Post on 11-Jan-2016
description
Assessment of Executive FunctionsAssessment of Executive Functions EF are dynamic, fluidEF are dynamic, fluid ““Executive” is often provided by the examinerExecutive” is often provided by the examiner Need intra-individual approach Need intra-individual approach All formal tests and informal tasks are multi-dimensional, All formal tests and informal tasks are multi-dimensional,
requiring both content and EF requiring both content and EF EF deficits should be seen across domainsEF deficits should be seen across domains Need content-matched control tasks for every EF taskNeed content-matched control tasks for every EF task Process method of assessment most functionalProcess method of assessment most functional
Problems with EF AssessmentProblems with EF Assessment
Fluid nature not as amenable to examiner- Fluid nature not as amenable to examiner- driven, pencil and paper testingdriven, pencil and paper testing
Psychometrics of fluid “online” behaviorPsychometrics of fluid “online” behavior Well-structured testing doesn’t provide full Well-structured testing doesn’t provide full
opportunity to observe fluid strategic opportunity to observe fluid strategic problem-solvingproblem-solving
““Test of EF” may not be so if it is familiarTest of EF” may not be so if it is familiar Second administration of EF test reduces Second administration of EF test reduces
EF demandEF demand
Assessment of Executive FunctionsAssessment of Executive Functions
No formal, single test of EFNo formal, single test of EF Many available measures are "adult" Many available measures are "adult" Indirect observation; inferences madeIndirect observation; inferences made IQ: tasks may be too easy to involve EF.IQ: tasks may be too easy to involve EF. Integrity of cognitive processesIntegrity of cognitive processes Need developmental perspective Need developmental perspective
Research-based "Tests" tapping Research-based "Tests" tapping Executive FunctionsExecutive Functions
Visual SearchVisual Search Tower of Hanoi/London/Toronto/CaliforniaTower of Hanoi/London/Toronto/California Tinker Toy TestTinker Toy Test Verbal/Nonverbal Verbal/Nonverbal
Learning-Proactive/Retroactive InhibitionLearning-Proactive/Retroactive Inhibition Matching Familiar Figures TestMatching Familiar Figures Test CHIPASAT CHIPASAT
Traditional "Tests" tapping Traditional "Tests" tapping Executive FunctionsExecutive Functions
Verbal Fluency/Figural FluencyVerbal Fluency/Figural Fluency Stroop Color-Word Interference TestStroop Color-Word Interference Test Rey-Osterrieth Complex FigureRey-Osterrieth Complex Figure Trailmaking TestTrailmaking Test Wisconsin Card Sorting TestWisconsin Card Sorting Test Verbal Learning (intrusions, perseverations)Verbal Learning (intrusions, perseverations) MazesMazes
Other means to assess EFOther means to assess EF
parents and teacher interviews (the real experts)parents and teacher interviews (the real experts) behavioral checklists (Conner’s, CBCL, BASC, behavioral checklists (Conner’s, CBCL, BASC,
BRIEFBRIEF)) continuous performance tests (TOVA, Gordon, continuous performance tests (TOVA, Gordon,
Conner’s CPT, TEC)Conner’s CPT, TEC) behavioral observations (classroom, testing)behavioral observations (classroom, testing) Observations during other cognitive testing Observations during other cognitive testing
(Cognitive, Language, Visual Motor, Memory, (Cognitive, Language, Visual Motor, Memory, Motor, Achievement)Motor, Achievement)
EF BatteriesEF Batteries
Delis-Kaplan Executive Function ScalesDelis-Kaplan Executive Function Scales NEPSYNEPSY Cognitive Assessment SystemCognitive Assessment System Welsh, Pennington & Groisser (1991)Welsh, Pennington & Groisser (1991)
Visual Search, Verbal Fluency, Motor Visual Search, Verbal Fluency, Motor Sequencing, WCST, TOH, MFFT)Sequencing, WCST, TOH, MFFT)
Verbal Fluency Verbal Fluency
F A SF A S
________ ________ ____ ____
________ ________ ____ ____
________ ________ ____ ____
Advantages of EF Performance Tests:
Increased specificity of processesIncreased specificity of processes
Increased task control and internal validityIncreased task control and internal validity
Decades of research on behavior of testsDecades of research on behavior of tests
Limitations to Performance Tests:Limitations to Performance Tests:
Performance tests tap individual Performance tests tap individual components of executive function over a components of executive function over a short time frame and not the integrated, short time frame and not the integrated, multidimensional, relativistic, priority-multidimensional, relativistic, priority-based decision-making that is often based decision-making that is often demanded in real world situations demanded in real world situations
