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    Manual de Administração WCST-64

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    Isabela Nerys

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    WCST, Wisconsin Card Sorting Test- 64 Card Version Professional Manual Susan K. Kongs, Laetitia L. Thompson, PhD, Grant L, Iverson, PhD, and Robert K. Heaton, PhD WCST44 Wisconsin Card Sorting Test- 64 Card Version Professional Manual Susan K. Kongs, Laetitia L. Thompson, PhD, Grant L. Iverson, PhD, and Robert K. Heaton, PhD PAR psychological Assessment Resources, Inc. ACKNOWLEDGMENTS We extend our sincere appreciation to Gordon J Chelune, Jack L. Talley, Gary G. Kay, and Glenn Curtiss, the co-authors of the 1993 Wisconsin Card Sorting Test, Manual-Revised and Expanded, who generously allowed us access to the data used in that manual. In particular, we are indebted to Glenn Curtiss for his help with the archival data, and for his advice in the early phases of the Wisconsin Card Sorting Test-64 Card Version (WCST-64) project. We also wish to thank the following individuals who contributed to the data sets used in the WCST and WCST-64 projects: Bradley N. Axelrod, Moms J. Cohen, Marilyn P Dombush, Maryruh Eaves-Herrera, Cheri L. Geckler, Dena M. Groisser, Shelley C. Heaton, Marion I. S. Huettner, George W. Hynd, James 8. Misko, Michael J. Nova, Bruce F, Pennington, Cheryl H. Silver, Michael Westerveld, and Greta Wilkening We greatly appreciate the work of Brandon Cornejo and Amy Clark who helped with the rescoring of the individual WCST protocols, and thank Jennifer Cronin who provided assistance with the development of the tables. We are most grateful to Christopher L. Leitten, Travis White, Kelly A. Crowe, Richard J. Latshaw, Sandra Schneider. Jodi Thompson, R. Bob Smith, Il, and the staff of PAR for their support and invaluable assistance in com- pleting this project. Susan K, Kongs Laetitia L. Thompson Grant L. Iverson Robert K. Heaton June, 2000 PAR Peychotogicat Assosement Resources, ine /P.0. x 908/0dessa, 38556 Toll-ee 1.500.351 TEST/wwnparinecom Copyright © 1981, 1993, 2000 by Psychological Assessment Resources, Inc, All ights reserved. May not be reproduced in whale crim part in any form or by any means without writen pennission of Psychological Assessment Resources, In. 9876543 Reorder #RO-84 Printed in the USA. Acknowledgments 1 3 TABLE OF CONTENTS Introduction...... WCST Test Development. Shortened Versions of the WCST. WCST-64 Test Materials and Appropriate Use .... ‘Test Materials eons Appropriate Populations... Professional Requirements, istration and Scoring.. Recording Responses. Specific Test Situations Scoring _ WCST:64 Scores and Scoring Dimensions... Caleutating WCST-64 Scores. Case Hlustrations of Scoring... Associated Normative Scores. Normative and Descriptive Statistics. Normative Sample. Selection of Normative Variables... Influence of Demographic Variables Demographically Corrected Normative Dat. ‘Continuous Norms Categorical Norms USS. Census Age-Matched Normative Data... Interpretation, Nommative Comparisons...00 Base Rate Comparisons. ss Interpretation of Multiple Scores on the WCST-64 Case Mlustrations Case 1 Case Case 3 Reliability and Validity Reliability ofthe WCST. Administration and Scoring Reliability. ‘Test Retest Reliability Validity of the WEST Construct Validity... Cross-Cultural Validity Empirical Validation ofthe WCST in nical Groups Lesion Studies. Functional Neuroimaging Reliability of the WCST-64. Fidelity of Measurement z Standard Error of Measurement. Empirical Validation of the WCST-64 in Clinical GeO PS Descriptions of Validity Groups. ‘Adult Validity Data Child and Adolescent Validity Dats. : Child and Adolescent Focal Lesion Groups. Child and Adolescent Diagnostic Groups.. Inlercomtelations of WCST-64 Scores Factor Structure of WCST-64 Scores, Clinical and Control Group Comparisons ‘Adults With Acquired Brain Damage Sensitivity and Specificity o Swuctural Bran Damage. Children and Adolescents With Brain Lesions : Sensitivity and Specificity to Structural Brain Damage. Child and Adolescent Diagnostic Groups Conclusions... Additional Studies. Comparisons of WCST and WCST-64.. ‘Administration Time ‘Test Results Normative Data. Clinical Applications... References. Appendix A: Glossary of Terms. ‘Appendix B: Normative Data for U.S. Census Age-Matched Adult Sample. Appendix C: Demographically Corrected Normative Data .. Appendix D: Base Rate Data for Normative and Clinical Samples... Appendix E: Cumulative Percentile Ranks for the Normative Sample by Aer for Selected WCST-64 T-Scores. ees 1 ‘The Wisconsin Card Sorting Test-64 Card Version (WCST.64) is an abbreviated form of the standard 128-card yession of the Wisconsin Card Sorting Test (WCST: R. K. Heaton, 1981). The WCST-64 normative, reliability, and validity data are derived from the same samples described in the Wisconsin Card Sorting ‘Test Manual-Revised and Expanded (R. K. Heaton, Chelune, Talley, Kay, & Curtiss, 1993). The WCST-64 maintains the task requirements of the WCST: therefore, much of what is known about the WCST will generalize to the WCST-64 (e.g., administration and scoring reliability). Although some of the WCST literature ‘may not be directly applicable to the WCST-64, it will pro- vide helpful information until additional WCST-64 studies become available. For this reason, a brief overview of the WCST is inchided in this chapter. WCST Test Development Loosely modeled after tests utilized by animal researchers (Settlage, Zable, & Harlow, 1948; Teuber, Bauersby, & Bender, 1951; Zable & Harlow, 1946), as well 88 an existing instrument, the Weigl Color-Form Sorting Test, used with humans (Weigl, 1941), the WCST was developed in 1948 Berg, 1948; Grant & Berg, 1948) as a ‘measure of abstract reasoning ability and the ability to shift cognitive set As such, the WCST can be considered a meas- urc-of “executive function,” requiring the ability to develop ‘and maintain an appropriate problem-solving strategy across changing stimulus conditions in order to achieve a future goal (Luria, 1973; Shallice, 1982). Similar to other meas- tres of executive function, the WCST requires (a) concen- ation, (b) planning, (c) organization, (d) cognitive ‘lexibilicy in shifting set, (e) working memory. and (f) ini bition of impulsive responding (Chelune & Baer, 1986: Gnys & Willis, 1991; Welsh & Pennington, 1988), ‘The current populatity of the WCST among clinicians stems from its reported sensitivity to brain dysfunction affecting the frontal lobes (Drowe TUTE Milner 19837 Robinson, R. K. Heaton, Lehman, & Stilson, 1980: ‘Weinberger, Berman, & Zec, 1986). Because of this apparent INTRODUCTION sensitivity to the effects of frontal Jobe lesions, the WCST is sometimes referred to as a measure of “frontal” or “pre: frontal” functioning. However, this labeling represents an oversimplification, The frontal lobes are highly complex structures and subserve @ far wider variety of cognitive functions than those assessed by the WCST alone. Additionally, impaired performance on the WCST can occur in clients who have brain disease that does not directly involve the frontal lobes. Clinical interpretation of WCST performance should be conducted within the context of a comprehensive neuropsychological evaluation that inte- grates neuropsychological data with medical, psychosocial, and historical information, The WCST consists of four stimulus cards and 128 response cards that depict figures of varying forms ot shapes (aosses, circles, triansles, or stats), colors (red, blue, yellow, oF green) and pumbers of figures (one, two. the, or {oup) Inthe standard administration, the four stimulus cards With the following characteristics are placed before the respondent in left-to-right order: one red triangle, two green stars, three yellow crosses, and four blue circles. The respondent is then handed a deck of 64 response cards and instructed to match each consecutive card from the deck with whichever one of the four stimulus cards he oF she thinks it matches, The respondent i told only whether each response is right or wiong and is never old the correct sort- ing principle (or category). Once the respondent has made @ specified namber of consecutive “correct” matches to the iniial sorting principle (Color), the sorting principle is changed to Form without warning, requiring the respondent to use the examiner's feedback to devclop a new sorting strategy. The administration proceeds in this manner through a number of shifts in set (i.e. sorting principles) among the three possible sorting categories (Color, Form, and Number). Numerous variations of the WCST have been advanced in which the number and order of the response cards, the umber and order of the sorting categories, and the criteria for shifting the sorting categories have differed. R. K. Heaton (1981) standardized the test materials (i.e., two ordered decks of 64 cards), as well as the administration (i.e., six category shifts following 10 consecutive correct responses to each sorting rule) and scoring procedures. Expanded normative data corrected for age (6% through 89 years) and education (& 8 years to 2 18 years) are provided in the Wisconsin Card Sorting Test Manual-Revised and Expanded (R. K. Heaton et al., 1993). Shortened Versions of the WCST ‘The WCST has enjoyed wide usage and application with many different patient groups. However, concerns for patient comfort, managed care, and tighter research budgets have encouraged clinicians and researchers to use shorter test batteries, Three shortened versions of the WCST that address these concerns have been reported in the literature: the Modified WCST (mWCST; Nelson, 1976). the WCST-3 (Robinson, Kester, Saykin, Kaplan, & Gur, 1991), and the WCST-64, first reported by Haaland, Vranes, Goodwin, and Garry (1987). ‘The mWCST was developed for administration to patients with Alzheimer’s disease and other patient popula tions for whom the standard WCST was considered to be too difficult. The task demands of the mWCST are signifi- cantly changed from those of the WCST; the mWCST uses only those standard WCST cards that match the stimulus cards in a single dimension (48 cards). After six correct responses, the respondent is informed by the examiner that the correct category is changing. The test is discontinued when six categories are achieved or when all of the 48 response cards have been used, whichever occurs first, The WCST-3 uses the standard administration proce- dure, but the test is discontinued when the respondent has completed three correct categories. This version has been shown to correlate well with the WCST. However, for indi- viduals who do not complete three categories (these are often those respondents who are most impaired and who ‘work more slowly), this version does not decrease adminis- tration ime because all 128 cards are administered. ‘The WCST-64 uses only the first 64 cards of the stan- dard version of the WCST and all respondents complete 64 lirials (or cards). The advantages of the WCST-64 over the shortened versions previously discussed are a significant ldccrease in administration time while, at the same time, retaining the task requirements of the standard version. | Additionally, the variability in the number of cards adminis- is removed (L.e., all examinees are administered all 64 lcards) so comparisons of test-retest stability are more jstraightforward, as are comparisons with normative and validity data. Information on WCST-64 materials, administration and scoring, reliability and validity, as well as guidelines for interpretation and normative tables are presented in the fol- lowing chapters. 