Assessment of Executive Function Deficits

Assessment of Executive Function Deficits

by Chris A. Zeigler Dendy

Executive function skills have a profound impact on a student’s school performance. So it is absolutely critical to assess whether or not the student with an attention deficit also has deficits in this area! Students with executive function deficits will have difficulty being organized, getting started and finishing work, remembering homework assignments, memorizing and later recalling facts, writing essays or reports, working math problems, being on time, controlling emotions, completing long-term projects and planning for the future. Some researchers believe that students with ADHD primarily inattentive type are more likely to have executive function deficits. Keep in mind, however, that not all students with ADHD have executive function deficits. And the converse is also true; all students with executive function deficits don’t have an attention deficit.

Unfortunately, assessment of executive function and its link to ADHD is still such a relatively new phenomenon, and there is no standard evaluation procedure. Dr. Warren Walter, a neuropsychologist in Atlanta, utilizes several tests to identify deficits in specific executive function skills. In the book, Teaching the Tiger: Classroom Documentation and Interventions for Students with Co-morbid Disorders, Dr.Walter and Sheryl Pruitt provide helpful information about this process.

Evaluation

Dr. Walter advises that a key part of an evaluation for executive function deficits is conducted thorough interviews. Taking a careful family history and interviews are critical parts of an evaluation for executive function deficits. The word disorganization is a key buzzword often heard in interviews. “Our children are extremely disorganized to a point that it interferes with their ability to fulfill responsibilities at home and school or plan for the future.” He addresses several topics in his interviews:

  • Describe the manner in which the student organizes school work. How does the student organize his academic life? Evidence of disorganization becomes especially obvious during the difficult transitions from elementary to middle school and then middle to high school. The increased organizational demands and increasingly complex academic materials make each passing school year more and more difficult.
  • Describe the student’s study skills. Can the student get started on her own, prioritize, organize and complete her work independently?
  • Describe the student’s management of academic materials. Does the student come home with the correct books and assignments, take them back to school and actually turn homework in to the teacher?
  • Describe the student’s bedroom, closet, dresser, book bag, desk or locker.
  • Give examples of forgetfulness or property that the student has lost.
  • Determine the level of external and internal disorganization. The preceding examples are observable examples of external disorganization; that is parents can easily see these problems. However, examples of internal disorganization are more difficult to see and may include great difficulty organizing and retrieving ideas to write an essay or retrieving rules or formulas to work math problems.

Formal Tests

Because assessment of executive function is still relatively new, few formal tests have been developed. However, Dr. Gerard A. Gioia’s Behavior Rating Inventory of Executive FunctionTM, (BRIEFTM), is one that shows promise. Dr. Gioia, a pediatric neuropsychologist, is the Children, Youth & Families Liaison at the Children’s National Medical Center in Washington, D.C. The test, which has both a parent and a teacher form, takes approximately 15 minutes or so to administer and 20 minutes to score.

The BRIEF includes 86 questions that tap eight critical executive function skills:

  • inhibiting
  • shifting
  • controlling emotions
  • initiating
  • working memory
  • planning and organizing
  • organizing materials
  • monitoring

Other Tests

In addition some subtests of existing instruments also measure at least three key elements of executive function:

  • working memory
  • retrieval of information stored in long-term memory
  • analysis, reconstitution and organization (complex problem solving)

For example, several of the subtests of the WISC measure working memory: the Arithmetic and Digit Span (backward) subtests. In addition, the Information and Vocabulary subtests measure working memory plus recall, and retrieval of information from long-term memory. The Coding subtest of the WISC identifies problems with slow processing speed and fine motor coordination. The Picture Arrangement subtest requires complex problem solving skills.

Other tests that are used less frequently include the Brown Scales and the Test of Written Language (TOWL).

The Brown Scales include both a 50-sentence selfreport and a parent-report checklist. The test results are grouped by six core clusters of symptoms:

  • Organizing, prioritizing and activating to work;
  • Focusing, sustaining and shifting attention to tasks;
  • Regulating alertness, sustaining efforts, and processing speed;
  • Managing frustration and modulating emotions;
  • Utilizing working memory and accessing recall;
  • Monitoring and self-regulating action.

In addition, the TOWL gives a good look at a student’s written expression skills that require strong analytical, sequencing and organizational skills.

Each student’s executive function deficits that are causing problems should be identified and addressed through inclusion of accommodations in an IEP or Section 504 Plan.


Chris A. Zeigler Dendy, MS has over 40 years experience as a teacher, school psychologist, mental health counselor and administrator. She is a prolific author on ADHD and the producer of 3 videos. She is a previous member of the CHADD board of directors and in 2006 was inducted into the CHADD Hall of Fame for outstanding contributions to the field. She is also the mother of three children who live with ADHD.