Executive Functions in the School Setting Stephen R. Hooper, Ph.D. Carolina Institute for Developmental Disabilities University of North Carolina School

Executive Functions Executive Functions in the School Settingin the School Setting

Stephen R. Hooper, Ph.D.Stephen R. Hooper, Ph.D.Carolina Institute for Developmental Carolina Institute for Developmental DisabilitiesDisabilitiesUniversity of North Carolina School of University of North Carolina School of MedicineMedicine

Learning ObjectivesLearning Objectives

Increase participants’ knowledge base Increase participants’ knowledge base with respect to the various definition with respect to the various definition and models of EF.and models of EF.

Provide exposure to the Provide exposure to the neurodevelopmental underpinnings for neurodevelopmental underpinnings for EF.EF.

Improve the participants’ familiarity Improve the participants’ familiarity with targeted assessment strategies with targeted assessment strategies for EFfor EF

Learning ObjectivesLearning Objectives

Increase the participants’ awareness of Increase the participants’ awareness of various conditions where executive various conditions where executive dysfunction may be present.dysfunction may be present.– Autism Spectrum DisorderAutism Spectrum Disorder– Written LanguageWritten Language– Traumatic Brain InjuryTraumatic Brain Injury

Provide an overview of specific Provide an overview of specific classroom management strategies for classroom management strategies for executive dysfunction.executive dysfunction.

DefinitionsDefinitions

DefinitionsDefinitions

Of all of the neurocognitive constructs, this Of all of the neurocognitive constructs, this one is probably the most complex.one is probably the most complex.– Is it taught as part of an assessment class sequence?Is it taught as part of an assessment class sequence?

The complexity comes not only in its overall The complexity comes not only in its overall regulatory functions, but also in how executive regulatory functions, but also in how executive functions interact with nearly every other functions interact with nearly every other neurocognitive function.neurocognitive function.

Executive processes have been deemed Executive processes have been deemed critical to the integrity of many learning and critical to the integrity of many learning and social-behavioral functions.social-behavioral functions.– And likely represent processes that are not typically And likely represent processes that are not typically

assessed in a routine psychoeducational evaluation.assessed in a routine psychoeducational evaluation. There are a number of definitions of executive There are a number of definitions of executive

functions, some extending back nearly 50 functions, some extending back nearly 50 years.years.

Executive FunctionsExecutive Functions(Luria, 1966)(Luria, 1966)

Executive function is defined as the Executive function is defined as the ability to maintain an appropriate ability to maintain an appropriate problem-solving set for attainment of a problem-solving set for attainment of a future goal. This set can involve:future goal. This set can involve:– an intention to inhibit a response or to defer an intention to inhibit a response or to defer

it to a later, more appropriate time;it to a later, more appropriate time;– a strategic plan of action sequences and/or;a strategic plan of action sequences and/or;– a mental representation of the task, a mental representation of the task,

including the relevant stimulus information including the relevant stimulus information encoded in memory and the desired future encoded in memory and the desired future goal-state.goal-state.

Executive FunctionsExecutive Functions(Welsh & Pennington, (Welsh & Pennington,

1988)1988) Executive function is primarily the set Executive function is primarily the set

maintenance required to achieve a maintenance required to achieve a future goal. This set would include the future goal. This set would include the requisite skills of planning, organization, requisite skills of planning, organization, inhibition of maladaptive responses, self-inhibition of maladaptive responses, self-monitoring, and flexibility of strategies monitoring, and flexibility of strategies contingent on feedback.contingent on feedback.

Goldman-Rakic (1990) would add to this Goldman-Rakic (1990) would add to this definition the concept of working definition the concept of working memory. memory.

Executive FunctionsExecutive Functions(Zelazo & Mueller, (Zelazo & Mueller, 2002)2002) Executive function (EF) describes Executive function (EF) describes

the control processes that affect the control processes that affect overall output. This collection of overall output. This collection of abilities involves:abilities involves:– Regulatory control over thoughts and Regulatory control over thoughts and

behaviors during goal-directed or behaviors during goal-directed or intentional actionintentional action

– Problem solvingProblem solving– Flexible shifting between actions to Flexible shifting between actions to

meet task demands.meet task demands.

Executive FunctionsExecutive Functions(Stuss & Alexander, (Stuss & Alexander, 2000)2000) Noted that one important Noted that one important

contribution of EF is the regulation contribution of EF is the regulation of affect and social behaviorof affect and social behavior

This notion is supported by the This notion is supported by the finding that abstract reasoning finding that abstract reasoning has been linked to vulnerability to has been linked to vulnerability to social anxiety during adolescence social anxiety during adolescence in typically developing children.in typically developing children.

ModelsModels

Models of Executive Models of Executive FunctioningFunctioning As can be surmised from the above definitions, As can be surmised from the above definitions,

executive functions are generally viewed within executive functions are generally viewed within a multidimensional framework of cognitive a multidimensional framework of cognitive abilities that provide critical support for goal-abilities that provide critical support for goal-directed, future-oriented behaviors.directed, future-oriented behaviors.

These behaviors typically include attention These behaviors typically include attention regulation, inhibitory control, working memory, regulation, inhibitory control, working memory, set shifting/cognitive flexibility, planning, and set shifting/cognitive flexibility, planning, and cognitive efficiency.cognitive efficiency.

The multiple dimensions of executive functions The multiple dimensions of executive functions have been embedded within conceptual and have been embedded within conceptual and empirical models that comprise two, three, four, empirical models that comprise two, three, four, and six factors.and six factors.

Executive FunctioningExecutive Functioning(Welsh et al., 1991)(Welsh et al., 1991)

Speeded respondingSpeeded responding– Visual search - achieved at age 6Visual search - achieved at age 6– Verbal fluency - > age 12Verbal fluency - > age 12– Motor sequencing - > age 12Motor sequencing - > age 12

Set maintenanceSet maintenance– Wisconsin Card Sort - achieved at age 10Wisconsin Card Sort - achieved at age 10– MFFT - achieved at age 10MFFT - achieved at age 10

PlanningPlanning– Tower of Hanoi (3 disk) - achieved at age 6Tower of Hanoi (3 disk) - achieved at age 6– Tower of Hanoi (4 disk) - > age 12Tower of Hanoi (4 disk) - > age 12

Executive FunctionsExecutive Functions(Pennington, 1997)(Pennington, 1997)

Implicated 4 empirical subcomponents Implicated 4 empirical subcomponents of EF using Typicals and children with of EF using Typicals and children with Reading Disabilities. Then applied to Reading Disabilities. Then applied to different disorders: different disorders: – Inhibition (ADHD< FXS, ASD; ADHD Inhibition (ADHD< FXS, ASD; ADHD

improves on medication)improves on medication)– Set Shifting (ADHD>FXS>ASD)Set Shifting (ADHD>FXS>ASD)– Working Memory (ADHD>ASD>FXS)Working Memory (ADHD>ASD>FXS)– Planning (ADHD>FXS>ASDPlanning (ADHD>FXS>ASD

Both the level and pattern of executive Both the level and pattern of executive abilities can discriminate across abilities can discriminate across disorders.disorders.

