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.     

The development of temporal coordination in children

The ability to learn temporal patterns in sequenced actions was investigated in elementary-school age children. Temporal learning depends upon a process of integrating timing patterns with action sequences. Children ages 6-13 and young adults performed a serial response time task in which a response and a timing sequence were presented repeatedly in a phase-matched manner, allowing for integrative learning. The degree of integrative learning was measured as the slowing in performance that resulted when phase-shifting the sequences. Learning was similar for the children and adults on average but increased with age for the children. Executive function measured by Wisconsin Card Sorting Test (WCST) performance as well as a measure of response speed also improved with age. Finally, WCST performance and response speed predicted temporal learning. Taken together, the results indicate that temporal learning continues to develop in pre-adolescents and that maturing executive function or processing speed may play an important role in acquiring temporal patterns in sequenced actions and the development of this ability.     

Validity of a short form of the WISC-III in children with traumatic head injury

The concurrent, construct, and criterion validities of Donders' (in press) short form of the Wechsler Intelligence Scale for Children - Third Edition (WISC-III) were evaluated in a sample of 171 children with traumatic head injury (THI). Correlations between the short-form deviation quotients and their full-length counterparts were statistically significant. Confirmatory factor analysis revealed that a four-factor model (composed of Verbal Comprehension, Perceptual Organization, Freedom from Distractibility, and Processing Speed) fit the data relatively well. The short-form deviation quotients also had statistically significant correlations with length of coma. It is concluded that this short form is an accurate and valid alternative to the full-length WISC-III in children with THI.     

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.     

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.     

Deficits in set-shifting ability in nonclinical compulsive checkers

Recent studies suggest deficits in set-shifting ability in patients with obsessive-compulsive disorder (OCD) as measured by tasks such as the Wisconsin Card Sorting Test (WCST; Berg, 1948). The present study examined the extent to which these deficits were demonstrated by nonclinical subjects selected on the basis of their checking scores on the Maudsley Obsessional-Compulsive Inventory. A multivariate analysis revealed that frequent checkers performed significantly worse on the WCST than noncheckers, making more total errors and more perseverative errors and requiring more time to complete the test. A follow-up analysis on a subset of the original sample found similar performance deficits in checkers. While the poorer performance of checkers could be statistically accounted for by anxiety during the first administration of the WCST, anxiety could not explain the relationship between checking status and WCST performance at follow-up. Therefore, there does appear to be some relationship between checking status and WCST performance beyond what can be explained by affective variables.     

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.     

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.     

Wisconsin Card Sorting in adolescents: analysis of performance, response times and heart rate

Forty-nine adolescents performed the Wisconsin Card Sorting Test (WCST). A main PCA component of WCST performance was identified as 'efficiency of reasoning'. This factor was related to feedback processing. From the WCST, a perseveration score can be derived. Perseveration is the continued application of a rule, after it has been disconfirmed. We compared more and less perseverating subjects in relation to stimulus-response (SR) time, feedback inspection time and cardiac acceleration and deceleration. Less perseverating subjects responded faster, and had longer and more adaptive inspection times of error feedback. We examined the switch from rule application to rule search, and the difference between correct and error responses. A transient cardiac deceleration at the initiation of rule search was interpreted as a change in supervisory attention. An error-related deceleration to negative feedback was interpreted as a disturbance of higher control processing. Previous trial feedback influenced current processing time, feedback inspection time, and the cardiac acceleration and deceleration responses.     

Cognitive Components in Perseverative and Nonperseverative Errors on the Object Alternation Task

Knowledge of response rules in the object alternation (OA) task was experimentally manipulated in 20 alcohol-dependent men and 20 controls. The results suggest that perseverative and nonperseverative errors in OA are under the direct control of task-specific knowledge which must be induced and retained from trial to trial, and that impaired response inhibition is not solely responsible for poor performance on these tasks. The demonstration of a cognitive contribution to poor performance on the OA task suggests that rule induction must be achieved before successful response selection and inhibition can take place. We conclude by discussing implications for our understanding of other delayed response tasks and clinical tests of prefrontal function (e.g., the Wisconsin Card Sorting Test (WCST) and the Halstead Category Test).     

