Skip to main content
SpringerLink
Log in

A Meta-analysis of the Wisconsin Card Sort Task in Autism

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

We conducted a meta-analysis of 31 studies, spanning 30 years, utilizing the WCST in participants with autism. We calculated Cohen’s d effect sizes for four measures of performance: sets completed, perseveration, failure-to-maintain-set, and non-perseverative errors. The average weighted effect size ranged from 0.30 to 0.74 for each measure, all statistically greater than 0. No evidence was found for reduced impairment when WCST is administered by computer. Age and PIQ predicted perseverative error rates, while VIQ predicted non-perseverative error rates, and both perseverative and non-perseverative error rates in turn predicted number of sets completed. No correlates of failure-to-maintain set errors were found; further research is warranted on this aspect of WCST performance in autism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. Two potential stoppage rules may be used, either six sets achieved or all cards administered. The total cards used may be 64 or 128. These variations have been criticized (see Greve et al. 2005), and may also have implications for interpretation in special populations such as autism, however this information was frequently omitted from the studies included in this meta-analysis.

References

(Articles included in the meta-analysis are denoted with *)

  • *Ambery, F. Z., Russell, A. J., Perry, K., Morris, R., & Murphy, D. G. M. (2006). Neuropsychological functioning in adults with Asperger syndrome. Autism, 10, 551–564. doi:10.1177/1362361306068507.

    Article  PubMed  Google Scholar 

  • Ankenman, K., Elgin, J., Sullivan, K., Vincent, L., & Bernier, R. (2014). Nonverbal and verbal cognitive discrepancy profiles in autism spectrum disorders: Influence of age and gender. American Journal on Intellectual and Developmental Disabilities, 119, 84–99.

    Article  PubMed  Google Scholar 

  • *Bennetto, L., Pennington, B. F., & Rogers, S. J. (1996). Intact and impaired memory functions in autism. Child Development, 67, 1816–1835. doi:10.1111/j.1467-8624.1996.tb01830.x.

    Article  PubMed  Google Scholar 

  • Calero, M. D., Mata, S., Bonete, S., Molinero, C., & Gómez-Pérez, M. M. (2015). Relations between learning potential, cognitive and interpersonal skills in Asperger children. Learning and Individual Differences. doi:10.1016/j.lindif.2015.07.004.

    Google Scholar 

  • Card, N. A. (2011). Applied meta-analysis for social science research. New York: Guildford Publications.

    Google Scholar 

  • Chelune, G. J., & Baer, R. A. (1986). Developmental norms for the Wisconsin card sorting test. Journal of Clinical and Experimental Neuropsychology, 8, 219–228. doi:10.1080/01688638608401314.

    Article  PubMed  Google Scholar 

  • *Ciesielski, K. T., & Harris, R. J. (1997). Factors related to performance failure on executive tasks in autism. Child Neuropsychology, 3, 1–12. doi:10.1080/09297049708401364.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences. New York: Psychology Press.

    Google Scholar 

  • Cumming, G. (2014). The new statistics: Why and how. Psychological Science, 25, 7–29. doi:10.1177/0956797613504966.

    Article  PubMed  Google Scholar 

  • Edgin, J. O., & Pennington, B. F. (2005). Spatial cognition in autism spectrum disorders: Superior, impaired, or just intact? Journal of Autism and Developmental Disorders, 35, 729–745. doi:10.1007/s10803-005-0020-y.

    Article  PubMed  Google Scholar 

  • Feldstein, S. N., Keller, F. R., Portman, R. E., Durham, R. L., Klebe, K. J., & Davis, H. P. (1999). A comparison of computerized and standard versions of the Wisconsin card sorting test. The Clinical Neuropsychologist, 13, 303–313. doi:10.1076/clin.13.3.303.1744.

    Article  PubMed  Google Scholar 

  • Geurts, H. M., Corbett, B., & Solomon, M. (2009). The paradox of cognitive flexibility in autism. Trends in Cognitive Sciences, 13, 74–82.

    Article  PubMed  Google Scholar 

  • *Geurts, H. M., Verte, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry, 45, 836–854. doi:10.1111/j.1469-7610.2004.00276.x.

