Many of us routinely use the test commonly referred to as the “Visual Rey.” Its formal name is the Rey Complex Figure Test (RCFT). In this test, the child is asked to copy a complex figure, reproduce it from memory after specified intervals, and recognize parts of it among distractors.
According
to the CHC framework, the memory-recall and recognition stages of the RCFT are
classified under learning efficiency. The copying stage is classified under
visual processing ability. It should be noted that tests that assess visual
processing most effectively do so without requiring motor involvement, as is
the case in the Woodcock-Johnson tests. The RCFT, by contrast, places
considerable demands on visuomotor abilities. Consequently, the scores obtained
on the RCFT are not always consistent with scores on other tests of visual
processing.
The RCFT is commonly regarded as a test that is strongly influenced by executive functions. Good performance requires the child to develop a working strategy—for example, distinguishing between the major and minor elements of the stimulus and beginning the copy with the major elements—and to monitor the work process.
We
tend to draw a parallel between the way a child approaches the RCFT and the way
the child approaches a text. A
child who has difficulty perceiving the figure as a whole and copies it using a
piecemeal approach, while focusing on individual details, may also have
difficulty seeing the overall picture that emerges from a text. Such a child
may struggle to integrate the details in the text into a coherent whole and to
understand the relationships among the different pieces of information.
But
are these assumptions correct? Is there any basis for drawing a parallel
between performance on the RCFT and reading comprehension? To the best of my
knowledge, no study has examined this parallel. To what extent is performance
on the RCFT influenced by executive functioning? The study described below
investigated this question.
In
this study, Davies, Field, Andersen, and Pestell examined the ecological
validity of the RCFT. They asked whether a child’s ability to copy the RCFT
figure in a planned, organized, and accurate manner corresponds to the child’s
everyday behavior at home or at school. Such behaviors include keeping one’s
room organized, completing tasks one has undertaken, and adapting to changes in
the daily schedule.
To
investigate this issue, the researchers used an existing database containing
information on 263 children and adolescents who underwent neuropsychological
assessment between 2006 and 2009. These children had either a known or
suspected brain injury resulting from trauma, illness, or a genetic syndrome.
The
researchers calculated scores for the RCFT copy condition using four different
scoring methods:
A.
Taylor’s psychometric approach, which focuses on accuracy. This familiar
approach divides the figure into 18 elements. Each element receives a score of
between 0 and 2 points, depending on its location and the accuracy with which
it was copied.
The
other three approaches emphasize strategy and organization:
B.
The Smith and Zahka approach (2006).
C.
The Bernstein and Waber approach (1996): the Developmental Scoring System
(DSS).
D.
The Anderson et al. approach (2001), which I reviewed in this post.
For
convenience, each approach will henceforth be referred to by the letter
assigned to it: Taylor’s approach will be called Approach A, Smith and Zahka’s
approach will be called Approach B, and so forth.
The
researchers calculated the correlations between the scores obtained using each
scoring method and parent-completed questionnaires concerning their children’s
behavior: the BRIEF and the PIC-2.
The
BRIEF 2000 version, whose full name is the Behavior Rating Inventory of
Executive Function, contains 86 items developed to assess the behavioral
manifestations of executive functioning in children between the ages of 5 and
18. Parents completing the questionnaire rate the child’s behavior on a
three-point scale: “never,” “sometimes,” or “often.”
The
questionnaire produces eight scales:
- Inhibit
- Shift
- Emotional Control
- Initiate
- Working Memory
- Plan/Organize
- Organization of Materials
- Monitor
Two
broader indices can be derived from these scales. The Behavioral Regulation
Index includes the Inhibit, Shift, and Emotional Control scales. The
Metacognition Index includes the Initiate, Working Memory, Plan/Organize,
Organization of Materials, and Monitor scales. These two indices are combined
to produce an overall score, the Global Executive Composite.
Significant
correlations have been found between these scales and performance on
traditional tests of executive functioning in both clinical and nonclinical
samples.
Contrary to the researchers’
hypothesis, the RCFT scores produced by the three methods emphasizing strategy
and organization—Approaches B, C, and D—were not correlated with any of the
BRIEF indices. The scores produced by these three strategy- and organization-focused
methods were highly correlated with one another. The RCFT scores produced by
Taylor’s accuracy-based method—Approach A, which does not emphasize strategy
and organization—were also not correlated with the BRIEF, as expected.
How
can the absence of a correlation between RCFT strategy and organization scores
and the BRIEF be explained?
Because
the sample consisted of children with known or suspected brain injuries, one
might have expected RCFT performance to be poor among all participants and the
parents’ questionnaire ratings to indicate numerous difficulties. However, this
was not the case. The distributions of the RCFT scores and the BRIEF and PIC-2
ratings were normal, and their ranges were not restricted.
It is possible that the executive
functions of organization and planning used by children when copying the RCFT
figure, as measured by Approaches B, C, and D, are not the same as the
executive functions of behavioral regulation and metacognition measured by the
BRIEF.
It
is also possible that the absence of a correlation between RCFT performance and
the BRIEF questionnaires resulted from the quiet, distraction-free environment
of the examination room, which differs from the child’s everyday environment.
The executive functioning required in everyday life is much more complex than
the executive functioning required by the RCFT.
Davies,
Field, Andersen, and Pestell also note that some studies have found
correlations between the BRIEF and tests of executive functioning to be
nonsignificant or, at best, moderate. In those studies, the interpretations
tended to favor the BRIEF and to attribute the problem to the
executive-function tests. But perhaps the problem lies with the BRIEF itself.
The
researchers further note that studies examining the relationship between RCFT
process measures and tests of executive functioning have produced inconsistent
findings.
Anderson et al. (2001) examined a
large group of children using the RCF-OSS method and found moderate
correlations with the Tower of London test, which assesses the planning and
organization aspects of executive functioning; a verbal-fluency test, which examines
executive functioning in terms of organizing the search of memory; and the
Trail Making Test (TMT), which assesses executive functioning in terms of set
shifting.
Another
researcher, however, studied a group of children between the ages of 5 and 14
who had a range of neurological disorders. The correlations between RCFT
planning and organization scores, calculated according to the BQSS scoring
method, and the number of perseverative errors on the Wisconsin Card Sorting
Test (WCST), a test of executive functioning, were not significant.
Another
group of researchers found no relationship between RCFT executive-function
measures obtained using the DSS and measures obtained from the WCST.
In conclusion, this study found no
relationship between process-oriented RCFT scoring methods and the BRIEF
questionnaire of executive functioning. Other studies have produced conflicting
findings concerning the relationship between RCFT process measures and tests of
executive functioning. In other words, we do not have unequivocal evidence that
the RCFT does, in fact, assess executive functioning.
Davies,
S. R., Field, A. R., Andersen, T., & Pestell, C. (2011). The ecological
validity of the Rey–Osterrieth Complex Figure: Predicting everyday problems in
children with neuropsychological disorders. Journal of Clinical and
Experimental Neuropsychology, 33(7), 820–831.
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