INTRODUCTION

The frontal lobe, located at the front of the brain, plays a vital role in higher cognitive
functions, including decision-making, problem-solving, planning, and emotional regulation.
It houses areas responsible for language production (Broca’s area) and motor functions,
particularly fine motor skills and voluntary movements. Psychologically, the frontal lobe is
central to executive functions, which allow us to set goals, regulate our behavior, and adapt to
complex social environments. Damage or dysfunction in this area can lead to difficulties in
impulse control, changes in personality, and challenges with goal-directed behavior,
underscoring its importance in both everyday functioning and mental health. Reaching full
maturity in the late 20s, the frontal lobe underpins cognitive maturity, aiding in problem-
solving, motor control, emotional regulation, and cognitive flexibility. While minor atrophy is
typical with age, damage here often leads to difficulties in adapting behavior based on
feedback, affecting everyday adaptability and decision-making.
Neuroscience research has highlighted that cognitive flexibility—a key component of
executive functioning—encompasses various cognitive processes, such as attention shifting,
conflict monitoring, and knowledge representation (Cañas et al., 2006; Ionescu, 2012).
Cognitive flexibility involves the ability to adapt mental frameworks in response to new
information, which builds upon foundational skills like inhibitory control and working
memory. This adaptability supports higher-order executive functions essential for reasoning,
problem-solving, and planning (Diamond, 2013).
In psychology, neuropsychological tests are frequently used to measure specific
psychological functions associated with particular brain regions. For instance, patients with
frontal-lobe damage often struggle to adjust responses in situations with shifting demands,
showing a pattern known as perseveration. The Wisconsin Card Sorting Test (WCST),
developed by Grant and Berg in 1948, is a widely used test to assess cognitive flexibility and
frontal lobe function, particularly in individuals with prefrontal cortex damage (Milner,
1960). The WCST assesses several frontal lobe functions, including strategic planning,
organized searching, the use of feedback for adapting cognitive sets, goal-directed behavior,
and impulse control. Successful performance on the WCST relies on cognitive processes like
attention, working memory, and visual processing, making it a valuable tool for evaluating
the impact of frontal-lobe injury (Wisconsin Card Sorting Inspired Task, 2021).
The Wisconsin Card Sorting Test (WCST) is a widely used neuropsychological tool for
assessing executive functions and cognitive flexibility, primarily in the frontal lobe. In this
test, participants are asked to match cards based on various criteria such as color, shape, and
number without prior instructions about the correct sorting rule. Instead, they receive
feedback after each match, requiring them to adjust their strategy based on trial and error. The
WCST measures several cognitive abilities, including strategic planning, organized
searching, working memory, impulse control, and the capacity to shift cognitive sets when the
sorting rule changes. Perseveration, where a participant repeatedly uses an old rule despite
feedback, is a significant indicator in this test, often revealing impaired cognitive flexibility
in individuals with frontal-lobe damage. Clinically, the WCST is invaluable for assessing
frontal-lobe function in patients with conditions like traumatic brain injury, schizophrenia, or
dementia, and has become a standard tool in evaluating prefrontal cortex function since its
development by Grant and Berg in 1948 and subsequent use by Milner in the 1960s.
Completing the WCST demands attention, working memory, visual processing, and the
ability to incorporate feedback, making it a comprehensive test of executive function.
In the present experiment, the Wisconsin Card Sorting Task (WCST) was administered as a
computer-based test using the software PsyToolKit. In this task, subjects are presented with
four stimulus cards, each differing in color, shape, and number of elements. The participant’s
goal is to sort cards based on a changing rule—color, shape, or number—and they only
receive feedback on whether their choice is correct or incorrect. Initially, the sorting rule is
based on color, but once the subject identifies this, the correct criterion changes without
warning to shape, and later to number, requiring the subject to inhibit their previous strategy
and adapt to a new sorting rule.
The WCST is particularly challenging for individuals with frontal-lobe damage, who often
struggle with shifting response strategies and show perseveration, where they continue
responding to the original rule despite feedback that it is incorrect. This tendency illustrates
the role of the frontal lobe in behavioral flexibility and adaptive control, as perseveration is
common in tasks requiring cognitive flexibility. However, Anderson et al. (1991) found no
significant difference in WCST performance between individuals with frontal and non-frontal
brain damage, suggesting that the WCST cannot exclusively index frontal lobe impairment.
In addition to behavioral flexibility, successful performance on the WCST relies on several
executive functions, including attention, working memory, and inhibitory control, as the
participant must monitor feedback and adjust behavior based on changing demands. These
elements make the WCST a valuable assessment tool, although it must be interpreted
alongside other assessments for an accurate understanding of frontal-lobe function.
There are many researches which study executive control functions (ECFs) using the WCST
test. A study by Stoet and Snyder (2009) on old-world macaque monkeys found that the
frontal lobes are important for executive functions. Cells that represent a current task are
driven by bottom up sensory signals or from a combination of sensory signals and feedback
from the frontal lobes. The WCST taps into various fundamental properties of ECFs: the
capacity to represent the current sorting rule, the capacity to monitor error feedback and the
capacity to change the course of action based on internal criteria. The failure to switch rapidly
after an error may reflect cognitive inflexibility (Monsell, 2003). The Wisconsin card sorting
test (WCST) was developed to measure flexibility of human thought. Today, it is considered
the ultimate test of ECFs. Each card is marked with one to four instances of one of four
symbols in one of four colours. Participants are not given explicit instructions about how to
sort the cards. Instead, they receive the feedback `right' or `wrong' after each card. The
sorting rule is changed every ten trials without an explicit cue. Participants must use the error
feedback to determine what rule to use and when to switch to a new rule. The WCST test is
widely used in psychology. It is used in the creation of validated psychological tests to
measure a person’s prefrontal function and thinking flexibility. It is also used in
neuropsychological assessments to examine a person’s set shifting abilities. The results can
help in the diagnosis and characterization of different psychiatric and neurological disorders
(Stoet & Snyder, 2009). The WCST is also used by NIMHANS neuropsychological
assessment battery to assess the set shifting capabilities in clinical patients with frontal lobe
damage.
Problem
What is the set shifting capability of the participant as evidenced by the Wisconsin
card sorting test ?
Objective
The objective of the present assessment is to assess the set shifting capability of the
participant using the Wisconsin card sorting test.

