Child Neuropsychology, 2015 Vol. 21, No. 4, 531–538, http://dx.doi.org/10.1080/09297049.2014.911271
Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders Amy C. Gross1, Lindsay A. Deling2, Jeffrey R. Wozniak3, and Christopher J. Boys1 1
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA Minnesota Organization on Fetal Alcohol Syndrome, Minneapolis, MN, USA 3 Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA 2
The purpose of the current study was to evaluate the relationship between parent-report and objective measures of executive function in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD). The participants were a clinical sample of 551 children who completed 597 evaluations, including initial and re-evaluations. Participants were 6–16 years old, with a mean age of 10. Pearson correlations were used to determine the relationship between performance-based measures and parent-report measures of executive functioning. Relationships among the same types of measures, that is, performance based or parent report, were also evaluated. The data largely demonstrate low nonsignificant correlations between performance-based measures and parental report of executive function. Parent-report measures were internally consistent as were objective measures. It is possible that a third variable, for example, parental frustration, significantly influences parent reports. It is also likely that objective measures, which are administered in a controlled environment, do not fully capture children’s day-to-day functioning. That is, a child may have the executive function abilities (i.e., good performance on objective measures) but may be unable to deploy the appropriate skills in their daily lives, as evidenced by parental report. Children with FASD who have executive function abilities but not implementation skills likely require different interventions than children who lack abilities and skills. Keywords: Fetal Alcohol Spectrum Disorder; Executive function; Behavior Rating Inventory of Executive Function; Children; Adolescents.
Fetal Alcohol Spectrum Disorder (FASD) is an overarching term used to classify individuals who have a range of physical abnormalities and neuropsychological deficits related to prenatal alcohol exposure (Davis, Desrocher, & Moore, 2011; Mattson et al., 2010). The spectrum includes Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (Partial FAS), and Alcohol Related Neurodevelopmental Disorder (ARND). FASD diagnoses are based on several features: (a) prenatal alcohol exposure, (b) growth deficits, (c) characteristic facial features, and (d) central nervous system (CNS) dysfunction (structural Address correspondence to Christopher J. Boys, PhD, 2512 Building, Third Floor, 2512 S 7th Street, Minneapolis MN 55454, USA. E-mail: [email protected]
© 2014 Taylor & Francis
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A. C. GROSS ET AL.
or functional) (Astley, 2004; Chudley et al., 2005; Hoyme et al., 2005; National Center on Birth Defects and Developmental Disabilities, Center for Disease Control, & Department of Health and Human Services, 2004). CNS dysfunction can range from intellectual impairments to more subtle neurocognitive difficulties (Davis et al., 2011; Mattson et al., 2010). One area of CNS dysfunction that has been well documented is executive function (Davis et al., 2011). Executive functions are several complex, cognitive processes that are interdependent and necessary for purposeful, goal-directed behavior (Lezak, 1995). This study will focus on specific components of executive function that are thought to be relatively independent of one another: working memory, initiating behavior, and shifting attention. Working memory is the ability to hold necessary information in mind while completing multistep tasks. Initiating involves developing ideas and beginning tasks, and shifting refers to the ability to flexibly move between tasks and to adapt to changing circumstances (Gioia, Isquith, Guy, & Kenworthy, 2000). Individuals diagnosed with FASD who have impaired intellectual functioning struggle with executive function. There are also individuals who demonstrate executive functioning deficits despite average intelligence (Connor, Sampson, Bookstein, Barr, & Streissguth, 2000). Particularly for the latter group, deficient executive functioning can interfere with their capacity to effectively apply their cognitive abilities to a problem (Chasnof, Wells, Telford, Schmidt, & Messer, 2010). For example, a child may have the intellectual capacity to complete a book report, yet an executive functioning weakness may cause the child to struggle to get started on the assignment (initiating) or to miss an important step of the process (working memory/shifting attention). Instances like these put individuals at risk for being misunderstood as noncompliant or lacking motivation, as opposed to having a neurocognitive weakness (Aragon et al., 2008). Previous research has demonstrated mixed results regarding the relationship between the Behavior Rating Inventory of Executive Function (BRIEF), a parent-report measure, and performance-based assessments of executive function (Gioia et al., 2000). Some studies found no