Executive Functioning Executive Functioning (Denckla, 1993)(Denckla, 1993)

Delay between stimulus and responseDelay between stimulus and response Internal representation of schemaInternal representation of schema Internal representation of action planInternal representation of action plan Response inhibitionResponse inhibition Efficiency and consistency of responseEfficiency and consistency of response Active strategies and deploymentActive strategies and deployment Flexible strategies and deploymentFlexible strategies and deployment

Executive Functioning Executive Functioning (Denckla, 1993)(Denckla, 1993)

Denckla utilized this conceptual framework to Denckla utilized this conceptual framework to propose a 4-factor model of executive propose a 4-factor model of executive functions:functions:– InitiatingInitiating– SustainingSustaining– Set-ShiftingSet-Shifting– InhibitingInhibiting

Has been applied to 4Has been applied to 4thth and 5 and 5thth grade grade students with Written Language Disorder students with Written Language Disorder (Hooper et al., 2002).(Hooper et al., 2002).– Poor writers were less proficient at initiation, set-Poor writers were less proficient at initiation, set-

shifting, and sustaining than Good writers.shifting, and sustaining than Good writers.

Executive Function Executive Function SummarySummary There are notable differences between these There are notable differences between these

models, but there does appear to be a number of models, but there does appear to be a number of specific executive functions that appear across the specific executive functions that appear across the models.models.– Planning and problem solving, inhibitory control, set Planning and problem solving, inhibitory control, set

shifting, and set maintenance usually are included in shifting, and set maintenance usually are included in some fashion in many of these models.some fashion in many of these models.

– Speeded responding and working memory also have Speeded responding and working memory also have been discussed as subcomponents of executive function.been discussed as subcomponents of executive function.

Most of these functions are linked to the dorsolateral Most of these functions are linked to the dorsolateral prefrontal cortex and associated brain regions, but it is prefrontal cortex and associated brain regions, but it is important to remember that the emotional control functions important to remember that the emotional control functions associated with the ventromedial prefrontal cortex also associated with the ventromedial prefrontal cortex also should be included in a larger executive function model.should be included in a larger executive function model.

This will be especially important for increasing our This will be especially important for increasing our understanding of the childhood neurobehavioral difficulties.understanding of the childhood neurobehavioral difficulties.

Neurodevelopmental Neurodevelopmental UnderpinningsUnderpinnings

Neurodevelopmental Neurodevelopmental UnderpinningsUnderpinnings Lesion, neuroimaging, and brain Lesion, neuroimaging, and brain

function (e.g., EEG) studies suggest that function (e.g., EEG) studies suggest that the prefrontal cortex (PFC) is primarily the prefrontal cortex (PFC) is primarily involved in executive processing.involved in executive processing.

Based upon anatomical connectivity, Based upon anatomical connectivity, two major regions of PFC:two major regions of PFC:– Dorsolateral PFC (DlPFC)Dorsolateral PFC (DlPFC)– Ventromedial PFC (VmPFC).Ventromedial PFC (VmPFC).

Neurodevelopmental Neurodevelopmental UnderpinningsUnderpinnings The so called “cool functions of The so called “cool functions of

dorsolateral prefrontal cortex represent dorsolateral prefrontal cortex represent the executive functions of motor planning the executive functions of motor planning and regulation, integration of sensory and regulation, integration of sensory and mnemonic information, working and mnemonic information, working memory, and attention regulationmemory, and attention regulation

The ventromedial regions of the The ventromedial regions of the orbitofrontal cortex are involved in orbitofrontal cortex are involved in planning and planning and decision-making, but they , but they also mediate affective regulatory also mediate affective regulatory functions, or the so called “hot” functions, or the so called “hot” functions.functions.

http://en.wikipedia.org/wiki/Decision-making


Dorsolateral Prefrontal Dorsolateral Prefrontal Cortex (DlPFC)Cortex (DlPFC)

Regions within DlPFC influence:Regions within DlPFC influence:– The selection of behaviorsThe selection of behaviors– Recognition of context-dependent Recognition of context-dependent

changes between stimuli and behaviorchanges between stimuli and behavior– Potentiation of sets of stimulus-Potentiation of sets of stimulus-

response contingencies related to response contingencies related to behaviors in contextbehaviors in context

– Flexible, goal-driven control of Flexible, goal-driven control of behaviorbehavior

Neurodevelopmental Neurodevelopmental UnderpinningsUnderpinnings Varying levels of damage to the Varying levels of damage to the

DlPFC are associated with:DlPFC are associated with:– Lack of motivation, creativity, or goal-following.Lack of motivation, creativity, or goal-following.– Difficulty in initiating or flexibly modifying actions, Difficulty in initiating or flexibly modifying actions,

resulting in stereotyped responses.resulting in stereotyped responses.– Loss of affect.Loss of affect.– Inability to assess others’ mental states – Theory of Inability to assess others’ mental states – Theory of

Mind.Mind.– Perseveration and more random-choice errors than Perseveration and more random-choice errors than

age-matched controls.age-matched controls.– Increased distractibility and problems with Increased distractibility and problems with

sustained attention.sustained attention.– Impaired working memory.Impaired working memory.– Understanding of complex task rules.Understanding of complex task rules.


Ventromedial Prefrontal Ventromedial Prefrontal Cortex (VmPFC)Cortex (VmPFC)

The VmPFC is critical for elucidating The VmPFC is critical for elucidating the relation between stimuli and the relation between stimuli and reinforcers, and for explaining the reinforcers, and for explaining the inability of individuals with vmPFC inability of individuals with vmPFC damage to learn reward damage to learn reward contingencies.contingencies.

Important for affective regulation.Important for affective regulation.

Neurodevelopmental Neurodevelopmental UnderpinningsUnderpinnings Varying levels of damage to the Varying levels of damage to the

vmPFC are associated with:vmPFC are associated with:– ImpulsivityImpulsivity– Sensitivity to immediate rewardsSensitivity to immediate rewards– Lack of self-controlLack of self-control– Disruption of both affective and Disruption of both affective and

nonaffective stimulinonaffective stimuli– Tendency to select behaviors with the Tendency to select behaviors with the

highest perceived reward, not the highest highest perceived reward, not the highest perceived utility.perceived utility.

Dorsolateral Prefrontal Cortex

Ventromedial Prefrontal Cortex

Frontal Pole

Neurodevelopmental Underpinnings

Neurodevelopmental Neurodevelopmental UnderpinningsUnderpinnings All of the various executive functions have a developmental All of the various executive functions have a developmental

basis that will have differential effects on learning and behavior basis that will have differential effects on learning and behavior over time.over time.

There is a sequential unfolding of various executive functions There is a sequential unfolding of various executive functions over the course of development.over the course of development.

