Executive Functioning - Advanced Assessment and Interpretation
Executive Functioning - Advanced Assessment and Interpretation
Shift
Inhibit
Behavioral
Regulation
Monitor
Organization
of Materials
Plan/Organize
Meta-
Cognition Working Memory
Initiate
Rating Scales (cont’)
• Behavior Assessment System for Children –
Second Edition (BASC-2)
Rating Scales (cont’)
• BASC-2
• TRS/PRS/SRP Externalizing Problems Scales
• Hyperactivity
• TRS/PRS/SRP School Problems Scales
• Attention
• TRS/PRS Adaptive Skills Scales
• Adaptability & Functional Communication
• TRS/PRS Content Scales
• Emotional Self-Control & Executive Functioning
• Negative Emotionality & Resiliency
Rating Scales (cont’)
• Conners – Third Edition (Conners 3)
Rating Scales (cont’)
• Conners 3
• P/T/SR Scales
• Inattention
• Hyperactivity/Impulsivity
• P/T Scales
• Executive Functioning
Rating Scales – Strengths and Weaknesses
F Index/ L Index/
Consistency
Self- Negativity Positivity Response
Rating Admin Parent Teacher Index/ V Internal Test-Retest Inter-Rater
Ages Report Scale/ Scale/ Pattern
Scale Time Form Form Inconsistency Index Consistency Reliability Reliability
Form Negative Positive Index
Scale
Impression Impression
.30 (P-T)
.82 (P) &
5-18 10-15
BRIEF Y Y Y Y Y N N N .80-.98 & .50 (S-P)
yrs min
.88 (T) &
.25 (S-T)
Attention
Attention Problems:
Problems: 0.60-0.85
0.80 Hyperactivity:
Hyperactivity: 0.70-0.84
0.70 Adaptive Individual
Adaptive Skills: 0.57- Scales: .70s
2- Skills 0.82 (P) 0.86 (P) (P)
10-30
BASC 2 21:11 Y Y Y Y Y Y Y Y & & &
min
yrs Attention Attention Individual
Problems: Problems: Scales:.53 to
0.90 0.85-0.93 .65 (T)
Hyperactivity: Hyperactivity:
0.91 0.83-0.92
Adaptive Adaptive
Skills: 0.87 (T) Skills: 0.82-
0.93
6-18 10-20
Conners 3 Y Y Y Y Y Y N N .77 to .97 .71 to .98 .52 to .94
yrs min
Rating Scales – Strengths and Weaknesses (cont’)
• Strengths:
• Integrative approach to the assessment of children, adolescents, and young adults
across multiple informants
• Easy to administer and score
• Can be filled out in a short amount of time
• Generate a comprehensive portrayal of both the child’s strengths and weaknesses
• Include a variety of validity indices
• Weaknesses:
• Measure a limited number of psychopathology, behavioral, and personality domains
• Structure sometimes makes comparison of child self-ratings from parents and
teachers difficult
• Must be somewhat familiar with student (i.e. at least one month)
• Questions sometimes require clarification or to be read aloud to informants
Observations & Interviews
McCloskey Book
Have you checked the modules on the CD?
•
observation tools
•
parent interview
•
child interview
•
handouts
Who at SSD has this book?
Allen, Ayanaw, Boeckmann, Bretz, Burton, Crooks, Crowe, Dolosic, Dorton, J.Driedger,
Emery, Engel, Foutch, Gaeta, Giger, Grace, Guzy, Haley, Hanna, Hartz, Hemmersmeier,
Henkelman, Kosta, L.Kurth, Larson, Maggard, Moritz, Morrill, Porter, Price, Reed,
Ronzio, Ross, Schieffer, Schneider, Schuh, Sinha, Stewart, Taylor, Traughber, Velk,
White, Yates
OBSERVATION
Classroom Observations
• Observe student’s executive functions
• Observe the external supports in the
environment
o Classroom or Lesson structure/organization
o Visual reminders of rules/routines/expectations
o Teacher cues - verbal, physical, visual
o Peer cues - helpful?
