Special Topic Workshop Assessment of Executive Functions

Zsuzsanna Kiraly, PhD THE CENTERS.

Sources: Dawson, P., & Guare, R. (2010). Executive Skills in Children and Adolescents. Miller, D.C. (2007). Essentials of School Neuropsychological Assessment.

Overview
Definitions Developmental Aspects Assessment Process Assessment Techniques

What are Executive Functions?

Problem solving (Temple, 1997; Stuss, 1992;

Denckla , 2001)

Executive functions are responsible for a persons ability

to engage in purposeful, organized, strategic, selfregulated, goal-directed behavior.

Conductor of an orchestra (McCloskey, 2008)

Executive functions can be thought of as a set of multiple

cognitive processes that act in a coordinated way to cue and direct a persons perception, emotion, cognition and motor functions.

Executive Functions
1. Set of thinking skills to select and achieve goals or

to develop problem solutions

Planning

Roadmap; priorities Keeping track of information How much time; how to allocate it; sense of time Hold information in mind; draw upon past experience Self-monitoring and self-evaluative skills

Organization Time management Working memory Metacognition

Executive Functions
2. Set of regulatory skills to guide our behavior
Response inhibition

Think before act

Task initiation Flexibility

Ability to begin task in a timely fashion Adaptability to changing conditions Manage emotions; control and direct behavior

Emotional control / self-regulation of affect

Executive Functions
Producing disability (Denckla, 2007)

Plan

Organize

Write

Edit

Revise

Development of Executive Functions

Executive Functions and the Brain

Neuroplasticity
Synaptic pruning or generation / reduction of nerve cells

and synaptic connections Use it or lose it

Learning from experience

Types of experience most associated with strengthening

synaptic linkages:

repetition, emotional arousal, novelty, focused attention

Degree of neuroplasticity window of opportunity for

change

continues into late adolescence and adulthood

Executive Functions and the Brain

Growth spurts in the brain parallel the time course and development of executive skill: occur at age 5 and 11-12 primarily in the frontal lobes that are associated with executive function skills Implications for executive functions importance of practice for the development of cortical structure that support executive function skills at these maturational points

Frontal Brain Systems

Frontal Brain Systems (frontal/prefrontal cortex and adjacent areas) make up the neurological base for executive function skills Decides what to attend to and what to do Provide continuity and coherence to behavior across time Modulate affective and interpersonal behaviors Monitor, evaluate, and adjust behavior

Development of Executive Functions

Self-regulation executive functions are

developmental in nature. Cultural change points (e.g., educational transitions 1st grade, junior high school) can serve to highlight executive function maturational delays or significant deficiencies. Intra-individually, all executive functions do not develop evenly. Inter-individually, there is also great variation relative to chronological age.
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Functional Areas Involved

Academic achievement Metacognitive skills guiding problem solving Regulatory skills motivation, effort, persistence Self-regulation Interpersonal relationships Attunement to the environment

Clinical Level of Executive Dysfunctions

Attention Deficit Disorders (ADD, ADHD) Specific Learning Disabilities (SLD) Affective/Mood Disorders Autism Spectrum Disorders (ASD)

Executive Functions / Intelligence

Operational definitions of intelligence usually do not include
executive control processes as a distinct content domain
performance of the tasks that are used to assess intelligence

executive control process are often involved in many ways in the

The manner in which most tests are constructed (explicit

directions, teaching items, examiner cueing of attention and performance) usually reduces the impact of executive control processes on performance of tasks thought to assess intelligence
control capacities

intelligence test scores often do not accurately reflect a childs executive

It is important to assess EF separately

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Assessment of Executive Skills

Challenges of assessing executive functions:

Developed for adult and clinical population Require the use of other skills (language,
memory) Ecological validity

Narrow, constrained Lesser demands on use of executive skills

Absence of evidence is not evidence of absence

Assessment of Executive Skills

1. Informal Assessment Measures 2. Behavior Checklists 3. Formal Assessment Measures

Informal assessment (interviews; rating scales) should be conducted prior to formal assessment

Assessment of Executive Skills

Informal Assessment Measures
1.

Case History/Interview
Can child plan tasks, complete homework, follow daily routines on his/her own or with supervision?

Behavioral Observations 3. Classroom Observation Best measure of EF skills!

2.

Complete interviews/rating scales prior to observation

4.

