Scaffolded instruction and the remediation of Wisconsin Card Sorting Test deficits in chronic schizophrenia

The purpose of this study was to explore the remediation of Wisconsin Card Sorting Test (WCST) deficits among highly chronic schizophrenic patients by employing an instructional technique known as scaffolding. The extent to which learning of the WCST generalized to a similar neuropsychological test, the Short Category Test (SCT) was examined. Forty-one chronic schizophrenic subjects drawn from in-patient and out-patient wards were given the WCST. Twenty-eight of the subjects who displayed the greatest impairment on the WCST were then administered the Brief Psychiatric Rating Scale (BPRS) and randomly assigned to groups that received three sessions of either scaffolded or didactic instruction. Post-testing with the WCST occurred an average of 1.9 (SD = 1.3) and again 31.4 (SD = 3.9) days after instruction. Subjects who received scaffolded instruction improved significantly in the number of categories achieved when compared to the didactic group. The improvement was sustained a month later. A strong trend favoring the scaffolded group on the SCT suggested that generalization of learning had occurred. Significant and durable improvement of WCST performance in severely disabled schizophrenics is clearly possible with the instructional method employed. The increment in abstract reasoning may generalize to other tasks. These findings have significant implications for psycho-social and cognitive rehabilitation.