OBSERVATION
Testing Observations (create your own code)
• Repetition of test items/instructions (R)
• Inattention/daydreaming (InAtt)
• Off-topic conversation (OffTop)
• Response to redirection (+ or - to Redirect)
• Impulsive responding (Imp)
• Difficulty shifting between subtests (Shift)
• Excessive motor movement (M)
• Self-corrections (SC)
INTERVIEW with STUDENT
• Determine a loose structure
o McCloskey: Executive Functions
o Sinha: Math, Read, Write, Relationships/conflicts at
Home, Relationships/conflicts at School
• Conversation-style vs. Structured interview
• Note their EF behaviors during interview
• Process-oriented questions: many students have
never done this before
READING: Tell me about the last book that you read.
Possible question probes: How did you choose it? What did you
like about that book? Is there a place at school or at home that
you like to read? Do you get distracted when you read? By
what? Do you find yourself reading a page and then having to
re-read that page? Tell me about what is happening for you
when you read. Does your mind wander to other topics, which
topics? Do you find it is difficult to sit still for an extended
period of time? Do others/sounds/sights distract you when you
are reading? Do you remember what you have read? Which do
you prefer and why: reading silently or outloud? Do you use
any strategies to help you remember what you have read?
Sometimes when reading there are words that you might not
know, what do you do when that happens? What helps you
figure out what the main point of the passage is? How do you
manage your time when you are given a long reading
assignment? Has a teacher ever done something that helped
WISC-IV INTEGRATED
Process Approach
Data from ADHD, AU and TBI groups
Correlational studies with D-KEFS
VCI
● Comprehension and Comprehension
Multiple Choice – pulls for impulsive
responding
Complex to score
Trail Making Test
Requires a student to create a trail with their
pencil by connecting numbers, letters, and
then alternating numbers and letters. A
measure of connecting dots (motor speed) is
also included.
Trail Making Test
Measures: Cognitive Switching (Flexibility),
Inhibit: the ability to not respond to Capture
Stimuli, Establishing and Maintaining
Cognitive Set and Working Memory (retaining
the alphabet in order).
Verbal Fluency Test
•Requires a student to generate words by first
letter, by category and then by alternating
between two categories.
•Measures: Verbal knowledge, systematic
retrieval of lexical items; Monitoring,
Cognitive Switching (Flexibility), and
Establishing and Maintaining Cognitive Set.
Design Fluency Test
Requires a student to create unique designs
by using exactly four straight lines to make
connections among 10 dots. Dots are filled
or empty. The task builds from single fills
(only empty or only filled) into a switching
task of between filled dots and empty dots.
Design Fluency Test
Measures: Cognitive Switching (Flexibility),
Inhibition.
Color-Word Interference Test
Requires a student to: Condition 1: name
colors, Condition 2: read color words,
Condition 3: look at color names that are
printed in different color ink (the word red in
blue ink) and name the color of the ink
instead of reading the word, and Condition 4:
switch between reading the ink color or
reading the color word name. (Stroop test)
Color-Word Interference Test
Measures: Monitoring, Inhibition and
Cognitive Switching (Flexibility), and
Establishing and Maintaining Cognitive Set.
Sorting Test
Requires a student take a set of cards and
repeatedly sort and describe the cards based
on attributes of shape, color, writing or word
meaning. The second part of this test
requires the child to describe examiner
created sorts.
Sorting Test
Measures: Verbal and Non Verbal conceptual-
reasoning skills, Generate, Cognitive
Flexibility, Inhibit.
Twenty Questions
•Requires the student to look at an array of
pictures and ask up to 20 yes/no questions to
guess which picture the examiner has
chosen.
•Measures: Establish and maintain cognitive
set, monitoring, categorization, ability to use
feedback (Correct), Capture Stimuli (Inhibit)
Word Context
•Requires the student to use verbal cues to
deduce to meaning of made-up words.
