Developmental and Neuropsychological Perspectives on the Wisconsin Card Sorting Test in Normal Children

Contemporary efforts in neuropsychological assessment of children are directed towards the use of developmentally sensitive instruments especially when targeting cognitive abilities, such as executive function, which are known to have a protracted period of development. The purpose of the present study was to advance the understanding of the WCST as a measure of executive function in six-year-old children. The test requires subjects to sort cards by three criteria: color, shape, and number of objects on the card. This study investigated the level of difficulty for young children required to use number as a sorting criterion. Based on developmental research on perceptual and conceptual behavior for color, shape, and number, it was hypothesized that the use of a concept with higher cognitive demands contributes to the impaired performance of six-year-old children when compared to that of older children or adolescents. Additionally, performance on the test was analyzed in an attempt to reflect possible developmental trends in the preference for the initial sorting criteria across the three age groups. One hundred and ninety six participants of three different ages groups (6, 11-12, and 18-19 years old), were administered either the standard or modified versions of the WCST. A between- subjects Multivariate Analysis of Variance (MANOVA) and a frequency study were used to analyze the data, given the characteristics of the variables and the research questions. Results revealed several developmental trends across the age groups: increases in the number of categories completed, increases in test efficiency, and difficulty in sorting by number. Analyses focused on the position of number in the test sequence revealed its interference on test performance across all ages and highlight ed the difficulty that six-year-old children have in sorting by number. No significant differences were observed in the choice of the first sorting criterion across the three age groups. Implications of these findings are discussed regarding the frequent use of the WCST with young children, the clinical implications for diagnosis and intervention, the contemporary status of developmental neuropsychological assessment instruments, and future research