Protocol - Cognitive Flexibility (Dimensional Change Card Sort) - Children, Adolescents, and Adults

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The Dimensional Change Card Sort (DCCS) Border Version is an iPad-administered task (by a research assistant) that measures the flexible use of rules to govern behavior as a means of providing an index of executive function development. DCCS is a measure of cognitive flexibility. Two target pictures are presented that vary along two dimensions (e.g., shape and color). Participants are asked to match a series of bivalent test pictures (e.g., yellow balls and blue trucks) to the target pictures, first according to one dimension (e.g., color) and then, after a number of trials, according to the other dimension (e.g., shape). “Switch” trials are also employed, in which the participant must change the dimension being matched. For example, after four straight trials matching on shape, the participant may be asked to match on color on the next trial and then go back to shape, thus requiring the cognitive flexibility to quickly choose the correct stimulus. Scoring is based on a combination of accuracy and reaction time. The DCCS task is a simplified version of the Wisconsin Card Sorting Test (WCST) that is available on the National Institutes of Health (NIH) Toolbox, where investigators will need to pay a licensing fee. The DCCS is suitable for testing subjects between the ages of 3 and 85. This task has demonstrated superior test-retest reliability in adult populations Zelazo et al. (2014).

Specific Instructions





Summary of the Dimensional Change Card Sort (DCCS) Border Version

The DCCS Border Version makes use of two different styles of bivalent cards, displaying, for example, a red boat and blue rabbit. The test cards additionally have either no border or a black border.

The protocol consists of the research assistant preparing the administration on an iPad, where data are transmitted via the Internet to the Apple iCloud for download by the investigator.

Personnel and Training Required

The assessor should be trained to respond in a neutral, nonevaluative, noncorrective manner during the task. The assessor should be trained in how to respond to hesitant or resistant behavior by the participant.

Equipment Needs

The iPad Air or iPad Air2 with Wi-Fi capacity that is running iOS version 8.4 or later.

Requirement CategoryRequired
Major equipment Yes
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered evaluation


Child, Adolescent, Adult


Adults and children aged 3 years or older

Selection Rationale

The Dimensional Change Card Sort (DCCS) is an easily administered and widely used measure of executive function.



Human Phenotype Ontology Cognitive impairment HP:0100543 HPO
Human Phenotype Ontology Addictive behavior HP:0030858 HPO
caDSR Form PhenX PX530101 - Cognitive Flexibility Dimensional Change Card Sort Old 6228787 caDSR Form
Derived Variables


Process and Review

The Expert Review Panel #3 (ERP 3) reviewed the measures in Alcohol, Tobacco and Other Substances, and Substance Abuse and Addiction domains.

Guidance from ERP 3 includes:

• No significant changes to measure

Back-compatible: NA no changes to Data Dictionary

Previous version in Toolkit archive (link)

Protocol Name from Source

Dimensional Change Card Sort (DCCS), Border Version


Zelazo, P. D. (2006). The Dimensional Change Card Sort (DCCS): A method of assessing executive function in children. Nature Protocols, 1(1), 297-301. www.nihtoolbox.org

General References

Errico, A. L., King, A. C., Lovallo, W. R., & Parsons, O. A. (2002). Cortisol dysregulation and cognitive impairments in abstinent male alcoholics. Alcoholism: Clinical and Experimental Research, 26(8), 1198-1204.

Klüber, A., Murphy, K., & Garavan, H. (2005). Cocaine dependence and attention switching within and between verbal and visuospatial working memory. European Journal of Neuroscience, 21, 1984-1992.

van der Plas, E. A., Crone, E. A., van den Wildenberg, W. P., Tranel, D., & Bechara, A. (2009). Executive control deficits in substance-dependent individuals: A comparison of alcohol, cocaine, and methamphetamine and of men and women. Journal of Clinical and Experimental Neuropsychology, 31(6), 706-719.

Verejo-García, A., Bechara, A., Recknor, E. C., & Pérez-García, M. (2006). Executive dysfunction in substance dependent individuals during drug use and abstinence: An examination of the behavioral, cognitive and emotional correlates of addiction. Journal of International Neuropsychological Society, 12,405-415.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX530101040000 Combined (Standard and Border version) score. N/A
PX530101010000 Dimension used for sorting border cards. N/A
PX530101020000 Number of cards correctly sorted: __________ N/A
PX530101030000 Standard and Border version administered? N/A
Substance Use-related Neurobehavioral and Cognitive Risk Factors
Measure Name

Cognitive Flexibility

Release Date

February 24, 2012


This measure assesses flexibility in detection and use of rules that govern behavior.


Cognitive flexibility is one component of the multidimensional construct "executive function." This measure provides a marker of the development of executive function. Substance use has been shown to correlate with deficits in both cognitive flexibility and other aspects of executive functioning.


Child, Cognitive Flexibility, DCCS, Dimensional Change Card Sort Border Version, Dimensional Change Card Sort Standard Version, Drug Abuse, drug use, Executive Function, Neuropsychiatry, NIH Toolbox, substance abuse, substance use, SAA, Substance Use-related Neurobehavioral and Cognitive Risk Factors

Measure Protocols
Protocol ID Protocol Name
530101 Cognitive Flexibility (Dimensional Change Card Sort) - Children, Adolescents, and Adults
530102 Cognitive Flexibility (Dimensional Change Card Sort) - Young Children

There are no publications listed for this protocol.