•Measures: Deductive reasoning, integrating
multiple bits of information, hypothesis testing
(Generation), Flexibility.
•Can be a measure of linguistic skills and not
EF
Tower Test
•Requires the student to use verbal cues to deduce to
meaning of made-up words.
•Measures: Deductive reasoning, integrating multiple bits
of information, hypothesis testing (Generation),
Flexibility.
•Can be a measure of linguistic skills and not EF
Proverb Test (16+)
•Requires students to interpret proverbs.
•Measures: verbal abstract thinking, semantic
integration , and generalization.
NEPSY-II
• The NEPSY-II is a neuropsychological
assessment for children ages 3-16
• Assesses 6 cognitive domains
o Attention and Executive Functioning
o Language
o Memory and Learning
o Sensorimotor
o Social Perception
o Visuospatial Processing
NEPSY-II
● Clinical Groups
● ADHD
● Asperger’s Disorder
● Autistic Disorder
● Emotional Disturbance
● Deaf/Hard of Hearing
● Language Disorder
● Mathematics Disorder
● Reading Disorder
● Intellectually Disabled
● Traumatic Brain Injury
NEPSY-II
● 32 subtests and four delayed tasks
● Flexible administration and subtest selection
is the intent
● The subtests within each domain vary widely
in terms of stimulus presentation,
administration requirements, response type,
and scoring emphasis.
● Use the Assessment Planner when starting
out
NEPSY-II Executive Functioning
Domain
Subtest Ages Scaled Process
Scores Scores?
?
Animal Sorting 7-16 Y Y
Clocks 7-16 Y N
Inhibition 5-16 Y Y
Statue 3-6 Y Y
NEPSY-II Subtest Composition
Auditory Attention/Response Set
NEPSY-II Subtest Composition
Inhibition
NEPSY-II Additional Subtests
• Affect Recognition
• List Memory
• Narrative Memory
• Speeded Naming
• Word Generation
• Theory of Mind
NEPSY-II
• No composites, only subtest interpretation
• Error analysis and base rates
• The NEPSY-II tends to work well with kids
that more impaired or have other cognitive
difficulties (e.g. unable to read) because the
tasks a little easier.
Executive Functions How To
• Inhibition – Joanna
• Monitoring – Nathan
• Transition/Shift/Cog Flexibility – Julie
• Working Memory – Elissa
• Planning/Organization – Scott
Inhibition is...
• Often be aware of their own behavior and the impact this behavior has on
their social interactions with others
• Be highly responsive to social cues and their situational context, and thus
change their behavior in order to fit different situations
• Appear to function better socially in groups
Monitoring (cont’)
• If a child has low monitoring skills, he/she may . . .
• Exhibit expressive controls congruent with their own internal states (i.e.
beliefs, attitudes, and dispositions) regardless of social circumstance
• Tend to consider expressing a self-presentation dissimilar from their internal
states as a falsehood and undesirable
• Appear to function better socially in more intimate relationships or in one-
on-one interactions
Measures of Monitoring Skills
• BRIEF
• Monitor Scale
• BASC-2
• Adaptability Scale
• Executive Functioning Scale
• Conners-3
• Executive Functioning Scale
• NEPSY-2
• Animal Sorting
• Design Fluency
Intervention for Task-Oriented Monitoring Example
• Description
• Teacher analyzes a particular student's pattern of errors commonly made when solving a
math algorithm (on either computation or word problems)
• Teacher develops a brief error self-correction checklist unique to that student
• Student uses this checklist to self-monitor—and when necessary correct—his/her
performance on math worksheets before turning them in
• Materials
• Customized student math error self-correction checklist
• Worksheets or assignments containing math problems matched to the error self-
correction checklist
• Steps
• 1) Develop the checklist, 2) Introduce the checklist, 3) Provide performance feedback,
