The Clinical Neuropsychologist

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Diagrammatic procedure for scoring the wisconsin

card sorting test

Steve Berry

To cite this article: Steve Berry (1996) Diagrammatic procedure for scoring the wisconsin card
sorting test, The Clinical Neuropsychologist, 10:1, 117-121, DOI: 10.1080/13854049608406670

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The Clinical Neuropsychologist 0920- 1 637/96/ I 00 1- 1 17$12.00
1996, Vol. 10, No. I , pp. 1 17- I2 1 0 Swets & Zeitlinger

BRIEF REPORT

Diagrammatic Procedure for Scoring the Wisconsin

Card Sorting Test*
Steve Berry
Justice Psychological Services, Hamilton, New Zealand

ABSTRACT

The Wisconsin Card Sorting Test (WCST) has received some attention in the literature because of its
complex scoring procedure. This brief communication is intended to fill agap in the literature by providing
a scoring procedure summarising the relevant rules for scoring perseveration in a diagrammatic format that
can be used to aid scoring. This scoring procedure is to be used in conjunction with the test manual and is
not intended to modify the rules, as set down in the manual, in any way.

The most useful diagnostic measure derived
from the Wisconsin Card Sorting Test (WCST
Heaton, 198 1 ) is the perseverative response
score (Heaton, 1981). Scoring perseveration, by
Heaton’s (198 1 ) own admission, is a rather com-
plicated procedure. Added to this difficulty are
ambiguities in published scoring rules (Flash-
man, Mandir, Horner, & Freides, 1991). These
factors may have been responsible for the vari-
ability i n scoring that is evidenced by concern in
the literature (e.g., Axelrod, Goldman, & Woo-
dard, 1992; Flashman et al., 199 l ) . Additionally,
although Axelrodct al. (1991) foundthat the test
was generally scored reliably, a senior hospital
clinical psychologist who has been responsible
for supervising a number of clinical interns
commented that the scoring of Ihe WCST pre-
sented formidable challenges to the novice (R.
Kinsey, personal communication, 1993).
The primary complexity in scoring persevera-
tion on the WCST is the fact that the persevera-
tion principle (the rule that dictates whether a
response is perseverative or not) changes depen-
~~~~
ding upon the subject’s responses.
Several scoring aids to the WCST have been
proposed in the literature. Flashman, Horner,
and Freides (1991) provided a useful summary
of the relevant rules for scoring perseveration.
This summary was intended to be a supplement
to the directions offered by Heaton (1981).
Axelrod et al. (1992) also developed supplemen-
tary scoring instructions. In addition, Flashman,
Mandir et al. (1991) proposed a set of clarified
rules for scoring perseveration and designed a
computer programme to implement these rules.
This programme can also be used to both admin-
ister and score the test.
Despite these useful additions there is a gap
in the literature for a diagrammatic representa-
tion of the scoring rules. It is proposed that a
diagrammatic representation would assist the
novice user of the WCST in both scoring and
learning the relevant rules, particularly those
who do not have easy access to a computer scor-
ing method.
This current report is intended to continue

*The author gratefully acknowledges Dr Nige1.V. Marsh and Keriata Paterson for their comments on this manu-
script. Correspondence concerning this article should be addressed to Steve Berry, Justice Psychological Scr-
vices, P.O. Box 19003, Hamilton, New Zealand.
Accepted for publication: January 10, 1995.
118 STEVE BERRY

SXEAs R R S E M P A T I M
Notes:
( I ). An unambiguous response is one in which the stimulus card
is matched wilh onlyone dimension (i.e.,C, F. N. or 0). An
example would be: Cf N0

(2a). The Perseveration Principle is the rule which determines

whether a response is perseverative or m t. The rule
is detined by the subject's respomes and changes
according to these responses as odlined in the dlagram.

(2b). ImmediatelyaHer a category is completed (i.e..lhe