Work Samples

Assessment of Executive Skills

Behavior Checklists

Behavior Rating Inventory of Executive Functions (BRIEF) Executive Skills Questionnaire for Parents/Teachers and Brown ADD Scales for Children and Adolescents P-T: 3-5/6-12 y.; Self: 8-12/12-18 y. Conners-3 P-T: 6-18 y.; Self 8-18 y. Conners Comprehensive Behavior Rating Scales (Conners Child Behavior Checklist (CBC) P-T: 1 1/2-5/6-18 y.; Self: 11-18 y. Behavior Assessment System for Children, 2nd Ed. (BASC2) P-T: 2-5/6-11/12-21 y.; Self: 8-11/12-21/18-25 y. CBRS) P-T: 6-18 y.; Self: 8-18 y. Students (Dawson & Guare, 2010) P-T: 3-5/6-18 y.; Self: 11-18 y.

Behavior Rating Inventory of Executive Functions (BRIEF)

Behavior Regulation Index (BRI) is an index of the ability to shift cognitive set and modulate emotions and behavior via appropriate inhibitory control; precursor to appropriate metacognitive problem solving and self-regulation Inhibit Shift (Behavioral/Cognitive) Emotional Control Metacognition Index (MI) is an index of the ability to cognitively self-manage tasks and monitor ones performance Initiate Working Memory Plan/Organize Organization of Materials Monitor Global Executive Composite
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Formal Assessment Measures

1. Comprehensive batteries designed to measure EF: Delis-Kaplan Executive Function Scale (D-KEFS) (2001) 2. Comprehensive batteries designed to measure

neurological processes, including EF:

NEPSY (1998); NEPSY-II (2007) Wisconsin Card Sorting Test (WCST) Stroop Color Word Test WJ III-COG; WISC-IV

3. Stand-alone tests designed to measure specific EF skills: 4. Tests of cognitive functions:

Areas of Assessment

Measures of Inhibition Measures of Planning and Organization Measures of Concept Generation Measures of Reasoning Measures of Cognitive Flexibility Measures Using Feedback During Task Performance Measures of Metacognition Measures of Attention Measures of Working Memory

Measures of Inhibition

Disinhibition is hallmark clinical feature of several

frontal lobe disorders (ADHD)

Behavioral manifestation in testing:

Answers questions without thinking Gives up quickly on challenging tasks Gives a quick answer then changes it Begins task without listening to all instructions

Measures of Inhibition

Conners Continuous Performance Tests-II Integrated Visual and Auditory Continuous

Performance Test (IVA) Stoop Color Word Test D-KEFS: Color-Word Interference Test (Cond.3: Inhibition)

D-KEFS: Color-Word Interference Test

Condition 1: Color Naming

C D-KEFS: Color-Word Interference Test Condition 2: Word Naming

D-KEFS: Color-Word Interference Test Condition 3: Inhibition

Measures of Planning and Organization

Tower Tests

Mazes ReyOsterrieth Complex Figure (REY)

D-KEFS Tower Test

D-KEFS Tower Test

D-KEFS Tower Test

Requires multiple cognitive skills and higher level functioning

Executive functions:
Spatial Planning Rule Learning Inhibition Establishing and Maintaining a Cognitive Set

WISC-IV Integrated Elithorn Mazes

WISC-IV Integrated Elithorn Mazes

ReyOsterrieth Complex Figure

REY Memory Profile Patterns

Measures of Concept Generation

Involves multiple cognitive processes:

Verbal and nonverbal concept formation Conceptual reasoning Initiation fluency Cognitive flexibility Ability to maintain cognitive set

Measures of Concept Generation D-KEFS: Card Sort Test

2 groups 3 cards in a group The cards in each group are the same in some way Tell how you sorted both groups Make different groups each time you sort

Free Sort concept formation skills flexibility in thinking initiate problem-solving and inhibit pull to repeat the same behavior Free description express conceptual relationships Sort Recognition initiation problem perseveration problem

Measures of Reasoning
Cognitive Batteries WJIII-COG Executive Process Cluster Concept Formation shifting Planning planning Pair Cancellation sustained attention Fluid Reasoning (Gf) tasks: WJIII-COG KABC-II WISC-IV

D-KEFS Word Context Twenty Questions

D-KEFS Word Context

Verbal Abstract Reasoning

What might sev mean? Many people eat sev.

D-KEFS Word Context

What might sev mean? Many people eat sev. Sev gores on trees.

D-KEFS Word Context

What might sev mean? Many people eat sev. Sev gores on trees. Sev are fairly round.

D-KEFS Word Context

What might sev mean? Many people eat sev. Sev gores on trees. Sev are fairly round. Sev are usually red.

