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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
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: 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).
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 AL, Hamsher K deS, Sivan AB. (1983). Multilingual aphasia examination (2nd ed.). Iowa City, IA: AJA Associates] were examined in 108 healthy young adults. The scoring systems developed by Troyer et al., 1997 and by Abwender et al., 2001 each demonstrated excellent interrater reliability (all indices at or above ricc = .9). Consistent with previous research [e.g., 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).
Strengths: The COWAT has a rich history of use in mild TBI and sports concussion, particularly 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 (e.g., 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 (e.g., Baldo et al., 2006; Grogan et al., 2009; Melrose et al., 2010), though other nonspecific cognitive skills/brain regions also play a role in performance. It can be compared to animal fluency performance.
Limitations: 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.
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;12(6):896-900.
Benton AL, Hamsher K deS, Sivan AB. (1994). Multilingual aphasia examination (3rd Edition) (MAE). Accessed: 8 May 2017. Available at:
Benton AL, Hamsher K deS, Sivan AB. (1983). Multilingual aphasia examination (2nd Edition). Iowa City: AJA Associates.
Benton A & Hamsher K. (1989). Multilingual aphasia examination. Iowa City: AJA Associates.
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Document last updated January 2022