Research in Developmental Disabilities 33 (2012) 858865

A R T I C L E I N F O

Article history:

Received 16 October 2011

Received in revised form 20 November 2011

Accepted 15 December 2011

Available online 8 January 2012

Keywords:

ADHD

BRIEF

BADS-C

Performance-based test

Parent questionnaire

A B S T R A C T

Difculty in executive functions (EF) is a core symptom of ADHD. Yet, the EF assessments

are still in controversy. It is still unclear whether the everyday implementation of EF can be

assessed under laboratory conditions. Therefore, the purposes of the present study are: (a)

to examine EF among boys with ADHD both in everyday behavior (as reported by parents)

and in a performance-based test. (b) To examine correlations between the two tests. Both

the Behavior Assessment of Dysexecutive Functions for Children (BADS-C) and the

Behavior Rating Inventory of Executive Functions (BRIEF) were independently applied to

25 boys aged 811 years with ADHD and 25 age-matched typical boys. Results of the two

assessments were compared between the two groups to indicate differences in EF.

Correlations between the two assessments for all participants were evaluated. Overall,

signicant differences in EF were found between the two groups on both assessments.

Signicant correlations were found between BADS-C and BRIEF, specically in

metacognition but not in behavioral regulation. Findings indicate that poor EF manifests

itself in everyday behavior. These difculties are found in metacognitive and behavioral

regulation components. Nevertheless, applying a valid ecological assessment of behavior

regulation merits future research.

2012 Published by Elsevier Ltd.

Contents lists available at SciVerse ScienceDirect

Research in Developmental Disabilities1. Introduction

Executive functions (EF) refers to the mental skills required to proceed towards future goals in terms of self-awareness,metacognition and attention skills (Welsh & Pennington, 1988; Welsh, Pennington, & Grossier, 1991). Difculties in EF arerelated to various frontal and prefrontal lobe disorders (Alverez & Emory, 2006; Fuster, 2002; Stuss, 1992; Stuss & Alexander,2000). Therefore, one would expect to nd high rates of EF difculties among children with ADHD (Barkley, 2006; Barkley &Murphy, 2010; Nigg, Stavro, et al., 2005; Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005). ADHD is a neuraldevelopmental disorder characterized by non-adaptive levels of sustained attention, impulsiveness and hyperactivity (DSM-IV, 2001). Inherent in this description are difculties in EF, particularly self-regulation difculties and uninhibited behavior.

Since Barkley (1997) rst published the model of inhibitory control as the basis of executive dysfunction (EDF) in ADHD,Executive dysfunctions among boys with Attention Decit HyperactivityDisorder (ADHD): Performance-based test and parents report

Maayan Shimoni a,*, Batya Engel-Yeger a, Emanuel Tirosh b,c

aDepartment of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Israelb The Hannah Khoushy Child Development Center, Bnai Zion Medical Center. Faculty of Medicine, Technion, Israelc Institute of Technology, Israelthis issue has been extensively investigated. Some have argued that inefcient regulatory control or delay aversion explainattention disorders and EF difculties (Sonuga-Barke, 2005; Sonuga-Barke, Sergeant, Nigg, & Willcutt, 2008; Thorell, 2007),

* Corresponding author.

E-mail address: mayyan74@walla.com (M. Shimoni).

0891-4222/$ see front matter 2012 Published by Elsevier Ltd.doi:10.1016/j.ridd.2011.12.014

M. Shimoni et al. / Research in Developmental Disabilities 33 (2012) 858865 859whereas others claimed that EDF are caused by energetic factors (Sergeant, 2000). Studies further examined whether EDF area co-morbidity or a core symptom in ADHD (Barkley, Murphy, & Fischer, 2008; Beiderman et al., 2006; Nigg, Willcutt, Doyle,& Sonuga-Barke, 2005). Either way, most studies found EDF to be a main component of ADHD (Barkley, 2006; Castellanos& Tannock, 2002; Pennington & Ozonoff, 1996; Willcutt, Doyle, et al., 2005; Willcutt, Pennington, Olson, Chhabildas, &Huslander, 2005).

Difculties in EF have far-reaching everyday implications and inuence academic achievement, social competence andprofessional occupation (Barkley & Murphy, 2010; Canu, Newman, Morrow, & Pope, 2008; Graaf, Kessler, Fayyad, Have,Alonso, Angermayer, Borges et al., 2008; Hale et al., 2011; Massetti et al., 2008; Rogers, Hwang, Toplak, Weiss, & Tannock,2011). Given that children with ADHD often show poor skills in these areas, assessing EF is most relevant for clinicians andfor research purposes. Moreover, assessments should have a wide perspective and include everyday behavior contexts alongwith specic skill measurements.

