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Wisconsin Card Sorting Test
Neuropsychological test

The Wisconsin Card Sorting Test (WCST) is a neuropsychological test of set-shifting, which is the capability to show flexibility when exposed to changes in reinforcement. The WCST was written by David A. Grant and Esta A. Berg. The Professional Manual for the WCST was written by Robert K. Heaton, Gordon J. Chelune, Jack L. Talley, Gary G. Kay, and Glenn Curtiss.

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Method

Stimulus cards are shown to the participant and the participant is then instructed to match the cards.3 They are not given instructions on how to match the cards but are given feedback when the matches they make are right or wrong.4 When the test was first released the method of showing the cards was done with an evaluator using paper cards with the evaluator on one side of the desk facing the participant on the other.5 The test takes approximately 12–20 minutes to carry out using manual scoring which is greatly reduced with the aid of computer testing.67 The test results produce a number of useful psychometric scores, including numbers, percentages, and percentiles of: categories achieved, trials, errors, and perseverative errors.89

The WCST has been shown to be reliable and valid in multiple populations including people with autism,10 people recovering from a stroke,11 pediatric populations,12 and psychiatric populations.13

Clinical use

Since 1948, the test has been used by neuropsychologists and clinical psychologists in patients with acquired brain injury,141516 neurodegenerative disease, or mental illness such as schizophrenia.1718 It is one of several psychological tests which can be administered to patients to measure frontal lobe dysfunction.1920 When administered, the WCST allows the clinician to speculate to the following frontal lobe functions: strategic planning, organized searching, utilizing environmental feedback to shift cognitive sets, directing behavior toward achieving a goal, and modulating impulsive responding.2122 The test can be administered to those from 6.5 years to 89 years of age.2324 The WCST, relies upon a number of cognitive functions including attention, working memory, and visual processing.252627 The WCST was originally developed to measure abstract reasoning28 as such it may be used to help measure an individual's competence in abstract reasoning, and the ability to change problem-solving strategies when needed.2930 In this test, a number of cards are presented to the participants. The figures on the cards differ with respect to color, quantity, and shape.31

Psychological tests such as the WCST, administered alone, cannot be used to measure the effects of a frontal lobe injury, or the aspects of cognitive function it may affect, such as working memory; a variety of tests must be used.323334 A participant may be good at one task but show dysfunction in executive function overall. Similarly, test results can be made misleading after testing the same individual over a long period of time. The participant may get better at a task, but not because of an improvement in executive cognitive function; they may have simply learned some strategies for doing this particular task that made it no longer a good measurement tool.3536

Further reading

References

  1. Monchi, O., Petrides, M. Petre, V., Worsley, K., & Dagher, A. (2001). Wisconsin card sorting revisited: Distinct neural circuits participating in different stages of the task identified by event-related functional magnetic resonance imaging. The Journal of Neuroscience, 21(19), 7733-7741. ↩

  2. E. A. Berg. (1948). A simple objective technique for measuring flexibility in thinking J. Gen. Psychol. 39: 15-22. ↩

  3. Grant, D. A.; Berg, E. A. (2014). "Wisconsin Card Sorting Test". APA Psycnet. doi:10.1037/t31298-000. Retrieved 7 August 2024. https://doi.org/10.1037/t31298-000 ↩

  4. Barceló, Francisco (2001). "Does the Wisconsin Card Sorting Test Measure Prefontral Function?". The Spanish Journal of Psychology. 4 (1): 79–100. doi:10.1017/S1138741600005680. ISSN 1138-7416. PMID 11705346. S2CID 10432180. https://www.cambridge.org/core/product/identifier/S1138741600005680/type/journal_article ↩

  5. Jodzio, Krzysztof; Biechowska, Daria (2010-11-30). "Wisconsin Card Sorting Test as a Measure of Executive Function Impairments in Stroke Patients". Applied Neuropsychology. 17 (4): 267–277. doi:10.1080/09084282.2010.525104. ISSN 0908-4282. PMID 21154040. S2CID 205615311. https://www.tandfonline.com/doi/full/10.1080/09084282.2010.525104 ↩

  6. Feldstein, Simeon N.; Keller, Frederick R.; Portman, Rebecca E.; Durham, Robert L.; Klebe, Kelli J.; Davis, Hasker P. (1999). "A Comparison of Computerized and Standard Versions of the Wisconsin Card Sorting Test". The Clinical Neuropsychologist. 13 (3): 303–313. doi:10.1076/clin.13.3.303.1744. ISSN 1385-4046. PMID 10726602. https://www.tandfonline.com/doi/full/10.1076/clin.13.3.303.1744 ↩

