Assessment and development of executive functions in school-age children

Abstract

Executive functions (EFs) are essential for coordination and controlling of other cognitive functions and behavior. EFs are involved in all purposeful activity, and for children, they are important for learning and functioning in school environments. Difficulties in EFs are common in school-age children with developmental disabilities, such as attention deficit disorder (ADHD). This thesis consists of three studies addressing EFs in school-age children. The first study employed neuropsychological tests from the Developmental Neuropsychological Assessment NEPSY to examine age-related differences in EFs in a sample of 400 children. The second study investigated the methodological factors related to EF measures in a sample of 340 children using response inhibition tasks from the NEPSY-II, the second edition of the Developmental Neuropsychological Assessment. The third study aimed at constructing a new instrument, the Attention and Executive Function Rating Inventory ATTEX, for the clinical assessment of EFs and verifying the psychometric properties of the rating scale in a sample of 916 children. Age-related improvement in EF task performance continued throughout the school-age period, proceeding from inhibition to attention control, and further to fluency of actions. A closer examination of response inhibition showed developmental variation even within this EF domain. The developmental change was apparent at school age, but different outcome measures and the cognitive requirements of tasks had an effect on how the development of response inhibition was depicted. In the assessment of everyday EF behaviors, the ATTEX rating scale demonstrated high internal consistency reliability and good criterion and discriminant validity for ADHD. The EF profiles were different for the ADHD subtypes, and children with predominantly inattentive symptoms showed more wide-ranging difficulties in EFs than children with combined symptoms of inattention and hyperactivity-impulsivity. Carefully examined, reliable, and valid measures are essential for both the scientific research and clinical assessment of EFs. Factors related to the measures, e.g., materials, stimuli, and the selected outcome measure, and the cognitive processes involved in tasks have effect on how development of EFs is depicted. Close examination of these factors can help to attain a more consisted account on EF development. In the clinical assessment of EF difficulties, the measures need to be sensitive to the actual difficulties that arise in every-day situations. These are best assessed with standardized rating scales. The new rating scale presented in this thesis proved to be a suitable measure both for screening and examining the detailed EF profiles of children in school situations.

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