Elsevier

Brain and Development

Volume 28, Issue 10, November 2006, Pages 641-648
Brain and Development

A developmental study of scores of the Boston Qualitative Scoring System

https://doi.org/10.1016/j.braindev.2006.04.011Get rights and content

Abstract

To elucidate developmental changes of the Summary Scores of the Boston Qualitative Scoring System (BQSS) for the Rey–Osterrieth Complex Figure (ROCF). One hundred healthy children aged 6–16 (average 9.7 ± 2.4; 60 boys, 40 girls). The ROCF was administered and graded based on the BQSS. The subjects were classified in four age-groups: 6- and 7-year-olds; 8- and 9-year-olds; 10- and 11-year-olds; and 12- and 16-year-olds. The differences in Summary Scores were examined among age-groups. All BQSS Summary Scores except Delayed Retention showed clear developmental changes. The Copy Presence Accuracy, the Immediate Presence Accuracy, the Delayed Presence Accuracy, and the Immediate Retention showed continuous development throughout childhood, though some differences were noted in the age ranges during which each score showed the most rapid development. The Organization score showed a somewhat peculiar pattern, with rapid development during the age ranges of 8–9 and 10–11 and with no distinctive development before and after these ranges. Five of the six BQSS Summary Scores showed clear developmental changes with a different developmental pattern in each score. Especially, the Organization score was unique and was supposed to reflect a different underlying process than the other Summary Scores, which might relate to the local and global processing style. BQSS is a promising tool for the evaluation of higher brain functions in childhood.

Introduction

Developmental disorders, such as pervasive developmental disorders, attention deficit/hyperactivity disorder, and learning disorders, are frequently encountered in childhood. Children with these disabilities or other neurological diseases such as epilepsy often show higher brain dysfunctions, including disabilities of visual memory, visuoconstructional ability, and executive functions. For this reason, in the daily clinical practice of developmental disabilities and other related neurological diseases in childhood, analyses of higher brain dysfunctions can give us important information, and we should evaluate the data, taking a patient’s age into consideration.

Andre Rey devised a complex geometric figure in 1941 to assess the visuoconstructional ability and visual memory performance in patients with brain injuries [1]. Three years later, Paul Osterrieth standardized Rey’s original method [2]. Since then this procedure has been called the Rey–Osterrieth Complex Figure (ROCF) and has been used for the assessment of visuoconstructional ability and visual memory. The scoring method most commonly used is Osterrieth’s method. This 36-point scoring system is based on an evaluation of the presence and accuracy of the 18 elements of the ROCF. Different investigators have developed several different systems that provided various criteria for scoring the ROCF quantitatively [3], [4]. Because of the complexity of the figure, the ROCF also reflects cognitive processes regarding strategies and organizational approach at the time the figure was drawn. Several scoring methods were developed to evaluate the qualitative nature of ROCF [5], [6]. The Boston Qualitative Scoring System (BQSS) for the ROCF is the scoring method developed by Stern et al. [7]. After one revision, it was put on the market in 1999 (Psychological Assessment Resources, Inc.). The BQSS provides numerous comprehensive qualitative scores and quantitative summary scores not only by assessing visual memory and visuoconstructional ability, but also by drawing strategies. BQSS was developed mainly for adults, and until recently clinical applications have been limited mostly to adult patients. However, we believe that as an ROCF scoring method, BQSS might also be useful for children because it enables us to evaluate ROCF multidimensionally, and its scoring criteria are very clear. In our previous study of children with various neurological disorders, we showed that BQSS scores reflect executive functions even in children [8]. In this study, we tried to elucidate the developmental changes of the BQSS Summary Scores and their characteristics.

Section snippets

Methods

The subjects of this study were 100 healthy children, all Japanese, aged 6–16 years (average age 9.7 ± 2.4; 60 boys and 40 girls; 86 right-handers and 14 left-handers) who agreed to participate in this investigation in response to a request made through our hospital employees group and the local parents’ associations of elementary schools and junior high schools. All subjects attended normal classes in elementary and junior high schools. Children with definite developmental retardation or a

Results

Fig. 1 shows examples of ROCF products. Fig. 2 and Table 1 show the distributions of respective Summary Scores, and Table 2 shows the results of comparisons among age-groups.

Discussion

The ROCF is expected to provide information regarding qualitative aspects in drawing performance. The scoring system developed by Osterrieth [2], which is commonly used today, depends on the presence of each element and the accuracy of the drawing. For this reason, little information is provided regarding the aspects of drawing sequence or strategy. Since Osterrieth, several methods assessing the strategy or organizational aspects in drawing ROCF have been devised [10], [11], [12], [13], [14].

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