1. Assessment of the Executive Functions

2. Assessment of Executive Functions
EF are dynamic, fluid
“Executive” is often provided by the examiner
Need intra-individual approach
All formal tests and informal tasks are multi-dimensional, requiring both content and EF
EF deficits should be seen across domains
Need content-matched control tasks for every EF task
Process method of assessment most functional

3. Problems with EF Assessment
Fluid nature not as amenable to examiner- driven, pencil and paper testing
Psychometrics of fluid “online” behavior
Well-structured testing doesn’t provide full opportunity to observe fluid strategic problem-solving
“Test of EF” may not be so if it is familiar
Second administration of EF test reduces EF demand

4. Assessment of Executive Functions
No formal, single test of EF
Many available measures are "adult"
Indirect observation; inferences made
IQ: tasks may be too easy to involve EF.
Integrity of cognitive processes
Need developmental perspective

5. Research-based "Tests" tapping Executive Functions
Visual Search
Tower of Hanoi/London/Toronto/California
Tinker Toy Test
Verbal/Nonverbal Learning-Proactive/Retroactive Inhibition
Matching Familiar Figures Test
CHIPASAT 9

6. Visual Search

7. Tower of Hanoi - 3 ring - Start

8. Tower of Hanoi - 2 move

9. Tower of Hanoi - 3 move

10. Tower of Hanoi - 4 move

11. Tower of Hanoi - 5 move

12. Tower of Hanoi - 6 move

13. Tower of Hanoi - 7 move

14. Tower of Hanoi - 4 Ring - 7 move

15. Tower of London
Starting Position

16. Tower of London

17. Tower of London

18. Tower of London

19. Tower of London

20. The “Real” Tower of London

21. Traditional "Tests" tapping Executive Functions
Verbal Fluency/Figural Fluency
Stroop Color-Word Interference Test
Rey-Osterrieth Complex Figure
Trailmaking Test
Wisconsin Card Sorting Test
Verbal Learning (intrusions, perseverations)
Mazes 10

22. Other means to assess EF
parents and teacher interviews (the real experts)
behavioral checklists (Conner’s, CBCL, BASC, BRIEF)
continuous performance tests (TOVA, Gordon, Conner’s CPT, TEC)
behavioral observations (classroom, testing)
Observations during other cognitive testing (Cognitive, Language, Visual Motor, Memory, Motor, Achievement)

23. EF Batteries Delis-Kaplan Executive Function Scales NEPSY
Cognitive Assessment System
Welsh, Pennington & Groisser (1991)
Visual Search, Verbal Fluency, Motor Sequencing, WCST, TOH, MFFT)

24. Wisconsin Card Sorting Test

25. Wisconsin Card Sorting Test - Color Match

26. Wisconsin Card Sorting Test - Form Match

27. Wisconsin Card Sorting Test - Number Match

28. F A S
____ ____ ____
Verbal Fluency

30. Rey Osterrieth Complex Figure

31. Advantages of EF Performance Tests:
Increased specificity of processes
Increased task control and internal validity
Decades of research on behavior of tests

32. Limitations to Performance Tests:
Performance tests tap individual components of executive function over a short time frame and not the integrated, multidimensional, relativistic, priority-based decision-making that is often demanded in real world situations
(Goldberg & Podell, 2000)

33. “The good Lord did not create us with the Woodcock-Johnson in mind.”
Deborah Waber

34. Executive Function Rating Scales
Behavior Rating Inventory of Executive Function
Frontal Systems Behavior Scale
DEX (Behavioural Assessment of the Dysexecutive Syndrome) 11

35. Advantages of EF Scales
Opportunity for EF in dynamic action
Increased ecological validity
Capture multiple perspectives
Time & cost efficiency
Rapidly developing literature

36. Limitations to Rating Scales
More global, less process-specific, information: Everyday behavior requires integration of EF, e.g., inhibit + working memory + planning, thus harder to fractionate
Poor control of environmental demands: WM deficits not noticeable on assembly line but problematic at Dunkin’ Donuts

