Thursday, January 12, 2017

Assessment of Executive Function (EF) in Autism

Executive Function Skills in Autism

Research evidence suggests that deficits in executive function (EF) are an important feature of autism spectrum disorder (ASD). Executive function is a broad term used to describe the higher-order cognitive processes such as response initiation and selection, working memory, planning and strategy formation, cognitive flexibility, inhibition of response, self-monitoring and self-regulation. It is generally acknowledged that these higher order processes are associated with the prefrontal cortex, which are necessary for regulating and controlling behavior. Executive functions include the many of the skills required to prepare for and execute complex behavior, such as planning, inhibition, organization, self-monitoring, cognitive flexibility, and set-shifting. 
Markers of executive dysfunction may include difficulty initiating action, planning ahead, inhibiting inappropriate responses, transitioning, switching flexibly between response sets, and poor self-monitoring. Indeed, poor performance monitoring and self-regulation may be associated with the core features of ASD such as a lack of social reciprocity, perseverative responses, and intense emotional responses to change (e.g., meltdowns). Moreover, school success depends on mastery of basic EF skills, including remembering and following instructions, completing tasks independently and smoothly transitioning between tasks, and inhibiting inappropriate behaviors. EF plays an important role in the acquisition of knowledge and social skills; the better children are at focusing and refocusing their attention, holding information in mind and manipulating it (i.e., working memory), resisting distraction, and adapting flexibly to change, the more positive the social, adaptive, and academic outcomes.

It is important to note, however, that executive function deficits are not experienced by all individuals on the autism spectrum nor do they appear to play a primary causal role in ASD. Nevertheless, executive dysfunction places a child at-risk and is likely to have an adverse impact on many areas of everyday life and affect adaptability in several domains (personal, social and communication). Therefore, an assessment of executive function can add important information about the child’s strengths and weaknesses and assist with intervention/treatment planning. The following measures may be included in a comprehensive developmental assessment battery for ASD.

·   The Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001) was co-normed on a large and representative national sample designed exclusively for the assessment of executive functions, including flexibility of thinking, inhibition, problem solving, planning, impulse control, concept formation, abstract thinking, and creativity. The D-KEFS, is composed of nine stand alone tests that can be individually or group administered that provides a standardized assessment of executive functions in children and adults between the ages of 8 and 89.

·   The Developmental Neuropsychological Assessment, Second Edition (NEPSY–II: Korkman et al., 2007) measures several neuropsychological abilities and was normed on children 3 to 16 years to 11 months of age. The NEPSY-II assesses six domains: 1) Attention and Executive Functioning, 2) Language, 3) Memory and Learning, 4) Sensorimotor, 5) Social Perception and 6) Visuospatial processing. It offers 32 subtests that the examiner can tailor to the specific examinee. In addition to tests of memory and executive functioning, the NEPSY-II also includes tests on Theory of Mind (which assesses the ability to recognize the feelings and thoughts of others) and Affect Recognition (which measures the ability to recognize feelings expressed on faces), both of which should be useful for assessing children on the spectrum.

·   The Wide Range Assessment of Memory and Learning, Second Edition (WRAML-2; Sheslow & Adams, 2003) is a direct assessment of both immediate and delayed memory ability, as well as the acquisition of new learning that can be useful in evaluating learning and school-related problems of students with ASD. This comprehensive measure includes a Core Battery and supplemental subtests that provide index scores for General Memory, Verbal Memory, Visual Memory, Working Memory, and Attention and Concentration. A brief four subtest Memory Screening Form that correlates highly with the full test is also available.

·   The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF- 2; Gioia, Isquith, Guy, & Kenworthy, 2015) is a parent-or-teacher rated questionnaire for children ages 5 to 18 years of age that can be used to assess executive functioning in ASD. The BRIEF-2 is comprised of the following scales: Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, Organization of Materials, Task-Monitor, and Self-Monitor. Summary indexes include Behavior Regulation (BRI), Emotion Regulation (ERI), Cognitive Regulation (CRI) and an overall score, the Global Executive Composite (GEC). The BRIEF-2 also includes a self-report measure for children and adolescents 11-18 years of age.

·   The Comprehensive Executive Function Inventory (CEFI; Naglieri & Goldstein, 2013) is an executive function (EF) rating scale for children and youth ages 5 to 18 years. The CEFI is designed to assess EF skills based on self, parent, and teacher reports, and provides specific and individualized intervention recommendations. The CEFI provides an overall full-scale executive functioning standard score and individual subtest standard scores on nine components of EF, including Attention, Emotion Regulation, Flexibility, Inhibitory Control, Initiation, Organization, Planning, Self-Monitoring, and Working Memory.

Because executive functions are important to social competence, academic success, and overall adaptability, these measures enable practitioners to assess impaired multi-task performance, document the impact of executive function deficits on functioning, and to plan educational interventions and classroom accommodations. Further information on best practice guidelines for assessment of ASD is available from the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

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