To address this issue, two types of EF assessments are in use: performance-based assessments (PBT) and everydayfunction assessments. PBT include tests that are administered under laboratory conditions and relate to specic EF skills.Among these tests are the commonly used Continuous Performance Tests (CPT) (Conners, 1997), Wisconsin Card Sorting Test(WCST) (Kimberg, DEsposito, & Farah, 1997), Tower of Hanoi (Borys, Spitz, & Dorans, 1982), Walk Dont Walk (Manly,Robertson, Anderson, & Nimmo-Smith, 1999), Trail-Making tests (Dellis, Kaplan, & Kramer, 2001) and others. These PBTs arebenecial for identifying specic executive difculties and are used in various studies that compare EF between typicalchildren and children with ADHD (Frazier, Demareem, & Youngstrom, 2004; Hervey, Epstein, & Curry, 2004). However, theylack ecological validity and do not express everyday EF. Designed to be administered under laboratory conditions, they lackdifferent attributes that are inherent to the routine use of EF, such as motivation, emotion control and sustained attention innatural distractions.

On the other hand, everyday function assessments evaluate everyday demands of EF in the natural setting. Parents,teachers, caregivers, or the person with the disorder are asked to describe the behavior related to EF. These assessments arerooted in the client/family-centered approach, according to which the perception of abilities and disabilities should beunderstood from the individuals point of view (Law, Baptiste, & Mills, 1998; Woodside, Rosenbaum, King, & King, 2001).Among these assessments, especially those referring to childrens assessments are parent and teacher questionnaires andcheck-lists.

Referring to the way EF decits are expressed in daily life scenarios is of supreme importance and ts the ICF framework(WHO, 2000). Accordingly, disabilities should be related to the everyday context rather than to the specic skill decits.Anchored in this updated framework, the Behavioral Rating Inventory of Executive Functions (BRIEF) (Gioia, Isquick, Guy, &Kenworthy, 2000) was designed to test EF in everyday life situations as perceived by parents and teachers. Using variousquestionnaire assessments, EF were found to discriminate between children with ADHD and typical children (Jarratt, Riccio,Siekierski, 2005; McCandless & Olaughlin, 2007). Nevertheless, family and parent perceptions of the childs disabilities areessential for diagnostic and intervention purposes, and cannot rely solely on potentially biased parent or teacher reports.

Although various studies found poor EF among people with ADHD (Berlin, Bohlin, Nyberg & Janols, 2004; Nigg, Stavro,et al., 2005; Sergeant, Geurtz, & Oosterlaan, 2002; Shallice et al., 2002; Willcutt, Pennington, et al., 2005), to the best of ourknowledge, only few studies have compared executive skills and their everyday expression. The existing studies show lowcorrelations between PBT meant to test executive skills and questionnaires that examine everyday functions (Bodnar,Prahme, Cutting, Dencla, & Mahone, 2007; Mahone et al., 2002). Yet, the assessments in these studies include a diversity of EFtests, each directed to specic executive skills.

The present study is designed to overcome the limitations of previously used EF assessments by using an ecologicallyvalid, comprehensive test together with a validated standardized parent report. In particular, this study aimed to: (a)compare EF of children with ADHD and typical children; and (b) examine the relationships between executive skills (asperformed by the children) and executive everyday functions (as reported by the parents). Our hypotheses were that usingthe Behavioral Assessment of Dysexecutive Functions for Children (BADS-C) and the BRIEF would reveal signicant lowexecutive skills and functions among the boys with ADHD compared to typical boys and that the BADS-C and BRIEF scores ofall study participants would be signicantly correlated in some aspects and complementary in others.

2. Method

2.1. Participants

A total of 50 Israeli boys aged 811 years (age range in months 96130; mean 110.0; SD 10.09) participated in the study.The study group comprised 25 boys with ADHD with either: hyperactive-impulsive, inattentive or combined type.Participants were recruited from several clinics in the north of Israel through convenience sampling. Diagnosis of ADHDsubtype was made by neurologists according to the DSM-IV criteria, and severity was assessed using other clinicalassessments such as the Conners Rating Scales-Revised CPRS-R (Conners, 1997). The group included 25 typically developingboys who were recruited as a convenience sample.

