Dimensions of Attention

8/20/2019 Dimensions of Attention

1/24

Cogniţie, Creier, Comportament / Cognition, Brain, Behavior

Copyright © 2007 Romanian Association for Cognitive Science. All rights reserved.

ISSN: 1224-8398Volume XI, No. 3 (September), 585 - 608

DIMENSIONS OF ATTENTION AND EXECUTIVE

FUNCTIONING IN 5-TO 12-YEARS-OLD CHILDREN:

NEUROPSYCHOLOGICAL ASSESSMENT WITH THE

NEPSY BATTERY Laura VISU-PETRA*, Oana BENGA, Mircea MICLEA

Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania

A BSTRACT

EF represents an umbrella-type concept for the complex set of cognitive processes

that underlies the coordination of goal-directed responses to novel or complex

situations. Developmental studies using standard neuropsychological tasks have

shown that EF has a protracted developmental course, beginning in early childhood

and continuing into adolescence. Our study aims to investigate the developmental

sequence of attention and executive functions using normative data from a

subsample (N = 485) of 5-to-12-years-old children evaluated during the

standardization process of “NEPSY: A developmental neuropsychological

assessment” (Korkman, Kirk, & Kemp, 1998) on the Romanian population. Eight

measures (Tower, Auditory Attention, Auditory Response Set, Visual Attention,

Verbal Fluency, Design Fluency, Statue, Knock and Tap) were selected for the

analysis, based on a rigorous task analysis process. The results suggest adifferential maturational timetable, with basic inhibitory responses and visual

search skills maturing early on, followed by response planning, focused attention,

and finally, by fluency measures. The measures clustered into two distinct factors;

based on their commonalities, we named them 1) Task-set selection (Tower, Verbal

and Design Fluency, Auditory Attention and Response Set) and 2) Inhibition (Knock

and Tap, Statue, Auditory Attention and Response Set). Three possible explanatory

frameworks are provided for this factorial structure: a linguistic account, a latent

variable approach and a maturational perspective.

K EYWORDS: executive functions, attention, NEPSY, exploratory factoranalysis.

* Corresponding author:

E-mail: [email protected]


2/24

L. Visu-Petra , O. Benga , M. Miclea

Cognition, Brain, Behavior 11 (2007) 585 - 608

586

INTRODUCTION

Welsh, Friedman and Spieker (2005) consider executive functioning (EF)research a “young, active and evolving area of scientific investigation that has notyet settled on a definition of executive function.” As Hughes and Graham (2002)

point out, we are dealing with an umbrella-type concept for the complex set of

cognitive processes that underlie flexible, goal-directed responses to novel ordifficult situations.

In our research we will prefer to use the term executive functioning (rather than executive function/s), not because it is more neutral and

does not require an explicit option between the unitary and the multifaceted

perspective upon EF, but because it reveals its process-oriented nature (Lehto,Juujärvi, Kooistra, & Pulkkinen, 2003), this representing, in our opinion, the best

way to approach the controversial construct of EF. We consider, along with Welsh

et al. (2005), that ecological problem–solving requires a range of higher-ordercognitive processes that are inextricably linked, this being the very essence of EF:

„it is precisely the coordination of multiple skills that makes executive function anunique cognitive domain”.

The context that generated the construct of EF is that of traditionalneuropsychological research. As a consequence of frontal cortical damage, a whole

constellation of cognitive skills appeared to be compromised; however, problemsassociated with frontal damage were “supramodal”, cutting across classical

cognitive, sensory, and motor distinctions (Lezak, 1995). Several case studies of

individuals who had suffered focal frontal damage portray them as easily distractedby irrelevant stimuli, unable to flexibly switch mental sets, failing to initiate

appropriate activity, lacking purposeful behavior based on anticipation, planningand monitoring (Shallice, 1982; Luria, 1966; Stuss & Benson, 1984; Eslinger,1996; Espy & Kaufman, 2002). It was documented that damage to the frontal lobes

did not impair attention, memory or language, per se, but rather „the ability to

marshall all of these cognitive skills, as well as others, in the pursuit of a futuregoal” (Welsh et al., 2005).

General developmental trends in EFDevelopmental studies using standard neuropsychological tasks have

shown that EF has a protracted developmental course, beginning in early childhood

and continuing into adolescence. In the literature, two main perspectives have beenproposed for the analysis of developmental trends in EF (Jarman, Vavrik, &Walton, 1995). Surprisingly, the first one – also chronologically - discards a true

developmental trajectory and postulates EF maturation through a series of stages,beginning in late childhood and early adolescence (Becker, Isaac, & Hynd, 1987).

The frontal lobes were not thought to play a discernible role during the early years

of child development, culminating with the extreme position that true executiveprocessing in the frontal lobes was not present to any significant degree until theonset of adolescence (Golden, 1981). Milder versions agree on a transitional period

during the 4th and 5

th year, up to the 7

th year, during which language exerts a


3/24



587

prominent influence over controlled behavior (Luria, 1973; Stuss & Benson, 1986;

Kaczmarek, 1987).The second approach is based on a continuity model of development

(Jarman, Vavrik, & Walton, 1995). According to this view, the functions of thefrontal lobes develop constantly throughout childhood, over a broad age span

(Case, 1992; Thatcher, 1991). There has been some early intuition that, at least insome “rudimentary” form, there is evidence for EF in very early age (Welsh &Pennington, 1988; Bruner, 1973; Haith, Hazan, & Goodman, 1988; Posner &

Rothbart, 1991); this intuition paralleled the proofs of earlier than previously

considered PFC functioning (Rakic, Bourgeois, Zecevic, Eckenhoff, & Goldman-Rakic, 1986). Welsh, Pennington and Groisser (1991) make an important point

concerning the very criteria for measuring frontal lobe functional maturation. Ifone is to consider EF maturity by reaching adult levels of performance on

traditional adult tasks, than it is most likely that only in adolescence this level

would be approximated. As a consequence of utilizing more adequatemeasurement methods, the initial two-stage perspective proposed by Luria wasreplaced by a multi-stage view (Welsh et al., 1991). Welsh et al. (1991) suggesteda three-staged skill development trajectory, with peaks at the age of 6, at the age of

10, and during adolescence; the researchers emphasize the “5 to 7 year shift”(White, 1970) as being the most important transition in EF development. However,

current perspectives emphasize essential progress as being made much earlier, thisdiscovery being a consequence of utilizing more age-appropriate tasks to measureearly EF development (Welsh et al., 2005; Gioia & Isquith, 2004). The progress is

already clear from 3 to 4 years of age, with a further developmental trend in the

ability to suppress information and actions over the ages 4 to 12, both in terms ofreaction time and accuracy (Benga & Petra, 2005).

An integrative perspective from the point of view of the second approach

is put forward by Welsh (2001), trying to integrate several findings ondevelopmental trends in EF. The author proposes three waves, or cycles: Cycle I,from 18 months to 5 years of age is characterized by emerging towards proficient

working memory, inhibition, and simple flexibility, revealed by mostly motor

tasks; Cycle II, 5 to 10 years of age, extremely dynamic, characterized by dramaticimprovements in performance at tasks requiring planning, working memory,

inhibition and self-monitoring skills; finally, Cycle III (10 to 14 years and beyond)is characterized by greater integration of processes and adult levels of performance.

The theoretical framework that we subscribe to is the continuity model of EFdevelopment; in this paper we focus upon the critical changes that unfold during

the 5-12 years interval, approximating the second Cycle of EF development asproposed by Welsh (2001). However, even within this “cycle” distinct EF

components develop at differential rates, as will be nuanced in the interpretation of

our results.


4/24



588

EF differentiation during development

The source of validation for the existence of a distinct cognitive domain,termed EF, comes consistently from adapting adult neuropsychological models and

is less extensively supported by statistical analyses from standardizeddevelopmental neuropsychological batteries. Regarding the fractionated nature of

the EF domain itself, relatively more developmental data is available. The generalconclusion is that there are differential rates at which distinct executive functionsdevelop (Diamond, 2002; Welsh, 2002). Although there is a great variation in the

names given to the factors underlying EF in children, there is still convergence on

them including processes such as inhibition, fluency, planning, working memory(Anderson, 2002). Molar analyses of the executive functions acknowledge the

distinct contribution of two basic components – working memory and inhibition(see Cohen & Servan-Schreiber, 1992; Kimberg & Farah, 1993). In their

normative-developmental study of EF, Welsh, Pennington and Groisser (1991)

reveal a three-factor structure: a Fluid & Speeded Response factor, a HypothesisTesting & Impulse Control factor, and a Planning factor.