    Article  PubMed  Google Scholar 

  • Gioia, G. A., & Isquith, P. K. (2004). Ecological assessment of executive function in traumatic brain injury. Developmental Neuropsychology, 25, 135–158.

    Article  PubMed  Google Scholar 

  • Goldstein, G., Johnson, C. R., & Minshew, N. J. (2001). Attentional processes in autism. Journal of Autism and Developmental Disorders, 31, 433–440. doi:10.1023/A:1010620820786.

    Article  PubMed  Google Scholar 

  • *Goldstein, G., Johnson, C. R., & Minshew, N. J. (2001). Attentional processes in autism. Journal of Autism and Developmental Disorders, 31, 433–440. doi:10.1023/A:1010620820786.

    Article  PubMed  Google Scholar 

  • Grant, D. A., & Berg, E. A. (1948). A behavioral analysis of degree of reinforcement and base of shifting to new responses in a Weigl-type card-sorting problem. Journal of Experimental Psychology, 38, 404–411. doi:10.1037/h0059831.

    Article  PubMed  Google Scholar 

  • *Greibling, J., Minshew, N. J., Bodner, K., Libove, R., Bansai, R., et al. (2010). Dorso-lateral prefrontal cortex MRI measurements and cognitive performance in autism. Journal of Child Neurology, 25, 856–863. doi:10.1177/0883073809351313.

    Article  Google Scholar 

  • Greve, K. W., Stickle, T. R., Love, J. M., Bianchini, K. J., & Stanford, M. S. (2005). Latent structure of the Wisconsin card sorting test: A confirmatory factor analytic study. Archives of Clinical Neuropsychology, 20, 355–364.

    Article  PubMed  Google Scholar 

  • Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin card sorting test manual revised and expanded. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Hill, E. L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental Review, 24, 189–233. doi:10.1016/j.dr.2004.01.001.

    Article  Google Scholar 

  • Hughes, C., Russell, J., & Robbins, T. W. (1994). Evidence for executive dysfunction in autism. Neuropsychologia, 32, 477–492. doi:10.1016/0028-3932(94)90092-2.

    Article  PubMed  Google Scholar 

  • Hus, V., & Lord, C. (2013). Effects of child characteristics on the Autism Diagnostic Interview-Revised: Implications for use of scores as a measure of ASD severity. Journal of Autism and Developmental Disorders, 43, 371–381.

    Article  PubMed  PubMed Central  Google Scholar 

  • *Kaland, N., Smith, L., & Mortensen, E. L. (2008). Brief report: Cognitive flexibility and focused attention in children and adolescents with Asperger syndrome or high-functioning autism as measured on the computerized version of the Wisconsin card sorting test. Journal of Autism and Developmental Disorders, 38, 1161–1165. doi:10.1007/s10803-007-0474-1.

    Article  PubMed  Google Scholar 

  • Kenworthy, L., Yerys, B. E., Anthony, L. G., & Wallace, G. L. (2008). Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychology Review, 18, 320–338.

    Article  PubMed  PubMed Central  Google Scholar 

  • *Kilinçaslan, A., Nahit, M. M., Kucukyazici, G. S., & Gurvit, H. (2010). Assessment of executive/attentional performance in Asperger’s disorder. Turkish Journal of Psychiatry, 21, 289–299.

    Google Scholar 

  • Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks: Sage.

    Google Scholar 

  • *Liss, M., Fein, D., Allen, D., Dunn, M., Feinstein, C., et al. (2001). Executive functioning in high-functioning children with autism. Journal of Child Psychology and Psychiatry, 42(2), 262–270. doi:10.1017/S0021963001006679.

    Google Scholar 

  • *Lopez, B. P., Lincoln, A. J., Ozonoff, S., & Lai, Z. (2005). Examining the relationship between executive functions and restricted, repetitive symptoms of autistic disorder. Journal of Autism and Developmental Disorders, 35, 445–460. doi:10.1007/s10803-005-5035-x.

    Article  PubMed  Google Scholar 

  • Milner, B. (1963). Effects of different brain lesions on card sorting. Archives of Neurology, 9, 101–110. doi:10.1001/archneur.1963.00460070100010.

