Abnormal Involuntary Movement Scale (AIMS)

William Guy, National Institute of Mental Health · 1976

The NIMH standard for rating drug-induced involuntary movements by body region, plus the three global judgements — the classic video-rated scale.

The AIMS is the instrument the tardive-dyskinesia literature is built on. Ten rated judgements — seven body regions plus three globals — each 0 to 4, following a standardized examination procedure that includes activation manoeuvres (open the mouth, protrude the tongue, tap finger to thumb, stand and walk). Blinded video AIMS rating was the primary endpoint method in the valbenazine and deutetrabenazine registration trials, which is exactly the workflow this library exists to support.

What the recording has to show. Dyskinetic movements must be seen, so the camera has to keep the relevant regions in frame — face and mouth, hands, feet, trunk — and the examination procedure has to actually be performed on tape. A talking-head recording of an interview will not support items 5 to 7. Say in your rationale which part of the examination each rating came from.

Two rules that change ratings. The published form instructs you to rate the highest severity observed, and to rate movements that appear only on activation one less than the same movements seen spontaneously. Both are easy to lose when raters work from a timeline instead of a paper form, and both change scores systematically, so state them in your codebook.

What we have not included. ECDEU items 11 and 12 cover dental status and whether the patient usually wears dentures. They are important context for interpreting oral movements but they are not observations of the recording, so they are not codes here — record them as study metadata. Note that the ECDEU total (range 0-42) is defined over all twelve items; the widely used "sum items 1-7" movement total is a later convention. Whichever you report, say which.

Item 10 is the one exception to "rate what you see": the form says to rate only the patient's own report of awareness, so it is coded from what they say, not from how the movements look.

Domains (10)

Muscles of Facial ExpressionAFE

Involuntary movements of forehead, brows, periorbital area and cheeks — frowning, blinking, grimacing.

Curated skill
Lips and Perioral AreaALP

Puckering, pouting, smacking of the lips and movements of the surrounding area.

Curated skill
JawAJW

Biting, clenching, chewing, mouth opening, lateral jaw movement.

Curated skill
TongueATG

Rolling or in-and-out movements of the tongue; rate only increase in movement, not inability to sustain a movement.

Curated skill
Upper ExtremitiesAUE

Arms, wrists, hands and fingers — choreic (rapid, irregular) or athetoid (slow, writhing) movement. Exclude tremor.

Curated skill
Lower ExtremitiesALE

Legs, knees, ankles and toes — lateral knee movement, foot tapping, heel dropping, toe squirming, inversion and eversion.

Curated skill
Neck, Shoulders and HipsATR

Trunk movements — rocking, twisting, squirming, pelvic gyrations.

Curated skill
Severity of Abnormal MovementsAGS

Global judgement of the overall severity of abnormal movements across all regions.

Curated skill
Incapacitation Due to Abnormal MovementsAGI

Global judgement of how much the movements interfere with the person's functioning.

Curated skill
Patient's Awareness of Abnormal MovementsAGA

Rate only the patient's own report: whether they are aware of the movements and how distressing they find them.

Curated skill
Guy W, editor. ECDEU Assessment Manual for Psychopharmacology, revised. Rockville, MD: US Department of Health, Education, and Welfare, National Institute of Mental Health; 1976:534-537. DHEW Publication No. (ADM) 76-338.

Public domain: a work of the US federal government (NIMH Psychopharmacology Research Branch, ECDEU Assessment Manual, 1976). Item names and the 0-4 anchor labels are reproduced verbatim; the per-level descriptions are condensed for a one-line rating control. Rate against the official form and its examination procedure — the full ECDEU text is freely available. Cite Guy (1976).