Performance on the Modified Card Sorting Test and its relation to psychopathology in adolescents and young adults with 22q11.2 deletion syndrome.
Poor scores on the Modified Card Sorting Test signal rising anxiety or psychosis risk in teens and young adults with 22q11DS.
01Research in Context
What this study did
The team gave the Modified Wisconsin Card Sorting Test to teens and young adults with 22q11.2 deletion syndrome. They also rated each person’s early signs of psychosis and anxiety.
The goal was to see if poor card-sort scores line up with emerging mental-health problems.
What they found
People with 22q11DS made far more errors and completed fewer categories than peers without the syndrome.
Lower scores on the test went hand-in-hand with stronger prodromal and internalising symptoms.
How this fits with other research
Niklasson et al. (2010) looked at 100 people with 22q11DS and found that executive-planning problems show up mainly when ASD or ADHD is also present. Wong et al. (2009) now show that even in a smaller, narrow-age sample, poor card-sorting still flags wider psychopathology risk.
Whitehouse et al. (2014) studied adults with 22q11DS plus moderate or severe ID and recorded even higher psychosis rates. Together the three papers draw a line: executive slips on the MCST can be an early warning, and the risk grows steeper when IQ drops.
Van Den Heuvel et al. (2018) tracked kids for two years and saw social problems worsen while IQ stayed flat. Their finding reminds you to keep re-screening social and executive skills; a single good score today does not rule out trouble tomorrow.
Why it matters
If you serve teens or young adults with 22q11DS, add the MCST to your intake battery. A weak score gives you a clear, low-cost red flag for anxiety or emerging psychosis. Pair the data with parent reports and repeat the test every year so you can adjust teaching plans or refer for mental-health care before problems snowball.
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02At a glance
03Original abstract
BACKGROUND: Approximately one-third of individuals with 22q11.2 deletion syndrome (22q11DS), a common genetic disorder highly associated with intellectual disabilities, may develop schizophrenia, likely preceded by a mild to moderate cognitive decline. METHODS: We examined adolescents and young adults with 22q11DS for the presence of executive function deficits using a modified version of the Wisconsin Card Sorting Test (MCST) and assessed whether specific performances were associated with concurrent schizophrenia-prodrome symptoms. We also examined possible relationships between MCST performance and broader indices of psychopathology, including self-reported internalising and externalising behavioural symptoms. RESULTS: Participants with 22q11DS scored significantly below age-matched controls on seven out of nine MCST measures, and poorer MCST performance was associated with increased positive prodromal and internalising behavioural symptoms. CONCLUSIONS: The schizophrenia-prodrome in 22q11DS involves executive dysfunction, and longitudinal investigation is necessary to examine if specific executive function impairments precedes or co-occurs with the emergence of behavioural psychopathology.
Journal of intellectual disability research : JIDR, 2009 · doi:10.1111/j.1365-2788.2009.01178.x