1. Executive Functions Assessment and Interventions
Milton J. Dehn, Ed.D.
Summer 2017

2. Notice of Copyright 2017
These PowerPoint slides are copyrighted by Milton J. Dehn and Schoolhouse Educational Services, LLC. They are not to be reprinted, copied, or electronically disseminated without written permission. To obtain permission,

3. Workshop Topics What are Executive Functions (EFs) EFs and Academics
Using behavior rating scales
The MEFS approach
Some intervention ideas

4. What are Executive Functions?
Directive, supervisory capacities
Purposeful, organized, strategic, self-regulated, goal-directed processing of emotions, thoughts, and actions
Self-awareness and self-regulation
From a neuropsych perspective, these are prefrontal cortex abilities

5. Executive versus Cognitive
Cue the use of other mental capacities such as cognitive abilities but are not those cognitive abilities themselves
The executive dimension of WM supervises short-term memory (a cognitive process)
The executive aspect of WM inhibits, shifts, and updates
The executive aspect of WM cues the use of an executive skill/strategy, such as rehearsal

6. Executive vs Cognitive
Executive includes both abilities and skills
EF’s are measured in cognitive scales
Directly: Working Memory, Planning, and Attention
Indirectly during any cognitive testing task

7. Self-Regulation EFs These are what are typically considered EFs
Cue and direct how we feel, think, and act
Can self-regulate without being consciously aware
McCloskey theory and McCloskey Executive Functions Scale (MEFS) has 31 specific self-regulation EFs (see image)

8. EF and Academic Learning
EFs are good predictors of achievement
EF deficits are more evident in production problems (homework) than acquiring academic skills
Production deficit: has the academic skills, but does not demonstrate/apply them
May be that teacher provides more executive controls during skill learning
EF demands increase in middle & high school
In middle school, there is a mismatch between demands and students’ EFs developmental level

9. EF and Reading Comprehension
Important EFs: Focusing, Sustaining, Organizing, Planning, Shifting, Inhibiting, Monitoring, Holding/Working, Generating, Associating, Storing/Retrieving, Balancing

10. EF and Math
EFs needed for math computation include: Focusing, inhibiting, storing/retrieving, monitoring, and correcting
For math reasoning/problem solving, planning is important

11. EFs and Written Expression
Of all academic skills, is the most impacted by EF difficulties
EFs needed to integrate the various processes, abilities, and skills when writing. Such EFs include: Sustaining, gauging, holding/working, organizing, planning, balancing, monitoring, correcting, generating, associating

12. EF and SLD Identification
A deficit in executive functioning (general or specific) is a “processing” deficit that can be used to document a processing deficit for SLD
In Pattern of Strengths and Weaknesses (PSW) approach EF scores are compared with scores of other processes
The Psychological Processing Analyzer (PPA; Dehn) statistically determines PSW

13. Assessment of EF
Should be a component of every psychological/educational evaluation
It determines success/failure; influences all aspects of functioning
Provides insights into what underlies, behavior, social functioning, learning, etc.
May be more informative than an FBA
Kids with EF deficits are the ones who get referred first for every type of disability

14. Problem with Direct Standardized Testing of EFs
Standardized tests provide structure, focus, short intervals; reduce need for EF functions
May lack validity for the individual. Typically, overestimate the EF abilities and skills
Multiple EFs are required by each task
The tasks also require cognitive processes that are difficult to separate out
The assessment task is not a real world task

15. Rating Scales vs Standardized Tests
Some studies have found rating scales to be more valid assessment of EFs than direct testing for reasons on previous slide
Rater is observing many aspects of EF; tests only sampling a few

16. Use of Rating Scales by Diagnosticians
They are standardized, norm-referenced tests
Avoid those that involve behavior, social-emotional (for LSSPs)
Understand T-Scores
Mean of 50; SD of 10
Often reverse scored: high scores mean a lack of ability skill
Study manual about use and interpretation

