Special Topic Workshop

Assessment of
Executive Functions

Zsuzsanna Kiraly, PhD

THE CENTERS.

Sources: Dawson, P., & Guare, R. (2010). Executive Skills in Children and Adolescents.
Miller, D.C. (2007). Essentials of School Neuropsychological Assessment.
 Overview

 Definitions
 Developmental Aspects
 Assessment Process
 Assessment Techniques
 What are Executive Functions?
• Problem solving (Temple, 1997; Stuss, 1992;
Denckla , 2001)
• Executive functions are responsible for a person’s 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 cue
and direct a person’s perception, emotion, cognition and
motor functions.

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4
 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
 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
 Executive Functions
“Producing disability” (Denckla, 2007)

Plan Organize Write Edit Revise

 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 strengthening

synaptic linkages:
 repetition, emotional arousal, novelty, focused attention

 Degree of neuroplasticity – window of opportunity for

change
 continues into late adolescence and adulthood
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 with
executive function skills

 Implications for executive functions

 importance of practice for the development of cortical
structure that support executive function skills at these
maturational points
 Frontal Brain Systems
Frontal Brain Systems (frontal/prefrontal cortex and
adjacent areas) make up the neurological base for
executive function skills
• Decides what to attend to and what to do
• Provide continuity and coherence to behavior
across time
• Modulate affective and interpersonal behaviors
• Monitor, evaluate, and adjust behavior
 Development of Executive Functions
• Self-regulation executive functions are
developmental in nature.
• Cultural change points (e.g., educational
transitions 1st grade, junior high school) can
serve to highlight executive function
maturational delays or significant deficiencies.
• Intra-individually, all executive functions do not
develop evenly.
• Inter-individually, there is also great variation
relative to chronological age.

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 Functional Areas Involved
 Academic achievement
 Metacognitive skills  guiding problem solving
 Regulatory skills  motivation, 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)
 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 (explicit

directions, teaching items, examiner cueing of attention and
performance) usually reduces the impact of executive control
processes on performance of tasks thought to assess
intelligence
• intelligence test scores often do not accurately reflect a child’s 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, constrained
• Lesser demands on use of executive skills
Absence of evidence is not evidence of absence
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
 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
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 and
Students (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 (Conners
CBRS) – 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, 2nd Ed. (BASC-
2) – P-T: 2-5/6-11/12-21 y.; Self: 8-11/12-21/18-25 y.
 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-manage
tasks and monitor one’s 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 Test
4. Tests of cognitive functions:
• WJ III-COG; WISC-IV
 Areas of Assessment
• Measures of Inhibition
• Measures of Planning and Organization
• Measures of Concept Generation
• Measures of Reasoning
• Measures of Cognitive Flexibility
• Measures Using Feedback During Task Performance
• Measures of Metacognition
• Measures of Attention
• Measures of Working Memory
 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
 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)
D-KEFS: Color-Word Interference Test
Condition 1: Color Naming
C D-KEFS: Color-Word Interference Test
Condition 2: Word Naming
D-KEFS: Color-Word Interference Test
Condition 3: Inhibition
 Measures of Planning and Organization

• Tower Tests
•D-KEFS Tower Test
• Mazes
• Rey–Osterrieth Complex Figure (REY)
D-KEFS Tower Test
 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
WISC-IV Integrated – Elithorn Mazes
WISC-IV Integrated – Elithorn Mazes
Rey–Osterrieth Complex Figure
REY Memory Profile Patterns
Measures of Concept Generation
• Involves multiple cognitive processes:
• Verbal and nonverbal concept formation
• Conceptual reasoning
• Initiation fluency
• Cognitive flexibility
• Ability to maintain cognitive set
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 way
Tell how you sorted both groups
Make different groups each time you sort
Free Sort
• concept formation skills
• flexibility in thinking
• initiate problem-solving and inhibit pull to repeat the same
behavior
Free description
• express conceptual relationships
Sort Recognition
 initiation problem
 perseveration problem
 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
 D-KEFS Word Context
Verbal Abstract Reasoning

What might sev mean?

Many people eat sev.
 D-KEFS Word Context

What might sev mean?

Many people eat sev.
Sev gores on trees.
 D-KEFS Word Context

What might sev mean?

Many people eat sev.
Sev gores on trees.
Sev are fairly round.
 D-KEFS Word Context

What might sev mean?

Many people eat sev.
Sev gores on trees.
Sev are fairly round.
Sev are usually red.
 D-KEFS Word Context

What might sev mean?

Many people eat sev.
Sev gores on trees.
Sev are fairly round.
Sev are usually red.
A sev a day keeps the doctor away.
 D-KEFS Word Context

What might grot mean?

Most houses have grots.
 D-KEFS Word Context

What might grot mean?

Most houses have grots.
A grot covers or goes over something.
 D-KEFS Word Context

What might grot mean?

Most houses have grots.
A grot covers or goes over something.
Grots can be pulled up or to the side.
 D-KEFS Word Context

What might grot mean?

Most houses have grots.
A grot covers or goes over something.
Grots can be pulled up or to the side.
A grot is usually made of cloth.
 D-KEFS Word Context

What might grot mean?

