Do parent and self-report rating scales of executive function measure the same constructs with adolescents?

OBJECTIVE: There are numerous measures of executive function (EF), yet the multiple definitions and constructions of EF suggest that these measures may not be measuring the same construct or domains within EF. The purpose of this study was to examine the concurrent validity of the BRIEF and the CEFI parent and self-report forms with adolescents. METHOD: Adolescent participants, ages 12-17 years, were recruited using a snowball method with recruitment targeting individuals from under-represented groups, as well as the general population. The resulting sample consisted of 52 cases with parent report. The adolescents were predominantly female (55.77%) and white (40.38%) with a mean age of 14.56 (1.72). RESULTS: For parent and adolescent self-report on both the BRIEF and CEFI, mean global scores were within the average range. To examine whether the two rating scales were measuring the same underlying constructs of EF, a multi-trait-multi-method (MTMM) model was conducted using correlated traits correlated methods (CTCM) and correlated traits uncorrelated methods (CTUM). CONCLUSION: While the global scores obtained for the instruments measure EF similarly, there is less consistency in how the subdomains parse out and are labeled for each of the two scales. Implications for practice are discussed.

Assessment of Adult ADHD With College Students.

Objective: When assessing adult ADHD, self-report measures are commonly used to guide clinical diagnosis. Self-report measures may be broadband covering a range of behaviors or narrowband and specific to symptoms associated with ADHD. Method: This study examined the results of broadband and narrowband measures for college students referred for evaluation of ADHD at a university clinic. Results: With consideration of diagnosis, which included additional information, the group of students who received a diagnosis of ADHD differed significantly from those who did not receive an ADHD diagnosis only on the symptom sets associated with ADHD for both the broadband and narrowband. At the same time, for the total sample, significant correlations emerged for ADHD symptoms with social stress, anxiety, and sense of inadequacy. Conclusion: This suggests the need for consideration of alternative or co-occurring factors influencing symptom presentation and functional impairment.

Neurocognitive and behavioral profiles of children with Landau-Kleffner syndrome.

This is a retrospective study of 14 cases of children with Landau-Kleffner syndrome (LKS), the most prominent feature of which is acquired aphasia. These children were followed at a tertiary care pediatric epilepsy center. From the research data base, all LKS cases with neuropsychological evaluation were extracted. Children ranged in age from 6 to 13 years (M = 9.12; SD = 2.19) at the time of assessment (1 to 10 years post-onset). The majority of the children were white males, and all but one continued to experience seizure activity. Global intellectual functioning ranged from 59 to 101 (M = 82.07; SD = 12.14). Across the 14 cases reviewed, the neuropsychological profiles are considered in the context of neurological and syndrome-related factors. For these cases, 86% demonstrated continued expressive, and 50% had receptive language problems with 57% exhibiting poor auditory processing. Furthermore, 50 to 57% had deficits in auditory working memory and verbal memory. Academically, the majority had poor reading fluency and comprehension; 50% exhibited difficulty with mathematics. Finally, 57% evidenced attentional or other behavioral problems. Better understanding of LKS can assist in targeted assessment and intervention planning.

Executive Function Performance for Children With Epilepsy Localized to the Frontal or Temporal Lobes.

Research with adults with epilepsy consistently indicates deficits in executive function (EF). There is less research specific to children with epilepsy and EF. The purpose of this study was to consider EF deficits in children with complex partial epilepsy and complex partial with secondary generalization epilepsy with onset localized to the frontal or temporal lobes. This was a retrospective study of 28 children followed in an outpatient pediatric epilepsy clinic who were consecutively referred for neuropsychological assessment, which included measures of EF. The sample was predominantly White and male, with a mean age of 12.88 years (SD = 1.64) and mean cognitive ability of 89.39 (SD = 13.41). Comparison of right-temporal, left-temporal, and frontal groups yielded significant differences (p = .01) between the left-temporal and frontal groups on the Wisconsin Card-Sorting Test (WCST) Categories with the frontal group demonstrating the greatest deficits. Although mean differences were not significant, the frequency of impaired performance by the frontal group on the Attention/Concentration Index was greater than in the temporal groups. Results indicate that for children with complex partial and complex partial with secondary generalized seizures localized to the frontal and temporal lobes, there is an increased likelihood for impaired EF evident on the WCST, but not on others. Implications of these findings for prevention and intervention are discussed.