2 WCST-64 TEST Test Materials ‘The WCST-64 test materials consist of Required Materials © WCST-64 Professional Manual Four stimulus cards One deck of 64 response cards WCST-64 Record Booklet Optional Materials WCST-64: Computer Version for Windows" (WCST-64:CV) Research Edition WCST-64:CV Scoring Program for Windows® Research Edition WCST-64:CV Record Form Wisconsin Card Sorting Test: Administration and Scoring Videotape Wisconsin Card Sorting Test: Individual Practice in Administration and Scoring (workbook) The stimulus and response cards use the figures with systematic figure configurations originally developed by Grant and Berg (1948) and described in the Wisconsin Card Sorting Test Manual-Revised and Expanded (R. K. Heaton ct al., 1993). The four stimulus cards display one red trian- als, two green stars, three yellow crosses, and four blue cit. ‘les, respectively. These four stimulus eards reflect three, ‘and only three, stimulus parameters: Color, Form, and ‘Number. The response card deck consists of 64 cards that also display figures of varying colors (red, blue, yellow, or figures of varying colors (red, yellox seen), forms (crosses, circles, triangles, or stars), and num ‘ets of figures (one, «wo, thre, or four), Each response card an be matched 10 a stimulus card on nse San be matched to a stimulus card on one, or any combina: on, of the three stimulus parameters. The response cards ae numbered from 1 10 64 on the lower left commer of the Feverse side to ensure a standard order of presentation in ‘hich no two successive response cards within the deck dis- play the same color, form, or number. ‘The four-page WCST-64 Record Booklet is designed for recording information about the respondent, recording MATERIALS AND APPROPRIATE USE the responses to the WCST-64 items, and calculating and recording WCST-64 scores. The first page of the booklet contains space for recording demographic information, the diate of testing, and the name of the examiner Areas are also provided for recording referral information, current medicn, tions, bchaviral observations, and judgments about several test performance factors. The second page of the record booklet is used for recording the fespondents performance and for entering seorin for calculating WCST-64 scores At the top of the second page of the booklet, the category sequence C, FN. C, FN corresponds to the sequence of sorting strategies. The individual's responses tothe 6d items are recorded as the esponse cards are presented in numer cal sequence. Each response item appears as{©F NO] where € = Color, E = Form, N.= Number, and Q = ‘Other. A space is provided to the left of each item for the examiner to record the consecutive number of correct responses (up to 10) within a category. The space to the right of each item allows the examiner to indicate vari ous scoring dimensions after the administration has been completed ‘The third page of the record booklet provides an area for calculating WCST-64 raw scores. Spaces are also pro- vided for entering associated normative scores (standard scores, T scores, and percentiles from the appropriate ‘Appendix tables in this manual), Appropriate Populations The Appendixes provide WCST-64 normative data for use with individuals ranging from 6 trough 89 years of age. There were few individuals above ihe age-oF 85 years Jn the normative sample, so interpretation of test perform. ance of individuals between ages 85 and 89 years should be approached cautiously, It is generally recognized that care should be taken in applying normative neuropaycho- logical test data to groups which differ culturally from the normative groups. There is curently no published research on the WCST-64 for non-nglish speaking individuals and 2 WCST-64 TEST Test Materials ‘The WCST-64 test materials consist of: Required Materials © WCST-64 Professional Manual ‘© Four stimulus cards ‘¢ One deck of 64 response cards ¢ WCST-64 Record Booklet Optional Materials WCST-64: Computer Version for Windows® (WCST-64:CV) Research Edition WCST-64:CV Scoring Program for Windows® Research Edition WCST-64:CV Record Form Wisconsin Card Sorting Test: Administration and ‘Scoring Videotape Wisconsin Card Sorting Test: Individual Practice in Administration and Scoring (rorkbook) The stimulus and response cards use the figures with systematic figure configurations originally developed by ‘Grant and Berg (1948) and described in the Wisconsin Card Sorting Test Manual-Revised and Expanded (R. K. Heaton et al., 1993). The four stimulus cards display one red trian- als, wo green stars, tee yellow crosses, and four blue cit- les, respectively. These four stimulus cards reflect three, and only three, stimulus parameters: Color, Form, and Number. The response card deck consists of 64 cards that also display figures of varying colors (ged, blue, yellow, or xcen), forms (cgosses, cicles, wianles, or