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Boston Qualitative Scoring System for the Rey-Osterrieth Complex Figure

Robert A. Stern, PhD, Debbie J. Javorsky, PhD, Elizabeth A. Singer, Naomi G. Singer Harris, PhD, Jessica A. Somerville, Lisa M. Duke, MA, Jodi A. Thompson, PsyD, and Edith Kaplan, PhD, ABPP/CN

Provides qualitative scoring of ROCF productions
Paper and pencil, E-Manual
Age range:
18 years to 94 years
Approximately 45 minutes (includes a 20–30 minute delay interval)
Qualification level:
All qualifications for Level B plus an advanced professional degree that provides appropriate training in the administration and interpretation of psychological tests, or license or certification from an agency that requires appropriate training and experience in the ethical and competent use of psychological tests. Close

The BQSS is a comprehensive scoring system that provides a highly reliable and quantifiable approach to rating the qualitative features of Rey-Osterrieth Complex Figure (ROCF) productions. These qualitative features of the ROCF are based on three sets of ROCF elements—Configural Elements, Clusters, and Details.

Features and benefits

  • In addition to the 17 Qualitative scores for the Copy, Immediate Recall, and Delayed Recall Conditions, there are six BQSS Summary scores derived from combinations of the Qualitative scores that provide a more quantitative evaluation of the respondent's overall ROCF performance.
  • Qualitative scores include Presence, Accuracy, Placement, Fragmentation, Planning, Neatness, Vertical Expansion, Horizontal Expansion, Reduction, Rotation, Perseveration, Confabulation, and Asymmetry for each condition. With the exception of Asymmetry, the qualitative scales are rated on a five-point scale ranging from 0 (e.g., extremely poor planning) to 4 (e.g., good planning); Asymmetry receives a categorical rating (N = No Asymmetry, L = Left-sided Asymmetry, R = Right-sided Asymmetry). The Summary scores include Copy Presence and Accuracy, Organization, Immediate Retention, and Delayed Retention.
  • The BQSS provides two methods for scoring ROCF productions: the Comprehensive Scoring Method (CSM) and the Quick Scoring Guide (QSG). The CSM provides the precise, reliable scores that are critical for patient diagnosis, litigation issues, and research. Experienced BQSS CSM users (including psychometricians, technicians, or research assistants) can score the three conditions in 10 to 15 minutes (i.e., about 5 minutes per production). For the clinician who is experienced with the CSM but who cannot take advantage of this method because of time constraints, the QSG provides the BQSS Qualitative and Summary scores for all three conditions in less than 5 minutes. The reliability and convergent validity of the QSG have also been demonstrated.

Test structure

  • BQSS materials include the 209-page Professional Manual, the laminated BQSS Stimulus Card, the laminated BQSS Reference Guide, the 12-page BQSS Scoring Booklet, a set of two BQSS Scoring Templates, the BQSS Response Sheets, and a clear, plastic ruler.
  • The Professional Manual provides information on the development of the BQSS, administration and scoring procedures, graphic examples of scoring criteria including a walk-through example using the BQSS Scoring Booklet, interpretation including three case examples, reliability and validity information, and conversion tables for cumulative percentages and T scores.

Technical information

  • The normative sample included 433 adults ages 18 to 94 years. Tables for the 10 age-by-gender groups allow conversion of the BQSS Qualitative scores to cumulative percentages and of the BQSS Summary scores to T scores and percentiles.
  • Interrater reliability coefficients for the majority of the 17 Qualitative scores were excellent. Interrater reliability for five of the six Summary scores was at least .90 or higher.
  • Studies suggest that the BQSS is able to successfully discriminate between individuals with known traumatic brain injury and those without, as well as between individuals with ADHD and those without. The BQSS has also been shown to discriminate among neurologically impaired patients (e.g., Alzheimer's disease vs. ischemic vascular dementia). Data show that the BQSS has more sensitivity and specificity than the traditional 36-point ROCF scoring system. Several of the BQSS variables have also been significantly correlated with standardized tests of executive functioning (e.g., WCST). Ecological validity of the BQSS and its utility in the detection of malingering are also discussed.