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CIB symbol Clock in the Box

INSTRUCTIONS

How to Administer the Clock-in-the-Box

The Clock-in-the-Box diagnostic has two parts to it. First there is a page of brief instructions that the test taker is asked to commit to memory. Then, when they are ready, they are given a response sheet, depicted below, on which they try to follow the instructions to the best of their ability.

The instructions given to the test taker are as follows:

Please read and do the following carefully:

  • In the blue box on the next page:
  • Draw a picture of a clock
  • Put in all the numbers
  • Set the time to ten after eleven.

Hand this sheet back and go to the next page

a blank clock-in-the-box response form
Fig. 1   A sample clock-in-the-box response form. To download this and other training materials, please click here.

Before handing the individual the instruction sheet and response form say the following:

"I am giving you two papers. The top page will have written instructions. I want you to read the instructions carefully, because I am going to ask you to do what it says. After you have read and understand the instructions, I will take the top paper away and ask you to complete the task on the second paper. Do you have any questions?"

Hand the two sheets to the individual, with the instructions on top and the colored boxes on the bottom. If the participant is unable to read the instructions, either because he/she cannot read or because they have visual problems, it is permissible to read the instructions aloud. Be certain to read them clearly and ask the participant if he/she understands the directions. If the participant is uncertain of the directions they may be read aloud one more time (note on the response sheet that the instructions were read aloud by the examiner). Be sure that the blue box is in the bottom right corner when the individual is looking at the page. If the participant reports that he/she is colorblind ask him/her to make a guess to the location (note color blindness on the response sheet). Do not repeat any of the instructions, except as described above.

SCORING CRITERIA

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

When you are ready, click the button below to proceed to the first example.

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USE OF THE CIB: The CIB was developed by Drs. Laura Grande, Regina McGlinchey, & William Milberg who were employees of the VA New England Geriatric Research, Education, & Clinical Center. All work using the CIB should cite the creators appropriately. A condition of use requires that recipients acknowledge the VA Boston G.R.E.C.C. ©2011


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