All participants attended mainstream elementary schools, were Hebrew speaking, and came from diverse socioeconomicbackgrounds. The study group and the control group were matched by age, socioeconomic background, place of residenceand religion. Boys with known chronic health conditions (except for ADHD) or with another associated formally diagnosed

pa

M. Shimoni et al. / Research in Developmental Disabilities 33 (2012) 858865860participants with IQ impairments scored far below the bottom published scale (page 371) indicating impaired EF.

2.2.3. Behavior Rating Inventory of Executive Functions (BRIEF)-parents

The BRIEF is a behavioral rating measure for children of 518 years old, designed to elicit everyday EF, as observed by theparents in natural, everyday environments (Gioia et al., 2000). The BRIEF composes two major index scales: behavioralregulation index (BRI) and metacognition index (MC), in addition to a global executive composite (GEC). Each index is furtherdivided into executive component scales: BRI is composed of inhibition, shift and emotional control scales, whereas MC iscomposed of initiation, working memory, planning, organization of materials, and monitoring scales. A total of 86statements describe various behaviors in which the parent rates the behavior frequency on a Likert Scale ranging from 1(rare) to 3 (often). Total scores are revised into standardized scores: scores above 60 reect executive impairments. Test-retest reliability r = .86 for GEC, r = .88 for BRI, r = .84 for MC (Gioia et al., 2000).

2.3. Procedure

The study was approved by the Helsinki ethics committee of the Bnai Zion Medical Center. Parents signed an informedconsent form and the childs informed consent was obtained. The control group was recruited through an advertisementpublished in several neighborhoods in the north of Israel calling for participating in a study about EF among boysbehpers(picture naming) and red task (sorting). Each of these tasks has two parts. Children have to schedule their time to attemptsomething from all six parts over a 5-min period with restrictions on the order in which the parts can be attempted. Thistest examines planning, task scheduling and performance monitoring.

Reliability: inter-rater reliability ranging from r = .91 to 1.00 on most tests (except water test r = .53) (BADS-C manualge 9). Discriminative validity was constructed comparing typical children and children with various learning andavioral disabilities (Baron, 2007). BADS-C discriminate validity was also conrmed in studies which compared EF ofons with intellectual disability to typical controls. For example, Willner, Bailey, Parry, and Dymond (2010) found that6. S

list. Planning skills in this test are examined in a rule governed task.ix-part test: Children are given three different color-coded tasks to perform: a green test (simple arithmetic), blue test5. ZZoo map 1: The children are asked to plan a pathway on a given zoo map in which they could pass through a list of drawnanimals according to a set of rules. This subtest is an open-ended task with little structure that examines the childrensability to plan.oo map 2: Similar to the zoo map 1 subtest, the children are asked to plan a pathway according to the order on the animale4. their key. Underneath the square is a dot showing where they are standing. The children are asked to draw a pathwaythrough which it would be reasonable to search for the lost key. This test examines the childrens ability to plan anfcient, systematic plan of action without monitoring.3. K

requires a ve-step plan of action. This test measures mainly the ability to plan a set of actions.ey search: The children are presented with a drawing of a 100 mm square that represents a eld in which they have lost2. Wdisorder such as depression or anxiety (DSM-TR) were excluded from the study. As ADHD symptoms may differ betweenboys and girls (Biederman et al., 2002; Gaub & Carlson, 1997), the study focused on boys only.

2.2. Measurements

2.2.1. Demographic questionnaire

Demographic questionnaire pertaining to participants personal data such as age, school grade, socioeconomic level,learning difculties and health status. This questionnaire was administered to the childrens parents.

2.2.2. Behavior Assessment of Dysexecutive Syndrome for Children (BADS-C)

Behavior Assessment of Dysexecutive Syndrome for Children (BADS-C) (Emslie, Wilson, Burden, Nimmo-Smith, & Wilson,2003), designed to assess EF among children and adolescents from 8 to 16 years old. The BADS-C includes multitaskscomprising six subtests. The six subtests examine several aspects of EF: planning, sequence behavior, sustained attention,resistance to interference, feedback utilization, changing sets and dealing with new situations. Standardized scores on eachsubtest range from 1 to 19. Total score is obtained by summing the six subtest scores (BADS-C manual).

