Essay // Biopsychology: Frontal Brain Damage & The Wisconsin Card Sorting Test (WCST)


(Photo: Jez C Self / Frontal Lobe Gone)

The Wisconsin Card Sorting Test (WCST; Grant & Berg, 1948; Heaton, Chelune,Talley, & Curtis, 1993) has long been used in Neuropsychology and is among the most frequently administered neuropsychological instruments (Butler, Retzlaff, & Vanderploeg, 1991).

The test was specifically devised to assess executive functions mediated by the frontal lobes such as problem solving, strategic planning, use of environmental instructions to shift procedures, and the inhibition of impulsivity. Some neuropsychologists however, have questioned whether the test can measure complex cognitive processes believed to be mediated by the Frontal lobes (Bigler, 1988; Costa, 1988).

The WCST test, until this day remains widely used in clinical settings as frontal lobe injuries are common worldwide. Performance on the WCST test is believed to be particular sensitive in reflecting the possibilities of patients having frontal lobe damage (Eling, Derckx, & Maes, 2008). On each Wisconsin card, patterns composed of either one, two, three or four identical symbols are printed. Symbols are either stars, triangle, crosses or circles; and are either red, blue, yellow or green.

At the start of the test, the patient has to deal with four stimulus cards that are different from one another in the colour, form and number of symbols they display. The aim of the participant would be to correctly sort cards from a deck into piles in front of the stimulus cards. However, the participant is not aware whether to sort by form, colour or by number. The participant generally starts guessing and is told after each card has been sorted whether it was correct or incorrect.

Firstly they are generally instructed to sort by colour; however as soon as several correct responses are registered, the sorting rule is changed to either shape or number without any notice, besides the fact that responses based on colour suddenly become incorrect. As the process continues, the sorting principle is changed as the participant learns a new sorting principle.

potbIt has been noted that those with frontal lobe area damage often continue to sort according to only one particular sorting principle for 100 or more trials even after the principle has been deemed as incorrect (Demakis, 2003). The ability to correctly remember new instructions with for effective behaviour is near impossible for those with brain damage: a problem known as ‘perseveration’.

Another widely used test is the ‘Stroop Task’ which sets out to test a patient’s ability to respond to colours of the ink of words displayed with alternating instructions. Frontal patients are known for badly performing to new instructions. As the central executive is part of the frontal lobe, other problems such as catatonia – a condition where patients remain motionless and speechless for hours while unable to initiate – can arise. Distractibility has also been observed, where sufferers are easily distracted by external or internal stimuli. Lhermite (1983) also observed the ‘Utilisation Syndrome’ in some patients with Dysexecutive Syndrome (Normal & Shallice, 1986), who would grab and use random objects available to them pathologically.



Butler, M., Retzlaff, P., & Vanderploeg, R. (1991). Neuropsychological test usage. Professional Psychology: Research and Practice, 22, 510-512

Demakis, G. J. (2003). A meta-analytic review of the sensitivity of the Wisconsin Card Sorting Test to frontal and lateralized frontal brain damage. Neuropsychology, 17, 255-264

Eling, P., Derckx, K., & Maes, R. (2008). On the historical and conceptual background of the Wisconsin Card Sorting Test. Brain and Cognition, 67, 247-253

Grant, D.A. and Berg, E.A. (1948). A Behavioural Analysis of Degree Impairment and Ease of Shifting to New Responses in Weigh-Type Card Sorting Problem. Journal of Experimental Psychology, 39, 404-411

Heaton, R.K., Chelune, G.J., Talley, J.L., Kay, G.G., & Curtis, G. (1993). Wisconsin Card Sorting Test manual: Revised and expanded. Odessa, FL: Psychological Assessment Resources

Lhermitte, F. (1983) “Utilization Behaviour” and its relation to lesions of the frontal lobes. Brain, 106, 237-255

Norman, D.A., & Shallice, T. (1986). Attention to action: Willed and automatic control of behaviour. (Center for Human Information Processing Technical Report No. 99, rev. ed.) In R.J. Davidson, G.E. Schartz, & D. Shapiro (Eds.), Consciousness and self-regulation: Advances in research, (pp. 1-18). New York: Plenum Press


18.08.2014 | Danny J. D’Purb |


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