How to Score the Clock-in-the-Box

The score of the Clock-in-the-Box diagnostic is based on a rubric of eight individual categories which are broken into two main subcategories. The sum of the Location, Object, Numbers and Time scores yields the Memory subtotal, while the Size, Number Order, Number Spacing and Hand Length & Origin yields the Executive Function subtotal. Each of the eight subcategories is graded with either a 0 or 1, based on the following criteria:

Working Memory Criteria

Location

Drawing is completed in correct (blue) square

• only in blue square
• if drawn in multiple boxes, no credit is given
• if drawn across multiple boxes, no credit is given
• if blue box itself is used as the clock's outline, credit is given

Object

Drawing resembles a clock

• any type of clock is acceptable (e.g. grandfather, digital, etc)

Numbers

Drawing includes all numbers

• 1 - 12 in any order is given credit
• numbers any location (e.g. written in a line) is given credit
• roman numerals are given credit
• if numbers other than 1 - 12 are present, no credit is given

Time

Correct time is indicated in any manner

• credit is given if time is written (e.g. "ten past eleven")
• credit is given if the 11 and 2 are circled (or otherwise highlighted)
• if the participant did not receive credit for the Numbers feature above due to addition of extra numbers, but the time is correctly indicated, full credit is given

Planning/Organization Criteria

Size

Drawing of clock is appropriate size

• small enough to fit in the blue square
• should not intersect other squares
• large enough to accommodate numbers 1 - 12
• if blue box itself is used as the clock's outline, no credit is given

Number Order

Numbers are in correct order

• numbers may be written in any format (e.g. in a line)

Number Spacing

Numbers are evenly spaced and drawn within the clock's outline

• if clock is scored as appropriate size (first feature of executive function subscore), no credit is given if numbers intersect the perimeter of the clock
• opposing anchor number of 3 & 9 and 12 & 6 should be relatively well-aligned
• if anchor numbers are well-aligned, the remaining numbers should be relatively well placed. if two or more quadrants have poor spacing, no credit is given

Hand Length & Origin

Hands should originate at the center of the clock and hands should be of different length

• hour hand must be 80% or less the length of the minute hand
• origin of hands must be within 50% of center