A meta-analysis of the Dimensional Change Card Sort: Implications for developmental theories and the measurement of executive function in children

doi:10.1016/j.dr.2015.09.001

Developmental Review

Volume 38, December 2015, Pages 241-268

https://doi.org/10.1016/j.dr.2015.09.001 Get rights and content

Highlights

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Results of a meta-analysis of the Dimensional Change Card Sort are reported.
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Age and several procedural variations predicted performance on the standard task.
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Dimensional separation and salience predicted switching on experimental versions.
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Children tended to switch more when prompted to label the test card themselves and to switch less when reversal instructions were used.
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Implications for theories and the measurement of EF in childhood are discussed.

Abstract

The Dimensional Change Card Sort (DCCS) is a widely used measure of executive function in children. In the standard version, children are shown cards depicting objects that vary on two dimensions (e.g., colored shapes such as red rabbits and blue boats), and are told to sort them first by one set of rules (e.g., shape) and then by another (e.g., color). Most 3-year-olds persist in sorting by the pre-switch rules, whereas 5-year-olds switch flexibly. We conducted a meta-analysis of standard and experimental versions of the task (N = 69 reports, 426 conditions) to examine the influence of diverse task variations on performance. Age, how the test stimuli were labeled for the child, emphasis on conflict in the verbal introduction of the post-switch rules, and the number of pre-switch trials each independently predicted switching on the standard DCCS, whereas pre-switch feedback, practice, and task modality did not. Increasing the relative salience of the post-switch dimension was associated with higher rates of switching, and, conversely, decreasing post-switch salience was associated with lower rates of switching, and under both kinds of manipulation performance continued to be associated with age. Spatially separating the dimensional values was associated with higher rates of switching, and it was confirmed that the degree of spatial separation matters, with children benefiting most when the dimensional values are fully spatially segregated.Switch rates tended to be higher in versions on which children were prompted to label the stimuli compared to when the experimenter provided labels, and lower when reversal instructions were used in conjunction with the standard task stimuli. Theoretical and practical implications for the study and measurement of executive function in early childhood are discussed.

Introduction

Being able to flexibly control our thoughts, actions, and emotions, especially in the face of conflicting habits and desires, is a key developmental achievement. Children are notorious for struggling with control, showing difficulty with simple tasks like sitting still and listening, raising their hand instead of blurting out thoughts, and flexibly switching from one activity to another. This skill, termed executive function (EF), develops markedly in the early childhood years (Carlson, 2005, Diamond, 2013, Zelazo et al, 2013), and can be described as the top-down, neurocognitive processes involved in goal-directed behavior, including inhibition of habitual or dominant responses, shifting between tasks or mental sets, and monitoring and updating information in working memory (Miyake, Friedman, 2012, Miyake et al, 2000). EF supports the development of a range of social and academic skills in childhood (e.g., theory of mind, math, and reasoning; Carlson, Moses, 2001, Hughes, 1998, Mazzocco, Kover, 2007, Richland, Burchinal, 2012) and also predicts numerous outcomes associated with success in adulthood (e.g., academic achievement, health, and wealth; Blair, Razza, 2007, Moffitt et al, 2011). Not surprisingly, deficits in EF can have wide-ranging negative consequences for adaptive functioning in children and adults (e.g., Bechara et al, 1994, Biederman et al, 2004, Pennington, Ozonoff, 1996). Given its central importance to healthy human functioning and development, gaining insight into the nature of EF and developing sensitive tools to measure it are key research goals.

One task that has been widely used in research on the development of EF in early childhood is the Dimensional Change Card Sort (DCCS) task (Frye et al, 1995, Zelazo, 2006; see Fig. 1). In the standard DCCS (see Zelazo, 2006 for a complete description of the most commonly used and recommended procedure), children are shown two target cards (e.g., a blue rabbit and a red boat) and then presented with a series of test cards (e.g., red rabbits and blue boats) that they are instructed to sort according to one of the dimensions (e.g., by color). On each trial, the experimenter repeats the relevant rules, labels the test card by the relevant dimension, and gives the card to the child to sort. After several trials (typically 5 or 6), children are instructed to sort by the other dimension (e.g., shape). Three-year-olds tend to perseverate and continue to sort the cards according to the initial sorting rules. By contrast, typically developing 5-year-olds tend to switch flexibly. This task is often described as a measure of cognitive flexibility or set-shifting, and, like most measures of set-shifting, performance on the DCCS likely involves several aspects of EF, including working memory to maintain the rules in mind, and inhibitory control to suppress attention to the previously relevant dimension.