– (Goldberg & Podell, 2000)(Goldberg & Podell, 2000)
Executive Function Rating Scales
Behavior Rating Inventory of Executive Function
Frontal Systems Behavior Frontal Systems Behavior ScaleScale
DEX (Behavioural Assessment of the Dysexecutive Syndrome)
Advantages of EF ScalesAdvantages of EF Scales
• Opportunity for EF in dynamic actionOpportunity for EF in dynamic action Increased ecological validityIncreased ecological validity Capture multiple perspectivesCapture multiple perspectives Time & cost efficiencyTime & cost efficiency Rapidly developing literatureRapidly developing literature
Limitations to Rating ScalesLimitations to Rating Scales
More global, less process-specific, More global, less process-specific, information: Everyday behavior requires information: Everyday behavior requires integration of EF, e.g., inhibit + working integration of EF, e.g., inhibit + working memory + planning, thus harder to fractionatememory + planning, thus harder to fractionate
Poor control of environmental demands: WM Poor control of environmental demands: WM deficits not noticeable on assembly line but deficits not noticeable on assembly line but problematic at Dunkin’ Donutsproblematic at Dunkin’ Donuts
Limitations to Rating ScalesLimitations to Rating Scales
Rater Bias:Rater Bias:Emotional state, personality of raterEmotional state, personality of raterRater’s context (e.g., math vs lit class)Rater’s context (e.g., math vs lit class)Halo effect: general like/dislike of personHalo effect: general like/dislike of personRater’s annoyance with filling out measuresRater’s annoyance with filling out measuresAwareness of deficit on self report measuresAwareness of deficit on self report measures
LaurenLauren
16 year old 1016 year old 10thth grade girl in regular classes grade girl in regular classes Longstanding problems since K with:Longstanding problems since K with:
Inattention (drifty, lost in a fog)Inattention (drifty, lost in a fog)Anxiety- prefers routines, dislikes changeAnxiety- prefers routines, dislikes changeSocial- ‘very shy’; peers think she is strangeSocial- ‘very shy’; peers think she is strangeLearns lists of facts about one topic at a timeLearns lists of facts about one topic at a timePoor comprehension of reading & math but good Poor comprehension of reading & math but good
basic skills; Very limited written outputbasic skills; Very limited written outputMotor coordinationMotor coordination
BUT functions in regular classes with some BUT functions in regular classes with some learning specialist time; Mostly A studentlearning specialist time; Mostly A student
CJ - 16 year old boy with ADHD-ICJ - 16 year old boy with ADHD-I
Medication: Adderall XR since 2002Medication: Adderall XR since 2002““When I don’t take it, I don’t do as well; I feel younger, When I don’t take it, I don’t do as well; I feel younger,
get distracted, go blank, stare at things”get distracted, go blank, stare at things” Anxiety issues - sensitivity to sarcasmAnxiety issues - sensitivity to sarcasm
““I take everything way too seriously”I take everything way too seriously” Parents’ goal: Parents’ goal:
““figuring out how JC can manage all this figuring out how JC can manage all this independently”independently”
CJ Test PerformanceCJ Test Performance
ACT ACT SSSS
9” 9” 100 100
18” 18” 87 87
36” 36” 8787
TOL-DXTOL-DXSSSS
Moves Moves 8282
Correct Correct 78 78
Total Time Total Time 8080
Johnny-13yo Male: NVLDJohnny-13yo Male: NVLD
Longstanding history of learning and social Longstanding history of learning and social difficulties. (poor effort social impulsivity)difficulties. (poor effort social impulsivity)
Impaired mathematical skillsImpaired mathematical skills Multiple previous evaluations suggested marked Multiple previous evaluations suggested marked
disparity between normal verbal cognitive (and disparity between normal verbal cognitive (and language-based academic skills) and weaker language-based academic skills) and weaker nonverbal/problem-solving abilities (and math)nonverbal/problem-solving abilities (and math)
Overall cognitive scores fell at 5Overall cognitive scores fell at 5 thth percentile so percentile so student identified with Cognitive Disabilitystudent identified with Cognitive Disability
Johnny-13yo Male: NVLDJohnny-13yo Male: NVLD
Child was placed in DH classroom with Child was placed in DH classroom with students with cognitive scores ranging from students with cognitive scores ranging from 55-79.55-79.
