assessment of executive functions in-service fall 2011

8/13/2019 Assessment of Executive Functions in-service Fall 2011

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pecial Topic WorkshopAssessment of

Executive Functions

Zsuzsanna Kiraly, PhD

THECENTERS.

Sources: Dawson, P., & Guare, R. (2010). Executive Skills in Children and Adolescents.

Miller, D.C. (2007). Essentials of School Neuropsychological Assessment.


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Overview

DefinitionsDevelopmental Aspects

Assessment Process

Assessment Techniques


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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, self-regulated, 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 cueand direct a persons perception, emotion, cognition andmotor functions.


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Executive Functions

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

to develop problem solutions

Planning

Roadmap; priorities

Organization

Keeping track of information

Time management

How much time; how to allocate it; sense of time

Working memory

Hold information in mind; draw upon past experience

Metacognition

Self-monitoring and self-evaluative skills


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Executive Functions

2. Set of regulatory skills to guide our behavior

Response inhibition

Think before act

Task initiation

Ability to begin task in a timely fashion

Flexibility

Adaptability to changing conditions

Emotional control / self-regulation of affect

Manage emotions; control and direct behavior


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PlanOrganize

Write Edit Revise

Executive Functions

Producing disability (Denckla, 2007)


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Development of Executive Functions


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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 strengtheningsynaptic linkages:

repetition, emotional arousal, novelty, focused attention

Degree of neuroplasticity window of opportunity for

change

continues into late adolescence and adulthood


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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 withexecutive function skills

Implications for executive functions

importance of practice for the development of corticalstructure that support executive function skills at these

maturational points


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Frontal Brain Systems

Frontal Brain Systems(frontal/prefrontal cortex and

adjacent areas) make up the neurological base forexecutive function skills

Decides what to attend to and what to do

Provide continuity and coherence to behavior

across time

Modulate affective and interpersonal behaviorsMonitor, evaluate, and adjust behavior


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Development of Executive Functions

Self-regulation executive functions are

developmental in nature. Cultural change points (e.g., educational

transitions 1st grade, junior high school) canserve to highlight executive functionmaturational delays or significant deficiencies.

Intra-individually, all executive functions do notdevelop evenly.

Inter-individually, there is also great variationrelative to chronological age.


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Academic achievementMetacognitive skillsguiding problem solving

Regulatory skillsmotivation, 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)

Functional Areas Involved


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Executive Functions / Intelligence

Operational definitions of intelligence usually do not include

executive control processes as a distinct content domain executive control process are often involved in many ways in the

performance of the tasks that are used to assess intelligence

The manner in which most tests are constructed (explicitdirections, teaching items, examiner cueing of attention andperformance) usually reduces the impact of executive controlprocesses on performance of tasks thought to assessintelligence intelligence test scores often do not accurately reflect a childs executive

control capacities

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, constrainedLesser demands on use of executive skills

Absence of evidence is not evidence of absence


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1. Informal Assessment Measures

2. Behavior Checklists

3. Formal Assessment Measures

Informal assessment (interviews; rating scales)

should be conducted prior to formal assessment


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Informal Assessment Measures

1. Case History/Interview

Can child plan tasks, complete homework, follow daily

routines on his/her own or with supervision?

2. Behavioral Observations

3. Classroom Observation Best measure of EF

skills!Complete interviews/rating scales prior to observation

4. Work Samples


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Behavior Checklists Behavior Rating Inventory of Executive Functions (BRIEF)

P-T: 3-5/6-18 y.; Self: 11-18 y.

Executive Skills Questionnaire for Parents/Teachers andStudents (Dawson & Guare, 2010)

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 (ConnersCBRS) P-T: 6-18 y.; Self: 8-18 y.

Child Behavior Checklist (CBC) P-T: 1 1/2-5/6-18 y.; Self: 11-18 y. Behavior Assessment System for Children, 2ndEd. (BASC-

2) P-T: 2-5/6-11/12-21 y.; Self: 8-11/12-21/18-25 y.


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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-managetasks 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)

3. Stand-alone tests designed to measure specific EF skills: Wisconsin Card Sorting Test (WCST)

Stroop Color Word Test4. Tests of cognitive functions: WJ III-COG; WISC-IV


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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


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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)


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Condition 1: Color Naming


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C D-KEFS: Color-Word Interference Test

Condition 2: Word Naming


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Condition 3: Inhibition


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Measures of Planning and Organization

Tower TestsD-KEFS Tower Test

Mazes

ReyOsterrieth Complex Figure (REY)


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D-KEFS Tower Test


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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


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WISC-IV Integrated Elithorn Mazes


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WISC-IV Integrated Elithorn Mazes


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ReyOsterrieth Complex Figure


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REY Memory Profile Patterns


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Measures of Concept Generation

Involves multiple cognitive processes:

Verbal and nonverbal concept formation

Conceptual reasoning

Initiation fluency

Cognitive flexibility

Ability to maintain cognitive set


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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 wayTell how you sorted both groups

Make different groups each time you sort


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Free Sort

concept formation skillsflexibility in thinkinginitiate problem-solving and inhibit pull to repeat the samebehavior

Free description

express conceptual relationshipsSort Recognition

initiation problem

perseveration problem


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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


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D-KEFS Word ContextVerbal Abstract Reasoning

What might sevmean?

Many people eat sev.


