How Are Executive Functions Assessed? (page 2)
Given the complex nature of EF, it is not surprising that there is no single assessment that can measure all aspects of EF. In addition, there are problems associated with assessing EF through performance-based measures because in these situations, the examiner often performs the majority of tasks that are related to EF (for example, tasks are initiated by the examiner; the test situation is planned and well organized; the goals of the test are pre-established; the assessment room is quiet and free from distractions; and tasks for the most part are time-limited and novel).
There are a number of different neuropsychological assessments that attempt to tap into parts of the executive functions. The Wisconsin Card Sorting Test and the Category Test are two tests that attempt to measure how an individual responds to finding the rule for solving a set of problems and then how the individual responds when given a new set of problems that cannot be solved by using the old rule. The theory is that those who experience problems have deficits in their ability to shift strategies between tasks, which is one component of EF. However, specific test responses may not capture the complex nature of how an individual solves problems about life on a daily basis. Also, problem solving in reality is far more complex and requires an individual to take many more factors into consideration. Currently, the test batteries (a test that includes several different components) that are available to evaluate executive functions in children, such as the Delis-Kaplan Executive Function System, often require considerable time to administer and expertise in neuropsychology. Procedures that can assist in determining brain scan activity, such as a magnetic resonance imaging (MRI), are cost prohibitive for most clinicians.
However, rating scales have been developed to rate a number of behaviors that are associated with EF. One of the most popular rating scales is the Behavior Rating Inventory of Executive Function (BRIEF), which has rating forms for parents and teachers of children aged two to eighteen and a self-report form for children aged eleven to eighteen (Gioia, Isquith, Guy, & Kenworthy, 2000). The BRIEF provides scores for Behavioral Regulation (Inhibit, Shift, and Emotional Control scales) and Metacognition (Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor scales), as well as an overall score for EF. The higher the scores on the BRIEF scales, the more serious the problem is. The instrument is reliable and has been used in a number of research studies.
Executive Functions: A Common Thread Among Disabilities
As was previously mentioned, given the number of abilities that are subsumed under EF, it is possible to anticipate a number of different profiles that could result, based on the specific types of strengths and weaknesses that may be involved. Not only are there differences in profiles between individuals, but students with different disabilities also may demonstrate different patterns of strengths and weaknesses in EF, which we will discuss in this section.
The National Center for Learning Disabilities (NCLD) identifies some of the general barriers to learning that are common to many of the disabilities, including problems with
- Developing a plan
- Initiating tasks and generating ideas
- Estimating the amount of time required to complete a project
- Communicating information in an organized, logical, and sequential manner
- Retrieving information from long-term memory and manipulating information in short-term memory
The NCLD also notes a number of typical comments made by parents and educators about children with disabilities who have deficits in EF:
- Forgetful, problems planning ahead, trouble with setting goals to plan ahead
- Problems with organizing and prioritizing information
- Engage in all-or-nothing thinking: either focus on details or on the big picture, but not both
- Difficulty disengaging from one task and shifting to another
- Have problems with shifting between time periods (for example from the past to the present) or types of information (from concrete to abstract)
- Become increasingly overwhelmed as workload increases
- Have problems with applying what has been learned to a task in order to demonstrate knowledge
Profiles of EF Among Different Groups
Gerard Gioia and his colleagues (Gioia, Isquith, Kenworthy, & Barton, 2002) conducted a study in which they administered the BRIEF to children who had various disabilities, including ADHD, reading disorders (RD), autistic spectrum disorders (ASD), and traumatic brain injury (TBI). The results of their study are summarized here.
Attention Deficit Hyperactivity Disorder (ADHD) Children with ADHD-Combined type (ADHD-C children demonstrate both inattention and hyperactivity-impulsivity) exhibit more overall problems in EF than those with ADHD-Inattentive type (ADHD-I), and significantly more severe problems on the BRIEF Inhibit Scale than children with ADHD-I, children with RD, children with ASD, or children with TBI. The Inhibit Scale measures a child's ability to "inhibit, resist or not act on an impulse, and the ability to stop one's behavior at the appropriate time."
