The Five Point Test –  a Test of Nonverbal Fluency: Normative Data for Adults

Authors: S. Johanidesová 1–4;  E. Bolceková 1,2,5;  H. Štěpánková 1,2;  M. Preiss 1,2,6
Authors‘ workplace: Národní ústav duševního zdraví, Klecany 1;  Psychiatrické centrum Praha 2;  1. LF UK v Praze 3;  Neurologické oddělení, Thomayerova nemocnice, Praha 4;  Neurologická klinika a Centrum klinických neurověd 1. LF UK a VFN v Praze 5;  University of New York in Prague, Praha 6
Published in: Cesk Slov Neurol N 2014; 77/110(6): 704-713
Category: Original Paper


Figural (or nonverbal) fluency is the ability of executive functions to provide information about divergent reasoning, divided attention, planning and mental flexibility. Impairments of figural fluency have been found in individuals with various neurological or psychiatric diseases. Five Point Test (5TT) is a neuropsychological test that assesses figural fluency. A participant is asked to generate as many unique designs as possible in a certain time limit. The aim of this study was to create Czech population norms for the Five Point Test. Normative data for adult population aged between 20 and 85 years (n = 503) are presented. We assessed the number of correct answers and the number of perseverations. The number of correct answers is influenced by age and education (r = –0.3 and 0.4, respectively, p < 0.0001); for this reason the norms are stratified into ten age ranges and also according to completed education. The number of perseverations correlates with these variables only weakly (rs = 0.1 and –0.1, respectively, p < 0.05). Gender has no impact neither on the number of correct answers nor on perseverative responses (t-test, p > 0.9 for both scores).

Key words:
Five Point Test – design fluency – normative data – executive functions – validity

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. 4th ed. New York: Oxford University Press 2004.

2. Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests. 3rd ed. New York (NY): Oxford University Press 2006.

3. Ruff RM, Allen CC, Farrow CE, Niemann H, Wylie T.Figural fluency: differential impairment in patients with left versus right frontal lobe lesions. Arch Clin Neuropsych 1994; 9(1): 41– 55.

4. Kopeček M, Kuncová A. Efekt nácviku testu generování slov a testování alternativní verze –  pilotní studie. Psychiatrie 2006; 10(4): 211– 215.

5. Kopeček M, Štěpánková H. Psychomotorické tempo a rychlost vyhledávání v sémantické paměti. Cas Lek Cesk 2008; 147: 44– 48.

6. Jason GW. Gesture fluency after focal cortical lesions. Neuropsychologia 1985; 23(4): 463– 481.

7. Robinson G, Shallice T, Bozzali M, CipolottiL. The differing roles of the frontal cortex in fluency tests. Brain 2012; 135(7): 2202– 2214. doi: 10.1093/ brain/ aws142.

8. Bryan J, Luszcz MA. Measurement of executive function: considerations for detecting adult age differences. J Clin Exp Neuropsychol 2000; 22(1): 40– 55.

9. Baldo JV, Shimamura AP, Delis DC, Kramer J, Kaplan E.Verbal and design fluency in patients with frontal lobe lesions. J Int Neuropsychol Soc 2001; 7(5): 586– 596.

10. Thurstone LL, Thurstone TG. Examiner Manual for the SRA Primary Mental Abilities Test. Chicago (IL): Science Research Associates 1949.

11. Jones-Gotman M, Milner B. Design fluency: the invention of nonsense drawings after focal cortical lesions. Neuropsychologia 1977; 15(4– 5): 653– 674.

12. Hanks RA, Allen JB, Ricker JH, Deshpande SA. Normative data on a measure of design fluency: The Make a Figure Test. Assessment 1996; 3(4): 459– 466.

13. Regard M, Strauss E, Knapp P. Children‘s production on verbal and non-verbal fluency tasks. Percept Mot Skill 1982; 55(3): 839–8 44.

14. Tucha L, Aschenbrenner S, Koerts J, Lange KW. The five-point test: reliability, validity and normative data for children and adults. PLoS ONE 2012; 7: e46080. doi: 10.1371/ journal.pone.0046080.

15. Ruff RM, Light R, Evans R. The Ruff Figural Fluency Test: a normative study with adults. Dev Neuropsychol 1987; 3: 37– 51.

16. Mitrushina M, Boone KB, Razani J, D‘Elia FL. Handbook of Normative Data for Neuropsychological Assessment, 2nd ed. New York: Oxford University Press 2005.

17. Delis, DC, Kaplan E, Kramer JH. Delis-Kaplan executive function system. San Antonio: Psychological Corporation 2001.

18. Preiss M, Bartoš A, Čermáková R, Nondek M, Benešová M, Rodriguez M. Neuropsychologická baterie Psychiatrického centra Praha. 3. vyd. Praha: PCP 2012.

19. Brenkus P. Londýnská věž –  neuropsychologický test plánování: srovnání dvou. Diplomová práce. Univerzita Karlova: Praha 2005.

20. Krivá Ľ. Stroopův test. Praha: Testcentrum 2013.

21. Krámská L. Hodnocení premorbidního intelektu v neuropsychologii: Český test čtení slov. Otrokovice: Propsyco 2014.

22. Vraná K. Subjektivně vnímaná depresivní symptomatika u dospělé české populace –  využití Beckova inventáře deprese. Rigorózní práce. Univerzita Karlova: Praha 2012.

23. The R project for statistical computing. Available from URL: http:/ / .

24. Rektorová I. Neurodegenerativní demence. Cesk Slov Neurol N 2009; 72/ 105(2): 97– 109.

25. Bezdicek O, Motak L, Axelrod BN, Preiss M, Nikolai T, Vyhnalek M et al. Czech version of the Trail Making Test: normative data and clinical utility. Arch Clin Neuropsychol 2012; 27(8): 906– 914. doi: 10.1093/ arclin/ acs084.

