Elsevier

Brain and Cognition

Volume 67, Issue 3, August 2008, Pages 247-253
Brain and Cognition

On the historical and conceptual background of the Wisconsin Card Sorting Test

https://doi.org/10.1016/j.bandc.2008.01.006Get rights and content

Abstract

In this paper, we describe the development of the Wisconsin Card Sorting Test (WCST). We trace the history of sorting tasks from the studies of Narziss Ach on the psychology of thinking, via the work of Kurt Goldstein and Adhémar Gelb on brain lesioned patients around 1920 and subsequent developments, up to the actual design of the WCST by Harry Harlow, David Grant, and their student Esther Berg. The WCST thus seems to originate from the psychology of thinking (‘Denkpsychologie’), but the test, as it is used in clinical neuropsychological practice, was designed by experimenters working within the behaviorist tradition. We also note recent developments suggesting that, contrary to the general impression, implicit learning may play a role in WCST-like discrimination learning tasks.

Introduction

The concept of executive functions has become very popular over the last two decades in clinical (neurological and psychiatric patients) and fundamental (neuroimaging) studies on the (pre-)frontal cortex (e.g., Stuss & Knight, 2002). These executive functions are assumed to serve as cognitive control processes, in particular for planning and organizing behavior. Luria (1966) argued that planning and organization of behavior occur in the prefrontal cortex. Clinical neuropsychological evidence seems to support this conclusion. For example, patients with frontal lesions due to traumatic brain injury show symptoms that are referred to as the Dysexecutive Syndrome (Baddeley & Wilson, 1988). Impairments in these executive functions are often assessed with the Wisconsin Card Sorting Test (WCST), along with a range of other instruments. According to Lezak (2004), the WCST is generally used to measure the capacity to deduce concepts and to apply a strategy to adapt behavior to changing conditions. Over the years several variants of the WCST have been developed. In the original version of Berg (1948), switching of the relevant concept (generally referred to as shifting) occurred without a warning by the examiner, whereas this shifting was explicitly announced in the version of Nelson (1976). Heaton, Curtiss, and Tuttle (1993) have introduced a computerized version of the test. A test frequently used in research is the set-shifting subtest of the CANTAB (Fray, Robbins, & Sahakian, 1996).

In this paper, we trace the history of the Wisconsin Card Sorting Test (WCST) and similar sorting tasks, beginning with the studies of Narziss Ach on the psychology of thinking, via the work of Kurt Goldstein and Adhémar Gelb around 1920 and subsequent developments, up to the actual design of the WCST by Harry Harlow, David Grant, and their student Esther Berg at the Wisconsin University. What we find interesting is the apparent discontinuity, where the cognitive underpinnings of the task are quickly turned intro a Behaviorist framework, and how long it has taken to rediscover its conceptual origins.

Section snippets

Ach and the ‘Denkpsychologie’

Wilhelm Wundt (1832–1920) was the founder of psychology as an institution (Bringmann & Tweney, 1980). He first defined scientific psychology in his Grundzüge der Physiologischen Psychologie (Principles of Physiological Psychology; Wundt, 1873). Although in the 1870s the word ‘physiological’ was acquiring its current meaning, it was often used in a broader meaning, more or less indicating an experimental approach to the study of natural phenomena (Leahey, 2001). Wundt distinguished the

From Ach to Goldstein

A second phase in the historical background of the WCST is formed by the studies on brain lesioned patients of the German neurologist Kurt Goldstein (1878–1965). Much has been written about Goldstein and we will not attempt to give a complete picture of his life and works here; we refer the reader to sources like Goldstein, 1967, Shakow, 1966, Simmel, 1968. In this section, we will examine some factors that may reveal why and how he came to study this issue. We will focus on the period leading

Adhémar Gelb

Trying to find the link between the work of Narziss Ach and Goldstein, one might also suspect that the ideas were transferred via Adhémar Gelb (1887–1936). The Russian Gelb studied Philosophy and worked as a voluntary assistant at the Psychological Institute in Berlin, working under supervision of Carl Stumpf, with Max Wertheimer and Kurt Koffka. After finishing his dissertation there in 1910, he became an assistant at the Psychological Institute in Frankfurt am Main in 1912. During WW I a long

Goldstein and the abstract attitude

Gelb and Goldstein (1920) originally used a sorting task in the examination of a patient Th. who suffered from color amnesia. This was the Holmgren-test, a test for color blindness (see below for a more detailed description). Goldstein noticed that neurological and psychiatric patients performed it in a way that differed remarkably from that of healthy persons. He also saw that patients tended to look at individual objects; they apparently cannot avoid the concrete object and detect

Sorting tasks

In this section, we will focus on the various sorting tasks that have been developed and used, in particular for the study of brain-injured individuals and patients with schizophrenia. Here, we will mainly concentrate on procedural aspects, first of some tasks used by Goldstein and followers, and then the Wisconsin Card Sorting Test and the Halstead’s Category Test. Subsequently we will discuss how performance on these tests were interpreted.

To analyze disorders in abstract behavior, Goldstein

Wisconsin Card Sorting Task

We have followed the development of the psychological investigation of thinking and the introduction of sorting tasks. We have seen how Goldstein and Gelb, followed by others, applied the task in their studies on patients. After emigrating to the United States, Goldstein also introduced this task in his clinical work (for instance, see Bolles & Goldstein, 1938). We now will discuss the development of the Wisconsin Card Sorting Test.

In 1946, Myra Zable and the American psychologist Harry Harlow

Category Test

Another sorting test may be mentioned here, namely the Category Test from Halstead, a subtest of the Halstead–Reitan test battery (Choca et al., 1997, Reitan, 1994, Parsons, 1986). Ward Halstead (1908–1969) developed the test with Paul Settlage in 1943, who was working in Harlow’s primate center (Choca, Laatsch, Wetzel, & Agresti, 1997). Already early in his career (around 1935), Halstead examined patients with brain lesions at the Medical School at the University of Chicago. Originally he used

Wisconsin Card Sorting Test: abstracting, reasoning, or discrimination learning?

We have seen how the WCST was developed as a kind of sorting task, originally introduced within the tradition of the ‘Denkpsychologie’. We will now discuss what the performance of individuals on these kinds of tasks was assumed or claimed to reflect. According to Goldstein (Goldstein & Scheerer, 1941), sorting tasks mainly are designed to assess conceptual thinking, and he emphasized that the test primarily evaluates the categorial or abstract attitude. The abstract attitude implies that a

WCST as a neuropsychological test

We will now briefly describe the final phase of the WCST, in which it was introduced as a neuropsychological instrument, first for the evaluation of frontal lobe lesions, and later for the assessment of the so-called executive functions. Harlow, Grant, and Berg developed a discrimination paradigm that could be applied in human studies. Despite the fact that Goldstein and others had used sorting tasks in patient studies, it took some 15 years before the WCST was introduced as a test to study

Acknowledgments

We are very grateful to Joseph Kemnitz of the Primate Center in Wisconsin, Joe Newman, head of the Psychology Department in Wisconsin and Carol Allen, also working at the Psychology Department for tracking down and sending me a copy of the masters thesis of Esther Berg. We also thank Helmut Hildebrandt and Lauren Harris for their comments on an earlier version.

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