Reduction of perseverative errors in patients with schizophrenia using monetary feedback.

The influence of monetary feedback on Wisconsin Card Sort Test (WCST) performance of 14 male schizophrenics was investigated. Patients were administered the test under standard instructions and with monetary feedback in counterbalanced order. Monetary reinforcement reduced perseverative errors and increased correct responses (p less than .05). These findings suggest that the WCST perseverative errors of schizophrenics reflect motivational as well as cognitive factors.     

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.     

Differences in baseline and process variables between non-responders and responders in Internet-based cognitive behavior therapy for chronic tinnitus

Although Internet-based cognitive behavior therapy (iCBT) is an effective treatment for chronic tinnitus, several patients do not improve. In the current study, baseline and process variables were compared between non-responders and responders. Data from patients participating in two randomized controlled trials on iCBT for chronic tinnitus were re-analyzed. Based on the literature, a pre-post difference on the “Tinnitus Handicap Inventory” (THI) of less than seven points improvement was used to operationalize non-response. Associations between non-response and baseline variables (age, gender, and questionnaire scores), patient progress (THI), the process of the therapeutic alliance (“Working Alliance Inventory-Short Revised”; WAI-SR), as well as other process variables (number of logins, amount of messages sent from therapists to patients) were investigated. The results showed that non-responders had a less favorable change on the THI than responders already at mid-treatment (p < .05). The alliance (WAI-SR) during iCBT was not associated with non-response. Non-responders showed more severe sleep disturbances, logged in less in the iCBT platform, and received fewer messages from the therapists than responders, but these differences were mostly not significant anymore when correcting for multiple testing. To conclude, no symptom change in the first half of iCBT for chronic tinnitus patients is a risk factor of not benefiting from iCBT.     

基于反馈加工的规则学习:研究儿童认知灵活性的新范式

认知灵活性作为执行功能的三个主要成分之一,对个体能力发展和环境适应起着重要作用。但以往研究多采用不同范式来考察不同年龄段儿童在一个优势规则失效后灵活转换至新规则的能力。本研究旨在威斯康星卡片分类任务(WCST)的基础上设计一种新任务范式,考察年龄范围更大的群体在规则习得过程中根据不同性质的反馈信息保持与灵活修订假设的能力。我们设计了目标选择任务(target choose task,TCT),考察181名5~11岁儿童的认知灵活性。其中24名儿童亦完成WCST。结果表明,TCT通过率界于32~65.7%;TCT高分组成绩显著高于低分组;分半信度计算结果表明奇数编号题目与偶数题目得分正相关;TCT分数与WCST完成分类数和概念化水平数分别呈正相关。这些结果表明TCT难度适中,具有区分度,内部一致性高,效度良好,可以在更大的年龄跨度上研究儿童在规则习得过程中的认知灵活性。     

Face and location processing in children with early unilateral brain injury

Human visuospatial functions are commonly divided into those dependent on the ventral visual stream (ventral occipitotemporal regions), which allows for processing the ‘what’ of an object, and the dorsal visual stream (dorsal occipitoparietal regions), which allows for processing ‘where’ an object is in space. Information about the development of each of the two streams has been accumulating, but very little is known about the effects of injury, particularly very early injury, on this developmental process. Using a set of computerized dorsal and ventral stream tasks matched for stimuli, required response, and difficulty (for typically-developing individuals), we sought to compare the differential effects of injury to the two systems by examining performance in individuals with perinatal brain injury (PBI), who present with selective deficits in visuospatial processing from a young age. Thirty participants (mean = 15.1 years) with early unilateral brain injury (15 right hemisphere PBI, 15 left hemisphere PBI) and 16 matched controls participated. On our tasks children with PBI performed more poorly than controls (lower accuracy and longer response times), and this was particularly prominent for the ventral stream task. Lateralization of PBI was also a factor, as the dorsal stream task did not seem to be associated with lateralized deficits, with both PBI groups showing only subtle decrements in performance, while the ventral stream task elicited deficits from RPBI children that do not appear to improve with age. Our findings suggest that early injury results in lesion-specific visuospatial deficits that persist into adolescence. Further, as the stimuli used in our ventral stream task were faces, our findings are consistent with what is known about the neural systems for face processing, namely, that they are established relatively early, follow a comparatively rapid developmental trajectory (conferring a vulnerability to early insult), and are biased toward the right hemisphere.     