17. Use of Rating Scales by Diagnosticians
Raters can be biased
Use more than one rater
Look at validity scales
Are responses consistent
Are they overly negative
Picks infrequent answers
Interpret only the parts of the scales that apply to cognitive and academic

18. Rating Scale Results Expect scores to vary by informant
May be due to different environments, executive function demands, experiences with the child, or bias by informant
Parent vs teacher are usually more discrepant than between parents or between teachers

19. BRIEF2 Index/Composites
Behavior Regulation Index (BRI)
Emotion Regulation Index (ERI)
Cognitive Regulation Index (CRI)
Use only CRI for SLD identification purposes
Global Executive Composite
BRI and ERI should only be used by psychologists

20. BRIEF2 Cognitive Regulation Index
CRI: “Ability to control and manage cognitive processes and problem solve effectively”
Initiate
Working Memory
Plan/Organize
Task-Monitor
Organization of Materials

21. BRIEF2 Validity Study
With both parent and teacher ratings, LD have elevated scores on all cognitive scales except Organization of Materials
LD students have elevated scores mainly on the Cognitive Regulation Index, but not the Behavior and Emotion Indexes

22. McCloskey Executive Functions Scale (MEFS) Standardization and Norming
254 Teacher raters, 167 cities, 29 states
Ages 5-19; N = 1,000; 5 age groups
Matches U.S. demographics well
17% of norming sample: disability/disorder
Online data collection
110 Items
<15 minutes to complete

23. MEFS Structure 7 Self-Regulation Clusters 31 Self-Regulation EFs
Also, Self-Realization and Self-Determination
Two arenas: Academic and Self/Social
Identifies strengths and deficits across self-regulation EFs by arena
Individual item analysis

24. McCloskey (MEFS) Self-Regulation Clusters
Attention
Engagement (initiating, inhibiting, flexible)
Optimization (monitoring, correcting)
Efficiency (pacing, using routines)
Memory (holding/working, storing/retrieving)
Inquiry (anticipating, analyzing)
Solution (organizing, planning, deciding)

25. McCloskey (MEFS) Self-Regulation EFs
Perceiving
Focusing
Sustaining
Initiating
Energizing
Inhibiting
Stopping
Pausing
Being Flexible
Shifting
Monitoring
Modulating
Correcting
Balancing
Sensing Time
Pacing
Using Routines
Sequencing
Holding/Working
Storing/Retrieving
Gauging
Anticipating
Estimating Time
Analyzing
Evaluating
Generating
Associating
Organizing
Planning
Prioritizing
Deciding
Link to Item Examples

26. Gender Differences
At all age levels, females significantly better EFs on Engagement and Optimization clusters
Ages 5-6, females better on all self-regulation clusters except Memory
Ages 7-8, females better only on Engagement and Optimization
Ages 9-10, females better on all except Efficiency and Memory
Ages 11-18, females better on all clusters

27. EF Correlation with Academic Skills
Teachers rated student’s overall academic skill level
Below average students had the lowest EF scores, and above average the highest
Significant differences by academic skill level for all MEFS clusters, regardless of disability status

28. Autism Profile
Autism sample had significantly lower scores on all MEFS clusters in both academic and self/social arenas
The majority of the differences were around one standard deviation

29. ADHD Profile
ADHD sample had significantly lower scores on MEFS clusters in both academic and self/social arenas, except for the Memory cluster and Self-Realization
The majority of the differences were around one half of a standard deviation
Those on medication did not have significant differences on Memory, Efficiency, and Self-Realization and self/social under Solution

30. Arenas of Involvement (McCloskey)
EF’s vary greatly by situation, environment, and domain of functioning
Intrapersonal (internal processes) and Interpersonal (social) (these two combined on MEFS)
Autism has deficits in this arena
Academic (symbol system)
Language and academic learning
LD often deficient in this arena

31. Awareness vs Skill Deficits
Awareness of the need to cue and then cuing and directing its executive skill counterpart, such as planning
Skill deficit: The actual expression of the EF skill, such as planning
Having the EF skill, but not expressing it because it has not been cued because of lack of awareness is an “EF production deficit”

