Wisconsin Card Sorting Test (WCST)

Background

The Wisconsin Card Sorting Test (WCST) is one of the oldest and most widely used neuropsychological assessments in clinical and research psychology. The test was developed in 1946 as a master's thesis project by Esther Berg under the supervision of Harry Harlow and David Grant at the University of Wisconsin with the goal of providing an objective, quantitative assessment of flexibility in thinking. The task took inspiration from previous card sorting tasks created by Naziss Ach in the 1900s to study the Psychology of Thinking ("Denkpsychologie"), and by Kurt Goldstein and Adhémar Gelb in the 1920 to study cognitive impairment from brain lesions.

The task was first used to study patients with brain leisons by Brenda Milner in 1963. The first computerized version was created by Heaton, Curtiss, and Tuttle (1993).

Task Procedure

The participant is presented cards drawn one at a time from a deck of 64 cards, twice for a total of 128 cards. The cards depict symbols that vary in shape, color, and quantity.

Shapes - cross, triangle, star, or circle Colors - red, blue, green, or yellow Quantities - one, two, three, or four

The participant must guess the sorting rule by selecting one four reference cards that match the target card based on color, shape, or quantity of symbols. After each sort, a feedback message indicates whether the sort was correct or incorrect, enabling the participant to deduce the rule. After 10 consecutive correct responses, the sorting rule changes and the participant must discover the new rule through trial and error.

What it Measures

The WCST is not diagnostic of any single condition, but rather a general assessment of frontal lobe function and prefrontal cortex integrity.

Psychological domains

• Executive Functioning
• Abstract reasoning: Identify and apply abstract categories
• Learning: Discover changing sorting rules through trial and error
• Cognitive Flexibility: Shift to a new rule when the previous rule no longer applies
• Perseveration: Failure to shift to a new rule despite error feedback
• Working Memory: Track previous rules and feedback while formulating hypotheses

Main Performance Metrics

• Perseverative Errors: Difficulty disengaging from the old rule (executive dysfunction)
• Categories Completed: Number of successfully discovered and applied rules
• Failure to Maintain Set: Forgetting a rule after discovering it (attentional problems, impulsivity)
• Total Errors: General efficiency
• Learning To Learn: Faster discovery of new rules over the course of the test

Psychiatric Conditions

WCST Performance tends to be impaired in patients with the following conditions.

• Schizophrenia
• Traumatic Brain Injury (TBI)
• Parkinson’s Disease
• Eating Disorders
• Obsessive-Compulsive Disorder (OCD)
• Dementia
• Attention Deficit Hyperactivity Disorder (ADHD)
• Autism Spectrum Disorder

Available Test Variations

References

Search Google Scholar for peer-reviewed, published research using the Inquisit Wisconsin Card Sorting Test (WCST).

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Grant, D.A. & Berg. E.A. (1948). A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card sorting problem. Journal of Experimental Psychology, 38, 404-411.

Heaton, R., Chelune, G., Talley, J., Kay, G., & Curtiss, G. Wisconsin Card Sorting Test Manual—Revised and Expanded 1993. Lutz, FL: Psychological Assessment Resources Inc

Miles, S., Howlett, C.A., Berryman, C. et al. Considerations for using the Wisconsin Card Sorting Test to assess cognitive flexibility. Behav Res (2021). https://doi.org/10.3758/s13428-021-01551-3