Contemporary findings from typical developmental studies, Contemporary findings from typical developmental studies, lesion studies, and primate studies suggest that the PFC is lesion studies, and primate studies suggest that the PFC is operational, at a basic level, by the end of infancy (i.e., ~24 operational, at a basic level, by the end of infancy (i.e., ~24 months), with some evidence of even earlier emergence.months), with some evidence of even earlier emergence.

While executive functions appear to develop from infancy into While executive functions appear to develop from infancy into early adulthood, it appears that the period of most rapid early adulthood, it appears that the period of most rapid development occurs between the ages of 6 and 8 years of age, development occurs between the ages of 6 and 8 years of age, followed by more modest gains between the ages of 9 and 12.followed by more modest gains between the ages of 9 and 12.

Continued, but differential development continues through Continued, but differential development continues through adolescence into early adulthood depending on the specific task adolescence into early adulthood depending on the specific task or behavior of interest.or behavior of interest.

Consequently, an injury during any of these periods of Consequently, an injury during any of these periods of developmental ascendancy will have an effect on specific developmental ascendancy will have an effect on specific functions along with the developmental trajectories of these functions along with the developmental trajectories of these functions.functions.

Neurodevelopmental Neurodevelopmental UnderpinningsUnderpinnings Disruption to the neurological underpinnings of Disruption to the neurological underpinnings of

any of these brain regions of the prefrontal cortex any of these brain regions of the prefrontal cortex could trigger specific executive dysfunctions in could trigger specific executive dysfunctions in cognitive and/or behavioral-emotional functioning.cognitive and/or behavioral-emotional functioning.

Given the developmental trajectories of many of Given the developmental trajectories of many of these functions, it also is possible for an earlier these functions, it also is possible for an earlier injury to “lie silent” until they are injury to “lie silent” until they are developmentally required, and a specific developmentally required, and a specific executive dysfunction could emerge at a later executive dysfunction could emerge at a later developmental epoch (e.g., during middle school).developmental epoch (e.g., during middle school).

This can create the apparent emergence of a This can create the apparent emergence of a “new” learning or behavior problem, and requires “new” learning or behavior problem, and requires that evaluators routinely inquire about brain that evaluators routinely inquire about brain injuries in their developmental history for any injuries in their developmental history for any given case.given case.

Disorders Showing Disorders Showing Executive DysfunctionExecutive Dysfunction

Disorders with Disorders with Executive DysfunctionExecutive Dysfunction The presence of executive deficits can The presence of executive deficits can

appear in a variety of disorders and appear in a variety of disorders and conditions.conditions.– Chronic illness (e.g., diabetes, chronic kidney Chronic illness (e.g., diabetes, chronic kidney

disease)disease)– Pediatric neurological conditions (e.g., Pediatric neurological conditions (e.g.,

traumatic brain injury, stroke)traumatic brain injury, stroke)– Psychiatric disorders (e.g., bipolar disorder, Psychiatric disorders (e.g., bipolar disorder,

schizophrenia, substance abuse)schizophrenia, substance abuse)– Developmental disabilities (e.g., Autism Developmental disabilities (e.g., Autism

Spectrum Disorder, learning disabilities, Spectrum Disorder, learning disabilities, ADHD)ADHD)

– Childhood maltreatment (e.g., abuse, neglect)Childhood maltreatment (e.g., abuse, neglect)

Autism Spectrum Autism Spectrum DisorderDisorder

Individuals with Autism—both low and Individuals with Autism—both low and high functioning—appear to manifest high functioning—appear to manifest significant impairments when significant impairments when compared to various comparison compared to various comparison groups.groups.

These deficits included:These deficits included:– Planning and organizationPlanning and organization– Set-Shifting and perseverative tendenciesSet-Shifting and perseverative tendencies– Abstract thinkingAbstract thinking

Executive dysfunction has been Executive dysfunction has been correlated with both the quality of correlated with both the quality of joint attention and social interactions.joint attention and social interactions.

Autism Spectrum Autism Spectrum DisorderDisorder In contrast, individuals with brain injuries In contrast, individuals with brain injuries

to the frontal region are not “autistic.”to the frontal region are not “autistic.” Neuroimaging studies have not Neuroimaging studies have not

documented clear frontal lobe brain documented clear frontal lobe brain injuries, but neurological abnormalities injuries, but neurological abnormalities have been reported (e.g., early white have been reported (e.g., early white matter tracts).matter tracts).

Neurocognitive findings have not been Neurocognitive findings have not been universally supportive of a global universally supportive of a global executive dysfunction in Autism.executive dysfunction in Autism.

Autism Spectrum Autism Spectrum DisorderDisorder Studies of older children have converged to Studies of older children have converged to

suggest that working memory is not a deficit suggest that working memory is not a deficit in Autism, and this is the only EF domain with in Autism, and this is the only EF domain with consistent results.consistent results.

Several research groups reported deficits in Several research groups reported deficits in problem solving and self-monitoring, perhaps problem solving and self-monitoring, perhaps secondary to a lack of verbal self-regulation, secondary to a lack of verbal self-regulation, but his has been contested.but his has been contested.

Deficits in cognitive flexibility were Deficits in cognitive flexibility were documented in some studies but, again, not in documented in some studies but, again, not in others.others.– Independent of verbal IQ or present even after Independent of verbal IQ or present even after

controlling for verbal IQ.controlling for verbal IQ.– Intact cognitive flexibility also has been linked to Intact cognitive flexibility also has been linked to

improvements in social competence.improvements in social competence.

Autism Spectrum Autism Spectrum DisorderDisorder Several research groups have reported Several research groups have reported

deficits in inhibition, while others reported no deficits in inhibition, while others reported no deficits.deficits.– Could they be related to poor verbal abilities or are Could they be related to poor verbal abilities or are

they unrelated?they unrelated? Regarding attention, children with Autism Regarding attention, children with Autism

performed similarly to children with performed similarly to children with developmental language delays matched on developmental language delays matched on nonverbal IQ on a sustained attention task, nonverbal IQ on a sustained attention task, although their modulation of arousal levels although their modulation of arousal levels has been implicated.has been implicated.– This was not consistent with the high prevalence of This was not consistent with the high prevalence of

ADHD symptoms in individuals with Autism.ADHD symptoms in individuals with Autism.– Individuals with Autism also seem to experience Individuals with Autism also seem to experience

less encroachment on their functioning during less encroachment on their functioning during divided attention tasks.divided attention tasks.

Autism Spectrum Autism Spectrum DisorderDisorder A model of executive functioning may A model of executive functioning may

prove to be useful in linking selected prove to be useful in linking selected executive functions to core and executive functions to core and associated symptoms. For example,associated symptoms. For example,– Working memory, cognitive flexibility, and Working memory, cognitive flexibility, and

response inhibition have been variably response inhibition have been variably related to restrictive and repetitive related to restrictive and repetitive symptoms, but planning and fluency were symptoms, but planning and fluency were not.not.

– Verbal fluency difficulties could be another Verbal fluency difficulties could be another contributor to communication contributor to communication impediments in individuals with Autism.impediments in individuals with Autism.

