Wisconsin Card Sorting Test (WCST)

AIM

To determine the higher-level cognitive functioning (set-shifting ability) of an individual using the Wisconsin Card Sorting Test.

INTRODUCTION

Wisconsin Card Sorting Test (WCST)

The WCST was developed by David A. Grant and Esta A. Berg. In 1948, Grant and Berg published their now very famous Wisconsin Card Sorting Test. It is a test of cognitive reasoning. Later, in the 1960s, Milner started to use this cognitive test to assess a patient’s level of brain damage to the prefrontal cortex.

The Wisconsin Card Sorting Test (WCST) is a neuropsychological test that is frequently used to measure such higher-level cognitive processes as attention, perseverance, working memory, abstract thinking, Contingency management, and set-shifting. It is particularly used in clinical fields to measure perseverative behaviors that refer to an individual’s insistence on wrong behavior. Moreover, to be able to change categories, one needs to have high intellectual flexibility and ability in concept formation.

The WCST consists of two card packs having four stimulus cards and 64 response cards in each. Each card measures 7×7 cm, and there are various geometric shapes in different colors and numbers. The participants are expected to accurately sort every response card with one of four stimulus cards through the feedback (right or wrong) given to them based on a rule.

HISTORY

Card sorting tests have a long tradition in psychology, going back more than 100 years to the work of Ach. History of sorting started from the studies of Narziss Ach on the psychology of thinking, via the work of Kurt Goldstein and Adhémar Gelb on brain lesion 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.

ABOUT THE TEST Wisconsin Card Sorting Test (WCST)

The Wisconsin Card Sorting Test (WCST) is a measure of executive function that is used both clinically and within research.

Each card measures 7×7 cm, and there are various geometric shapes in different colors and numbers. Among various versions, the version of WCST with 128 cards developed by Heaton was used in this study. The test was applied individually, and 12 scores were obtained (Heaton, Chelune, Talley, Kay, & Curtiss, 1993). A reliability study could not be conducted due to the nature of the test. The validity studies, on the other hand, were conducted on both sick and healthy groups, and it was shown that the test was valid for a Turkish sample (Kafadar, 2004).

The WCST requires the participant to sort a set of cards according to implicit rules and based on the limited corrective feedback provided by the examiner. The participant’s responses can be analyzed to produce separate indices of sources of difficulty on the test. There are four different ways to classify each card, and the only feedback is whether the classification is correct or not. One can classify cards according to the color of their symbols, the shape of the symbols, or the number of the shapes on each card.

The classification rule changes every 10 cards, and this implies that once the participant has figured out the rule, the participant will start making one or more mistakes when the rule changes. The task measures how well people can adapt to the changing rules.

The WCST consists of two identical sets of 64 response cards. Each of the cards measures 7×7 cm, and there are various geometric shapes in different colors and numbers. The Three possible perceptual sorting dimensions: color (red, blue, yellow, or green), form (crosses, circles, triangles, or stars), and a number of figures (one, two, three, or four).

Four target cards that represent the range of dimensions (one red triangle, two green stars, three yellow crosses, and four blue circles) are placed in a prescribed order in front of the participant. The value of the WCST, therefore, lies in its sensitivity for detecting and characterizing aspects of executive dysfunction. The participants tend to make some errors and test results is usually consist of these different types of error reports:

  • Total number errors (The sum of perseveration and non-perseveration errors is the total number of error).
  • Perseveration errors (when you keep applying the old rule)
  • Non-perseveration errors (non-perseverative WCST errors does not discriminate between errors related to the efficient test of hypotheses during set shifting (‘efficient errors’), and random failures to maintain set (‘random errors’).

Features and benefits

Completion of the WCST requires the ability to develop and maintain an appropriate problem-solving strategy across changing stimulus conditions in order to achieve a future goal. Unlike other measures of abstraction, the WCST provides objective measures of overall success and identifies particular sources of difficulty on the task (e.g., inefficient initial conceptualization, perseveration, failure to maintain a cognitive set, inefficient learning across stages of the test). When used with more comprehensive ability testing, the WCST is helpful in discriminating frontal from non-frontal lesions.

Test structure

Four stimulus cards incorporate three stimulus parameters (color, form, and number). Respondents are required to sort numbered response cards according to different principles and to alter their approach during test administration. To complete the task, clients should have normal or corrected vision and hear sufficient to adequately comprehend the instructions and to visually discriminate the stimulus parameters.

METHODOLOGY

MATERIAL REQUIRED

Paper, Pencil, and WCST 64 cards.