This is the behavioral inhibition function that was described by Barkley earlier. One of the problems that individuals with ADHD-C exhibit is an inability to sustain goal-directed behaviors in situations that are mentally challenging and not immediately rewarding (for example, homework or studying). People often ask why children with ADHD are able to sustain attention for video games and not homework. The answer is that video games are self-rewarding, while homework is not. Other scales that were clinically significant for the ADHD-C group include Shift (flexibility to shift from one activity to another) and Emotional Control (regulation of emotional responses).
Children with ADHD-I have higher scores than children with other disabilities in Working Memory (capacity to hold information in mind while mentally manipulating it), Plan/Organize (ability to manage current and future-oriented tasks), and Monitor (self-appraisal during and after task completion). Children with ADHD-I exhibit more problems with tasks associated with the metacognitive aspects of EF (working memory, planning, organization, self-monitoring), while those with ADHD-C experience problems with EF in areas of metacognition and behavior regulation (inhibitory control, emotional modulation).
Reading Disabilities or Disorders (RD) Children with a reading disability (RD) score significantly lower than those with ADHD-I on the scales of Working Memory and Plan/Organize; however, they are not lower than those with ADHD-I on the Self-Monitoring scale. Compared with individuals who do not have reading disorders, those with RD score higher on all scales of the BRIEF, with significant differences noted in Working Memory and Plan/Organize. Similar to children with ADHD-I, those with RD also scored higher on EF scales related to metacognition rather than EF scales associated with behavior regulation.
Autistic Spectrum Disorders (ASD) Children with autistic spectrum disorders (ASD) score significantly higher than children with no disabilities on all the EF scales, and they score significantly higher than any disability group on the Shift scale of the BRIEF. This is not surprising, given that symptoms of ASD often include a rigid adherence to nonfunctional routines in their daily life and highly stereotypical and repetitive behaviors (for example, hand flapping, lining up objects) that they resist being disengaged from. In addition, for children with ASD, scores on Emotional Control were among the highest overall, only slightly lower than the scores of children with ADHD-C, suggesting very poor ability to manage their emotional responses, which may result in exaggerated reactions to even minor events. Significant weaknesses in self-monitoring (high scores on the Monitor scale) were also noted for children with ASD, who typically have difficulty understanding how their behavior may affect others.
Traumatic Brain Injury (TBI) Results concerning EF for children with traumatic brain injury (TBI) were directly related to the extent of injury. Children with severe TBI were at greater risk for dysfunction in EF related to behavior regulation and metacognitive problem solving. Even children with moderate levels of TBI demonstrated significant problems in metacognitive skills related to planning, organization, and self-monitoring.
Behavioral Disorders Although Gioia and his colleagues (2002) did not include children with behavioral disorders in their study, many children with behavioral disorders also have ADHD-C and learning disabilities, which would result in EF deficits in areas found for children with disabilities in these areas. Children who have behavioral problems often exhibit significant difficulties in the EF areas related to behavioral regulation, including Inhibit (ability to control impulses and stop an ongoing behavior) and Emotional Control (appropriate modulation of emotional responses). If metacognitive deficits also exist, it is important to address issues in behavior regulation prior to interventions for metacognitive functions.
Remember: Scores on the BRIEF indicate worse performance the higher the scores are on the different scales. So when comparing children with RD to those with ADHD-I, children with RD do better in areas of Working Memory and Plan/ Organize, but perform as poorly as those with ADHD-I in areas of Self-Monitoring.
- Coats and Car Seats: A Lethal Combination?
- Kindergarten Sight Words List
- Child Development Theories
- Signs Your Child Might Have Asperger's Syndrome
- 10 Fun Activities for Children with Autism
- Why is Play Important? Social and Emotional Development, Physical Development, Creative Development
- The Homework Debate
- Social Cognitive Theory
- First Grade Sight Words List
- GED Math Practice Test 1