An adult study of Miyake et al. (2000) reveals a distinct dimension beyondinhibition and working memory: shifting or flexibility. Hughes (1998) also

obtained a similar three-factor structure, comprising Attentional Flexibility,Inhibitory Control and Working Memory. This was also supported by findings

from an earlier extensive study (Pennington, 1997), that revealed three factors:Motor Inhibition, Set Shifting (Cognitive Flexibility) and Verbal WorkingMemory.

As they rely on task associations, and not necessarily on process association,

these factors should not be confounded with true EF subcomponents; yet thisapproach represents an empirical starting point in generating hypotheses about EF

processes that can be experimentally tested (Zelazo & Mueller, 2002). More

exploratory work is still needed in order to clarify the factorial structure of EFduring the 5-12 years interval: the development of EF is a dynamic process andspecific links between EF subcomponents could be identified at different ages

along this interval.

The Attention / Executive Functions core domain in the NEPSY batteryThe NEPSY test battery (Korkman, Kirk, & Kemp, 1998) was developed

based on the flexible model and diagnostic principles of Luria (Luria, 1973;

Korkman, 1999). There are five domains within which the tests have beenconstrued: Attention/Executive Functions, Language, Visual-Spatial Processing,

Sensoriomotor Functioning and Memory and Learning. According to Lurianassessment principles, a cognitive function can be impaired in one functional

domain with the deficit affecting performance in other domains as well; the

diagnostic task is to identify the primary deficits in one domain that lead tosecondary deficits in another domain (Korkman, 1999). The tasks that comprise the

Attention / Executive functions domain were selected to tap crucial elements in theassessment of this domain: selective and sustained attention (Auditory Attention;

https://www.researchgate.net/publication/216743350_Normal_Development_of_Prefrontal_Cortex_from_Birth_to_Young_Adulthood_Cognitive_Functions_Anatomy_and_Biochemistry?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/10855413_Assessment_and_Development_of_Executive_Function_EF_During_Childhood?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/14934756_A_Unified_Account_of_Cognitive_Impairments_Following_Frontal_Lobe_Damage_The_Role_of_Working_Memory_in_Complex_Organized_Behavior?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/12374714_The_Unity_and_Diversity_of_Executive_Functions_and_Their_Contributions_to_Complex_'Frontal_Lobe'_Tasks_A_Latent_Variable_Analysis?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232601253_Executive_function_in_preschoolers_Links_with_theory_of_mind_and_verbal_ability?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/12790206_Applying_Luria's_diagnostic_principles_in_the_neuropsychological_assessment_of_children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/12790206_Applying_Luria's_diagnostic_principles_in_the_neuropsychological_assessment_of_children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/12374714_The_Unity_and_Diversity_of_Executive_Functions_and_Their_Contributions_to_Complex_'Frontal_Lobe'_Tasks_A_Latent_Variable_Analysis?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/14934756_A_Unified_Account_of_Cognitive_Impairments_Following_Frontal_Lobe_Damage_The_Role_of_Working_Memory_in_Complex_Organized_Behavior?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232601253_Executive_function_in_preschoolers_Links_with_theory_of_mind_and_verbal_ability?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/216743350_Normal_Development_of_Prefrontal_Cortex_from_Birth_to_Young_Adulthood_Cognitive_Functions_Anatomy_and_Biochemistry?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/10855413_Assessment_and_Development_of_Executive_Function_EF_During_Childhood?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==


5/24



589

Visual Attention), response set (Auditory Response Set), nonverbal problem

solving (Tower), figural fluency (Design Fluency), inhibition, monitoring and self-regulation (Knock and Tap, Statue) (Korkman et al., 1998). We added to our

analysis the Verbal fluency task from the Language domain; the justification willbe presented in the following task analysis section.

Task analysisAs the NEPSY tasks designed to measure EF mostly rely on classical adult

measures (at least in their general design) that have been adapted for use with

children, we can find evidence for their interrelations and even attempts atdetermining their biological underpinnings in the literature. Of course, we prefer to

present developmental data; only if evidence is too scarce will we refer to adultresearch, as direct analogies especially in this domain could be misleading. In our

task analysis, we will only refer to neurobiological and cognitive mechanisms and

to developmental trends, the procedure details for each subtest being presented inthe Method section.

The Tower of London (Shallice, 1982), a version of the Tower of Hanoitest, is a test that is often used to probe the integrity of prefrontal cortex, patients

with frontal lobe damage showing difficulties in solving this task (Anzai & Simon,1979). Because the success of this task depends on a predetermined set of correctly

executed responses, it has been considered primarily a measure of responseplanning. However, this complex task requires multiple cognitive and motorprocesses: mainly response inhibition and working memory (Asato, Sweeney, &

Luna, 2006) but also attention, instruction comprehension, imitation of visual-

spatial models and motor skills (Stinnett, Oehler-Stinnett, Fuqua, & Palmer, 2002).A study with children aged 7 to 15 (Levin et al., 1991) supported the idea of a

separable planning component and the sensitivity of TOL to developmental

changes; however it has been suggested that TOL might not measure the samefunctions in children and in adults (Baker, Segalowitz, & Ferlisi, 2001, as cited inBaron, 2004); additionally, it seems that there are some particular aspects in the

NEPSY Tower standardized scores that make it less sensitive to the developmental

aspects that it measures (Gioia, Isquith, Hoffhines, & Guy, 1999); thus we decideto use the raw scores in our analysis. Several studies indicated significant

development of TOL performance through adolescence (De Luca et al., 2003;Luciana & Nelson, 1998), although the underlying mechanisms of this

development are still unclear.The two auditory attention subtests have distinct enough demands to

justify a separate analysis. The first part, auditory attention, is a continuousperformance test (CPT) that measures the child’s ability to attend selectively to

simple auditory linguistic stimuli during a monotonous task. The second part, the

auditory response set, requires the child to maintain a more complex cognitive setwhile sustaining auditory attention; it assesses the ability to shift set and to regulate

a response according to matching and contrasting auditory stimuli (Klenberg.,Korkman, & Lahti Nuuttila, 2001). Specific rules and task procedure precludes a

https://www.researchgate.net/publication/17060286_Specific_Impairments_of_Planning?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/261658942_Developmental_changes_in_performance_on_tests_of_purported_frontal_lobe_functioning_Special_Issue?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/17060286_Specific_Impairments_of_Planning?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/261658942_Developmental_changes_in_performance_on_tests_of_purported_frontal_lobe_functioning_Special_Issue?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==


6/24



590

direct comparison with other neuropsychological measures; yet the data from the

Finnish sample reveals a later maturing course, with children reaching the 12-year-old level only at 10 years.

Visual search tests are usually paper-and-pencil cancellation tests used todetermine visual attention, often by calculation of the number of omission and

commission errors in each hemispace (Baron, 2004). In the neuropsychologicalliterature, it has been proven to be sensitive to frontal lesions (Teuber, Battersby, &Bender, 1960). The NEPSY subtest is a classic visual search task requiring

selective attention deployment and a degree of inhibition in resisting distractor

information. It requires attentional control in the continual selective processing ofdifferentially relevant stimuli features (Espy & Bull, 2005), and it has been shown

to mature quite early in development, being indistinguishable from adultperformance as early as the age of 6 (Welsh et al., 1991).

