various part:, of the design were copied could be
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

retrieved, the color coding described by Osterrieth ( 1946)was employed, the only modifica-
tion being that the colors were switched according to fixed time intervals rather than when a
structure was judged to have been completed. When the tester signaled the children to start,
they were to pick up a designated colored pencil and begin to copy the design. When told to
switch, they would put down that pencil and continue drawing with the next color
designated. This procedure was continued until all the colors had been used.
The time limit for each color was 60 s for kindergarten and first grade children, 45 s for
second to sixth graders, and 30 s for seventh and eighth graders. The red pencil was always
used last since red was thought to be a more salient color than the others, and the order of
presentation of the other four colors was randomized t(or each classroom group.

Data Reduction
Objective Rating. The goal of the data reduction procedure was to code objectively as
much information as possible from the drawings. Prior to coding, all identifying informa-
tion (name, age, and handedness) was removed from the drawings and random identifica-
tion numbers were assigned.
Detailed illustrations of the coding criteria described below can be found in Figure 2.
1. Accuracy. The design was broken down into thc smallest line segments possible and
each segment categorized as belonging to one of the four major components of the
structure: base rectangle, BR (Figure ?A); main substructure, MS (Figure 2B); outer
configuration, OC (Figure 2C); and, internal detail, ID (Figure 2D). When a line segment
was judged to be present, it was coded by its entry color (1 through 5). If absent, it was
assigned a score of 0. If a line were drawn twice, the one drawn in the later color was
considered to be a double and entered in that category (e.g., BR8 Double) so that amount of
doubling could later be retrieved.
2. fntersections (Figure 2E). All possible intersections, including corners, main diago-
nals contacting corners, the central intersection (diagnonals, horizontal and vertical), the
left-side interior box (corners and diagonals), the lower left box, the upper right exterior
triangle, and the far right exterior triangle. were scored as present (1) or absent (0).
3. Alignments (Figure 2F). Alignment of segments of the base rectangle and main sub-

Comparison of the scores generated f r o m chi5 \ample & t i o were >een in groups, with those from
comparable groups seen by us in other studies in which the tt-\r was admlnistered individually indicated
n o difference in overall level of performance
 268 D.P. WABER and J. M.HOLMES
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

Figure 2. A. Base rectangle (BR) (1 2 elements). B. Main sub-structure (MS) (13 elements).
C. Outer configuration (OC)(27 elements). D. Internal detail (ID)(13 elements).
E. Intersections. F. Alignments.

structure, as well as of the base rectangle within the exterior structures, was scored as
present (I) or absent (0).
4. Direction of Execution. Color order was used to determine whether the drawing had
been executed from right to left or from left to right.
All the drawings were scored by one individual. In order to insure reliability, every 25th
protocol was scored by two independent raters. For each protocol, the proportion of entries
for which the three raters agreed was computed. Overall, interrater agreement thus calcula-
ted was 95%.
 REY-oSTERRIETH 269

ClinicalRating. In addition to the objective scoring of discrete component features, the

designs were rated clinically for goodnessof organization and style. The organization rating
was based on a 5-point scale ranging from poor (1) to excellent(5).The style rating included
four categories: (a) part-oriented; (b) exterior configurationallinterior part-oriented; (c)
exterior part-orientedhterior configurational; and, (d) configurational. The ratings were
carried out by two judges (JMH and DPW) who were blind to the identity of the children;
they agreed on all protocols. Protocols were rated in two separate passes, first for organiza-
tion and then for style, so that the judgements for the two parameters would be indepen-
dent.
The positive correlation between the organization ratings and chronologicalage ( I = .72,
p < .OOOOl) lends confirmation to the validity of these judgements. The organization and
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

style ratings, moreover, were systematically related to one another (see Table 2). At the
lowest level, the majority of protocols were rated as part-oriented. As level of organization
increased, the largest proportion was rated as configurational.