Over the past two decades, the DCCS has been used in over 150 studies and has been modified in theoretically motivated ways to examine cognitive mechanisms that underlie switching and EF. Developmental theories of EF that address the DCCS have focused on reflection and rule complexity (Zelazo, Müller, Frye, & Marcovitch, 2003), attentional inertia and inhibition (Kirkham, Cruess, & Diamond, 2003), representational redescription (Kloo & Perner, 2005), and working memory (Morton & Munakata, 2002).

On the Cognitive Complexity and Control-Revised account (CCC-r; Zelazo et al., 2003), successful switching requires the formulation and use of a higher-order rule for switching between dimensions (e.g., If it's the color game, then the red ones go here and the blue ones go there; but if it's the shape game, then the rabbits go here and the boats go there), which is achieved through developmental increases in reflection. Zelazo et al. (2003) examined performance on more than a dozen versions of the task to test theoretical predictions. For example, they tested the hypothesis derived from the CCC-r theory that a hierarchical rule is needed whenever rules are nested under different setting conditions (i.e., contexts that specify when it is appropriate to use a given rule), and found that children experienced difficulty switching in a modified version in which they needed to switch from sorting a single test card by shape to sorting it by color (e.g., sorting a green car with a green flower and switching to sorting it with a yellow car), and that children switched more on a version in which the rules conflicted but were not nested under different setting conditions (e.g., sorting a red and blue test card with a blue target card and then switching to sorting it with a red test card; Zelazo et al., 2003; Expts. 4 and 5).

By contrast, the Attentional Inertia account posits that children perseverate not because of the failure to construct a higher-order rule, but because they cannot inhibit the tendency to think of the stimuli in a particular way and continue to attend to the pre-switch dimension (Kirkham et al., 2003). This account has been tested by modifying the DCCS procedure such that the sorted test cards were left face-up in the sorting tray, which was hypothesized to increase the demands placed on children's fledgling inhibitory control. Results indicated that children were less likely to switch when the test cards were left face up. In another experimental condition, children were prompted to label the test cards themselves, which was expected to help children refocus attention to the new sorting dimension in the absence of a developed inhibitory mechanism, and, consistent with this hypothesis, children switched more often in this condition vs. when the experimenter labeled the card for them.

A related developmental theory of EF is the representational redescription account, which suggests that children's difficulty on the DCCS lies in their inability to appreciate that a single stimulus can be described differently from different perspectives (Kloo, Perner, 2005, Perner, Lang, 2002). One way this account has been assessed is by separating the depicted dimensional values on the test and/or target cards (e.g., a blue filled circle next to an outline of a banana, as in Kloo & Perner, 2005; see also Diamond, Carlson, & Beck, 2005). In this version, children do not have to change how they think about the stimuli in order to sort correctly (the blue thing is always the blue thing and the banana always a banana), and, consistent with the redescription account, children were more likely to switch on this version than on the standard task (Diamond et al, 2005, Kloo, Perner, 2005).

Others have argued that the ability to overcome perseveration depends on the development of sufficiently strong active representations that correspond to current goals. On the active–latent account (Morton, Munakata, 2002, Munakata, 1998), the ability to actively maintain information in working memory develops, and switching on the DCCS occurs when the actively maintained rules outcompete latent representations that correspond to the practiced pre-switch rules. One way this theory has been tested is by having children sort novel dimensional values during the pre-switch phase (i.e., unfamiliar colors or shapes), and familiar values during the post-switch phase (Yerys & Munakata, 2006). This was expected to result in children forming relatively weak latent representations of the pre-switch rules that young children's active representations could compete with. Children tended to switch more in this condition vs. the standard task in which the dimensional values in both phases were familiar.

The extensive literature that has accumulated on the DCCS presents a unique opportunity to synthesize, clarify, and extend the findings of primary studies by examining the influence of a range of variations to both the standard and experimental versions of the task. Gaining further insight into the variations that influence switching has the potential to be both theoretically and practically significant. A meta-analysis of the DCCS can confirm theoretically relevant findings and also bring clarity in cases where there has been inconsistency both by aggregating across primary studies to reduce sampling error and increase precision in estimates (Hunter & Schmidt, 2004), and by including unpublished studies in an effort to address the bias to publish only positive results (Borenstein et al, 2009, Ferguson, Heene, 2012, Lipsey, Wilson, 2001). It can also extend the findings of primary DCCS studies by classifying them in meaningful ways and examining patterns of performance across classes, which may, in turn, yield new findings in need of interpretation.