Verbal fluency tests are often mentioned in the neuropsychological

literature as measures of cognitive functions after brain injury; neuroimagingstudies have identified anterior, left prefrontal regions (Elfgren & Risberg, 1998), supplementary motor cortex, anterior cingulate cortex (ACC), the precuneus andcerebellum (Fu et al., 2006; Ravnkilde, Videbech, Rosenberg, Gjedde, & Gade,

2002) as being involved during this task, with strong similarities between child andadult patterns of activation (Gaillard et al., 2000). There are two common forms of

verbal fluency tests: letter (phonemic) fluency, testing the ability to generate wordsin response to a letter cue, and category (semantic) fluency, which tests the abilityto generate words in response to a category cue (e.g. “animals”). The test involves

a generative process based on a linguistic and an ideational component, followed

continuously by orthographic/semantic validation, sustained attention, errormonitoring, response selection, and working memory processes (Friedman et al.,

1998). The ability to form semantic clusters appears to follow a developmental

trajectory from early childhood (children as young as 6 already showed clustering)to adult maturation (Bjorklund & Douglas, 1997). The second component,switching/ shifting between the clusters (Troyer, Moscovitch, & Winocur, 1997)

relies more heavily on EFs such as strategic search and set shifting, and shows a

more protracted developmental period, not reaching maturity until adolescence. Design fluency tests are considered analogous to verbal fluency tests and

potential measures of right frontal cerebral function (Lee et al., 1997). However,the classical neuropsychological distinction between left frontal mediation of

verbal fluency and right frontal mediation of design fluency proved less clear,more recent adult studies pointing to contributions from both right and left frontal

regions (Glosser & Goodglass, 1990; Butler, Rorsman, Hill, & Tuma, 1993;Elfgren & Risberg, 1998). Design fluency involves EF abilities such as shifting,

self-regulating, self-monitoring (Baron, 2004). Design fluency also differs from

verbal fluency tests in the fact that verbal fluency tests rely heavily on strategicgeneration of already stored words, therefore relating to long-term memory, while

the designs that are generated are not previously stored in memory. Normativestudies have found that the number of generated figures increased with age, peaked

https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/222119749_Lateralized_blood_flow_increases_during_fluency_tasks_Influence_of_cognitive_strategy?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/222678337_Modulation_of_effective_connectivity_by_cognitive_demand_in_phonological_verbal_fluency?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/12678613_Functional_anatomy_of_cognitive_development_FMRI_of_verbal_fluency_in_children_and_adults?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/12678613_Functional_anatomy_of_cognitive_development_FMRI_of_verbal_fluency_in_children_and_adults?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/222678337_Modulation_of_effective_connectivity_by_cognitive_demand_in_phonological_verbal_fluency?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/222119749_Lateralized_blood_flow_increases_during_fluency_tasks_Influence_of_cognitive_strategy?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==


7/24



591

between ages 16 and 24, remained constant between 25 and 55, and than declined

(Baron, 2004). The Statue subtest is a simple measure of response suppression, requiring

a motor response (motor persistence). Conflict is introduced through the distractorsand stimulus type is non-verbal (Espy & Bull, 2005). The Knock and Tap NEPSY

subtest is a classical Lurian GoNoGo test. It is a nonverbal conflict task thatmeasures self-regulation and inhibition of immediate impulses evoked by visualstimuli that conflict with verbal directions (Klenberg et al., 2001). The first part

relates to the need to inhibit motor response in a single cognitive set, while the

second part requires the subject to break the well-routinized set, inhibit the desireto respond to the previous set, and to shift to a new one. Functional neuroimaging

studies link frontal systems function to this task (Kawashima et al., 1996),especially to the orbitofrontal cortex (Casey et al., 1997). Data suggests that in the

case of response suppression tasks (here we can include the Statue subtest also)

inhibition occurs at a primary, non-mnemonic level, maturing very early in life, asearly as 6 years (Diamond, 1991; Espy & Bull, 2005; Klenberg et al., 2001).

The aims and research questions of the present study

Although EF research represents a “hot topic” in nowadays developmental(neuro)psychology, there is little consensus regarding the status of EF among other

cognitive functions, the EF subcomponents and their maturational timetable. Theuse of different research paradigms, of various test versions and task demands ismaking the establishment of normative data particularly difficult. The current study

aimed to provide further knowledge regarding the standardized assessment of

attention and EF development in a large sample of 5-to-12-year olds. Due to theabovementioned inconsistencies, even if few similar attempts have been

documented in the literature (Klenberg et al., 2001), the study is essentially

exploratory. The main aims are to reveal the interrelations between different EFtests and to outline the developmental pathways of the postulated underlying EFprocesses (after a rigorous task analysis), and the clustering of these abilities for

the target age range, using exploratory factor analysis. Secondary aims were to test

for gender differences and to reveal the similarities and discrepancies withprevious normative data on the same battery from the Finnish (Klenberg et al.,

2001) and American (Korkman et al., 1998) samples.

METHOD

ParticipantsThe analysis has been performed on a subsample from the data collected in

the ongoing research project of adapting NEPSY: A Developmental

Neuropsychological Assessment for the Romanian population. The project beganin 2004 after a formal agreement between the official copyright-holder: The

Psychological Corporation, and the local publisher, Cognitrom. A total of 485children (234 girls and 251 boys), aged 5-12 years, with no documented history of

https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/11533466_Differential_Development_of_Attention_and_Executive_Functions_in_3-_to_12-Year-Old_Finnish_Children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/256075168_A_Developmental_Functional_MRI_Study_of_Prefrontal_Activation_during_Performance_of_a_Go-No-Go_Task?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/7617851_Inhibitory_Processes_in_Young_Children_and_Individual_Variation_in_Short-Term_Memory?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/11533466_Differential_Development_of_Attention_and_Executive_Functions_in_3-_to_12-Year-Old_Finnish_Children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/256075168_A_Developmental_Functional_MRI_Study_of_Prefrontal_Activation_during_Performance_of_a_Go-No-Go_Task?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/7617851_Inhibitory_Processes_in_Young_Children_and_Individual_Variation_in_Short-Term_Memory?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/11533466_Differential_Development_of_Attention_and_Executive_Functions_in_3-_to_12-Year-Old_Finnish_Children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/11533466_Differential_Development_of_Attention_and_Executive_Functions_in_3-_to_12-Year-Old_Finnish_Children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/11533466_Differential_Development_of_Attention_and_Executive_Functions_in_3-_to_12-Year-Old_Finnish_Children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/21079995_Developmental_Time_Course_in_Human_Infants_and_Infant_Monkeys_and_the_Neural_Bases_of_Inhibitory_Control_in_Reaching?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/232606336_Neuropsychological_Evaluation_of_the_Child?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==


8/24



592

neurodevelopmental disorders have been selected for the present the study. The

participants were divided into 8 age groups: 5-year-olds (N = 53; 22 girls), 6-year-olds (N = 55; 22 girls), 7-year-olds (N = 63; 35 girls), 8-year-olds (N = 73; 31

girls), 9-year-olds (N = 66; 33 girls), 10-year-olds (N = 72; 30 girls), 11-year-olds(N = 77; 40 girls), 12-year-olds (N = 26; 16 girls). The sample is highly

representative for the Romanian population, comprising subjects from 23 counties,both from urban and from rural regions.

EF MeasuresAlthough the original Attention/Executive Functions Domain only

contained six NEPSY subtests (Tower, Auditory Attention and Response Set,

Visual Attention, Design Fluency, Statue, Knock and Tap), based on the literaturedescribing EF subcomponents and their measurement (see the Introduction) and on

a subsequent study by Klenberg et al. (2001), we decided to add to the analysis the

Verbal Fluency subtest (from the Language domain). The description of the tasks,of the coding and scoring procedure is briefly provided next:

Tower

This subtest is an adaptation of Shallice’s (1982) Tower of London test.

The child moves three colored balls to target positions on three pegs in a prescribednumber of moves (1-7). There is a time limit (30-60 sec) and also complex rules to

which the child must adhere. The score is the number of correctly achieved targetpositions, within the time limit (maximum 20 points).

Auditory Attention and Response Set (AARS)

The AARS is a continuous performance test that includes two distinct

parts. In both conditions, after the general instruction and some practice trials, thechild hears a recorded sequence of items and has to perform (or refrain from

performing) a certain motor response. Part A (AARS-A), the auditory attention

condition, the child listens to a list of words presented at 1-second intervals; he/shehas to react only to the word “red” by picking up a red square from the table and byplacing it into a nearby box. In Part B (AARS-B), the response set condition, the

child is asked to shift between target and response categories and to select a yellow

square when the word “red” was heard and vice-versa, and to select a blue cubewhen the word “blue” was heard. For each correct, immediate selection, 2 points is

scored. For a correct, but delayed response, 1 point is given. Finally, responses tonon-targets receive 1 minus point. For the total 30 target words of AARS-A, a

maximum score of 60 points can be obtained; for AARS-B the maximum score is72 points.

Visual AttentionIn this test, the child is instructed to select only the items that match the

target stimuli on the page containing both targets and distractors. The number of

targets, both on the Cats subtest (max. 20) and on the Faces subtest (max. 20) isscored, with a maximum of 40 points to be earned.

https://www.researchgate.net/publication/11533466_Differential_Development_of_Attention_and_Executive_Functions_in_3-_to_12-Year-Old_Finnish_Children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==https://www.researchgate.net/publication/11533466_Differential_Development_of_Attention_and_Executive_Functions_in_3-_to_12-Year-Old_Finnish_Children?el=1_x_8&enrichId=rgreq-7410ff50-e6e2-4ae5-b890-35483f9ab4b6&enrichSource=Y292ZXJQYWdlOzI2ODI1NjgyODtBUzoxNjUxMjE3NjY3MzE3NzZAMTQxNjM3OTUwNTAzMg==


9/24



593

Statue

In this test, the child is required to stand still in a position as a “statue”holding a flag (eyes closed, no body movements or vocalizations) over a 75-second

interval. At pre-set intervals distractors are introduced (the examiner coughing,dropping a pen, etc.) For each 5-sec interval, the child is awarded 2 points for lack

of inappropriate responses, 1 point for one inappropriate response (bodymovement, vocalization), and 0 points for more than one inappropriate response.The maximum score is 30.