Table 2

Percent of Drawings at Each Organizational Level

Categorized in Each of 4 Style Categories (Clinical Ratings)

Exterior Exterior
Configurational Part-Oriented/
Part Interior Part Interior
Oriented Oriented Configurational Configurational
1 (Poor) 66.10 10.20 11.90 1 1.90
2 (Fair) 47.10 23.10 19.20 10.60
3 (Average) 40.00 16.30 12.60 31.10
4 (Very Good) 26.70 22.90 8.60 4 1.90
5 (Excellent) 20.70 17.20 5.20 56.90

RESULTS

Descriptive Findings
Accuracy. Accuracy was measured by the number of segments copied within
each of the four main categories: base rectangle, main substructure, outer configu-
ration, and inner detail (see Table 3). According to this criterion, nearly total
accuracy was achieved for all four categories by age nine, with little change
occurring thereafter.

Direction of Execution. Direction of execution was inferred from the color order
(see Table 4). Young children. between the ages of 5 and 7, were equally likelv to
start on the left or the right side. At age 8, however, a left-side preference appeared;
64% of the children started on that side. 'X'his proportion increased to 80%
 270 D.P.WABER and J. M. HOLMES

Table 3

Means and Standard Deviations for Number of Components Copied Within Each of Four
Major Categories(Numbers in Parentheses Indicate Maximum Number of Parts)

Base Rectangle Main Structure Outer Configuration Internal Detail

(12) (13) (27) (13)
M SD M SD M SD M SD
5 8.29 3.55 6.91 3.76 18.79 5.61 5.45 4.52
6 9.63 2.68 9.25 3.44 21.87 5.08 7.48 4.68
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

7 10.64 1.90 11.61 2.35 25.12 3.68 10.70 3.35

8 11.30 1.28 12.04 1.69 25.41 2.91 11.51 2.23
9 11.29 1.20 12.68 .84 25.92 1.88 12.50 .68
10 11.62 .79 12.40 1.31 26.11 2.77 12.02 2.30
11 11.70 .73 12.70 .85 25.86 2.72 12.34 1.34
12 11.86 .57 12.59 1.19 26.03 2.73 12.05 1.98
13 11.78 .64 12.80 .84 26.33 1.72 12.48 1.73
14 11.90 .30 12.92 .35 26.32 2.23 12.75 .49

Table 4

Direction of Execution (9% at each age level)

~~

Age L-R R-L

5 60.90 34.80
6 42.60 57.40
7 51.10 48.90
8 64.20 32.10
9 81.60 18.40
10 76.20 23.80
11 81.80 18.20
12 79.70 20.30
13 91.70 6.70
14 90.00 7.50

between the ages of 9 and 12 and, by age 13, reached 90%. Direction of execution
was not systematicallyrelated to handedness.

Development of Scoring Procedure

The major aims of this proportion of the data analysis were (1) t o determinewhich
specific features of the design were most salient for the judges and (2) t o quantify
and order them in such a way that they could be applied reliably by other clinicians
 REY-OSTERRIETH 27 1

and researchers in evaluating children’s productions. The results, however, can

also serve to highlight the nature of developmental changes in organization and
style.
A statistical technique commonly used in situations such as this is discriminant
function analysis, which assigns weights to raw scores on a number of variables to
yield composite scores that best discriminate members of different groups. Dis-
criminant function analysis was therefore used in a descriptive way, in conjunction
with univariate analyses, frequencies, and correlations, to identify salient features
and thus guide construction of the scoring system.

Organization. In order to identify the features most salient for the clinical
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