  7. Heaton, R. K., & Staff, P. A. R. (1993). Wisconsin card sorting test: computer version 2. Odessa: Psychological Assessment Resources, 4, 1-4. ↩

  8. Romine, C (2004). "Wisconsin Card Sorting Test with children: a meta-analytic study of sensitivity and specificity". Archives of Clinical Neuropsychology. 19 (8): 1027–1041. doi:10.1016/j.acn.2003.12.009. PMID 15533695. https://doi.org/10.1016%2Fj.acn.2003.12.009 ↩

  9. Bowden, Stephen C.; Fowler, Kylie S.; Bell, Richard C.; Whelan, Gregory; Clifford, Christine C.; Ritter, Alison J.; Long, Caroline M. (1998). "The Reliability and Internal Validity of the Wisconsin Card Sorting Test". Neuropsychological Rehabilitation. 8 (3): 243–254. doi:10.1080/713755573. ISSN 0960-2011. http://www.tandfonline.com/doi/abs/10.1080/713755573 ↩

  10. Ozonoff, Sally (1995). "Reliability and validity of the Wisconsin Card Sorting Test in studies of autism". Neuropsychology. 9 (4): 491–500. doi:10.1037/0894-4105.9.4.491. ISSN 1931-1559. http://doi.apa.org/getdoi.cfm?doi=10.1037/0894-4105.9.4.491 ↩

  11. Chiu, En-Chi; Wu, Wen-Chi; Hung, Jen-Wen; Tseng, Yu-Hsuan (2018-07-31). "Validity of the Wisconsin Card Sorting Test in patients with stroke". Disability and Rehabilitation. 40 (16): 1967–1971. doi:10.1080/09638288.2017.1323020. ISSN 0963-8288. PMID 28494623. S2CID 205662922. https://www.tandfonline.com/doi/full/10.1080/09638288.2017.1323020 ↩

  12. Lichtenstein, Jonathan D.; Erdodi, Laszlo A.; Rai, Jaspreet K.; Mazur-Mosiewicz, Anya; Flaro, Lloyd (2018-02-17). "Wisconsin Card Sorting Test embedded validity indicators developed for adults can be extended to children". Child Neuropsychology. 24 (2): 247–260. doi:10.1080/09297049.2016.1259402. ISSN 0929-7049. PMID 27892806. S2CID 4546591. https://www.tandfonline.com/doi/full/10.1080/09297049.2016.1259402 ↩

  13. Bell, Morris D.; Greig, Tamasine Conway; Kaplan, Edward; Bryson, Gary (1997). "Wisconsin card sorting test dimensions in schizophrenia: Factorial, predictive, and divergent validity". Journal of Clinical and Experimental Neuropsychology. 19 (6): 933–941. doi:10.1080/01688639708403774. ISSN 1380-3395. PMID 9524888. http://www.tandfonline.com/doi/abs/10.1080/01688639708403774 ↩

  14. Chiu, En-Chi; Wu, Wen-Chi; Hung, Jen-Wen; Tseng, Yu-Hsuan (2018-07-31). "Validity of the Wisconsin Card Sorting Test in patients with stroke". Disability and Rehabilitation. 40 (16): 1967–1971. doi:10.1080/09638288.2017.1323020. ISSN 0963-8288. PMID 28494623. S2CID 205662922. https://www.tandfonline.com/doi/full/10.1080/09638288.2017.1323020 ↩

  15. Greve, Kevin W.; Bianchini, Kevin J.; Mathias, Charles W.; Houston, Rebecca J.; Crouch, John A. (2002). "Detecting Malingered Performance With the Wisconsin Card Sorting Test: A Preliminary Investigation in Traumatic Brain Injury". The Clinical Neuropsychologist. 16 (2): 179–191. doi:10.1076/clin.16.2.179.13241. ISSN 1385-4046. PMID 12221480. S2CID 42534630. https://www.tandfonline.com/doi/full/10.1076/clin.16.2.179.13241 ↩