Student enjoyed slower pace of classroom Student enjoyed slower pace of classroom and lack of demands (wanted to stay)and lack of demands (wanted to stay)
Student struggling with peersStudent struggling with peers
Johnny-13yo Male: NVLDJohnny-13yo Male: NVLD
Neuropsychological profile similar to previousNeuropsychological profile similar to previous VCI=95 (37VCI=95 (37thth percentile) percentile) Reading=47Reading=47thth percentile) percentile) POI=63POI=63 (<1(<1stst percentile) percentile)
Mathematics=12Mathematics=12thth percentile) percentile) PS=73 (3PS=73 (3rdrd percentile) percentile)
Socioemotional:somewhat hyperemotional and immature, Socioemotional:somewhat hyperemotional and immature, now avoiding others but often complains of wanting now avoiding others but often complains of wanting peers. Active in sportspeers. Active in sports
Does the WISC tap EF problems?Does the WISC tap EF problems?
Verbal tasks knowledge-basedVerbal tasks knowledge-based Performance tasks require more EFPerformance tasks require more EF
Initiate: Initiate: time to respondtime to respondDB > DFDB > DFPoor retrieval on Information vs recognitionPoor retrieval on Information vs recognition
Inhibit: Inhibit: PC or MR impulsive; PC or MR impulsive;
can correct errors can correct errors Stimulus-bound BDStimulus-bound BD
Shift:Shift: Carry-over on verbal Carry-over on verbal
taskstasks Carry-over on DSCarry-over on DS
Organize:Organize: BD vs OA (don’t you miss it?!)BD vs OA (don’t you miss it?!) Comprehension-verbal Comprehension-verbal
organizationorganization
Plan:Plan: MazesMazes Problem solving approach on Problem solving approach on
BD, OABD, OA
Monitor:Monitor:Self-corrects errorsSelf-corrects errorsAble to compare product with stimulus (BD)Able to compare product with stimulus (BD)
Working Memory:Working Memory:Digits Reversed - manipulating digitsDigits Reversed - manipulating digitsArithmetic (repetitions)Arithmetic (repetitions)Letter NumberLetter Number
Does the CELF measure EFDoes the CELF measure EF
Sentence Structure/Semantic Relationships Sentence Structure/Semantic Relationships versus Concepts and Directionsversus Concepts and Directions
Word Classes (working memory)Word Classes (working memory) Recalling sentences (loss of detail or Recalling sentences (loss of detail or
meaning)meaning) Sentence Assembly/Semantic Relationships-Sentence Assembly/Semantic Relationships-
Impulsive respondingImpulsive responding Word AssociationsWord Associations
Do achievement tests tap EF?Do achievement tests tap EF?
Impulsive reader but accurate decoder Impulsive reader but accurate decoder Comprehension of shorter but not longer passagesComprehension of shorter but not longer passages Word retrieval problemsWord retrieval problems Poor self-monitoring when completing arithmetic Poor self-monitoring when completing arithmetic
(misreads signs, misaligns info)(misreads signs, misaligns info) Basic writing mechanicsBasic writing mechanics Longer written work/output (organized or random Longer written work/output (organized or random
thoughts) (WIAT-2, TOWL etc.)thoughts) (WIAT-2, TOWL etc.)
Do memory tests tap EF?Do memory tests tap EF?
CVLT-C (semantic versus serial, intrusions, CVLT-C (semantic versus serial, intrusions, perseverations, proactive/retroactive perseverations, proactive/retroactive interference)interference)
Story memory-organization of recall?Story memory-organization of recall? Visual memory (scanning?, recall of Visual memory (scanning?, recall of
complex versus simpler info)complex versus simpler info)
Motor TestsMotor Tests
PegboardPegboard Finger Tapping TestFinger Tapping Test Stressed Gaits examinationStressed Gaits examination Timed Motor ExaminationTimed Motor Examination Graphomotor speed/precision testsGraphomotor speed/precision tests
Before beginning a task
1. Self-awareness of ability: Ask the child whether the task will be easy or
difficult and to explain the choice of answer. If relevant, ask for a prediction of
performance.
2. Goal-setting, strategic behavior: Ask the child what their goal is Ask him/her to explain plans for achieving his
or her goal.
Observational procedures for assessing EF during task performance (Ylvisaker)
During the task
1. Initiation: If appropriate, create opportunities for initiation (e.g., insufficient materials, requiring the child to initiate a request).
2. Inhibition: If appropriate, create some distractions that would require active inhibition from the child.
3 Self-monitoring: Ask the child how he or she is doing.
4. Strategic behavior/ Problem-solving: If appropriate, create obstacles that would require active, flexible
problem-solving.
After completion of the task
1. Self-evaluation: Ask the child how he or she did and how the results compare to their prediction.
2. Strategic behavior and problem-solving: Ask what the child did to succeed List relevant strategic procedures Ask the child whether he or she used them or
whether they might be useful.