Description of the six subtests is as follows:

1. Playing cards test: This assesses the childs ability to change an established pattern of responding. The test uses 21 spiral-bound non-picture playing cards that are turned over one at a time. In the rst part of the test, children are instructed tosay yes to red cards and no to black cards, and to respond as quickly as possible. In the second part of the task, the rule ischanged: The children are asked to say yes if the card is the same color as the one before it and to say no if the card is of adifferent color from the one before it. This test measures cognitive exibility as the child shifts from one rule to anotherand also assesses the childs ability to keep track of the color of the previous card and the current rule (BADS-C manualpage 7).ater test: The children are asked to extract a cork from a tube full of water using a set of tools. Reaching the solution

in elementary school. Each participant completed the BADS-C while parents lled in the BRIEF questionnaire in anearby room.

2.4. Data analysis

t-Tests were applied on BRIEF and BADS-C total scores, and on BADS-C subtests. Given the signicant correlationsbetween the BRIEF scales and subscales, MANOVA was applied on these variables. Pearson test was applied to computecorrelations between BADS-C and BRIEF total scores and subtests/scales for all participants.

3. Results

3.1. EF comparison between ADHD and typical boys

3.1.1. Executive functions assessed by BADS-C performance-based test

Analysis indicated that compared to the typical group, the ADHD group scored signicantly lower on the total score andon four subtests: Water, Key, Zoo 1 and Zoo 2. On two subtests, however, Cards and Six-part, no signicant differences werefound between the groups (Table 1).

3.1.2. Executive functions assessed by BRIEF parent questionnaire

Analyses indicated lower EF among boys with ADHD compared to typical boys on the BRIEF total score (GEC) and on bothMC and BRI. Lower EF was also found among ADHD boys on all subscales, with the exception of Attention shift andOrganization (see Table 2).

3.2. Correlations between PBT and parent report

Signicant correlations were found between BRIEF and BADS-C total scores and between BADS-C total score andBRIEF MC Scale and emotion control, working memory, planning, monitoring and inhibition subscales. No

Table 1

Statistical comparison for the two groups on BADS-C total score and on each BADS-C subscale separately.

BADS-C scores Boys with ADHD Boys without ADHD t-Test

Mean SD Mean SD

a ***

M. Shimoni et al. / Research in Developmental Disabilities 33 (2012) 858865 861Total score 48.36 11.24 66.88 8.21 5.21

Cards 7.00 4.23 8.80 3.34 1.67Water 10.96 3.27 13.27 2.05 2.80**Key 7.32 3.28 9.84 2.32 3.14***Zoo 1 8.84 3.70 12.08 3.52 3.17***Zoo 2 8.96 5.12 11.68 2.61 2.37*Six-part 5.92 1.52 6.32 3.67 .50* p 0.05.** p 0.01.*** p 0.001.a Total score range 3585.

Table 2

Statistical comparison for the two groups on BRIEF total score and on each index separately.

BRIEF scores Boys with ADHD Boys without ADHD F values

Mean SD Mean SD

BRIEF total score 59.16 9.10 46.56 7.06 5.47***

MC 58.88 9.66 45.28 8.50 27.96***

BRI 61.04 12.33 50.64 7.80 12.7***

Inhibition 50.80 7.93 41.60 6.18 20.95***

Attention shift 70.52 15.89 63.92 12.23 2.71

Emotional control 61.52 10.00 50.16 8.90 18.00***

Initiation 56.20 10.47 46.56 8.19 13.14***

Working memory 61.16 10.62 46.32 7.16 33.55***

Planning 58.84 11.59 47.32 7.70 17.14***

Organization 41.20 12.59 41.12 5.32 .001

Monitoring 55.28 10.06 39.88 11.19 26.19***

*p 0.05.**p 0.01.*** p 0.001.

M. Shimoni et al. / Research in Developmental Disabilities 33 (2012) 858865862signicant correlations were found between BADS-C total score and organization of materials, initiation and attention shift(see Table 3).

4. Discussion

The present study examined EF among boys with ADHD and typical peers by comparing executive functions as measuredby PBT and as expressed in their parents reports regarding everyday behavior. As hypothesized, in general, boys with ADHDhad lower EF according to both measures.