– Organizational deficits have been noted, Organizational deficits have been noted, but not thoroughly studied.but not thoroughly studied.

Autism Spectrum Autism Spectrum DisorderDisorder While this theory can explain some While this theory can explain some

aspect of each of the core problems aspect of each of the core problems with Autism, they are not universally with Autism, they are not universally supported and account for small supported and account for small amounts of the variance of the core amounts of the variance of the core symptoms.symptoms.– Executive dysfunction also is not exclusive to Executive dysfunction also is not exclusive to

Autism and, consequently, is not the sole cause Autism and, consequently, is not the sole cause of autistic behaviors.of autistic behaviors.

These deficits also cannot explain some These deficits also cannot explain some of the assets that many children with of the assets that many children with Autism can manifest (e.g., savant skills).Autism can manifest (e.g., savant skills).

Autism Spectrum Autism Spectrum DisorderDisorder Current theorizing indicates that while Current theorizing indicates that while

executive dysfunction can be present early in executive dysfunction can be present early in development, it also can surface as a development, it also can surface as a secondary deficit as children with Autism secondary deficit as children with Autism increase in age.increase in age.– There also may be environmental contributors to There also may be environmental contributors to

the executive dysfunctions, such as a caregiver the executive dysfunctions, such as a caregiver unintentionally reinforcing cognitive rigidity in an unintentionally reinforcing cognitive rigidity in an interaction.interaction.

Further, given the prolonged Further, given the prolonged developmental trajectory of many developmental trajectory of many executive functions, might an extended executive functions, might an extended window for neurorehabilitation be present?window for neurorehabilitation be present?

Traumatic Brain InjuryTraumatic Brain Injury

Along with attention impairments, Along with attention impairments, one of the most common findings one of the most common findings in pediatric traumatic brain injury in pediatric traumatic brain injury is the presence of various types is the presence of various types of executive dysfunction.of executive dysfunction.

This is not unexpected given that This is not unexpected given that many cases of TBI will evidence many cases of TBI will evidence some degree of frontal lobe some degree of frontal lobe involvement.involvement.


Empirical studies have documented Empirical studies have documented the presence of impairments in:the presence of impairments in:– Planning and problem solvingPlanning and problem solving– Abstract thinking and analogical reasoningAbstract thinking and analogical reasoning– Set-shifting and cognitive flexibilitySet-shifting and cognitive flexibility– Inhibitory controlInhibitory control– Metacognitive capabilitiesMetacognitive capabilities– Processing speedProcessing speed– Working memoryWorking memory


Given the regulatory role of the Given the regulatory role of the ventromedial prefrontal cortex in social ventromedial prefrontal cortex in social and affective functions, a number of and affective functions, a number of studies have documented the difficulties studies have documented the difficulties of self-regulation and social cognition in of self-regulation and social cognition in children following a traumatic brain children following a traumatic brain injury.injury.– These impairments have been documented in moderate to These impairments have been documented in moderate to

severe brain injuries up to five years post injury.severe brain injuries up to five years post injury. Self-regulatory abilities also can serve as Self-regulatory abilities also can serve as

mediators of the effects of traumatic mediators of the effects of traumatic brain injury and the emergence of social-brain injury and the emergence of social-behavioral difficulties in this population.behavioral difficulties in this population.


Additionally, children sustaining a TBI have Additionally, children sustaining a TBI have evidenced problems in:evidenced problems in:– Identifying emotionsIdentifying emotions– Labeling emotionsLabeling emotions– Extracting meaning from non-literal social Extracting meaning from non-literal social

communicationcommunication– Evaluating problem solving outcomesEvaluating problem solving outcomes

Higher-order language impairments also Higher-order language impairments also have been reported such that both have been reported such that both expressive and receptive language expressive and receptive language pragmatic skills (e.g., understanding pragmatic skills (e.g., understanding proverbs, figurative sayings).proverbs, figurative sayings).


In general, following a TBI, nearly all of In general, following a TBI, nearly all of these executive functioning these executive functioning components will evidence some components will evidence some degree of impairment that is dictated, degree of impairment that is dictated, in part, by the severity of the brain in part, by the severity of the brain injury.injury.– These findings have been reported for These findings have been reported for

children with a mild TBI, although results children with a mild TBI, although results were not as striking.were not as striking.

These deficits also have been reported These deficits also have been reported to be persistent in some fashion seven to be persistent in some fashion seven to ten years post injury.to ten years post injury.


Executive function ratings have been Executive function ratings have been associated with:associated with:– Psychiatric statusPsychiatric status– Family burdenFamily burden– General family functioningGeneral family functioning

Adolescents with severe TBI tended to Adolescents with severe TBI tended to report fewer problems in executive report fewer problems in executive functioning, when compared to their functioning, when compared to their parents, particularly in their metacognitive parents, particularly in their metacognitive abilities.abilities.– Assessment and treatment issues?Assessment and treatment issues?

Written Language Written Language DisorderDisorder A number of studies have begun to document A number of studies have begun to document

the importance of executive functions to the the importance of executive functions to the writing process.writing process.

Hooper et al. (2002) showed that fourth and Hooper et al. (2002) showed that fourth and fifth grade students with and without writing fifth grade students with and without writing problems manifested specific differences in problems manifested specific differences in their executive functions, with the poor writers their executive functions, with the poor writers being less proficient at initiation, set-shifting, being less proficient at initiation, set-shifting, and sustaining.and sustaining.

From a developmental perspective, it would From a developmental perspective, it would seem that executive functions will carry more seem that executive functions will carry more variance with respect to written language variance with respect to written language production as students move into their middle production as students move into their middle school years, perhaps serving as moderators school years, perhaps serving as moderators to specific types of writing interventions.to specific types of writing interventions.

Z-s

core

s

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

Good Writers

Poor Writers

Executive Functions of Good Writers vs. Poor Writers

Written Language Written Language DisorderDisorder One key executive function that has been the One key executive function that has been the

target of scientific investigations is working target of scientific investigations is working memory.memory.

The cognitive workspace, or working The cognitive workspace, or working memory, is important to written expression memory, is important to written expression because it is the function that underlies the because it is the function that underlies the active maintenance of multiple ideas, the active maintenance of multiple ideas, the retrieval of grammatical rules from long-term retrieval of grammatical rules from long-term memory, and the recursive self-monitoring memory, and the recursive self-monitoring that is required during the act of writing.that is required during the act of writing.

Working memory contributes to the Working memory contributes to the management of these simultaneous management of these simultaneous processes, and a breakdown may lead to processes, and a breakdown may lead to problems with written output.problems with written output.

Written Language Written Language DisorderDisorder Reduced working memory capacity has been Reduced working memory capacity has been

reported in poor writers when compared to reported in poor writers when compared to good writers, and it appears to have both good writers, and it appears to have both general and domain-specific contributions to general and domain-specific contributions to the writing process.the writing process.