respowe after the tenth corrsct response) the PP is
deemed to have lapsed. The PP then becomes the response
that was correct In the previous category.

Diagram I (a). Scoring Unambiguous Perseverative Responses on the Wisconsin Card Sorting Test.
 DIAGRAMMATIC PROCEDURE FOR SCORING THE WCST 119

ARE THE UNAMBIGUOUS

RESFONSESIN THE SERIES OF
3 SEPARATED BY AMBIGUOUS

INVOKE AS THE NEW PP

RESPONSESALL CONTAINTHE SCOAE ALL RESPONSES
DIMENSION CONTAINED IN THE 3 THAT MATCH THIS PP
STARTING FROMTHE
NEXT UNAMBlGuOuS
REspcr\lsE.
YES 1

REVERTTO P E W S F F
INVOKE AS THE NEW PP.
AND CONTIWE.
ScOpE As PERSEKWTIM

FROMTHE NEXT UNAMBIGUOUS

Notes:
(3). An ambiguous response is one in which the stimulus card
is matched with more than one dimension. An example is

Hg’do.
Diagram I (b). Continuation of Scoring Unambiguous Perseverative Responses on the Wisconsin Card Sort-
ing Test.

this process of making scoring the WCST easier, the supplementary scoring protocols discussed
particularly for the first time user of the WCST. above. As with Flashman, Horner, and Freides
It was based on the manual (Heaton, 1981) and (1991) only scoring of perseverative responses
120 STEVE BERRY

PRINCIPLE (PP) IN PLACE? (4)

1 \

DO N3T SCORE AS
THE CATEGORY WHCH IS
IIALEADY DEFINED AS
PERSEVERATIMBY M E
II

+
W M)T SCORE AS PERSEV-
ERATIM, CONTINUE.

ARE TI+ CLOSESTUWBIGUOUS

RESPONSESPFEEEDEXiAND FOCLCWING
THIS ON PERSEMRATIM TO THE

_I
Notes:
(4). If the ambiguous response is Ihe
fits! within a category (Le.,
occurs after 10 correct previous
DOALLOTHERAWIGUOUSRESWNSES responses) H cannot be
B E W E NTt€ N 3 W S T UNAMBIGUUJS perseveratwe (see note 2 (b)).
RESPONSESONElMERSlDE CF M
RESPONSEIN QUESTKW ALSO CONTAIN

Diagram 2. Scoring Ambiguous Perseverative Responses on the Wisconsin Card Sorting Test.
 DIAGRAMMATIC PROCEDURE FOR SCORING THE WCST
-
is described and the reader is referred to Heaton
(198 I ) for directions on all other aspects of the
administration and scoring of the WCST. Al-
though the use of this algorithm has not been
experimentally validated its relative merits over
the instructions in the manual have been attested
to anecdotally, by novice users (T. Kilgour, per-
sonal communication, 1993).
These diagrams can be considered “diagnos-
tic” in that they classify any individual response
as perseverative or nonperseverative. In addi-
tion, the diagram proceeds in a linear fashion in
that the classification of any item as perse-
verative or nonperseverative depends upon pre-
vious responses (reflecting the scoring rules for
the WCST). Therefore, it is recommended that
when scoring the WCST using these flow dia-
grams the scorer begins with the subject’s first
response and continues, without interruption,
scoring to the end of the test. Such an approach
ensures that the scorer is aware of the relevant
perseveration principle (i.e., the rule “in force”
immediately before a particular response).
121
INSTRUCTIONS
Diagrams 1 (a) and l(b) are to be used to diag-
nose unambiguous perseverative responses and
Diagram 2 to diagnose those responses that are
ambiguous. Begin with the first response in the
test and follow the arrows on the appropriate
diagram. When a rectangular box is reached the
diagnosis of perseveration and any change to the
perseverative principle is outlined.
REFERENCES
Axelrod, B.N., Goldman, R.S., & Woodard, J.L.
( 1 992). Interrater reliability in scoring the Wiscon-
sin Card Sorting Test. The Clinical Neuropsycholo-
gist, 6, 143-155.
Flashman, L.A., Horner, M.D., & Freides. D. (1991).
Note on scoring perseveration on the Wisconsin
Card Sorting Test Manual. The Clinical Neuropsy-
chologist, 5 , 190- 194.
Flashman, L.A., Mandir, A S . , Horner, M.D., & Frei-
des. D. (1991).Increasinginterscorer reliability on
the Wisconsin Card Sorting Test (WCST) using
clarified scoring rules. Journal of Clinical and Ex-
perimental Neuropsychology, 13,431-431.
Heaton, R.K. (1981). Wisconsin Curd Sorting Test
Manual. Odessa, FL: Psychological Assessment
Resources. Inc.