  16. Drewe, E.A. (1974). "The Effect of Type and Area of Brain Lesion on Wisconsin Card Sorting Test Performance". Cortex. 10 (2): 159–170. doi:10.1016/S0010-9452(74)80006-7. PMID 4844468. https://doi.org/10.1016%2FS0010-9452%2874%2980006-7 ↩

  17. Bell, Morris D.; Greig, Tamasine Conway; Kaplan, Edward; Bryson, Gary (1997). "Wisconsin card sorting test dimensions in schizophrenia: Factorial, predictive, and divergent validity". Journal of Clinical and Experimental Neuropsychology. 19 (6): 933–941. doi:10.1080/01688639708403774. ISSN 1380-3395. PMID 9524888. http://www.tandfonline.com/doi/abs/10.1080/01688639708403774 ↩

  18. Banno M, Koide T, Aleksic B, et al. (2012). "Wisconsin Card Sorting Test scores and clinical and sociodemographic correlates in schizophrenia: multiple logistic regression analysis". BMJ Open. 2 (6): e001340. doi:10.1136/bmjopen-2012-001340. PMC 3533115. PMID 23135537. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533115 ↩

  19. Anderson, Steven W.; Damasio, Hanna; Jones, R. Dallas; Tranel, Daniel (1991). "Wisconsin Card Sorting Test Performance as a Measure of Frontal Lobe Damage". Journal of Clinical and Experimental Neuropsychology. 13 (6): 909–922. doi:10.1080/01688639108405107. ISSN 0168-8634. PMID 1779030. https://www.tandfonline.com/doi/full/10.1080/01688639108405107 ↩

  20. Robinson, Amy L.; Heaton, Robert K.; Lehman, Ralph A.; Stilson, Donald W. (1980). "The utility of the Wisconsin Card Sorting Test in detecting and localizing frontal lobe lesions". Journal of Consulting and Clinical Psychology. 48 (5): 605–614. doi:10.1037/0022-006X.48.5.605. ISSN 1939-2117. PMID 7410659. http://doi.apa.org/getdoi.cfm?doi=10.1037/0022-006X.48.5.605 ↩

  21. Weyandt, Lisa L.; Willis, W. Grant (1994). "Executive functions in school-aged children: Potential efficacy of tasks in discriminating clinical groups". Developmental Neuropsychology. 10 (1): 27–38. doi:10.1080/87565649409540564. ISSN 8756-5641. http://www.tandfonline.com/doi/abs/10.1080/87565649409540564 ↩

  22. Rzezak, Patricia; Fuentes, Daniel; Guimarães, Catarina A.; Thome-Souza, Sigride; Kuczynski, Evelyn; Guerreiro, Marilisa; Valente, Kette D.R. (2009). "Executive dysfunction in children and adolescents with temporal lobe epilepsy: Is the Wisconsin Card Sorting Test enough?". Epilepsy & Behavior. 15 (3): 376–381. doi:10.1016/j.yebeh.2009.04.014. PMID 19379836. S2CID 19431911. https://linkinghub.elsevier.com/retrieve/pii/S152550500900225X ↩

  23. Rhodes, Matthew G. (2004). "Age-Related Differences in Performance on the Wisconsin Card Sorting Test: A Meta-Analytic Review". Psychology and Aging. 19 (3): 482–494. doi:10.1037/0882-7974.19.3.482. ISSN 1939-1498. PMID 15382998. http://doi.apa.org/getdoi.cfm?doi=10.1037/0882-7974.19.3.482 ↩

  24. Chelune, Gordon J.; Baer, Ruth A. (1986). "Developmental norms for the wisconsin card sorting test". Journal of Clinical and Experimental Neuropsychology. 8 (3): 219–228. doi:10.1080/01688638608401314. ISSN 0168-8634. PMID 3722348. https://www.tandfonline.com/doi/full/10.1080/01688638608401314 ↩

  25. Barceló, Francisco; Muñoz-Céspedes, Juan M; Pozo, Miguel A; Rubia, Francisco J (2000). "Attentional set shifting modulates the target P3b Response in the Wisconsin card sorting test". Neuropsychologia. 38 (10): 1342–1355. doi:10.1016/S0028-3932(00)00046-4. PMID 10869577. S2CID 10663176. https://linkinghub.elsevier.com/retrieve/pii/S0028393200000464 ↩