Adaptive skills and somatization in children with epilepsy.

Objective. Children with epilepsy are at risk for less than optimum long-term outcomes. The type and severity of their epilepsy may contribute to educational, psychological, and social outcomes. The objective of this study was to determine the relation between somatization and adaptive skills based on seizure type that could impact on those outcomes. Methods. This study examined adaptive functioning and somatization in 87 children with epilepsy using archival data from a tertiary care facility. Results. No significant differences in adaptive skills emerged between groups of children diagnosed with complex partial (CP) as compared to CP-secondary generalized (SG) seizures; however, deficits in adaptive behavior were found for both groups. The number of medications, possibly reflecting the severity of the epilepsy, was highly correlated to adaptive function. Conclusions. Identification of deficits in adaptive behavior may represent an opportunity for tailored prevention and intervention programming for children with epilepsy. Addressing functional deficits may lead to improved outcomes for these children.

Interventions for executive function deficits in children and adolescents.

For children with neurodevelopmental or acquired disorders, deficits in executive function (EF) processes (i.e., attention, working memory, cognitive flexibility, and problem solving), are often evident. Moreover, EF deficits are associated with academic difficulties, behavioral and social difficulties, and long-term psychological maladjustment rendering prevention and intervention of EF deficits an important consideration. Many methods exist to address EF processes; this review will focus on pharmacological, cognitive/metacognitive, computerized, and neurofeedback approaches. Across research reviewed, results tend to vary depending on age, disorder, comorbid conditions, and outcome measures. Notably, there is limited research to suggest long-term maintenance of changes in symptom presentation, improved developmental trajectory, normalization of EF processes, or alteration to the associated neural connections. Implications for practice and future research for evidence-based interventions to address EF are discussed.

Two-factor structure of the Comprehensive Trail-making Test in adults.

Previous evaluation of the Comprehensive Trail-Making Test (CTMT) using a confirmatory factor analysis (CFA) revealed that for children, a two-factor model provided a better fit than did a one-factor model. The purpose of this study was to explore whether these findings suggested a developmental factor structure or if the two-factor structure also would be supported for adults. CFA was conducted using M-plus to examine the factor structure for adults in the standardization sample using all five trails tasks from the CTMT. The findings of the CFA indicated an excellent fit for the two-factor model. In contrast, the one-factor structure (i.e., use of a composite score) was not supported. Results were the same when younger (younger than 50 years of age) and older (50 years old or older) adults were considered separately. These data suggest that a single score may not be a valid representation of executive functioning. The results support a two-factor structure that represents attention/sequencing and set switching/inhibition.

Does Rey Complex Figure copy performance measure executive function in children?

The Rey Complex Figure Task (RCFT) is currently utilized with both adult and child clinical populations. In addition to the measurement of visual-constructional ability and memory, the RCFT has also been suggested as a measure of executive function (EF), specifically requiring planning and organizing skills. The purpose of the current study was to determine the extent to which the RCFT Copy task, using the scoring system developed by Meyers and Meyers (1995), tapped components of EF. The participants in this study were 108 children (M(age) = 12.61 years; SD = 2.27) who were administered a battery of neuropsychological measures including the RCFT Copy, NEPSY Tower and Arrows subtests, Clock Face Drawing, and a measure of verbal fluency, in addition to other measures of visual-motor integration and cognitive ability. Overall, in this clinically mixed population, scores on the RCFT Copy correlated significantly only with overall cognitive ability, Block Design, and visual-motor integration scores. Implications of these results are discussed.

Complementary and alternative treatment use for autism spectrum disorders.

Autism spectrum disorders (ASD) have rapidly become one of the more frequent reasons for seeking diagnosis and treatment. Depending on health care services available, the standard treatment options are often limited; many parents turn to complementary and alternative medicine (CAM) approaches. CAM treatments and some of the factors that may contribute to parents' decisions to use CAM treatments were examined using a web-based survey. Four general factors emerges as influencing the decision-making processes of parents/caregivers - severity, child acceptance of the treatment, marital status, and educational level. Notably, research support did not emerge as contributing to variance for CAM use.

Comprehensive trail-making test: gender and ethnic differences for ages 8 to 18 years old.

