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Controlled Oral Word Association Test (COWAT) Subtest of the Multilingual Aphasia Examination (MAE)
Availability
Please visit this website for more information about the instrument: Controlled Oral Word Association Test
Classification
NeuroRehab Supplemental - Highly Recommended
Recommendations for Use: Indicated for studies requiring a measure for language or executive functions (i.e., taps into prefrontal language circuits).
 
Supplemental - Highly Recommended: Epilepsy and Sport-Related Concussion (SRC)
 
Supplemental: Mitochondrial Disease (Mito), Multiple Sclerosis (MS), Stroke, and Traumatic Brain Injury (TBI)
Short Description of Instrument
The Controlled Oral Word Association Test (COWAT) is a measure of verbal fluency and is a subtest of the Multilingual Aphasia Examination (Benton, Hamsher, & Sivan, 1994).
 
The COWAT uses the three letter set of F, A, and S (alternative: C, F, and L) to assess phonemic fluency. Individuals are given 1 min to name as many words as possible beginning with one of the letters. The procedure is then repeated for the remaining two letters (see Strauss et al., 2006 and Benton et al., 1994 for specific administration instructions).
Scoring and Psychometric Properties
Scoring: The data collection form provides numbered lines on which the participant's responses can be recorded. If the participant's speed of word production is too fast to permit verbatim recording, a "+" should be recorded to indicate a correct response. Total all correct answers.
 
Psychometric Properties: The reliability and validity of two qualitative scoring systems for the COWAT (Benton et al., 1983a,b) were examined in 108 healthy young adults. The scoring systems developed by Troyer et al., 1997 and Abwender et al., 2001 each demonstrated excellent interrater reliability (all indices at or above ricc = .9). Consistent with previous research (Ross 2003), test-retest reliability coefficients (N = 53; M interval 44.6 days) for the qualitative scores were modest to poor (ricc = .6 to .4 range).
Rationale/Justification
Strengths: The COWAT has a rich history of use in mild TBI and sport-related concussion, particularly for older adolescents and adults, as well as many other adult disorders of the CNS (e.g., age-related neurodegenerative disease, epilepsy, MS, HIV, Huntington's disease, etc.). Quick to administer. Appears sensitive to TBI and predicts severity. Strong psychometric properties with representative normative standards available (Heaton et al., 2004; Mayo's Older Americans Normative Study - Steinberg et al., 2005). There is some neuroanatomical specificity to left prefrontal speech areas, namely the left inferior frontal gyrus (Baldo et al., 2006; Grogan et al., 2009; Melrose et al., 2009), though other nonspecific cognitive skills/brain regions also play a role in performance. It can be compared to animal fluency performance.
 
Weaknesses: Less use with children. The abilities underlying performance on the test can be varied (generativity, working memory, processing speed). Highly influenced by premorbid verbal IQ.
References
Key References:
Benton AL. Development of a multilingual aphasia battery. Progress and problems. J Neurol Sci. 1969 Jul-Aug;9(1):39-48.
 
Benton AI, Hamsher K. Multilingual Aphasia Examination. Iowa City, University of Iowa Hospitals, 1978.
 
Benton AI, Hamsher K. Multilingual Aphasia Examination. Iowa City, Department of Neurology, University of Iowa Hospitals and Clinics., 1983a.
 
Benton AI, Hamsher K. Multilingual Aphasia Examination. Iowa City: AJA Associates; 1989
 
Benton AL, Hamsher KD, Sivan AB. Multilingual Aphasia Examination. Lutz, FL: Psychological Assessment Resources, Inc., 1994.
 
Additional References:
Abwender DA, Swan JG, Bowerman JT, Connolly SW. Qualitative analysis of verbal fluency output: review and comparison of several scoring methods. Assessment. 2001 Sep;8(3):323-38.
 
Baldo JV, Schwartz S, Wilkins D, Dronkers NF. Role of frontal versus temporal cortex in verbal fluency as revealed by voxel-based lesion symptom mapping. J Int Neuropsychol Soc. 2006 Nov;12(6):896-900.
 
Benton AL, Hamsher K, Varney NR, Spreen O. Contributions to Neuropsychological Assessment. New York: Oxford University Press, 1983b.
 
Chahal N, Barker-Collo S, Feigin V. Cognitive and functional outcomes of 5-year subarachnoid haemorrhage survivors: comparison to matched healthy controls. Neuroepidemiology. 2011;37(1):31-8.
 
Filley CM, Brown MS, Onderko K, Ray M, Bennett RE, Berry-Kravis E, Grigsby J. White matter disease and cognitive impairment in FMR1 premutation carriers. Neurology. 2015 May 26;84(21):2146-52.
 
Gomez Beldarrain M, Garcia-Monco JC, Quintana JM, Llorens V, Rodeno E. Diaschisis and neuropsychological performance after cerebellar stroke. Eur Neurol. 1997;37(2):82-9
 
Grogan A, Green DW, Ali N, Crinion JT, Price CJ. Structural correlates of semantic and phonemic fluency ability in first and second languages. Cereb Cortex. 2009 Nov;19(11):2690-8.
 
Heaton RK, Miller SW, Taylor MJ, Grant I. Revised comprehensive norms for an expanded Halstead-Reitan Battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults, professional manual. Psychological Assessment Resources. 2004.
 
Lezak MD, Howieson DR, Bigler ED, Tranel D. Neuropsychological Assessment, 5th Ed, Oxford, New York, 2012.
 
Melrose RJ, Campa OM, Harwood DG, Osato S, Mandelkern MA, Sultzer DL. The neural correlates of naming and fluency deficits in Alzheimer's disease: an FDG-PET study. Int J Geriatr Psychiatry. 2009 Aug;24(8):885-93.
 
Miceli G, Caltagirone C, Gainotti G, Masullo C, Silveri MC. Neuropsychological correlates of localized cerebral lesions in non-aphasic brain-damaged patients. J Clin Neuropsychol. 1981 May;3(1):53-63.
 
Ross TP. The reliability of cluster and switch scores for the Controlled Oral Word Association Test. Arch Clin Neuropsychol. 2003 Mar;18(2):153-64.
 
Steinberg BA, Bieliauskas LA, Smith GE, Ivnik RJ. Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Trail-Making Test, the Stroop Test, and MAE Controlled Oral Word Association Test. Clin Neuropsychol. 2005 Sep-Dec;19(3-4):329-77.
 
Strauss E, Sherman EMS, Spreen O. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary, 3rd ed. New York: Oxford University Press; 2006, pp. 501-526.
 
Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol. 1999 Feb;14(2):167-77.
 
Troyer AK, Moscovitch M, Winocur G. Clustering and switching as two components of verbal fluency: evidence from younger and older healthy adults. Neuropsychology. 1997 Jan;11(1):138-46.
 
Troyer AK, Moscovitch M, Winocur G, Leach L, Freedman M. Clustering and switching on verbal fluency tests in Alzheimer's and Parkinson's disease. J Int Neuropsychol Soc. 1998 Mar;4(2):137-43.
 
Document last updated March 2024