On the historical and conceptual background of the Wisconsin Card Sorting Test

In this paper, we describe the development of the Wisconsin Card Sorting Test (WCST). We trace the history of sorting tasks from the studies of Narziss Ach on the psychology of thinking, via the work of Kurt Goldstein and Adhémar Gelb on brain lesioned patients around 1920 and subsequent developments, up to the actual design of the WCST by Harry Harlow, David Grant, and their student Esther Berg. The WCST thus seems to originate from the psychology of thinking ('Denkpsychologie'), but the test, as it is used in clinical neuropsychological practice, was designed by experimenters working within the behaviorist tradition. We also note recent developments suggesting that, contrary to the general impression, implicit learning may play a role in WCST-like discrimination learning tasks.     

Latent Structure of the Wisconsin Card Sorting Test after Pediatric Traumatic Head Injury

The performance of 80 pediatric patients with traumatic head injury (THI) on the Wisconsin Card Sorting Test (WCST; Heaton, Chelune, Talley, Kay, & Curtiss, 1993) was examined to determine the underlying latent structure. Exploratory factor analysis with oblique rotation identified three factors: response accuracy, failure to self-monitor, and learning. The response accuracy factor was directly affected by both age and length of coma. Level of performance on this factor also covaried with post-injury psychometric intelligence. It is concluded that interpretation of the WCST results of children with THI should consider the multifactorial nature of the instrument in combination with injury severity characteristics and demographic variables.     

Latent structure of the Wisconsin Card Sorting Test after pediatric traumatic head injury.

The performance of 80 pediatric patients with traumatic head injury (THI) on the Wisconsin Card Sorting Test (WCST; Heaton, Chelune, Talley, Kay, & Curtiss, 1993) was examined to determine the underlying latent structure. Exploratory factor analysis with oblique rotation identified three factors: response accuracy, failure to self-monitor, and learning. The response accuracy factor was directly affected by both age and length of coma. Level of performance on this factor also covaried with post-injury psychometric intelligence. It is concluded that interpretation of the WCST results of children with THI should consider the multifactorial nature of the instrument in combination with injury severity characteristics and demographic variables.     

Wisconsin Card Sorting Test embedded validity indicators developed for adults can be extended to children

Past studies have examined the ability of the Wisconsin Card Sorting Test (WCST) to discriminate valid from invalid performance in adults using both individual embedded validity indicators (EVIs) and multivariate approaches. This study is designed to investigate whether the two most stable of these indicators—failures to maintain set (FMS) and the logistical regression equation S-B_LRE—can be extended to pediatric populations.

The classification accuracy for FMS and S-B_LRE was examined in a mixed clinical sample of 226 children aged 7 to 17 years (64.6% male, MAge = 13.6 years) against a combination of established performance validity tests (PVTs).

The results show that at adult cutoffs, FMS and S-B_LRE produce an unacceptably high failure rate (33.2% and 45.6%) and low specificity (.55–.72), but an upward adjustment in cutoffs significantly improves classification accuracy. Defining Pass as <2 and Fail as ≥4 on FMS results in consistently good specificity (.89–.92) but low and variable sensitivity (.00–.33). Similarly, cutting the S-B_LRE distribution at 3.68 produces good specificity (.90–.92) but variable sensitivity (.06–.38). Passing or failing FMS or S-B_LRE is unrelated to age, gender and IQ.

The data from this study suggest that in a pediatric sample, adjusted cutoffs on the FMS and S-B_LRE ensure good specificity, but with low or variable sensitivity. Thus, they should not be used in isolation to determine the credibility of a response set. At the same time, they can make valuable contributions to pediatric neuropsychology by providing empirically-supported, expedient and cost-effective indicators to enhance performance validity assessment.     

Temporal stability of the Wisconsin Card Sorting Test in a chronic traumatic brain injury sample

The aim of the present study was to investigate the temporal stability of the Wisconsin Card Sorting Test (WCST) in a clinical population with documented brain pathology, stable cognitive deficits, and for whom repeated testing is common: chronic severe traumatic brain injury (TBI). Participants were 34 patients at least 1 year post severe TBI living at a large residential rehabilitation facility. The WCST was administered in standard fashion with both the standard and 64-card versions scored. All derived scores with norms were examined. Results indicated acceptable temporal stability of most scores for both the standard and short WCST, although the stability of the WCST-64 was poorer than for the standard WCST. Three sets of significant change indices are provided for clinical use.     