Knock and Tap

In this test, the child is initially required to knock on the table when theexaminer taps, and to tap when the examiner knocks. On the second part, the child

has to tap with the side of the fist when the examiner knocks with the knuckles,and vice-versa, and not to respond at all when the examiner taps with the palm.

The score is the total number of correct responses (maximum 30 points).

Verbal FluencyFor a 1-minute interval, children are asked to generate words belonging to

either two semantic categories (animals and food/drinks) or two phonemiccategories (words beginning with an “S” or an “F”). The sum of correct distinct

words across the four categories constitutes the test score. Design Fluency

This visuomotor fluency subtest assesses the child’s ability to generatenovel designs on structured and on unstructured arrays of dots as quickly aspossible. The score is the total number of designs produced by the child.

ProcedureThe tests were administered by licensed psychologists who had already

undergone a NEPSY training course. When evaluations were conducted in a

child’s home, efforts were made to ensure a well-lit, well-ventilated, quiet roomwith minimal distractions. However, most of the evaluations were conductedindividually in educational centers (kindergartens and schools) in a quiet, separate

room. The process of administering the whole NEPSY battery lasted about two

hours for the 5-12 year-olds and one hour for the 3-4 year-olds; when it wasdeemed necessary, the session was divided in two (in two subsequent days), so as

to ensure an optimum of motivational and attentional implication from the child.


10/24



594

RESULTS

Descriptive results and developmental trends

The means and standard deviations, as well as age group differences(compared with one-way ANOVAs) of the EF measures for each age group are

given in Table 1.

T a b l e 1

D e s c r i p t i v e S t a t i s t i c s a n d A g e G r o u p s D i f f e r e n c e s ( O n e - W a y A N O V A s ) f o r E F M e a s u r e s


11/24



595

To investigate the effects and interactions of age and sex, a two-way analysis

of variance (ANOVA; 8 x 2) was performed for each subtest. In this analysis, theeffects of age group were proven significant (p < .05) for all the subtests except the

Visual Attention subtest, F(7, 254) = 1.35, p = .22. The gender effect was onlyvisible in the AARS-A, F(1, 254) = 4.44, p < .04, with girls outperforming boys.

As for the interaction effects, there were no significant results at a p < .05significance level.

Next, we were interested in developmental trends for each task. We

examined with post-hoc comparisons (Tukey’s HSD test) which was the age level

the subtest performance no longer improved significantly. In line with theKlenberg et al. (2001) similar study on the Finnish sample, we decided that when

the performance of a specific age group in a specific skill did not differsignificantly from that of any older groups, the development in that skill could be

considered to have reached a 12-year-old level (the oldest age-group performance

as measured by the NEPSY battery; so conventionally chosen as the highest levelthat can be attained in the NEPSY subtests).

This level was first reached in the Tower subtest at the age of 7 (compared tothe age of 8 in the Finnish sample). Both in the Knock and Tap and in the Statue

subtests, this level was reached at the age of 6 (similar to the Finnish sample). Inthe Visual Attention subtest this level was reached already at age 6, much earlier

than the results in the Finnish sample, where 12-year-old performance was onlyreached at age 10. In the Verbal Fluency subtest, the level of 12-year-olds wasreached at the age of 10, while Design Fluency reached it at the age of 11 (both

identical to the Finnish sample). Finally, performance at AARS-A / AARS-B

reached the level of 12-year-olds at the age of 9 / 10 years, similar to the Finnishsample.

Correlations among EF subtestsTaking into account the fact that age correlated significantly with each EF

measure, partial correlations were conducted to determine the interrelatedness of

different EF measures controlling for the influence of the age factor (Table 2).

With few exceptions, all EF measures appear to intercorrelate, although themagnitude of the correlations varies from low to moderate. Performance at the

Statue subtest is not associated with performance at the Tower subtest, or with anyfluency measure (Design Fluency or Verbal Fluency). Finally, performance at the

Knock and Tap subtest is also not significantly associated with both fluencymeasures.

The strongest associations are between the Tower and the AARS-A, andthe Tower and the Verbal Fluency measure; as well as between both AARS-A and

AARS-B and Verbal Fluency. The parts of the same test (AARS-A and AARS-B),

as well as the two measures of fluency (Design and Verbal) have highintercorrelations, but are clearly distinct enough to suggest separate analysis. The

fact that our EF measures correlated even when controlling for age provided thebasis for our analysis of their groupings with the help of factor analysis techniques.


12/24



596

Table 2Partial Correlations between All EF Measures, Controlling for Age

Tower

AARS-

A

AARS-

B

Visual

Attention Statue

Design

Fluency

Verbal

Fluency

Knock

and Tap

Tower - .42** .29** .32** -.02 0.27** 0.41** 0.16**

AARS-A - 0.67** 0.27** 0.20** 0.19** 0.35** 0.20**

AARS-B - 0.27** 0.21** 0.26** 0.34** 0.27**

VisualAttention - 0.20** 0.10* 0.26** 0.22**

Statue - 0.05 0.05 0.23**

Design Fl. - 0.32** 0.04

Verbal Fl. - 0.05

Knockand Tap

-

Note. AARS-A = Auditory Attention and Response Set – Part A; AARS-B = Auditory Attention andResponse Set – Part B; *p < .05, **p < .001.

Exploratory factor analysis

In order to identify the dimensions of EF as measured by the NEPSY tasks,

the total score from each task was entered into the exploratory factor analysis

(EFA). A preliminary analysis with the Kaiser-Meyer-Olkin (KMO) methodregarding the adequacy of performing EFA on the present sample revealed an

adequate value of .76 (KMO varies between 0 and 1, with values between 0.5 and0.7 considered satisfactory, above 0.7 adequate, and above 0.8 excellent, (Field,

2000, as cited in Sava, 2004). The analysis (Principal Axis Factoring with direct

oblimin rotation) produced a two factor-solution, when applying the criterion ofretaining factors with eigenvalues greater than 1. The solution accounted for 53.84% of the total variance. The same two-factor solution appeared the best when

examining Cattell’s scree plot.

When a loading of .30 was used as a criterion, five tests loaded on the firstfactor, and four tests (two cross-loading) loaded on the second factor (see Table 3

for factor loadings). Therefore we examined the theoretical sensibility of subteststhat loaded together within the factor solution. The first factor included measureswith a strong verbal component (Verbal Fluency, Tower – complex instructions,

AARS-A, AARS-B), but also with a visual component (Design Fluency, Tower).

The main variables grouped in this factor comprise 1) fluency (both verbal anddesign), an ability to generate clusters according to a rule (semantic or phonemic

resemblance) and to switch between these clusters; and 2) flexible generation of

plans in order to reach a determined goal (Tower) (we could add an attentionaldeployment component, but the AARS –A and especially AARS-B loaded weakeron this factor and much stronger on the second one). Considering the abstract,

high-order, self-generated abilities involved in both planning and fluency tasks, the


13/24



597

first factor was named Task-set selection (after the description of task-set selection

offered by Zelazo, Carlson and Kesek, 2007). The second factor clearly includedmeasures of inhibition, with a focus on response suppression (AARS-B and

secondly AARS-A, Statue, Knock and Tap). Based on this grouping, the secondfactor was named Inhibition. A subtest (Visual Attention) did not load significantly

on any of the two factors; however, looking at the Structure matrix from the EFA itcorrelates more (.40) with the second, Inhibition factor.

Table 3

Factor Loadings for EF Measures: Two-Factor Solution

Factor

1 2

Tower .604 .012

AARS-A .441 .466AARS-B .371 .537

Visual Attention .249 .289

Statue -.086 .488

Design Fluency .560 -.030

Verbal Fluency .772 -.041

Knock and Tap .002 .456

Note: Extraction Method: Principal Axis Factoring with direct oblimin rotation. Bold coefficientsindicate that the subtest loaded on the factor.