  26. Wang, Lihong; Kakigi, Ryusuke; Hoshiyama, Minoru (2001). "Neural activities during Wisconsin Card Sorting Test — MEG observation". Cognitive Brain Research. 12 (1): 19–31. doi:10.1016/S0926-6410(01)00022-2. PMID 11489605. https://linkinghub.elsevier.com/retrieve/pii/S0926641001000222 ↩

  27. Berman, K (1995). "Physiological activation of a cortical network during performance of the Wisconsin Card Sorting Test: A positron emission tomography study". Neuropsychologia. 33 (8): 1027–1046. doi:10.1016/0028-3932(95)00035-2. PMID 8524452. S2CID 21624133. https://linkinghub.elsevier.com/retrieve/pii/0028393295000352 ↩

  28. Eling, Paul; Derckx, Kristianne; Maes, Roald (2008). "On the historical and conceptual background of the Wisconsin Card Sorting Test". Brain and Cognition. 67 (3): 247–253. doi:10.1016/j.bandc.2008.01.006. hdl:2066/73651. PMID 18328609. S2CID 205788199. https://linkinghub.elsevier.com/retrieve/pii/S0278262608000250 ↩

  29. Biederam J, Faraone S, Monutaeux M, et al. (2000). "Neuropsychological functioning in nonreferred siblings of children with attention deficit/hyperactivity disorder". Journal of Abnormal Psychology. 109 (2): 252–65. doi:10.1037/0021-843X.109.2.252. PMID 10895563. /wiki/Doi_(identifier) ↩

  30. Teubner-Rhodes, Susan; Vaden, Kenneth I.; Dubno, Judy R.; Eckert, Mark A. (2017). "Cognitive persistence: Development and validation of a novel measure from the Wisconsin Card Sorting Test". Neuropsychologia. 102: 95–108. doi:10.1016/j.neuropsychologia.2017.05.027. PMC 5538310. PMID 28552783. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538310 ↩

  31. US National Library of Medicine National Institutes of Health, 2009 ↩

  32. Anderson, Steven W.; Damasio, Hanna; Jones, R. Dallas; Tranel, Daniel (1991). "Wisconsin Card Sorting Test Performance as a Measure of Frontal Lobe Damage". Journal of Clinical and Experimental Neuropsychology. 13 (6): 909–922. doi:10.1080/01688639108405107. ISSN 0168-8634. PMID 1779030. https://www.tandfonline.com/doi/full/10.1080/01688639108405107 ↩

  33. Mountain, Mary Ann; Snow, William G. (1993). "Wisconsin card sorting test as a measure of frontal pathology: A review". Clinical Neuropsychologist. 7 (1): 108–118. doi:10.1080/13854049308401893. ISSN 0920-1637. http://www.tandfonline.com/doi/abs/10.1080/13854049308401893 ↩

  34. Stuss, D.T.; Levine, B.; Alexander, M.P.; Hong, J.; Palumbo, C.; Hamer, L.; Murphy, K.J.; Izukawa, D. (2000). "Wisconsin Card Sorting Test performance in patients with focal frontal and posterior brain damage: effects of lesion location and test structure on separable cognitive processes". Neuropsychologia. 38 (4): 388–402. doi:10.1016/S0028-3932(99)00093-7. PMID 10683390. S2CID 23448920. https://linkinghub.elsevier.com/retrieve/pii/S0028393299000937 ↩

  35. Kane, M.J. & Engle, R.W. (2002). "The role of prefontal cortex in working-memory capacity, executive attention, and general fluid intelligence: An individual-differences perspective." Psychonomic Bulletin & Review 9(4), 637-671. Retrieved from "Archived copy" (PDF). Archived from the original (PDF) on 2011-12-27. Retrieved 2011-12-31.{{cite web}}: CS1 maint: archived copy as title (link) https://web.archive.org/web/20111227095933/http://psychology.gatech.edu/renglelab/Publications/2002/The%20role%20of%20prefrontal%20cortex%20in%20working-memory%20capacity.pdf ↩

  36. Basso, Michael R.; Lowery, Natasha; Ghormley, Courtney; Bornstein, Robert A. (2001). "Practice Effects on the Wisconsin Card Sorting Test–64 Card Version Across 12 Months". The Clinical Neuropsychologist. 15 (4): 471–478. doi:10.1076/clin.15.4.471.1883. ISSN 1385-4046. PMID 11935448. S2CID 28784781. https://www.tandfonline.com/doi/full/10.1076/clin.15.4.471.1883 ↩