    Article  Google Scholar 

  • *Minshew, N. J., Meyer, J., & Goldstein, G. (2002). Abstract reasoning in autism: A dissociation between concept formation and concept identification. Neuropsychology, 16, 327–334. doi:10.1037/0894-4105.16.3.327.

    Article  PubMed  Google Scholar 

  • *Minshew, N. J., Muenz, L. R., Goldstein, G., & Payton, J. B. (1992). Neuropsychological functioning in nonmentally retarded autistic individuals. Journal of Clinical and Experimental Neuropsychology, 14, 749–761. doi:10.1080/01688639208402860.

    Article  PubMed  Google Scholar 

  • Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41, 49–100.

    Article  PubMed  Google Scholar 

  • *Nyden, A., Gillberg, C., Hjelmquist, E., & Heiman, M. (1999). Executive function/attention deficits in boys with Asperger syndrome, attention disorder and reading/writing disorder. Autism, 3, 213–228. doi:10.1177/1362361399003003002.

    Article  Google Scholar 

  • *Ozonoff, S. (1995). Reliability and validity of the Wisconsin card sorting test in studies of autism. Neuropsychology, 9(4), 491.

    Article  Google Scholar 

  • Ozonoff, S., Cook, I., Coon, H., Dawson, G., Joseph, R. M., et al. (2004). Performance on Cambridge Neuropsychological Test Automated Battery subtests sensitive to frontal lobe function in people with autistic disorder: evidence from the Collaborative Programs of Excellence in Autism network. Journal of Autism and Developmental Disorders, 34, 139–150. doi:10.1023/B:JADD.0000022605.81989.cc.

    Article  PubMed  Google Scholar 

  • *Ozonoff, S., & Jensen, J. (1999). Brief Report: Specific executive function profiles in three neurodevelopmental disorders. Journal of Autism and Developmental Disorders, 29, 171–177. doi:10.1023/A:1023052913110.

    Article  PubMed  Google Scholar 

  • *Ozonoff, S., & McEvoy, R. E. (1994). A longitudinal study of executive function and theory of mind development in autism. Development and Psychopathology, 6, 415–431. doi:10.1017/S0954579400006027.

    Article  Google Scholar 

  • *Ozonoff, S., Pennington, B. F., & Rogers, S. J. (1991). Executive function deficits in high-functioning autistic individuals: Relationship to theory of mind. Journal of Child Psychology and Psychiatry, 32, 1081–1105. doi:10.1111/j.1469-7610.1991.tb00351.x.

    Article  PubMed  Google Scholar 

  • Ozonoff, S., & Strayer, D. L. (2001). Further evidence of intact working memory in autism. Journal of Autism and Developmental Disorders, 31, 257–263. doi:10.1023/A:1010794902139.

    Article  PubMed  Google Scholar 

  • Ozonoff, S., Strayer, D. L., McMahon, W. M., & Filloux, F. (1994). Executive function abilities in autism and Tourette syndrome: An information processing approach. Journal of Child Psychology and Psychiatry, 35, 1015–1032. doi:10.1111/j.1469-7610.1994.tb01807.x.

    Article  PubMed  Google Scholar 

  • *Pascualvaca, D. M., Fantie, B. D., Papageorgiou, M., & Mirsky, A. F. (1998). Attentional capacities in children with autism: Is there a general deficit in shifting focus? Journal of Autism and Developmental Disorders, 28, 467–478. doi:10.1023/A:1026091809650.

    Article  PubMed  Google Scholar 

  • Prior, M., & Hoffmann, W. (1990). Brief report: Neuropsychological testing of autistic children through an exploration with frontal lobe tests. Journal of Autism and Developmental Disorders, 20, 581–590. doi:10.1007/BF02216063.

    Article  PubMed  Google Scholar 

  • *Robinson, S., Goddard, L., Dritschel, B., Wisley, M., & Howlin, P. (2009). Executive functions in children with autism spectrum disorders. Brain and Cognition, 71, 362–368. doi:10.1016/j.bandc.2009.06.007.