judgement of organization, discriminant function analyses were carried out in a

random sample of 50% of the protocols. The results of these analyses were used to
construct a scoring system that could then be tested on the whole sample. The
groups to be discriminated were the five organizational levels; the predictors
included all the variables representing alignment and intersection. Preliminary
computations suggested that discriminant analyses carried out for contiguous
organizational levels (e.g., I versus 11; I1 versus 111) produced more readily
interpretable results than did comparable analyses carried out for all five groups at
once. All the analyses, therefore, were performed for contiguous groupings.
Based on these discriminant analyses (in conjunction with frequency data), 24
discriminating features were identified. These included the following: (a) the four
corners of the base rectangle; (b) alignment of the four sides of the base rectangle
and the middle vertical line; (c) alignment of the middle vertical and middle
horizontal lines of the base rectangle with exterior (outer configurational) structu-
res; (d) intersection of the main diagnonals with the main horizontal/vertical; (e)
intersection of the diagonals of the left interior box; (f)intersection of the four
corners of the left interior box with the left vertical side and the main diagonals of
the base rectangle; and, (g) intersection of the upper right triangle with the upper
right corner of the base rectangle.
Different subsets of these features were effective discriminators for different
pairs of organizational levels. Those that discriminated I from I1 were relatively
ineffective in discriminating I11 from IV, and vice versa. The scoring system,
therefore, could not be based on a single linear index whose value increased with
increasing organization, but rather had to be hierarchical in nature.
The scoring procedure was structured as follows: If a protocol had all features
required for Level I, the rater could then go on to determine whether it had the
features required for Level 11, and so forth, until a basic level was obtained.
Criteria1 features achieved above the basic level were treated as extra points and
used to assign the protocols to one of three sub-levels within each of the major
levels (except V). The criteria for each level are described in detail in Table 5 and
illustrative examples of protocols from each level are shown in Figure 3.
 272 D. P.WABER and J. M.HOLMES

Table 5

Criteria for 5 Levels of Organization

Level I: Any production that does not satisfy criteria for Level 11.
Level II: (1) Upper left corner of base rectangle and one other corner;
(2) Left vertical of base rectangle aligned;
(3) Middle vertical of base rectangle aligned,
(4) Three of 6 of the following aligned: upper horizontal of base rectangle,
middle vertical of base rectangle aligned with upper right cross; middle
horizontal of base rectangle a w e d with horizontal of external right
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

triangle, right vertical of base rectangle aligned, lower horizontal

aligned at middle of base rectangle.
Level III: (1) Both corners on left side of base rectangle and one on the right;
(2) Two of three sides of base rectangle (excluding left side);
(3) One of three outer configuration structuresaligned with main horizon-
tal and vertical;
(4) Diagonals of left interior box intersect;
(5) Upper right triangle intersects right corner appropriately.
Level IFC (1) All four corners of base rectangle;
(2) All sides of base rectangle aligned;
(3) Two of 3 outer configuration structures aligned with main horizontal
and vertical;
(4) Main diagnonals or horizontal and vertical intersect;
(5 ) Two left corners and one right of left interior box touche base rectangle
and main diagonals appropriately.
Level FC (1) All three outer configuration structures aligned with main horizontal
and vertical;
(2) Diagonalsand horizontal and vertical all intersect;
(3) All four corners of left interior box touch appropriately.

Using the system, which was based on analyses of the random sample, scores
were generated by computer for the full sample and compared to the clinical
organization ratings. Agreement was moderate (44%). Those protocols for which
the objective ratings differed from the clinical ones were, therefore, examined to
determine why discrepancies had occurred. In general, the discrepancies were
attributable to one of the following factors:
(1) Because the criteria applied in the original coding of the data were very
strict, alignments and intersections that were only slightly inaccurate were scored
as errors, even though (from a clinical point of view) the child’s intention had
clearly been an accurate representation.
(2) One criteria1 feature was left out, and so an otherwise well-organized design
 REY-OSTERRIETH 273

LEVEL I 1
1
LEVEL II 1 LEUEL 111
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

LEVEL I U LEYEL U
Figure 3. Representative examples of children’s productionsat each of the 5 organizational
levels.

was scored at an unrepresentatively low basal level.

(3) The design gave the subjective impression of being better or worse organi-
zed than the objective criteria in fact indicated, usually because of line quality (i.e.,
excessive neatness or sloppiness).
These situations were treated as follows: It was decided that the scoring of
criteria1features should permit a limited margin of error, that is, the width of the
pencil line. In addition, each design was to be permitted one “legal error”: that is,
an error in which the child clearly intended a correct execution, but failed to do so
by more than the margin of error criterion. If more than one such error occurred,
the one at the lowest possible level was scored as correct. These legal errors,
however, could not be counted towards extra points. Finally, we decided that a
certain number of misclassifications (ix., designs that were clearly well-organized
but scored low because they lacked one criteria1 feature) would have to be
tolerated for normative purposes. In clinical practice, however, a rater could, of
course, score a protocol with or without the missing feature in order to obtain a
more accurate estimate of the child’s competence.
Since these modifications could not be applied to the computer-coded data, the
entire sample was rescored by hand using the objective system. With these
 274 I) P WABERandJ M.HOLMES