The unity and diversity of executive functions and their contributions to complex "Frontal Lobe" tasks: a latent variable analysis

This individual differences study examined the separability of three often postulated executive functions-mental set shifting ("Shifting"), information updating and monitoring ("Updating"), and inhibition of prepotent responses ("Inhibition")-and their roles in complex "frontal lobe" or "executive" tasks. One hundred thirty-seven college students performed a set of relatively simple experimental tasks that are considered to predominantly tap each target executive function as well as a set of frequently used executive tasks: the Wisconsin Card Sorting Test (WCST), Tower of Hanoi (TOH), random number generation (RNG), operation span, and dual tasking. Confirmatory factor analysis indicated that the three target executive functions are moderately correlated with one another, but are clearly separable. Moreover, structural equation modeling suggested that the three functions contribute differentially to performance on complex executive tasks. Specifically, WCST performance was related most strongly to Shifting, TOH to Inhibition, RNG to Inhibition and Updating, and operation span to Updating. Dual task performance was not related to any of the three target functions. These results suggest that it is important to recognize both the unity and diversity of executive functions and that latent variable analysis is a useful approach to studying the organization and roles of executive functions.     

Wisconsin card sorting test and Halstead Category Test performances of children and adolescents who exhibit the syndrome of nonverbal learning disabilities

Abstract

Wisconsin Card Sorting Test (WCST) and Halstead Category Test (HCT) performances of 15 children/adolescents (age range 9 to 17 years) diagnosed with the syndrome of nonverbal learning disabilities (NLD) and 15 age-, gender-, and FSIQ-matched verbal learning-disabled (VLD) controls were examined. The VLD group made significantly fewer errors on the HCT than did the NLD group. In addition, the VLD controls significantly outperformed the NLD participants on seven of the nine WCST index scores (all except failure to maintain set and learning to learn scores). Consistent with the adult literature, the common variance between the HCT and WCST was modest, indicating that these two neuropsychological measures gauge different domains of functioning. It is suggested that the HCT assesses conceptualization/higher order reasoning abilities, whereas the WCST taps dimensions of executive functioning.     

Is problem solving dependent on language?

There has been a long-standing debate in the fields of philosophy and cognitive science surrounding the relationship of language to cognition, but the exact nature of this relationship is still unclear (Sokolov, 1968/1972). In the current study, we explored the role of language in one aspect of cognition, namely problem solving, by administering the Wisconsin Card Sorting Test (WCST) to stroke patients with varying degrees of language impairment (Experiment 1) and to normal participants under conditions of articulatory suppression (Experiment 2). In Experiment 1, there was a significant correlation between performance on the WCST and language measures such as comprehension and naming. Demonstrating the specificity of this result, we also found a significant relationship between language performance and another test of problem solving, the Raven's Colored Progressive Matrices, but no relationship between language and a test of visuospatial functioning. In Experiment 2, normal participants were significantly impaired on the WCST under conditions of articulatory suppression, relative to a baseline condition. Together, these findings suggest that language plays a role in complex problem solving, possibly through covert language processes.     

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.     

Age-related differences in performance on the Wisconsin card sorting test: a meta-analytic review

Two meta-analyses investigating age-related differences in performance on a popular measure of executive function, the Wisconsin Card Sorting Test (WCST), are reported. The 1st meta-analysis examined age-related changes in performance for the number of categories achieved, and the 2nd meta-analysis examined performance for the number of perseverative errors committed. Results indicated that robust age differences were present on both measures. Further analysis of moderator variables revealed reliable effects of education and test version on both measures, whereas test modality led to marginally significant differences in effect sizes obtained only for the number of categories achieved. Findings are discussed along with current accounts of age differences in performance of the WCST.