An attempt to discriminate different types of executive functions in the Wisconsin Card Sorting Test

This study examined the roles of the phonological working memory and the central executive in the Wisconsin Card Sorting Test by altering the materials and the procedure of the task and using a dual-task design, in which cognitive abilities of normal participants were manipulated by performance of the secondary tasks selectively taxing the phonological loop or the central executive. The present study used three novel versions of the Wisconsin Card Sorting Test, namely the WCST-4 stimuli, the WCST-12-stimuli, and the WCST-12-stimuli-box, in all of which the participants were given the exact sorting criterion. So the tasks did not involve processes such as maintenance of inferences about the sorting criterion which would require phonological memory load. However, the tasks were assumed to require the executive process of response inhibition. In the WCST-4-stimuli condition no change was made to the WCST materials. In the other two conditions, relying on the assumption that the three-dimensional nature of the cards triggers inappropriate responses, unidimensional stimulus cards were used instead of the four normal three-dimensional WCST stimulus cards. The difference between these two conditions was that, in the WCST-12-stimuli-box condition, boxes were used to conceal the response cards previously sorted. The results supported Dunbar and Sussman's (1995) argument that some executive processes in the Wisconsin Card Sorting Test require the use of phonological store, and the present design was able to differentiate the type of executive functions that do not involve the use of a phonological loop from the ones that do. In addition, the results concerning manipulations of the visual aspects of the Wisconsin Card Sorting Test suggest that the three-dimensional nature of the WCST stimulus cards leads to an increase in the number of inappropriate responses produced with the executive secondary task interference.     

The impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance

Several lesion and imaging studies have suggested that the Wisconsin Card Sorting Test (WCST) is a measure of executive dysfunction. However, some studies have reported that this measure has poor anatomical specificity because patients with either frontal or non-frontal focal lesions exhibit similar performance. This study examined 25 frontal, 20 non-frontal low-grade brain tumor patients, and 63 normal controls (NC) on the WCST. The frontal patients were also assigned to either a left frontal (n=10) group or a right frontal group (n=15) and compared with the non-frontal group and NC. It was hypothesized that the frontal brain tumor patients would display greater deficits on categories achieved and a higher number of perseverative errors than non-frontal brain tumor patients on the WCST. Finally, it was predicted that right frontal brain tumors would result in greater executive functioning deficits than left frontal or non-frontal brain tumors. Results indicated that the left frontal group achieved the fewest categories and committed the most perseverative errors compared to the other patient and normal control groups. In addition, the left frontal group committed significantly more perseverative errors than the right frontal group. These results suggest that the WCST is sensitive to the effects of low-grade brain tumors on executive functioning.     

Accounting for age differences on the Wisconsin Card Sorting Test: decreased working memory, not inflexibility

Two experiments examined the role of cognitive inflexibility and reduced working memory in age-related declines on the Wisconsin Card Sorting Test. Both standard scoring procedures and newly developed scores were used to measure each construct, and modifications of the test further evaluated the role of working memory. Results indicated that age differences are not due to cognitive inflexibility but that for a subset of older adults errors are associated with a reduction in the amount of information that can be stored or processed in working memory. These age differences disappear, however, when visual cues provide information about the immediately preceding sort. The authors conclude by proposing a decline in updating working memory as the explanation that can best account for the entire pattern of age differences on this test.     

The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: A critical update

For over four decades the Wisconsin Card Sorting Test (WCST) has been one of the most distinctive tests of prefrontal function. Clinical research and recent brain imaging have brought into question the validity and specificity of this test as a marker of frontal dysfunction. Clinical studies with neurological patients have confirmed that, in its traditional form, the WCST fails to discriminate between frontal and non-frontal lesions. In addition, functional brain imaging studies show rapid and widespread activation across frontal and non-frontal brain regions during WCST performance. These studies suggest that the concept of an anatomically pure test of prefrontal function is not only empirically unattainable, but also theoretically inaccurate. The aim of the present review is to examine the causes of these criticisms and to resolve them by incorporating new methodological and conceptual advances in order to improve the construct validity of WCST scores and their relationship to prefrontal executive functions. We conclude that these objectives can be achieved by drawing on theory-guided experimental design, and on precise spatial and temporal sampling of brain activity, and then exemplify this using an integrative model of prefrontal function [i.e., Miller, E. K. (2000). The prefrontal cortex and cognitive control. Nature Reviews Neuroscience, 1, 59–65.] combined with the formal information theoretical approach to cognitive control [Koechlin, E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive function. Trends in Cognitive Sciences, 11, 229–235.].     