revisions in the procedure, absolute agreement between the clinical and objective
levels increased to 52% (see Table 6). For only 5% of the sample, however, were
the scores discrepant by more than one level, and the correlation between the
clinical and objective ratings was very high (r = .82, p < .oooOl).
Inclusion of sublevels made it possible to assign to each protocol a score based
on a 13-point scale (3 sublevels at each level from I through IV, plus level V). These
scores were also highly correlated with the clinical ratings (r = .84,p < .00oOl).
Mean values of these scores for each of the age groups appear in Table 7. The
strength of the correlation between these scores and age (r = -67, p < ,0001) is
comparable to that obtained through the clinical ratings. Moreover, the mean
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

values of these scores increase as a monotonic function of age, and variability

within age levels is fairly uniform across age groups. A random sample of 52
protocols was selected for reliability scoring by the two raters (JMH and DPW)
who scored the entire sample. Interrater reliability for scoring organizational level
was .95. These 52 protocols were also scored according to the Osterrieth system
and there was a high correlation between it and the organization score (r = .87).

Table 6

Percent Children Within Each Organizational Level (By Clinical Judgment) Who Score At
Each Organization Level (By Objective Scoring)

C1I nical Judgment

Objective ~~

Score 1 2 3 4 5
~~

I 87.9 26.5 5.2 1.o 0

I1 12.1 60.8 32.8 6.7 0
I11 0 9.8 29.1 20.0 0
IV 0 29 26.9 36.2 16.1
V 0 0 6.0 36.2 83.9

Style. A similar procedure was applied to develop a method for scoring the style
parameter. Since the clinical style ratings were related systematically to those for
goodness of organization, these analyses were carried out separately within each
of these levels, however, precluded use of a random sample for generating a
scoring system as was done for the organization parameter. Therefore, discrimi-
nant function analyses were applied to all the cases within each organizational
level (as categorized by the objective rating system) to identify the features most
indicative of the style parameter at that level.
The discriminating variables were based on the alignment variables and the
color code. Some discontinuities may have occurred because a child switched
pencils while in the midst of drawing a line. We reasoned that such discontinuities
 REY-OSTERRIETH 275

Table 7

Mean Organization Score For Each Age Group

(1-3 = I; 4-6 = 11; 7-9 = 111; 10-12 IV; 13 = V)
~

M SD
5 2.08 1.47
6 3.31 2.09
7 5.46 3.22
8 6.05 3.09
9 7.86 3.46
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

10 8.33 3.31
11 9.25 3.07
12 9.82 3.63
13 10.59 2.93
14 11.34 2.54

would occur randomly across the whole sample and so would not affect the
validity of the scoring procedure. A variable was created to correspond to each
juncture of the segments of a single line in the design. If the adjacent segments
were produced in the same color and both were properly aligned, then the whole
line was judged to have been drawn continuously and the variable received a score
of 1. If the two were produced in different colors or if they were produced in the
same color but not aligned, or if they were not present, the variable received a
score of 0.
These analyses led to identification of a total of 18 criteria1juncture features.
E:xamination of the frequency distribution of each of the 17 features across the
four style ratings within each organizational level indicated that different features
were effective discriminators at different organizational levels. Features whose
distribution was demonstrated to be related systematically to the style ratings by
Chi-square analysis (p <.05) were considered to be effective discriminators at that
level.
The main diagonals of the base rectangle were important discriminators at
every organizational level. For the lower levels, I and 11, continuity around the
perimeter of the figure (including outer configuration structures) was important;
whereas at the higher levels, the continuity of the base rectangle was important.
Continuity of the middle horizontal was most discriminating at Levels 11,111, and
IV.
Since the features that discriminated style at each level were not all equally
salient, they were assigned weights in order to generate a composite style score for
each organizational level. This was accomplished by a point system in which the
number of points was commensurate with the strength of the correlation between
the variable representing the feature and the clinical style rating within that
 276 D.P.WABER and J. M.HOLMES