32. Unique Rating Structure Identifies Different Types of EF Deficits
Rating Description
Strengths or Deficits
5 – Almost always does on own without prompting 4 – Frequently does on own without prompting 3 – Seldom does it on own without prompting 2 – Does it, but only after prompting 1 – Only does it with direct assistance 0 – Unable to do even with assistance
5 and 4 – Executive Function Strength (has both directive function and expressive skill) 3 and 2 – Executive Function Deficit (directive EF lacking but has expressive skill) 1 and 0 Executive Skill Deficit (the executive skill is lacking; can’t do even when cued)

33. Case Study 12 year old, 6th grade female
WJ IV GIA of 71; ST WM a strength (95)
Academic skills 2nd to 4th grade level
She is in unstructured charter school project-based regular ed. class; performance is poor
No interest in learning
Can shut down and become noncompliant
Can be socially appropriate when she chooses to

34. Case Study MEFS Results
MEFS completed by classroom teacher
All cluster scores 1st percentile except Memory
No EF strengths
EF Deficits and Executive Skills Deficits are fairly even, meaning she can perform the EF when prompted and thus has the capacity/skill
Has more EF deficits under academic than self/social, consistent with underachievement indicators on the WJ IV
NEPSY-II EF scaled scores are 7-12, majority around 9
Why? See Report

35. EF Assessment to Intervention
Prioritize; select EF’s to work on first based such considerations as:
Safety of self and others
Ability to function independently
Social vs Academic
Parent goals
Self goals
Environmental modifications necessary when EFs are very deficient

36. EF Intervention Considerations
Don’t assume the child has conscious control over the EFs in question
Awareness Deficits: Skill is present; needs to be taught how to recognize cues (yellow column on MEFS)
If EF skills are lacking, then they need to be taught before cuing is taught
When skills taught, awareness component needs to be included

37. Awareness Emphasis “Thinking about thinking”
Applies to all EF Deficits and EF Interventions
Teach child how EF works
Inform child of strengths and weaknesses
Teach how to control, apply, use the EF skills
Emphasize personal efficacy of intervention
Includes strategy knowledge and application
Teach conditional strategy knowledge: how, when, where, why

38. Help Teachers Understand
The extent of the EF demands they make on students and how these overwhelm students with slower EF development
How EF deficits contribute to academic production problems
Encourage them to have an EF focused class, such as a memory strategies focused classroom

39. EF Strategies for the Whole Class (Meltzer): Goal Setting
Short-Term and Long-Term goals
Makes students more motivated when they set goals themselves
Identify the steps involved
Visual the steps
Breaking tasks into manageable parts
Identify the strategies needed
Includes planning and time management
Example of a college class

40. EF Strategies for the Whole Class (Meltzer): Flexibility and Shifting
Shifting examples: from one approach to another, from one process to another, from the main ideas to the details, from writing to editing, from reading to computing
Flexibility examples: interpreting information in different ways, solving math problem in different ways, studying differently for different kinds of tests

41. EF Strategies for the Whole Class (Meltzer): Organizing and Prioritizing
Prioritize based on level of importance
Allocate time based on priority
Teach them to impose their own structure on the task
Organize concepts, such as semantically
Organize materials and work space
Graphic organizers
Following a rubric for writing

42. EF Strategies for the Whole Class (Meltzer): Working Memory
Learn how to manage cognitive load
What is cognitive load?
Using rehearsal
Chunking and visualizing
Using long-term memory mnemonics, such as keyword

43. EF Strategies for the Whole Class (Meltzer): Self-Monitoring & Checking
Review progress towards goals
Reflect on strategy use
Develop and use personalized checklists
Use self-cuing

44. Free Recorded Webinar on the MEFS
An hour in length
Can be accessed at:
NOTE: An internet search for the MEFS will bring up the Minnesota Executive Functions Scale. This is NOT McCloskey’s Executive Functions Scale (the real MEFS)