stars), and num, bers of figures (one, wo, three, or four). Each response card an be matched to a stimulus card ‘combina: on, of the three stimulus parameters. The response cards axe numbered from 1 to 64 on the lower left corner of the Teverse side to ensure a standard order of presentation in which no two successive response cards within the deck dis- play the same color, form, or number. ‘The four-page WCST-64 Record Booklet is designed for recording information about the respondent, recording MATERIALS AND APPROPRIATE USE the responses 0 the WCST-64 items, and calculating and recording WCST-6! scores, The first page of the booklet Contains space for recording demographic information, the date of testing. and the name of the examiner. Areas are also provided for recording referral information, curren medica- ions, Yehavioral observations, and judgments about several test performance factors. ‘The second page of the record booklet is used for recording the respondent's performance and for entering scorin for calculating WCST-64 sc At the top of the second page of the booklet, the category sequence C, FN. C, FN corresponds to the sequence of sorting strategies. The individual's responses to the 64 items are recorded as the response cards are presented in numeri- cal sequence. Each response item appears as CFO] where €= Color, B= Form, N= Number, and @ = Other: A space is provided to the left of each item for the examiner to recotd the consecutive number of correct Tesponses (up to 10) within a category. The space to the ight of each item allows the examiner to indicate vari- ous scoring dimensions after the administration has been completed. The third page of the record booklet provides an area for calculating WCST-64 raw scores. Spaces are also pro- vided for entering associated normative scores (standard Scores, T scores, and percentiles from the appropriate Appendix tables in this manual). Appropriate Populations ‘The Appendixes provide WCST-64 normative data for se with individuals ranging from 6% trough 89 years of age. There were few individuals above the age of $3 years Inthe normative sample, so interpretation of test perform ance of individuals between ages 85 and 89 year should be approached cautiously. It is generally recognized that care should be taken in applying normative newopsycho- logical test data to groups which differ eulually from the normative groups. There is curently no published research on the WCST.64 for non-English speaking individuals and ‘additional research is needed before use of the WCST-64 can be recommended in these non-English speaking popula tions, However, the WCST-64 maintains the task require~ ments of the WCST and several studies of WCST performance of non-U.S. respondents have found relatively ‘good concordance with the R. K. Heaton et al. (1993) nor- ‘mative data (see chapter 6 for a review), Respondents should have adequate vision to sce the test materials. Most individuals who report that they are color blind are able to discriminate well enough to tell that each of the four colors used in this testis different from the oth- ‘rs, and they are able to use color as one of the sorting cate~ gories. Unless the individual introduces the topic of ability to discern the various colors, the examiner should wait until after the test to assess this ability. Some examiners routinely determine whether the patient has poor vision or hearing, is colorblind, and/or has language problems prior to beginning a comprehensive evaluation. However, this determination should be made well before the WCST-64 is administered Respondents must be able to comprehend the test instruc tions. Because the WCST-64 is effort-dependent, as are most neuropsychological tests, valid and interpretable results depend on the respondents’ willingness and ability to attend to and work toward the solution of the test, Among Clinical populations with known or suspected brain dysfunc- tion, these requirements will not always be met, In such cases, the validity of the WCST-64 test results must be determined by the examiner/psychologist. Professional Requirements It is generally accepted that individuals trained and supervised by a qualified psychologist may administer and scare this test. Before administering the test, examiners should be familiar with the test materials, memorize the test instructions, and be adept at recording and scoring responses. Clinical interpretation of the WCST-64 requires professional training and expertise in clinical psychology ‘and/or neuropsychology. The utility and validity of the WCST-64 as a clinical measure of cognitive ability are dependent on the professional's background and mowledse. fas well as the mastery of the information contained in this ‘manual. Interpretation of WCST-64 scores for clinical or diagnostic purposes should not be attempted without ade~ ‘quate understanding of brain—behavior relationships and the ‘medical and psychological factors that affect them. ‘The WCST-64 test materials and manual should be used in accordance with the standards of practice established by the “General Guidelines for Providers of Psychological Services” (American Psychological Association, 1987), Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, & National Council on ‘Measurement in Education, 1999), and “Ethical Principles of Psychologists and Code of Conduct” (American Psycho- logical Association, 1992). Unless required by lav, test materials and record forms should not be released to anyone other than