Calculators / Medication side effects

AIMS

Abnormal Involuntary Movement Scale. Tardive dyskinesia screening and tracking.

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The AIMS calculator is in the Library.

Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.

Use it for

  • A baseline exam before or soon after starting a dopamine-blocking drug.
  • Regular monitoring for tardive dyskinesia in people on antipsychotics, metoclopramide and similar drugs.
  • Measuring change after a dose change, a switch or a VMAT2 inhibitor.

Do not use it for

  • Diagnosing tardive dyskinesia. That is a clinical judgment about exposure, the movements, and other causes.
  • Rating tremor, parkinsonism, akathisia or dystonia. The BARS covers akathisia.
  • Use by an untrained rater without the standard exam. Ratings change a lot with technique.

Rate the highest severity observed. Movements seen only on activation, such as during the finger-tapping or walking steps, are rated one level lower than the same movements at rest.

Remove gum or candy first, and ask about dentures. Ratings are 0 none, 1 minimal (could be normal), 2 mild, 3 moderate, 4 severe.

Has the person had at least 3 months of cumulative exposure to a dopamine-blocking drug? (1 month if aged 60 or older.)Optional context. Needed for the Schooler-Kane criteria for probable TD.

Facial and oral movements

1Muscles of facial expressionMovements of the forehead, eyebrows, periorbital area and cheeks. Include frowning, blinking, smiling and grimacing.
2Lips and perioral areaFor example puckering, pouting and smacking.
3JawFor example biting, clenching, chewing, mouth opening and lateral movement.
4TongueRate only increased movement in and out of the mouth, not inability to sustain a movement.

Extremity movements

5Upper (arms, wrists, hands, fingers)Include choreic movements (rapid, purposeless, irregular, spontaneous) and athetoid movements (slow, irregular, complex, serpentine). Do not include tremor.
6Lower (legs, knees, ankles, toes)For example lateral knee movement, foot tapping, heel dropping, foot squirming and inversion or eversion of the foot.

Trunk movements

7Neck, shoulders, hipsFor example rocking, twisting, squirming and pelvic gyrations. Include diaphragmatic movements.

Global judgments

8Severity of abnormal movementsBased on the highest single score on items 1 to 7.
9Incapacitation due to abnormal movements
10Patient's awareness of abnormal movementsRate only the patient's report.

Dental status

11Current problems with teeth and/or dentures
12Does the patient usually wear dentures?

AIMS

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More about the AIMS

About the AIMSWhat it is and what it is for

The AIMS was written by the National Institute of Mental Health in 1976 to record abnormal involuntary movements in people taking dopamine-blocking medication. A clinician watches the person through a short standard exam, then rates movements in seven body areas from 0 (none) to 4 (severe). Three global items cover overall severity, incapacitation and the person's awareness. Two items record dental status.

The total of items 1 to 7 runs from 0 to 28. The scale gives a baseline and a way to follow change. It does not diagnose tardive dyskinesia. The Schooler-Kane criteria add a rule for probable TD on top of the ratings.

How to use itGiving it and scoring it

Seat the person in a firm chair without arms. Observe them at rest first. Then work through the standard exam: ask about the mouth, teeth and dentures, and any movements they notice.

Watch with hands on knees; with hands hanging; with the mouth open and the tongue out; during finger-to-thumb tapping; during arm flexion and extension; standing; with arms outstretched; and walking a few paces, turning and returning.

Rate each body area for the highest severity seen, from 0 to 4. Rate activated movements one level lower than spontaneous ones. Then give the three global judgments and the dental items.

Interpreting the scoreScore ranges and what they suggest

The AIMS total has no validated severity bands. The result is read from the pattern of ratings in items 1 to 7 instead.

Pattern in items 1 to 7Reading
Every item 0No abnormal movementsRecord as a baseline and repeat on schedule.
Only ratings of 1, or a single rating of 2Below the probable TD patternMovements may be minimal or normal. Keep monitoring.
A rating of 2 or more in at least two items, or a rating of 3 or 4 in at least oneSchooler-Kane pattern for probable TDConfirm exposure and exclude other causes, then decide on treatment.

Probable TD by the Schooler-Kane criteria needs the score pattern above, at least 3 months of cumulative exposure to a dopamine-blocking drug (1 month if aged 60 or older), and other causes excluded. These are research criteria. A clinician decides whether a person has TD.

Pearls and pitfallsTips and common mistakes
  • Note that the tongue is rated only for increased movement. Not being able to hold it out is a different finding.
  • Observe the person before the exam starts, in the waiting room or while talking. Movements often show when they think no one is looking.
  • Distraction can bring movements out. Counting backward or tapping can unmask dyskinesia that was quiet at rest.
  • TD can follow any dopamine blocker, including metoclopramide and prochlorperazine. It is not limited to older antipsychotics.
  • Do not mistake akathisia (a drive to move, felt inside) or tremor for dyskinesia. Use the BARS for akathisia.
EvidenceAccuracy and reliability
  • The AIMS was developed at NIMH (Guy 1976) and has been the most widely used instrument for TD in clinical practice and trials.
  • The Schooler-Kane criteria (1982) set the research definition of probable TD: moderate movements in one area or mild movements in two areas, after cumulative exposure, with other causes excluded.
  • In the pivotal valbenazine and deutetrabenazine trials, AIMS total scores of items 1 to 7 fell about 3 points on active drug and 0 to about 1.5 points on placebo.
  • The APA 2020 schizophrenia guideline recommends treating moderate to severe or disabling TD with a VMAT2 inhibitor.
Source, license and referencesWhere it comes from

The AIMS was developed by William Guy at the National Institute of Mental Health (1976) and is in the public domain. The exam procedure and item descriptions here follow the published form.

  1. Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised. US Department of Health, Education, and Welfare; 1976:534-537.
  2. Schooler NR, Kane JM. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982;39(4):486-487.
  3. Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2020;177(9):868-872.
  4. Hauser RA, Factor SA, Marder SR, et al. KINECT 3: a phase 3 randomized, double-blind, placebo-controlled trial of valbenazine for tardive dyskinesia. Am J Psychiatry. 2017;174(5):476-484.
  5. Anderson KE, Stamler D, Davis MD, et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD). Lancet Psychiatry. 2017;4(8):595-604.

Clinical decision support, not a diagnosis. Each calculator scores a published scale the way its authors intended. A score informs a clinical interview and examination and never replaces them. If you are a patient using this page, please review the result with your clinician. In an emergency, call 911 or call or text 988 in the United States.