relationships between BRIEF scores and performance-based measures of executive function (McAuley, Chen, Goos, Schachar, & Crosbie, 2010). Others, however, indicated significant correlations between BRIEF scales and particular aspects of performance-based measures (Toplak, Bucciarelli, Jain, & Tannock, 2009). Notably, the purpose of the BRIEF is to provide an ecologically valid measure of executive function, which is not a focus of performance-based measures (Gioia & Isquith, 2004). The BRIEF has been shown to relate to ratings of attention concerns, behavior problems, and social-emotional difficulties in school-aged clinical patients (i.e., youth with attention, learning or behavior problems) and controls (McAuley et al., 2010). The literature also suggests that BRIEF scores can distinguish clinical from nonclinical populations, as well as differentiate subtypes of clinical populations. For example, children diagnosed with attention deficit/hyperactivity disorder (ADHD) have higher BRIEF scores than controls. Those diagnosed with ADHD Combined subtype have higher Behavior Regulation Index scores, whereas those diagnosed with ADHD Inattentive subtype have higher Metacognitive Index scores (Toplak et al., 2009). Research suggests that aspects of executive function are weaker in children diagnosed with FASD than children from other clinical populations, in particular ADHD (Mattson, Crocker, & Nguyen, 2011). However, data regarding the relationship between parent-report and objective measures of executive function are not available for an FASD population. Therefore, the purpose of the current study was to evaluate the relative
EXECUTIVE FUNCTION AND FASD
533
contributions of parent-report and objective measures of executive functioning to the clinical assessment of children diagnosed with FASD. METHODS Participants were a clinical sample of 551 children diagnosed with FASD. Participants were included if they were 6–16 years old, evaluated for and diagnosed with FASD and contained in the clinical database. Mean age was 10. There were 317 males and 234 females. These children had 597 evaluations, including initial and re-evaluations; 7.7% of children had multiple evaluations in the database. These were included because the purpose was to evaluate the relationship between objective and parent-report measures at any developmental stage. Children were evaluated neuropsychologically by a psychologist and medically by a physician trained on the University of Washington diagnostic system for FASD (Astley, 2004). Diagnoses were made based on the modified Institute of Medicine criteria (Hoyme et al., 2005). Of the 551 children, 81 met criteria for FAS (14.7%), 208 for Partial FAS (37.7%), and 262 for ARND (47.5%). Participants were administered an extensive neuropsychological battery during a one-day clinic appointment. Specific elements of the battery were included in this study. Objective measures included the Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001) Trails and Sorting subtests and the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV; Wechsler, 2003). The DKEFS Trails subtest measures the ability to scan a page systematically and maintain attention, as well as to demonstrate cognitive flexibility, simultaneous processing, and divided attention. D-KEFS Trails Condition 4: Number-Letter Switching most specifically measures the ability to shift cognitive set. D-KEFS Sorting conditions are intended to measure initiation of problem solving, flexibility in responding, and inhibition (Delis et al., 2001). D-KEFS scaled scores were included for Trails Condition 4 and Sorting conditions: Confirmed Correct Sorts, Free Sort Description, and Sort Recognition Description. The WISC-IV is a measure of intellectual ability for individuals ages 6 to 16 (Wechsler, 2003). It yields four indices: Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), and Processing Speed (PSI), as well as a Full-Scale Intelligence Quotient (FSIQ). The WMI was of particular interest for this study because working memory is often considered a primary aspect of executive function, and a common area of deficit for children diagnosed with FASD (Rasmussen, 2005). WISCIV index and full-scale scores were available but subtest scores were not in the database. The BRIEF, Child Behavior Checklist (CBCL), and Scales of Independent Behavior-Revised (SIB-R) were the parent-report measures (Achenbach & Rescorla, 2001; Bruininks, Woodcock, Weatherman, & Hill, 1996; Gioia et al., 2000). The BRIEF is a questionnaire regarding executive function of individuals ages 5–18. There are several subscales and index scores. Those most related to this study include the Global Executive Composite (GEC), or overall score, as well as the Initiate, Shift, and Working Memory subscales (Gioia et al., 2000). The CBCL is a parent-report questionnaire for emotional and behavior problems of individuals ages 6–18 (Achenbach & Rescorla, 2001). T-scores for Internalizing, Externalizing, and Total Problems were included. Finally, analyses included the Broad Independence standard score from the SIB-R, an assessment of adaptive behaviors for individuals ages 3 months to 80+ years old (Bruininks et al., 1996).