professionals qualified to interpret this test. a ‘The WCST-64 may be used as a clinical or research instrument in combination with other test procedures to assess aspects of cognitive and neuropsycholosical fune- tioning, Administration and scoring guidelines are presented in the following sections. In addition, case examples are provided to illustrate scoring procedures. With the exception of a few minor necessary adjustments, the administration and seoring procedures of the WCST-64 are the same as those of the WCST. As such, the Wisconsin Card Sorting Test: Administration and Scoring Videotape (S. K, Heaton, 1995) and the accompanying Workbook, Wisconsin Card Sorting Test: Individual Practice in Administration and Scoring (8. K. Heaton & Tnompson, 1995) may be used to facilitate mastery of these techniques to increase accuracy of test administration and scoring. Administration Administration should take place in a quiet room with ilumination adequate for viewing the WCST-64 stimuli, A fable or desk and two chairs, one for the examiner and one for the respondent, are required. The table or desk should provide ample space for arranging the cards and should be free of extraneous materials. In addition to the WCST-64 ‘materials, the examiner will ned a pen or pen) for record- ing the individual's responses. A cliphaard to hold the record booklet is also desirable to shield the record booklet from the respondent's view. Prior to administration, the ‘ \n the individual that he or she is recording color, form, or number for each response card). @u the respondent becomes frustrated by the ambiguity of the test instructions or reacts nega tively to being told he or she is “wrong,” the examiner should remain calin and encourage the {individual to continue to try to get them right. It is sometimes helpful to tell the individual that there is a way to get them right. It is permissible torespond “correct” or “incorrect” if the individ= tual finds these words more acceptable. However, it is recommended that the examiner avoid ‘switching terminology back and forth during an administration re sesponen changes response etre eeeince nas ingicated in amy wy that the cig or wrong tis 6 allowed, Te eBid be cael not invent See aaa by waiting longer respond te inconet cat 0 1f the respondent attempts to remove a response ‘card after being told that it is wrong, the individ- al should be reminded to leave that card in place IF the respondent does not appear to be paying attention, the examiner should encourage him or her to concentrate (e-g., “You need t0 really con- centrate on this test.” or “There is a way 10 get them righty to figure it out”) An individual who responds quickly and without tnuch thought should be encouraged to slow down and try to get the items right. Ifthe indi- vidual responds ata rate that is faster than about cone card per second and is making frequent errors, the examiner may ask the individual to respond more slowly (¢.g.. “Please respond @ litle more slowly so that T have time to record your response and Tet you know if you are right or wrong.”). @U the respondent makes an Other response (i.¢.. a response that does not match any of the stim lus dimensions), the examiner should ask whether the individual is matching to the key card above the pile of response cards. If the indi- vidual indicates that the response card was placed to match any other key card of the response pile itself, that response is not recorded, ‘The individual is asked 10 take that card back and ig reminded that the card should be placed below the Key card that it matches. QB te nas ben an terepin in he a I a ris often el 1 show te a sin last response and to 7=peat ‘whether that response Was tight or wrong. Jf the examiner realizes that he or she has incorrect feedback to the respondent regarding ‘one of more cards, the examiner should go back to the last card where correct feedback was given, The examiner would pick up the cards placed during these tials, reorder them, and return them to the individual's response deck. ‘The individual is told that the examiner made an error “I made a mistake and we are going to back up a few cards." The examiner may point out the ast response oF two before the feedback error ‘was made, reminding the individual whether the response was right or wrong. If this type of ‘examines error does occur, it should be noted on the record sheet. Scoring ‘An advantage of the WCST-64 and WCST over many other tests of “executive functioning” is the generation of ‘nultiple scores that reflect different aspects of test performn- ‘ancs, However, calculating these test measures require carefully following complex scoring provedures. Obtaining ‘an operational understanding of the test (Le... becoming: familiar with the manner in which the scores are derived) ‘will greatly facilitate clinical interpretation. Before delineating the specific steps for scoring the WCST-64 administration, itis helpful to reexamine the rhe ofthe test and the terms used to describe the various Teanres of a espondent’s response. Successful performance ton the WCST-64 requires a respondent to first determine the onect soning principle on the basis of examiner feedback cet hon to quaintain this sorting principle or set, (@-8.