PROCEDURE TO FIND THE PARTICIPANT

The participant was selected based on ease of access. Finding a participant with neurological impairment or brain dysfunction was difficult to approach.

INFORMED CONSENT

The participant was first given a brief description of the test. He was also informed that this test would be conducted entirely at his own discretion which implies that he could decline his participation in this experiment if it was not convenient.

He was then given a consent form and all the relevant details related to the form were explained before soliciting the signature.

__________________________________________________________________________________________________________________________________________________

INFORMED CONSENT FORM

This form seeks to take your consent to participate in a study. The following will provide you with information about the study that will help you in deciding whether or not you wish to participate. If you agree to participate, please be aware that you are free to withdraw at any point throughout the duration of the experiment. All information you provide will remain confidential and will not be associated with your name. If for any reason during this study you do not feel comfortable, you may leave the laboratory and your information will be discarded.

When this study is complete you will be provided with the results of the experiment if you request them, and you will be free to ask any questions. Please indicate with your signature on the space below that you understand your rights and agree to participate in the experiment.

Your participation is solicited, yet strictly voluntary. All information will be kept confidential and your name will not be associated with any research findings.

Ny

SIGNATURE OF THE APPLICANT

____________________________________________________________________________________________________________________________________________________

RAPPORT FORMATION

A rapport was established before giving the instructions by giving him a brief detail of the study. It was also ensured that the details were explained to the participant in the language which was most agreeable to her.

All the arrangements regarding the experiment were arranged in an appropriate manner. The participant’s concerns if any were also managed for the smooth conduction of the experiment.

DEMOGRAPHIC DETAILS

  • NAME: NY
  • AGE: 22
  • GENDER: FEMALE
  • DATE OF ADMINISTRATION OF THE TEST: 25th December 2020.

INSTRUCTIONS

The stimulus cards are placed in a row in front of the subject. “There are four cards in front of you. These are called key cards. Besides you on the left side are a deck of cards similar to these key cards. You will have to take one card at that time from the top of this deck and match it with one of the key cards in front of you according to some principle, which I have in mind. If I would principled our same I will say “correct” otherwise I will say “wrong”. You have to think with which key card the particular card in your hand will match and then place the card below the key card. Each card will match with one of the key cards. I will not tell you how to match the cards. I will merely tell you whether you are right or wrong after every time you play the card. If you are wrong leave the card where it is and take the next card. Pink as to why I said wrong or correct. If you have any doubts please ask now. (The subjects are usually puzzled by this and are told to treat it as a game. Occasionally they get angry and frustrated at not being able to arrive at the concept. Some subjects may even plead for the concept. In such situations the subject is encouraged to think about what the concept could be) “please try to think what I have in my mind. If you try you will be able to do it” (some subjects pink that the examiner is cheating in the game when they have attained a concept and it is changed without their knowledge. They may get angry, frustrated, or feel betrayed by this. In such a situation, the examiner has to reassure saying that it is the nature of the rest and he or she has not created in the game). No, I did not cheat you. The nature of the test is itself like this. Please try to think what I have in my mind each time I say correct or wrong.”

PROCEDURE

After the rapport was established with the participant, instructions were given clearly to the participant, and were asked to get their confusion clear. The test was conducted and during the conduction, the participant was encouraged to help themselves whenever there was confusion instead of giving them any hint. The scoring was done based on norms of scoring also errors and trials were recorded carefully so to avoid any mistakes in the analysis and results of the test.

RESULTS

  ScoresPercentile
Total number of trials124
Total number of correct response8680%
Total number of categories completed6
Total number of errors2881%
Percent errors2587%
Perseveration errors697%
Percent Perseveration errors897%
Non-Perseveration errors894%
Percent Non-Perseveration errors790%

INTERPRETATION AND DISCUSSION

The subject has scored a percentile is 80 for the total number of trials in all the dimensions of the Wisconsin card sorting test, which indicates that subject has a good set-shifting ability because the subject total percentile comes above the average scores. The subject’s perseveration errors scored  4 and its percentile score is 97.  This means the subject has better scores than the rest of 91 percent of the general population and indicates that subject has the normal level of perseveration error, Subject has scored 7 on a non-perseveration error and the percentile score is 90. The scores on non-perseveration errors indicate that subject performs better than the rest of  90percent of the general population.

CONCLUSION

The subject has scored a percentile of 90%  for all the dimensions of the Wisconsin card sorting test, which indicates that the subject has a good set-shifting ability.

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