26. Gelziniene G, Jurkeviciene G, Marmiene V, Adomaitiene V, Endziniene M. Executive functions in adolescents with idiopathic generalized epilepsy. Medicina 2011; 47(6): 313– 319.

27. Ownsworth T, Shum D. Relationship between executive functions and productivity outcomes following stroke. Disabil Rehabil 2008; 30(7): 531– 540.

28. Tucha O, Smely C, Preier M, Lange KW. Cognitive deficits before treatment among patients with brain tumors. Neurosurgery 2000; 47(2): 324– 333.

29. Ruff RM. Ruff Figural Fluency Test professional manual. Odessa: Psychological Assessment Resources Inc 1988.

30. Izaks GJ, Joosten H, Koerts J, Gansevoort RT, Slaets JP. Reference data for the Ruff Figural Fluency Test stratified by age and educational level. PLoS ONE 2011; 6(2): e17045. doi: 10.1371/ journal.pone.0017045.

31. Demakis GJ. Serial malingering on verbal and nonverbal fluency and memory measures: an analogue investigation. Arch Clin Neuropsychol 1999; 14(4): 401– 410.

32. Boone KB, Ananth J, Philpott L, Kaur A, Djenderedjian A. Neuropsychological characteristics of non-depressed adults with obsessive-compulsive disorder. Neuropsy Neuropsy Be 1991; 4: 96– 109.

33. Beatty WW, Jocic Z, Monson N, Staton RD. Memory and frontal lobe dysfunction in schizophrenia and schizoaffective disorder. J Nerv Ment Dis 1993; 181(7): 448– 453.

34. Mataix-Cols D, Barrios M, Sanchez-Turet M, Vallejo J, Junque C. Reduced design fluency in subclinical obsessive-compulsive subjects. J Neuropsych Clin N 1999; 11(3): 395– 397.

35. Abrahams S, Leigh PN, Harvey A, Vythelingum GN,Grise D, Goldstein LH. Verbal fluency and executive dysfunction in amyotrophic lateral sclerosis (ALS). Neuropsychologia 2000; 38(6): 734– 747.

36. Boone KB, Swerdloff RS, Miller BL, Geschwind DH,Razani J, Lee A et al. Neuropsychological profiles of adults with Klinefelter syndrome. J Int Neuropsych Soc 2001; 7(4): 446– 456.

37. Demakis GJ, Harrison DW. Relationships between verbal and nonverbal fluency measures: Implications for assessment of executive functioning. Psychol Rep 1997; 81(2): 443– 448.

38. Berning LC, Weed NC, Aloia MS. Interrater reliability of the Ruff Figural Fluency Test. Assessment 1998; 5(2): 181– 186.

39. Fama R, Sullivan EV, Shear PK, Cahn-Weiner DA, Yesavage JA, Tinklenberg JR et al. Fluency performance patterns in Alzheimer‘s disease and Parkinson‘s disease. Clin Neuropsychol 1998; 12: 487– 499.

40. Ross TP, Foard EL, Hiott FB, Vincent A. The reliability and production strategy scores for the Ruff Figural Fluency Test. Arch Clin Neuropsych 2003; 18(8): 879– 891.

41. Harter S, Hart C, Harter G. Expanded scoring criteria for the design fluency test: reliability and validity in neuropsychological and college samples. Arch Clin Neuropsych 1999; 14(5): 419– 432.

42. Ruff RM, Evans R, Marshall LF. Impaired verbal and figural fluency after head injury. Arch Clin Neuropsych 1986; 1(2): 87– 101.

43. Woodard JL, Axelrod BN, Henry RR. Interrater reliability of scoring parameters for the Design Fluency Test. Neuropsychology 1992; 6: 173– 178.

44. Varney NR, Roberts RJ, Struchen MA, Hanson TV, Franzen MD, Connel SK. Design fluency among normals and patients with closed head injury. Arch Clin Neuropsych 1996; 11(4): 345– 353.

45. Carter SL, Shore D, Harnadek MCS, Kubu CS. Normative data and inter-rater reliability of the Design Fluency Test. Clin Neuropsychol 1998; 12(4): 531– 534.

46. Goebel S, Fischer R, Ferstl R, Mehdorn HM. Normative data and psychometric properties for qualitative and quantitative scoring criteria of the Five-point Test. Clin Neuropsychol 2009; 23(4): 675– 690. doi: 10.1080/ 13854040802389185.

47. Cattelani R, Dal Sasso F, Corsini D, Posteraro L.The Modified Five-Point Test: normative data for a sample of Italian healthy adults aged 16– 60. Neurol Sci 2011; 32: 595– 601. doi: 10.1007/ s10072-011-0489-4.

48. Khalil MS. Preliminary Arabic normative data of neuropsychological tests: the verbal and design fluency. J Clin Exp Neuropsychol 2010; 32(9): 1028– 1035. doi: 10.1080/ 13803391003672305.

49. Troyer AK. Normative data for clustering and switching on verbal fluency tasks. J Clin Exp Neuropsychol 2000; 22(3): 370– 378.

50. Bolla KI, Lindgren KN, Bonaccorsy C, Bleecker ML. Predictors of verbal fluency (FAS) in the healthy elderly. J Clin Psychol 1990; 46(5): 623– 628.

51. Ross, TP, Foard, EL, Hiott, FB, Vincent, A. The reliability of production strategy scores for the Ruff Figural Fluency Test. Arch Clin Neuropsychol 2003; 18(8): 879– 891.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2014 Issue 6

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account