Assessment of the Executive Functions

1. Assessment of theExecutive 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

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

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)

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 ACT SS 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 55-79. • 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: 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