    Article  PubMed  Google Scholar 

  • Rosenthal, R. (1984). Meta-analytic procedures for social science research. Thousand Oaks: Sage.

    Google Scholar 

  • Rosselli, M., & Ardila, A. (1993). Developmental norms for the Wisconsin card sorting test in 5-to 12-year-old children. The Clinical Neuropsychologist, 7, 145–154. doi:10.1080/13854049308401516.

    Article  Google Scholar 

  • *Rumsey, J. M. (1985). Conceptual problem-solving in highly verbal, nonretarded autistic men. Journal of Autism and Developmental Disorders, 15, 23–36. doi:10.1007/BF01837896.

    Article  PubMed  Google Scholar 

  • *Rumsey, J. M., & Hamburger, S. D. (1988). Neurophysiological findings in high-functioning men with infantile autism, residual state. Journal of Clinical and Experimental Neuropsychology, 10, 201–221. doi:10.1080/01688638808408236.

    Article  PubMed  Google Scholar 

  • *Rumsey, J. M., & Hamburger, S. D. (1990). Neuropsychological divergence of high-level autism and severe dyslexia. Journal of Autism and Developmental Disorders, 20, 155–168. doi:10.1007/BF02284715.

    Article  PubMed  Google Scholar 

  • Russell, J., Jarrold, C., & Hood, B. (1999). Two intact executive capacities in children with autism: Implications for the core executive dysfunctions in the disorder. Journal of Autism and Developmental Disorders, 29, 103–112. doi:10.1023/A:1023084425406.

    Article  PubMed  Google Scholar 

  • Russo, N., Flanagan, T., Iarocci, G., Berringer, D., Zelazo, P. D., & Burack, J. A. (2007). Deconstructing executive deficits among persons with autism: Implications for cognitive neuroscience. Brain and Cognition, 65, 77–86.

    Article  PubMed  Google Scholar 

  • *Schneider, S. G., & Asarnow, R. F. (1987). A comparison of cognitive/neuropsychological impairments of nonretarded autistic and schizophrenic children. Journal of Abnormal Child Psychology, 15, 29–46. doi:10.1007/BF00916464.

    Article  PubMed  Google Scholar 

  • Schopler, E., & Mesibov, G. B. (1995). Executive functions in autism. Learning & cognition in autism. New York: Plenum Press.

    Book  Google Scholar 

  • Shallice, T. I. M., & Burgess, P. W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727–741.

    Article  PubMed  Google Scholar 

  • *Shu, B. C., Tien, A. Y., & Chen, B. C. (2001). Executive function deficits in non-retarded autistic children. Autism, 5, 165–174. doi:10.1177/1362361301005002006.

    Article  PubMed  Google Scholar 

  • *Steel, J. G., Gorman, R., & Flexman, J. E. (1984). Case report: Neuropsychiatric testing in an autistic mathematical idiot-savant: Evidence for nonverbal abstract capacity. Journal of the American Academy of Child Psychiatry, 23, 704–707. doi:10.1016/S0002-7138(09)60540-9.

    Article  PubMed  Google Scholar 

  • Sullivan, E. V., Mathalon, D. H., Zipursky, R. B., Kersteen-Tucker, Z., Knight, R. T., & Pfefferbaum, A. (1993). Factors of the Wisconsin card sorting test as measures of frontal-lobe function in schizophrenia and in chronic alcoholism. Psychology Research, 46, 175–199. doi:10.1016/0165-1781(93)90019-D.

    Google Scholar 

  • *Sumiyoshi, C., Kawakubo, Y., Suga, M., Sumiyoshi, T., & Kasai, K. (2011). Impaired ability to organize information in individuals with autism spectrum disorders and their siblings. Neuroscience Research, 69, 252–257. doi:10.1016/j.neures.2010.11.007.

    Article  PubMed  Google Scholar 

  • *Szatmari, P., Tuff, L., Finlayson, A. J., & Bartolucci, G. (1990). Asperger’s syndrome and autism: Neurocognitive aspects. The American Academy of Child & Adolescent Psychiatry, 29, 130–136. doi:10.1097/00004583-199001000-00021.