There is increasing concern for possible gender and ethnic differences on neuropsychological measures. The purpose of this study was to examine gender and ethnicity differences on the Comprehensive Trail-Making Test (CTMT) with a focus on individuals from 8 to 18 years of age. From the standardization sample, this included 251 boys and 306 girls with a mean age of 12.76 years (SD = 3.07 years) and who were predominantly White (81.51%). Only those participants who completed all five tasks that comprise the CTMT were considered; participants representing special groups were excluded. For ethnic group, no significant differences emerged; for gender, significant differences emerged; and no interaction effects for sex by ethnicity were found. Further, no differences based on ethnicity were found. Implications and possible explanations for this difference for practice and additional research are discussed.

Relation of measures of executive function to aggressive behavior in children.

This study investigated the role of executive function in relation to aggression in a sample of children (N = 93) aged 9 to 15 years. Based on parent ratings of aggression, the sample was divided into low- (n = 66) and high- (n = 27) aggression groups. Although the groups did not differ significantly on laboratory measures of executive function, significant differences emerged on behavioral regulation and metacognition ratings by parents. Notably, a high level of behavioral dysregulation was predictive of placement in the high-aggression group; both good metacognitive skills and behavior regulation served as significant predictors of prosocial and adaptive skills.

Confirmation of a two-factor model for interpretation of the comprehensive trail making test with children.

Exploratory factor analyses (EFAs) of the Comprehensive Trail Making Test suggested a possible two-factor solution that might better reflect the differences in Trails 1-3 and Trails 4 and 5 as opposed to a single Composite Index for the total standardization sample. The purpose of this study was to conduct a confirmatory factor analysis (CFA) of the two-factor structure with a subset of the standardization sample ages 18 or younger that had completed all five-trail tasks. The sample included 251 boys and 306 girls, ages 8-18, with a mean age of 12.76 (SD = 3.07). Data were collected across 16 states with representation from all regions of the USA. Standardized scores on each of the trails (1-5) tasks were considered. The results of CFA using M-plus indicated a good fit for the two-factor model, χ(2)(4) = 18.686, p = .0009, root mean-square error of approximation = 0.081, comparative fit index = 0.986 and standardized root-mean-squared residual = 0.021. A one-factor model was not supported. As suggested by the EFA in the manual, Trails 1-3 and Trails 4 and 5, while related, appear to be different in subtle ways that may be most meaningful in conjunction with evaluation of children with neurodevelopmental differences. Implications and possible explanations for this difference are discussed.

Language functioning and deficits following pediatric traumatic brain injury.

The purpose of this article is to provide a current review of language functioning and deficits following traumatic brain injury (TBI), specifically among the pediatric population. This paper will: (a) outline the manner in which these deficits may impede functioning across environments; (b) review methods of assessing language functioning within this population; and (c) discuss empirically supported interventions to address noted language deficits as they present in pediatric TBI.

Pesticide poisoning in a preschool child: a case study examining neurocognitive and neurobehavioral effects.

Exposure to environmental toxins, such as pesticides, has been shown to have adverse effects in humans, particularly neurological effects. Cases of acute pesticide poisoning occur less frequently and are less well documented; specific deficits (e.g., in processing speed, working memory) have not consistently been discussed. This is a case study of a preschooler who underwent a neuropsychological assessment due to a pesticide poisoning. His parents reported attention, speech, social, and gross and fine motor concerns after the poisoning. A number of methods and measures were used, including observational data, neuropsychological, and behavioral and social-emotional measures. Consistent with past research, results from the assessment demonstrated the subtle and not-so-subtle effects of acute pesticide poisoning. Implications of the findings are discussed.

Concurrent validity of the tower tasks as measures of executive function in adults: a meta-analysis.

Executive function refers to a variety of behaviors and abilities related to planning and strategy use, as well as to the maintenance of attention and behavior in the pursuit of some goal. Many instruments have been designed for the purpose of assessing executive function, and the tower tasks represent a specific group of measures commonly used in the assessment of this construct. This review and meta-analysis examines the theoretical and psychometric basis for the use of the various tower tasks in neuropsychological assessment of adults. Neuroimaging and electrophysiological evidence are consistent with theoretical hypotheses of frontal involvement (e.g., planning and strategy use) in tower task performance. Further, adults with various disorders of presumed neurological basis demonstrate impaired performance on tower tasks. Implications for the use of tower tasks in practice and research are discussed.

Learning and memory performance of children with specific language impairment (SLI).

