Computerized version of the Wisconsin card sorting test in children with high-functioning autistic disorder or attention-deficit/hyperactivity disorder

doi:10.1016/j.braindev.2004.06.008

Brain and Development

Volume 27, Issue 3, April 2005, Pages 233-236

https://doi.org/10.1016/j.braindev.2004.06.008 Get rights and content

Abstract

To determine executive dysfunctions in children with autistic disorder or attention-deficit/hyperactivity disorder (ADHD), we investigated high-functioning autistic (full scale IQ score ≧70), ADHD, and control children using the computerized version of the Wisconsin Card Sorting Test. Data were obtained from 17 autistic children (16 boys and 1 girl, mean age±SD: 12.5±4.3), 22 ADHD children (20 boys and 2 girls, mean age±SD 11.3±2.6), and 25 control children (13 boys and 12 girls, mean age±SD: 12.7±3.1). Performances, indicated by mean number of categories achieved (5.4 in autistic, 6.5 in ADHD, and 8.8 in control group), total errors (38.2, 38.4, and 25.6, respectively), perseverative errors (11.4, 13.5, and 5.7), nonperseverative errors (27.1, 25.0, and 19.9), and Nelson type perseverative errors (8.9, 8.4, and 2.3), were significantly poorer in both autistic and ADHD groups than control group (P<0.01). Comparing the autistic group to the ADHD group, there were no significant differences in age, gender, scores of full-scale intelligent quotient (IQ), verbal or performance IQ, number of categories achieved or errors. The ADHD group, however, showed more frequent Milner type perseverative errors than the autistic group (P<0.05). The present study suggests that some kinds of executive function are more impaired in children with ADHD than in those with high-functioning autism, and that Milner type perseverative errors is useful parameter to differentiate the executive dysfunctions between autistic and ADHD children.

Introduction

It has been proposed that some impairments of executive functions, such as those involving flexibility, set maintenance, organization, and planning, might play part in autism and attention-deficit/hyperactivity disorder (ADHD). The Wisconsin Card Sorting Test (WCST), which assesses the ability to form abstract concepts, to sustain attention, and to shift cognitive set flexibly in response to changing conceptual rules while inhibiting inappropriate responses [1], [2], [3], is one of the most commonly used tests for executive function in the school-aged population [4]. In patients with autism or ADHD, the variables reported for the standard WCST differ across studies, making comparisons between studies difficult [5].

Ozonoff et al. reported that participants with autism tended to perform better on the computerized WCST than on the standard format [2]. They suggested that the computerized version of this test would more accurately reflect executive function in autism, because it involves less social and verbal demands than the standard format. If the examiner wants to evaluate achievement under supportive conditions, to see how well the child is potentially capable of performing, the computer administration format may, therefore, be preferable [6].

Although, the clinical syndrome of autism appears different from that of ADHD, children with autism may be initially diagnosed as having ADHD in clinical practice. Moreover, many children with pervasive developmental disorder not otherwise specified experience problems with attention processes, hyperactivity, acting-out behavior, and poor self-control [7]. Furthermore, in a genetic study, Smalley et al. reported that variations in a gene on 16p13 might contribute to deficits common to both ADHD and autistic disorders [8]. Clarifying the differences and similarities between autistic spectrum disorders and ADHD is of clinical significance and is also very important for clinical practice and research purposes. To investigate the possibility that executive impairment in ADHD might differ from that in autism, the present study administered the computerized version of the WCST to children with high-functioning autism, ADHD, and controls.