534
A. C. GROSS ET AL.
Data from each evaluation were included in the analyses. However, not all evaluations included each measure; therefore, the number of subjects varies across measures. Pearson correlations were used to determine the relationship among variables. Analyses evaluated the relationships between objective measures (i.e., D-KEFS Trails Condition 4 and Sorting Conditions; WISC-IV FSIQ and WMI) and parent-report measures (i.e., BRIEF GEC, Initiate, Shift, and Working Memory). Test selection was based on measures available in the database. Specific correlations were run between available objective measures and BRIEF subscales that purported to measure the same aspects of executive functioning. For example, because D-KEFS Sorting conditions are intended to measure initiation and flexibility (Delis et al., 2001), these were analyzed with BRIEF Initiate and Shift. Relationships among the same types of measures, objective or parent-report, were also evaluated. Parent-report correlation analyses included the BRIEF, CBCL, and SIB-R; objective measure correlations included D-KEFS subtests and WISC-IV indices. RESULTS AND DISCUSSION Participants demonstrated slightly below average cognitive performance and difficulties with executive function, emotional and behavioral regulation, and adaptive behaviors (see Table 1). This profile is consistent with prior reports of individuals diagnosed with FASDs (Connor et al., 2000; Davis et al., 2011; Kully-Martens, Treit, Pei, & Rasmussen, 2013). Pearson correlations revealed no significant correlations between objective measures and parental report of executive functions (see Table 2). There were no significant relationships between D-KEFS subtests and BRIEF subscales, WISC-IV WMI and BRIEF Working Memory subscale, or WISC-IV FSIQ and BRIEF GEC. There was internal consistency among the objective measures. That is, there were significant relationships among D-KEFS Trails Condition 4 and each D-KEFS Sorting Condition and among Sorting Conditions. Furthermore, D-KEFS Trails Condition 4 and Sorting Conditions were each related to WISC-IV WMI and FSIQ. Finally, WISC-IV WMI and FSIQ were significantly correlated. Table 1 Mean Scaled Score, Range, and Number of Participants for Measures. Mean (SD) DKEFSa Trails 4 D-KEFS Confirmed Correct Sorts D-KEFS Free Sorting Description D-KEFS Sort Recognition Description WISC-IVb FSIQ WISC-IV WMI BRIEFc GEC BRIEF Initiate BRIEF Shift BRIEF Working Memory CBCLd Total Problems SIB-Re Broad Independence
7 8 8 6 84 85 75 69 72 74 71 75
(4) (3) (3) (3) (15) (15) (10) (10) (13) (10) (8) (24)
Range
N
1–16 1–16 1–16 1–17 41–130 50–144 41–120 35–101 37–117 40–107 42–92 0–157
235 223 223 220 494 493 495 503 502 503 467 479
Notes. aDelis-Kaplan Executive Function System. bWechsler Intelligence Scale for Children-Fourth Edition. Behavior Rating Inventory of Executive Function. dChild Behavior Checklist. eScales of Independent BehaviorRevised. c
EXECUTIVE FUNCTION AND FASD
535
