Abstract
Executive functions are the basis for goal-directed activity and include planning, monitoring, and inhibition, and language seems to play a role in the development of these functions. There is a tradition of studying executive function in both typical and atypical populations, and the present study investigates executive functions in children with severe speech and motor impairments who are communicating using communication aids with graphic symbols, letters, and/or words. There are few neuropsychological studies of children in this group and little is known about their cognitive functioning, including executive functions. It was hypothesized that aided communication would tax executive functions more than speech. Twenty-nine children using communication aids and 27 naturally speaking children participated. Structured tasks resembling everyday activities, where the action goals had to be reached through communication with a partner, were used to get information about executive functions. The children (a) directed the partner to perform actions like building a Lego tower from a model the partner could not see and (b) gave information about an object without naming it to a person who had to guess what object it was. The executive functions of planning, monitoring, and impulse control were coded from the children's on-task behavior. Both groups solved most of the tasks correctly, indicating that aided communicators are able to use language to direct another person to do a complex set of actions. Planning and lack of impulsivity was positively related to task success in both groups. The aided group completed significantly fewer tasks, spent longer time and showed more variation in performance than the comparison group. The aided communicators scored lower on planning and showed more impulsivity than the comparison group, while both groups showed an equal degree of monitoring of the work progress. The results are consistent with the hypothesis that aided language tax executive functions more than speech. The results may also indicate that aided communicators have less experience with these kinds of play activities. The findings broaden the perspective on executive functions and have implications for interventions for motor-impaired children developing aided communication.
Highlights
Executive functions are understood, not as a unitary function but as a psychological construct defined as a set of interrelated high-level cognitive skills that are necessary for purposeful, goaldirected activity (Stuss, 1992; Anderson, 2008; Wiebe et al, 2008; Willoughby and Blair, 2011; Miyake and Friedman, 2012; Benson et al, 2013; Usai et al, 2013)
Monitoring and impulsivity were not related to verbal comprehension or expressive verbal abilities, neither in the aided group nor the comparison group alone, or in the groups combined. Both the aided group and the comparison group completed most of the items in the BAC Description and BAC Construction tasks correctly
The considerable time and effort the aided communicators needed to complete the tasks compared to their typically developing peers imply a continuous demand on executive functions
Summary
Not as a unitary function but as a psychological construct defined as a set of interrelated high-level cognitive skills that are necessary for purposeful, goaldirected activity (Stuss, 1992; Anderson, 2008; Wiebe et al, 2008; Willoughby and Blair, 2011; Miyake and Friedman, 2012; Benson et al, 2013; Usai et al, 2013). There is a consensus that executive functioning is central in cognitive skills like planning, monitoring results, updating, shifting, and inhibition (Kinsella et al, 2007; Böttcher et al, 2010; Miyake and Friedman, 2012). Monitoring, or updating (Miyake and Friedman, 2012), involves constant supervision of tasks, with rapid addition and fading of content in working memory. Inhibition involves overriding of “automatic” behaviors when they are not appropriate (Doebel and Zelazo, 2013). The age at which executive functions emerge is still under debate, but important developments seem to take place from the age of 3 to 4 years (Brocki and Bohlin, 2004; Doebel and Zelazo, 2013)
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