Gifted Issues Discussion homepage Forums Identification, Testing & Assessment Wisconsin card sorting test - Aeh can you help?

Hello,

My 2e DS who recently became a DYS due to criteria changes and had a complete neuropysch evaluation was found to be ADD inattentive instead of ASD and provisionaly diagnosed with Dysgraphia, and possibly CAPD. I'm having a hard time understanding the test results but the particularly confused about a note made by doctor regarding the Wisconsin card sorting test. "DS performs at top 5% to 10% in academic achievement, but actually has trouble with effective learning of new concepts, one aspect involved in executive functioning." I believe she is referring to "trials to complete 1st category" 27 standard score, 11-16 percentile.
Does this test really capture learning new concepts difficulties? Where would it impact him academically? For example, I do see that it takes him longer to grasp abstract concepts, where my DD can do the balance benders pages in her sleep. TIA!

The WCST is one of the classic executive function tests. The examinee sorts images on cards according to rules that one must figure out along the way. Periodically, and unexpectedly, the rules change, and the examinee must figure out the new rules. Many examiners use it to assess concept formation, cognitive shift (an EF skill), and maintenance of mental set (also an EF), among other things.

Although it is a venerable test, with a long and storied history in neuropsychology, its psychometric qualities are actually not as strong as one might think. The research finds that it does have good sensitivity to neuropsychological concerns, including ADD, ASD, and LDs, but not particularly good specificity, mainly because good/NT performance on it appears to involve many more parts of the brain than previously believed. The range of performance in normals is also pretty wide. In addition, the norms for children are not of the best, as they are relatively old (early 1990s), and relatively small (899 samples).

The value and meaning of the interpretation lie largely in the interpreter, and the other data obtained. For example, his difficulty with "trials to complete first category" could be a reflection of weaknesses in concept formation, or working memory, or sustained attention, or hypothesis testing, among other things. Where he also has a Dx of ADHD primarily inattentive, with provisional/rule-outs for dysgraphia and CAPD, I would wonder if this is a working memory deficit (often a primary deficit in dysgraphia, secondary deficit in ADHD, and a frequent confound with CAPD).

Sorry, this probably did not clear up anything for you...

Thank you Aeh! I did read that it's psychometric qualities aren't as strong as you wrote, which made me wonder. His working memory score on the WISC IV was 123, so high average I believe. Had no idea the norms were so old. To give you more data on the WCST:

Total errors SS 99, 47 percentile
Conceptual Level response SS 95, 37 percentile
Categories completed ss 3 out of 5, >16 highest score possible

I'm also wondering what each executive function test is targeting. Am I right that the D-KES is assessing visual attention, NEPSY - auditory attention, and CPT general sustained attention?
Thank so much - your help is greatly appreciated!!

slammie, the WCST was one of the tests that was included in my ds' neuropsych eval (he's diagnosed with dysgraphia and developmental coordination disorder). I looked back to see how he had performed on it, and it's not directly mentioned in the report (as in, the name WCST plus score or comment), but from aeh's description and reading through the report, I think that ds' performance on it was a relative weakness.


aeh, this is interesting - are working memory deficits sometimes associated with dysgraphia? DS' working memory scores on his first WISC were not as low as his processing speed scores, but they were definitely lower than his other scores (I can't remember how much lower at the moment, but it was greater than 2 SD, and low enough that I remember being concerned about it but his neuropsych wasn't... possibly because he had much more obvious challenges to be concerned about!). His wm scores improved when he had a WISC at 11, but homework and studies seem to take him *forever* compared to other high school students we know... even though he's using accommodations for his dysgraphia. So I wonder about things like this! Anyway, just curious about this note.

polarbear

Yes, in some cases verbal working memory deficits are associated with dysgraphia. Other deficits include retrieval fluency, motor planning, and of course, all the phonological and orthographic skills associated with decoding and encoding written language. Not every dysgraphic has deficits in every area, or in the same areas.

Deficits in working memory aren't always clear cut on the WISC-IV, especially when Arithmetic is used as one of the subtests, as math ability is a confound.

The D-KEFS can assess multiple aspects of EF, as can the NEPSY-II. The CPT assesses mainly attention, inhibition, and sustained attention. Your evaluator may have used selected subtests from each measure (which definitely is an appropriate use of the instruments), which is giving you the impression that the aspects of EF you list are assessed by those tests.

Your DC's working memory on the WISC-IV would be considered Superior, which suggests that that is not the primary problem. It also looks like, once he caught on to the task (completed the first category), he picked up the remaining categories presented relatively easily, but probably ran out of opportunities. It appears he was administered one of the short forms of the WCST. There is some data that suggests that children who are slow to grasp the task at the beginning tend to have low estimates of ability on the short form, versus the full 20-30 minute form, as their performance improves over the course of the test.

Hey there Slammie,

Just wanted to chime in and let you know that DS8 (6-years when he was assessed) had a really similar result on that card-sorting test. Interestingly (since I sort of think we had the same tester) he was assessed as dysgraphic/CAPD, but not ASD, ADHD or ADD.

Anyway - I always have this feeling that our boys are twins separated at birth!

Take care,
Sue

Thank you so much Aeh, and your last point I think describes him pretty well. Polarbear, thanks for sharing your experience.

I am still perplexed on one thing - DS had vision issues and had vision therapy twice. He just completed a 5 month course in which he supposedly was "cured" of his convergence issue. Curiously, his visual perception skills were very, very high prior to the therapy with the exception of the visual spatial section, which went up to 99% after the therapy. Yet his visual motor coordination was in the 18 and 7th percentile according to the neuropsych. Although not a fast writer, he isn't excruciatingly slow and although sloppy, can produce neat writing. Does this mean he is expending a large amount of energy when doing writing activities to compensate?

Suevv, yes, they do appear to have similar issues, don't they? Thanks for chiming in!

Very possibly, yes. His visual perceptual and spatial reasoning skills may be exceptionally strong, but that doesn't mean he can make his hands do what he can see, without effort. Especially if we are asking him to produce symbols automatically, at speed (e.g., writing as a tool for language expression, rather than letter formation as an artistic exercise). Classic dysgraphic situation.

Thanks again Aeh. I am so grateful for your time and contribution here.