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Controlled Oral Word Association Test (COWAT) subtest of the Multilingual Aphasia Examination (MAE)
Please visit this website for more information about the instrument: Controlled Oral Word Association Test
Supplemental – Highly Recommended: Epilepsy and Sport-Related Concussion (SRC)
Supplemental: 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 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).
Advantages: The COWAT has a rich history of use in mild TBI and sports concussion, particularly older adolescents and adults.   Quick to administer. Appears sensitive to TBI and predicts severity.  Strong psychometric properties.    
Limitations: Less use with children with mild TBI, none with sports concussion. Low specificity. The abilities underlying performance on the test are varied (attention, working memory, processing speed, episodic memory), thus it is difficult to attribute impairment to a particular cognitive function. Highly influenced by premorbid verbal IQ.
Comments/Special 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 Controlled Oral Word Association Test [Benton, A. L., Hamsher, de S. K., & Sivan, A. B. (1983). Multilingual aplasia examination (2nd ed.). Iowa City, IA: AJA Associates] were examined in 108 healthy young adults. The scoring systems developed by Troyer et al. [Troyer, A. K., Moscovich, M., & Winocur, G. (1997). Clustering and switching as two components of verbal fluency: Evidence from younger and older healthy adults. Neuropsychology, 11, 138–146] and by Abwender et al. [Abwender, D. A., Swan, J. G., Bowerman, J. T., & Connolly, S. W. (2001a). Qualitative analysis of verbal fluency output: Review and comparison of several scoring methods. Assessment, 8, 323–336] each demonstrated excellent interrater reliability (all indices at or above ricc = .9). Consistent with previous research [e.g., Ross, T. P. (2003). The reliability of cluster and switch scores for the COWAT. Archives of Clinical Psychology, 18, 153–164), test–retest reliability coefficients (N = 53; M interval 44.6 days) for the qualitative scores were modest to poor (ricc = .6 to .4 range).
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Benton AL, Hamsher K deS, Sivan AB. (1994). Multilingual Aphasia Examination, 3rd Edition (MAE). Accessed: 8 May 2017. Available at:
Benton, A., & Hamsher, K (1989). Multilingual Aphasia Examination. Iowa City: AJA Associates.
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Ross TP. The reliability of cluster and switch scores for the Controlled Oral Word Association Test. Arch Clin Neuropsychol. 2003;18(2):153-164.
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, T.N., Kozak, J., Rees. Normative Data Stratified by Age and Education for Two Measures of Verbal Fluency: FAS and Animal NamingArchives of Clinical Neuropsychology, Vol. 14, No. 2, pp. 167-177, 1999
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Document last updated May 2020