Section snippets

Subjects

We obtained psychiatric data from children more than 8 years of age, on the basis of the suggestion of Filley et al. that the WCST might have diagnostic utility in children as young as 8-years-old [9], although it has been recommended that caution is exercised in children under 10 [10]. The Wechsler Intelligence Scale for Children-Revised (WISC-R; 1974) or WISC-Third Edition (WISC-III; 1991) were used to measure general intellectual ability. We obtained informed consent for all participants

Methods

Each participant was administered a computerized version (version 1.00 for Windows 95) of the WCST. The WCST consists of four stimulus cards that vary along three dimensions (color, shape, and number). Participants are given 128 cards that vary along the same dimensions and are asked to match the cards in the deck with one of the fourth stimulus cards. The computer screen displays ‘○’ for correct placement of a card and ‘×’ for incorrect placement, but does not reveal the sorting strategy,

Results

Results of the computerized version of the WCST are shown in Table 1.

Discussion

As executive dysfunction has been reported in the developmental, psychiatric and neurological disorders, it has been proposed that autistic subjects suffer from primarily deficiencies in flexibility and planning, and that ADHD subjects have difficulties of sustaining attention and inhibiting behavior [2], [14], [15]. The WCST, one of the tests reflecting executive function, is thought to measure set maintenance skills, the ability to flexibly modify incorrect strategies, and to inhibit

Conclusion

The computerized version of the WCST revealed similar degree of executive dysfunction in both children with autism and ADHD compared with control subjects. However, ADHD subjects showed more Milner type perseverative errors. These results suggest that children with ADHD show more deficient in flexibility than high-functioning autistic children. The authors, therefore, recommend that perseverative errors on the WCST should be categorized as Milner or Nelson type in order to discriminate the

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Potentially pathogenic cytogenetic deletions within Xp22.3 are relatively common in patients with autistic spectrum disorders (ASDs) (Thomas et al., 1999; Chocholska et al., 2006; Vorstman et al., 2006; Kent et al., 2008; Shinawi et al., 2009), characterised by social/communication impairments, restricted interests or repetitive/stereotyped behaviours, hyperactivity and anxiety (O’Hare, 2009). Xp22.3 deletions have also been reported in cases of attention deficit hyperactivity disorder (ADHD) (Boycott et al., 2003; Lonardo et al., 2007; Kent et al., 2008), a second neurodevelopmental condition characterised by inattention, pathological impulsivity and hyperactivity (Thapar et al., 2012) which is commonly comorbid with autism and which is thought to share overlapping genetic aetiology (Rommelse et al., 2010); individuals with ADHD may also display a heightened tendency towards behavioural perseveration (Fischer et al., 2005; Tsuchiya et al., 2005). Several Xp22.3 genes represent good candidates for conferring vulnerability to psychiatric illness: functional mutations within NLGN4X (encoding the synaptic neuroligin 4X protein) have been reported in cases of autism (Jamain et al., 2003; Laumonnier et al., 2004), whilst mutations within ASMT (encoding the acetylserotonin-O-methyltransferase enzyme involved in the biosynthesis of melatonin from serotonin) have been seen in individuals with autism (Melke et al., 2008; Jonsson et al., 2010) and ADHD (Chaste et al., 2011).
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Original articleComputerized version of the Wisconsin card sorting test in children with high-functioning autistic disorder or attention-deficit/hyperactivity disorder

Abstract

Introduction

Section snippets

Subjects

Methods

Results

Discussion

Conclusion

Behav Brain Res

Am J Hum Genet

Cortex

Neuropsychological and psychophysiological differentiation of inattention/overactivity and aggression/defiance symptom groups

J Clin Child Psychol

Reliability and validity of the Wisconsin Card Sorting Test in studies of autism

Neuropsychology

Neuropsychological performance in DSM-IV ADHD subtypes: an exploratory study with untreated adolescents

Can J Psychiatry

Executive function deficits in high-functioning autistic individuals: relationship to theory of mind

J Child Psychol Psychiatry

Contributions of psychology

How unspecified are disorders of children with a pervasive developmental disorder not otherwise specified?

Eur Child Adolesc Psychiatry

Frontal lobe lesions and executive dysfunction in children

Neuropsychiatry Neuropsychol Behav Neurol

Original article
Computerized version of the Wisconsin card sorting test in children with high-functioning autistic disorder or attention-deficit/hyperactivity disorder