Table 2 Correlations between Measures. Measures Objective & Parent Report D-KEFSa Trails Condition 4 & BRIEFb Shift D-KEFS Confirmed Correct Sorts & BRIEF Shift D-KEFS Free Sorting Description & BRIEF Shift D-KEFS Sort Recognition Description & BRIEF Shift D-KEFS Confirmed Correct Sorts & BRIEF Initiate D-KEFS Free Sorting Description & BRIEF Initiate D-KEFS Sort Recognition Description & BRIEF Initiate WISC-IVc WMI & BRIEF Working Memory WISC-IV FSIQ & BRIEF GEC Objective & Objective D-KEFS Trails Condition 4 & D-KEFS Confirmed Correct Sorts D-KEFS Trails Condition 4 & D-KEFS Free Sorting Description D-KEFS Trails Condition 4 & D-KEFS Sort Recognition Description D-KEFS Trails Condition 4 & WISC-IV WMI D-KEFS Trails Condition 4 & WISC-IV FSIQ D-KEFS Confirmed Correct Sorts & WISC-IV WMI D-KEFS Confirmed Correct Sorts & WISC-IV FSIQ D-KEFS Free Sorting Description & WISC-IV WMI D-KEFS Free Sorting Description & WISC-IV FSIQ D-KEFS Sort Recognition Description & WISC-IV WMI D-KEFS Sort Recognition Description & WISC-IV FSIQ WISC-IV WMI & WISC-IV FSIQ Parent Report & Parent Report BRIEF GEC & CBCLd Total BRIEF GEC & CBCL Internalizing BRIEF GEC & CBCL Externalizing BRIEF GEC & SIB-Re Broad Independence
r
p
−.120 .009 .017 .029 .004 .059 .029 −.025 .030
N
.075 .895 .800 .679 .952 .391 .679 .585 .525
222 213 213 210 213 213 210 461 454
.392* .407* .379* .448* .570* .349* .455* .422* .524* .375* .538* .779*
< < < < < < < < < < <
Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders Amy C. Gross1, Lindsay A. Deling2, Jeffrey R. Wozniak3, and Christopher J. Boys1 1
Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA Minnesota Organization on Fetal Alcohol Syndrome, Minneapolis, MN, USA 3 Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA 2
The purpose of the current study was to evaluate the relationship between parent-report and objective measures of executive function in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD). The participants were a clinical sample of 551 children who completed 597 evaluations, including initial and re-evaluations. Participants were 6–16 years old, with a mean age of 10. Pearson correlations were used to determine the relationship between performance-based measures and parent-report measures of executive functioning. Relationships among the same types of measures, that is, performance based or parent report, were also evaluated. The data largely demonstrate low nonsignificant correlations between performance-based measures and parental report of executive function. Parent-report measures were internally consistent as were objective measures. It is possible that a third variable, for example, parental frustration, significantly influences parent reports. It is also likely that objective measures, which are administered in a controlled environment, do not fully capture children’s day-to-day functioning. That is, a child may have the executive function abilities (i.e., good performance on objective measures) but may be unable to deploy the appropriate skills in their daily lives, as evidenced by parental report. Children with FASD who have executive function abilities but not implementation skills likely require different interventions than children who lack abilities and skills. Keywords: Fetal Alcohol Spectrum Disorder; Executive function; Behavior Rating Inventory of Executive Function; Children; Adolescents.