The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: A critical update

For over four decades the Wisconsin Card Sorting Test (WCST) has been one of the most distinctive tests of prefrontal function. Clinical research and recent brain imaging have brought into question the validity and specificity of this test as a marker of frontal dysfunction. Clinical studies with neurological patients have confirmed that, in its traditional form, the WCST fails to discriminate between frontal and non-frontal lesions. In addition, functional brain imaging studies show rapid and widespread activation across frontal and non-frontal brain regions during WCST performance. These studies suggest that the concept of an anatomically pure test of prefrontal function is not only empirically unattainable, but also theoretically inaccurate. The aim of the present review is to examine the causes of these criticisms and to resolve them by incorporating new methodological and conceptual advances in order to improve the construct validity of WCST scores and their relationship to prefrontal executive functions. We conclude that these objectives can be achieved by drawing on theory-guided experimental design, and on precise spatial and temporal sampling of brain activity, and then exemplify this using an integrative model of prefrontal function [i.e., Miller, E. K. (2000). The prefrontal cortex and cognitive control. Nature Reviews Neuroscience, 1, 59–65.] combined with the formal information theoretical approach to cognitive control [Koechlin, E., & Summerfield, C. (2007). An information theoretical approach to prefrontal executive function. Trends in Cognitive Sciences, 11, 229–235.].     

Serving Families of Children with Developmental Disabilities

Abstract

Increased cultural diversity in the United States and elsewhere in the west requires that the school special services providers be aware of differences among identity groups, and sensitive to how these variations influence parents' perceptions of, and responses to, their child with a developmental disability. Because concern about diversity is relatively recent, the data base for action is virtually nonexistent. Nonetheless, there exists sufficient information to alert the special services provider to such factors as culture, religion, race, and social class in developing service programs. Understanding the values, beliefs, and experiences of families enables one to provide more effective services than does operating with the assumption that everyone views the world through essentially the same lens.     

The development of attention regulation in the Wisconsin Card Sorting Task

The present study examined performance on a computerized version of the Wisconsin Card Sorting Test (WCST) in participants between 6 and 18 years. Test trials were presented upon request, without time constraints, and with a direct coupling between the participant's response and the onset of the feedback. The pattern of findings that emerged from the self-controlled computerized WCST permitted unique insights into the developmental changes in reasoning and attention regulation during childhood and adolescence. The number of WCST categories achieved developed linearly between 6 and 11 years and asymptoted beyond this age, whereas attentional responses continued to develop. More specifically, a decrease in distractive attention to correct feedback predicted performance in the younger group. In contrast, an increase in attention to error feedback predicted the number of WCST categories achieved by the older children. This pattern of findings indicates that, although trial-by-trial feedback monitoring is crucial for the successful detection of WCST categories in both younger and older children, the specifics of attention regulation differ greatly between children and adolescents.     

Construction and validation of an ecological version of the Wisconsin Card Sorting Test applied to an elderly population

ABSTRACT

The goal of this project was to construct and validate an ecological version of the Wisconsin Card Sorting Test (WCST) aimed at the elderly. This was accomplished by replacing the geometric stimuli of the traditional version with stimuli belonging to the semantic category of transport vehicles, and by elimination of the color yellow. The results showed the ecological WCST version was preferred over the traditional version and older people felt less tired during test performance. In the two independent normal elderly groups, all pairs of scores that can be derived from the WCST correlated significantly with each other. Six of 11 outcome measures of the traditional WCST-128 (long) version were significantly influenced by age. By contrast, in the WCST-64 (short) version and in the ecological WCST-54 version only one measure was affected by the age variable. No significant effect of education level or gender emerged from the results in any WCST version. Again, the subjects with cognitive deterioration had lower performance in the ecological WCST-54 version than in the two traditional WCST versions. It seems reasonable to assume that the ecological version of WCST is more discriminating and has more advantages than the traditional versions. Further research on individual differences in the performance on this task will increase understanding of the components of the test, and of the variety of factors and possible deficits that could lead to an impaired performance of the test.     

Fathers as Intervention Agents for Their Children with Developmental Disabilities

ABSTRACT

Parent training aimed at aiding children to overcome social and behavioral problems is an area that has continued to gain attention and support. Very little of the current research has been with developmentally disabled children, the focus of this study. Additionally, for most parent training programs, “parents” actually refers to mothers. In this study three fathers and their developmentally disabled children, who ranged in age from 2 years 10 months to 4 years 5 months, were studied. A multiple baseline across fathers' behaviors was utilized for participants to evaluate effects of parent training on fathers' target behaviors. Child compliance and inappropriate behaviors were also addressed. Parent training resulted in desirable changes on a range of target behaviors. The implications of these findings are discussed.     