DISCUSSION

This study was undertaken in order to reveal the structure and developmentof EF in 5- to 12-year-olds typically developing Romanian children. The

performance that we observed on various EF measures was relatively similar to theone we can approximate from the NEPSY American (Korkman et al., 1998) and

Finnish (Korkman et al., 1997, as cited in Klenberg et al., 2001) standardizationsample, for the same age groups. Table 4 presents informative descriptive data for

comparison with reported performance in these samples; we selected only the

tests and indexes of performance used in all three samples.


14/24



598

Table 4

Mean (Standard Deviation) Performance across Romanian, Finnish, and American

Samples

Note. AARS-A = Auditory Attention and Response Set – Part A; AARS-B = Auditory Attention and

Response Set – Part B.; * = not available in reported data.

The correlations between EF tasks remain significant –although moderate-

even when controlling for the strong influence of the age factor. Even from a visualinspection of Table 2, it is clear that the two motor inhibition measures (Statue;

Knock and Tap), although interrelated, are not significantly correlated with the

other EF measures.

Developmental pathwaysIn our study the development of attentional and EFs appeared to proceed

gradually. The 12-year-old level was first reached on tasks of motor inhibition andresponse suppression, subsequently on measures of visual search, response

planning, selective and sustained attention, and finally on verbal and designfluency measures. These trends are similar to those found in the Klenberg et al.

(2001) study using the same measures. Taking into account disparate findings onseveral NEPSY (or similar to NEPSY) subtests, convergent evidence appears (see

also 1.3.1 above). Espy and Bull (2005) found the same early development ofresponse suppression; Visual Search is already well-developed early in

development (Welsh et al. 1991), while fluency has a more protracted

developmental course (Welsh et al. 1991; Shute & Huertas, 1990).

Two elements should be stressed here. First, although performance at theTower subtest reaches a 12-year-old level at an early age (7 years), this does not

mean that it is an adult-level performance, in fact ceiling levels are far from being

attained even in the 12-year-old sample (mean: 13.8 out of 20). Studies by Luciana& Nelson (1998; 2002) reveal that performance on the TOL is still immature by the

age of 12, and matures during adolescence (De Luca et al., 2003; Asato, Sweeney,& Luna, 2006). Second, one should also note that in the Lurian tradition, the

NEPSY tests have different degrees of complexity. Some focus on a discreteability (e.g. Statue), others integrate skills in order to solve complex tasks. A

careful task analysis (see 1.3.1 above) reveals the multitude of mechanismsinvolved in successful task accomplishment; therefore a longer maturational course

NEPSY test Romanian sample Finnish sample American sample

Tower 13.2 (3.54) 10.6 (1.72) 9.84 (.60)

AARS-A 43.64 (16.09) 42.37 (6.34) -*

AARS-B 42.35 (18.94) 40.12 (8.27) -*

Design Fluency 19.03 (9.57) 19.5 (7.37) 11.20 (3.16)

Statue 26.54 (4.70) -* 25.32 (6.46)

Knock and Tap 26.51 (5.15) 28.37 (5.12) 27.35 (4.26)


15/24



599

in such complex tasks could reflect either lack of maturation in some

subcomponents, or true EF (coordinative) immaturity.

EF structureAs a result of our EFA analysis, we obtained a two-factor solution that

accounts for EF subtest groupings in our sample. The first factor, Task-setselection, comprises distinct but related abilities, and has been reported by severalprevious studies (Mirsky, Anthony, Duncan, Ahearn, & Kellam, 1991; Taylor

Saint-Cyr, & Lang, 1986). Basic task demands are different between a verbal

fluency task (comprising both semantic and phonemic association criteria) and adesign fluency task: while the first one requires search within an existing

vocabulary, the visual fluency task requires a generation of designs according torules. However, evidence is provided by our results and by previous findings

(Klenberg et al., 2001) that there is a common underlying variable, revealing

clustering abilities (Troyer, Moscowitch, & Winocur, 1997), abstract reasoning anda common generative skill. The same association is to be found between the twoauditory attention measures (AARS-A and AARS-B). It is interesting to note thatthey cross-load on both factors, but with different weights. AARS-A is better

associated with the first factor, Fluency; while the AARS-B has a stronger link tothe second factor of Inhibition, being obviously a test with multiple inhibitory

demands.A somehow puzzling finding is the association of the Tower of London

performance with the fluency and attentional measures within the first factor.

Indeed, we could not find evidence for a distinct factor of planning and strategy

employment, as shown by previous studies (Welsh et al., 1991). A first reasoncould be the young age of the sample: immature abilities are often considered less

differentiated (Espy & Bull, 2005). Moreover, although performance in the TOL

has been repeatedly associated with inhibitory tasks in adult samples (Asato,Sweeney, & Luna, 2006) in children this association could not be proven,suggesting that children could use a different strategy than the adult one to solve

the task (Huiziniga, Dolan, & Van der Molen, 2006). A similar very strong

association between TOL and fluency (poor) performance has been identified in amixed neuropsychiatric group (Hanes, Andrewes, Smith, & Pantelis, 1996). A

second reason could be the complex nature of this task, which has been shown torequire planning (Baker et al., 1996; Shallice, 1982), working memory (Carpenter,

Just, & Shell, 1990; Roberts & Pennington, 1996; Welsh et al., 1999), inhibition(Goel & Grafman, 1995; Miyake et al., 2000), and last, but not least, verbal

comprehension and reasoning abilities, taking into account the complexinstructions the child has to process in order to understand the rules of the task.

The second factor reveals an association between two types of inhibitory

measures: response suppression (Knock and Tap, Statue), and attentional control(AARS-A and especially -B). In motor response suppression tasks, the conflict is

typically derived through a prohibited action; in attention control tasks, the childmust suppress an internally represented rule or response set that had been


16/24



600

previously active and has to be inhibited in favor of a new response according to

rules (Espy & Bull, 2005). Our findings confirm the lack of differentiation betweenthese two types of inhibition in children: “proficiency in resolving conflict

provided through prohibited action is an earlier, developmentally boundmanifestation of attentional control; …both types of conflict might elicit executive

processes that are indistinguishable at this young age, unlike adults” (Espy & Bull,2005, p. 682-683).

AN EXPLANATORY FRAMEWORK

Benson (1998) proposed that validity research should undergo three stages:

an initial substantive stage when psychological constructs are defined in terms of atheoretical template, followed by a structural stage in which these constructs are

operationalized, measured and re-analyzed to see how well they reflect the

theoretical template on which the measurement is based, and finally, an externalstage during which ecological/clinical validity has to be proven (Stinnett et al.,2002). From this perspective, the NEPSY has a very solid substantial stage, relyingon a strong (Lurian) tradition enriched with up-to-date developmental

considerations. The external stage is also quite well represented, the test beingproven to be selectively impaired in neurological groups, when compared to

controls or to children with scholastic concerns only (Schmitt & Wodrich, 2004,although the difference came only from the Language and the Sensoriomotordomain) and when comparing typical development to populations with prenatal

exposure to organic solvents (Till, Koren, Westall, & Rovet, 2001), in utero

cocaine exposure (Bandstra et al., 2002), juvenile neuronal ceroid lipofuscinosis(Lamminranta et al., 2001), ADHD, Learning Disabilities, autism, Fetal Alcohol

Syndrome, hearing impairments (Korkman et al., 1998) and different forms of

epilepsy (Bender, Marks, Brown, Zach, & Zaroff, 2007; Petra & Benga, 2003).However, the essential stage of structural validation is less well

represented, perhaps because the complex nature of the tasks that were devised to

assess interactive functional systems, generating a “task impurity” problem

(Rabbitt, 1997). Carlson (2003) stated that because there are no “process pure”measures of EF, multi-method approaches are valuable for triangulating the

process involved. The difficulty arises in interpreting the results of multiple testresults: composite scores have been used, but when this arbitrary grouping is not

sustained by domain specificity measures, it could be misleading (for instance,although scores could be homogenous within typical samples, a strong within-

domain fractionation is noted in atypical development, arguing against the use ofcomposite scores – Petra & Benga, 2004).

In reference to an earlier version of NEPSY, the author (Korkman, 1988)

stated that factor analysis is not an appropriate mechanism for studying the test’sstructure because “such data reduction was not considered compatible with Luria’s

approach, in which a good test coverage and stepwise, qualitative differences areessential, and some test overlap is justified” (p. 384, as cited in Stinnett et al.,


17/24



601

2002). However, in order to prove that the tasks that measure EF are interrelated

and measure a common latent variable, a factorial approach is indispensable.Interpretation of factors extracted by EFA or of those postulated in the

confirmatory factor analysis is not straightforward due to the same task impurityproblem.