Fetal Alcohol Spectrum Disorder (FASD) is an overarching term used to classify individuals who have a range of physical abnormalities and neuropsychological deficits related to prenatal alcohol exposure (Davis, Desrocher, & Moore, 2011; Mattson et al., 2010). The spectrum includes Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (Partial FAS), and Alcohol Related Neurodevelopmental Disorder (ARND). FASD diagnoses are based on several features: (a) prenatal alcohol exposure, (b) growth deficits, (c) characteristic facial features, and (d) central nervous system (CNS) dysfunction (structural Address correspondence to Christopher J. Boys, PhD, 2512 Building, Third Floor, 2512 S 7th Street, Minneapolis MN 55454, USA. E-mail: [email protected]
© 2014 Taylor & Francis
532
A. C. GROSS ET AL.
or functional) (Astley, 2004; Chudley et al., 2005; Hoyme et al., 2005; National Center on Birth Defects and Developmental Disabilities, Center for Disease Control, & Department of Health and Human Services, 2004). CNS dysfunction can range from intellectual impairments to more subtle neurocognitive difficulties (Davis et al., 2011; Mattson et al., 2010). One area of CNS dysfunction that has been well documented is executive function (Davis et al., 2011). Executive functions are several complex, cognitive processes that are interdependent and necessary for purposeful, goal-directed behavior (Lezak, 1995). This study will focus on specific components of executive function that are thought to be relatively independent of one another: working memory, initiating behavior, and shifting attention. Working memory is the ability to hold necessary information in mind while completing multistep tasks. Initiating involves developing ideas and beginning tasks, and shifting refers to the ability to flexibly move between tasks and to adapt to changing circumstances (Gioia, Isquith, Guy, & Kenworthy, 2000). Individuals diagnosed with FASD who have impaired intellectual functioning struggle with executive function. There are also individuals who demonstrate executive functioning deficits despite average intelligence (Connor, Sampson, Bookstein, Barr, & Streissguth, 2000). Particularly for the latter group, deficient executive functioning can interfere with their capacity to effectively apply their cognitive abilities to a problem (Chasnof, Wells, Telford, Schmidt, & Messer, 2010). For example, a child may have the intellectual capacity to complete a book report, yet an executive functioning weakness may cause the child to struggle to get started on the assignment (initiating) or to miss an important step of the process (working memory/shifting attention). Instances like these put individuals at risk for being misunderstood as noncompliant or lacking motivation, as opposed to having a neurocognitive weakness (Aragon et al., 2008). Previous research has demonstrated mixed results regarding the relationship between the Behavior Rating Inventory of Executive Function (BRIEF), a parent-report measure, and performance-based assessments of executive function (Gioia et al., 2000). Some studies found no relationships between BRIEF scores and performance-based measures of executive function (McAuley, Chen, Goos, Schachar, & Crosbie, 2010). Others, however, indicated significant correlations between BRIEF scales and particular aspects of performance-based measures (Toplak, Bucciarelli, Jain, & Tannock, 2009). Notably, the purpose of the BRIEF is to provide an ecologically valid measure of executive function, which is not a focus of performance-based measures (Gioia & Isquith, 2004). The BRIEF has been shown to relate to ratings of attention concerns, behavior problems, and social-emotional difficulties in school-aged clinical patients (i.e., youth with attention, learning or behavior problems) and controls (McAuley et al., 2010). The literature also suggests that BRIEF scores can distinguish clinical from nonclinical populations, as well as differentiate subtypes of clinical populations. For example, children diagnosed with attention deficit/hyperactivity disorder (ADHD) have higher BRIEF scores than controls. Those diagnosed with ADHD Combined subtype have higher Behavior Regulation Index scores, whereas those diagnosed with ADHD Inattentive subtype have higher Metacognitive Index scores (Toplak et al., 2009). Research suggests that aspects of executive function are weaker in children diagnosed with FASD than children from other clinical populations, in particular ADHD (Mattson, Crocker, & Nguyen, 2011). However, data regarding the relationship between parent-report and objective measures of executive function are not available for an FASD population. Therefore, the purpose of the current study was to evaluate the relative
