Thursday, May 12, 2005

Wisconsin Card Sorting Test and ADHD

FYI meta-analytic review of sensitivity of Wisconsin Card Sorting Test for ADHD.

Bottom line practical conclusion - the WCST, much like other measures of cognitive efficiency (e.g., Gs measures), might best be viewed as a thermometer of the efficiency of a person's information processing system. If the scores are poor (the temperature is high), it tells you that something is amiss in the IP processing system, but like a thermometer, it doesn't posses the diagnostic specificity to tell you what the problem is.


Romine, C. B., Lee, D., Wolfe, M. E., Homack, S., George, C., & Riccio, C. A. (2004). Wisconsin Card Sorting Test with children: a meta-analytic study of sensitivity and specificity. Archives of Clinical Neuropsychology, 19(8), 1027-1041.

Abstract
  • More and more frequently the presence of executive function deficits appears in the research literature in conjunction with disabilities that affect children. Research has been most directed at the extent to which executive function deficits may be implicated in specific disorders such as attention deficit hyperactivity disorder (ADHD); however, deficits in executive function have been found to be typical of developmental disorders in general. The focus of this paper is to examine the extent to which one frequently used measure of executive function, theWisconsin Card Sorting Test (WCST), demonstrates sensitivity and specificity for the identification of those executive function deficits associated with ADHD as well as its use with other developmental disorders through meta-analytic methods. Evidence of sensitivity of the WCST to dysfunction of the central nervous system is reviewed. Effect sizes calculated for all studies compared groups of children on differing variables of the WCST. The results of this meta-analysis suggest that across all of the studies, individuals with ADHD fairly consistently exhibit poorer performance as compared to individuals without clinical diagnoses on the WCST as measured by Percent Correct, Number of Categories, Total Errors, and Perseverative Errors. Notably, other various clinical groups performed more poorly than the ADHD groups in a number of studies. Thus, while impaired performance on the WCST may be indicative of an underlying neurological disorder, most likely related to frontal lobe function, poor performance is not sufficient for a diagnosis of ADHD. Implications for further research are presented.

2 comments:

Joseph Claeys said...

I've always thought that the WCST was more of a Gf inductive reasoning task as opposed to a Gs task. Creating categories for items seems simliar to the task demand of the WJIII concept formation task. It has a certain "learning to learn" attribute to it in that categorization is an essential bedrock for higher order thinking. There was a psych in the early '70's (forget his name but could look it up) that went so far as to say the the entire neo-cortex was designed to categorize information. Instead of my chair being a single object it belongs to a "class" of chairs (while all different sharing important attributes) therefore with this understanding I can sit my A$$ down on something that falls within that class safe in the knowledge that it won't cause me any harm... This study seems to mirror the findings of any general IQ test where (as you pointed out) the scores for the clinical ADHD group are lower than the mean (much like several other clinically diagnosed groups).

Interesting nonetheless

~joe

Anonymous said...

In our paper, due out any day, we found that only those children with significant executive impairment responded to stimulants, the WCST was only a weak predictor of executive impairment however.

Here's the reference:

Hale, J. B., Fiorello, C. A., & Brown, L. (in press). Determining medication treatment effects
using teacher ratings and classroom observations of children with ADHD: Does
neuropsychological impairment matter? Educational and Child Psychology, 22.

James B. Hale, Ph.D.