Measures of figural fluency: Relationship to neuropsychological variables and traumatic brain injury severity

Figural fluency tests were originally developed as a measure of right frontal lobe integrity and are presently a standard component of neuropsychological evaluation. To better understand the clinical interpretation of figural fluency scores (design output and perseverative errors), the current study investigated two trials from the Ruff Figural Fluency Test (RFFT) and their correlations with other neuropsychological variables in examinees who were being evaluated for cognitive difficulties (N = 84). Design output was significantly correlated (r > .4) with psychomotor speed, non-verbal memory, and false positive recognition errors on a verbal memory test, while perseverative errors did not show a significant correlation with these variables or with design output. Design output also showed a significant correlation with phonemic fluency (r > .3) as well as correlations (r > .25) with semantic fluency and intellectual functioning. In a sample of examinees with mild (n = 33), complicated-mild (n = 11), and moderate-severe (n = 16) traumatic brain injuries (TBI), group differences in design output did not reach significance, whereas perseverative errors were significantly related to the severity of injury. This study suggests that design output and perseverative errors on figural fluency may be separate measures, and their clinical interpretations are discussed.