- Color) across changing stimulus conditions while ignoring Sther stimulus dimensions (e.g., Form and Number). Failure to Maintain Set (see Glossary in Appendix A) occurs when 258 kes fv conect responses and then makes an erioe-befare sicssss- schissing a category (see Glossary in Appendix A) by getting 10 consecutive comect mai iches. However, as soon as ate individual makes 10 consecutive correct responses weithin a category (e.g. Color), the examiner changes the Sorrest sorting principle to a new category (6-8. For) Cvithout informing the respondent. Now, in back thatthe previous sorting principle is nolo ree ndividval must inhibit the tendency to persist or perse= verate (see Glossary in Appendix A) ‘with the old principle Sah ambst use the examiner's feedback Jing the new contect sorting principle. WCST-64 Scores and Scoring Dimensions Each response an individual makes can be thought of as occurring on three separate dimensions, each of which should be evaluated: incorrect. ambiguous ‘unambiguous, and perseverative-nonper + Couect Incorrect, The examiner gives the respondent teedback for each response indicating whether itis courect or incorrect, depending on whether or not the response ratches the current cortect sorting principle. Responses that match the current sorting principle are scored as correct (see Glossary in Appendix A) whereas incorrect respaner are scored a5 errors (sce Glossary in Appendix A). Couect cs < items the examiner numbered i ord booklet durin isttation of the WCST-64. After the administration is completed, the examiner should viele all items that were not numbered during the administra ‘Gicled Connumbered) tems represent incomrect respons (G.e., errors). These recording and scoring procedures are depicted in Figure 3. gFNCEN C _GeFKD (Brors ape circled] £FNO — [Qnly correct responses i zene ¢FNO s£FKO s£F¥NO. of FNO sZEKO TZ. sGFNO ofFNO 2 ufFNo 10 .gFNo SOT C Figure 2, Mlustration of scoring correct responses and errors on the WCST-64, * Ambiguous-Unambiguous. When a response card ‘matches a stimulus card on one and onl - acteristic (e., Color), the principle the respondent used for the match is obvious and unambiguous (see Glossary in Appendix A) to the examiner. For example, a response card with three red circle is matched to the stimulus card with a single red twiangle. However, response cards can match the stimulus card on more than one stimulus dimension: Far example, & response card with three red rianglesis marched {0 the stimulus card with a single red triangle. In this situs- tion it is uncleay, or ambiguous (sec Glossary in Appendix A) to the examiner whether the respondent is matching on the basis of Galor or Form. Simply stated, a response that matches a stimulus card on one and only one characteristic said to be an unambiguous response (e-g., @ FN O), and any Tesponse that matches a stimulus card on two or mor q sis said to be an ambisuous response (e-2. EEN O). Other responses are also ambiguous because she ‘basis forthe response is unclear. The ambiguous-inambiguous response dimension is independent of whether the response. iS 4 correct response or an error (@.., is possibie to {unambiguously match to a sorting principle that is not cur, rently correct), Carefully recording all characteristics on Which the response card matches the stimulus card through, out the WCST-64 administration allows the examines to Score this dimension accurately after the testis completed + Perseuerative-Nonperseverative. When a respondent Pers in responding oa stimulus characteristic that nen Feet, the response is suid to match the "perseverated age principe (see Glossary in Appendin A) and is seated ss severatve (see Glossary in Appendix A). Respondents Sor Petseverate to Color, Form, or Number However iti n, ssible 10 perseverate 10 the Other category because ox sure of the basis for the match Once a perseverated-t0 principle has been enable, and is operative, or “in effec," responses that much wn Perseverated-to principle are scored as perseveratine regardless of whether they are correct or iment Responses that donot match the perseverated-to pci ac nonperseverative (see Glossary in Appendix Ay, Perseverative Responses are indicated after completion of the tet by entering the Jeter“ inthe gpa a eit ot hice distinct situations define the perseverated-to principle for scoring Perseverative Responses 1. The perseverated—to principle is established at the beginning of the test the first time the Zespondent makes an unambiguous error (sce Glossary a Appendix A). The first unambiguous stor only establishes the perseverated-to princi. cL pe and js not scored as perseverative. Any deabelee 2 gave; be po pe epee? : subsequent unambiguous error tl severated-to prin hes the ppc ae Rive oven flier responses tha do 0 eae rr peresveated-toprincple intervene i the sequence, Thus, i-is possible to make Perseveraine ResoOns fully eae augoty Figure oases the Sea roing stan. The respondent sted theeecond eat which contains ovr red crosses we ike sumulgeeard with tee yellow eroses Mie reoponse fs a7 unalibisuaus exrr that nuches be soning panepe of Eom ie. C# NO) and establishes Form as the perscverated- tp prigaple, Every time the respondent 20W ere ambiguous enor wo Form (Cards 3 ad f) the neponse Ts Seoed os pereverative aati ube perseverated-to princinle chan BEND estates thisseorng rule when ter Papen tat donot msch is penteverated-10 eeetieimervene in the Sequence. This respon- ven rade un unambiguous er to the piniple fron on Card 2, bu conetly matched the sen Tou cards wo Ge pingple of Color before Making the fst Perseveratve Response 1 Form on Card 7 ; (4a) 2 : eho yo ehtg _GD “tc vblguns Do Geen ot F (4b) ED GND po wh cern pCR GAD 1G FKO sfFNO of FNO nf ENO ugFNO ¢FNO ug FNO uf FNO 2 