In children, some studies have found evidence for the same three-factorialstructure as proposed by Miyake, Freidman and Emerson (2000) for the adultpopulation. Lehto et al. (2003) present a similar three-factor solution, although

there are some things that can be questioned in the apparent similarity with the

Miyake et al. (2000) model. First of all, the tasks are very different from the onesemployed by the adult study. Second, the theoretical interpretation of factors is

post-hoc and sometimes “forced” to fit the hypothesized factors: the AARS-part Bis considered to be primarily a WM measure rather than an inhibitory one (counter-

intuitively, as acknowledge by the authors); the Tower of Hanoi (TOH) is entered

in the Inhibition factor (although the correlation between inhibition andperformance at the TOH is frequently found to be low – Welsh et al., 1999). Thethird factor, named Shifting after the Miyake et al. (2000) study, had a loweigenvalue (.99) and consisted of a Word Fluency test and the part B of the

classical Trail Making test, with the association between the two being lessobvious.

Our two-factor EFA solution confirms EF task partially confirmsassociations identified in previous studies that have included a younger group ofchildren in the analysis and could suggest at least three conjectures, depending on

distinct frameworks of reference. As mentioned before, the interpretation of EF

factors is a tedious process, and “forcing” the factorial structure into pre-existentfactors often seems arbitrary and post-hoc (Miyake et al., 2000). We therefore

propose three possible interpretations; future research is needed to clarify which is

the most appropriate, or to suggest an alternative account.First, when considering previous findings on the one-factor structure of the

whole NEPSY battery (Stinnett et al., 2002; Jarratt, 2005), a general hypothesis

could provide a good account for the associative solution that we have obtained.

The authors state that “the primary and robust factor appears to reflect aspects oflinguistic-verbal ability” (Stinnett et al., 2002, p. 78), this being confirmed by a

unique, Language factor model identified by Jarratt (2005). The essential roleplayed by the child’s linguistic abilities as a basis for solving all these apparently

unrelated tasks provides a plausible explanation for the strong association found inour study between the subtests measuring planning, attentional and fluency

measures. As the measures from the second factor have much simpler linguisticdemands (Knock and Tap, Statue) and rely rather on motor (suppression)

responses, we could argue that this is the true reason behind the existence of a

distinct factor in our study. However, this linguistic vs. non-linguistic explanationcannot completely clarify the cross-loading of the Auditory Attention subtests on

both factors. This test has strong verbal processing demands, and yet it seems toload strongly on the second, non-linguistic factor.


18/24



602

An alternative account takes into account possible true underlying latent

variables within these two factors. Accordingly, we have called the first factorTask-set selection, taking into account the requirements posed by both fluency and

Tower subtests to generate, maintain and flexibly shift between responsecategories, an ability that is also required by the two auditory attention subtests.

“To adopt a task-set is to select, link, and configure the elements of a chain ofprocesses that will accomplish a task” (Rogers & Monsell, 1995). Zelazo, Carlson,& Kesek (2007) propose task-set selection as being a reflection on task sets, as

when switching between two abstract rules or when coordinating hierarchically

embedded goals, a higher-order ability relying on the anterior or rostrolateralprefrontal cortex (RLPFC). We can speculate further on this ability as being

commonly involved by our tasks (Tower and Fluency) considering the unifyinghypothesis for RLPFC functions proposed by Christoff, Ream, Geddes, & Gabrieli

(2003): the RLPFC is supposed to be involved in processing self-generated

information. According to the authors, processing internally generated informationand establishing a task-set occurs “when novel information, such as an inference, ahypothesis, a relation, or a plan, needs to be inferred, or self-generated; and second,when previous information from an earlier episode or experience needs to be

retrieved from memory, or again, self-generated” (p. 1166), the description appearsto fit perfectly the requests of the two types of tasks that load highly on the first

factor: Tower and Fluency. The second factor, Inhibition is less ambiguous inrevealing distinct requirements tapping inhibitory control, both in its motorresponse suppression component (Statue, Knock and Tap), and in its attentional

control element (AARS-A and especially AARS-B). Similar to our findings,

inhibitory tasks have presented high intercorrelations in children samples (Espy &Bull, 2005), although in the adult samples (Friedman & Miyake, 2004) the two

dimensions (response suppression and attentional control) appeared independent.

A third perspective - perhaps complementary to the second account –integrates the maturational aspects captured by this factor structure. Howevertempting the second account might be, it has to be validated against developmental

constraints of this age. One should embrace the adult model with great caution,

because as our data points out, there is diverging evidence. Unlike adult findings,performance in TOL is not associated in our sample with inhibition and it does not

constitute a separate planning factor; additionally, attentional control is not yetdifferentiated from response suppression. The task-set selection - RLPFC

hypothesis has been proposed taking into account adult data (Christoff et al., 2003;Baker et al., 1996), and the authors admit that there is limited research exploring

the neural basis associating self generated task-set selection to RLPFC activity inchildren. Therefore, from a third perspective, we can envision the first factor as a

prototype of immature and therefore undifferentiated EFs, while the second reflects

already-matured, distinct, inhibitory abilities. Although mean performance scoresand developmental patterns are extremely similar to the Finnish 5-12 year old

sample (Klenberg et al., 2001), in their exploratory factor analysis performed onthe 7-12 year old subsample they already obtained a four-factor solution, two


19/24



603

similar to ours (a Fluency factor and an Inhibition factor), two new ones: Visual

Search and Auditory Attention. This provides additional support to thedevelopmental differentiation of EF as measured by the NEPSY battery. EF has

been repeatedly characterized by functional unity as well as functional diversity(Miyake et al., 2000); perhaps in the stage of development that we have focused

upon, the functional diversity is still in a latent, potential state; it will only becomereality during later maturational stages. This perspective would be supported bydata revealing the developmental shift from more diffuse to more focal and

efficient frontal networks (Durston et al., 2006; Luna et al., 2001).

At the end of these clarifications, we must acknowledge that a trueassessment of EF, especially in the context of its development, is - adapting an

analogy used by Burgess (1997) - like shooting a moving target. The intrinsicdevelopmental constraints as well as the dynamic nature of task response make the

process of evaluation elusive and create the need for perpetual task refinement and

subsequent theory revisal.

REFERENCES

Anderson P., (2002). Assessment and development of executive function (EF) during

childhood. Child Neuropsychology, 8 , 71–82

Anzai, Y., & Simon, H. A. (1979). The theory of learning by doing. Psychological Review,86 , 124-140.

Asato, M. R., Sweeney, J. A., & Luna, B. (2006). Cognitive processes in the development

of TOL performance. Neuropsychologia, 44, 2259-2269.

Baker, K., Segalowitz, S. J., & Ferlisi, M. C. (2001). The effect of differing scoring

methods for the Tower of London task on developmental patterns of performance.

Clinical Neuropsychologist , 15, 309–313.

Baker, S. C., Rogers, R. D., Owen, A. M., Frith, C. D., Dolan, R. J., Frackowiak, R. S. J.,Robbins, T. W. (1996). Neural systems engaged by planning: a PET study of the

Tower of London task, Neuropsychologia. 34, 515-526.

Bandstra, E. S., Morrow, C. E., Vogel, A. L., Fifer, R. C., Ofir, A. Y., Dausa, A. T., et al.

(2002). Longitudinal influence of prenatal cocaine exposure on child language

functioning. Neurotoxicology and Teratology, 24, 297–308.

Baron, I. S. (2004). Neuropsychological evaluation of the child . New York: Oxford

University Press.

Becker, M., Isaac, W., & Hynd, G. (1987). Neuropsychological development of nonverbal

behaviors attributed to frontal lobe functioning. Developmental Neuropsychology, 3,

275– 298.

Bender H. A., Marks B. C., Brown E. R., Zach L., Zaroff C. M. (2007). Neuropsychologic

performance of children with epilepsy on the NEPSY. Pediatric Neurology, 36 , 312-

317.

Benga, O., & Petra, L. (2005). Social cognition and executive functioning: A constructivistdevelopmental approach. Cognition, Brain, Behavior , 2, 301-317

Benson, J. (1998). Developing a strong program of construct validation: A test anxiety

example. Educational Measurement: Issues and Practice. 17 , 5-9.


20/24



604

Bjorklund and Douglas, 1997 D.F. (1997). The development of memory strategies. In: N.

Cowan, Editor, The development of memory in childhood , Psychology Press, Hove

East Sussex, UK, pp. 201–246.