Verbal Learning Strategies of Adolescents and Adults with the Syndrome of Nonverbal Learning Disabilities

Abstract

Although many psychometric studies of individuals with the syndrome of nonverbal learning disabilities (NLD) have been conducted, one relatively neglected area has been the study of their performance on explicit verbal memory measures. We examined the performance of adolescents and adults with NLD on the California Verbal Learning Test, a measure allowing analysis of self-initiated learning strategies, and compared their performance to age- and Full Scale IQ-matched verbal learning-disabled (VLD) controls. Mean performance of the NLD sample on the semantic clustering index fell one standard deviation below the normative mean, whereas their serial clustering score was within normal limits. Additionally, the serial clustering score for our NLD sample was significantly greater than their semantic clustering score, suggesting that these individuals are more likely to spontaneously employ serial verbal learning strategies as opposed to those that are semantically driven. This difference in serial versus semantic clustering scores was not seen in our VLD controls, who performed equally well, and within normal limits, on both indices.     

The Role of Switching,Inhibition and Working Memory in Older Adults' Performance in the Wisconsin Card Sorting Test

ABSTRACT

The Wisconsin Card Sorting Test (WCST) is considered a typical executive test. However, several interesting questions are still open as to the specific executive processes underlying this task. In the present study, we explored how local and global switching, inhibition and working memory, assessed through the Number–Letter, the Stop Signal and the Reading Span tasks, relate to older adults' performance in the WCST. Results showed that older adults' performance variability in the number of perseverative errors was predicted by the local switch component of the Number–Letter task. Results also showed age-related differences in inhibition, working memory and global switching, while local switching resulted largely spared in aging. This study provides evidence that switching abilities may contribute to performance of older adults in the WCST. It also provides initial evidence suggesting that switching processes, associated with local switch costs, are involved in performance on the WCST, at least in older adults.     

Tailoring Social Competence Interventions for Children with Learning Disabilities

Challenges in social competence are common in children with Learning Disabilities (LDs), particularly those who present with co-occurring mental health challenges (LD + MH). Social competence calls upon a complex set of skills, including social skills, perspective-taking abilities, and an understanding of the social environment. Successful enactment of these skills necessitates behavioral and emotion regulation, an area of weakness for many youth with LD + MH. Using a mixed-method design, the present study assessed the efficacy of a social competence group program for children with LD + MH (mean age = 11.4 years) in which group size, content, and structure are tailored to the child’s level of emotion regulation, information processing abilities, and social competence goals. Quantitative measures completed by parents and coded behavioral observations completed pre- and post-treatment indicated significant gains in initiation and engagement in positive social interactions, foundational skills that support improvement in social competence. Qualitative interviews with parents, children and teachers suggested improvements in social self-concept, initiation, and emotion regulation. Tailoring treatment to the child’s information processing and emotion regulation abilities, as well as ‘in the moment’ feedback, supported gains made and contributed to participants having a positive social experience. Directions for future research are discussed.     

学习不良儿童的工作记忆

近年来大量的研究发现：阅读障碍儿童和数学学习不良儿童在言语工作记忆和执行性功能上存在缺陷;数学学习不良儿童在视-空工作记忆上也存在一定的缺陷,但关于阅读障碍儿童是否存在视-空工作记忆缺陷尚存在着争论;关于这种缺陷究竟是一种发展滞后还是发展缺陷尚存在着争论,与所采用的研究方法有一定关系。目前该领域在学习不良与工作记忆的因果关系,工作记忆测量材料的效度及其敏感性,工作记忆与其它认知功能的关系上面临挑战。因此,采用纵向的研究设计、多变量的统计技术,革新工作记忆的评估方法和技术,阐明工作记忆在各学业领域及亚领域中的作用及其内在工作机制是该领域的研究趋势。     

学习困难的ERP研究

事件相关脑电位（Event—related potentials,ERPs）是研究心理学和认知神经科学的重要技术手段,将该技术用于学习困难的脑机制的研究,有助于发现学习困难的神经机制。研究表明,学习困难者的P300波幅较小,潜伏期较长。学习困难者的MMN波幅比控制组小,在信息的自动加工方面存在缺陷。在单词命名任务中,学习困难者的N400较小,而且不同类型学习困难者的波幅和潜伏期存在明显差异。