Evaluation of Executive Functions

Best practice in the evaluation and intervention of executive functioning skills (e.g., planning, organization, initiation, time management, working memory, flexibility, cognition, memory, attention, reasoning, abstract thinking, judgment, and problem-solving) has been particularly difficult when assessing students with traumatic brain injury. Although it is tempting to look for a single measure to give an indication of a student’s abilities in these areas, the structured format of a formalized assessment often masks a student’s true performance, giving an overly optimistic portrayal of abilities. Information from multiple sources is preferable and may be gathered using the following procedure.

Key components of an intervention plan for executive functions

An intervention plan and a strategy with embedded evaluation are the keys to effective interventions for students with traumatic brain injury.

• Gather information from a variety of sources, including interviews, behavior checklists, observations, and work samples, along with the formalized assessment.
• List the problem areas and link those areas to the executive functions that best describe the areas of difficulty.
• Pick one or two executive functions to work with, initially. Work with the student (if possible) to create a behavioral goal that addresses an area of difficulty. Do this by looking at all of the data and compiling information across and between settings and domains.

For example, Sally has noticed that no one wants to talk with her. This bothers her, and she wants to fix it. It has been observed that she picks a topic of conversation and is only able to talk about her topic. Using her goal and addressing Sally’s need for greater conversational flexibility, these two areas can be linked to help create Sally’s intervention.

Create an intervention and teach it with at least one of the following:

• Support from the environment.
• Motivations or positive behavioral supports to increase the likelihood that the student will want to participate in using the new skill.

For example, Sally might identify a goal about flexibility. Using the "Goal, Plan, Predict, Do, Review" strategy (Feeney, 2007), Sally can set a goal of talking to others about something of interest to them. Sally would then work with the speech pathologist to generate a list of topics of interest to a target individual. Then she could practice speaking to the person with the guidance of the speech pathologist or other mentor. Afterward, Sally could practice with other people of her choosing, using less and less adult coaching for increasing flexibility in a variety of situations.  Looking at all of the data and including Sally’s own motivation to “fix” her ability to speak with others allowed an intervention to be designed that addresses Sally’s own motivation and needs.

Less ideal, but often effective, is using an external motivator to ensure student involvement in the intervention.

Examine the effectiveness of the intervention by documenting the following:

• Were the intervention and supports put into place?
• How did they work (were they effective)?
• What is the plan for reducing the number of supports for this goal?

Adapted from:

Dawson, G. (2006). Executive Skills in Children and Adolescents: A practical guide to assessment and intervention. Guilford Press: New York.

Feeney, T. (2007). Behavioral Supports for Students with TBI. Statewide Educator Series: Teaching Research Institute, Eugene, OR.