Wisconsin Card Sorting Test embedded validity indicators developed for adults can be extended to children

Jonathan D. Lichtenstein, Laszlo A. Erdodi, Jaspreet K. Rai, Anya Mazur-Mosiewicz, Lloyd Flaro

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Past studies have examined the ability of the Wisconsin Card Sorting Test (WCST) to discriminate valid from invalid performance in adults using both individual embedded validity indicators (EVIs) and multivariate approaches. This study is designed to investigate whether the two most stable of these indicators—failures to maintain set (FMS) and the logistical regression equation S-BLRE—can be extended to pediatric populations. The classification accuracy for FMS and S-BLRE was examined in a mixed clinical sample of 226 children aged 7 to 17 years (64.6% male, MAge = 13.6 years) against a combination of established performance validity tests (PVTs). The results show that at adult cutoffs, FMS and S-BLRE produce an unacceptably high failure rate (33.2% and 45.6%) and low specificity (.55–.72), but an upward adjustment in cutoffs significantly improves classification accuracy. Defining Pass as <2 and Fail as ≥4 on FMS results in consistently good specificity (.89–.92) but low and variable sensitivity (.00–.33). Similarly, cutting the S-BLRE distribution at 3.68 produces good specificity (.90–.92) but variable sensitivity (.06–.38). Passing or failing FMS or S-BLRE is unrelated to age, gender and IQ. The data from this study suggest that in a pediatric sample, adjusted cutoffs on the FMS and S-BLRE ensure good specificity, but with low or variable sensitivity. Thus, they should not be used in isolation to determine the credibility of a response set. At the same time, they can make valuable contributions to pediatric neuropsychology by providing empirically-supported, expedient and cost-effective indicators to enhance performance validity assessment.

Original languageEnglish
Pages (from-to)247-260
Number of pages14
JournalChild Neuropsychology
Issue number2
StatePublished - 17 Feb 2018


  • Effort testing
  • Embedded validity indicators
  • Pediatric PVTs
  • Pediatric neuropsychological assessment
  • Performance validity testing
  • WCST


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