Recent work by our group with fourth and Recent work by our group with fourth and fifth grade students with and without writing fifth grade students with and without writing problems has documented not only working problems has documented not only working memory deficits, particularly in verbal memory deficits, particularly in verbal working memory and its development, but working memory and its development, but also broader memory problems that could also broader memory problems that could undermine the entire writing process.undermine the entire writing process.

Written Language Written Language DisorderDisorder A contemporary model of written expression, A contemporary model of written expression,

the Not-So-Simple View of Writing, the Not-So-Simple View of Writing, incorporates three major components:incorporates three major components:– Transcription (handwriting or letter production and spelling or

word production)– Executive functions (planning, monitoring, revising)– Text generation (i.e., the main writing goal of the beginning i.e., the main writing goal of the beginning

writer)writer) Text generation occurs at the word, sentence, and text levels; consequently, Text generation occurs at the word, sentence, and text levels; consequently,

automatic production of letters is necessary, but not sufficient, as spelling words automatic production of letters is necessary, but not sufficient, as spelling words via the alphabetic principle and related orthographic elements are necessary for via the alphabetic principle and related orthographic elements are necessary for writing proficiency. Working memory provides a mechanism for linking all of the writing proficiency. Working memory provides a mechanism for linking all of the components.components.

The Not-So-Simple View of Writing Model The Not-So-Simple View of Writing Model postulates that neuropsychological, linguistic, postulates that neuropsychological, linguistic, and related cognitive functions will be and related cognitive functions will be recursive throughout the development of the recursive throughout the development of the writing process, but that each of these writing process, but that each of these functions will exert relatively more influence at functions will exert relatively more influence at different points in the developmental process.different points in the developmental process.

Written Language Written Language DisorderDisorder According to this model, early elementary According to this model, early elementary

school students will be constrained by factors school students will be constrained by factors related to fine-motor output (e.g., letter related to fine-motor output (e.g., letter formation), memory for letters and words, formation), memory for letters and words, emergent working memory capacity, and emergent working memory capacity, and linguistic capabilities. By middle school, many linguistic capabilities. By middle school, many but not all children have sufficient transcription but not all children have sufficient transcription skills, and their writing skills will progress with skills, and their writing skills will progress with increased emphasis being placed on the increased emphasis being placed on the development of their executive functions.development of their executive functions.

We have demonstrated the general utility of this We have demonstrated the general utility of this model, particularly with respect to the stability model, particularly with respect to the stability of the cognitive components over time, with the of the cognitive components over time, with the impact of executive functions being noted even impact of executive functions being noted even in first grade.in first grade.

Neurocognitive Neurocognitive ComponentsComponents

Fine Motor

Attention/

Executive

Function

Language

WIAT IIWritten

Expressionand Spelling

PAL Finger

Succession

Dominant

PAL Finger Succession

Non-Dominant

Verbal Working Memory

WJ-III Retrieval Fluency

WJ-III Planning

VIGIL Omission

s

VIGILCommissions

PAL Letters

PAL Word

Choice

Elision/PAL

Phonemes

Visual Working Memory

Written Language Written Language DisorderDisorder In the cognitive literature, the concept of self-regulation In the cognitive literature, the concept of self-regulation

also has been employed in the study of the writing also has been employed in the study of the writing process.process.

This has contributed to the development of empirically-This has contributed to the development of empirically-based treatment strategies based on a larger executive based treatment strategies based on a larger executive function model.function model.

One example is the Self-Regulated Strategy One example is the Self-Regulated Strategy Development (SRSD) model.Development (SRSD) model.– Such models enables students to develop their skills in Such models enables students to develop their skills in

composing, improve automatic, but reflective writing composing, improve automatic, but reflective writing strategies, understand the parameters of “good” writing, strategies, understand the parameters of “good” writing, and finally to increase positive attitudes about their and finally to increase positive attitudes about their abilities to communicate via writingabilities to communicate via writing

– Other research groups also have demonstrated significant Other research groups also have demonstrated significant writing gains of elementary school students following a writing gains of elementary school students following a metacognitive intervention for planning, organizing, and metacognitive intervention for planning, organizing, and self-regulation.self-regulation.

The findings point to the importance of various The findings point to the importance of various executive functions from both assessment and executive functions from both assessment and intervention perspectives.intervention perspectives.

Executive Function Executive Function Assessment StrategiesAssessment Strategies

AssessmentAssessment

Most psychoeducational measures do not Most psychoeducational measures do not assess executive functions.assess executive functions.

These deficits can appear in a myriad of These deficits can appear in a myriad of medical conditions and disorders and can medical conditions and disorders and can impact both learning and social-behavioral impact both learning and social-behavioral functioning.functioning.

In this regard, the inclusion of executive In this regard, the inclusion of executive functions measures should be considered in any functions measures should be considered in any assessment of neurocognitive abilities.assessment of neurocognitive abilities.

In the past, there were few instruments In the past, there were few instruments available to clinicians—even neuropsychologistsavailable to clinicians—even neuropsychologists—for the assessment of executive functions.—for the assessment of executive functions.– This was accentuated by the lack of training in these This was accentuated by the lack of training in these

types of assessments.types of assessments.


Over the past 20 years or so, however, the Over the past 20 years or so, however, the assessment of executive functions has seen the assessment of executive functions has seen the development of a number of tools, many of which development of a number of tools, many of which are normatively based, standardized, and span a are normatively based, standardized, and span a wide age range—including the preschool years.wide age range—including the preschool years.

In fact, assessment tools even have been In fact, assessment tools even have been developed to assess executive functioning using developed to assess executive functioning using qualitative approaches and rating scales in an qualitative approaches and rating scales in an effort to have these tasks be more ecologically effort to have these tasks be more ecologically valid.valid.

The value added aspects may be critical to The value added aspects may be critical to treatment planning and developmental treatment planning and developmental surveillance.surveillance.


There are a number of more standardized measures that There are a number of more standardized measures that provide estimates of selected executive functions, and more provide estimates of selected executive functions, and more recently, executive function batteries and ratings scales have recently, executive function batteries and ratings scales have been developed.been developed.

When one considers the various subcomponents of executive When one considers the various subcomponents of executive functions, there are measures offunctions, there are measures of– Inhibitory control (e.g., errors of commission on the Continuous Inhibitory control (e.g., errors of commission on the Continuous

Performance Tests, Matching Familiar Figures Test, Go No-Go Performance Tests, Matching Familiar Figures Test, Go No-Go tasks. Stop Signal Test)tasks. Stop Signal Test)

– Speeded responding (e.g., Rapid Naming tasks, motor sequencing Speeded responding (e.g., Rapid Naming tasks, motor sequencing tasks, verbal fluency tasks such as Controlled Oral Word tasks, verbal fluency tasks such as Controlled Oral Word Association Test, nonverbal fluency tasks such as the Ruff Association Test, nonverbal fluency tasks such as the Ruff Nonverbal Fluency Test)Nonverbal Fluency Test)

– Planning and problem solving (e.g., Wisconsin Card Sorting Test Planning and problem solving (e.g., Wisconsin Card Sorting Test Categories Correct, Tower of Hanoi, Tower of London, Porteus Categories Correct, Tower of Hanoi, Tower of London, Porteus Mazes)Mazes)

– Set maintenance and perseveration (e.g., Wisconsin Card Sorting Set maintenance and perseveration (e.g., Wisconsin Card Sorting Test Perseveration Score)Test Perseveration Score)

– Set-shifting (e.g., Stroop Color and Word Test, Wisconsin Card Set-shifting (e.g., Stroop Color and Word Test, Wisconsin Card Sorting Test)Sorting Test)

– Working memory (e.g., Digit Span, Spatial Span)Working memory (e.g., Digit Span, Spatial Span)– Attention regulation (e.g., CPT Variability Scores). Attention regulation (e.g., CPT Variability Scores).