sf FNo 10 ng ¥xo \ ae 2 Figure 4 usteation of scoring Perseveraive Responses. [unambiguous error] 6 —GgEND P F 1 .gPNwo _GEERD P —GEEND P 1 nd ¥to 2, The most common situation in which a respon- dent makes Perseverative Responses occurs after the individual completes a category by making 10 consecutive correct matches. Because the Fespondent is not aware that the examincr has now changed the sorting principle, he or she is likely to continue To respond according to the previously correct principle, However. after a ‘category has been successfully completed and the examiner has changed the sorting principle, the previously correct category now becomes the| perseverated-to principle currently in effect. Although some researchers consider this rule to be “counterintuitive” (Flashman. Horner, and Freides, 1991, p. 193), the first unambiguous response to match the new perseverated-t0 prin ciple (Le, the previous correct sorting category) ‘is an unambiguous Perseyerative Error (see Glossary in Appendix A). Figure 4c presents an example of seoring according to this rule, Trial 11 in Figure 4c is an unambiguous Perseverative Enror because the Color response matches the petsexeraledch (he category just com- pleted) currently in effect. (4c) (4d) ID 2fFNO sfFNO GRD p FXO —GEFND s$¥NO Lsgyno p of ¥NO. 2 «ftyno p “fF HO —GEFND p sHFNO GERD tex CED nf ENO _ GERD GRD _ FD END —GED Caney —GCERD _». The usates¢ unambiguous responses both pre. ceding (Card 11) and following (Card 13) the ambiguous response (Card 12) must each be per- seuecatixe and must mat severated~ (© ptinciple This is known as the sandwich tile, in that the ambiguous response must be “sandwiched” between (wo unambi; Perseverative Responses (Flashman et al., 1991, p. 191). p> For consecutive ambiguous responses to be scored as perseverative, all responses between {he.two unambiguous Perseverative Responses USL mach the perseverated-to principle in cffect. That is, the match to the perseverated~ to principle must run continuously throughout all responses between the two unatnbiguous Perseverative Responses and must not be bro ken by any response that does not match this new perseverated-to principle. In Figure 4d, Cards 5 and 6 are both scored as Persey- erative Responses, regardless of whether they are correct responses or errors. Likewise, Card 12 presented in Figure 4c is an ambigu- ‘ous response that is scored as perseverative, As illustrated by Cards 5 and 6 in Figure 4d, ambiguous responses may also be scored as ps ‘Scverative before the respondent successfully completes 1 egory if they meet these same three conditions. First, the response or responses must match the perseverated-to prin- Siple currently in effect (in the current example, the perseverated-to principle is Form as defined by the first unambiguous error on Card 2). Next, the response or responses must be preceded and followed (sandwiched) by unambiguous Perseverative Responses (Cards 4 and 7). Finally, the match (o the perseyerated-to principle must Cuncentinuously throushourall. responses, tween the two unambiguous Perseverative Responses and must not be broken, The final situation defining a perseverated=to principle occurs when a responcient changes the principle to which he or she is perseverating. That is, itis possible for the perseverated—to principle to change within any category of the test when (a) the respondent makes dee unam- bisuous errors to a sorting principle that is nei- ther correct nor currently perseverative, and (b) all fesponses between the first and the third lunambiguous error match this sorting principle. ‘When this situation occurs, the sorting principle running through these three unambiguous errors becomes the new perseverated-io principle. Ths nex perseveratednto principle, however, 108 operative Tor scoring purposes until. he second enambiguous error occu. Figure Sa illustrates the simplest example ofthis scoring situation, Figure Sa presents the responses from a respon- dent who sorted to Form on Card 2, which estab- lishes Form as the perseverated-to principle at the beginning of the test. The unambiguous ‘matches to Form on Cards 4,7, and 8 are, there- fore, scored as Perseverative Errors. However. starting with Card 9, the respondent makes the next three matches to Number. Because Cards 9, 10, and 11 are uninterrupted, unambiguous errors to a principle other than Form, Number becomes the pew perseverated-to principle on ‘Card 10. Thus, the responses made on Canis 10 and 11 are scored as Perseverative Errors. Figure Sb illustrates these scoring principles for a longer series of Perseverative Errors where the Perseverated-to principle has changed from Form (Card 2) fo Number (Card 11), when jaiiae ot Roepe a td heen Pitre orccrmraran| ceanaass. Provided thatthe esting contains three unambiguous errors that match the new perseverated-to principle and is not broken by any response that does not match the new perseverated-to principle, the second unambigu- ous incorrect response in the sequence is scored as perseverative, Additionally, all of the ambigu- ‘ous responses sandw) the second and third unambiguous Perseverative Errors are also scored as perseverative, regardless of u (a) (Sb) (Se) (a) CFO C CED C ORD F 3 x¢fno GRD _cofn bens _ GERD ES Gaps GND —CIND p EID 1 sfFNo TEND P Lw¢¥no Ze. 2 L «¢fno 4 atfxo & & afFxo ier HO _GEEFD embiqnons shfNo CERES HMBIBNO KE AAOD pleas _ GERD P mani » : {unambiguous —EEFND P PF KO 1 .gr¥o p CAD po SIND P sfFNO —LEFFD pT _GEFLD —GEFHOy Wnaghigiens 7 