EXECUTIVE FUNCTION AND FASD
533
contributions of parent-report and objective measures of executive functioning to the clinical assessment of children diagnosed with FASD. METHODS Participants were a clinical sample of 551 children diagnosed with FASD. Participants were included if they were 6–16 years old, evaluated for and diagnosed with FASD and contained in the clinical database. Mean age was 10. There were 317 males and 234 females. These children had 597 evaluations, including initial and re-evaluations; 7.7% of children had multiple evaluations in the database. These were included because the purpose was to evaluate the relationship between objective and parent-report measures at any developmental stage. Children were evaluated neuropsychologically by a psychologist and medically by a physician trained on the University of Washington diagnostic system for FASD (Astley, 2004). Diagnoses were made based on the modified Institute of Medicine criteria (Hoyme et al., 2005). Of the 551 children, 81 met criteria for FAS (14.7%), 208 for Partial FAS (37.7%), and 262 for ARND (47.5%). Participants were administered an extensive neuropsychological battery during a one-day clinic appointment. Specific elements of the battery were included in this study. Objective measures included the Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001) Trails and Sorting subtests and the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV; Wechsler, 2003). The DKEFS Trails subtest measures the ability to scan a page systematically and maintain attention, as well as to demonstrate cognitive flexibility, simultaneous processing, and divided attention. D-KEFS Trails Condition 4: Number-Letter Switching most specifically measures the ability to shift cognitive set. D-KEFS Sorting conditions are intended to measure initiation of problem solving, flexibility in responding, and inhibition (Delis et al., 2001). D-KEFS scaled scores were included for Trails Condition 4 and Sorting conditions: Confirmed Correct Sorts, Free Sort Description, and Sort Recognition Description. The WISC-IV is a measure of intellectual ability for individuals ages 6 to 16 (Wechsler, 2003). It yields four indices: Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), and Processing Speed (PSI), as well as a Full-Scale Intelligence Quotient (FSIQ). The WMI was of particular interest for this study because working memory is often considered a primary aspect of executive function, and a common area of deficit for children diagnosed with FASD (Rasmussen, 2005). WISCIV index and full-scale scores were available but subtest scores were not in the database. The BRIEF, Child Behavior Checklist (CBCL), and Scales of Independent Behavior-Revised (SIB-R) were the parent-report measures (Achenbach & Rescorla, 2001; Bruininks, Woodcock, Weatherman, & Hill, 1996; Gioia et al., 2000). The BRIEF is a questionnaire regarding executive function of individuals ages 5–18. There are several subscales and index scores. Those most related to this study include the Global Executive Composite (GEC), or overall score, as well as the Initiate, Shift, and Working Memory subscales (Gioia et al., 2000). The CBCL is a parent-report questionnaire for emotional and behavior problems of individuals ages 6–18 (Achenbach & Rescorla, 2001). T-scores for Internalizing, Externalizing, and Total Problems were included. Finally, analyses included the Broad Independence standard score from the SIB-R, an assessment of adaptive behaviors for individuals ages 3 months to 80+ years old (Bruininks et al., 1996).