4.1. EF comparison between ADHD and typical boys

4.1.1. Executive functions assessed by BADS-C performance-based test

As measured by the BADS-C, compared to typical controls, poor EF were found among boys with ADHD. This supports theability of BADS-C to reveal EF difculties in this population. Results of the present study are consistent with recent researchusing other EF assessments (Castellanos, Edmund, Sonuga-Barke, Milham, & Tannock, 2006; Martinussen, Hayden, Hogg-Jhonson, & Tannock, 2005; Nigg, 2001; Pennington & Ozonoff, 1996; Willcutt, Doyle, et al., 2005). However, as opposed toother assessments, the advantages of BADS-C are its ability to test a variety rather than a limited number of EF with the sameinstrument and its ecological validity. The tests innovation lies in the similarity of its tasks to those required of children andadolescents in everyday life as opposed to the tasks required in many other, more widely used, EF tests (Baron, 2007).Whereas many EF tests evaluate separate EF components in closed-ended tasks, BADS-C subtests include open-ended tasksand enable the children to integrate their various abilities into a purposeful goal-oriented activity (Engel-Yeger, Josman, &Rosenblum, 2009).

Although the differences between the performances of the two groups were signicant for the Water, Key search, Zoo 1,and the Zoo 2 BADS-C subtests, on the Card and Six-part subtests, both study groups had similar averages. On the Cardsubtest, both groups excelled with high scores. This result is probably due to a ceiling effect, whereas the Six-part testseemed to be difcult for the two study groups. The Six-part test involves shift of attention, planning and organization. Asshift of attention did not differ in either the Card test, the Six-part test or the BRIEF subscale, it is possible that these attributesare unique to a subgroup of children with ADHD or alternatively, that the present test is not sensitive enough to detect thesedifferences. This issue merits further research.

4.1.2. Executive functions assessed by BRIEF parent questionnaire

In line with recent research (Isquick & Gioia, 2000; Jarratt, Riccio, & Siekierski, 2005; McCandless & Olaughlin, 2007;Pratt, 2000), using the BRIEF, parents of children with ADHD reported lower EF as expressed in their childrens everydaybehavior. This enables the understanding of further EF implications and removes the assessment from the laboratory to reallife. However, as for specic executive skills, results were equivocal: on most metacognition indices and behavior regulationindices, boys with ADHD had signicantly lower executive skills than typical boys. Nonetheless, on the attention shift and

Table 3

Correlations between BADS-C and BRIEF.

BRIEF Total score MCa BRIb ECc Working memory Plan Monitor Inhibition Organize Initiation Attention shift

BADS-C .36* .37** .25 .32* .47** .46** .41** .27** .25 .20 .06a MC metacognition.b BRI behavioral regulation index.c EC emotion control.* p 0.05.** p 0.01.***p 0.001.organization indices (similar to the BADS-C results), the differences between the two groups were not signicant.Regarding attention shift scores, the similarity between the groups might have resulted from the childrens stage of

development. According to Brocki and Bohilin (2004), there are two stages of attention shift maturation: one between theages 7.6 and 9.5 years and the other between the ages 9.6 and 11.5 years. Similar results were also found by Engel-Yeger et al.(2009). In the present study, childrens age ranged from 8 to 11.5 years and results from both groups indicated difculties inthis domain. Thus, differentiating between the children according to their chronological age and subsequent stage of EFmaturation might show different results.

Referring to the Organization of materials, the similar scores of the two groups can possibly be explained by parentssubjectivity. On the BRIEF Organization of materials index, statements include: organizing the closet, etc. It is possible thatorganizing materials does not depend on executive abilities but on familial habits or parents attitude. This explanation isindirectly supported by previous studies (Isquick & Gioia, 2000; Jarratt, Riccio, & Siekierski, 2005), showing disagreementsbetween parent and teacher rating in this subscale. As Organization of materials relies on external support, this might be the

M. Shimoni et al. / Research in Developmental Disabilities 33 (2012) 858865 863underlying factor explaining both the parents rating in the present study and the lack of agreement between the twomeasures in recent studies.

In the past decade, an increasing number of intervention programs emerge from the family-centered approach. Accordingto this approach, attitudes, beliefs and routines differ from family to family and should be considered in the evaluationprocess and in constructing therapy (Law et al., 1998; Woodside, Rosenbaum, King & King, 2001). Hence, using the BRIEF mayenhance parents awareness, involvement in therapy and interactions with their child. All of this may lead to optimaltherapeutic results expressed in the childs better performance in daily living.

4.2. Correlations between PBT and parent report

The second goal of the present study was to examine the executive skills as assessed by the laboratory test and theirrelationships to everyday executive functions. This goal was based on the World Health Organization new ICF (WHO, 2001),dening the relationships between skill acquisition and everyday functions as the basis of health and sickness.