Most houses have grots.
A grot covers or goes over something.
Grots can be pulled up or to the side.
A grot is usually made of cloth.
A grot can hang in a window or in a theater.
D-KEFS Twenty Questions
Problem Solving
 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)
 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)
Wisconsin Card Sorting Test
 D-KEFS Trail-Making Test
Condition 4: Number- Letter Switching
 D-KEFS Trail-Making Test
Condition 1: Visual Scanning
 D-KEFS Trail-Making Test
Condition 2: Number Sequencing
 D-KEFS Trail-Making Test
Condition 3: Letter Sequencing
D-KEFS Trail-Making Test
Condition 5: Motor Speed
 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 between fruits and furniture
Set-Shifting Tests
Design Fluency (Cond.3)
D-KEFS: Color-Word Interference Test
Condition 4: Inhibition/Switching
 Measures Using Feedback During
Task Performance

• Wisconsin Card Sorting Test (WCST)

• D-KEFS Twenty Questions
• WJIII-COG
• Analysis-Synthesis
• Concept Formation
• Visual-Auditory Learning
 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
Measures of Metacognition
• D-KEFS – Verbal reasoning tasks
• Sorting
• 20 Questions
• Word Context
• Proverbs
• Measures using feedback during task
performance
 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
 Measures of Attention
 Measures of Selective, Focused, and Sustained
Attention
 Test for Everyday Attention for Children
 Subtests of working memory and processing speed

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

 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
 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)

THANK YOU !

QUESTIONS ?
 Common Neuropsychological Tests for Measuring Executive Functioning
Age Range
Measures of D-KEFS: Card Sorting Test 8-89 years
Concept
Generation
Measures of NEPSY/NEPSY-II: Auditory Attention and Response Set 5-12 years
Inhibition Knock and Tap (NEPSY only) 5-12 years
Statue (NEPSY only) 3-12 years
Visual Attention (NEPSY only) 3-12 years
Stroop Color-Word Test 8-89 years
WJIII COG: Pair Cancelations 2-80+ years
Measures of Motor Dean-Woodcock Sensory-Motor Battery: Fingertip Tapping 4-80+ years
Programming NEPSY: Fingertip Tapping 5-12 years
Manual Motor Sequences 3-12 years
Measures of Category Tests 5+ years
Planning, Tower Tests 8+ years
Reasoning, Trail-making Tests 8+ years
Problem-Solving D-KEFS: 20 Questions 8-89 years
Tower 8-89 years
Proverbs 16-89 years
Word Context 8-89 years
KABC-II: Conceptual Thinking 3-6 years
Pattern Reasoning 5-6 years
Rover 6-18 years
Story Completion 6 years
Triangles 3-18 years
NEPSY/NEPSY- II: Block Construction 3-16 years
Tower (NEPSY only) 5-12 years
Route Finding 5-12 years
Porteus Maze Test 3+ years
SB-5 Fluid Reasoning Tests (both verbal and nonverbal) 2-85+ years
UNIT Reasoning Tests: Analogic Reasoning 5-17 years
Cube Design
Mazes
WJIII COG: Executive Processes Cluster 2-80+ years
Fluid Reasoning tests
WISC-IV: Block Design 6-17 years
Matrix Reasoning
Picture Completion
Picture Concepts
WISC-IV Integrated: Elithorn Mazes 6-17 years
Measures of Set Category Tests 5+ years
Shifting CAS: Expressive Attention 5-17 years
D-KEFS: Color-Word Interference Tests (Condition 4) 8-89 years
Design Fluency (Condition 3)
Trail-making (Condition 4)
Verbal Fluency (Condition 3)
Measures of Set NEPSY/NEPSY- II: Auditory Attention and Response Set (Part B) 5-12 years
Shifting (cont.) Stroop Tests 8+ years
Trail-making Tests 8+ years
Wisconsin Card Sorting Test 6.5-89 years
Measures of Non-verbal: D-KEFS: Design Fluency (Conditions 1&2) 8-89 years
Retrieval Fluency NEPSY/NEPSY -II: Design Fluency 5-12 years
Verbal: D-KEFS: Verbal Fluency (Conditions 1&2) 8-89 years
NESPY: Verbal Fluency Test 3-12 years
WJIII COG: Retrieval Fluency 2-80+ years
Measures of CAS: Expressive Attention 5-17 years
Selective/Focused Number Detection
Attention Receptive Attention
D-KEFS: Color-Word Interference Test 8-89 years
NEPSY/NEPSY- II: Auditory Attention and Response Set 5-16 years
Visual Attention (NESPY only) 3-12 years
WISC-IV: Coding 6-17 years
Symbol Search
WJIII COG: Auditory Attention 2-80+ years
Measures of CAS: Number Detection 5-17 years
Sustained Receptive Attention
Attention NEPSY/NEPSY-II: Auditory Attention and Response Set 5-16 years
Visual Attention (NEPSY only) 3-12 years
WISC-IV: Cancellation 6-17 years
WJIII COG: Pair Cancellation 2-80+ years
Measures of the Category Tests 5+ years
Use of Feedback in Wisconsin Card Sorting Test 6.5-89 years
Task Performance D-KEFS: 20 Questions 8-89 years
WJIII COG: Analysis-Synthesis 2-80+ years
Concept Formation
Visual-Auditory Learning
Measures of KABC-II: Word Order 3-18 years
Working Memory SB5: Delayed Response 2-85+ years
Block Span
Memory for Sentences
Last Word
WISC-IV: WMI Tests 6-17 years
WISC-IV Integrated: Arithmetic Process Approach 6-17 years
Digit Span: Backward
Letter-Number Sequencing Process Approach
Spatial Span
WJIII COG: Working Memory Cluster 2-80+ years
WRAML-2: Symbolic Working Memory 5-90 years
Verbal Working Memory

Daniel Miller (2007). Essentials of Neuropsychological Assessment

 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 eight
essential 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.