Bruner, J. S. (1973). Organization of early skilled action. Child Development , 44, 1-11.

Burgess, P. W. (1997) Theory and methodology in executive function research. In

Methodology of Frontal and Executive Function (ed. P. Rabbitt), Hove: Psychology

Press, pp. 81-112.

Butler, R. W., Rorsman, I., Hill, J. M., & Tuma, R. (1993). The effects of frontal brain

impairment on fluency: Simple and complex paradigms. Neuropsychology, 7 , 519–

529.

Carlson, S. M. (2003). Executive function in context: Development, measurement, theory,

and experience. Monographs of the Society for Research in Child Development, 68 ,

138-151.

Carpenter, P. A., Just, M. A., & Shell, P. (1990). What one intelligence test measures: A

theoretical account of the processing in the Raven Progressive Matrices Test.

Psychological Review, 97 , 404-431.

Case, R. (1992). The role of the frontal lobes in the regulation of cognitive development. Brain & Cognition, 20, 51–73.

Casey, B. J., Trainor, R. J., Orendi, J. L., Schubert, A. B., Nystrom, L. E., Geidd, J. N.,

Castellanos, F. X., Haxby, J. V., Noll, D. C., Cohen, J. D., Forman, S. D., Dahl, R.

E., & Rapoport, J. L. (1997). A developmental functional MRI study of prefrontal

activation during performance of a go-no-go task. Journal of Cognitive

Neuroscience, 9, 835- 847.Christoff, K., Ream, J. M., Geddes, L. P. T., & Gabrieli, J. D. E. (2003) Evaluating self-

generated information: Anterior prefrontal contributions to human cognition.

Behavioral Neuroscience, 117, 1161-1168.

Cohen, J. D., & Servan-Schreiber, D. (1992). Context, cortex, and dopamine: A

connectionist approach to behavior and biology in schizophrenia. Psychological

Review, 99, 45–77.

De Luca C., Wood S. J., Anderson V., Buchanan J., Proffitt T., Mahony K., Pantelis C.

(2003). Normative data from the CANTAB: development of executive function overthe lifespan. Journal of Clinical and Experimental Neuropsychology, 25, 242-254.

Diamond, A. (1991). Developmental time course in human infants and infant monkeys, and

the neural bases of inhibitory control in reaching. Annals of the New York Academy

of Sciences: Part VII. Inhibition and Executive Control, 637–704.

Diamond, A. (2002). Normal development of prefrontal cortex from birth to young

adulthood: Cognitive functions, anatomy, and biochemistry. In D. T. Stuss & R. T.

Knight (Eds.), Principles of frontal lobe function (pp. 466–503). New York: Oxford

University Press.

Durston, S., Davidson M. C., Tottenham N., Galvan A., Spicer J., Fossella J. A., Casey B.

J. (2006) A shift from diffuse to focal cortical activity with development. Developmental Science, 9, 1–8.

Elfgren, C. & Risberg J. (1998). Lateralized frontal blood flow increases during fluency

tasks: Influence of cognitive strategy. Neuropsychologia, 36, 505-512.

Elfgren, C. I., & Risberg, J. (1998). Lateralized frontal blood flow increases during fluencytasks: Influence of cognitive strategy. Neuropsychologia, 36 , 505–512.

Eslinger, P. J. (1996). Conceptualizing, describing, and measuring components of executive

function, a summary. In G. R. Lyon & N. A. Krasnegor (Eds.), Attention, memory

and executive function (pp. 367-396). London: Paul H. Brookes.


21/24



605

Espy, K. A., & Bull, R. B. (2005). Inhibitory processes in young children and individual

variation in short-term memory. Developmental Neuropsychology, 28, 669-688.

Espy, K. A., & Kaufmann, P. M. (2002). Individual differences in the development of

executive function in children: Delayed response and A-not-B tasks. In V. J. Molfese

& D. L. Molfese (Eds.), Developmental variations in learning: Applications to

social, executive function, language, and reading skills (pp. 113-137). Mahwah, NJ:

Lawrence Erlbaum Associates.

Field, A. P. (2000). Discovering statistics using SPSS: Advanced Techniques for Beginners.

London: Sage publications.

Friedman, L., Kenny J., Wise, A., Wu, D., Stuve, T., Miller, D., Jesberger, J., & Lewin, J.

(1998). Brain activation during silent word generation evaluated with functional

MRI. Brain and Language, 64, 943-959.

Friedman, N. P., & Miyake, A. (2004). The relations among inhibition and interference

control functions: A latent variable analysis. Journal of Experimental Psychology:

General, 133, 101-135.

Fu, C. H., McIntosh A. R., Kim J., Chau W., Bullmore E. T., Williams S. C., Honey G. D.,

McGuire P. K. (2006). Modulation of effective connectivity by cognitive demand inphonological verbal fluency. Neuroimage. 30, 266-71.

Gaillard, W. D., Hertz-Pannier L., Mott S. H., Barnett A. S., LeBihan D., Theodore W. H.

(2000). Functional anatomy of cognitive development: fMRI of verbal fluency in

children and adults. Neurology. 54, 180-185.

Gioia, G. A., & Isquith, P. K. (2004). Ecological assessment of executive function in

traumatic brain injury. Developmental Neuropsychology, 25, 135-158.Gioia, G. A., Isquith, P. K., Hoffhines, V., & Guy, S. C. (1999). Examining the clinical

utility of the NEPSY Tower: A tale of two towers. Journal of the International

Neuropsychological Society, 5, 117.

Glosser, G., & Goodglass, H. (1990). Disorders in executive control functions among

aphasic and other brain-damaged patients. Journal of Clinical and Experimental Neuropsychology, 12, 485-501.

Goel, V., & Grafman, J. (1995). Are the frontal lobes implicated in "planning" functions?

Interpreting data from the Tower of Hanoi, Neuropsychologia, 33, 623-642.Golden, C. J. (1981). Diagnosis and rehabilitation in clinical neuropsychology. Springfield:

Charles C. Thomas.

Haith, M. M., Hazan, C. & Goodman, G. S. (1988). Expectation and anticipation of

dynamic visual events by 3.5 month-old babies. Child Development , 59, 467-479.Hanes, K. R., Andrewes D. G., Smith D. J., Pantelis C. (1996). A brief assessment of

executive control dysfunction. Archives Clinical Neuropsychology, 11, 185-191.

Hughes, C. (1998). Executive function in preschoolers: Links with theory of mind and

verbal ability. British Journal of Developmental Psychology, 16, 233-253.

Hughes, C., & Graham, A. (2002). Measuring executive functions in childhood: Problems

and Solutions ? Child and Adolescent Mental Health, 7, 131-142.

Huizinga, M., Dolan, C. V., & Van der Molen, M. W. (2006). Age-Related Change in

Executive Function: Developmental Trends and a Latent Variables Analysis.

Neuropsychologia, 44, 2017-2036.

Jarman, R. F., Vavrik, J., & Walton, P. D. (1995). Metacognitive and frontal lobeprocesses: At the interface of cognitive psychology and neuropsychology. Genetic,

Social and General Psychology Monographs, 121, 155-210.

Jarratt, K. P. (2005). The CAS and NEPSY as Measures of Cognitive Processes: Examining

the Underlying Constructs. Unpublished doctoral dissertation.


22/24



606

Kaczmarek, B. L. J. (1987) Regulatory function of the frontal lobes. A neurolinguistic

perspective. In Perecman, E. (ed.) The frontal lobes revisited, 40, New York

Kawashima, R., Satoh, K., Itoh, H., Ono, S., Furumoto, S., Go-toh, R., Koyoma, M.,

Yoshioka, S., Takahashi, T., Takahashi, K., Yanagisawa, T., & Fukuda, H. (1996).

Functional anatomy of GO/NO-GO discrimination and response selection: A PET

study in man. Brain Research, 728 , 79-89.

Kimberg, D. Y., & Farah, M. J. (1993). A unified account of cognitive impairments

following frontal lobe damage: The role of working memory in complex, organized

behavior. Journal of Experimental Psychology: General, 122, 411-428.

Klenberg, L., Korkman, M., & Lahti Nuuttila, P. (2001). Differential development of

attention and executive functions in 3- to 12-year-old Finnish children.

Developmental Neuropsychology, 20, 407–428.

Korkman, M. (1988). NEPSY. A proposed neuropsychological test battery for young

developmentally disabled children. Theory and evaluation. Academic Dissertation,

Helsinki, Finland.