organization level (i.e., .5 = 5 , .6 = 6, etc.). Thus, for each juncture that is aligned
with both segments executed in one color, the drawing receives the number of
points assigned to that juncture. The style score is the cumulative total of all these
points (see Table 8). Correlations between the objective style scores thus derived
and the clinical style ratings were .62 for organizational level I, .8 1for level 11, .80
for level 111, .84 for level IV, and .88 for level V.
In order to make these style scores more easily interpretable, we classified them
(within each organizational level) as part-oriented, intermediate, and configura-
tional. Criteria for assignment to each of these categories were established by
comparing the distribution of the style scores with the distribution of the clinical
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

style ratings shown in Table 2. Cut-off points were selected so that the distribution
of the objective and clinical style categories would roughly coincide.
For theoretical reasons, however, we felt that it was important to maintain the
distinction within the intermediate category between designs that were outer
configuratiodinner part and those that were outer part/inner configuration.
Therefore, we segregated the style points associated with the intenor structure

Table 8

Criteria and Weighting for Style Score

(Labels for Junctures Refer to Figure 2, A-C)
~

I I1 111 IV V
MS2MS9 3 7 8 8
MS7MS11 5 8 8 8
MS8MS13 3 4 4
MS4MS5 2 3
MSSMSlO 3 6 7 6
MS100C20 2
BR9BR10
BR7BR8 2 2
BR 12BR 1 3
BR4BR5
BR11BR12 4
BR2BR3 2 3
BR6BR7 2 3 4 6
BR8BR9 3 3
OC26BR12
OC6BR6
OC160C27 2
BR70C14 3
 REY-0STERRI ETH 277

from those associated with the exterior structure, and again used discriminant
function analysis to determine which set of stylistic criteria best discriminated
between the two types of intermediate style productions. The criteria associated
with the interior structure were effective discriminators while those associated
with the exterior structure were not. Distributions of the clinical style ratings were
then compared to those for the total score for the interior style criteria for each
organizational level in order to choose the cut-off point that best discriminated the
two intermediate style groupings from one another. Thus, for designs that receive
an “intermediate” rating, the procedure is to sum the total number of interior style
points and compare it to the cut-off criterion in order to determine whether the
production is best classified as “outer parthnner configuration” or “outer con-
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

figuratiodinner part”.
Table 9 shows the joint distribution of the clinical style ratings and those arrived
at by the objective scoring procedures described above. The correlation between
the two is high ( r = .78). Interrater reliability for the 52 designs in the random
sample for these objective style scores was .88.

Table 9

Percent of Children Within Each Style Category (By Clinical Judgment) Who Score in
Each Style Category (By Objective Scoring)

Objective
Outer Outer Part/
Part- Configurational/ Inner
Clinical Oriented Inner Part Configurational Configurational
Part-Oriented 79.4 12.8 5.6 2.2
Outer Configura-
tional/ Inner Part 34.5 35.7 9.5 20.2
Outer Part/Inner
Configurational 10.7 5.4 48.2 35.7
Configurational 3.7 0.7 17.9 77.6

Individual differences
The effects of sex and handedness on the organization scores were examined by a
three-way, Age by Sex by Handedness, ANOVA. There was no effect of sex, but
there were main effects for age, F (9,401) 134.43, p < .001, and handedness,
F (1,401) = 5.68, p < .018. In every age group, right-handed children produced
better organized designs than did left-handed children. A three-way, Age by Sex
by Handedness, ANCOVA on the style scores (with the 13-point organization
 278 D. P.WABER and J. M.HOLMES

score the covariate) indicated that the productions become more configurational
with age, F(9,W) = 1 . 9 9 , <
~ .05, and that left-handed children tend to produce
more part-oriented designsF(1,400)= 2 . 8 7 , ~< . I .
A two-way, Age x Direction of Copy, ANOVA revealed no effect of directionof
copy on the organization scores. However, a two-way, Age x Direction of Copy,
ANCOVA on the style scores, with the organizationscore the covariate, indicated
that children who copy the design from right to left produce more partsriented
productionsthan do those whodraw it fromle€ttonght,F(1,437)= 12.2,p<.001.
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