D-KEFS Word Context

What might sev mean? Many people eat sev. Sev gores on trees. Sev are fairly round. Sev are usually red. A sev a day keeps the doctor away.

D-KEFS Word Context

What might grot mean? Most houses have grots.

D-KEFS Word Context

What might grot mean? Most houses have grots. A grot covers or goes over something.

D-KEFS Word Context

What might grot mean? Most houses have grots. A grot covers or goes over something. Grots can be pulled up or to the side.

D-KEFS Word Context

What might grot mean? Most houses have grots. A grot covers or goes over something. Grots can be pulled up or to the side. A grot is usually made of cloth.

D-KEFS Word Context

What might grot mean? Most houses have grots. A grot covers or goes over something. Grots can be pulled up or to the side. A grot is usually made of cloth. A grot can hang in a window or in a theater.

D-KEFS Twenty Questions

Problem Solving

Measures of Cognitive Flexibility

Behavioral manifestation in testing:

(WISC-IV Comprehension) (WJ III COG: Concept Formation)

Unable to generate multiple answers to questions Adjusts slowly to task when instructions change Cannot figure out a new approach to task when the
first approach does not work
(D-KEFS Towers)

Measures of Cognitive Flexibility

Category Tests

Set-Shifting Tests

Wisconsin Card Sorting Test (WCST) Stoop Color Word Test D-KEFS:

Trail-Making (Cond.4) Verbal Fluency (Cond.3) Design Fluency (Cond.3) Color-Word Interference (Cond.4)

Wisconsin Card Sorting Test

D-KEFS Trail-Making Test Condition 4: Number- Letter Switching

D-KEFS Trail-Making Test Condition 1: Visual Scanning

D-KEFS Trail-Making Test Condition 2: Number Sequencing

D-KEFS Trail-Making Test Condition 3: Letter Sequencing

D-KEFS Trail-Making Test Condition 5: Motor Speed

D-KEFS Verbal Fluency (Cond.3)

Condition 1 Letter Fluency
Say as many words as you can starting with letter F, A, S

(observe rules)

Condition 2 Category Fluency Say as many animals/ boys names as you can Condition 3 Category Switching Switching back and forth between fruits and furniture

Set-Shifting Tests

Design Fluency (Cond.3)

D-KEFS: Color-Word Interference Test Condition 4: Inhibition/Switching

Measures Using Feedback During Task Performance

Wisconsin Card Sorting Test (WCST) D-KEFS Twenty Questions WJIII-COG

Analysis-Synthesis Concept Formation Visual-Auditory Learning

Measures of Metacognition

Behavioral manifestation in testing:

Shows no evidence of thinking through

either knows an answer or does not May not realize that he does not understand task Not aware that more than one strategy may be necessary Does not check work

Measures of Metacognition

D-KEFS Verbal reasoning tasks

Sorting 20 Questions Word Context Proverbs

Measures using feedback during task

performance

Measures of Attention

Behavioral manifestation in testing:

Rushes through Asks frequently when the testing will be over Easily drawn off tasks by minor distractions Irrelevant talking during subtests

Measures of Attention
Measures of Selective, Focused, and Sustained

Attention

Test for Everyday Attention for Children Subtests of working memory and processing speed

* For comprehensive list see Essentials of School Neuropsychology (Ch.6)

Measures of Working Memory

Behavioral manifestation in testing:

sequence Needs prompting

Asks to have questions repeated Remembers either the beginning or the end of a

Measures of Working Memory

Subtests of working memory Subtests requiring adherence to specific rules Subtests requiring holding previous
information in mind (D-KEFS: Sorting; Fluency tasks)

* For comprehensive list see Essentials of School Neuropsychology (Ch.9)

THANK YOU ! QUESTIONS ?

Common Neuropsychological Tests for Measuring Executive Functioning

Measures of Concept Generation Measures of Inhibition D-KEFS: Card Sorting Test NEPSY/NEPSY-II: Auditory Attention and Response Set Knock and Tap (NEPSY only) Statue (NEPSY only) Visual Attention (NEPSY only) Stroop Color-Word Test WJIII COG: Pair Cancelations Dean-Woodcock Sensory-Motor Battery: Fingertip Tapping NEPSY: Fingertip Tapping Manual Motor Sequences Category Tests Tower Tests Trail-making Tests D-KEFS: 20 Questions Tower Proverbs Word Context KABC-II: Conceptual Thinking Pattern Reasoning Rover Story Completion Triangles NEPSY/NEPSY- II: Block Construction Tower (NEPSY only) Route Finding Porteus Maze Test SB-5 Fluid Reasoning Tests (both verbal and nonverbal) UNIT Reasoning Tests: Analogic Reasoning Cube Design Mazes WJIII COG: Executive Processes Cluster Fluid Reasoning tests WISC-IV: Block Design Matrix Reasoning Picture Completion Picture Concepts WISC-IV Integrated: Elithorn Mazes Category Tests CAS: Expressive Attention D-KEFS: Color-Word Interference Tests (Condition 4) Design Fluency (Condition 3) Trail-making (Condition 4) Verbal Fluency (Condition 3)