534
A. C. GROSS ET AL.
Data from each evaluation were included in the analyses. However, not all evaluations included each measure; therefore, the number of subjects varies across measures. Pearson correlations were used to determine the relationship among variables. Analyses evaluated the relationships between objective measures (i.e., D-KEFS Trails Condition 4 and Sorting Conditions; WISC-IV FSIQ and WMI) and parent-report measures (i.e., BRIEF GEC, Initiate, Shift, and Working Memory). Test selection was based on measures available in the database. Specific correlations were run between available objective measures and BRIEF subscales that purported to measure the same aspects of executive functioning. For example, because D-KEFS Sorting conditions are intended to measure initiation and flexibility (Delis et al., 2001), these were analyzed with BRIEF Initiate and Shift. Relationships among the same types of measures, objective or parent-report, were also evaluated. Parent-report correlation analyses included the BRIEF, CBCL, and SIB-R; objective measure correlations included D-KEFS subtests and WISC-IV indices. RESULTS AND DISCUSSION Participants demonstrated slightly below average cognitive performance and difficulties with executive function, emotional and behavioral regulation, and adaptive behaviors (see Table 1). This profile is consistent with prior reports of individuals diagnosed with FASDs (Connor et al., 2000; Davis et al., 2011; Kully-Martens, Treit, Pei, & Rasmussen, 2013). Pearson correlations revealed no significant correlations between objective measures and parental report of executive functions (see Table 2). There were no significant relationships between D-KEFS subtests and BRIEF subscales, WISC-IV WMI and BRIEF Working Memory subscale, or WISC-IV FSIQ and BRIEF GEC. There was internal consistency among the objective measures. That is, there were significant relationships among D-KEFS Trails Condition 4 and each D-KEFS Sorting Condition and among Sorting Conditions. Furthermore, D-KEFS Trails Condition 4 and Sorting Conditions were each related to WISC-IV WMI and FSIQ. Finally, WISC-IV WMI and FSIQ were significantly correlated. Table 1 Mean Scaled Score, Range, and Number of Participants for Measures. Mean (SD) DKEFSa Trails 4 D-KEFS Confirmed Correct Sorts D-KEFS Free Sorting Description D-KEFS Sort Recognition Description WISC-IVb FSIQ WISC-IV WMI BRIEFc GEC BRIEF Initiate BRIEF Shift BRIEF Working Memory CBCLd Total Problems SIB-Re Broad Independence
7 8 8 6 84 85 75 69 72 74 71 75
(4) (3) (3) (3) (15) (15) (10) (10) (13) (10) (8) (24)
Range
N
1–16 1–16 1–16 1–17 41–130 50–144 41–120 35–101 37–117 40–107 42–92 0–157
235 223 223 220 494 493 495 503 502 503 467 479
Notes. aDelis-Kaplan Executive Function System. bWechsler Intelligence Scale for Children-Fourth Edition. Behavior Rating Inventory of Executive Function. dChild Behavior Checklist. eScales of Independent BehaviorRevised. c
EXECUTIVE FUNCTION AND FASD
535
Table 2 Correlations between Measures. Measures Objective & Parent Report D-KEFSa Trails Condition 4 & BRIEFb Shift D-KEFS Confirmed Correct Sorts & BRIEF Shift D-KEFS Free Sorting Description & BRIEF Shift D-KEFS Sort Recognition Description & BRIEF Shift D-KEFS Confirmed Correct Sorts & BRIEF Initiate D-KEFS Free Sorting Description & BRIEF Initiate D-KEFS Sort Recognition Description & BRIEF Initiate WISC-IVc WMI & BRIEF Working Memory WISC-IV FSIQ & BRIEF GEC Objective & Objective D-KEFS Trails Condition 4 & D-KEFS Confirmed Correct Sorts D-KEFS Trails Condition 4 & D-KEFS Free Sorting Description D-KEFS Trails Condition 4 & D-KEFS Sort Recognition Description D-KEFS Trails Condition 4 & WISC-IV WMI D-KEFS Trails Condition 4 & WISC-IV FSIQ D-KEFS Confirmed Correct Sorts & WISC-IV WMI D-KEFS Confirmed Correct Sorts & WISC-IV FSIQ D-KEFS Free Sorting Description & WISC-IV WMI D-KEFS Free Sorting Description & WISC-IV FSIQ D-KEFS Sort Recognition Description & WISC-IV WMI D-KEFS Sort Recognition Description & WISC-IV FSIQ WISC-IV WMI & WISC-IV FSIQ Parent Report & Parent Report BRIEF GEC & CBCLd Total BRIEF GEC & CBCL Internalizing BRIEF GEC & CBCL Externalizing BRIEF GEC & SIB-Re Broad Independence
r
p
−.120 .009 .017 .029 .004 .059 .029 −.025 .030
N
.075 .895 .800 .679 .952 .391 .679 .585 .525
222 213 213 210 213 213 210 461 454
.392* .407* .379* .448* .570* .349* .455* .422* .524* .375* .538* .779*
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