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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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
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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?
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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Assessment of Executive Skills
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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D-KEFS: Color-Word Interference Test
Condition 1: Color Naming
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C D-KEFS: Color-Word Interference Test
Condition 2: Word Naming
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D-KEFS: Color-Word Interference Test
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?
Many people eat sev.
Sevgores on trees.
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D-KEFS Word Context
What might sevmean?
Many people eat sev.
Sevgores on trees.
Sevare fairly round.
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D-KEFS Word Context
What might sevmean?
Many people eat sev.
Sevgores on trees.
Sevare fairly round.
Sevare usually red.
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D-KEFS Word Context
What might sevmean?
Many people eat sev.
Sevgores on trees.
Sevare fairly round.
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?
Most houses havegrots.
Agrot covers or goes over something.
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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.
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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.
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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
Behavioral manifestation in testing:
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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D-KEFS Trail-Making Test
Condition 1: Visual Scanning
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D-KEFS Trail-Making Test
Condition 2: Number Sequencing
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D-KEFS Trail-Making Test
Condition 3: Letter Sequencing
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D-KEFS Trail-Making Test
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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D-KEFS: Color-Word Interference Test
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
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
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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
Wisconsin Card Sorting Test
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
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
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
Wisconsin Card Sorting Test
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.