The purpose of this study was to examine learning and memory in children with Specific Language Impairment (SLI) as compared to 30 normally functioning children on the Children's Memory Scale. Results indicated that children in the SLI group exhibited impaired performance on the Attention/Concentration Index (working memory), as well as significantly lower scores on both the immediate and delayed auditory/verbal indices and subtests relative to the control group. In contrast, no between group differences emerged for the visual/non-verbal indices and subtests. Results demonstrated that children with SLI possess normal ability to process, maintain and manipulate visual/non-verbal information in working memory along with normal ability to store and retrieve visual/non-verbal material from long-term storage. These results provide support for the contention that children with SLI have a "diminished verbal capacity" to process, organize, and maintain auditory information in working memory.

Diagnostic group differences in parent and teacher ratings on the BRIEF and Conners' Scales.

OBJECTIVE: Behavioral rating scales are common instruments used in evaluations of ADHD and executive function. It is important to explore how different diagnostic groups perform on these measures, as this information can be used to provide criterion-related validity evidence for the measures. METHOD: Data from 92 children and adolescents were used to examine differences among participants in a No Diagnosis group, ADHD group, and Other Clinical group in terms of parent and teacher ratings on the Behavior Rating Inventory of Executive Function (BRIEF) and Conners' Rating Scales Revised-Short Form. RESULTS: Participants in the ADHD and Other Clinical groups generally received similar scores on the scales, and both groups were generally rated higher in ADHD characteristics and executive dysfunction than were participants in the No Diagnosis group. CONCLUSION: Although the measures were successful at distinguishing clinical from nonclinical participants, their ability to distinguish among different clinical groups deserves further investigation.

Relations between the Test of Variables of Attention (TOVA) and the Children's Memory Scale (CMS).

OBJECTIVE: There is considerable overlap in the constructs of attention and memory. The objective of this study was to examine the relationship between the Test of Variables of Attention (TOVA), a measure of attention, to components of memory and learning as measured by the Children's Memory Scale (CMS). METHOD: Participants (N = 105) were consecutive referrals to an out-patient facility, generally for learning or behavior problems, who were administered both the TOVA and the CMS. RESULTS: Significant correlations were found between the omissions score on the TOVA and subscales of the CMS. TOVA variability and TOVA reaction time correlated significantly with subscales of the CMS as well. TOVA commission errors did not correlate significantly with any CMS Index. CONCLUSION: Although significant, the correlation coefficients indicate that the CMS and TOVA are measuring either different constructs or similar constructs but in different ways. As such, both measures may be useful in distinguishing memory from attention problems.

An empirical analysis of the BASC Frontal Lobe/Executive Control scale with a clinical sample.

Data from a clinical sample of children and adolescents were used to examine the characteristics of the Frontal Lobe/Executive Control (FLEC) scale of the Behavior Assessment System for Children Parent Rating Scales, including preliminary evidence of the scale's clinical utility and relationship to other behavioral measures of executive function and characteristics of Attention Deficit Hyperactivity Disorder (ADHD). Results indicate that participants in the ADHD and other clinical groups received very similar scores on the FLEC scale, and both groups were rated significantly higher in behaviors associated with executive dysfunction than were participants in the no diagnosis group. Correlational results indicate that scores on the FLEC scale were significantly correlated with scores on the Behavior Rating Inventory of Executive Function-Parent Form and Conners' Parent Rating Scales Revised-Short Form. Based on our results, the FLEC scale appears to be a useful behavioral rating tool in the assessment of executive function that may serve as a supplement to more traditional measures.

Differences in academic and executive function domains among children with ADHD Predominantly Inattentive and Combined Types.

Differences between the subtypes of Attention Deficit Hyperactivity Disorder (ADHD) continue to have a place in the clinical and research literature. The purpose of this study was to examine differences specific to academic and executive function deficits in a sample of 40 children, aged 9-15 years. Although there was a tendency for the Predominantly Inattentive (PI) group to evidence lower performance on calculation and written expression tasks, these differences dissipated when IQ was included as a covariate. For executive function domains of set shifting, interference, inhibition, and planning, differences emerged for interference, but only when girls were excluded from the analysis and no control for IQ was made. For parent ratings of executive function, expected differences were found on the Inhibit scale with the Combined Type (CT) group evidencing greater problems in this area; this difference remained even when girls were excluded and IQ was controlled. Implications for research and practice are presented.