METHOD
Plan and Design
Table 7.1
Participant
Participant M.K is a 20 year old male who lives in a semi urban area. He is a 3rd year student
of mechanical engineering at a government college. He belongs to the middle socio economic
class. A total of N=6 participant’s data was pooled for analysis. The average age of the
participants in this study was 24.1 years. There were 5 males and 1 female.
Instrument and material
The Wisconsin card sorting task was developed by David Grant and Esta Berg. It is a test of
cognitive reasoning. The present experiment uses a computer based Wisconsin card sorting
task. For online data collection, the software PsyToolkit was used (Stoet, 2010, 2017). The
test contains 60 stimulus cards. Each card contained from one to four identical figures of a
single colour. Four kinds of figures were used : stars, crosses, triangles, and circles ; four
colours were used : red, yellow, blue, and green. A single card might have four green
triangles, or two yellow circles or any other such combination. Each card could then be sorted
or categorised according to the number, the form, or the colour of the figures. During the test,
the participant has to classify cards according to different criteria. The participant is told to
match the cards but not how to match. There are four different ways to classify each card and
the only feedback is whether the classification is correct or not. The task requires participants
to find the correct classification principle by trial and error and feedback. Once the subject
chooses the correct rule they must maintain this sorting principle (or set) across changing
stimulus conditions. After ten consecutive correct matches, unknown to the participant the
classification principle changes without warning, demanding a flexible shift in set. The
participant now has to discover the new changed rule based on the feedback provided alone.
The participant commits a perseveration error when they continue to classify the cards based
on the previous rule even after the rule has changed. The number of perseveration errors
made determines the participant’s cognitive flexibility and the ability to consider
environmental cues to alter behaviour. A high number of perseveration errors shows lack of
cognitive flexibility and a high number of non perseveration errors show reduced
concentration abilities. The expected time to finish the task is 10-15 minutes.
Scoring and interpretation
The Wisconsin card sorting test is a test of set shifting. The participant is presented with four
stimulus cards bearing designs that differ in colour, form and number of elements and is told
to match the cards but not how to match. The total number of errors made by the participant,
number of perseveration error and number of non perseveration error are noted down. The
total time taken to complete the test is also noted down. If the perseveration errors are high, it
is indicated as a lack of cognitive flexibility. A high number of non perseveration errors
shows lack of memory for rules and reduced concentration abilities. The participant’s error
scores and total time taken is compared with 5 other participants whose data was obtained
and an across subject data analysis was conducted.
Procedure
The participant was seated comfortably in a well ventilated room free from distractions.
Demographic details were collected and a rapport was established. Informed consent was
given to the participant. The participant was made aware of the benefits and confidentiality
maintained in the study. The participant was also informed that he had the freedom to
withdraw from the study at any point in time. The participant was shown a laptop with the
Wisconsin card sorting task opened. The participant was asked to match the cards according
to a criteria they think is applicable. The time taken and errors committed are noted down.
The participant was informed to clarify doubts if any regarding instruction. While taking the
test, behavioural observations were noted down. An introspective report was collected. The
aim of the study was debriefed to the participant and was asked whether to withdraw from the
study. Gratitude was expressed and the participant was allowed to leave.
Instructions
“In this test, you need to match a card to one of four tasks presented at the top of the screen.
Click one of the four cards that match the card on the left. Following your selection, you will
get feedback . If your match was not correct, you need to try a different rule. You will need to
find out whether to match according to colour, number or shape. You need to carefully
monitor the feedback. If the computer gives you error messages, you need to change your
rules. There are 60 trials. The time taken for you to complete that list and the errors
committed will be measured. Try to answer as fast as possible. Your answers will be kept
confidential and you have every right to discontinue the study at any point of time.”
RESULT
Table 6.2
Total time taken and number of errors of the participant in the Wisconsin card sorting test.