DISCUSSION

The first goal of the study was to describe developmental changes in children’s
copy productions of a complex figure, including the ability to organize complex
visual material, individual variations in strategies for doing so, and systematic
relationships between organization and strategy. Consistent with Osterrieth’s
(1946) findings, by age 9 children can reproduce reliably all the parts of the design.
Changes in performance occurring after that age reflect primarily the capacity to
plan and organize reproduction of this complex material in an effective fashion.
The features that we determined to be criteria1for the five organizational levels
highlight the nature of some of these age-related changes. First, the requirement
that features on the left side of the figure be present at the lower levels (I and 11)
indicates that the left side serves to anchor the rest of the figure. The disposition to
use the left side as an anchor becomes clearly established around age 8, coincident
with the emergence of a preferencefor a left to right copy direction. This develop-
mental shift is reflected in the scoring procedure, since failure to organize the left
side effectively after age 8 leads to a relatively low organization score. In the
clinical neuropsychological assessment of adults, directional preference is an
important diagnosticindicator (Goodglass& Kaplan, 1979). The cuqent findings
indicate that, in the assessment of children, directional preferences can be viewed
as diagnosticallysignificant only at age 9 or older.
Second, the requirements for alignment of parts of‘the main substructure at
each organizationallevel reflect a developmental shift in the perceptual salience of
different structural aspects of the design. The youngest children organize their
productions around the vertical axis and older children around both the horizon-
tal and vertical axes. Organization around the diagonal axes appears last. This
developmental sequence, as manifest in the construction of a complex visual
configuration, is consistent with the sequence described for the perception of
structure among children in the same age range (Chipman & Mendelson, 1979).
Third, for children who produce the better organized productions (Levels IV
and V), the base rectangle is the salient organizational unit, as evidenced by the
requirement that all of its corners be present and its sides aligned. Thus, these
children appear to treat the information logically rather than figurally. The
 REY-OSTERRIETIf 279

emergence of a more logical approach at this level is consistent not only with
Osterrieth’s (1946) observations of children’s performance on this task but also
with cognitive developmental theories that describe the evolution from concrete to
logical reasoning in childhood (Inhelder & Piaget, 1958). Level IV becomes modal
at age 13, the same age at which formal operational thinking generally becomes
evident in the propositional domain.
Our normative findings for the stylc parameter indicate that the designs are
most commonly executed in a part-oriented fashion by younger children and that
they become more configurational with increasing age and organization, a pattern
reminiscent of Werner’s (1948) concept of hierarchical integration. At the lower
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

organizational levels (I and 11), those drawings characterized as configurational

are typically executed in a stimulus-bound fashion, the child tracing around the
perimeter of the figure. At the higher organizational levels, consistent with the
shift to the base rectangle as the salient organizational unit, those children whose
designs are characterized as configurational use continuous lines to execute the
base rectangle and its main substructures, Similarly, the character of part-
orientation changes with the level of organization. At the lower organizational
levels, part-oriented productions consist of isolated elements; whereas, at the
higher levels, part-oriented occurs in the context of a coherent configuration:
That is, the drawing is executed logically, but with quadrants or halves of the base
rectangle as the salient units rather than the whole structure.
Whether the significanceof the terms “part-orientation” and “configurational”
is the same at different levels of organization is thus debatable. Longitudinal data
are needed to determine whether part-orientation as seen at the younger ages is
indeed a precursor of part-orientation as seen at older ages. Rourke’s (1975)
observation that the adult neuropsychological model does not apply for children
under age 9 suggests that it may not be legitimate to interpret stylistic variations as
reflecting the relative contribution of the cerebral hemispheres for younger chil-
dren.
The second major goal of the study was to generate a reliable and valid method
for quantifying both the organizational and stylistic components of these produc-
tions. The scoring system generated was based on 24 criteria1 features for organi-
zation and 18 criteria1features for style. Not only was interjudge reliability high,
but the outcome scores based on this objective system matched the clinical ratings
of the same dimcnsions quite well. The scoring system thus provides an objective
basis for specifying parameters of particular relevance to neuropsychological
diagnosis - planning and organizational skill (presumed to reflect functions
associated with the anterior-posterior dimension) and approach or style (presu-
med to reflect functions associated with the left-right dimension). Validation of
these assumptions about underlying neural mechanisms, however, awaits sub-
stantiation through application of the scoring procedure to the productions of
patients with documented lesions.
In sum, the findings presented here describe an objective method for quantify-
 280 D. P.WABER and J. M.HOLMES