praise, and encouragement, 4) Provide reinforcement for checklist use [Optional], 5)
Fade the intervention
Intervention for Task-Oriented Monitoring Sample
Intervention for Self-Monitoring Example
• Description
• Behavioral expectations defined
• The student measures and records his or her own behavior
• The student compares that recorded behavior to a pre-determined standard
• Materials
• Customized student behavior self-monitoring form
• Monitoring cue
• Steps
• 1) Define behavior target(s) to self-monitor, 2) Choose method for recording
self-monitoring data, 3) Select self-monitoring schedule, 4) Decide on a
monitoring cue, 5) Choose rewards for successful behavior change
[Optional], 6) Conduct periodic accuracy checks, 7) Fade the intervention
Intervention for Self-Monitoring Sample
SMART Goals for Monitoring
• Task-Oriented Monitoring
• _______ will finish __ out of __ of his/her long-term assignments with ___% completion
by breaking them down into smaller pieces, setting up blocks of time for completion of
each part, and recording and monitoring progress towards objectives
• The number of pieces and time allotment to complete objectives would be reviewed by the
instructor
• A schedule is set up by the student and instructor to promote accountability
• Self-Monitoring
• _______ will demonstrate the ability to recognize expected and unexpected behaviors
as well as rate his own behavior as part of his/her self-monitoring system with ___%
accuracy as compared to teacher ratings of behavior on __ out of __ opportunities.
• Examples of expected/unexpected behaviors: using inappropriate language, drumming on
his/her desk, leaving his/her seat, etc.
• The self monitoring system would allow the student to describe his/her behavior as well as the
event(s) and emotion(s) preceding the behavior, as well as rate his/her response on a
quantitative scale
Transition/Shift/Cognitive Flexibility
● The ability to switch attention between
two different activities or concepts and to
think about multiple concepts
simultaneously.
Transition/Shift/Cognitive Flexibility
● What does it look like?
•BRIEF
•NEPSY
Memory for Designs
Memory for Faces,
Memory for Names,
Narrative Memory
Sentence Repetition
bit.ly/17t2Lvf
Feedback
https://docs.google.com/forms/d/1VlzC6aASD
dqg7I1jqOmFIcH1OUmh6G88zrxIHXVmQnE/
viewform
References
● Hattie (2009) Visible Learning
● NEPSY-II Manual
● McCloskey (2009) Assessment and Intervention for
Executive Function Difficulties
● Academy Activity (Academy 1: Behavioral and
Academic Observations [9/30/2013])
● Educational Consultants and Research Associates
(2011) White paper: Addressing Executive Function at
the Secondary Level
● McCloskey & Perkins (2012) The Essentials of
Executive Functions
● ¨Miller, D. C. (2007). Essentials of School
References
•Dawson, Peg, Ed.D. and Richard Guare, Ph.D. (2009).
Smart but Scattered. New York, NY: The Guilford Press.
•Prifitera, A., Saklofske, D. H., & Weiss, L. G., (Ed.).
(2008). Neuropsychological Applications of the WISC-
IV and WISC-IV INTEGRATED.
•Wechsler, D. (2004). WISC-IV Integrated Technical and
Interpretive Manual. San Antonio, TX: Pearson.
•Weiss, L. G., Saklofske, D. H., Prifitera, A., and
Holdnack, J. A. (2006). WISC-IV Advanced Clinical
Interpretation. New York, NY: Academic Press.
Learningworksforkids.com
References
•American Psychiatric Association: Diagnostic and
Statistical manual of Mental Disorders, Fifth Edition.
Arlington, VA, American Psychiatric Association, 2013.
•Flick, G. L. (1998) ADD/ADHD Behavior-Change
Resource Kit. The Center of Applied Research in
Education, West Nyack, NY.
•Gioia, G.A., Isquith, P.K., Guy, S.C., Kenworthy, L.
(2000) BRIEF Manual and Supplemental Materials,
Psychological Assessment Resources, Lutz, FL.
References
•Stormont, M.A. (2008) Increase Academic Success for
Children with ADHD Using Sticky Notes and
Highlighters.
DKEF Manual