1. Executive functioning
Dr. Elizabeth Sheppard
Developmental Cognitive Neuropsychology
(C8CLDC)
Child Clinical Neuropsychology
(C8DCHN)

2. Objectives:
Be able to explain what is meant by executive functions (defining/problems)
Give examples and explain cognitive tests used to test EF
Discuss the strengths and limitations of EF measures in adults and children
Explain how EF develops in typical children
Discuss the extent to which adult models of EF can be applied to children using evidence from typically developing children and children with acquired brain lesions

3. What are Executive functions?
Set of processes that underlie flexible goal-directed behaviour (e.g. planning, inhibitory control, attentional flexibility,working memory), Bianchi (1922)
High-order control processes
Domain general i.e. operate across cognitive systems/ modalities
This definition is provisional & under-specified – we don’t know much about this area of cognition!

4. How many components of Executive abilities are there?
Lezak Suggests there are 4 components of Executive function:
Volition
Planning
Purposeful behaviour
Effective performance
Stuss Identifies a number of associated skills necessary for goal-directed behaviour
Ability to shift from one concept to another
Ability to modify behaviour in light of new info
Ability to synthesise & integrate isolated details into coherent whole
Ability to manage multiple sources of information
Ability to make use of relevant acquired knowledge

5. How many components of Executive abilities are there?
Anderson et al. (2001) propose 3 separable but unified components of EF:
1.)  Attentional control: selective attention and sustained attention
2.)  Cognitive flexibility: working memory, attentional shift, self-monitoring, and conceptual transfer
3.)  Goal setting: initiating, planning and organisation, generating and implementing strategies for problem solving, and strategic behaviour

6. What is Executive Dysfunction (dysexecutive syndrome)?
1.) Behavioural features - Poor self-control, impulsivity, erratic careless responses, poor initiation of speech, inflexibility (Lezak, 1995)
Case of Phineas Gage – quiet family man – yard long spike forced through his head
Memory, language & motor functions in tact
Complete personality change

7. What is Executive Dysfunction (dysexecutive syndrome)?
2.) Cognitive features – People with Executive Dysfunction exhibit poor performance on tasks which require one to use Executive Abilities
Tasks developed for use with adult participants with brain injuries
Large range of tasks tapping into various aspects of EF

8. Measures of EF - Wisconsin Card Sort
Cards vary along several dimensions
Sort & given feedback – infer rule
Experimenter changes rule
Change strategy & infer new rule
Involves problem solving & cognitive flexibility

9. Measures of EF - Tower of Hanoi
Move all hoops from left peg to right peg without putting larger hoop on top of smaller
Involves attentional shifting, planning, inhibition

10. Measures of EF - Stroop Task
Read colour words
Either congruous or incongruous
Take longer if incongruous
Involves selective attention & inhibition
RED
BLUE
GREEN
YELLOW
RED
BLUE
GREEN
YELLOW

11. Measures of EF - Verbal Fluency Task
Generate as many words as possible in one minute that begin with the letter ‘ N ’?
Requires the use of a self generated strategy
Time limit imposed

12. Measures of EF - Rey Figure Test
Copy figure as accurately as possible
Accuracy score measures spatial organisation
Organisational strategy score measures strategic decision making
Memory test also used sometimes

13. Measures of EF - Self-ordered Pointing task
Present series of arrays with a number of different elements
Point to different element in each array until all pointed to
Spatial location of elements changes in arrays
Involves working memory and strategic planning

14. Problem with measurements
Some question over reliability of measures e.g. WCST (Pennington et al.)
Discriminant validity = the ability to discriminate between distinct constructs
Tasks tap multiple EF components so unclear which EF causes poor performance
Tasks also involve non-EF processes so are poor at differentiating between EF deficits and non-EF deficits

15. What is executive dysfunction?
3). Biological features
The “Frontal Metaphor”
Association noted between tasks which involve EF processes and damage to the pre-frontal cortex
Neuropsychologists may say an individual’s symptoms “look frontal”, without knowing the nature of the brain damage

16. What is executive dysfunction?
Studies documenting effects of frontal lesions report heterogeneous range of tasks & behaviours disrupted
But… all require goal-directed behaviour, usually in novel contexts e.g. Cohen & Servan-Schreiber, 1992
Patients with lesions fail despite understanding goal of task due to perseveration, impersistence, intrusions of task irrelevant behaviour or lack of initiative
Cannot be attributed to more basic deficit in memory, perception or language comprehension

17. What is executive dysfunction?
Evidence from neuroimaging and neuroanatomical studies suggests that EF processes are associated with the PFC (Rakic, Bougeois, Zecevic, Eckenhoff & Goldman-Rakic, 1986)
Strong evidence from PET scan studies showing association between WCST and activity in the PFC in normal and schizophrenic patients (Weinberger et al. 1994)