Wisconsin Card Sorting TestWisconsin Card Sorting Test Test of Problem Solving Skills-RevisedTest of Problem Solving Skills-Revised HRNB Category Test (Booklet version)HRNB Category Test (Booklet version) Tower Tasks (Hanoi, London, Montreal)Tower Tasks (Hanoi, London, Montreal) Fluency tasks (verbal and nonverbal)Fluency tasks (verbal and nonverbal) WJ-III Processing Speed ClusterWJ-III Processing Speed Cluster WJ-III Fluid Reasoning ClusterWJ-III Fluid Reasoning Cluster Working Memory Battery for ChildrenWorking Memory Battery for Children Delis-Kaplan Executive Function SystemDelis-Kaplan Executive Function System Behavioural Assessment of the Dysexecutive Behavioural Assessment of the Dysexecutive

Syndrome for ChildrenSyndrome for Children

Wisconsin Card Sorting Test

Tower Task

Tower Task

WISV-IV Integrated Spatial Span

Stroop Color and Word Test



HRNB Trail-Making Test Part A

HRNB Trail-Making Test Part B

Delis-Kaplan Executive Function Delis-Kaplan Executive Function System (D-KEFS)System (D-KEFS)

9 Subtests tapping major dimensions of 9 Subtests tapping major dimensions of EFEF– Trail-Making Test (set-shifting)Trail-Making Test (set-shifting)– Verbal Fluency Test (verbal efficiency)Verbal Fluency Test (verbal efficiency)– Design Fluency Test (nonverbal efficiency)Design Fluency Test (nonverbal efficiency)– Color-Word Interference Test (inhibition)Color-Word Interference Test (inhibition)– Sorting Test (cognitive flexibility)Sorting Test (cognitive flexibility)– Twenty Questions Test (problem solving)Twenty Questions Test (problem solving)– Word Context Test (abstract problem solving)Word Context Test (abstract problem solving)– Tower Test (problem solving)Tower Test (problem solving)– Proverb Test (abstract thinking)Proverb Test (abstract thinking)

D-KEFS Sorting Test

D-KEF Sorting Test D-KEF Sorting Test SolutionsSolutions

Small vs. large cardsSmall vs. large cards Animals vs. transportationAnimals vs. transportation Straight edges vs. curvedStraight edges vs. curved One-syllable vs. two-syllableOne-syllable vs. two-syllable Blue vs. yellow cardsBlue vs. yellow cards Air vs. land things Air vs. land things Red vs. white labelRed vs. white label Uppercase vs. lower case lettersUppercase vs. lower case letters


Additionally, there are relatively new measures Additionally, there are relatively new measures becoming available to assess selected executive becoming available to assess selected executive functions in the preschool population, with tasks functions in the preschool population, with tasks going down to two years of age.going down to two years of age.

Several of these tasks includeSeveral of these tasks include– The Shape School, which assesses inhibitory controlThe Shape School, which assesses inhibitory control– The IS Task, which measures set-shiftingThe IS Task, which measures set-shifting– Working memory span tasksWorking memory span tasks– The Tower Task, which assesses planning and problem The Tower Task, which assesses planning and problem

solvingsolving– Continuous performance tests (e.g., Kiddie Conners Continuous performance tests (e.g., Kiddie Conners

CPT) also are available for use for children ages 3 to 5CPT) also are available for use for children ages 3 to 5


To assess affective regulation, there To assess affective regulation, there are emergent tasks that extend from are emergent tasks that extend from the laboratory into the clinical arena:the laboratory into the clinical arena:

Reading the Mind in the Eyes TestReading the Mind in the Eyes Test Benton Facial Recognition TestBenton Facial Recognition Test The Awareness of Social Inference TestThe Awareness of Social Inference Test NEPSY-II Social Perception DomainNEPSY-II Social Perception Domain

– Affect RecognitionAffect Recognition– Theory of MindTheory of Mind


A number of the measures to assess affective A number of the measures to assess affective regulation are now computerized.regulation are now computerized.

The Penn Neuropsychological BatteryThe Penn Neuropsychological Battery– Emotional Recognition TaskEmotional Recognition Task

The Affective Go No-Go task from the Cambridge The Affective Go No-Go task from the Cambridge Neuropsychological Automated BatteryNeuropsychological Automated Battery– The individual is asked to inhibit responses to selected The individual is asked to inhibit responses to selected

targetstargets The Diagnostic Assessment of Nonverbal Abilities The Diagnostic Assessment of Nonverbal Abilities

(DANVA)(DANVA)– Provides estimates of emotional regulation and control Provides estimates of emotional regulation and control

via visual and auditory pathways. Scores provide an via visual and auditory pathways. Scores provide an indication of both receptive and expressive affective indication of both receptive and expressive affective regulation.regulation.


There are several ratings scales available to There are several ratings scales available to assess executive functioning in children and assess executive functioning in children and adolescents.adolescents.

The Dysexecutive Questionnaire for Children The Dysexecutive Questionnaire for Children (DEX-C), which is part of the larger (DEX-C), which is part of the larger Behavioural Assessment of the Dysexecutive Behavioural Assessment of the Dysexecutive Syndrome for Children, and the Behavior Syndrome for Children, and the Behavior Rating Inventory of Executive Function Rating Inventory of Executive Function (BRIEF).(BRIEF).

These measures are not direct assessment These measures are not direct assessment batteries per se, but rather comprehensive batteries per se, but rather comprehensive rating scale that provides estimates of both rating scale that provides estimates of both cognitive and affective regulatory functions cognitive and affective regulatory functions in a multi-rater, multi-setting framework.in a multi-rater, multi-setting framework.


For the BRIEF, there is a preschool version, a For the BRIEF, there is a preschool version, a school-age version, and an adult self-report school-age version, and an adult self-report version, thus providing a mechanism to assess version, thus providing a mechanism to assess executive functions across the age span from executive functions across the age span from preschool into adulthood.preschool into adulthood.

Like all ratings scales, the BRIEF and the DEX-C Like all ratings scales, the BRIEF and the DEX-C are subject to attribution bias and responder are subject to attribution bias and responder acquiescence, but they can provide useful acquiescence, but they can provide useful information on the application of executive information on the application of executive functions in the child’s ecology.functions in the child’s ecology.

