Validez y baremos del Test de Clasificación de Tarjetas de Wisconsin (WCST) en sus versiones computarizada y manual en niños

Abstract

El WCST es un instrumento ampliamente utilizado durante la evaluación neuropsicológica como medida de la flexibilidad cognitiva reactiva. A pesar de que su utilización está muy extendida, continúa el debate sobre la naturaleza de los procesos cognitivos que subyacen a su desempeño y sobre las relaciones entre las diversas puntuaciones derivadas de la prueba en función de su modo de administración. Por otra parte, existen escasos estudios normativos en población hispanohablante, y particularmente, que hayan empleado la versión computarizada del WCST en niños. El objetivo del presente estudio fue examinar la validez factorial y convergente del WCST en su versión computarizada y manual en niños, y establecer las normas para cada versión. La muestra estuvo constituida por 359 niños de 7 a 12 años: 138 completaron el WCST manual y 221 el WCST computarizado. Se administró el WCST en sus dos versiones, el K-BIT, la prueba de memoria de trabajo (MT) del WISC-IV, el test de Stroop y la prueba de fluidez verbal (FV) semántica y fonológica. Se empleó Análisis Factorial Exploratorio, correlación de Pearson y análisis de variancia. el análisis paralelo indicó una solución unidimensional, agrupando respuestas eficientes e ineficientes para ambas versiones del WCST. En cuanto a las correlaciones, los resultados mostraron que el desempeño en el WCST y tareas que valoran otros procesos cognitivos difiere en función de la versión completada. Los baremos se establecen por primera para niños argentinos para ambas versiones. Los resultados enfatizan la importancia de no considerar ambas versiones como intercambiables en población infantil.

The Wisconsin Card Sorting Test (WCST) was initially developed to measure problem solving and abstract reasoning. Currently, it is widely used for the neuropsychological evaluation of those cognitive processes related to frontal lobe functioning, more specifically as a measure of reactive cognitive flexibility. Although its use is widespread both in clinic and research settings, controversies remained regarding the nature of the cognitive processes that underlie WCST performance and the relationships between its diverse scores and other related cognitive measures. To date, studies have been conducted in adolescents and adults, where two- and three-factor solutions predominate, although a one-dimensional structure has also been reported. On the other hand, there are few normative studies in the Spanish-speaking population, and, to our knowledge, there are no normative studies that contemplate the two versions of the WCST. The aim of the present study was to examine the factorial and convergent validity of the WCST in its computerized and manual version in children and to establish normative values for each version indicator according to age and sex. The sample consisted of 359 children aged 7 to 12, divided as follows: (1) manual WCST: 138 children aged 7 to 12 from both sexes and (2) computerized WCST: 221 children 7 to 12 from both sexes and. The inclusion criteria were the following: (1) children with no clinical, neurological, or psychiatric history; (2) who attend their school studies regularly; (3) without school repetition. The WCST in its two versions (computerized vs manual), the Kaufman Brief Intelligence Test (K-BIT) to assess children intellectual functioning, and the working memory (WM) subtask of the WISC-IV, the Stroop Color and Word test and the semantic and phonological verbal fluency (VF) test were administered to test the WCST convergent validity. Intellectual functioning (IQ) was within the normal range expected for the age of children who completed both versions of the WCST. Exploratory Factor Analysis (EFA), Pearson's bivariate correlations and multivariate analysis of variance (MANOVA) were used. For both the computerized and the manual WCST, the parallel analysis yielded a one-dimensional solution, grouping efficient and inefficient responses, with Complete Categories (CC) being the indicator that obtained the most weight. When comparing the structure found for each version, it is observed that Total Correct (TC) weighed only in the computerized version of the WCST. Regarding the WCST convergent validity, the results with the computerized WCST indicated positive and significant relationships (r = .17 to r = .33) between Total Correct and Complete Categories of the WCST and IQ, MT, FV and Inhibition. In turn, Perseverative Responses, Perseverative Errors, and Non-Perseverative Errors, presented negative and low correlations (r = .17 to r = .29) with IQ, MT, and FV. For the manual WCST, only Complete Categories presented significant positive correlations (r = .20 to r = .39) with CI, FV, Inhibition and MT. The other indicators of the manual WCST presented negative correlations (r = .18 to r = .44) with CI, FV and MT. Regarding the factorial validity of the instrument, our results suggest that the structure of the WCST would be unidimensional in children, regardless of the type of version under analysis (i.e., manual vs. computerized). However, the relationship between WCST performance and the tasks that assess other cognitive processes differs depending on the version. Normative data is established for the first time for Argentine children for both versions. The results emphasize the importance of not considering both versions as interchangeable in child populations and interpreting each version according to its respectively norms.