18. How does executive function relate to IQ?
Effects of adult frontal lesions on IQ appear to be negligible (Kolb & Wishaw, 1990)
Frontal lobes may be important for fluid intelligence but less important for crystallised intelligence
Duncan et al. (1995) – patients with frontal lesions showed disparity between scores on Wechsler IQ test & Culture Fair IQ test; those with lesions elsewhere/ no lesions did not

19. Why might damage occur to the PFC?
Acquired adulthood
Acquired childhood
Congenital (developmental disorder)

20. Why study Executive Functioning in children?
Are adults and children qualitatively different in terms of EF? (frontal metaphor)
Some EF behaviours may actually be evident in childhood but redundant in adulthood (Smith et al., 1992)
Gets around discriminant validity problem in adult tasks – simpler tasks can be used.
We need to know about typical development of EF skills to help us understand developmental disorders that involve EF impairments.

21. Stages of Executive development
Frontal lobes originally thought to be functionally silent during childhood – EFs not measurable until second decade
This has been refuted now – e.g. Diamond & Doar argue cognitive skills necessary for EF are demonstrated in young children
Studies have shown frontal activity during even infancy
e.g. Chugani et al. (1987) – measured local cerebral metabolic rates of glucose & found evidence of frontal activation in infants of 6 months

22. Stages of Executive development
Older children make age-related gains on battery of EF tasks
Levin et al. (1991) – gains in concept formation, mental flexibility, planning & problem solving
Researchers agree that EF skills produce stage-like development
Some EFs appear to mature earlier than others – supporting multidimensional nature

23. Stages of Executive development
Welsh, Pennington & Groisser (1991)
Studied children aged 3-12 yrs on various EF measures – argue for 3 distinct developmental stages
Age 6- Competence with simple planning and organised visual search.
Age 10- Set maintenance, hypothesis testing, and impulse control attained.
Adolescence- Complex planning, motor sequencing, and verbal fluency
In general, greatest development occurs in middle childhood with slower development continuing later

24. EF development and frontal lobe development
Evidence for direct link between frontal development & EF from studies of object permanence in monkeys
Object permanence requires working memory & inhibition – develops in children around 7 months
Diamond & Goldman-Rakic
(1989) – animals with lesions
to parietal lobes passed A
not B task; those with frontal
lesions did not

25. EF development and frontal lobe development
Evidence suggests improvement in EF during childhood corresponds with growth spurts in frontal lobe development
Bell & Fox (1992) – EEG changes in frontal lobes during 1st year of life correlate with length of delay for response in delayed response tasks
However, some argue EF maturation reflects integrity of cerebral development throughout the brain; or EF maturation dependent on emergence of other cognitive abilities (see Anderson et al.)
Skill learning approach (similar to interactive specialisation account) – frontal cortex consistently involved in acquisition of new skills & knowledge from early on in life & plays role in organising other parts of cortex (e.g. Thatcher, 1992)

26. Children with acquired frontal damage – case studies
If children with frontal lesions different from adults, problems for ‘frontal metaphor’
Children with acquired frontal damage are rare so case study approach used for studying frontal injuries in children
Therefore, note that limitations of case studies apply here
Lack of consistent measures across cases
Ascertainment biases (bias in sampling – non-random)
Nevertheless case studies produce fairly consistent findings
N.B. Very important to consider cases within developmental perspective

27. Children with acquired frontal damage – case studies
Williams & Mateer (1992) DR- 8:11, falling beam
- EEG & MRI showed damage to frontal region.
Failure to maintain intellectual ability after injury
Social & language problems, but Verbal and non-verbal memory intact
Difficulty with acquisition of new information
Little spontaneous activity
Tantrums, aggression, unpredictable outbursts, impulsivity

28. Children with acquired frontal damage – case studies
Williams & Mateer (1992) - SN age 11, fell from tree
- CT scan showed bilateral frontal lobe damage.
- Dramatic changes in PIQ
- Problems with sustained attention, visuo-spatial planning, & motor control
- Inappropriate problem solving strategies, -Verbal reasoning and expressive vocabulary good, but not verbal inductive reasoning.
- Tantrums, aggressive, inappropriate laughter, eating problems

29. Children with acquired frontal damage – case studies
Age 12-probs with mental flexibility, sustaining attention, verbal fluency, & perceptual organisation.
Age 13-Bi-frontal abnormalities evident (EEG). Superior verbal ability, non-compliant behaviour
Age 15- probs with inhibiting verbal responses, extreme literalness, compulsive attention to detail, directing attention, high distractibility.

30. Children with acquired frontal damage – case studies
Marlowe (1992) - PL 3;11, lawn dart
Age 5
- good intellectual levels
- good simultaneous but poor sequential processing
- Verbal processing excellent, but needed instructions repeated extensively
Age 6
- similar intellectual level (but reduced efficiency in learning new info)
- A number of other cognitive deficits were evident: poor anticipatory behaviour, verbal understanding, visuo-spatial organisation and production, distractible, inhibition problems, perseveration.