ageno —GEFKD P 1 agtho GERAD) plOmebltons _ GEARS somes ERD _ RD _eaRD CEFAD) plimnincoom ERR olomambires 7 TL ack#o 1 wffno AD TS ~ SED P GRD GND _ CFF _EFRO p —GCFED P —CIRD _ GERD P _ GERD p i agpno —GEKD 0 IND GERD P —LID 1 ugfho 1 u¢¥to I ngeno —GEFKD pr? Figure 5, Ulustration ofthe perseverated-to principle changing within a category: whether they are correct or incorrect. Even though the ambiguous responses sandwiched between the frst and second unambiguous errors must match the new perseverated-to principle, the new-principle is not operative until the see- ond unambiguous error; therefore, these ambigu- fous responses are not scored as perseverative. For example, in Figure Sc the respondent makes the §irst_unambiguous error by matching to Form on Card 2 and, thus, makes the first per- severative enor on Card 3, However, the respon- dient then beyins to sort by Number, making the first una 19 Number on Card 5. (Card 6 is also an unambiguous error to Number, ‘as is Card 8, which represents the third_unam- ambiguous response on Card 7 is also scored as pevseverative, even though it is correct, because itis both preceded and followed by unambigu- ous Perseverative Errors, The example, Figure 5d, illustrates a similar situation, with the first ‘unambiguous error of the series beginning with the Number response on Card 36, In this case, the ambiguous response on Card 38 (ie, ¢ FM (©) that separates the second and third unambigu- ous incorrect responses is a Perseverative Response. Itis also an error and is, therefore, it~ lod. ‘This Perseverative Response may also be called a Perseverative Error. Card 40 is not_ scored as perseverative because it does not con- form to the sandwich rule Number of Categories Completed. The Number of Categories Completed (see Glossary in Appendix A) is sim- ply the number of categories (i.e., each sequence of 10 con- secutive correct matches to the current sorting category) that the respondent successfully completed during the test. ‘Typically, the examiner marks off each category (C FN CF N) as it is successfully completed at the top of the second page of the record booklet. bisuous eivor that matches the principle of Number Because the ambiguous response on Card 7 (¢ F M O) matches the principle of Number, the responses from Card 5 to Card 8 all ‘match to Number without interruption, defining Number as the new perseverated—to principle. Thotefore, beginning with the second unambigu- cous error in the sequence (ie., Card 6), responses S through 15 are all scored as perseverative. The + Dials 10 Complete First Category. The total number of rials to Successfully complete the first category (see Glossary im Appendix A) gives an indication of initial con- ceptualization of sorting strategy before a shift of set is also required. The scoring examples presented in Figure 4 show that Respondent “a” took 16 tials to complete the first cate- wy, whereas Respondent “a” took only 10 trials. On rare occasions, a respondent will be administered all 64 cards ‘without ever successfully completing the first category. In tis case, the respondent receives a Trials to Complete First Category Taw score of 65, + Failure to Maintain Set. A Failure to Maintain Set (see Glossary in Appendix A) occurs when a respondent makes, five or more consecutive correct matches but then makes an error before successfully completing the category, A Failure to Maintain Set is nor scored if, toward the end of the test, the respondent has matched correctly five or more cards and simply rns out of cards (.e., Card 64 is eompleted), Figure 6 provides an example of a respondent who had considerable difficulty maintaining the correct sorting. prin- ciple of Color. On Card 2 (not shown), the respondent made an unambiguous error to Form which established Form as the perseverated-to principle. Despite receiving positive feedback from the examiner for numerous unambiguous correct matches to Color, this individual was unable to con- tinue responding consistently according to this principle. Within a series of fewer than 15 trials, this respondent failed ‘to maintain set two times on Cards 23 and 30, + Conceptual Level Responses. Conceptual Level Responses (see Glossary in Appendix A) presumably reflect insight into the correct sorting principles, Conceptual Level Responses are defined as consecutive comect responses eccurring in runs of three or more, These responses ate called Conceptual Level Responses because it is presamed that some insight into the correct sorting strategy is required in order to make three or more consecutive correct matches and that a comrect series of this length would be unlikely to ‘cour by chance alone. Figures 7 and § illustrate the scoring 9 Conceptual Level Responses. Results in Figure 7 show an individual who made 33 Conceptual Level Responses across ‘the 64 cards of the test. Figure 8 presents the data for a Fespondent who made 35 Conceptual Level Responses cr038 the 64 cards of the test. Note that Card 59 is scored as @ Conceptual Level Response, although a change in cate- Bory occurs as Card 59, + Learning 10 Learn. Learning to Learn (after Tarter, 1973; see Glossary in Appendix A) reflects the respondent's sverage change in concepiual efficiency across the consecu- We categories of the WCST-64. This measures whether ot 201 a respondent becomes increasingly proficient in moving ‘om one principle to the next as the test progress Calculating this score requires four steps, C

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