Participant 1 Total number of Perseveration Non- Time taken (in

errors error perseveratio minutes)
n error
NM(23, female) 11 6 5 5

Table 6.2 shows the number of errors and the total time taken by the participant to complete
the Wisconsin card sorting test. The participant has made a total of 11 errors, in which 6 are
perseveration errors and 3 are non perseveration errors. The total time taken by the
participant to complete the experiment was 5 minutes.
DISCUSSION
The participant for the study was NS, a 23-year-old female who lives in a semi urban area.
She is currently in her 1st year of MSW. She belongs to the middle socio economic class. The
aim of the study was to assess the set shifting capability of the participant using the
Wisconsin card sorting test.
Cognitive flexibility is the capacity to adapt cognitive strategies and processes in response to
new, changing, or unexpected situations (Cañas et al., 2003). It allows individuals to shift
from one task to another, consider multiple perspectives, devise new solutions to problems,
and effectively respond to novel environmental demands (Dajani & Uddin, 2015; Ionescu,
2012). This flexibility is essential for navigating complex social and problem-solving
scenarios, as it underpins our ability to manage diverse situations and adjust our thinking as
needed.
The participant was comfortably seated in a well-ventilated, distraction-free room. After
collecting demographic details, rapport was established, and informed consent was obtained.
The participant was informed about the benefits of the study, assured of confidentiality, and
reminded of their right to withdraw at any time. The Wisconsin Card Sorting Task was
presented on a laptop, and the participant was instructed to sort cards according to the criteria
they believed was correct. Both the time taken and the number of errors made were recorded.
The participant was encouraged to ask questions about instructions if needed, and behavioral
observations were noted during the test. Following the task, an introspective report was
collected, and the study's aim was debriefed. The participant was once again given the option
to withdraw from the study.
Table 6.2 shows the participant’s total time taken and the number of errors made in the
WCST test. As observed in the table, the participants took 6 minutes to complete the test and
made 11 total errors, 6 perseverance errors and 5 non perseverance errors.
The participant’s performance, with a total of 11 errors 6 being perseverative and 3 non-
perseverative suggests a balanced yet somewhat speed-focused approach to the task.
Perseverative errors indicate mild difficulty with cognitive flexibility, as the participant
occasionally struggled to adapt to new sorting rules after feedback. However, this error count
is moderate, suggesting only minor challenges with set-shifting rather than significant
impairment. Non-perseverative errors point to occasional lapses in attention or minor
misunderstandings of the current rule but do not indicate issues with rule adherence.
Completing the task in 5 minutes reflects a relatively fast pace, which may have contributed
to the error rate if the participant prioritized speed over accuracy. Overall, the participant’s
results suggest functional executive processing with mostly intact cognitive flexibility,
tempered by a few attentional slips or impulsive responses in adapting to rule changes.
During rapport building, the participant shared that he did not experience any headaches and
expressed enthusiasm about participating in the test, eagerly awaiting the results. His
cooperative and engaged attitude contributed to the smooth progression of the session, and he
completed the card-sorting task relatively quickly. Notably, when the sorting rule changed, he
verbalized the new rule repeatedly, explaining afterward that this technique helped him stay
focused and remember the shifting criteria. He mentioned viewing the experiment as a "fun
psychology test" and disclosed that he generally finds following rules challenging, which he
felt could impact his performance. However, despite his concerns, the participant understood
the core of the task as following and adapting to rules when new ones were introduced.
In analyzing his performance, the participant demonstrated no difficulty with set-shifting
adjusting his responses as the task rules changed without signs of perseveration. His scores
on metrics of the WCST, including time taken and errors, fell within the average performance
range of the sample, indicating effective cognitive flexibility and executive control.
Behavioral observations, coupled with his self-reported insights, suggest that he engaged with
the task thoughtfully and adapted his strategies as needed. These findings support the
conclusion that the participant’s set-shifting capability is intact, with performance well within
the expected range for cognitive flexibility. This adaptability highlights effective frontal-lobe
function and aligns with normative data on similar tasks, affirming his capacity for behavioral
flexibility under shifting task demands.