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D-KEFS Word Context

What might sevmean?


Sevgores on trees.


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D-KEFS Word Context

What might sevmean?


Sevgores on trees.

Sevare fairly round.


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D-KEFS Word Context

What might sevmean?


Sevgores on trees.


Sevare usually red.


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D-KEFS Word Context

What might sevmean?


Sevgores on trees.


Sevare usually red.A seva day keeps the doctor away.


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D-KEFS Word Context

What mightgrotmean?

Most houses havegrots.


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D-KEFS Word Context

What mightgrotmean?


Agrot covers or goes over something.


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D-KEFS Word Context

What mightgrotmean?



Grots can be pulled up or to the side.


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D-KEFS Word Context

What mightgrotmean?



Grots can be pulled up or to the side.

Agrotis usually made of cloth.


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D-KEFS Word Context

What mightgrotmean?

Most houses havegrots.Agrot covers or goes over something.

Grots can be pulled up or to the side.Agrotis usually made of cloth.Agrotcan hang in a window or in a theater.


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D-KEFS Twenty Questions

Problem Solving


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Measures of Cognitive Flexibility


Unable to generate multiple answers to questions(WISC-IV Comprehension)

Adjusts slowly to task when instructions change

(WJ III COG: Concept Formation)

Cannot figure out a new approach to task when the

first approach does not work(D-KEFS Towers)


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Measures of Cognitive Flexibility

Category Tests

Wisconsin Card Sorting Test (WCST)

Set-Shifting Tests

Stoop Color Word Test

D-KEFS:

Trail-Making (Cond.4)

Verbal Fluency (Cond.3)

Design Fluency (Cond.3)

Color-Word Interference (Cond.4)


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Wisconsin Card Sorting Test


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D-KEFS Trail-Making Test

Condition 4: Number- Letter Switching


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Condition 1: Visual Scanning


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Condition 2: Number Sequencing


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Condition 3: Letter Sequencing


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Condition 5: Motor Speed


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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 betweenfruitsandfurniture


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Set-Shifting TestsDesign Fluency (Cond.3)


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Condition 4: Inhibition/Switching


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Measures Using Feedback During

Task Performance

Wisconsin Card Sorting Test (WCST)

D-KEFS Twenty Questions

WJIII-COG

Analysis-Synthesis

Concept Formation

Visual-Auditory Learning


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Measures of Metacognition


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


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Measures of Metacognition

D-KEFS Verbal reasoning tasks

Sorting

20 Questions

Word Context

Proverbs

Measures using feedback during taskperformance


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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


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Measures of Attention

Measures of Selective, Focused, and SustainedAttention

Test for Everyday Attention for Children

Subtests of working memory and processing speed

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


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Measures of Working Memory

Behavioral manifestation in testing:Asks to have questions repeated

Remembers either the beginning or the end of a

sequence

Needs prompting


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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)


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THANK YOU !

QUESTIONS ?


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Common Neuropsychological Tests for Measuring Executive FunctioningAge Range

Measures of

Concept

Generation

D-KEFS: Card Sorting Test 8-89 years

Measures ofInhibition

NEPSY/NEPSY-II: Auditory Attention and Response SetKnock and Tap (NEPSY only)

Statue (NEPSY only)

Visual Attention (NEPSY only)

Stroop Color-Word Test

WJIII COG: Pair Cancelations

5-12 years5-12 years

3-12 years

3-12 years

8-89 years

2-80+ years

Measures of Motor

Programming

Dean-Woodcock Sensory-Motor Battery: Fingertip Tapping

NEPSY: Fingertip Tapping

Manual Motor Sequences

4-80+ years

5-12 years

3-12 years

Measures of

Planning,

Reasoning,Problem-Solving

Category Tests

Tower Tests

Trail-making TestsD-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 ConceptsWISC-IV Integrated: Elithorn Mazes

5+ years

8+ years

8+ years8-89 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

6-17 years

Measures of Set

Shifting

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)

5+ years

5-17 years

8-89 years


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Daniel Miller (2007). Essentials of Neuropsychological Assessment

Measures of Set

Shifting (cont.)

NEPSY/NEPSY- II: Auditory Attention and Response Set (Part B)

Stroop Tests

Trail-making Tests


5-12 years

8+ years

8+ years

6.5-89 years

Measures of

Retrieval Fluency

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

8-89 years

5-12 years

8-89 years

3-12 years

2-80+ years

Measures of

Selective/Focused

Attention

CAS: Expressive Attention

Number Detection

Receptive Attention


NEPSY/NEPSY- II: Auditory Attention and Response Set

Visual Attention (NESPY only)

WISC-IV: Coding

Symbol Search

WJIII COG: Auditory Attention

5-17 years

8-89 years

5-16 years

3-12 years

6-17 years

2-80+ years

Measures of

Sustained

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

5-17 years

5-16 years

3-12 years

6-17 years

2-80+ years

Measures of the

Use of Feedback in

Task Performance

Category Tests


D-KEFS: 20 Questions

WJIII COG: Analysis-Synthesis

Concept FormationVisual-Auditory Learning

5+ years

6.5-89 years

8-89 years

2-80+ years

Measures of

Working Memory

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

3-18 years

2-85+ years

6-17 years

6-17 years

2-80+ years

5-90 years


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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 eightessential 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.

assessment of executive functions in-service fall 2011

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