ing neuropsychologicallyrelevant aspects of children’s copy productions of the

Rey-Ostemeth Complex Figure. They also provide the detailed description of the
developmental characteristics of children’s productionsthat is necessary for mea-
ningful interpretation of individual protocols. It is hoped, therefore,that they will
serve to facilitate use of this very informative instrument in the clinical neurpsy-
chological assessment of children.

REFERENCES

Annett, M. (1970). The growth of manual preference and speed. British Journal of Psycho-
logy, 61, 545-558.
Downloaded by [Carnegie Mellon University] at 02:10 02 February 2015

Binder, L. M. (1982). Constructional strategies on complex figure drawings after unilateral

brain damage. Journal of ClinicalNeuropsychology, 4, 5 1-58.
Chipman, S., & Mendelson, M. (1979). Influence of six types of visual structure on
complexityjudgments in children and adults. JournuI ofExperimentalPsychology:Hmm
Perception and Perfolmance. 5.365-378.
Goodglass, H., & Kaplan, E. (1979). Assessment of cognitive deficit in the brain-injured
patient. In M. S. Gazzaniga (Ed.), Handbook of behavioral nezuobiology (Vol2, Neuro-
psychology, p. 3-22. New York: Plenum Press.
Holmes, J., & Waber, D. (1977). Developmental parameters of a complex design copying
task. Paper presented to the 5th Annual Meeting of the International Neuropsychological
Society, Santa Fe, NM.
Inhelder, B., & Piaget, J. (1958). The growth of Iogical thinkingfrom childhood to adoles-
cence. New York: Basic Books.
Lhermitte, F., Derouene, J., & Signoret, J. L. (1972). Analyse neuropsychologique du
syndrijme frontal. Revue Neurologipe. 127.415-440.
Messerli, P., Seron, X.,& Tissot, R. (1979). Quelques aspects des troubles de la programma-
tion dans le syndrame frontal. Archive Suisse de Neurologie, Neurochirurgie et de Psyc-
hiatrie, 125, 23-35.
Michel, G. F. (198 1). Right-handedness: a consequence of infant supine head-orientation
preference. Science, 212, 685-687.
Osterrieth, P. (1946). Le test de copie d’une figure complexe. Les Archives de Psychologie,
31,206-356.
Rey, A. (1941). L‘examen psychologique dans les cas d’encephalopathie traumatiques.
Archives de Psychologie, 28, 286-340.
Rourke, B. P. (1975). Brain-behavior relationships in children with learning disabilities: A
research program. American Psychologist, 30,911-920.
Wabex, D. P. (1979a). Neuropsychological aspects of Turner’s syndrome. Developmental
Medicine and Child Neurology, 21, 58-70.
Waber, D. P. (1979b). Cognitive abilities and sex-related variations in the maturation of
cerebral cortical functions. In: M. A. Wittig & A. C. Petersen (Eds.). Determinants of
sex-relateddifferences in rognitivefunctioning@p. 161-186). New York: Academic Press.
Waber, D. P., Mann, M. B., Merola, J., & Moylan, P. M. (in press). Physicalmaturation
rate and cog&tive performance in early adolescence: A longitudinal examination. Deve-
lopmental Psychology.
Werner, H. (1948). Comparativepsychology of mental development. New York: Internatio-
nal Universities Press.