REFERENCES

APPENDICES
Consent form

1. Purpose of the Study:

This study is conducted to know your set shifting capability using the Wisconsin cardsorting
task. This study will help me to understand set shifting capability.
2. Benefits of the study.
You will be able to know about the WCST test and set shifting capability and I can give you
further information on set shifting capability and cognitive flexibility. The academic
community will benefit from this assessment in many ways:
1. The participant who administers will gain practice in the relevant fields.
2. This assessment will help us to understand cognitive flexibility..
3. This assessment will give us a better understanding of the benefits of different types of
WCST tests.
3. What you will be asked to do:
The test is a computer based test. The test contains 60 stimulus cards. Each card
contains from one to four identical figures of a single colour. Four kinds of figures
were used : stars, crosses, triangles, and circles ; four colours were used : red, yellow,
blue, and green. A single card might have four green triangles, or two yellow circles
or any other such combination. Each card could then be sorted or categorised
according to the number, the form, or the colour of the figures. The participant has to
match the cards on colour, shape or number and based on the response provided
(Good or Wrong), the participant can change their response. All the answers will be
kept confidential and the participant has every right to discontinue the study at any
point of time. Try to answer as fast as possible.
4. What you can expect to happen as a result of your participation in this study:
This is a fairly short study that would require about 5-10 minutes of your time. If you
want to leave, you may do so at any point in time during the study. If you have any
queries, you may ask me and I will try to help. If you are reluctant to participate in the
experiment, you may decline to participate in the study.
5. If you would like more information about this study:
If you have any queries or doubts regarding any questions at any point, feel free to
contact the examiner/assessor who will try their best to clear the same. For further
details regarding the results, you may contact Gouri Nandana V and also the Psychology
Department of Central University of Tamilnadu at [email protected]
6. Withdrawal from the study:
You have the right to withdraw your participation at any point when you are doing the
WCST test for any of the reasons. If you are willing, you can give feedback about the
test. Please feel free to ask your queries or concerns to the experimenter. Even after
completion, you have the power to rescind your responses and I will promptly delete
them.
7. Confidentiality of your data.
The data will be used for academic purposes only. Name and responses will not be
revealed to anyone else. Participation in this will remain confidential.

I have read the above and understood its contents. I agree to participate in this study.

Signature : N.M Date: 12/11/2024

Printed name : N.M

Introspective report
“I was very excited to do this test. This was a fun psychology test. It was like playing a game.
I was very conscious and focused on the rules and when the rules are changing”

Observation report
The participant demonstrated a high level of enthusiasm throughout the test, showing
considerable interest in the process and curiosity about the results. He approached the task
with a positive and cooperative attitude, allowing the experiment to proceed smoothly and
efficiently. Notably, the participant adapted quickly to the task changes, verbalizing each new
rule as it was introduced. When asked afterward about this behavior, he explained that saying
the rule aloud helped him maintain focus and keep the shifting criteria clear in his mind. He
described the experiment as engaging and enjoyable, viewing it as an interesting
psychological exercise.