Such approaches provide a time effective Such approaches provide a time effective alternative to direct assessment, and they also alternative to direct assessment, and they also may provide a different type of (ecological) may provide a different type of (ecological) information pertaining to executive functioning in information pertaining to executive functioning in children with TBI.children with TBI.

Behavior Rating Inventory of Executive Function


The BRIEF:The BRIEF:– Three overall summary indicesThree overall summary indices

Metacognitive IndexMetacognitive Index Behavioral Regulation IndexBehavioral Regulation Index Global Executive CompositeGlobal Executive Composite

– Eight different empirically derived scales:Eight different empirically derived scales: InhibitInhibit ShiftShift Emotional ControlEmotional Control InitiateInitiate Working MemoryWorking Memory Plan/OrganizePlan/Organize Organization of MaterialsOrganization of Materials Self-MonitorSelf-Monitor


Qualitative tasks that involve real-life simulations Qualitative tasks that involve real-life simulations include:include:– Video-taped vignettes of social situationsVideo-taped vignettes of social situations– The Party Planning TaskThe Party Planning Task– The Child-Kitchen TaskThe Child-Kitchen Task– The School Assessment of Motor and Process SkillsThe School Assessment of Motor and Process Skills

From a school-based perspective, this task provides an From a school-based perspective, this task provides an appraisal of skills that children need to function in the appraisal of skills that children need to function in the classroom setting.classroom setting.

– The Children’s Cooking TaskThe Children’s Cooking Task An adaptation of an adult task that was designed to An adaptation of an adult task that was designed to

determine the child’s ability to follow a checklist without determine the child’s ability to follow a checklist without being distracted, evaluate the outcomes with respect to the being distracted, evaluate the outcomes with respect to the initial goals for cooking, and make adjustments for any initial goals for cooking, and make adjustments for any errors.errors.

The task was comprised of actually making a chocolate cake The task was comprised of actually making a chocolate cake and a fruit cocktail, and the task is performed in a kitchen.and a fruit cocktail, and the task is performed in a kitchen.

Variables of interest from this task include the number of Variables of interest from this task include the number of errors and an overall qualitative analysis of the task.errors and an overall qualitative analysis of the task.

Children with TBI made more errors in the cooking process Children with TBI made more errors in the cooking process as compared to aged matched controls. as compared to aged matched controls.

Executive Function Executive Function Management Management StrategiesStrategies

Management Management StrategiesStrategies

Problem SolvingProblem Solving Develop a guide to help student through Develop a guide to help student through

the stages of problem solvingthe stages of problem solving– Identifying the problemIdentifying the problem– Acquire relevant informationAcquire relevant information– Generate several possible solutionsGenerate several possible solutions– List pros and cons for each solutionList pros and cons for each solution– Identify best solutionIdentify best solution– Create a plan of actionCreate a plan of action– Evaluate the effectiveness of the planEvaluate the effectiveness of the plan– Encourage generalizationEncourage generalization


Problem SolvingProblem Solving Raise questions about alternatives and Raise questions about alternatives and

consequences (Can they predict outcomes?)consequences (Can they predict outcomes?) Allow the student to bring up relevant real-life Allow the student to bring up relevant real-life

problems that are appropriate for group problems that are appropriate for group discussions, and promote brainstormingdiscussions, and promote brainstorming

Introduce roadblocks and complications to Introduce roadblocks and complications to encourage flexibilityencourage flexibility

Provide ongoing, non-judgmental feedbackProvide ongoing, non-judgmental feedback


Problem SolvingProblem Solving Computerized intervention for problem Computerized intervention for problem

solving have received some supportsolving have received some support– Teen Online Problem Solving Program for Teen Online Problem Solving Program for

pediatric traumatic brain injurypediatric traumatic brain injury Computerized interventions for Computerized interventions for

attention regulation have been mixed.attention regulation have been mixed.


Organizational ProcessesOrganizational Processes Limit the number of steps in a taskLimit the number of steps in a task Provide part of a sequence and have the Provide part of a sequence and have the

student finish itstudent finish it Give cues such as, “Correct, but what do Give cues such as, “Correct, but what do

you think will happen next?you think will happen next? Structure thinking processes graphically Structure thinking processes graphically

(e.g., time lines, outlines, flow charts, (e.g., time lines, outlines, flow charts, graphs, etc.)graphs, etc.)


Organizational ProcessesOrganizational Processes Use categories to focus on one topic Use categories to focus on one topic

at a timeat a time Identify the main idea and supporting Identify the main idea and supporting

details, categorize them, and details, categorize them, and encourage student to do the sameencourage student to do the same

Have the student practice Have the student practice organizational skills in other settingsorganizational skills in other settings


Speed of Information ProcessingSpeed of Information Processing Recognize as the student fatigues, Recognize as the student fatigues,

speed of processing declinesspeed of processing declines Recognize speed of processing can be Recognize speed of processing can be

negatively affected by some negatively affected by some medicationsmedications

Eliminate timed measures to assess Eliminate timed measures to assess learninglearning

Reduce the amount of work requiredReduce the amount of work required


Speed of Information ProcessingSpeed of Information Processing Provide a reader for text materials and Provide a reader for text materials and

teststests Permit the student the use of an aide Permit the student the use of an aide

or peer tutor to take notes for them, or or peer tutor to take notes for them, or a computer for written languagea computer for written language

Lower difficulty level until speed of Lower difficulty level until speed of processing improvesprocessing improves


Speed of Information ProcessingSpeed of Information Processing Allow extra time for the completion of Allow extra time for the completion of

tests and assignmentstests and assignments Frequent breaks allow the student to Frequent breaks allow the student to

“recharge”“recharge” When necessary, allow the student When necessary, allow the student

extra time to travel between classesextra time to travel between classes


Feeney & Ylvisaker (1995) employed Feeney & Ylvisaker (1995) employed this approach to reduce maladaptive this approach to reduce maladaptive behaviors and increase on-task efforts:behaviors and increase on-task efforts:– Analysis and restructuring of the individual’s daily Analysis and restructuring of the individual’s daily

routine wherein the sequencing of the routine was routine wherein the sequencing of the routine was negotiated (e.g., task analysis)negotiated (e.g., task analysis)

– Liberal use of visual cues to facilitate the Liberal use of visual cues to facilitate the sequencingsequencing

– Liberal rehearsal prior to each component, Liberal rehearsal prior to each component, accompanied by a performance reviewaccompanied by a performance review

Management Management StrategiesStrategies Feeney & Ylvisaker found that this Feeney & Ylvisaker found that this

program:program:– Promoted predictability and orderlinessPromoted predictability and orderliness– Gave the individuals a sense of controlGave the individuals a sense of control– Promoted goal settingPromoted goal setting– Lessened oppositionality and Lessened oppositionality and

impulsivityimpulsivity– Increased decision-makingIncreased decision-making– Increased problem solving effortsIncreased problem solving efforts

Management Management StrategiesStrategies Math Curriculum: Solve It!Math Curriculum: Solve It! A research-based instructional program in which teachers A research-based instructional program in which teachers

explicitly teach the processes and strategies that underlie explicitly teach the processes and strategies that underlie mathematical problem solving.mathematical problem solving.