A meta-analysis of the DCCS can also provide practical insights that can inform the development of reliable, developmentally sensitive measures of EF. In addition to experimental manipulations designed to test hypotheses derived from specific theories, researchers have introduced variations to the standard task to address more practical concerns, such as the desire to maintain children's interest in the task and ensure their understanding of the rules (e.g., how the experimenter labeled the test card, feedback on sorting during pre-switch phase, etc.). Determining the influence of such variations would provide new information on this widely used task, as well as new ideas about how changes to this and other EF tasks might be introduced to adjust EF demands. These insights can inform the development of measures to address various research aims, including measuring individual differences in EF, and also sensitively measuring change in EF across development and following interventions. In the following sections, we briefly describe key task variations that might be expected to influence performance on the DCCS.

Section snippets

Card labeling procedure

In the majority of studies involving the DCCS, the test card has been labeled by the relevant sorting dimension only (e.g., “Here is a rabbit. Can you put it where it goes [in the shape game]?”). In some studies, however, the test card has been labeled by both dimensions (e.g., “Here is a red rabbit”). This difference in the labeling procedure is subtle, but there are reasons to expect that it might affect performance. Prior research has found that providing children with labels that highlight

Perceptual salience

Salience refers to those properties of a perceived stimulus that attract attention, and that “stand out” to a typical, healthy observer. For example, a bright red ball against a white background would be relatively salient to an ordinary perceiver, as would a sudden loud noise. Salient stimuli might be expected to exert an influence on attention and behavior in a relatively automatic, bottom-up fashion. In the standard DCCS, the pre- and post-switch stimuli and dimensions are presumed to be

Alternate versions

In addition to the experimental manipulations described above, many other modified versions of the DCCS have been created to test different theories (e.g., Zelazo et al, 2003, Kirkham et al, 2003, Perner, Lang, 2002). This affords the opportunity to further examine, at the meta-analytic level, whether performance on these versions differs from performance on the standard version. Specifically, a meta-analysis can clarify previous findings by reducing sampling error, increasing statistical power

The current study

The aim of the current study was to conduct a series of meta-analytic tests to systematically examine the influence of diverse task variations on children's performance on both standard and experimental versions of the DCCS in order to (a) confirm and extend theoretically relevant findings and (b) provide new information that could be useful for researchers seeking to create developmentally sensitive measures of EF to address a range of research goals. To pursue this aim, we conducted a series

Method

The unit of analysis in the current study was conditions within experiments, and the dependent variable was the proportion of children passing the post-switch phase within a condition. By using a single dependent measure for all conditions included in the meta-analysis, we were able to avoid the interpretational limitations associated with transforming reported inferential statistics (Borenstein et al., 2009).

Results

To satisfy the assumption of linearity that underlies regression, raw proportions were transformed into logits using the natural log (Lipsey & Wilson, 2001). Transforming the data rendered it appropriate for linear regression by increasing its range from negative infinity to positive infinity, as opposed to the restricted range between 0 and 1 that characterizes proportional data. While logits are not as intuitive as raw scores, they can be converted to back into proportions and odds ratios for

Discussion

The current study confirms and extends our knowledge about task variations affect switching performance on the DCCS, a widely used measure of EF in childhood. In addition to confirming that age is a robust predictor of switching on the standard version, labeling the test card by the relevant dimension and verbally emphasizing the conflict between the pre- and post-switch games were both positively associated with switching, whereas the number of pre-switch trials was negatively associated with

Conclusion

The meta-analysis reported here clarifies and extends our knowledge of the DCCS, and generates theoretical and practical insights that together have the potential to advance research on the development of EF in early childhood. The findings suggest new directions for research on the developmental mechanisms underlying EF and indicate new approaches to the development of sensitive child EF measures that can facilitate a range of research goals.

Acknowledgments

This research was supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award 5T32HD007151 from the NICHD to the first author. The authors thank Stephanie Carlson, Melissa Koenig, Yuko Munakata, Sashank Varma, and anonymous reviewers for comments on earlier drafts of the manuscript; Brenton McMenamin for assistance with the analysis; David Wilson for the meta-regression macros used to conduct the analysis; and Jerome Hoover and Zach Machacek for

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