Age Range 8-89 years

Measures of Motor Programming Measures of Planning, Reasoning, Problem-Solving

5-12 years 5-12 years 3-12 years 3-12 years 8-89 years 2-80+ years 4-80+ years 5-12 years 3-12 years 5+ years 8+ years 8+ years 8-89 years 8-89 years 16-89 years 8-89 years 3-6 years 5-6 years 6-18 years 6 years 3-18 years 3-16 years 5-12 years 5-12 years 3+ years 2-85+ years 5-17 years 2-80+ years 6-17 years

Measures of Set Shifting

6-17 years 5+ years 5-17 years 8-89 years

Measures of Set Shifting (cont.) Measures of Retrieval Fluency

Measures of Selective/Focused Attention

Measures of Sustained Attention

Measures of the Use of Feedback in Task Performance

Measures of Working Memory

NEPSY/NEPSY- II: Auditory Attention and Response Set (Part B) Stroop Tests Trail-making Tests Wisconsin Card Sorting Test Non-verbal: D-KEFS: Design Fluency (Conditions 1&2) NEPSY/NEPSY -II: Design Fluency Verbal: D-KEFS: Verbal Fluency (Conditions 1&2) NESPY: Verbal Fluency Test WJIII COG: Retrieval Fluency CAS: Expressive Attention Number Detection Receptive Attention D-KEFS: Color-Word Interference Test NEPSY/NEPSY- II: Auditory Attention and Response Set Visual Attention (NESPY only) WISC-IV: Coding Symbol Search WJIII COG: Auditory Attention CAS: Number Detection Receptive Attention NEPSY/NEPSY-II: Auditory Attention and Response Set Visual Attention (NEPSY only) WISC-IV: Cancellation WJIII COG: Pair Cancellation Category Tests Wisconsin Card Sorting Test D-KEFS: 20 Questions WJIII COG: Analysis-Synthesis Concept Formation Visual-Auditory Learning KABC-II: Word Order SB5: Delayed Response Block Span Memory for Sentences Last Word WISC-IV: WMI Tests WISC-IV Integrated: Arithmetic Process Approach Digit Span: Backward Letter-Number Sequencing Process Approach Spatial Span WJIII COG: Working Memory Cluster WRAML-2: Symbolic Working Memory Verbal Working Memory

5-12 years 8+ years 8+ years 6.5-89 years 8-89 years 5-12 years 8-89 years 3-12 years 2-80+ years 5-17 years 8-89 years 5-16 years 3-12 years 6-17 years 2-80+ years 5-17 years 5-16 years 3-12 years 6-17 years 2-80+ years 5+ years 6.5-89 years 8-89 years 2-80+ years 3-18 years 2-85+ years

6-17 years 6-17 years

2-80+ years 5-90 years

Daniel Miller (2007). Essentials of Neuropsychological Assessment

References
Alloway, T.P. (2011). Improving Working Memory: Supporting Students Learning. London, UK: SAGE publications, Ltd. Cox, A.J. (2007). No Mind Left Behind: Understanding and fostering executive control the eight essential brain skills every child needs to thrive. New York, NY: The Penguin Group. Dawson, P., & Guare, R. (2010). Executive Skills in Children and Adolescents. New York, NY: The Guilford Press. Dawson, P., & Guare, R. (2009). Smart but Scattered. New York, NY: The Guilford Press. Gathercole, S.E., & Alloway, T.P. (2008). Working Memory & Learning: A practical guide for teachers. London, UK: SAGE publications, Ltd. McCloskey, G. Perkins, L.A., & Divner, B.V. (2009). Assessment and intervention for executive function difficulties. New York, NY: Taylor & Francis Group, LLC. Meltzer, L. (Ed.). (2007). Executive Function in Education: From theory to practice. New York, NY: The Guilford Press. Meltzer, L. (2010). What Works for Special-needs Learners: Promoting executive function in the classroom. New York, NY: The Guilford Press. Miller, D.C. (2007). Essentials of School Neuropsychological Assessment. Hoboken, NJ: John Wiley & Sons, Inc.