Korkman, M. (1999). Applying Luria’s diagnostic principles in the neuropsychological

assessment of children. Neuropsychology Review, 9, 89-105.Korkman, M., Kirk, U., & Kemp, S. L. (1997). NEPSY. Lasten neuropsykologinen

tutkimus. Helsinki, Finland: Psykologien kustannus.

Korkman, M., Kirk, U., & Kemp, S. L. (1998). NEPSY. A developmental

neuropsychological assessment. San Antonio, TX: Harcourt Brace.

Lamminranta, S., Aberg, J. E., Autti, T., Moren, R., Laine, T., Kaukoranta, J. et al., 2001.

Neuropsychological test battery in the follow-up of patients with neuronal ceroidlipofuscinosis. Journal of Intellectual Disability Research, 45, 8–17.

Lee, G. P., Strauss, E., Loring, D. W., McCloskey, L., Haworth, J. M., & Lehman, R. A.

W. (1997). Sensitivity of figural fluency on the Five-Point Test to focal neurological

dysfunction. The Clinical Neuropsychologist, 11, 59-68.

Lehto, J., Juujärvi, P., Kooistra, L. & Pulkkinen, L. (2003). Dimensions of executive

functioning: evidence from children. British Journal of Developmental Psychology,21 , 59-80.

Levin, H. S. Culhane, K. A., Hartmann, J., Evankovich, K., Mattson, A. J., Harward, H.,Ringholz, G., Ewings-Cobbs, L., & Fletcher, J. M. (1991). Developmental changes

in performance on tests of purported frontal lobe functioning. Developmental

Neuropsychology, 7 , 377-395.

Lezak, M. D. (1995). Neuropsychological Assessment, Third Ed ., New York: OxfordUniversity Press.

Luciana, M., & Nelson, C. A. (1998) The functional emergence of prefrontally-guided

working memory systems in four-to- eight year-old children. Neuropsychologia, 36,

273-293.

Luciana, M., & Nelson, C. A. (1998). The functional emergence of prefrontally-guided

working memory systems in four- to eight-year-old children. Neuropsychologia,36 (3), 273–293.

Luciana, M., & Nelson, C. A. (2002). Assessment of neuropsychological function in

children through the Cambridge Neuropsychological Testing Automated Battery

(CANTAB): Normative performance in 4 to 12 year-olds. Developmental Neuropsychology. 22, 595-624

Luna, B., Thulborn, K. R., Munoz, D. P., Merriam, E. P., Garver, K. E., Minshew, N. J., et

al. (2001). Maturation of widely distributed brain function subserves cognitive

development. NeuroImage, 13, 786-793.


23/24



607

Luria, A. R. (1966). Human brain and psychological processes. New York: Harper & Row

Publishers.

Luria, A. R. (1973). The Working Brain. New York: Basic Books.

Mirsky, A. F., Anthony, B. F., Duncan, C. C., Ahearn, M. B., & Kellam, S. G. (1991).

Analysis of the elements of attention: A neuropsychological approach.

Neuropsychological Review, 2, 109-145.

Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D.

(2000). The unity and diversity of executive functions and their contributions to

complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41,

49–100.

Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D.

(2000). The unity and diversity of executive functions and their contributions to

complex "frontal lobe" tasks: A latent variable analysis, Cognitive Psychology, 41,

49-100.

Pennington, B. F. (1997). Dimensions of executive functions in normal and abnormal

development. In G. R. Lyon & N. A. Krasnegor (Eds.), Development of the

prefrontal cortex: Evolution, neurobiology, and behavior (pp. 265–281). Baltimore,MD: Paul H. Brookes.

Petra, L., & Benga, O. (2003). Neuropsychological assessment of children with epilepsy,The Journal of the Romanian Society of Neurology and Child Psychiatry, 6, 70-79

Petra, L., Benga, O., (2004). Methodological Controversies in the Neuropsycholgical

Assessment of Atypical Development. Implications for the Study of Autism, Studia

Universitatis Babe ş-Bolyai, 1, 93-107Posner, M. I., & Rothbart, M. K. (1991). Attention mechanisms and conscious experience.

In M. Rugg & A. D. Milner (Eds.), The neuropsychology of consciousness (pp. 91–

112). London: Academic Press.

Rabbitt, P. (1997). Introduction : methodologies and models in the study of executive

functions. In P. Rabbitt (Ed.), Methodology of frontal and executive function (pp. 1-

38). Hove : Psychology Press.

Rakic, P., Bourgeois, J. P., Zecevic, N., Eckenhoff, M. F., & Goldman-Rakic, P. S. (1986).

Isochronic overproduction of synapses in diverse regions of the primate cerebralcortex. Science,232, 232–235.

Ravnkilde, B., Videbech, P., Rosenberg, R., Gjedde, A., Gade, A. (2002). Putative Tests of

Frontal Lobe Function: A PET-Study of Brain Activation During Stroop's Test and

Verbal Fluency, Journal of Clinical and Experimental Neuropsychology, vol. 24 nr.

4, s. 534-547.

Roberts, R. J., & Pennington, B. F. (1996). An integrative framework for examining

prefrontal cognitive processes. Developmental Neuropsychology, 12, 105-126.

Rogers, R. D., & Monsell S. (1995). Costs of a predictible switch between simple cognitive

tasks. Journal of Experimental Psychology: General 124, 207-231

Sava, F. (2004). Analiza datelor in cercetarea psihologica. Metode statistice

complementare. Cluj-Napoca: ASCR.

Schmitt, A. J., & Wodrich, D. L. (2004). Validation of A Developmental

Neuropsychological Test via comparison of neurological, scholastic concerns, and

control groups. Archives of Clinical Neuropsychology, 19, 1077-1093.Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of the

Royal Society of London, B298 , 199-209.

Shute, G. E., & Huertas, V. (1990). Developmental variability in frontal lobe function.

Developmental Neuropsychology, 6, 1–11.


24/24



608

Stinnett, T. A., Oehler-Stinnett, J., Fuqua, D. R., & Palmer, L. S. (2002). Examination of

the underlying structure of the NEPSY: A developmental neuropsychological

assessment. Journal of Psychoeducational Assessment, 20, 66-82.

Stuss, D. T., Benson, D. F. (1986). The frontal lobes. New York: Raven.

Stuss, D.T., & Benson, D. F. (1984). Neuropsychological studies of the frontal lobes.

Psychological Bulletin, 95, 3-28.

Taylor, A. E., Saint-Cyr, J. A., & Lang, A. E. (1986). Frontal lobe dysfunction in

Parkinson’s disease. Brain, 109, 845–883.

Teuber, H. L., Battersby, W. S., & Bender, M. B., Visual Defects after Penetrating Missile

Wounds of the Brain (Harvard University Press, Cambridge, Massachusetts, 1960).

Thatcher, R. W. (1991). Maturation of the frontal lobes: Physiological evidence for aging.

Developmental Neuropsychology, 7 , 397-419.

Till, C., Koren, G. J., Westall, C., & Rovet, J. (2001). Prenatal exposure to organic solvents

and child neurobehavioral performance. Neurotoxicology and Teratology, 23, 235-

245.

Troyer, A. K., Moscowitch, M., Winocur, G. (1997). Clustering and switching as two

components of verbal fluency: evidence from younger and older healthy adults. Neuropsychology. 1, 138 - 146.

Welsh, M. C. (2002). Developmental and clinical variations in executive functions. In: D.

L. Molfese, & V. J. Molfese, (Eds.), Developmental variations in learning:

Applications to social, executive function, language, and reading skills (pp. 139–

185). Mahwah, NJ, US: Lawrence Erlbaum Associates.

Welsh, M. C., & Pennington, B. F. (1988). Assessing frontal lobe functioning in children :views from developmental psychology. Development Neuropsychology, 4, 199-230.

Welsh, M. C., Satterlee-Cartmell, T., and Stine, M. (1999). Towers of Hanoi and London:

Contribution of working memory and inhibition to performance. Brain & Cognition,

41, 231–242.

Welsh, M., Friedman, S., & Spieker, S. (2005) Executive functions in developing children:

Current conceptions and questions for the future. In K. McCartney & D. Phillips

(eds.) Handbook on early childhood development. Malden:MA; Blackwell.

Welsh, M., Pennington, B. F., & Groisser, D. B. (1991). A normative-developmental studyof executive functions: A window on prefrontal function in children? Developmental

Neuropsychology, 7, 131-149.

Welsh, M.C. (2001). The pref

Dimensions of Attention

Documents

Transcript of Dimensions of Attention