As was hypothesized, BADS-C and BRIEF scores were signicantly correlated indicating that EF (low as well as normalscores) have everyday expressions that are observed by parents. These results are only partially in line with previousresearch. Toplak et al. (2009) tested the associations between PBT and BRIEF in adolescents, using the Stop task-SSRT, trailmaking, verbal and memory composite, and Stockings of Cambridge standard scores. Every one of these tests wasindependently applied. Their results showed that although overall correlations were found, each measure was notcorrelated with its respective BRIEF subscale. Likewise, Barkley and Murphy (2010) tested self-reports of EF and EF tests aspredictors of occupation functions among adults with ADHD. Although several EF tests were signicant predictors offunction impairments, EF self-ratings had substantially more contribution. However, as opposed to the specic skill PBTused in these previous studies, BADS-C uniqueness is expressed in its integration of simultaneous executive functions ineach subtest.

Although total scores were related between BRIEF and BADS-C, BADS-C was signicantly correlated only with BRIEFmetacognition but not with BRI index. Two explanations are possible: rst, the nature of the BADS-C subtests; second, theconnection between EF decits and ADHD subtypes. In natural settings, behavior regulation includes affective characteristicsand processes such as maintenance of motivation, goal-oriented behavior or response to distractions. BADS-C tasks areadministered in short sessions, over a limited time, with a constructed goal and therefore do not involve behavior regulationas it is expressed in everyday functions. Alternatively, the BADS-C tasks do require problem-solving processes that rely onmetacognition. Moreover, factors such as familiarity with the task and the consequent degree of automatic performance, asare required in the BRIEF, may have been the cause of the differences. The second explanation refers to the relationshipbetween ADHD subtypes and EF decits. Whereas the ADHD-inattentive subtype is associated with metacognitiondifculties, BRI difculties are related to the ADHD-combined subtype (Isquick & Gioia, 2000; McCandless & Olauplin,2007). Due to the small sample of participants, we could not conrm this hypothesis.

To conclude this issue, in general, both assessments indicated difculties in EF in children with ADHD; these difcultieswere present in test performance and in parents reports regarding childrens everyday behavior. The fact that eachassessment emphasizes different aspects of EF supports the need to combine the two assessments in the evaluationprocedure. Evaluating how specic difculties are expressed in daily living, referring to parents reports together withevaluating the childrens performance can assist in dening therapeutic goals related to the childrens and familys real lifesituations, applying the childrens abilities to actual daily activities.

4.3. Research limitations

The study had limitations and further research is needed. First, a larger sample would facilitate demonstration of possibledifferences between ADHD subtypes, age and other related variables (August & Garnkel, 1989; Lockwood, Marcotte, &Stern, 2001; Marshall, Schafer, ODonnell, Elliot, & Handwerk, 1999; Nolan, Volpe, Gadow, & Sprafkin, 1999). Furthermore,the use of a teachers report in addition to the parents report may shed more light on the value of EF assessment as related toschool performance, thereby increasing the signicance of this assessment. An additional intriguing challenge is to nd aclinical performance-based measure that assesses the behavioral regulation (such as motivation and initiation) toaccompany the assessment of metacognition and everyday EF.

5. Conclusion

In conclusion, boys with ADHD show lower EF abilities than typical peers according to both PBT and parent report BADS-C and BRIEF. The combination of an ecological assessment such as the BADS-C, together with parents reports aboutchildrens real-life performance may facilitate an integrative and ecologically more valid delineation of the childrensweaknesses and strengths and consequently a more effective intervention.

Thus, it is recommended to use both childs evaluations and parents reports in the evaluation process. This may alsoenhance childrens and parents awareness of difculties that arise from limited EF abilities, assist in providing them withstrategies to deal with these difculties in daily living, and strengthen the involvement of both children and parents in thetherapeutic process.

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Executive dysfunctions among boys with Attention Deficit Hyperactivity Disorder (ADHD): Performance-based test and parents reportIntroductionMethodParticipantsMeasurementsDemographic questionnaireBehavior Assessment of Dysexecutive Syndrome for Children (BADS-C)Behavior Rating Inventory of Executive Functions (BRIEF)-parents

ProcedureData analysis

ResultsEF comparison between ADHD and typical boysExecutive functions assessed by BADS-C performance-based testExecutive functions assessed by BRIEF parent questionnaire

Correlations between PBT and parent report

DiscussionEF comparison between ADHD and typical boysExecutive functions assessed by BADS-C performance-based testExecutive functions assessed by BRIEF parent questionnaire

Correlations between PBT and parent reportResearch limitations

ConclusionReferences