Brain functions that manage attention, emotions, and goal pursuit.
Emerge during preschool years and mature into early adulthood.
Predictive of school success, sometimes more so than IQ.
Depend on the prefrontal cortex.
Lizak's definition: Ability to engage in independent, purposeful, self-directed behavior.
Deficiencies can occur in:
Evaluation
Planning
Purposive actions
Self-awareness and self-monitoring
Components of Executive Functions
Core Executive Functions:
Inhibitory control (self-control): Stopping an impulsive act by thinking about it and its consequences. Examples include not crossing the street without looking or avoiding fattening foods while on a diet.
Working memory
Cognitive flexibility
Higher Order Executive Functions:
Problem-solving
Reasoning
Planning
Shift: Transitioning between tasks or activities.
Examples: Switching from a preferred to an unpreferred activity, letting go of a specific interest, or shifting emotional states (e.g., from sadness at a funeral.
Cognitive Control
Initiation: Beginning tasks independently without reminders.
Working Memory: Sustaining attention to tasks and following directions.
Organization/Planning: Planning ahead and developing strategies, organizing materials.
Monitoring: Paying attention to what we're doing and error monitoring.
Thinking:
Concrete approaches limit flexibility.
Abstraction allows for more flexible thinking.
Looking beyond immediate experience.
Formulating hypotheses.
Using imagination and creativity.
Emotional Control
Regulating reactions appropriately to the size of the problem.
Importance of Executive Functions
School readiness and success
Job success
Relationship success
Critical for cognitive, social, and psychological development.
Essential for independent and productive functioning.
Example: Mild stroke patients with executive function deficits may face job termination and relationship problems long-term.
The Marshmallow Test
Tests executive control by requiring children to inhibit the immediate desire to eat a marshmallow.
Involves thinking about consequences and delayed gratification.
Original study aimed to correlate the ability to delay gratification with later school success.
Assessments of Executive Functions
Rating forms: Assess behaviors in unstructured situations involving planning, organization, and problem-solving.
Flexibility and shifting of sets.
Generation of ideas or concepts.
Categorization, organization, and planning tasks.
Standardized Tests:
Executive Functions Route Finding Task
Multiple Errands Task
Behavioral Assessment of the Dysexecutive Syndrome (BADS)
Tower of London
Delis-Kaplan Executive Function System (D-KEFS)
Weekly Calendar Test
Behavioral Assessment of Dysexecutive Syndrome (BADS): Includes a dis-executive questionnaire for clients and caregivers, focusing on judgment, shifting rules, problem-solving, and organization.
The BADS has six subsets and predicts everyday problems arising from executive function issues.
Toglia Categorization Assessment: A dynamic assessment exploring the use of cues to facilitate performance. Cues move from general to specific feedback.
Aims to sort out reasons for difficulty and includes investigations of awareness.
Detective Reasoning Test: A deductive reasoning test where the client asks questions to identify a utensil the examiner is thinking of.
Risk Classification Test: Sorting objects by color and shape.
Problem Solving Assessments
Example: What to do when a drug expires.
Tests problem-solving skills and world knowledge.
Executive Functions Performance Test (EFPT) by Caroline Baum:
Includes tasks like handwashing, oatmeal preparation, telephone use, medication management, and bill payment.
Evaluates initiation, execution, organization, sequencing, judgment, safety, and independence.
Scoring is based on the level of assistance required.
Multiple Errands Test (MET)
Performance-based assessment of functional cognition.
Involves completing unstructured tasks in a novel environment.
Creates a cognitive challenge by requiring test-takers to execute multiple tasks, manage money, calculate, and remember prospective tasks while adhering to specific rules.
Involves pre-MET orientation and post-MET debrief.
Rules include completing all tasks, staying within a budget, limiting purchases, working quickly without risks, staying on the first floor, avoiding staff-only areas, not returning to previously visited areas, and not speaking to the examiner unless required by the task.
Treatment Strategies
Verbal Mediation: Verbalizing a plan of action before and during task execution.
Self-Questioning: Asking questions like "What do I need to do?" or "What do I have to do next?"
Steps for teaching skills:
Set a goal.
Teach the skill.
Look for opportunities to pursue independence.
Discuss the skill verbally.
Model the skill.
Practice the skill.
Create opportunities for success and failure.
Review and revise.
Goal Management Training (GMT):
Stop and discuss what you are doing prior to acting.
Define what needs to be done.
List the steps.
Learn the steps.
Do it.
Check progress.
GMT is a package of educational material, tasks, homework or practice assignments, and a narrative package that is aimed at raising awareness of patients towards these types of deficits when they occur and giving patients some very practical tools to use in their day to day life to compensate for these types of deficits.
Addresses distractibility, decreased concentration, poor planning, and difficulties in completing tasks.
Focuses on raising awareness, stopping to think, and monitoring progress.
Strategies for Keeping Track:
Crossing or checking off items on a checklist.
Mental rehearsal and self-talk.
Adapting tasks and the environment:
Using external strategies such as checklists.
Test-specific training or cross-situational training.
Periodic auditory alerts for self-monitoring.
Highlighting important information.
Creating charts and diagrams.
Checklists:
Operating devices.
Taking medication.
Morning routines.
Meal preparation.
Leaving the house.
Occasional tasks.
Creating Checklists:
Person performs task and writes down steps.
Watching a therapist or video of someone performing the task.
Structures of Problem Solving:
Identify the problem.
Separate relevant from irrelevant information.
Draw links between relevant items.
Generate possible solutions.
Monitor effectiveness of the solution.
Cognitive Flexibility Strategies:
Use imagery or visual pictures.
Search for different ways to represent the problem.