    Article  Google Scholar 

  • Teunisse, J. P., Roelofs, R. L., Verhoeven, E. W., Cuppen, L., Mol, J., & Berger, H. J. (2012). Flexibility in children with autism spectrum disorders (ASD): Inconsistency between neuropsychological tests and parent-based rating scales. Journal of Clinical and Experimental Neuropsychology, 34, 714–723. doi:10.1080/13803395.2012.670209.

    Article  PubMed  Google Scholar 

  • Tien, A., Spevack, T. V., Jones, D. W., Pearlson, G. D., Schleapfer, T. E., & Strauss, M. E. (1996). Computerized Wisconsin card sorting test: Comparison with manual administration. Kaohsiung Journal of Medical Science, 12, 479–485.

    Google Scholar 

  • *Tsuchiya, E., Oki, J., Yahara, N., & Fujieda, K. (2005). Computerized version of the Wisconsin card sorting test in children with high-functioning autistic disorder or attention-deficit/hyperactivity disorder. Brain & Development, 27, 233–236. doi:10.1016/j.braindev.2004.06.008.

    Article  Google Scholar 

  • Van Eylen, L., Boets, B., Steyaert, J., Evers, K., Wagemans, J., & Noens, I. (2011). Cognitive flexibility in autism spectrum disorder: Explaining the inconsistencies? Research in Autism Spectrum Disorders, 5, 1390–1401.

    Article  Google Scholar 

  • *Voelbel, G. T., Bates, M. E., Buckman, J. F., Pandina, G., & Hendren, R. L. (2006). Caudate nucleus volume and cognitive performance: Are they related in childhood psychopathology? Biological Psychiatry, 60, 942–950. doi:10.1016/j.biopsych.2006.03.071.

    Article  PubMed  PubMed Central  Google Scholar 

  • Williams, D. M., Lind, S. E., Boucher, J., & Jarrold, C. (2013). Time-based and event-based prospective memory in autism: The roles of executive function, theory of mind, and time estimation. Journal of Autism and Developmental Disorders, 43, 1555–1567. doi:10.1007/s10803-012-1703-9.

    Article  PubMed  Google Scholar 

  • *Winsler, A., Abar, B., Feder, M. A., Schunn, C. D., & Rubio, D. A. (2007). Private speech and executive functioning among high-functioning children with autistic spectrum disorders. Journal of Autism and Developmental Disorders, 37, 1617–1635. doi:10.1007/s10803-006-0294-8.

    Article  PubMed  Google Scholar 

  • *Yang, J., Zhou, S., Yao, S., Su, L., & McWhinnie, C. (2009). The relationship between theory of mind and executive function in a sample of children from Mainland China. Child Psychiatry Human Development, 40, 169–182. doi:10.1007/s10578-008-0119-4.

    Article  PubMed  Google Scholar 

  • Zelazo, P. D., Müller, U., Frye, D., Marcovitch, S., Argitis, G., et al. (2003). The development of executive function in early childhood. Monographs of the Society for Research in Child Development. doi:10.1111/j.0037-976X.2003.00266.x.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Sura Muscati, Christopher Degagne, Philippe Chouinard, Jake Burack, and Natalie Russo for comments on the manuscript, and all the researchers who facilitated this meta-analysis by tracking down colleagues and sharing raw data.

Author Contributions

OL conceived of the study, participated in its design and coordination, performed measurement and statistical analysis, interpretation of the data, and drafted the manuscript; SA participated in the design and coordination of the study, performed measurement and statistical analysis, and helped to draft the manuscript. Both authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. School of Psychological Science, La Trobe University, Bendigo, VIC, 3550, Australia

    Oriane Landry

  2. Department of Psychology, Neuroscience, and Behavior, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

    Shems Al-Taie

Authors
  1. Oriane Landry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shems Al-Taie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oriane Landry.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 62 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Landry, O., Al-Taie, S. A Meta-analysis of the Wisconsin Card Sort Task in Autism. J Autism Dev Disord 46, 1220–1235 (2016). https://doi.org/10.1007/s10803-015-2659-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-015-2659-3

Keywords

Search

Navigation