31. What do childhood case studies tell us?
Frontal lesions have dramatic and lasting effects
Suggests that effects of frontal lesions are NOT silent, temporary, or radically different than adults (support frontal metaphor)
Severity and time of insult are important
- down stream effects
Some of the symptoms are similar to those for developmental disorders (e.g. conduct disorder, ADHD), although they do not meet all criteria – seems to support frontal metaphor for developmental disorders

32. Summary
EFs – multi-componential processes underlying flexible goal-directed behaviour
EFs associated with PFC
Number of EF tasks/ but problematic – discriminant validity
Child research gets around this to some extent
Case studies suggest EFs similar in children and adults

33. References
Anderson, V., Northam, E., Hendy, J., & Wrennall, J. (2001). Developmental Neuropsychology: A Clinical Approach. Hove: Psychology Press.
Bell, M. A., & Fox, N. A. (1992). The relations between frontal brain electrical activity and cognitive development during infancy. Child Development, 63,
Bianchi, L. (1922). The Mechanism of the Brain and the Function of the Frontal Lobes. Edinburgh: Livingstone.
Chugani, H. T., Phelps, M. E., & Mazziotta, J. C. (1987). Positron emission tomography study of human brain functional development. Annals of Neurology, 22,
Cohen, J. D., & Servan-Schreiber, D. (1992). Context, cortex, and dopamine: A connectionist approach to behavior & biology in schizophrenia. Psychological Review, 99, 45-77
Diamond, A., & Doar, B. (1989). The performance of human infants on a measure of frontal cortical development: The delayed response task. Developmental Psychology, 22,
Diamond, A., & Goldman-Rakic, P. (1989). Comparison of human infants and rhesus monkeys on Piaget’s AB task: Evidence for dependence of dorsolateral prefrontal cortex. Experimental Brain Research, 74,
Duncan, J., Burgess, P., & Emslie, H. (1995). Fluid intelligence after frontal lobe lesions. Neuropsychologia, 33,

34. References
Glosser, G., & Goodglass, H. (1990). Disorders in executive control functions among aphasic and other brain-damaged patients. Journal of Clinical and Experimental Neuropsychology, 12,
Kolb, B., & Wishaw, I. Q. (1990). Fundamentals of Human Neuropsychology. New York: W H Freemont & Company.
Levin, H. S., Culhane, K. A., Hartmann, J., Evankovich, K., Mattson, A. J., Howard, H., Ringholz, G., Ewing-Cobbs, L., & Fletcher, J. M. (1991). Developmenal changes in performance on tests of purported frontal lobe functioning. Developmental Neuropsychology, 7,
Lezak, M. (1995). Neuropsychological Assessment. (3rd edn.). New York: Oxford University Press.
Luciana, M., & Nelson, C. (1988). The functional emergence of pre-frontally guided working memory systems in four-to-eight year old children. Neuropsychologia, 30,
Marlowe, W. B. (1992). The impact of a right prefrontal lesion on the developing brain. Brain and Cognition, 20,
Mateer, C. A., & Williams, D. (1991). Effect of frontal lobe injury in childhood. Developmental Neuropsychology, 12, 95.
Rakic, P., Bourgeois, J.-P., Zecevic, N., & Goldman-Rakic, P. (1986). Concurrent overproduction of synapses in diverse regions of the primate cortex. Science, 232,

35. References
Smith, S. D., Kates, M. H., & Vriezen, E. R. (1992). The development of frontal lobe functions. In S. J. Segalowitz & I. Rapin (Eds.). Handbook of Neuropsychology: vol 7. Child Neuropsychology. Amsterdam: Elsevier.
Stuss, D. T. (1987). Contribution of frontal lobe injury to cognitive impairment after closed head injury: Methods of assessment and recent findings. In H. S. Levin, J. Grafman, & H. M. Eisenberg (Eds.). Neurobehavioural Recovery from Head Injury. New York: Oxford University Press.
Thatcher, R. W. (1991). Maturation of the human frontal lobes: Physiological evidence for staging. Developmental Neuropsychology, 7,
Thatcher, R. W. (1992). Cyclic cortical reorganisation during early childhood. Special Issue: The role of frontal lobe maturation in cognitive and social development. Brain and Cognition, 20,
Weinberger, D. R., Behrman, K. F., Gold, J., & Goldberg, T. (1994). Neural mechanisms of future-oriented processes: In vivo physiological studies of humans. In M. M. Haith, J. B. Benson, R. J. Roberts, & N. F. Pennington (Eds.). The Development of future-oriented processes. Chicago: University of Chicago Press.
Welsh, M., Pennington, B. F., & Groissier, D. B. (1991). A normative-developmental study of executive function: A window on prefrontal function in children. Developmental Neuropsychology, 7,
Williams, D., & Mateer, C. A. (1992). Developmental impact of frontal lobe injury in middle childhood. Brain and Cognition, 20,