37. Limitations to Rating Scales
Rater Bias:
Emotional state, personality of rater
Rater’s context (e.g., math vs lit class)
Halo effect: general like/dislike of person
Rater’s annoyance with filling out measures
Awareness of deficit on self report measures

38. Lauren 16 year old 10th grade girl in regular classes
Longstanding problems since K with:
Inattention (drifty, lost in a fog)
Anxiety- prefers routines, dislikes change
Social- ‘very shy’; peers think she is strange
Learns lists of facts about one topic at a time
Poor comprehension of reading & math but good basic skills; Very limited written output
Motor coordination
BUT functions in regular classes with some learning specialist time; Mostly A student

39. EL: Rey
Lauren: Rey

40. CJ - 16 year old boy with ADHD-I
Medication: Adderall XR since 2002
“When I don’t take it, I don’t do as well; I feel younger, get distracted, go blank, stare at things”
Anxiety issues - sensitivity to sarcasm
“I take everything way too seriously”
Parents’ goal:
“figuring out how JC can manage all this independently”

41. CJ Test Performance 18” 87 36” 87 ACT SS 9” 100 TOL-DX SS Moves 82
9” 100
18” 87
36” 87
TOL-DX SS
Moves 82
Correct 78
Total Time 80

42. CJ 16 yo male ADHD-I

43. Johnny-13yo Male: NVLD
Longstanding history of learning and social difficulties. (poor effort social impulsivity)
Impaired mathematical skills
Multiple previous evaluations suggested marked disparity between normal verbal cognitive (and language-based academic skills) and weaker nonverbal/problem-solving abilities (and math)
Overall cognitive scores fell at 5th percentile so student identified with Cognitive Disability

44. Johnny-13yo Male: NVLD
Child was placed in DH classroom with students with cognitive scores ranging from
Student enjoyed slower pace of classroom and lack of demands (wanted to stay)
Student struggling with peers

45. Johnny-13yo Male: NVLD Neuropsychological profile similar to previous
VCI=95 (37th percentile)
Reading=47th percentile)
POI=63 (<1st percentile)
Mathematics=12th percentile)
PS=73 (3rd percentile)
Socioemotional:somewhat hyperemotional and immature, now avoiding others but often complains of wanting peers. Active in sports

49. Does the WISC tap EF problems?
Verbal tasks knowledge-based
Performance tasks require more EF
Initiate:
time to respond
DB > DF
Poor retrieval on Information vs recognition

50. Inhibit: Shift: Organize: Plan: PC or MR impulsive; can correct errors
Stimulus-bound BD
Shift:
Carry-over on verbal tasks
Carry-over on DS
Organize:
BD vs OA (don’t you miss it?!)
Comprehension-verbal organization
Plan:
Mazes
Problem solving approach on BD, OA

51. Monitor: Working Memory: Self-corrects errors
Able to compare product with stimulus (BD)
Working Memory:
Digits Reversed - manipulating digits
Arithmetic (repetitions)
Letter Number

52. Does the CELF measure EF
Sentence Structure/Semantic Relationships versus Concepts and Directions
Word Classes (working memory)
Recalling sentences (loss of detail or meaning)
Sentence Assembly/Semantic Relationships-Impulsive responding
Word Associations

53. Do achievement tests tap EF?
Impulsive reader but accurate decoder
Comprehension of shorter but not longer passages
Word retrieval problems
Poor self-monitoring when completing arithmetic (misreads signs, misaligns info)
Basic writing mechanics
Longer written work/output (organized or random thoughts) (WIAT-2, TOWL etc.)

54. Do memory tests tap EF?
CVLT-C (semantic versus serial, intrusions, perseverations, proactive/retroactive interference)
Story memory-organization of recall?
Visual memory (scanning?, recall of complex versus simpler info)

55. Motor Tests Pegboard Finger Tapping Test Stressed Gaits examination
Timed Motor Examination
Graphomotor speed/precision tests

56. Observational procedures for assessing EF during task performance (Ylvisaker)