It incorporates the cognitive processes critical to It incorporates the cognitive processes critical to mathematical problem solving, with a particular focus on mathematical problem solving, with a particular focus on strategies: strategies: – Reading the problem and developing math vocabularyReading the problem and developing math vocabulary– ParaphrasingParaphrasing– VisualizingVisualizing– Hypothesizing about problem solutions and their orderHypothesizing about problem solutions and their order– Estimating and predicting the answerEstimating and predicting the answer– Computing via procedures and calculationsComputing via procedures and calculations– Checking the problemChecking the problem

Students also learn a metacognitive strategy that they apply Students also learn a metacognitive strategy that they apply at each step: at each step: – Say aloud or to themselves what the problem is asking them to Say aloud or to themselves what the problem is asking them to

dodo– Ask themselves if they understand the problemAsk themselves if they understand the problem– Check their progressCheck their progress

Data on children with math disabilities are encouragingData on children with math disabilities are encouraging

Management Management StrategiesStrategies Self-Regulated Strategy Development Self-Regulated Strategy Development

(SRSD) is a model wherein students are (SRSD) is a model wherein students are taught an overarching strategy to learn taught an overarching strategy to learn specific strategies.specific strategies.

Written language is considered a problem Written language is considered a problem solving process that involves planning, solving process that involves planning, knowledge transfer, and various skills.knowledge transfer, and various skills.

SRSD comprises three major areas:SRSD comprises three major areas:– Six stages of explicit writing instruction (i.e., Six stages of explicit writing instruction (i.e.,

Develop background knowledge; Discuss it; Model it; Develop background knowledge; Discuss it; Model it; Memorize it; Support it; and Independent Memorize it; Support it; and Independent performance)performance)

– Explicit instruction in self-regulation strategies Explicit instruction in self-regulation strategies including goal setting, self-monitoring, and self-including goal setting, self-monitoring, and self-instructioninstruction

– Development of positive self-efficacy about writingDevelopment of positive self-efficacy about writing

Management Management StrategiesStrategies The SRSD model distinguishes itself from The SRSD model distinguishes itself from

alphabetic principle-based intervention alphabetic principle-based intervention strategies (e.g., PAL) as the focus is on strategies (e.g., PAL) as the focus is on advancing higher-order executive functions advancing higher-order executive functions versus developing phonological processes, versus developing phonological processes, vocabulary, or other language functionsvocabulary, or other language functions

Developmentally, this is highly appropriate Developmentally, this is highly appropriate for middle school students.for middle school students.

Significantly positive data for students with Significantly positive data for students with writing disabilities.writing disabilities.

Holds promise for teaching other self-Holds promise for teaching other self-regulatory skills (e.g., behavior).regulatory skills (e.g., behavior).

ConclusionsConclusions


There are numerous definitions and There are numerous definitions and models of executive function to models of executive function to consider, but the available evidence consider, but the available evidence clearly indicates that this a complex, clearly indicates that this a complex, multidimensional construct that evolves multidimensional construct that evolves over the course of development.over the course of development.

There is a clear linkage to underlying There is a clear linkage to underlying neurological integrity and neurological integrity and neurodevelopmental processes that is neurodevelopmental processes that is critical to understanding executive critical to understanding executive functions and dysfunctions.functions and dysfunctions.


The assessment of executive functions has come a The assessment of executive functions has come a long way over the past two decades, with many long way over the past two decades, with many measures moving out of the laboratory into the measures moving out of the laboratory into the clinical settingclinical setting– Affective regulatory measuresAffective regulatory measures

Even with these advances, though, the assessment Even with these advances, though, the assessment of executive functions typically is not conducted as of executive functions typically is not conducted as part of a routine psychoeducational or psychological part of a routine psychoeducational or psychological evaluation, or as part of other types of evaluation evaluation, or as part of other types of evaluation (e.g., speech and language, occupational therapy, (e.g., speech and language, occupational therapy, etc.).etc.).

Given the relatively high prevalence of frontal lobe Given the relatively high prevalence of frontal lobe involvement in children and adolescents with a wide involvement in children and adolescents with a wide variety of disorders, this oversight could leave a variety of disorders, this oversight could leave a significant hole in the overall profile of the impact of significant hole in the overall profile of the impact of a specific disorder or condition on cognitive a specific disorder or condition on cognitive functioning, adherence to care, response to functioning, adherence to care, response to treatment, and quality of life.treatment, and quality of life.


Given the regulatory aspects of many of the executive Given the regulatory aspects of many of the executive functions, it is not uncommon to see such isolated functions, it is not uncommon to see such isolated functions as expressive and receptive language, functions as expressive and receptive language, sensory-motor functions, or academic achievement sensory-motor functions, or academic achievement skills appearing to be unaffected by a brain injury, yet skills appearing to be unaffected by a brain injury, yet the child is not able to access the preserved the child is not able to access the preserved information accurately and/or efficiently secondary to information accurately and/or efficiently secondary to executive dysfunction.executive dysfunction.

Without the assessment of executive functions, those Without the assessment of executive functions, those working with the child are left with other plausible, but working with the child are left with other plausible, but incorrect assumptions about the nature of the child’s incorrect assumptions about the nature of the child’s capabilities (e.g., lazy, unmotivated, uninterested, capabilities (e.g., lazy, unmotivated, uninterested, behavioral problems, etc.).behavioral problems, etc.).

Consequently, it is essential for the examiner to Consequently, it is essential for the examiner to include executive function measures as part of any include executive function measures as part of any assessment of a child as part of a larger assessment.assessment of a child as part of a larger assessment.


As a final note, it is suspected that the As a final note, it is suspected that the administration, scoring, and interpretation of administration, scoring, and interpretation of executive function measures are rarely taught executive function measures are rarely taught across the various professional training programs across the various professional training programs (e.g., clinical psychology, school psychology, (e.g., clinical psychology, school psychology, speech and language, occupational therapy, speech and language, occupational therapy, etc.), and it is time for these types of assessment etc.), and it is time for these types of assessment procedures to become part of a training program.procedures to become part of a training program.

This is important not only from an assessment This is important not only from an assessment perspective, but also with respect to how perspective, but also with respect to how executive dysfunctions can impact upon executive dysfunctions can impact upon therapeutic activities of children and the therapeutic activities of children and the understanding of how these deficits can emerge understanding of how these deficits can emerge later in development.later in development.

Field needs more evidence-based treatments!Field needs more evidence-based treatments!

Questions?Questions?

Contact Information:Contact Information:

[email protected]@cidd.unc.eduu

Documents

Executive Functions in the School Setting Stephen R. Hooper, Ph.D. Carolina Institute for Developmental Disabilities University of North Carolina School